Clinical review pharmacists working remotely have demonstrated remarkable success in reducing cancer care costs, with a new study from The US Oncology Network showing nearly $9 million in total cost of care savings through systematic medication optimization interventions.
The study, conducted from July 2023 to December 2024, involved seven clinical review pharmacists across five practices participating in the Centers for Medicare and Medicaid Services' Enhancing Oncology Model (EOM). These pharmacists remotely reviewed oncology treatment orders for over 5,600 patients, identifying 1,271 potential cost-saving interventions with an impressive acceptance rate of 93% (1,180 interventions).
Strategic Cost-Reduction Initiatives
The pharmacist-led program focused on six primary cost-saving strategies: monoclonal antibody dose rounding, pembrolizumab dose banding, biosimilar therapeutic interchange to preferred products, and preferred use of zoledronic acid. According to Daniel Kendzierski, PharmD, a senior clinical pharmacist at McKesson Specialty Health, The US Oncology Network, pembrolizumab dose banding and the preferred use of zoledronic acid emerged as the largest contributors to these savings.
Beyond the primary initiatives, clinical review pharmacists contributed an additional $1.2 million in medication savings through other drug selection optimizations. The significance of these interventions is underscored by the fact that drug costs represent an average of 63% of a patient's total cost of care within The Network, which represents approximately 50% of all EOM providers nationwide.
Economic Impact and Implementation
The investment in clinical review pharmacist positions proved highly cost-effective, with each position costing approximately $25,000 according to Kendzierski. This modest investment yielded substantial financial returns while providing additional operational benefits to participating practices.
Clinical review pharmacists actively contributed to saving providers valuable time by leveraging their deep understanding of available clinical resources. They developed and implemented medication protocols that streamlined changes, which, with initial approval, could be made independently. This approach not only benefited practices financially but also helped them meet critical benchmarks within the EOM and other value-based care initiatives.
Addressing Systemic Healthcare Barriers
Complementary research from the University of California, San Diego revealed additional opportunities for cost optimization in cancer care. The study assessed more than 1,200 inpatient admissions for chemotherapy regimens typically suitable for outpatient administration, finding that approximately 9% of inpatient treatments were due solely to transportation or housing challenges.
This research identified more than $7 million in potentially avoidable hospital costs over five years, with additional patients discharged within 24 hours of chemotherapy completion, raising questions about the necessity of inpatient stays. In response, UCSD implemented interventions including revised order entry protocols, pharmacist-led utilization reviews, and a donor-sponsored housing initiative to support patients receiving outpatient chemotherapy.
Expanding Outpatient Care Capabilities
Recent studies presented at the 2025 Oncology Pharmacists Connect meeting demonstrate the safety and feasibility of outpatient administration of high-risk therapies, including bispecific T-cell engagers. Real-world data showed successful outpatient step-up dosing protocols, with researchers finding no recorded use of tocilizumab for cytokine release syndrome in community clinics, suggesting that with proper infrastructure, these therapies can be safely managed outside the hospital setting.
Healthcare Context and Future Implications
The escalating cost of cancer care, projected to exceed $245 billion by 2030 largely due to expensive cancer drugs, highlights the critical need for these cost-effective strategies. The Centers for Medicare and Medicaid Services launched the Enhancing Oncology Model as a voluntary, risk-based payment model designed to improve care quality while simultaneously reducing total cost of care.
These substantial total cost of care savings ultimately benefit patients, practices, and CMS, demonstrating the value of pharmacist-driven interventions in lowering costs and fostering the success of value-based care models within oncology practices. As institutions continue to expand ambulatory cancer care, pharmacy-led initiatives will remain central to achieving both clinical and economic success.
