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.

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)Image

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.)

2 Responses to “Getting Back Into The Pharmacy Industry”

  1. Your talents, experience, and criteria points will not be used and/or met by the medium to large PBMs,unless as a consultant you are set to become their press secretary expounding their views and justifying their short comings. Leaving just us little guys. Jim


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    […] I’m enjoying my time thinking about what’s next, one of the things that I’ve thought a lot about key problem areas in our healthcare system. […]

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