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PARP Inhibitor Access
How I Work to Improve PARP Inhibitor Access and Outcomes for My Patients With Advanced Ovarian Cancer

Released: June 22, 2023

Emily Hollinghurst
Emily Hollinghurst, PharmD, BCOP, CSP, APh
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Key Takeaways
  • Specialty pharmacists can help improve equitable medication access by addressing the need for authorization and copay assistance programs.
  • By providing education and medication management, specialty pharmacists can promote adherence through conducting a complete medication reconciliation, reinforcing the importance of laboratory testing, and providing education on key adverse events.

Disparities in cancer incidence and mortality vary by race and ethnicity among women. Morbidity and mortality associated with many cancers can be reduced with timely screening, diagnosis, and treatment. For example, when looking at the overall landscape of ovarian cancer and how healthcare disparities affect outcomes and mortality, there is a lower survival rate among Black women. Adherence to guideline-directed therapy leads to reduced mortality, and receipt of evidence-based treatment has significant survival benefit across race and socioeconomic status. Outcomes in ovarian cancer potentially can be improved by facilitating access to on-time care and addressing socioeconomic factors. Patients may need social support, perhaps from support groups, and transportation assistance may be necessary for patients who live in rural areas. Treatment team members working with patients in the clinic should know how to access these important resources to optimize care. In addition, help with logistical barriers can work toward enrolling patients into clinical trials as appropriate for their diagnosis. Furthermore, because health disparities often involve medication-related concerns (eg, access, cost, adherence), managed care and specialty pharmacy professionals can and should urgently address these concerns if they arise.

Patients with stage III or IV advanced ovarian cancer who experience a partial or complete response to frontline platinum-based chemotherapy are candidates for PARP inhibitor maintenance therapy. Specialty pharmacists play an important role in assisting the patient with starting and adhering to therapy. The patient is the center of everything that we do. As specialty pharmacists and pharmacy personnel, we should collaborate with the clinic, oncologist, surgeon, patient navigator, and with advanced practice providers. In terms of PARP inhibitors, the correct treatment option should be implemented on time, which means following up on germline and somatic testing results. We need to make sure patients are being taken care of by working as a cohesive team.

Pharmacists can address many issues with medication access. We review whether the prescribed drug is a limited distribution medication, meaning that the manufacturer may limit the number of specialty pharmacies with access. In addition, the patient may have a specific in-network specialty pharmacy. Pharmacists can communicate with providers’ offices about the need for authorization or high copays. Once authorization is obtained, there may be discussion about financial assistance if the patient has a high copay, is underinsured, or is uninsured. Patients with employer benefits or private commercial insurance may be eligible to utilize manufacturer copay cards, which can lower their out-of-pocket costs. Members of the specialty pharmacy and clinic teams should know how to access foundations or manufacturer assistance programs and enroll patients quickly and prevent delays in therapy.

When patients are either going to initiate PARP inhibitor therapy or are scheduled for a follow-up, the specialty pharmacist should perform a complete and thorough medication reconciliation. This includes asking patients about herbal supplements or other dietary supplements—I often ask what has been recommended to them by family members or friends. Given that PARP inhibitors are associated with hematologic toxicities, it is important to assess if the patient may be taking herbal supplements or over-the-counter medications that can increase the risk of bleeding. In addition to medication understanding and adherence, we can educate patients about the importance of adhering to laboratory testing and coming to their follow-up visits to make sure they are not having any adverse reactions. We also need to ensure that patients have realistic expectations about the duration of therapy and confirm clear consent for treatment up front.

It is helpful to follow up with patients approximately 7-14 days after starting therapy to make sure they are tolerating it. It is important patients have a scheduled follow-up visit and preferably laboratory monitoring for review prior to refills. Patient education and reiteration about the need to continue monitoring blood tests for risk of secondary malignancies is also an important role of the pharmacist. We also ensure that refills are timed around the clinic and laboratory monitoring follow-up visits to ensure the next refill is appropriate for the patient. The dispensing pharmacy should be documented in the medical record to ensure refills or dose adjustments are routed to the correct specialty pharmacy. If patients are enrolled in a patient assistance program, the patient and the clinic should be provided with information on how to re-enroll and how to contact the program. To prevent delays in therapy, patient reenrollment forms will need to be addressed.

In summary, pharmacists can help address healthcare disparities by facilitating patient‒provider communication and ensuring that patients are being adequately monitored. We can work alongside the treatment team to identify assistance programs or grants to ensure access to essential therapies. From a larger system standpoint, specialty pharmacists, nurses, navigators, and providers are an integral part of providing quality care to patients with ovarian cancer. Our role is to empower and educate patients and caregivers and assist with navigating the vast and complex healthcare system. Educating patients and families on how to recognize adverse events and navigate the healthcare system can empower them to assume control of their health and help ensure that they receive adequate care.

Your Thoughts?
How does your practice improve outcomes for your patients with ovarian cancer receiving PARP inhibitors? Answer the polling question and join the conversation by adding a comment in the discussion section.

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