Working In Oncology
Working In Oncology

Episode 1 · 1 year ago

The Biggest Problem for Patients Is… Access w/ Allie Anders


Your access to patients is through 2 little sliding pharmacy windows, and your “office” is just 5 feet wide. 


Welcome to the workplace where our very first podcast guest gets face-to-face with patients: her dispensary. 


In this episode, I interview Allie Anders, Dispensary Manager at Carolina Oncology Specialists, and we dive into the details about the biggest problems facing her patients and how Covid-19 has affected the community oncology setting. 


Listen, as we cover: 

-The #1 problem for her patients: The falsehood that they can’t get access 

-Why she meets with so many mid-levels 

-Covid-19 changes in the dispensary ... & which of these changes will stick around for the long-haul 

And, of course, this wouldn’t be a healthcare podcast without touching on insurance! 


Stay connected with Working in Oncology on Apple Podcasts, Spotify, or our podcast website.

Bo You're listening to working inOnchology, a podcast and video, show that spotlights ontology pactice staffand industry. influencers who work behind the scenes to shake the fetureof Acomedy, the more knowledge the encologycommunity shares with each other, the more we all grow, let's get into theshow. Welcome back to working in Onchology,I'm Scott Coterin, with bioplus Specialty Pharmacy, and today my guestis Ali Anders who's, a dispensery manager with Carolina oncollogyspecialist in Hickory North Carolina. How are you doing good, yoing, good, very good, so today we're going to betalking about working in anchology, obviously or catchy title, but morespecifically about your role and what you do on a daily basis, its maybe somechanges and some things that might be impacting your job or your industry orhow you interact with patients but before we dig into the technical stuff.So for our listeners tell us a little bit about yourself- and I know theanswer to this, so I'm cheating, but you can tell me something that hasrecently happened to you, that's very exciting, so about me. I have worked in Parmizy for SixteenYears Start Outn Wat till working crosstill IV, mixing primarily thenswitched over to retail. Again, because everybody knowsyou can always in a job. An Rachael doesn't mean youll enjoy it, but youcan always get one, and then I came back to community oncollegy. I actually fot the first time just by chance, because a persona workeat the hospital was working in it and yeah. So here I am loving it. Threeyears later in the community on collengy setting and most recently Ihad a bavy number. This is number three, I'm not busy at all O. No, no new, mom, Lifeis, easy andcalm right, O Worri, Theyr, tasteful, very peaceful yeah. So work is probablya great escape batd. Then you get to have all the fun when you get home atnight, Ridt or in the morning, that's exactly rpmy blue titthe girl, and theydon't stop till. I don't know whatever thing's done, thats a twenty four sevenjob hat's! That's awesome, and congratulations on that. So so you mentioned your path topharmacy. Tell me a little bit and our listers a little bit about yourspecific role, your daily specific roll at Carolina College, Yo, specialist,first of all, just blessed to get to work here myself, an I have a cotworker Melissa.Our jobs are to just ensure, from start to finish, that our patients haveaccess to their oral medications, something also, sometimes that includes shots, but primarily oial medicationsfrom start to finish, so we do everything from when the doctorprescribes it. So when it's actually in the patient's hands, we don't clear outanything from Ourq until we know it's in the patients heans. Sometimes wefill meditations in office in house in our dispinsary, or we will shifp themout to or send them out to special departacies, just depending oninsurance and so many factors as anybody that works in charmacy nows right. Well, you mentioned you mentioneaccess and that that leads to a separate topic that I think is isrelevant every day and certainly with what you do with Patiente. So as far asaccess goes, what are your biggest challenges that you see on a dailybasis around access, whether it's cost or insurance, or you know just speak toyour personal experience. I think the biggest in my opinion and inexperience,the biggest problem for our patient number one is the falsehood that theycan't get access. I did not realize until recently, inother areas and other practices, I've...

...spoken with just depending on where they're atbecause we are in a mountainous community, where you know we don't haveoneothe big city and most of the places around us are not either. So I have my patience to tell me. Oh, Ijust didn't think I'l be able to take it, so I'm just not going to, and it'sjust a sad issue, because we know that there's help out there and most of thetime, especially because we're under the poverty level here most patientscan have access to these medications for free or very reduced cross, butthey have no idea. It's like o growing up the best of us.I heard my grandfather and my father teaching me don't ever assume. Someone knows how toget access to this if they don't even have access to get the access. So that's our jobs to show them that therethere is help and they can. They can get it and we can lead them and Guidthem to do it, but I think that wors gin O walk and I think I think you're right. Ithink that's that's great, especially considering your unique. I think.Geographically, you mentioned you know being below the poverty level verymountainous area and there's some challenges financially what whatobstacles tend to get in your way as far as access you know dealing maybewith manufacturers or insurance plans, or you know, what's what I? What do youfind is most challenging to get that financial Assystam insurance definitelyis the first step. So when we go to feel a medication or try to feel themoication for Pation, we know that every drug, almost every drug, lea Arpuscribers srebscribe, it's usually going to require poer authorization.Now, when I didn't work on this side ofpharmacy, I always thought man. Why aren't those darkers offices hurryingup on these proor authorizations and even more so now? I know that somepeople may feel the opposite, but if you have someone dedicated to doingthat, there's no reason. Patiente should be waiting weeks to start theirmedications. On my one of my physicians offices fourteen days authomatically,that's ridiculous. I can get prior authorizations. Ive returned in twentyfour hours at sometimes two hours. So that's a big access issue, because ifyou don't have someone willing to fight or advocate for you and you don't knowhow to do it, then you're going to go without mids, and these are people whohave extreme diagnosies run off the back. So they need it as soon aspossible. So I think that's a big issue, but the intrance is the biggestobstacle in that case, but we've learned to overcome them because weknow thetr how to get around things. But secondly, I think I don't know: We've become good withour drug rips and our manufacturers most are good about giving us samplesor vouchers for a thirty day free start, so that helps our patients. But thebiggest issue, really that throws a kink in our plans, always is theinturance truthfully sure eathat's true, and we certainly hearthat a good bit and I think that's just part of the overall landscape. You knowit's something: That's inescapable, what what type of you know tips or whattype of I guess tricks. Maybe have you come upwith in working with these patients on a daily basis? You know to maybeimprove your workflow or maybe improve. Like you mentioned, speeding things up,you know what what do you do that? Maybe some of our listers might beinterested in? It would be a helpful hint around PAS or speeding up theprocess. Well in our practice, when I came here, there had been one otherperson here before me and she was a Fronshi tech also, but it was very newand she was kind of overhalmed and she did was not. She did her best. I meanshe id a great job, but her passion was elsewhere. When I came in, I learnedfor the clid from that and then look at all. I saw that our nurses, who work inour rofusion center here were literally...

...doing the prior authorizations for oralmids. They were sending and refills. They were doing everything to do with.I was like Weym I here, because you know they were doing everything that Icould be doing. I think, having a dedicated team to if you work in aspecialty practice in Ochology, you need someone in your practice dedicatedto solely gettin these medications in patient's hands. You can add otherduties to those and before our practice started picking up and becoming busierand busier in the dismansery. I did halel other duties in other forms inour practice, but we knew that someone need to bededicated to getting these drugs into the patient's hands because there's nosets in the followweal if they haven't even star in the medicine. So I thinkthat's the biggest thing is making sure there's a team or oneperson starting out dedicated to ensuring the patient, has you knowtheir medicines but within saying that they also drug rips. I know some peoplelike to get off and say they don't help and Oh they're annoying me my drog APSare fantastic. They are the reason I can have access to what I do. They keepme sampled up. They keep me Bal tru IP. I mean without having those samples andBouchers. When I first started, my doctors would come to me and say, forinstance, Promacta for ITP humatolity jog. They would come up and say thispatient's play lit during the take. I need it right now and I would say I'msorry, I'm Goinna have to get the intrest to prove that I'm Goin t haveto do this. We promector has a voucher for a free, thiryday supply. I canorder the bed haveit in the next day. We do not personally keep these drugsand stock because, as everyone knows, theyre twenty thousand fourteenthousand just depends so what we can have is next day, that'susually good enough for my doctors, my physicians, now everyone's different,some people's physicians may want to have things and stock. We keep certainthings and stuck, but a fourteen housand dollar drug we're not justgoing to keep sitting on a shelf, so we use the vouchers toour Bigash to havethe meds in the next day. We also keep the samples Froug if the next dayis notgood enough. So I think knowing your drugs, knowing what Sayn have samplesand Bouchers, that's really a big benefit to being able to help yourpatients asap. Then you have time to you, have a couple days to work on theinturance portion. Appreciate you Shar in that, and youknow you bring up another interesting point. What's the communication likebetween yourself and the physicians you mentioned just now the situation wherethey've got you know, patients playlits that are at risk and you need somethingnow. What's your kind of describe your your direct communication withphosicians in your practice, I'm very blessed firt all like. I havethree Physitians here and we have fourteen midlevels. We do things alittle bit differently. Every time we do tho meetings, everyone raises theireyebrows as if to say, why would you meet so many mid litels? Well, ourPhositians know the cases that they go in the rooms with the mid levels butthey've alrea Veda case the Middle Evel also ves their case, and so therefore,when they go in, they they've already taught both discussed,and so they get filled in on the little things that may have happened inbetween the visits. The darker knows, the whole gets the whole picture, plusthe things the patient might forget to tell the visite an when they walk inthe room. You know he Lov goes in, firnt comes get. The dark got goes backin as soon as they need. If they're going to prescribelidication, they usually message medarectly from the room now, usuallythe mid level. Does that? Because we try to get our phositions in and outlike to the next Brin, so they'll message me from their roomsay: Hey! I want to do a new start on revement and I'll, say: okay, I'mGoingno need to see that patient and they'll say: okay, anything Ot. Youneed for me right now and I'm like no just sent them by our window wheneveryou're done and so of course, those things I need thedoctors sang off on to with certain...

...drugs. So there's very opencommunication you have, if you want to have a dispensry in your practice, excuse me or even fo Trov, these typeof meitations. There has to be open communication between the physiciansand the practitioner you work with, or it's not going to work. I have a verygood relationship with every single one of them and they are fantastic well. I could certainly attest to that.Knowing how hard you work and how connected you are to everybody therethan I know, you're so vital to the overall function of that practice. Talk to me a little bit about yourpatient interactions, and I know how passionate you are about patients tellme o your general interaction with them and what that looks like, and you knowsome of your different aspects around the patient care, maybe be itcounseling or logistics. You know anything that fallsin line with that. So we have we're blessed at our windowto our dispenseris a little two door windows, probably like a fivefoot lideoffice MLIs and I definitely Couln't be six AF part fee opart an love pandemic,however, we're right as to face wot patient. So when they're in the lobbywaiting, they have access to come, ask US questions, they have access to come,say: Hey! I just held him Min five minutes ago. Say: Hey the pharmacyhasn't called me about my palmlist. Can you help me- and I was able to do thatjust for jumping on this meeting? I mean you know, I'm able to have theyhave access to US O. I think that's important and then because if a patientfeel like ee Ive al been a donters officers where we feel like I'm havingan issue hut now, actually where we feel like okay. Why is no one callingme Bhat? Why is no one being attentive to this small issue? ining the grandscheme of things, but it's still n issue. So that's our big thing for ourpatiencs is we want them to know? We have our own phone line in thedisminsery, we have our personal eqil work, emails for them to have access to and just making sure they no call us.If this is gon me a dew Pation, I say anything with aural medications. Can'tme just just can't me off the back now sad offix or if you having a reactionof course, Conon Ner, caler nurses, but they know Tho call us if they needthings and then we also when patients are getting. We have aninfusion center, so inpatients argetting treatment in that we willbring their medications to them in their Bey they're in and then, if apatient is a patient who's, switching medications, maybe they've hadprogression or or maybe they're just having access issues. Sometimes thepractitional Messagus UNTELLUS. Can you come talk to them where the doctors alittle bit behind so can you go hend and talk to them? You know. So it'sjust want Tagain. It's really about communication between us all that makesit work. Yeah Yeah. I agree with that and that's,I think, that's great device and I think that's a great way to do whatyou're doing you mentioned. Behid social distance from Melissa so tell meabout how you've been intacted by Covid, and you know: What did you change orwhat did you discover in during the pandemic that maybe you'relike hey? This is great or Hey. Well, let's hope this never happens again. So yeah NOM Wutd a we're fortunate again,like I can't say enough about the practice I workd for it. We werefortunate to have. We were already kind of watching covid from a distance, andI think a lot of the places deep down were. We've already took someprecautions before they made it. You know I had the baby in Aprilso in Marchthat asthe weekend the Black Frinday in March, we out to call it the when theykinly came down and all of us we already were prepaired in a seents. Noone could bully prepare. I don't think, but we were already prepared for somechanges to roll in now. At's gain we're, probably affiliated so we're veryfortunate that we don't work. For you know we definitely follow standards,but we were able to make some calls on our oown. You know so we were able togo ahead and order. Things and IDD...

...already starts up on breathingtreatments, and you know just different things that we knew we may need. So that was an impact just turng tobrate for the unknown, which and our patients getting Camo and already havean no immune system. We did. We had to do some rranical things like we have atreatment curve. Arya now we have, but POVIT has afeus. In God, ways to. Wenow have a fatch track for labs. We didn't have that before everybody wasmucked all together now, if you're just needing ladwork and that's it andyou're not needing to stay for results, we just we have a fat track area nowwhere patients come in and they can check in and they go get their labs.NTE leave and hat takes to CIME. Just fifteen minutes ten minutes so tobid WT.We try to find the DOD in Turbin we on Lotf people in our lobb. We havea rather Larg Ofe, but we didn't want them Al out there so and that that makes perfect sense. Sowhat what will you continue to do that you discovered still post Covid, like you mentionedthe fast track lads, but I'm assuming you'll continue that or will thatchange or is there anything else that well e, keep taking on we're goingtoeven have a new area for it we're going to we're going to have a new fash trackarea. We're going NA we've actually had been able toHarrison New People, we're going to have a new fwe're going to rerange the Front desTaf. So there's always going to be like a confeers kind of person of the frontto help patients direct them where they need to go and check them in, so thatour front dust staff is not as overbagd when their schedulin oriscts and allthese kinds of things. It's definitely open around to somethings that you can even do better. So we try to look at covid an whati do ina positive way, but look how l this benefited US instead of Lookatg, allthis joke were have Te. Do that, maybe we don't even know if it's helping youknow, because I alwas Ho, I o still ocavid, but we try to focus on thatfact and then, as far as in the dispensery, there are certain drugs and certainenviodics that it's scary to think about not being able to get so for ourpatients, especially who just sometimes need to take it because they have likeno black CCOUNT. So we are definitely keeping things and stock t hit beforewe kind of like. Oh, we can justorder it. If we need it now we're a littlebit more cautious to keep those the SUCF, especially if it's a drug we knowis going to fict to their flot count right right, that's interesting! Well,you got fantastic optimism coming out of covid and it's alwaysit's always interesting that sometimes o trials and struggles end up open upnew avenues and new things that that you know hopefully make you in the patient'slife easier. What type of resources or tools do you duse in your daily activities? Do youhave like you know, source that you tap industrywide or like a dispensory publication or community group, or anything thatmaybe makes your dob a little easier or that you w glean helpful hints fromwell? You guys help me a lot. You know that, but I also use the drug rips. Like I said before to there were three new drugs that cameout in the past week a week from today backward so two were for really refusion drugs, andthen I can't even think of what the other one was right now, but two lungdrugs and another one, I think, was promoal aml anyway immediately called the drug retch forthise companies that Hav good asid hey. I know it just got to prove today, butI need I need to go IV got patients. The Dotatari told me like I need, I told him. I need need to know moreabout this, so they go ahead and they let me know so, that's a really bighelpful thing for me and then smart. I D work as who we use to helpmanage our dispenseary. Have you ever heard them...

...not familiar with them? No, you canexfill free expand on that, so we use QS one for our operating system for ourdispensery, which is where we feill the prescriptions through, and everythinglike that process claims. So smart ide works is the side of tos one that like.If I have a CLAIMI, didn't get a Paigon. I call swor ayworks. If I need to get adoctor's license put into my system, I casse myadyworks. If I just anything, Ijust call it theyre fantastic can't speak enough about them small company,but great rewards. They I mean I personally like they know mykids names there they're that itsait's Sotatoo Much O. that's Ho kids this,but they really clear about doing us Throv. So they make sure we are up today on everything we need tobe, and you know, run in Accordun Til Estate Law and can't speak enough about them and then,like clinically, we use up today a lot. I use apocrates a lot, those two forinteraction, chicks and things like that, and in general I mean my physicianswere very lucky to work for we work and then we have good contact with you knowbabgists and things like that. So we're fortunate to have you know if we have questions, we havegood resources. I guess the point, but I can't stress enough having a good APPlike apocrates or up Todat to goodbye, because just the knowledge, that's onthose caps are important. Well, that's great information. I hopesome of our audience and listeners that something maybe they've heard for thefirst time so appreciate your sharing that. So what do you have? Are you working one current projects or what's the future, look like for your role, just statusquo or anything coming down the pipeline regarding the practice ordoesn? Everyone want to say it depends on what happens with these insurancecompanies. Obviously, with the meyear coming, I don't choose to. Let itstress me out the dour fees and the we could have a whole segment on that, butI she as not let it bother me instead of try to keep searching for ways tofat them, I don't they are doing bordirlon. It reallyshould be illegal, there's just Lopholes, so instead how aboutlegislation closes those look hols for them, but that's a Luk another topicfor another Hay, but we keep toensure that we keep our really tighteye on our billing and everything like that. So we really try not to take to Har e risks becausesometimes Timlis is not our tim informancy. So we really and that'slike I said- that's wher. My specially pharmacies help me, but I we're going to expand our dispitcory.Hopefully some a little bit make a bigger area and better access forpatients, because some of our patiens peo they can't stand, and they can'tnecessarily stand outside of my window. So we're going to have a different areafor them to be able to sit and discuss with us when we're going over newpaysient starts oning this and then I mean, as far as I'ncology is a whole.What's coming for the future, I hope good things I mean y know. I hope I always hope for good things. I saidthis week if we sould create a cure for the allergy cough and neuropathy wed never have to work agin,you know so right, but I mean I really like, like the three drugsthat have came out in the past week, I'm really hoping we're going to helpthese people that are like family to so know there there's too manyreaccurrences and there's two. You know when you worke in it you're like okay.I swear the more cancer this week that player, but it's going to always bethat way, because that's why we're here, SOI'm really excited to see these newdrugs coming out, and I want access to abrogress span up pharmacies, becausesome people tha get access really, in my opinion, shouldn't have it. So...

I would love to see better pharmacies get access to thesedrugs. I advocate for that all the time I'm like. Why are you giving YourBusiness to this times? Yo Talk? It won bi, one that as great fea service.Please that's right! Well, NW! That's been so informative todayand I really appreciate your time and if some of our listeners want to followup with you, what would be a good way for them tocontact you? You know if they wante to follow back and someing. You said todayand get more IMFO from you. Oh email, you know the lovely email anytime. Idon't wind. I think that the biggest thing onchology is making sure that you we have to work as a team to get to theMenco, which is given the patient, the best quality of life and care possible.So if anybody wants to reach out to me, they can email me at my work, emailwhich is a anders. So it's a an de rs onchology, Desh, CSCOM and anybody's welcome to reach out andif have any questions and last versa. They need to teach me something. I'malways open on a new things, because it's definitely an ever ivolvingsituation in oncology. Well appreciate you sharein thatinformation and I think, you're right on Colloge, YS, so dynamic, and it'schanging every day, and I think you know like with this podcast and some ofthe communities with everybody being able to connect a network. I thinkeverybody we all benefit from that, especially keeping the patient as ourfocus. So we will leave it at that and I want to think again: Ali AndersRejoinin us today at killanchology specialist in Hickory North Carolina,who is a dispensing manager and again this is Scott Posom with bioplusspecialty pharmacy, and thank you for listening to working in Onchologypodcast. Thank you, Alec. So much have great rest of the day. Thanks you to. Are You satisfied with your patient'scurrent speed therapy, or are you just settling? You can improve patientoutcomes with bioplus specialty pharmace power of to the first ever twohours today, together, promise it's bester easier for you, Antourpation tolearn more VISI bioplus rxcom you've been listening to working inOncolleg to ensure that you never miss an episode. UBSCRIDE to the show inyour favorite lodcast player, if you're listening an out the PODCASTO lovewylev EI Radin on the show just have the number of stars. You Tet the podcast todirs. Thank you. So much for listening, UNTELL thext time.

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