In this episode, join CSI Specialty Group President and CEO Suzette DiMascio, CHE, CMCE, CPC, as she shares her holiday healthcare wish list, and the 4 key areas the industry needs to address moving forward to satisfy the needs of all stakeholders, citizens, and at-risk patients.
Listen in as Suzette shares why, with no safety net for disadvantaged families grappling with catastrophic illnesses, now is the time to develop a sustainable national plan to protect our nation’s most vulnerable patients.
Tune in to Discover:
- Suzette’s personal holiday healthcare wish list to improve the patient journey
- The latest challenges PBMs are creating in the healthcare world
- How access to rare and orphan drugs can be improved
- A vision for a national catastrophic care program for America
- Creative solutions to challenge the status quo in healthcare
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.
About CSI University
CSI University is the industry’s leading online training platform specific to specialty pharmacy sales professionals.
After years of conducting successful on-site training, CSI University’s online sales training course offers groundbreaking, cutting-edge and on-demand training to new and existing sales representatives of specialty pharmacies. The program is built from the ground-up to ensure individuals and entire sales teams are ready and able to take their game to the next level and optimize sales to expand their company’s foundation in the ever-changing marketplace.
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 DiMascio.
Suzette: Hi, this is Suzette DiMascio with the CSI Specialty Group Specialty Pharmacy podcast. And today I am going to burden you with about 10 minutes of my wishlist for Santa. And I thought I’d take a little spin on our normal informative and enlightening podcast to basically give you what I’m asking Santa for Christmas this year as it relates to the world of healthcare.
The first thing on my list for Santa is could we please get the PBMs to really take a look at the challenges that they’re creating in this healthcare world. And by that, I mean this year we’ve seen the resurgence or the growth of copay accumulators. Now where’s the logic in taking the chance that an MS patient relapses when they can’t afford to pay their deductible for a product they’ve been on for the past couple years, that has eliminated their need for additional therapies because their MS is stable? Where is the logic in that?
Where is also the logic in a Medicaid plan like Ohio, paying more monies in fees than they pay in preventative care or for physicals for adults in their plans? Where is the logic in there? I also would ask you where is the logic in situations like the Kaleo incident where their product was priced at $565 to $575. Don’t remember the exact number there, but priced at a point where first responders, anyone could pretty much afford this product. But alas, there wasn’t enough money in rebates or in fees for the PBMs to allow it to be covered.
Then, oh my, gosh, some PBMs had a first fail policy on the product, and I’m sorry, but if you haven’t had a chance to see the CBS 60 Minutes that aired on the Sunday before Thanksgiving about Kaleo and their product and how they took that price up from the 565 to a ridiculous amount that I can’t even say here without getting aggravated about in order for the PBMs to cover it because they’d make more money. This product actually, in some PBMs, have a first fail indication before it actually gets approved, and I don’t know about you all, but I think most of us are smart enough to understand that if someone is in an overdose situation, they don’t have a chance at first fail. If they don’t get the product, it’s death, most likely. That certainly needs to stop. Get a little bit passionate and tongue-tied here.
The second thing on my wish list for Christmas is that all of the challenges that we’re seeing with access to rare and orphan drugs gets a little bit better. By that, I mean there is a whole process of which these products are going through the pipeline and getting approved, but I think there are some sticking points that I’ve seen happen recently that I would like to see fixed a little bit better.
I have to applaud [inaudible] and everybody there for doing a wonderful job at getting things through a little bit more effectively. But there are some really critical products that are out there that need to get into the market fairly quickly. Fortunately for us, with some of the changes that President Trump has made, I think the compassionate care opportunity will still not be an issue moving forward in most cases.
The other thing that I would like Santa to bring for us is some level of catastrophic care for America. And many of those who know me have heard me talk a little bit about my vision for healthcare for the US, but I hear stories from our health system clients, from our pharma clients, from friends and family of what happens to people when they don’t have insurance and they are diagnosed with a catastrophic illness? Cancer invades their body. It devastates families. It devastates lives. It devastates organizations. It touches everyone.
I’m a big proponent for a national catastrophic care program where, as a right as an American, we should not have to lose our homes and our livelihoods in order to take care of ourselves if we’re diagnosed with a catastrophic disease or one of our loved ones unfortunately are diagnosed in that fashion. And then I think it’s up to the employers at that point to provide additional policies potentially for better drug reimbursement, for maintenance products and so forth, for better access to physician care, maybe lower copays.
But that as a whole, we as Americans, no longer have to worry about what devastating things could happen if someone we know or ourselves are diagnosed with a disease that quite honestly not only affects you from a mental perspective, a health perspective, but your entire family could be homeless. And I don’t mean to be so dramatic, but it’s time we wake up and realize that this is a big issue in America.
I’ve seen seniors that literally have died within three months of a diagnosis when they probably could have gotten the right treatment and the right protocols done and have lived. I’ve seen children struggle, their parents struggle with taking care of a sick child and not losing their job, and then losing their job because they had to take too much time off to take care of that sick child. We’ve got to be compassionate.
We can’t fix the fact that we don’t know the true stories behind rebates and PBMs and the BS that goes on behind closed doors with the top insurers and everyone else in the marketplace, but what we can look at fixing is something simplistic as a catastrophic program across the US. Charge us one more percent in our taxes. Lord knows that many of us are being taxed to death in city and state taxes. I am forever grateful that I live in Florida and don’t have to experience that, but charge us 1% more. Do something for the common good.
I have hope that with some of the changes that we’ve seen in our House of Representatives and in Congress that there are smarter heads coming in, newer faces, newer ideas, and a lot of healthcare professionals. Here’s hoping that maybe they can shake things up a little bit and challenge the status quo. I think that we have a president that, in my humble opinion … this is not a political opinion, just my humble opinion … really has compassion for those that are in need. Hence, the reason some of the great changes that we’ve seen happening with the time to market for a lot of these therapies.
I think that it’s the right time to approach something like this. Love your opinions, love to see what your thoughts are, but my last wish on my Santa list for 2018 is that 2019 brings every one of you listening to our show great health, great success, and all your dreams come true for 2019. 2019 is going to be a wonderful year for my family, as my son graduates from West Point on May 25th, and will be going into aviation and become a helicopter pilot, so we’re pretty excited to see the next stage of our son’s life evolving, and with that, I will probably be working more hours because I’ll have less time to worry about where he’s at, now that I know he is going to be an aviator.
With that, I bid everyone ado, and have a wonderful, wonderful holiday season with your family. We will be playing a couple of best of podcasts through the rest of the year, and then start off the year with some predictions for 2019. Thanks for being loyal listeners. If you have any suggestions on podcast topics that you might like to hear, if you’d like to be a guest yourself, please don’t hesitate to contact me. The office number is 407-688-6727 and my email is email@example.com. Thank you.
Have you heard the news? The 2018 State of Specialty Pharmacy Report is now available to download for free at csigroup.net/survey. For the report, we surveyed specialty pharmacy professionals of all level 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 manufacturers, 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.
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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.