At Morgantown, W.Va.-based WVU Medicine, one of the biggest shifts in cancer care is not happening inside a hospital. It is happening closer to patients’ homes.
Over the past several years, the health system has expanded oncology and infusion services across its growing regional footprint, reducing the need for many patients to travel hours for treatment. Dmitry Walker, PharmD, director of pharmacy for oncology and investigational drug services, said the shift has transformed access to care across West Virginia and neighboring states.
“Parts of the region either had no access before or they had to travel three, four, five hours to Morgantown,” Dr. Walker said on Becker’s “Pharmacy Leadership Podcast.” Now much of that care can be delivered locally.
That progress, however, has created new challenges for pharmacy leaders, especially as cancer treatment grows more complex and expensive.
Dr. Walker oversees pharmacy services supporting adult oncology care across inpatient units, outpatient infusion centers and clinical trials. One major initiative over the past year has focused on improving safety around oral oncology medications, which patients take at home rather than receiving through infusion.
Unlike many traditional prescriptions, these therapies often require genetic testing, specialized monitoring and close follow-up. To reduce the risk of prescribing or dosing errors, WVU Medicine implemented a system in which oncology pharmacists review prescriptions for clinical appropriateness and accuracy before they are sent to specialty pharmacies.
Dr. Walker said the effort has been a multiyear project that recently expanded to include patients being discharged from the hospital, helping catch issues before patients leave care settings.
At the same time, the organization has worked to shield patients from recurring national shortages of critical oncology drugs. After severe shortages of chemotherapy agents such as carboplatin and cisplatin several years ago, WVU Medicine began increasing safety stock for essential sterile oncology products.
“We don’t want our patients to go without,” Dr. Walker said.
Previously, storage limits at the academic medical center restricted how much medication could be held in reserve. Over the past year, the health system partnered with a centralized warehouse operation to expand storage capacity, allowing pharmacy teams to build larger safety reserves for key drugs.
The goal is simple, Dr. Walker said: Avoid situations in which patients are forced to delay or miss treatment because medications are not available.
But pharmacy leaders now face an even larger pressure:
“These are therapies where providers are purchasing treatments for anywhere between $500,000 and $3 million for a one-time treatment,” Dr. Walker said.
Use of CAR T-cell therapy and other advanced treatments has accelerated quickly. WVU Medicine once treated only a few such patients per year; now the system treats dozens annually while also preparing to open clinical trials involving even more complex therapies.
Managing these treatments requires careful coordination across pharmacy, clinical teams and revenue cycle operations. Dr. Walker said mistakes in authorization, documentation or billing could create catastrophic financial consequences for organizations, potentially limiting access to lifesaving therapies in the future.
At the same time, growth across WVU Medicine’s regional hospital network has created workforce challenges. Recruiting oncologists and specialized oncology pharmacists to rural communities can be difficult, even as demand for care increases.
Still, Dr. Walker described the work as deeply rewarding, as expanding local access allows patients to receive advanced care without leaving their communities.
Looking ahead, he sees the biggest opportunities not inside hospitals but in ambulatory and outpatient settings, where treatments increasingly shift closer to home or even into patients’ homes.
“It’s an opportunity to make sure that each patient in your community, when they need your healthcare services, they’re getting them on the right side of care,” Dr. Walker said.
For oncology patients, whose treatment journeys often span hospital stays, outpatient visits, infusion appointments and home medication management, that coordination is critical.
And for pharmacy leaders, it means ensuring medications, workflows and reimbursement processes function seamlessly across every step of care, Dr. Walker said.
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