Pharmacy-Driven Pathways: Enhancing Efficacy, Tolerability, and Value in Oncology Care
At CPC+CBEx 2025, James Gilmore, PharmD, discussed how the American Oncology Network is elevating pharmacist-driven clinical pathways through data, technology, and collaboration to advance value-based care and enhance patient safety with innovative therapies like bispecific antibodies.
How has the American Oncology Network (AON) approached integration pathways to elevate pharmacist-driven programs, and what specific outcomes have you observed as a result?
James Gilmore, PharmD: At AON, we've used our clinical pharmacists, from a clinical pathway perspective, through our Pharmacy and Therapeutics (P&T) committee. This is a highly pharmacy-driven process where we meet every other week and we evaluate therapies based on efficacy, tolerability, and value. We make our decisions around our pathway and clinical guidance from that committee's participation with all of the different stakeholders.
We [implement] those initiatives through many different tools that are also pharmacy-driven. We have a formulary navigator tool, which is available to all of our providers through a desktop link, a mobile app, and a link from the electronic health record (EHR). In that formulary navigator, we provide guidance in about 40 different diseases. We customize our EHR through Flatiron Assist to ensure that the physicians have access to what our guidance is across the enterprise.
Our pharmacists also provide texts and newsletters to the providers, again, sharing information about what our guidance is. Our pharmacists have direct interventions where they're working through a work queue every day on specific patients, intervening to drive adherence with our guidance.
Finally, we go back and measure our adherence across the board on all of our initiatives. We're tracking at about 90% right now. That's a result of the pharmacist interventions.
What challenges have you encountered when embedding pharmacists into care pathways, and how has your team addressed them to ensure sustained clinical impact?
Gilmore: When you think about challenges to the pharmacists being involved in the process, I would say that there are not a lot of challenges. Our pharmacists have been welcomed into all the aspects of driving our clinical guidance and pathways. They are the logical choice. They're able to bridge both the clinical and the business aspect of what we're doing in community oncology. The only real challenge that we have, from a pharmacist perspective, is that we're continuing to need more resources in that area. We have bandwidth challenges.
How do you envision the evolving role of the pharmacist in shaping clinical pathways, especially in value-based oncology care models?
Gilmore: Our clinical pharmacists are very involved in pathway development already. If you think about alternative payment models and value-based care arrangements, they're heavily engaged with both the business and clinical analytics side of evaluating new opportunities that come our way. Once they're assessing that, they're working really closely with the payer teams to pull through on those initiatives. I think that there will be more and more of a role for the pharmacist to play in continuing to work on value-based care and alternative payment models in the future.
Can you share a specific example where pharmacist input directly influenced pathway design or modification at the American Oncology Network, and what was the downstream impact on patient care or provider collaboration?
Gilmore: An example of how pharmacists have been involved in a specific initiative is with the bispecific therapies. These are bispecific antibodies or bispecific T-cell engagers. These are new therapies that weren't in the market as recently as a couple of years ago. These new therapies are exciting and they're providing a lot of clinical advantages to the patients, but they also have a lot of unique side effects.
Our pharmacy team, through the P&T committee, evaluated how we were going to roll out initiatives around these new therapies in our offices. They developed educational opportunities for the providers and the staff, as well as patients. They created relationships with adjacent hospitals to help with side effect management, if that was needed. They ensured that we were able to safely give these drugs in our offices by providing protocols around how to deal with adverse events and making sure we had drugs around that might be needed to manage those adverse events.
They did some unique things too. They created wristbands for the patients with QR codes so that, if a patient happened to be admitted to a hospital that wasn't familiar with bispecific therapies, the emergency department (ED) staff could scan that QR code and get information about the treatment the patient was on, as well as specific side effect management, which is unique in the oncology space.
I think that's one example of how pharmacists were able to be involved in rolling out a new process in the pathway space.
