Getting a life-saving therapy into the hands of a patient who needs it is much easier said than done. While overcoming the numerous hurdles to adequate access typically falls to manufacturers, there are many stakeholders involved in this effort, from providers to payers to patients themselves.
Pharmacists, too, play a key role in helping patients get the medications they need, yet most aren’t taught the ins and outs of managed care or market access in pharmacy school. Instead, their training revolves around clinical education and is oftentimes geared toward earning a spot in residency.
To learn more, we sat down with Rachel DeLucy and Madeline Verbeke—both Clinical Advisors on MMIT’s Data Operations team and recent pharmacy school grads—to discuss how schools can better prepare students to address barriers to access at the pharmacy counter, and what manufacturers need to know about pharmacists’ unique role in the patient access journey.
Q: Tell me what, exactly, a managed care pharmacist is and what opportunities exist to help patients get access to therapies.
Rachel DeLucy: Many roles are utilization management pharmacists, so they work on prior authorizations and such. But you can also get involved with organizations like a PBM and work on building formularies. Or you can work with new medications that are coming to market. In pharmacy school, I participated in the AMCP (Association of Managed Care Pharmacists) P&T competition, which is basically a mock P&T committee. You review a new drug and assess not only its clinical benefits but also the value of it. You also compare it to other drugs in its class and determine how much it’s going to cost because those are all of the things that payers consider when you’re adding something to a formulary.
No matter how much good you want to do as a pharmacist, and how much you want to change healthcare, pharmacists need to understand that side of things to really make a difference.
Madeline Verbeke: I agree. If you’re ignoring the cost and access side of things, this just causes more problems. If people aren’t able to afford their drugs, then they just slip away, and there’s only so much that pharmacists can do if they don’t understand that side of it. And then the patient doesn’t get the drug that they need, or they have to forego other things they need to get their medications. And a lot of times pharmacists feel like there isn’t much that can be done. I had friends in pharmacy school who didn’t know what step therapy was and had never read a prior authorization form. But a pharmacist, especially in retail, is the last person to talk to the patient, so it’s really important to understand market access.
I also think that having this knowledge makes you a more empathetic pharmacist. If you know just how difficult it is to get some drugs, or how much patients have had to go through to get to the prescription stage, then you’ll be far more effective at your job.
Q: What should future pharmacists be learning about managed care and market access, and why aren’t the learning it in school?
RD: Pharmacy school was definitely more focused on the clinical benefits of drugs, with very few classes that centered on how much it would cost or how easy it would be for patients to access it. I also wish there was more of a focus on how clinical trial data—the exclusion and inclusion criteria, endpoints, etc.—can play into market access since pharmacists might see those criteria on prior authorization forms and policies.
MV: One thing I did learn was how to read a study and determine if it’s well-written. Pharmacists definitely need to know how to tell the difference between a quality study and one that’s poor quality, but then once you weed through them, what do you do with that information? If students were taught to connect that info with the economics side of things, it would open up a whole new world and a whole new understanding for pharmacists.
Q: What do manufacturers need to know about pharmacists’ role in the patient access journey?
RD: Pharmacists, with adequate training, are one of the few players that understand the issue of medication access from almost every angle. We are well-versed in the clinical knowledge behind the drugs themselves, as well as using them appropriately in patients. On top of that, all pharmacy students need to complete some sort of community practice hours as a requirement for licensure, but many are working in these pharmacies as interns throughout school. In some capacity we all have many hours of community exposure and, in turn, many hours on the phone with insurance companies and doctors’ offices. We have even spent time calling manufacturers for coupons trying to get a medication covered for a patient. We are there on the frontlines working face to face with these patients—and like all healthcare professionals, it’s personal for us. If pharmacy students had more exposure to the last piece of the issue—understanding the pharmacoeconomic principles—we could have a new generation of pharmacists ready to remove some of those barriers to access.
MV: I think pharmacists are probably some of the most well-suited professionals to be working in market access and to be helping manufacturers on their journey to smooth access to therapy. They have unique insight into the struggles many patients must go through to get their medications and the clinical training to be able to interpret prior authorizations and understand the “why” behind many payer decisions. This distinctive skill set puts pharmacists at the top when it comes to patient access even though they are an often-overlooked profession. Market access is not something commonly taught in pharmacy school, but manufacturers could greatly benefit from providing learning experiences to pharmacy students such as internships, rotation experiences, and even just giving guest lectures when possible. The earlier students are exposed to this area of pharmacy, the better prepared they will be when they enter the profession and the more value they will provide to drug manufacturers.