The specialty pharmacy’s mapping protocol for risk stratification supports a multipronged workflow for oral oncolytics patients at all points in the oncology care journey. An interdisciplinary care team and clear communication are central to their approach. Clinical pharmacists and pharmacy liaisons (advanced pharmacy technicians trained in oncology) work with providers and nurse educators to help patients understand their therapy, have the financial support to continue it, and receive refills in a timely manner.

1. Before therapy begins, a nurse educator ensures that the patient understands how and when to take their medications and how to respond to potential side effects.
2. When the provider sends the specialty pharmacy a prescription, a pharmacy liaison manages the prior authorization process and helps the patient secure other financial assistance, if necessary. For example, if a copay is more than $40, the pharmacy liaison may look into the possibility of the patient receiving financial assistance.
3. A clinical pharmacist assigns the patient a score using the risk stratification strategy (Section 1). The score is used to determine the number and cadence of follow-up calls.
4. The fulfillment team — which includes clinical pharmacists, pharmacy liaisons, and pharmacy technicians — fills and ships the medication overnight in temperature-controlled packaging.
5. Once therapy is underway, the clinical pharmacist follows up with the patient at predetermined intervals based on the patient’s risk score. The pharmacist uses those calls to help the patient manage side effects, address other medication-related issues, and provide ongoing patient education.
6. At the same time, the pharmacy liaison manages refills and coordinates with the patient’s provider, if needed. If a patient doesn’t respond to outreach or there are issues with the refill, the liaison notifies the clinical pharmacist and prescribing provider for additional outreach.

Finally, because coordinating with providers is crucial to the success of the oral oncology workflow, the pharmacy reached out to educate clinic leadership, physicians, and other providers about the workflow and how it fit into patients’ care journey.

The health system’s specialty pharmacy began by focusing on a small patient population so they could effectively build a foundation for managing patient therapies.

When the specialty pharmacy opened, its services were available only to health system employees who were members of the organization’s employer-sponsored health plan (ESHP). Serving a smaller patient population for the first year both gave the specialty pharmacy a focused subset of patients and time to hone their processes before expanding their services to all appropriate health system patients one year later.

¹ Unless otherwise noted, all information in this case study came from Advisory Board interviews with officials from the leadership team at the specialty pharmacy.

² All patients receive their first follow-up call within 7 to 10 days after their initial onboarding call. For patients with a high-risk score, the clinical pharmacist will follow up again in 30 to 90 days. For patients with a medium-risk score, the clinical pharmacist will follow up in 3 to 6 months. And for patients with a low-risk score, the clinical pharmacist will follow up in 10 to 11 months. The clinical judgement of the pharmacist determines where within the time range the follow up call is made.

³ The specialty pharmacy’s Net Promoter Score (NPS) was calculated by SullivanLuallin Group, which reported a national average NPS of 77.1 from the specialty pharmacies they surveyed in 2024.