CSI Specialty Pharmacy Podcast

In this episode, Richard Williams, R.Ph., Senior Vice President of Pharmaceutical Innovation and Insights at CSI Specialty Group, joins host Andrew Maddigan, Vice President, Client Engagement, to share new insights on a busy fall conference season, including:

  • Health Management Academy
  • CBI’s Trade and Channel Strategies
  • The ASHP Midyear Clinical Meeting
  • AMCP Nexus 2019
  • PCMA

Richard also breaks down the strategic priorities facing hospital pharmacies, Washington’s inertia on pharmacy policy, and the future of technology and healthcare.

Tune in to Discover:

  • Lessons learned at the nation’s most impactful and high-profile meetings and conferences
  • Where pharmacy is headed in 2020 and beyond
  • Legislative activities around pharmacy policy
  • The impact of pharmacogenomics and personal technology on healthcare

About Richard Williams, R.Ph.

Richard Williams is a second-generation pharmacist who has spent three decades in the pharmaceutical industry. Throughout his pharma career, he has sold, promoted and contracted for more than 40 products, including more than a dozen blockbuster drugs and many specialty molecules. His background includes experience in neuroscience, endocrine, including diabetes, oncology, and cardiovascular diseases.

In his role as Senior Vice President of Pharmaceutical Innovation and Insights, Richard provides executive leadership and strategic direction to CSI and their partners with an emphasis on business development and growth. 

Prior to joining CSI, Richard practiced retail and hospital pharmacy before joining Eli Lilly & Company. During his time at Lilly, he worked with physicians, integrated delivery systems, academic medical centers, long-term care providers, specialty pharmacies, regional and national health plans, and PBMs.

Richard earned his bachelor’s degree in pharmacy from the University of Mississippi in Oxford, MS. He has served on several boards, including Christian Leadership Concepts and Hope Smiles. He regularly volunteers with The Bridge, a Nashville based non-profit that helps the homeless, where he is currently working on intersecting street medicine with population health.

About Andrew Maddigan

During the past 30 years, Andrew Maddigan has directed business strategy and marketing functions in a variety of venues, including health care, education, aerospace, and energy. His previous roles have included VP of marketing for the nation’s largest not-for-profit hospice agency, VP of sales and marketing for a national specialty and long-term care pharmacy, and communications director at a large urban school district.

Andrew also led marketing and strategic communications efforts for an international health care accreditation agency, serving as the organization’s liaison to the United Nations Development Program. Andrew earned his BS in Broadcast Journalism from the S.I. Newhouse School of Public Communications at Syracuse University. He earned an MS in Educational Administration from Canisius College and an MBA from St. Bonaventure University. Andrew currently serves as VP of client engagement at CSI Specialty Group.

Transcript Notes:

Speaker 1: Welcome to the Specialty Pharmacy Podcast, your prescription for specialty pharmacy success.

Andy Madigan: Hello and welcome to the CSI Specialty Pharmacy Podcast. I’m Andy Madigan, CSI’s vice president of client engagement and your host for this episode. Today, we have the pleasure of visiting once again with Richard Williams. Richard at the CSI is senior vice president of pharmaceutical innovation and insights. Richard is a second generation pharmacist who spent the last three decades in the pharmaceutical industry. Welcome back, Richard.

Richard W.: Thank you, Andy. I’m glad to be here.

Andy Madigan: So fall is a very busy time of year for industry meetings and conferences, and as 2019 comes to a close, I know you’ve been on the road quite a bit and attending several of these events during the last few months. Can you tell us a little bit about where you’ve been and what some of the lessons you’ve learned from the road had been?

Richard W.: Yeah, Andy, it has been a very busy fall. I have been to Philadelphia and Washington, DC; Las Vegas. This is a busy time because it’s an opportunity to put closure on the contracting that pharmaceutical companies do with managed care organizations as we prepare for next year. With January 1 start dates, everybody’s finishing up red lines and contracts in preparation for that, but also everybody’s doing strategic planning and getting ready for the following year. That includes the payers as well as integrated delivery networks and hospitals as they go through budgets and business plans. So this is a busy time of year for meetings.

Richard W.: During the last probably six to eight weeks, I have been to a couple of CBI conferences on rare and orphan drugs as well as biosimilars, which we’ll talk about a little bit later. I had the opportunity and privilege to participate in the Health Management Academy, which is kind of a think tank organization out of Washington, DC. It’s becoming one of my favorite meetings and, of course, big conferences like PCMA, AMCP, and ASHP, which are all really designed for pharmacists, hospitals, manufacturers, and payers.

Andy Madigan: Quite a full agenda there. So from these meetings, can you tell me what some of the recurring themes were, the strategic priorities, if you will, as it relates to hospital pharmacies for 2020 and beyond?

Richard W.: Well, let me start by just saying regardless of the audience, regardless of the meeting that you attend, this is a really exciting time for pharmacy with amazing new drugs being developed that may offer cures to diseases like sickle cell anemia, hemophilia A, and other diseases that we only dreamed of treating and curing a few years ago. So the energy level within all of these meetings is really very high, particularly from a pharmaceutical standpoint. At the same time, there’s the downward pressure of how are we going to pay for this innovation and how are we going to manage it going forward.

Richard W.: One of the things that I had the opportunity to participate in was the health Management Academy, and I’m sure they’ll be publishing the entire document, but there were three things that came out of that, to really address your question about hospital pharmacies, and one is sustaining margins while transforming how pharmaceutical care is delivered. That was almost universally selected as one of the top priorities, not only by chief pharmacy officer, but by chief financial officers and chief executive officers. There’s tremendous strain in our hospital systems to protect margin while improving and enhancing how we deliver care.

Richard W.: The second one that really surface was site of care or site of service is being heavily discussed, specifically home infusion and also how to manage rare and ultra rare products. Some of those now cost upwards of $2 million, and so there was a lot of tactical discussion of when you receive a prescription and you have a patient that’s going to require one of those medications, how do you handle it? That’s a little bit different and unique than what pharmacies have done historically. So there has to be a lot of thought that goes into that.

Richard W.: Then, finally, is the need to invest in succession planning and leadership development. This was probably one of the most robust discussions. As we look at the profession, a lot of the leaders that are driving and running integrated delivery networks, large hospital pharmacies, they’re mature in their careers. How do you invest in younger pharmacists that are going to take and lead the future? So that was really an area that there was a significant amount of time spent on.

Andy Madigan: So looking ahead to 2020, it’s an election year and, obviously, anybody who hasn’t been living under a rock has been exposed to increased discourse and will be increasing, ever-increasing discourse on various political themes that are taking place. How do you believe pharmacy is viewing state and local policy decisions, and even the federal situation, how are they handling this?

Richard W.: Andy, I happened to be in Washington a couple times during the fall and outside of the Beltway it appears that everything has come to a complete standstill, but inside the Beltway, inside Washington, that is not true at all. There is much work being done with regard to health policy, and this is one area where there is clear bipartisanship and alignment, not only between the House and the Senate, but also the White House.

Richard W.: Let me give you a couple of examples. First of all, you have to put it in the context of who pays for healthcare in the United States. Today, the U.S. government accounts for almost 50% or $1.68 trillion of healthcare. I can’t even fathom what a trillion dollars looks like. We throw it around pretty routinely, but it’s a really, really big number. But when the government pays for half of the cost of healthcare in the United States, they are going to have a major say in how it’s going to be delivered and what the expectations are. So let me give you four or five areas that people really are looking at.

Richard W.: First is rising list prices for pharmaceutical products. The challenge there, Andy, is this: if you have a product that you know is going to have three or four or five indications in the future, and your first indication is so-so, it’s modest improvement over what currently exists. The inability to raise prices going forward really handcuffs you that you have to price that product even though that it’s not significantly better with that first indication. You have to price it really high because you’re not going to have the ability when you receive your third approved indication that could be a really robust and significant contribution to healthcare. You’re not going to have the ability to raise your price, so you price it for the third indication although the first indication may go, “Uh, that’s not really that good.” The optics of that is not really positive.

Richard W.: The second would be transparency, and this really gets into the relationships between managed care organizations and PBMs and, of course, Safe Harbors, that initiative in Washington who fell flat, I don’t think it’s over. I think after the election, depending on what Congress looks like, that will resurface in 2020, towards the latter part of 2020, so stay tuned on that one. Clearly, misaligned incentives, that has got to be adjusted on how we reimburse, particularly part B drugs. We incentivize physician’s offices to use a higher priced drug because they get reimbursed on it. It’s a percent of that product with ASP pricing methodology. We got to transform that and incentivize doctors to use the low cost drugs, and there’s a lot of discussion around that. Of course, there’s a lot of debate about the international pricing index, which has been proposed, and everybody, because they are voters, I would say everybody is focused on patient out-of-pocket expenses. I would turn that to say everybody is focused on voter out-of-pocket expenses.

Andy Madigan: Good point.

Richard W.: Yeah, and we’re in the middle of a Star Wars innovation with a Flintstone payment system. The payment system just hasn’t caught up with all the exciting innovation that’s taking place, but those are four or five things that everybody’s focused on. I can tell you, there’s a lot of work being done and if your audience thinks Washington is at a standstill, it’s not. All of these are moving forward very quickly.

Andy Madigan: So technology plays a role in this, I would imagine. What are some of the themes that have emerged from the events that you’ve attended, some of the presentations you’ve seen?

Richard W.: Well, there’s really three buckets that I look at with regard to that, Andy. The first one is the concept of telepharmacy. Telemedicine has evolved in the last four to five years with companies like Teladoc and others and every major hospital is doing some type of telemedicine. But there is an opportunity for pharmacy to get involved, and there are a lot of organizations that are starting to build out those capabilities to do medication therapy management and follow up on patient care after discharge from the hospital. So telepharmacy is going to be an evolving area, and how we will better use technology going forward.

Richard W.: The other big topic is pharmacogenomics. Everybody has seen 23andMe advertisements, and there are a lot of discounts in the marketplace today, but who is going to own pharmacogenomics going forward? What we know about the human body through the Human Genome Project, etcetera, really does give us an ability to tailor medication and therapies to an individual patient. A number of people have suggested pharmacy should own pharmacogenomics, and I personally agree with that. There’s nobody better equipped to think about how to dose and the different therapies that should be considered for a patient, but it’s also going to require some additional education because we’re going to have to become somewhat like a genetic doctor. Of course, you’ve got other people who are involved with looking at the ethics behind this, but that’s an area that I think pharmacy is going to really excel in the future.

Richard W.: The final thing, and this one’s something that we all were involved with, is this concept of digital therapeutics, the so-called invisible data that is being generated on our Fitbit’s and our Iwatches. Of course, the new Iwatch four has the ability to check for arrhythmias. I heard at AMCP that there are more than 500 clinical apps under development. How will all these tools and data that they create be used to improve an individual’s care? How will consumers know which ones are reliable and work and which ones they should really pay attention to? There are organizations, and they’re big organizations that everybody in healthcare knows their name, that are creating entire departments whose sole responsibility is to evaluate this new technology and apps that are going to be coming to the market in the next year.

Andy Madigan: Certainly, with the fast pace of development of these new apps and new technologies, unfortunately, we also have to consider the potential for either unintended uses or misuse, privacy issues, those sorts of things, and almost putting a throttle on some of the development or the release of some of this in trying to protect the interests of private individuals and release of, frankly, very private data out into the public domain.

Richard W.: Well, certainly, the headlines over the last couple of months with healthcare companies working with IT companies have been at the forefront of the news. We all need to be aware of that and we’re all conscious of the concern for privacy. But my personal experience is if somebody is able to prevent me from having a heart attack because they shared my data with a company, I’m going to be thankful and grateful that that occurred, that you’re right.

Andy Madigan: Absolutely.

Richard W.: There is this concern about privacy and who has access to data, but with artificial intelligence and machine learning, there are some amazing companies being developed that will be able to provide predictive analytics to help all of us stay healthier and live better lives.

Andy Madigan: Excellent. So yeah, as I said, you’ve been on the road quite a bit this last quarter and that kind of brings us to a close for this episode. With that, I just want to say thank you, Richard, for sharing your insights with us. As usual, we look forward to having you join us again. I want to thank our listeners for tuning in to the CSI Specialty Pharmacy Podcast. If you’ve enjoyed listening today, I encourage you to subscribe to the podcast on your favorite podcast delivery platform. I also encourage you to visit our website, csigroup.net, and download your free copy of the 2019 State of Specialty Pharmacy Report. Again, that’s csigroup.net/survey, and we’ll be working on the 2020 report very soon so you can look for that in the coming months, first part of 2020.

Andy Madigan: You can also keep up with us on social media by following CSI Specialty Group on LinkedIn, Twitter, and Facebook. I should also mention CSI Specialty Group is a subsidiary of group purchasing organization, Intalere. CSI expands Intalere’s suite of solutions to healthcare providers, health systems, pharmacies, and pharmaceutical partners. Intalere is owned by Intermountain Healthcare, a leading healthcare system based in Salt Lake city, Utah. CSI supports our parent organization’s vision of providing tailored smart solutions to help deliver superior services at an affordable cost. You’ve been listening to the CSI Specialty Pharmacy Podcast. From all of us at CSI Specialty Group, please accept our sincere wishes for a wonderful holiday season. Until next time. Good day.

Speaker 1: Thanks for listening to the 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 go-to firm for all things specialty pharmacy. Thanks again for listening and we’ll catch you next time, doctor’s orders.

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