Getting Back Into The Pharmacy Industry

After working at Express Scripts for almost 5 years and then selling into the PBM industry for almost 5 years, I’ve had the chance to lead and work on a ton of very interesting projects:

• Electronic prescribing
• Generic sampling
• Generic promotion – DTC, plan design, utilization management
• Formulary support programs
• Mail order promotion – mandatory mail, retail-to-mail, 90-day
• Prilosec and Claritin going from Rx to OTC
• Adherence
• Pill splitting
• $0 copay / VBID

I’ve found that I love business development (working with clients and vendors).  I enjoy bringing ideas from concept through pilots and then determining how to scale them.  I love doing research and presenting.  I enjoy working cross functionally.  I enjoy leading teams and pushing the envelope to get people to think different.  Ultimately, I enjoy solving problems.  I like being the person who’s brought in with a business challenge and can then figure out the solution – do the research, evaluate the options, create a plan, implement the plan, and create a process of continuous improvement.

So, after spending 2 years working in the care management side of healthcare and learning about case management, disease management, claims code editing, and other solutions to manage complex patients with cancer or chronic kidney disease, I’m ready to jump back into the pharmacy industry (specialty, PBM, retail, pharma, payers or related companies).  (And, I’ll be bringing a lot of lessons learned with me.)

I think the industry is going through another inflection point which is what Mark Merritt from PCMA pointed out a few years ago is the core skill – adaptability.  If you think about the trends, I think there are several key things that make this an interesting time to be in the industry.  And, everyone is fighting commoditization by trying to differentiate themselves.

• The focus on specialty will make integration between care management and traditional PBM services critical.
• The complexity of care is driving a huge focus on evidence based medicine (e.g., Best Doctors or Eviti) which will eventually lead to companion diagnostics and personalized medicine.
• Pharma is trying to figure out their role in this new world and will start looking at creative ways to blend product and services (e.g., Merck’s investments in Vree Health).
• The market is full of change with new technologies and new start-ups that will lead to more unique mash-ups, and I still think you could see Google Health come back in some form.
• Medication adherence continues to be such a huge opportunity that no one’s cracked with over 100 vendors that I identified, and no one has figured out how to fully integrate medical and pharmacy benefits to address specialty medications.

And, the fundamentals are good for the industry.

1. The PBMs are big and need to grow so they’ll have to do some creative things.
2. People continue to get older and take more medications.
3. Health reform is forecasted to grow the market by over $200B in the next 10 years.  (from recent CatamaranRx presentation on their investor website)

Of course the question is what to do…

All of these things sound interesting, but here’s what I’m going to focus on:

• A company with an entrepreneurial (or intrapreneurial culture).
• A role working directly with clients (no Ivory Tower role).
• A mission driven organization which wants to change the world and improve outcomes.
• A passionate leader and team that I can learn from.
• A leadership role where I can help a PBM or payer (or a group of them as a consultant) help make this transformation.  Some of the roles that would interest me would be:
  • MD strategy
    • Adherence
    • ACOs
    • Shared risk
    • Evidence-based care
  • Consumer experience
    • Journey mapping
    • Consumer advocate
    • Incentives
    • Gamification
    • Plain language
    • Patient Activation
  • Consumer engagement
    • Multi-channel coordination (print, web, IVR, mobile, SMS, F2F, telehealth)
    • Big data
    • Segmentation
    • A-B testing
    • Social media
  • mHealth / Care coordination
    • Risk and segmentation algorithms
    • Coordination with caregivers and providers
    • Remote monitoring
    • Working with clinics and telehealth
  • Beyond The Pill
    • Obesity
    • Chronic Kidney Disease
    • Oncology
    • Diabetes
  • Innovation and business development

(If you know of something interesting, let me know.)