Ep. 83 – Optimizing HIV Specialty Pharmacy Care: An Interview with the CEO of MichRx

Suzette Dimascio - Specialty Pharmacy Podcast

In this episode, Michelle Sherman, president of MichRx Pharmacist Consulting Services, joins host Suzette DiMascio, CHE, CMCE, CPC, to detail her role in transforming the care model for HIV patients while becoming one of the specialty pharmacy industry’s leading HIV experts.

She also discusses the critical role HIV specialty pharmacists play in delivering patient care and helping patients overcome the financial and administrative challenges posed by the healthcare system.

Tune in to Discover:

  • Why HIV specialty pharmacist plays such a critical role on any HIV patient’s care team
  • How HIV pharmacists help patients navigate the healthcare landscape, including coordination of benefits and copays
  • What the Ubuntu Pharmacist Care Program is and how it empowers patients, their families and communities
  • How health systems can develop strong HIV care programs to support patient needs and optimize outcomes
  • Where HIV specialty pharmacist care is heading in an ever-changing healthcare system

About Michelle Sherman

Michelle Sherman founded MichRx Pharmacist Consulting Services, Inc. in 2005. MichRx Pharmacist Consulting Services, Inc. is a top provider of innovative services and solutions for Pharmacists who want to grow and expand their businesses and focus on specialty niche markets such as HIV/AIDS.

Ms. Sherman is a nationally recognized HIV Specialist Pharmacist practicing in Orange County, California for over eighteen years. As an advocate for pharmacists to be at the forefront of care and recognized as a healthcare provider nationally, she is passionate about taking care of patients by arming caregivers, patients and the industry with the knowledge they need to advance the care of HIV patients. Ms. Sherman has extensive experience and expertise in building profitable specialty pharmacies and is a published author of the book “Saving Lives: The Role of The Pharmacist in HIV.”

About CSI Specialty Group

CSI Specialty Group is a globally recognized leadership, strategy and talent consulting firm dedicated to helping clients drive sustainable, accelerated growth while continually elevating the specialty pharmacy industry. By providing inventive specialty pharmacy consulting, workforce planning and talent acquisition solutions, CSI uniquely tailors its service offerings to help clients drive sustainable, accelerated growth. As the provider of the industry’s first, dedicated podcast for specialty pharmacy, CSI is at the forefront of pioneering innovative concepts to meet the changing needs of specialty pharmacy, home infusion, mail order/PBM, health systems and pharma/biotech clients across the USA and throughout Europe.

Transcript Notes:

Speaker 1: Welcome to the specialty pharmacy podcast. Your prescription for specialty pharmacy success. Now here’s your host, globally recognized industry leader and CEO of CSI Specialty group, Suzette Demasio.

Suzette DiMascio: Hi, this is Suzette Demasio with the CSI Specialty group, specialty pharmacy podcast. And today on our show, we’ll be talking with Michelle Sherman who is the president of Mish RX Pharmacy Consulting Services, a boutique firm that specializes in working with HIV providers and developing ways to enhance care in the HIV world. Michelle, I am thrilled to have you on the show and look forward to learning a little bit more about you during this time.

Michelle Sherman: Great, thank you so much for having me.

Suzette: Michelle, can you tell our listeners a little bit about yourself and how you started your firm and the services that you offer?

Michelle Sherman: Absolutely. So I moved to the United States 31 years ago from South Africa. And when I moved over, we had learned nothing about HIV or heard not much about it in South Africa. But all I knew was what was happening in the United States. Rob [inaudible 00:01:23] had just died, we saw this mess of explosion within the gay community and then I moved to southern California, 31 years ago, and after I started working in pharmacy, I really realized what was going on with HIV and many of my friends started to die. And it became a thing. Like a purpose. And I just knew, I said, I needed to work in this space. I needed to make a difference to my friends and to my patients that were just dying. At that point, we only had one drug, we had ABT. And the doses were so toxic and people were literally dying all around me.

And when I moved from Bakersfield, California where I began my career and started working down to Orange County to Laguna Beach and Irvine, I just knew this was what I needed to do. And I began volunteering for an organization and literally everyday, every week, the people I interacted with were dying. So it became my mission, my purpose, it was like a journey from the soul basically. This is what I had to do. And my career took off from there. Created the first HIV specialty pharmacies here in Orange County and then in 2005, I wanted to expand my work and my practice and created Michelle RX Pharmacy Consulting services. To be able to broaden my base of expertise out of my little, myopic program to spread it across the country. To teach others how to do this correctly. In the pharmacy space, and then also empower HIV patients to take care of their own health through my patient website, HIVthrive.com.

Suzette: Wow. I mean, what an amazing time to be part of the movement to change. Because I remember, back in my home infusion days, gosh, I’m dating myself now. Back in the early ’90s, exactly what you were talking about. I mean patients didn’t survive most of the time from HIV. It was a death sentence.

Michelle Sherman: Oh absolutely.

Suzette: And it wasn’t a pretty death sentence. I remember one of the home infusion companies I work with Michelle, actually were taking care of Ryan White and his siblings. And I used to see what was happening and all of the craziness happening on the hemophilia patients, primarily, that were getting this tainted factor because of the blood bank issues and so forth. So wow! You’ve really just seen a complete 360 perspective change in going from a death sentence to a diagnosis now that has hope because a lot of the work that people like you have done to champion the cause.

Michelle Sherman: No absolutely. It’s been an extraordinary journey. Through dealing with these patients, like so intimately, that I’ve been able to grow and expand and make the program flourish to be able to take care of more people.

Suzette: That’s fantastic. So when you take a look at the healthcare model today, do you find that enough emphasis is being made in having a specialty pharmacist trained in HIV? And tell me a little bit about- from your perspective, how important it is to have someone like that if you’re in a specialty pharmacy, especially from a health system based perspective, I would imagine is even more critical. How important is it to have someone trained in taking care of the patient specifically for HIV?

Michelle Sherman: It’s absolutely critical. For me, I find where we’re going with healthcare and the changes and everything extremely exciting. But when you look at it as a whole, it’s extremely fractured. And the HIV patients, while many of them are being taken care of by HIV providers, they have so many [inaudible 00:05:45] that they [inaudible 00:05:48] to different providers, right across the spectrum. And there’s no continuity of care. And the focus and what’s keeping them healthy are their HIV meds and the pharmacist. The HIV pharmacist, in my opinion, is one of the most important healthcare providers on their team. Because it is the pharmacist that can coordinate this breakdown in the care and ensure that the patient is getting excellent pharmacist care, not only with HIV but all the other [inaudible 00:06:20] that go along with it.

And especially, translating that maybe into health system and into a hospital setting, I think it’s even more important. So getting pharmacists credentials and trained through programs like, The American Academy of HIV Medicine. Those expert pharmacists, play a vital role in the outcomes of HIV patients and through some of the work I’ve been doing through my program, the outcomes are extraordinary and in some instances, like lifesaving.

Suzette: So you started a program- and I am not going to try and pronounce it, I’m going to let you talk about it. Because I have to tell you, I am intrigued. I purposefully didn’t do any research prior to our call so that I could hear it from you because I’m sure that the acronym has- the name has some acronym meaning to it. So tell me a little bit about the program that you actually developed.

Michelle Sherman: So I had culminated like my 30 years of working in this space into my pharmacist care program. It’s called the Ubuntu pharmacist care program. So since I’m from South Africa, Ubuntu, is like an African word, it’s an African philosophy. And the essence of what Ubuntu really means, is what happens to me, happens to you, happens to all of us. So, it’s like a sunctual, philosophical connection and I wanted to name my program this because I’ve found that when I sit down with patients, and work with them and go through my program and try to make their lives better, it is the spirit of Ubuntu. Because what happens to them, directly affects me. So what happens to them, happens to me. And the work and the information that I provide them and the empowerment in their own care, affects not only them but their entire family. And they’re whole community at large. So the spirit of Ubuntu is translated to my pharmacist care program.

Suzette: I love that.

Michelle Sherman: Exactly. It transcends as more than just some pharmacist coming down and telling you how to take your medicine. It’s really- impacts the whole social thing. My philosophy for the patients is, like a healthy patient is a wealthy patient. And I’m not talking about dollars but their whole life changes by the work and the information I could provide to them. So that’s how I came up with the name.

Suzette: That’s just wonderful. I think of the circle of life because you’re giving back and you’re getting, sometimes more than what you give and I think that’s what makes most people passionate about healthcare. It’s that patient centric approach, you know, you look at researchers that work for years and years to develop cares for Hep C. Would you have ever thought in our lifetime we’d see a cure for Hep C? But we do that and it perpetuates giving and giving back because now these patients are able to contribute to society and give back and I think back to the days- I remember one of the patients that we took care of, back in the day of neural healthcare was the founder of the Publisher’s Clearing house. Charming gentleman, who had HIV and here is this man that has more money than God and there’s nothing that can be done to help him. Nothing. And now, 20 years later, innovation and passion and compassion. Passion to me has to be combined with compassion or it doesn’t work. We now have solutions and you have been part of that entire movement, gosh, so God bless you. I’m jus honored to have you on the show.

Michelle Sherman: Thank you. Thank you. It’s been a- extraordinary work. When I speak at conferences and everything, I always bring up the reason why. And I think, you know, all of us do the work that we do for a reason. And it’s all my patients [inaudible 00:10:50], which are hundreds and hundreds and hundreds of them. That have died. Plus all the ones that are like bravely living with HIV everyday. You know, could spurn me on for 30 years to do this work. And that makes a difference in not only the patient’s life that you touch but also [inaudible 00:11:11] other pharmacists and other healthcare providers, how to provide these services. You know, pay it forward, to taking care of more patients.

Suzette: So as our healthcare environment is getting more challenging, and the navigation, just to be able to help patients understand copays and how to get access to products and afford products and so forth. Where do you see the roles changing from a pharmacist professional especially when it comes to helping HIV patients?

Michelle Sherman: So, I think it’s critically important that HIV patients utilize pharmacies that are HIV specialty focused. Because hopefully they have providers in there that know how to navigate this. And navigating the benefit maze is enormous. I mean, patients are never going to do this on their own. There’s no way. And most of time, if they have to call the insurance or try to find out how to get approved, they just don’t fill the prescription. So having HIV specialty pharmacists and technicians that know how to do this- they know how to navigate the maze and do coordination of benefits and finding solutions for the patient, without the patient having to take the lead. And I think that’s really important.

My philosophy is there is always a way. And in 31 years of doing this work, I have never not been able to find a solution one way or another for the patient. So being able to be resourceful and knowing all the organizations that can provide assistance. All the copay programs and all those challenges that patients face. My goal is always to have the patients have the longest copay possible and 0 would be the optimal result. There’s always a way.

And I think geographically depending on where the patients are located, not all things are created equally. So there are more challenges depending on where the patients live as to how they’re going to get these services taken care of for them. The pharmacist is- I call it the bullseye. You can have the whole dartboard and everybody involved, but right in the middle is the pharmacist taking care of this whole piece.

Suzette: And you know, I’ve been an advocate for many years and will continue to be advocates that you know, if anyone has a lifelong illness of any kind. Clearly, it’s a big part of- their care is the right medication at the right time and physicians influence and decide but it’s the pharmacist that really manages the, the place. If you take a look at a football team, you’ve got a head coach and that’s the physician but then you’ve gotta have an offensive coordinator that’s making sure that everything’s being done properly and to me that’s the pharmacist. And it’s neat to see a lot of the collaborative practices come about across the U.S. and different states but I would just love to see that whole collaborative practice model be extended nationally from a national initiative, what do you think about that? Do you think that there’s chance that’ll eventually happen?

Michelle Sherman: Oh. I do. The American Pharmacist Association is working very aggressively with getting [inaudible 00:14:51] passed through Congress to make that happen. I mean, I’m very fortunate and I’m so grateful that I’m licensed and I practice in California because California’s been on the cutting edge of this. Pharmacists have been able to work within collaborative practice agreements for a number of years now. The law changed a few years ago to advance pharmacy practice and the state of California actually has an advanced practice license, designation now for pharmacists, over and above the regular pharmacist license. So, I’m fortunate that I’ve been able to work with clinics within these collaborative practice agreements. And I’m actually waiting, everyday, holding my breath to actually get my advanced practice license.

Suzette: That’s awesome.

Michelle Sherman: From California. And the data and the outcomes that I’ve had working within these agreements and implements in my program for patients is just extraordinary. I can’t believe some of the results. And ultimately, this work, making the difference within the clinic or within these, [inaudible 00:16:04] under these agreements, improves patient care, improves their outcome. And the ultimate goal is to get paid for these services, that are really quite extraordinary, really.

Suzette: I agree. I agree. So as health systems advance their role in specialty pharmacy, what are some of the things that you would recommend, let’s say for example, I’m a regional health system, starting a specialty pharmacy and have a population of patients with HIV. What are some of the steps you would recommend that they do in order to develop a strong program to support the patients needs?

Michelle Sherman: So I think you have to build a comprehensive program where you have pharmacists that are HIV credentialed and know the know in that arena. I think those pharmacists then have to work alongside the providers, like in the clinic setting, as well to be able to have access to the entire patient record or patient chart to evaluate everything. And I think more importantly, within that specialty pharmacy, it mustn’t just be the furnishing of the HIV regimen. I think in order to provide complete patient care, you have to provide all the drugs that the patient requires for their health.

So, one focusing on the HIV as a specialty, you have to look at all the other [inaudible 00:17:37]. What about mental health and depression? What about- renal disease, cardiovascular disease? You have to look at the patient like holistically and in a 360 degree picture to take care of everything, so that you’re not just [inaudible 00:17:56] the specialty drugs and then sending the patient off to another pharmacy to take care of the rest.

I think in order to manage the patient, you have to manage everything for that patient. From putting things in place to provide their care, also making sure that the stock is- and the pharmacist are fully trained and educated. Not only about HIV and the disease thing but HIV sensitivity issues. I mean I run across problems that patients have encountered like every week of being treated badly or discriminated against in some way or another, not only by a pharmacy but also maybe by medical providers offices. So even though we’re in 2018, a lot of those stigmas and those old kind of images still exist in many providers mind. And patients get stigmatized.

Teaching the pharmacy and the healthcare systems, all about these HIV sensitivity issues is critical to have a complete comprehensive program where the patients come to the clinic, to the pharmacy and then [inaudible 00:19:11] their pharmacist to provide excellent care for them.

Suzette: Agreed. Agreed. So tell me a little bit about the book that you wrote. I actually- I’m looking forward to reading it. Again, I always like to wait to read or do much research so that it gives me an opportunity to let you talk versus me.

Michelle Sherman: So I called my book, Saving Lives: The Role of the Pharmacist in HIV because that’s truly what I believe it is. As an HIV pharmacist, we have an opportunity with every patient interaction to- in hospitals with our patients and also, in many instances is to save their lives.

So the book goes through multiple chapters about taking care of HIV patients. What pharmacists need to know. It’s kind of an abridged version of my online training certification that I had for pharmacists but it goes through all the steps, if somebody picked up the book and read, and fumble through how to take care of HIV patients in their pharmacy. Whether it’s just a community pharmacy or a specialty pharmacy. It gives them a good idea of what to do on HIV sensitivity issues, [inaudible 00:20:28] the insurance maze. That’s like- as we talked before, that’s like an enormous piece. Getting drugs covered for patients during the coordination of benefits, all those types of things. So the book really, [inaudible 00:20:43] really talks about why I did the book and why I wrote the book and then each chapter goes through step by step on how to take care of patients.

Suzette: I love it. I love it. I love it. So, Michelle, if any of our listeners would like to learn a little bit more about how they can work with you to develop a program, to better take care of their HIV patients, what’s the best way that they can get a hold of you?

Michelle Sherman: So you can contact me through my website, it’s Mish Rx consulting.com

They could email me just at mishrxconsulting.com or- and we also have our phone number on the website. It’s an 800 number. 8-8-8 6-6-1 4-4-0-3. They can give me call, shoot me an email and we’ll contact them and try to see what they need. Just like I believe every HIV patient needs to have their therapy customized to them, every one of our pharmacy clients also need their services customized to their needs and what their patient population needs.

Suzette: Absolutely.

Michelle Sherman: So it’s a very customized approach.

Suzette: Absolutely, absolutely. So last question for you, crystal ball, if there were three things you could change about healthcare today in the U.S., what would it be and why?

Michelle Sherman: Okay. The first thing is that pharmacists need to be recognized as healthcare providers nationally. It needs to be a national program. Secondly, pharmacists need to be paid for the services that they’ve been providing for so many years and I have irrefutable proof how it changes a patient life. And the third thing is that I think, I mean I’m a big proponent of healthcare for everybody. I think healthcare is a right. I think that if people have access to affordable healthcare, it makes our entire society a healthy society. I think when we have healthy citizens that are able to contribute to society. They’re able to work and make our society stronger so instead of having these sky rocketing costs for healthcare that we have right now, I think somehow, we have to come together as a country to readjust everything, reformulate everything and make it such a way that people have access or affordable healthcare. Affordable prescription drug coverage. So that people can remain healthy.

Suzette: Agreed agreed. You know I was listening to one of the Senate hearings on a train trip from D.C. to New York. It was one of the first times I actually sat and listened to one, because usually they put you to sleep. But it was fascinating Michelle, because one of the senators said something that thought was actually very thought provoking. Is that when you take a look at our health system today, med D, any of the pharmacy plans and programs that are out there. Our entire health system was built before the genetic code was cracked. And once the genetic code was cracked, we were able to have drugs like harmonium and life saving drugs that either eliminated disease or allow it- someone from MS that went from a death sentence or HIV especially you know where there wasn’t a very good prognosis to now having a life sustaining medicine that they can utilize and have a quality of life, we’ve gotta have something.

And what I’m a proponent for, I think that the government at the very least- to have a sustainable economy and workforce as you talked about. Provide catastrophic care. So that if you get- or someone in your family gets diagnosed with a life threatening disease, cancer or any type of debilitative disease such as HIV, that that’s covered. They’re not gonna have to worry about losing their house or their family or their job because they can’t afford the medicines that are critical to keep them alive and healthy and productive.

Michelle Sherman: Exactly.

It shouldn’t be a financial drain or worry or threat to any family across this country that if somebody gets sick, they’re gonna die or they’re gonna lose everything. Absolutely. There should be those elements in place that we take care of our citizens.

Suzette: Our people. Agreed. Agreed. You take a look at these copay cumulators that have come out that I’m just aggravated at seeing this year. How is it better for a patient to have medicine for three months and then have this copay cumulator issue happen and then go back in the hospital and have readmission issues because they now have relapsed because they can’t take their medicine because they can’t afford it. So how does that help the system?

Michelle Sherman: I mean, it’s absolutely ridiculous. And really see it starting to happen with HIV patients because with HIV patients, we’ve got so many resources, the manufacture of copay cost, many [inaudible 00:26:10] programs pay those copays and those deductibles and things like that. What difference does it make if a check is coming out of a patient’s bank account or from any of these other resources that can assist him? Because you’re right. They can’t afford the drugs. So the health system is actually making them sicker by instituting these things, then keeping them healthy by them able to take their medicine continuously.

Suzette: It’s gotta change. It’s gotta change. And you know, the drug pricing is- in my humble opinion, and again I don’t like to say my humble opinion, they’re looking at the wrong thing. They’re all worried about how do we lower the costs. How do you increase accessibility, affordable accessibility? Not how you lower the price, lowering the price doesn’t make it accessible or affordable.

Michelle Sherman: Exactly. Exactly. The whole system needs to be revamped and I think everyone of us has a role and an advocacy role in trying to make that happen.

Suzette: Agreed. Agreed. Well Michelle, I am just again honored and thrilled that- you know we’ve been trying to get you on the show for about a year now. Our calendar’s actually aligned and I will love to have you on any time that there’s something new or anything that you’d like to share with the listeners. Our whole goal with our podcast is to educate and inform and this has certainly been very enlightening for me and I’m sure the listeners will all agree. And again, thank you for your passion, your compassion and your dedication to making difference because it’s people like you in the healthcare environment that actually stand up and give a damn. And that’s important because too many people want to just got along with status quo and not challenge things and I find everything that you’ve done just very inspirational.

Michelle Sherman: Thank you so much. Well, it’s been a pleasure being on your show. Thank you so much for having me.

Suzette: Awesome. Well, thank you again.

Suzette: Have you heard the news? The 2018 state of pharmacy report is now available to download for free at CSIgroup.net/survey. For the report, we surveyed specialty pharmacy professionals of all levels, across all the main channels, to uncover trends, opinions, and future predictions about the specialty pharmacy industry. Please feel free to download the report today and find out what manufactures, health systems, and independent specialty pharmacy professionals across the nation say the biggest opportunities as well as the biggest challenges are as we all work toward improving the patient journey.

Get your free download today at CSIgroup.net/survey.

Speaker 1: Thanks for listening to the specialty pharmacy podcast. If there’s anything that we mentioned in today’s show you missed, we take the show notes for you at CSIgroup.net/podcast. If you’re not already subscriber, please consider pressing the subscribe button on our podcast so you never miss one of our future episodes. And if you haven’t given us a rating or a review on iTunes yet, please find a spare minute and help us reach and educate even more of our specialty pharmacy peers. The specialty pharmacy podcast is a production of CSI specialty group, your go to firm for all things specialty pharmacy. Thanks again for listening and we’ll catch you next time. Doctors orders.

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About The Specialty Pharmacy Podcast

Join host Suzette DiMascio, CHE, CMCE, CPC, President and CEO of CSI Specialty Group, as she answers questions, addresses concerns and discusses the news you need to stay on top of the ever evolving world of specialty pharmacy. Tune in every episode to hear real world examples of the good, the bad and the outrageous from the experts at CSI Specialty Group, and to learn about the limitless growth opportunities available in the specialty pharmacy industry.

2018-11-16T19:10:19+00:00