“When you have a good leadership team, a clear vision, stay true to your course, and you do your job, great things can happen.”
Join host and CSI Specialty Group President and CEO Suzette DiMascio, CHE, CMCE, CPC, live from Atlanta following the New England Patriots sixth Super Bowl championship.
Suzette praises the unsung heroes in specialty pharmacy who, in the words of Coach Belichick, “do their jobs day in and day out,” so patients can afford their life-sustaining medication. She also breaks down the latest HHS proposals to end “backdoor deals” in the drug industry, bring real transparency to drug markets and deliver savings directly to patients.
Tune in to Discover:
- The importance of unsung heroes in specialty pharmacy
- The latest on the proposed HHS ruling regarding PBM rebates for Med D recipients
- How DIR fees continue to impact independent specialty pharmacies
- Grassroots initiatives undertaken by the NASP to raise awareness and help patients have access to choice
- Why Select Health could be the PBM/Health System model of the future
About CSI Specialty Group
CSI Specialty Group is a globally recognized leadership consulting firm dedicated to providing solutions that continually elevate the specialty pharmacy industry and improve the patient journey. By providing inventive consulting, workforce planning and talent acquisition solutions, we uniquely tailor our service offerings to help clients drive sustainable, accelerated growth.
As the producer of the industry’s first dedicated podcast for specialty pharmacy and the publisher of the Annual State of Specialty Pharmacy Report, 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.
For more information about CSI Specialty Group, visit www.CSIgroup.net.
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 D.: Hi, this is Suzette DiMascio with the CSI Specialty Group Podcast. And today I am doing this podcast from Atlanta. I was fortunate enough to go see my beloved Patriots last night when there six super bowl ring and I have to say that other than a first boring half of the game, it was quite an experience to be able to see my favorite team win their six super bowl win and just incredible. As you can imagine as a sports fan, when your team gets a chance to go to the Super Bowl, it’s quite an honor. And then being able to watch them win just was a great moment that I think I’ll never forget. And I was trying to think today as I’m doing the podcast, how can I relate the patriots to healthcare and in general anything related to healthcare except the fact that you always find a way to win and take care of patients the best way that you can.
And I take a look, I guess at the critics and for some reason this world has gotten into an arena of mediocrity. And by that I mean when I was growing up, and I’m sure many of our listeners would feel the same way, it used to be that you looked at people that were successful and said, “Wow, how do I be like that? How do I be more like that individual? What did it take for them to achieve the level of success that they had?” I know that through my life, there have been individuals that I’ve looked up to and wanted to emulate as well as have as mentors that helped me along my journey to start my career, continuing my career, and ultimately lead my company. And today it just seems like we want to look for something wrong. I take a look at Adam Levine from Maroon 5.
Now here’s an individual that did the Halftime Show. People found fault in the fact that he didn’t want to support someone not kneeling like Colin Kaepernick, which I could go on my little dog and pony about that, but I won’t except to say if you are an American, you need to stand and salute your flag. Because my son and many sons and daughters of many people around this great land are fighting for your safety and it’s critical that we support them. But I won’t go down that road even though I just did, so they criticized him before he got on stage. They criticized him once he was on stage. And you know what this man did? Every penny that Maroon 5 received for participating in the Super Bowl Halftime was given to a children’s charity. 100%. Now I ask you how many people that were pointing the finger at Adam Levine and Maroon 5 would give their entire paycheck of well over a half a million dollars to a charity?
My guess is very few. And so I was always taught when you’re pointing at another, look back and see where the other threes are pointing and they’re coming back at you. We just have to change. I mean we have to be more forgiving, more respectful of people’s differences, more respectful of the uniqueness. There’s so many things that are happening in this world from a healthcare perspective that we can’t change. At least we can always hope for the best for someone. And it’s interesting to me. I applaud HHS this week for proposing the change to Med D making it essentially illegal to have any type of rebates given back to the entity, that is the plan sponsor. I think that that’s a great idea.
I think that will increase the level of transparency, it will also increase or decrease, I should say, the out–of–pocket expense to Med D recipients, which many of which suffer greatly during that doughnut hole period. And for those of you that aren’t familiar with what I mean by doughnut hole, there’s a period in a Med Ds recipients drugs spend where they have to spend an additional $2,500 out of pocket before the rest of their drug coverage is covered 100%. And I have to tell you many times I look at this as instead of the donut hole, I look at it as a death whole because a lot of these seniors cannot afford these products. They will make sure that their animal gets their food before they will take care of their medicine. And it’s just a tragedy. So if there’s anything that we can do to help the plight of senior citizens being able to afford sometimes these life sustaining medicines, especially in the specialty products, I applaud at 150% because they do need our help.
I also think that we have to take a look at what the ripple effect will be. If this does in fact pass, it’ll be a fantastic thing, excuse me, and if my voice is hoarse is because of course I was cheering so loud for my Patriots last night, so what will end up happening is it will be a substantial benefit for the Med D recipients, but there’ll be a ripple effect down to the commercial products as well. When an employer negotiates or a plan sponsor negotiates on behalf of their entire organization, there is commercial as well as Med D patients that they are negotiating for. So the whole contract cost comes together under one umbrella. So common sense would tell you that if you’re lowering the rebates and the cost on one that you’ll have increasing costs on the other unless it’s a brand new contract that’s getting negotiated.
So all of this is yet to be seen If this is passed, I would imagine that they’re saying that the net price after a rebate ranges anywhere between 26 to 30%. So I doubt that that entire 26 and 30% will ripple back to the Med D recipient, however, it is yet to be seen. So I applaud HHS and Alex Azar in the attempts to try to lower and mitigate costs for Med D recipients. I also think that we need to think a little bit about what’s also happening to specialty pharmacies from a DIR perspective, because they are getting held accountable for a lot of these DIR fees that necessarily shouldn’t ripple back to them. When we take a look at choice as well, if we’re going to affect the rebates, we also need to address choice. And by that I mean Med D is supposed to be a technically an any willing provider product, which means that anyone should be able to provide coverage or dispense a product for Med D patient if they’re in that network.
The challenge is, is that a lot of the big three PBMs have been locking everyone out of network so that Med D recipients have not had the ability to get their drugs suspensed by their pharmacy of choice. And if they do get a dispense by the pharmacy of choice, then the pharmacy puts itself at risk for DIR fees that can come back and hit them very hard and often put them underwater to dispense that particular product. So there is a little bit of work to be done there. Actually, there’s a lot of work to be done there. I applaud NASP for all their grassroots and their legal team that they’re working with and the lobbyist to bring awareness, super proud of all the work that [inaudible] is doing at NASP and all of the governmental teams there because we need to bring awareness to this.
Competition is healthy, but it has to be fair competition. And right now the way that the program has been working with Med D for specialty pharmacy, it hasn’t been fair and it has not been competitive at all. So hopefully that’ll change a little bit. The other thing that I think is important to take a look at is with the PBM world changing a little bit, there’s a lot more opportunity for choice. It used to be that you had three to 10 PBMs to pick from. Now you’ve got a whole bevy of them coming out as well as some really interesting PBA models that do supposedly offer some more transparency. On the health system side, I’ve been very, very impressed with Intermountain SelectHealth. I may be a little bit biased because I’ve had an opportunity to meet with Pat Richards and her team at SelectHealth and I’ve heard her speak at several conferences, but this particular PBM is owned by a health system and has a very good offering for health systems as they’re looking to change and go away from the big three.
So it’ll be interesting to see in the next three to five years how SelectHealth grows as well as if there’s any other models that will come out from the world of health systems. If I take a look at today in the marketplace, the two that really come to mind are SelectHealth and then UPMC. Now UPMC has their own health plan, however they use their PBMs through one of the big threes. So they actually do not have their own PBM offering or SelectHealth is also a health plan. It also has its own PBM. So if you are looking at making any changes and needs some information, just give me a call, happy to put you in contact with the right person at many of the PBMs out in the marketplace. But in particular the health system based worn by SelectHealth.
I think that we’re also going to see some interesting things happen in the next couple of months as it relates to the orphan products and how those are handled from a reimbursement perspective, we have seen a lot of the drugs come out of the marketplace or excuse me, come out of the FDA a little bit quicker. But it’s been interesting to see some of the snafus that some of them have had when it comes to being reimbursed, even if they’re in a unique category and there is no other incumbent in that particular category, I.e. hence the reason for calling it orphan and rare, there’s been some challenges along the way. I really I’m looking forward to some of the pipeline biosimilars and generics specialty products that are coming out to see how the PBMs handle this. If it’s an AB–rated generic specialty product, one would assume the lower cost the PBMs would put them directly on formulary.
But what I’m seeing recently is that’s not the case. And a lot of it has to do with some of the rebate games that are being played. Again, it’s not what’s best for the patient. It is what’s best for a for profit organization. So we need to have a little bit more change come about to make this better for patients. But then again, every time we take a step forward, sometimes we take a step back, but I have to say I’m very, very excited by HHSs proposed changes to the rebates for Med D products. And I think it’s the first step in a long a way of opening eyes to what’s happening to the plight of patients on these very, very expensive products. So that’s great. The other thing that I would say to each and every one of you that own a specialty pharmacy today or running a specialty pharmacy today is thank the unsung heroes in your office.
Thank the individuals that work with patients day in and day out to help find patient assistance programs for them, to help them get a foundational support to just do anything that they can to help them get access to the drugs that very often they can’t afford. These are really the unsung heroes in our industry that countlessly spend hours trying to figure out ways to get access to these products for these patients. So today I applaud you and everything that you do to help your patients be better and stay healthy. We thank you for your dedication to this industry and know that your job is not easy, but the fact that you care and go that extra mile makes a lot of difference to a lot of people. And as a die–hard Patriot fan, the one saying that always stays in mind with me with bell check is do your job and that’s what you do every day. So we thank you.
You are the true Super Bowl heroes for all of our patients and don’t let anyone say anything different to you because as a Patriot fan, I have heard everything from, I won’t even go into detail on this podcast, but all I can tell you is this, when you have a good leadership team and you have a vision and you stay true to your course and you do your job, great things can happen. So this is Suzette aka die hard Patriot fan, excited about her number six win, signing off for this week and remember, make a difference in someone’s life. Only you can do it. And we appreciate everything that you do each and every day to keep patients healthy. Have a great week. Go Pats, congrats on beating the Rams. Whew.
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.