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Transcription

Mike: Hello, and welcome to Avalere’s fourth episode in a podcast series focused on specialty pharmacy stakeholder perspectives. My name is Mike Schneider, and I am a principal in the Market Access practice at Avalere. Today, I am joined by Adam Hanauer, Associate Vice President at Humana Specialty Pharmacy, and Mark Sasala, a Principal Business Analyst of Products at Creehan & Company. In today’s episode we will focus on the outlook of specialty pharmacy, with a focus on the environment considerations, including potential impacts of COVID-19.

First question, in terms of short- and longer-term specialty pharmacy and retail business continuity: What are the top business impacts of COVID-19 on the specialty pharmacy landscape? Adam, we would welcome your thoughts on how Humana is thinking about this.

Adam: Yes. Thank you, Mike! So much has changed and so quickly. A top-of-mind consideration for Humana Specialty was protecting our operations. We very quickly began accelerating our business continuity plans, which included organizing, communicating, and executing near-term plans while also trying to predict the different phases and associated timing for the pandemic and events to come. Having lived through a barrage of emerging data and perspectives, it was important for us to have top-down leadership and direction. We have centered our priorities on:

• Care for our associates, ensuring safety and protection, to continue to operate and support our members, patients, and providers during this pandemic. As an organization, we have done a great job of executing across clinical, operational and pharmacy portions of our business. One example of this is the speed in which we transitioned our front-line service workers to work at home. We got this done in a matter of days. We were able to quickly mobilize our IT leadership across the teams to get folks at home. At the same time, we have essential workers that need to continue to go in to deliver services, so we had to quickly implement new protocols across the distribution sites. There are several activities that we activated to ensure the ongoing safety of those members as well.
• Protecting our supply chain and supply chain activities to be able to procure and deliver the necessary supplies and medications to customers and provide support to patients and providers. We worked closely with pharmacy partners to share and gather emerging insights and plans in real time with great collaboration.

COVID-19 is going to reshape our supply chain in the future. Along with that, we are looking at the longer-term impact within pharmaceuticals. There are great stories of companies utilizing their assets and scale to combat the virus. But I also wonder what impact that may have on future innovation as well. So much is going into developing the treatments and vaccines–and rightly so–it will be interesting to see if there is any slowing in innovation in the specialty channel. These are just a few considerations we are thinking about from a continuity perspective.

Mike: Great! Thank you, Adam. Mark, anything you would like to add?

Mark: Sure! Thank you, Adam. That is a great perspective from the front lines of the pharmacy world. From the broader market, what we are seeing and hearing is that early in the pandemic, there was a mass shift to 90-day supplies and filling prescriptions early to allow patients to better weather through the quarantine timeframe. To support this, there was some relaxation of early prior authorizations and refill-too-soon edits so that dispensing could occur in an earlier time frame. What we saw overall from a market perspective was that the dispensing volumes did spike in the March timeframe, and since then there has been a decrease in some dispensing volumes. Additionally, we are seeing reduced volume of onboarding patients, as they are delaying appointments with their medical providers and not initiating new therapies. Therefore, fewer new therapies have been started, while the normal attrition of patients on therapy is steady. As we establish a new normal and return to regular provider visits, we anticipate the dispensing volume will return, and some of the supply-chain issues that Adam described will stabilize as patient reinitiate treatment and typical regiments.

Mike: Wow! Thank you, Adam and Mark. It is interesting to see what impact COVID-19 is having on the specialty landscape and how that is potentially going to continue in the long term. How will the roles of specialty pharmacy and the pharmacist evolve when it comes to patient support and patient engagement in the short and long term? Adam, why don’t we start with you again.

Adam: We have thought about this a great deal. Even in my experience through the pandemic, for first time, I sought healthcare services on an app when I could not get to my doctor. While for me it was relatively minor and non-urgent, I still felt a clinical consultation was necessary. I think these technologies and partnerships are going to continue to evolve in the specialty landscape and become increasingly important, not just in the pandemic. They will also become part of the new way of healthcare services and how they are going to be delivered. There is a lot of value in meeting patients when and where they want to receive care and being able to deliver the capabilities that make that experience easy for the patients and for the clinicians delivering that care. So, where we can empower patients to engage in their health and capture real-world outcomes and then deliver it directly to pharmacists, it is going to be game changing for the clinical models. This is already happening, and it will continue to scale and evolve. Specialty pharmacy and pharmacists have already driven performance and value to their insights and clinical models.

Mike: Great! Thank you, Adam. Mark, is there anything you would like to add to patient support and patient engagement?

Mark: Sure! And I would echo what Adam has indicated on the push to move forward on those engagements. Specialty pharmacy has always been focused on high touch, and now we are seeing an increased emphasis on evolving methods to have the technological capabilities that support that expansion. We are seeing tremendous interest and expansion in patient digital, which includes video chat, texting, and 2-way messaging. Part of this is driven by increased comfort and familiarity in interactive options like Zoom meetings, which are becoming standard interactions. There is interest to extend these options for clinicians and other interactions across the care continuum. By allowing for direct person-to-person telehealth visits, it allows pharmacist to operate at the top of their license. While these capabilities were available previously, the adoption was low and the reimbursement was not available. In the transition to providing payment for these interactions, pharmacists are being recognized as providers by the Centers for Medicare and Medicaid Services (CMS) and other payers. There is an opportunity to pursue these services and be reimbursed for them. I participated in an National Council for Prescription Drug Programs emergency work group developing a new set of standards to support billing for pharmacist services during COVID-19. However, 1 aspect that is still unclear is that while there was initial support for telehealth and payment for those services by commercial payers and CMS, it is unknown whether telehealth will still receive this support as we relax some of the social distancing requirements. It will be interesting to monitor closely.

Mike: Great point, Mark! I agree, it will be interesting to see how telehealth and telemedicine impact specialty pharmacy and patient engagement, as well as more broadly in healthcare as providers engage with patients using telehealth and look to be reimbursed. With the infrastructure in place, is there an opportunity for the specialty pharmacy to differentiate in home-based services? And if so, how can they go about doing so? Adam, I am curious how you are thinking about this.

Adam: Mike, that is a great question and top of the mind from a Humana and a Humana Specialty Pharmacy perspective. The resounding answer is yes. We have been working for some time to take advantage of the advancements in technology in the past decade and integrate them more deeply in our care delivery model. This time has been an accelerator for that work and provided the impetus for patients and providers to embrace them as part of the system models and workflows in which we operate, as Mark alluded to in the previous question. Pharmacies that innovate and embrace technology with an integrated strategy can deploy these initiatives across their customer base, and this will position pharmacists and pharmacies to deliver the necessary care in the coming years. Our focus with Humana at Home is supporting the convenience that patients want, while also striving for direct opportunities for clinicians to align on treatment plans and goals for patient therapy journeys. Pharmacists will play a key role in differentiating that experience and being part of the overall care team and activities. All of this is enabled by the technologies and appropriate integration of these technologies to remove frictions between the patient and providers to deliver optimal outcomes.

Mike: Great! Thank you, Adam! Mark, anything you would like to add?

Mark: Sure! I would even add from what Adam said, is that it is technologies not just technology. We are seeing a strong interest in extending care into the home as well. This is driven partially by the industry transition to value-based reimbursement. As we move into value-based reimbursements, there is a natural focus on the holistic patient and ensuring we have the available technologies to provide this kind of view and insight, and to understand what is occurring with the patient, regardless of where they present. We have access to the patient’s full record, which has not historically been available. As providers are equipped with this information, they can consider the multiple impacts to the patients to give a holistic view at that point of care. As the growth of connected devices continues to expand, there is an opportunity to have real-time data insights for everything from adherence with smart bottles that provide feedback to the provider when the patient has taken their medication to integrated EKG results and other heart-monitoring type tools. As the adoption of technologies increase, the ability to present it to the user at the right time becomes key to driving new services that offers the value-based differentiation.

Mike: Great points, guys! Mark, I agree with you! The technology that is becoming available to monitor adherence especially is going to have a huge impact. Any closing thoughts as we continue to look at the outlook of specialty drugs and specialty pharmacy? Adam, I will start with you again.

Adam: Okay! I would also like to say thank you for the opportunity to engage in a forum like this. There is an underlying acceleration in the market and in particular specialty pharmacy, because of the critical medications being used for patients. There is a desire to meet patients where they are, have real-world impactful information, and empower clinicians to practice at the top of their licenses. I think it is the technologies that we will see emerge across the market, and specialty pharmacy is well positioned to take advantage of those and be a critical component of outcomes and success for the patients. I am excited to be where I am, leading a major specialty pharmacy, and I look forward to what the future holds, not just through the pandemic but also the good that comes out of it as an industry and within the markets that we serve.

Mike: Great! Thank you, Adam! Mark, any closing thoughts?

Mark: Sure, and I also appreciate the opportunity to engage in this discussion. I echo what Adam has said about specialty pharmacy at that growth projection and transition. The change we have seen in the marketplace during COVID-19 will allow us to continue to speed up the adoption of these different interoperability changes. They were underway before the pandemic, such as the 21st Century Cures Act, as well as advancements in our own technologies and systems as mentioned. I think this additional access and availability of data will continue to help us to significantly reduce manual processes that have historically caused a huge cost-to-fill impact as well as extended time to fill. Reducing those impacts and access to data will allow pharmacists and other physicians to provide better personalized care. This is an exciting time in healthcare, and I appreciate the time to share my observations.

Mike: Thank you so much, Adam and Mark! It has been a pleasure speaking to you both today. Your insights are invaluable to our listeners. Thank you all for tuning in. Please stay tuned for more episodes on Avalere Health Essential Voice. If you would like to learn more, please visit us at Avalere.com.