In this episode, Suzette DiMascio, President and CEO of CSI Specialty Group, discusses the latest breaking developments across the specialty pharmacy spectrum. She also breaks down what to look forward to at the industry’s biggest conference, Asembia’s Annual Specialty Pharmacy Summit in Las Vegas, including her role as moderator of the first-ever Women’s Leadership Forum at the event.
Tune in to Discover:
- The latest industry trends reported by IQVIA
- Recent West Virginia legislation making waves in the copay accumulator space
- An update on PBM lockouts from Capitol Hill
- Why Civica RX could be a game-changer for patient access and care
- How the Asembia Women’s Leadership Forum will explore how can women come together to be stronger for themselves, the industry, and patients
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: Hi, this is Suzette DiMascio with the Specialty Pharmacy Podcast, and I am just sitting here getting ready to go to the Asembia conference next week and wanted to just give you a few thoughts on things that I am looking forward to seeing and hearing about at the conference as well as a couple of things happening in the industry. We all know that IQVIA is an incredible organization that puts out some pretty terrific work on trends that are happening in the pharmacy arena. I look forward to the reports and get a lot of insight from them and they put out a report actually just earlier this week, talking about the enormous amount of molecules that are entering the late stage of their pipeline development. It’s pretty exciting time to be in the rare and orphan disease space with all of these drugs that are coming out that are a lot of the breakthrough on first time line of therapies for rare diseases.
Suzette: It’s just an honorable time to be in this industry to see the difference it can make for patients that have really had little to no hope for their disease state based on how long it’s taken us to break the genetic code through the years. But now that we have, watch out world, it’s going to continue to be a very exciting time how to help these patients. Now of course with increased opportunity for help, there’s also increased opportunity for access lock out. And you know when you take a look at the economics of bringing a drug to market, it is astronomical and when you take a look at what it takes them to distribute that product, to make sure it’s in the right hands that the right patient gets it and then gets … the Pharma company gets reimbursed for it from the health plan. It is a pretty spectacular process that takes place.
Suzette: We’ve seen a couple of laws come into place recently in Virginia, in West Virginia that are now no longer allowing copay accumulators to be utilized by health plans. For those of you who are not familiar with copay accumulators, they’re basically a tool that is used by health plans to, I would say, limit the effect of a manufacturer’s contribution to help a patient get access to drug when actually what typically happens, let’s say for example, best case, take a look at a MS patient that might be on Tecfidera. They typically will get copay assistance from a manufacturer, and typically that copay the first month would probably cover their deductible, knowing how expensive Tecfidera is. So under the copay accumulator process, if that copay accumulator is utilized, that same monies that spent … does not go towards the patient’s copay or their deductible, it actually only go … only what they pay goes towards the deductible.
Suzette: So for example, if the patient paid $100 and the Pharma company paid $5,000, instead of their $5,000 deductible being met, only $100 would be met. So what happens typically in a lot of cases is that a lot of patients who cannot afford these drugs, you know, will stop taking them. And so the ripple effect, we haven’t quite seen yet. It’s only been a year that these have been really in place. But I would venture to say that there’s going to be a huge ripple effect that’ll happen if we don’t do something more to combat the copay accumulators. Now, I understand there is also a new CMS ruling that’s come out that will allow copay accumulators if there is a generic equivalent that isn’t used. So for example, if there was a generic for Tecfidera and there probably will be a biosimilar in the near future and the patient uses the generic, the copay accumulator would not be in effect.
Suzette: But if they use the brand, it would be, as the perception, and which typically is true that the brand is higher than the generic. So there’s a lot of different posturing at play here. But bottom line, we all have to find a way to help patients be able to afford their medicines. And I think when you take a look at a lot of the things that are happening from a government perspective, there is a lot of finger pointing. Few weeks ago we saw all the top PBM executives come to Walls … Excuse me, come to Wall Street, listen to me, come to DC. It’s a different type of Wall Street, isn’t it? That was a Freudian slip, come to DC to talk a little bit about their marketplace and there … a lot of the accusations against them for what they’re trying to do to lock out independent pharmacies, how they’re not allowing access.
Suzette: There was an article just recently in the Wall Street Journal last week talking about how a pharmacy up north in … I believe it was the New Hampshire area, literally in a month’s time lost about a hundred thousand dollars of business because of some lockouts that they had that the managed care plan happened to have. Now there’s two sides to every story. That particular drug store, whichever one it was, may have done a reason they get locked out. It may not have just been a random lockout. It could have been a quality issue, could have been a cost containment issue, could be a lot of things, but I would venture to say the truth as usual always lies in the middle, and we as a nation have to get together and stop pointing fingers and just come up with solutions. I’m very excited when I see programs like the Civica Rx program open up where we’re trying to help lower the cost of drugs to help patients.
Suzette: It’s very interesting for me to see some of these things that are happening behind the scenes at a lot of the health systems that are coming up with different foundational programs and grants that they can help patients get access to products. It isn’t just a one size fits all. You know, we have to spend time identifying where the major issues and roadblocks are for these patients and try and help them. And so you see a lot of specialty pharmacies across the country really do a lot of great things to work with their patients, especially in the rare and orphan space to be able to get access to the medication, to be compliant with their medication, and to monitor them to make sure that it’s effective for them. And that’s really important. This week at Asembia there’s a lot of great conferences or a lot of great sessions.
Suzette: I’m honored to be the spokesperson or the moderator for the first women’s leadership forum at Asembia. I’ll be joined by a couple of fantastic women that have some great careers themselves to talk about in the marketplace. As we take a look at how can women come together and be stronger in order to be successful for not only themselves, but for their family, for the industry and for patients. And it’s not just about doing the right things right anymore. That always has to be done. It’s thinking smarter and coming up with solutions that will help patients on a longer perspective. Because I just, I get very frustrated when I see these great programs come up to help patients with their copay programs. And then the next thing you know, there’s another right turn that ends up happening and they’re locked out of a network and they can’t get access to their drug or a copay accumulator comes, or something else happens, there’s a shortage.
Suzette: You know, this is not right. I mean, this is people’s lives that we’re playing with here and I as an advocate strongly … I’m opposed to these games that are being played. And point is is that everyone’s doing it, it’s not just the PBM, it’s not just the manufacturer, it’s everyone has got a little bit of culpable negligence in this, in the marketplace. But getting back to that conference, the Asembia meeting, the altogether women’s leadership forum, Suzanne Soliman, who is the founder of Pharmacist Mom, and Keena Patel, who is a senior leader with Accenture, will be talking a little bit about their journeys as a female in leadership. And of course I will be there to have a little bit of fun with everybody and also talk a little bit about what makes us tick and why we care so much about forwarding the cause for women leadership in the marketplace.
Suzette: You know, the Asembia Conferences I always like to say is the prom of the Specialty Pharmacy industry. It never seems to disappoint. I spend most of my time in meetings and catching up with colleagues and clients that we sometimes miss seeing at different meetings because everybody seems to be there, and it just is a fun light environment where everybody just wants to get together, see what the newest trends are, see what the newest ideas are coming out and you know, just kind of celebrate the industry and no one does it better than Asembia and the Irenes at the wind and of course shout out to Chris Benz who is an unsung hero behind the scenes. Chris, we love you. You do an awesome job getting everything together and looking forward to seeing you at the Asembia conference.
Suzette: If you are going to be at the conference, you know, please feel free to come by and see my team. We’ve got a booth there as always. I’ll be there too, probably locked away in my suite and meetings, but please feel free to reach out to me. You can either email me or send me a LinkedIn message and we’d love to at least say hi to you. Our listeners are very, very important to us on the show and we really look forward to your feedback and anything that you think we can do to help the show be even better.
Suzette: That’s it for now over and out, Suzette DiMascio, with the Specialty Pharmacy Podcast. Thanks.
Suzette: Have you contributed your opinion and insight to the 2019 State of Specialty Pharmacy report yet? If not, we need you. You’ve got until April 12th to complete the anonymous survey that will help us create the industry’s leading rapport. To get started, set aside about 10 minutes and head to csigroup.net\2019 survey. Please be sure to do this as soon as possible as we really want to hear from each and every one of our listeners in order to get your opinion on the State of Specialty Pharmacy in 2019
Speaker 1: Thanks for listening to this Specialty Pharmacy podcast. If there’s anything we mentioned in today’s show you missed, don’t worry, we take the show notes for you at csigroup.net/podcast. If you’re not already a subscriber, please consider pressing the subscribe button on our podcast player 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 goto firm for all things specialty. Thanks again for listening and we’ll catch you next on doctor’s 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.