Presenting Authors: Kelsey Schildknecht, PharmD, and Lauren Gilmer, PharmD, TriHealth, Cincinnati, OH
BACKGROUND: Community oncology practices face operational barriers to adopt comprehensive biomarker testing, including electronic medical record (EMR) limitations, financial toxicity, and complex payer requirements. Pharmacists serve as a bridge between molecular diagnostics, prescribers, and patients, ensuring testing compliance, optimal treatment choice, and access to costly targeted therapies as well as continued adherence through monitoring and adverse event management.
OBJECTIVE: To evaluate the practice management outcomes of integrating a precision oncology workflow with next-generation sequencing, discrete genomic reporting, and artificial intelligence (AI)-supported decision tools, with emphasis on specialty pharmacy prescribing patterns, financial outcomes, and equitable testing access.
METHODS: By August 2025, TriHealth integrated biomarker and germline testing from 12 laboratories (7 Health Level Seven, 5 Aura Practice Management) into the EMR with standardized workflows to expedite prior authorization, financial aid applications, and AI-enabled care gap identification. Outcomes from 2022 to 2025 included testing/prescribing trends, pharmacy growth, financial savings, downstream revenue, and equity in patient access to testing.
RESULTS: Implementation of the February 2024 workflow led to 100% compliance with non–small cell lung cancer (NSCLC) biomarker testing within 12 weeks, and this was sustained over a 12-month period. Biomarker positivity in advanced NSCLC was as follows: EGFR, 22%; ALK, 13%; PD-L1, 75% (February 2024-July 2025). Actionable mutations in addition to ALK/EGFR (eg, BRAF V600E, KRAS G12C) occurred in 7.7% of patients. A total of 91% of NSCLC patients assessed received biomarker testing within 30 days of diagnosis. From January 2024 to August 2025, targeted therapy prescriptions rose 72%, with 48% biomarker-driven, yielding $1.2 million in gross margin and 130% year-over-year growth. The system achieved $14.5 million in 340B savings in FY2025. A standardized financial assistance process eliminated out-of-pocket testing costs for 95% of patients, with 2024 data showing no biomarker testing disparities by race, zip code, or social vulnerability index.
CONCLUSION: EMR-integrated biomarker workflows improved operational efficiency, reduced financial toxicity, and drove measurable growth in specialty pharmacy prescribing and revenue. Pharmacists played a central role in bridging biomarker testing to practice management outcomes, highlighting their impact on financial sustainability and equitable receipt of optimized oncology treatment through precision oncology in the community setting.
Implementation of EMR-integrated biomarker workflows and AI-supported care gap identification significantly increased biomarker testing compliance and specialty pharmacy prescribing, improved operational efficiency, and generated substantial financial benefits while preserving equity in patient access. These findings highlight the vital role of oncology pharmacists in bridging biomarker testing with practice management to enhance precision oncology and choice of therapy using interdisciplinary healthcare teams.
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