Pharmacy leaders in Minnesota gathered on June 23, 2026, to discuss how expanding pharmacy operations can support the growing use of bispecific antibodies and CAR T‑cell therapies in oncology.
Operational and Financial Hurdles in Outpatient Immunotherapy
During the “Advancing Pharmacy Operations & Workflows in Oncology” panel, Kirollos Hanna, PharmD, BCPS, BCOP, opened with a look at the step‑wise rollout of outpatient bispecific therapy at Minnesota Oncology. The plan starts with maintenance dosing, adds inpatient observation for early administrations, and aims for fully outpatient treatment once protocols prove safe. Home monitoring kits—including thermometers, blood‑pressure cuffs and pulse oximeters—are supplied to patients to catch early toxicities.
Allina Health’s oncology pharmacy program manager, Sara Moran Smith, noted that the health system has not launched a CAR T program, but pharmacists have already built outpatient bispecific protocols. Those protocols define patient‑selection criteria and toxicity‑management algorithms, which the team hopes to adapt for future cellular therapies.
HealthPartners’ Paul Forsberg, PharmD, MHA, described a collaborative model where pharmacy works with nursing and physicians to identify outpatient candidates, handle prior authorizations, and manage transitions between inpatient and outpatient settings. He warned that “the administrative burden has increased substantially.”
At the Mayo Clinic, director of formulary management Chelsee Jensen, PharmD, RPh, BCPS, highlighted that the institution already runs outpatient CAR T and bispecific programs and is exploring regional expansion. She stressed that extensive training for patients and caregivers—especially on recognizing early signs of cytokine release syndrome—remains essential for safe home administration.
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High‑risk agents like tebentafusp (Kimmtrak) for uveal melanoma still demand close monitoring. Hanna explained that the drug carries about a 90 % cytokine release syndrome rate and requires at least 16 hours of observation after each of the first three doses, limiting its use to core sites near hospital partners.
Formulary management is becoming a strategic lever as multiple‑myeloma therapies generate significant financial toxicity. Forsberg said health systems are weighing whether to standardize formularies around fewer products to simplify prior‑authorization workflows. Nevertheless, Moran Smith cautioned that “drug acquisition cost alone should not drive formulary decisions,” urging organizations to factor in reimbursement, patient convenience, operational efficiency and clinical outcomes when evaluating biosimilars.
Hanna concluded that reimbursement models have not kept pace with oncology advances. He pointed to the CMS Enhancing Oncology Model, which can penalize finite‑duration regimens that have higher short‑term episode costs, even when they provide comparable long‑term value. “We just fall under this algorithm where we are writing off $5,000 worth of waste because the payer says we used a larger‑than‑necessary vial size,” he said.
Precision Testing and Clinical Trial Integration in Lung Cancer
The evening’s second panel, “Precision in Practice: Implementing Biomarker Testing in Lung Cancer,” shifted focus to molecular diagnostics. Kurt Demel, MD, MBA, moderated a discussion featuring University of Minnesota’s Robert Kratzke, MD, and HealthPartners oncologists Yan Ji and Priya Kumar, MBBS.
Kumar advocated for broad next‑generation sequencing (NGS) panels even in early‑stage disease, arguing that full testing offers the greatest clinical utility. Kratzke echoed this stance, describing the university’s reflex testing approach where every lung‑cancer case automatically undergoes molecular profiling. Ji highlighted the role of lung‑cancer navigators in coordinating biopsies, staging and sample collection for testing.
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Despite Minnesota’s biomarker‑testing mandate improving insurance coverage, operational barriers remain. Demel noted the Medicare 14‑day rule can prevent ordering molecular tests during inpatient stays, while clinicians often wait two weeks for sequencing results, delaying targeted‑therapy initiation. Ji recounted a patient whose NGS result took nearly four weeks, during which an effusion developed, forcing clinicians to start empiric chemotherapy.
Panelists also discussed trial enrollment challenges. Kumar said matching patients to biomarker‑driven studies frequently requires collaboration with other institutions when local trials are unavailable. Kratzke referenced the state’s MNconnect initiative aimed at improving trial awareness, though Kumar warned that busy physicians are unlikely to search separate apps for eligibility, preferring embedded alerts within electronic health records.
“The take‑home message here is that we’re all huge proponents of precision medicine and getting access to this for our patients because it has impactful outcomes and value,” Demel said.
Success will depend on seamless data flow and sustained collaboration among community and academic sites.
