Addressing Financial Toxicity: Team-Based Workflows in Oncology Care

In oncology care, managing a patient’s diagnosis extends far beyond clinical treatment. Healthcare providers must also address the significant, non-clinical challenge of financial toxicity. Beth Sandy, MSN, CRNP, FAPO, an Adult Nurse Practitioner in Medical Oncology at Penn Medicine’s Abramson Cancer Center, highlighted how this issue is critical in modern oncology in a recent interview with Oncology Nursing News.

Sandy, who practices at the Perelman Center for Advanced Medicine in Philadelphia, notes that financial toxicity is a major hurdle, especially when prescribing oral oncology therapeutics. In her daily practice, she coordinates a highly integrated, team-based workflow to manage these financial obstacles.

The Challenge of Oral Therapeutics and the Medicare Barrier

Oral oncology agents have transformed cancer care, but they have also introduced substantial financial challenges. As Sandy explained, "financial toxicity is a real thing, particularly with the oral agents." Oral agents can frequently place a heavy financial burden on patients, requiring clinical teams to evaluate what a patient’s out-of-pocket costs will be.

This financial challenge is further complicated by the type of insurance coverage a patient holds. Penn Medicine providers, for example, accept a wide variety of insurance plans; while patients with private commercial insurance may be eligible for manufacturer-sponsored co-pay assistance programs, patients covered by government insurance face strict limitations. Sandy noted that "we all know with Medicare we can't use those things," indicating that standard co-pay assistance programs are unavailable to Medicare beneficiaries. For these patients, the care team must evaluate whether the patient qualifies for direct patient assistance from the drug manufacturer to obtain their medication.

Coordinated Team Roles: Pharmacists and Triage Nurses

To navigate the complex administrative hurdles of securing oral therapeutics, Sandy relies extensively on a multidisciplinary clinical team. "I look for so much help from our pharmacists and from our triage nurses in my practice," she emphasized.

Pharmacists play an indispensable role in resolving initial insurance barriers, navigating prior authorization processes with insurance carriers. In addition to managing prior authorizations, pharmacists actively search for available co-pay assistance programs that can help reduce out-of-pocket costs for eligible commercially insured patients.

When patients do not qualify for commercial co-pay assistance, the team must transition to securing direct patient assistance. Triage nurses are vital to facilitating this process, handling the specialized administrative requirements of manufacturer-sponsored assistance programs.

"That's where our triage nurses are really helpful," Sandy explained. "They have the forms for each of those companies to apply for free drug if the patient qualifies for that." By maintaining these manufacturer-specific application forms and helping patients navigate the qualification criteria, triage nurses are able to apply for free medication directly from the pharmaceutical companies.

This coordinated care model demonstrates how nurse practitioners, pharmacists, and triage nurses can collaborate to systematically address financial toxicity, helping adult oncology patients gain access to necessary oral medications.