Daniel Kendzierski, PharmD, discusses how remote clinical pharmacists within the US Oncology Network implemented cost-saving drug strategies—such as biosimilar interchange and dose optimization—that supported value-based care under the Enhancing Oncology Model and enabled practices to achieve significant performance-based payments from CMS.

Please introduce yourself by stating your name, title, and any relevant experience you’d like to share.

Daniel Kendzierski, PharmD: My name is Daniel Kendzierski, and I'm a doctor of pharmacy. I'm currently working with US Oncology Network, in association with McKesson, to provide clinical pharmacy services to some of their community oncology practice sites.

Can you provide an overview of your study presented at ASCO 2025?

Kendzierski: Our study evaluated the impact of remote clinical pharmacists on reducing the total cost of care within the Enhancing Oncology Model (EOM) across 5 practices in the US Oncology Network. Pharmacists implemented 6 drug initiatives within the US Oncology Network, such as monoclonal antibody dose rounding, pembrolizumab dose banding, and biosimilar therapeutic interchanges. These were designed to reduce medication costs without compromising clinical outcomes.

Our study period spanned 18 months, and 7 clinical review pharmacists conducted about 1180 accepted interventions, resulting in a projected total cost of care of nearly $9 million. These interventions supported practices in achieving performance-based payments from the Centers for Medicare and Medicaid Services (CMS) totaling about $3.4 million, with 3 evaluable sites reporting savings of 5.7%, 8.1%, and 23.6% compared with benchmark.

Again, this was data provided by CMS for Performance Period 1, which spanned from July to December of 2023. This work highlights the critical role pharmacists can have in advancing value-based oncology care.

With drug costs comprising 63% of total cost of care in the Network, how do your findings inform the broader goals of the Enhancing Oncology Model? Are there areas where the model could better support these pharmacist-led strategies?

Kendzierski: Our findings directly align with the EOM's goal of improving care while reducing costs. Because drug costs account for 63% of the total cost of care within the Network, pharmacist-led offer a high-impact, scalable solution. The study demonstrated that with minimal investments—approximately $25 000 across 5 practices for the pharmacists' work—pharmacists helped practices achieve substantial savings and qualify for performance-based payments from CMS.

The model could better support these strategies by incentivizing pharmacist integration through dedicated funding or Monthly Enhanced Oncology Services (MEOS), which is a payment incentive.

Additionally, it could streamline data sharing between CMS and practices to better track intervention outcomes. Currently, CMS is providing data for Performance Period 1, which started almost 2 years ago. Having some sort of ongoing evaluation of how practices are doing through their current performance period would be very helpful to gauge how they're doing in real time, as well as to encourage broader adoption of pharmacists-led protocols through CMS.

These adjustments would greatly amplify the impact of pharmacists and help smaller practices with limited resources participate in the EOM more effectively.

How did the use of biosimilars and dose modifications maintain clinical integrity while reducing cost?

Kendzierski: We prioritized interventions that were clinically equivalent, but more cost-effective. For example, biosimilar therapeutic interchange involves selecting the lowest-cost biosimilar agent within select therapeutic drug classes, such as bevacizumab, trastuzumab, filgrastim, pegfilgrastim, and rituximab. These were based on CMS allowable costs. This strategy alone saved $1.5 million.

Another initiative that we conducted, such as pembrolizumab dose banding, adjusted dosing based on patient weight and vial size to reduce waste while maintaining therapeutic efficacy. This particular initiative had the highest average savings per intervention at just over $18 500.

All of the strategies that we employed were vetted by a multidisciplinary team and aligned with National Comprehensive Cancer Network (NCCN) guidelines to ensure that cost savings did not compromise patient outcomes.

What policy changes or CMS adjustments would help amplify the impact of pharmacist interventions in value-based oncology care moving forward?

Kendzierski: To enhance the role of pharmacists in value-based care, I would recommend the following changes: reimbursement for pharmacy services under EOM to recognize their role in clinical and financial stewardship; inclusion of a pharmacist-led initiative and quality metrics to incentivize adoption and standardization; improved access to real-time CMS data to enable pharmacists and practices to make more informed, cost-effective decisions; and support for remote pharmacist infrastructure—especially for community practices lacking onsite pharmacy staff, as is the case for many resource-limited community practices.

These changes would not only expand the reach of pharmacist interventions but also strengthen the sustainability and equity of value-based care models.