(48) Implementing a Standardized Process for Blinatumomab Administration Across the System

Title: Implementing a Standardized Process for Blinatumomab Administration Across the System

Abstract : During the Children’s Oncology Group study, blinatumomab was dispensed through the Investigational Drug Pharmacy at Children’s Hospital Colorado (CHCO). In 2024, the FDA approved blinatumomab as a standard of care for leukemia protocols. At that time only two homecare agencies could provide this infusion, both limited based on payor, excluding patients with Colorado or out of state Medicaid. Later both companies stopped supporting all payors due to drug cost. Since CHCO does not have a homecare or Durable Medical Equipment (DME) license, these patients at higher risk for low resources would have to be admitted for 28-days of therapy.

The Center for Cancer and Blood Disorders (CCBD) leadership identified key stakeholders to evaluate and develop a process for administering home blinatumomab without a homecare or DME license.

We reached out to the Colorado State Board of Pharmacy to determine allowance without a homecare license. By initiating while the patient was within the facility, it met regulatory requirements. Next, we partnered with an external agency to provide patients the home infusion pump, which met risk management and legal requirements. The agency agreed to support patients regardless of payor. This process included submitting orders, family consent and treatment records for billing directly with the company.
Strong collaboration between inpatient and outpatient across our system of care occurred to develop nurse, patient and family education materials. Additionally, we updated our policy, addressing central line care for these patients. The group standardized pump use between inpatient and home pumps, developed afterhours management plans, partnering with our Emergency Department leadership, and created documentation in the electronic health record.

Since November 2024, we have administered CHCO dispensed blinatumomab to 16 patients. Providing this critical treatment to pediatric patients in and outside of Colorado and developing a framework for other home infusions.