Pharmacy Benefit Managers and the Future Role of Managing Cancer Drug Optimization and Value

Conference Correspondent - AVBCC 2019 Summit

At this fully represented panel, moderator AVBCC Co-Chair Barry Brooks, MD, Medical Director and Chairman, The US Oncology Network P&T Committee, McKesson Specialty Health, kept the responses and range of topics moving at a brisk pace. The overarching topic was the future role of pharmacy benefit managers in optimizing value in the oncology drug realm, but many aspects of that broad question were given time for discussion. Experts from several areas of cancer care weighed in with well-considered opinions that addressed topics relative to a variety of stakeholder perspectives.

Dr Brooks opened the morning’s discussion with a question that elicited varied responses when he asked how pharmacy managers do their work. “Work,” of course, can encompass a large number of things specific to the workplace in question.

Benito Fernandez, Vice President, Trade Operations & Account Management, Onco360 Oncology Pharmacy, said that his goal is to provide a service to physicians through his company’s access to most therapies. In the future, he also wants to do more partnering with providers and think about what a pharmacy can do to drive value.

Ross Hoffman, MD, Chief Medical Officer, Envolve Pharmacy Solutions, said that his emphasis is on trying to cut waste through the use of technology such as to drive value and innovation.

As a pharmacy benefit manager, Mostafa Kamal, Chief Executive Officer, Magellan Rx Management, says he has “3 major functions—processing claims, negotiating with pharma, and leveraging what comes from there, making sure that specialty pharmacies are not spending too much or submitting duplicative claims.”

He added that the existing funding model is not going to work indefinitely. There is a need to create a model different from the existing one, and it is incumbent on industry to find a new model, he believes.

These remarks opened up a discussion of some measures that are being taken to address many of the issues pharmacy benefit managers currently encounter now as technology and increasingly complex oncology drug protocols challenge existing models of fulfillment and payment.

Surya Singh, MD, Former Vice President, Medical Management, CVS Health, brought up the issue of prescription synchronization, saying, “it is a very simple thing that increases patient adherence, being a more sophisticated AI-enabled way to provide care to patients.”

At Cleveland Clinic, they “have had pathways for safety and cost efficacy,” and are “trying to make value-based decisions,” said Marc Earl, PharmD, BCOP, Assistant Director, Pharmacy.

Ray Bailey, BPharm, RPh, Pharmacy Director, Florida Cancer Specialists, noted, as stakeholders, everyone is “in it together” and everyone shares that they “just want to take care of patients inside an integrative system.”