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Phillip Koo: Hi, I'm Phillip Koo and welcome back to our special feature, looking at how to operationalize and integrate a PLUVICTO program into a large urology group practice. One of the components of a program is to make sure patients have smooth transitions in care. And I think that coordination piece is something that we don't talk enough about and I think we all see the value in how care coordination really makes a big difference. And we're very fortunate to have with us, Liz Davis, who's the Coordinator here at Chesapeake Urology. Thank you, Liz, for joining us.

Elizabeth Davis: Thank you.

Phillip Koo: Let's say one of the patients, the physicians decide this is a patient that should get PLUVICTO. Talk us through what happens next and how you're able to facilitate that process from ordering to treatment.

Elizabeth Davis: Sure. So when the doctor and the patient meet and decide that PLUVICTO is what they want to do going forward, I receive the paperwork, make sure it's signed, then I send it off to the PLUVICTO organization to run benefits, I also send it to our billing department in-house. And then once I receive the approval, I can then order the drug for the patient, get them on the schedule, get them scheduled for blood work and everything that they need to do to prepare for the injection.

Phillip Koo: So when you go ahead and start scheduling these patients, do you go ahead and schedule all six doses at one time or do you schedule four or do you schedule each dose separately?

Elizabeth Davis: So I try to schedule all six doses at once, if possible. Now, of course, sometimes with the doctor's schedule, that's not an option. But I do try to get all six doses scheduled right at the beginning so that I know that they're there for each injection date.

Phillip Koo: So a big piece to whether or not the patient moves forward with the treatment is lab values. How do you guys manage the labs, timing of the labs, how they're reviewed and how those decisions are made?

Elizabeth Davis: Sure. So every month, 10 days before the injection date, they need to have a CBC and a CMP done. They get the labs done wherever is convenient for them and then when I receive the results, I get them to the doctor to approve. If the labs are not what the doctor is hoping to see and then I will call and cancel. But yeah, within 10 days we want to get that blood work approved by the doctor.

Phillip Koo: That's great. I think it's always that balance between getting them too early versus too late and I've heard seven to 10 days gives you enough time to review and make that decision whether you move forward or not. Being a patient coordinator, you interface and interact with these patients, in some ways, probably spend more time with them than the physicians do. And I imagine there's a comfort level that develops and they often ask you certain questions that they may not feel comfortable asking to others or they might bring to you concerns that they might have. So are there any themes or things that they've brought to your attention?

Elizabeth Davis: Sure. I think that I get a lot of questions regarding side effects. What should they expect? They also want to know how they should be interacting with family members. I get a lot of questions as to, "Should I stay away from, should I sleep in the same bed with my partner?" Things like that. Generally the questions are pretty easy to answer.

Phillip Koo: Side effects is something that often comes up and what we've seen and what the literature also shows, it's a very well tolerated drug. What sort of processes do you have in place to manage these side effects? Do the calls come to the coordinator first? Do they go to the navigator first? Do they go to the APP, physicians? How does that work?

Elizabeth Davis: Typically, they will come to either myself or the nurse navigator. Most medical questions I let the nurse navigator answer, so I will forward those questions to her and then she will reach out to the patient.

Phillip Koo: So Liz, after prior auth is obtained, tell me about how you go ahead and start ordering the drug?

Elizabeth Davis: So once I get approval from insurance, I then go into the ROME system, which is the PLUVICTO ordering system. It's very straightforward, very user-friendly. I go in and I'm able to order all six doses at once or one at a time or a couple at a time. But again, it's very easy to navigate.

Phillip Koo: So this ROME system is part of Novartis' process?

Elizabeth Davis: Yes. I can go in monthly to order or, like I said, all six doses can be ordered at once. And then as soon as it's ordered, I will get a confirmation email that the doses are ordered and then I will get follow-up emails when they're... I'm able to follow along the process and make sure that the drug gets here safely.

Phillip Koo: Great. And if labs are reviewed and one patient will not go on with the next treatment, you could cancel through the ROME system as well?

Elizabeth Davis: Yes.

Phillip Koo: So given your experience coordinating these various pieces, any words of advice that you have for other coordinators or other practices that are looking to get into this and how they maximize the use of someone like yourself?

Elizabeth Davis: I think that lots of communication with the patients, emails, calls, letters, any way that you can keep the line of communication open with the patient and walk them through each step because every month they are in charge of getting that blood work done. So we follow along with them and make sure that the steps are being taken in order to have a successful six injections.

Phillip Koo: Great. Well, thank you very much, Liz.

Elizabeth Davis: Thank you.