A Few New Things in Pharmacy.
I had the pleasure of attending two pharmacy conferences over the last two weeks and wow! I couldn’t be more excited about the future. I saw it all, from gene therapy to digital marketing to pick up kiosks. Yes, many are very worried about what’s to come. There’s so many changes in healthcare now-a-days so I can completely understand the fear of the uncertain. But there really is so much to be excited about. I want to share some take-a-ways of some recent experiences.
It all started with a talk by Andrew Scharenberg, the Chief Scientific Officer of Casebia Therapeutics. He gave those in attendance at the Magellan Rx Specialty Summit a brief overview of gene therapy and what they’re doing to treat and cure diseases. He specifically talked about a retinal treatment that costs up to $850K per year. Yup, you read that right. $850,000. In understanding the way they use a vector from a virus to infiltrate the center of a cell and change its genes, I came to a wild, but possible revelation. When this technology hits scale, our life spans are going to be greatly increased. The way they are treating diseases are so out of this world it’s ridiculous. And it’s only just begun. However, there are large hurdles here because the structure of these drugs are so complex, they actually make biologics look like child’s play. But, these medications are fundamentally approaching the way we treat diseases a completely different way. These treatments are going straight to the source of the pathology. It’s crazy to think about, but it’s a really exciting time. I hope to see more pharmacists involved and leading the way in helping people manage their newly invented gene therapies.
That day ended with a talk by Dr. Bruce Levine, a professor in cancer gene therapy where he helped work on a revolutionary treatment called T-cell therapy to treat leukemia. His story spoke of how they used an HIV virus to make sure a therapy got to the cells it needed to treat (or kill). It’s important to note that because of the design of the therapy, even though using the HIV virus, it wasn’t able to actually cause HIV. The explanation of that is WAY out of the scope of this article (and my clinical expertise). The patient in his story was of Emily Whitehead and the craziest surprise was that her and her family were actually in the crowd! It was awesome hearing first hand from the family the impact this therapy had on her and the livelihood of her family. The reason I think this story is important is because there are so many new treatments that are coming out in all types of areas and I think pharmacists need to be ready to support these new advancements in medications and prepared to be an expert in therapy management.
Innovation: Amazon and Facebook
That was the bulk of day one. The next day I stayed for a talk by an Amazon executive. He focused more on leadership and organizations that innovate. He went into the culture of Amazon and the environment they’ve built with innovation. What really stuck out was that he had mentioned that Amazon rewards innovation, even if it fails. They are not scared to try new things and of those things that do fail, they’re usually some great lessons learned. For example, the Amazon Fire Phone was considered a failure, but what came out of it was some of the tech behind Amazon’s Echo. Fostering the innovative culture not only as an individual, but as an organization, is what will make for success.
Now onto my second conference, this one kicked off with a talk by Facebook. The speaker gave an overview of the reach and targeting abilities of Facebook, which is pretty remarkable. Facebook has so much information about individuals, it makes targeting individuals one of the easiest in the world. What I thought was interesting was how behind some of the retailers were in understanding this. However, as they start to catch on, we’ll start to see a huge focus on digital media and marketing VERY soon.
Changes in Prescriptions
Surescripts, a leader in e-prescribing, had a really good presentation. They spoke about all the changes coming to e-prescribing requirements and a few other things they were working on. Two things of particular interest stuck out to me. The first one being the eventual use of electronic transfers. If you’ve ever worked in a pharmacy, you dreaded transferring prescriptions to other pharmacies. It’s such a painful process, especially if it’s more than one prescription that needs to be transferred. But, great news! Surescripts will soon make it possible for prescriptions to be transferred electronically to other pharmacies. #Win
The other thing that was pretty awesome that they’re working on is actually a process that occurs before a prescription is even sent to the pharmacy. In the coming years, when a prescriber writes a prescription for a patient, Surescripts will now have a system in place to show the prescriber how much the medication will cost a patient. And not only will the prescriber get the price and benefits information, they’ll also be able to see what the therapeutic alternatives are and their respective prices as well. This is intended to allow prescribers to have conversations with the patient and make an informed decision on which therapy to prescribe. This will also let the prescriber know if a prior authorization (PA) is required. What I’m wondering is, will prescribers welcome this process into their workflow? Or will they still want others healthcare professionals like PAs, Nurses, and pharmacists to intervene and help make a clinical recommendation?
The second conference was one of the largest gatherings of retailers I had ever seen, called NACDS Total Store Expo, and it was MASSIVE. Easily one of the largest number of exhibitors I’ve seen at a conference. What was quite interesting though is that this conference didn’t have a lot of foot traffic going from booth to booth. Instead, it was an appointment heavy event. Most of the booths had meeting spaces and could have upwards of 20 meetings a day scheduled at their booth.
In walking the trade show floor, I found two companies in particular that really stuck out. The first one was MedAvail (www.medavail.com) a company that created a kiosk where patients can come pick up their medications. However, it’s not as straight forward as I thought it would be. Currently, the machine actually facilitates the final verification of product to be dispensed when the patient is at the kiosk. I don’t know exactly what’s going on inside the machine, but It also seemed like the label didn’t even get put onto the box that was dispensed up until this point. When using the kiosk, If it’s the first fill of a medication, the patient will be required to video chat with the pharmacist. If it’s a refill, the patient will have the option to video chat with a pharmacist. But, this is a very limiting process, especially if the pharmacist is tied up with other tasks. I could see huge lines being formed behind these things because of it. I’m sure there’s some legal reasoning behind this, but for now, it seems like it may cause more delays in workflow than help. When this kiosk can get to a point where it acts as a true pick up station AFTER the medication has been verified and labeled, that is when I can truly see the benefits of having these at pharmacies. Maybe pharmacies can allow for refills only to be stored inside them and have new scripts still be required to be dispensed the “traditional” way.
I posted an image of the kiosk on social media and, as expected, received a lot of negative comments about it. The main concern was this kiosk will be replacing the pharmacist. But in its current form, this machine is just intended to replace the clerical work of dispensing a medication. So what are we defending here? The need for us to continue to be able to be a cashier face to face? In fact, in that act alone, we’re just a highly paid cashier. We need to really evaluate what it is that we’re doing at work as a “Pharmacist.” For example, when we are verifying a prescription, we are just matching words, literally making sure it says Lisinopril 10 mg on the left side and that matches to Lisinopril 10 mg on the right side and boom, verified! What should be much more concerning to think about is the program/software that gets developed to match words 10x more accurately and faster than a human Pharmacist’s eyes can. That’s when uproar would be a bit more justified, not by creating a kiosk where a patient can pick up their medication. But, even the process of verifying is not something we necessarily went to school for. Think about it, what year in pharmacy school did we take a class on verifying? In evaluating the majority of “Pharmacist” work we do day to day, we really need to start displaying our training and expertise to justify the need for $100K+ in salary. Just because we have student loans doesn’t mean people owe us money. We need to make sure our worth is being utilized, not just recognized. And will all this talk about a kiosk, who knows, this may be leapfrogged in the new world of PillPack and medications being delivered to the home. This is actually a great segue into the next company that caught my attention.
At Home Monitoring
One of the other companies that caught my attention is a company is called Life 365. They are making it easy to monitor certain health conditions in the patient’s home, measures like blood glucose, pulse, blood pressure. They’re allowing values to be easily monitored by a healthcare provider allowing them the ability to take real-time action. What does that have to do with the above paragraph? Well, pharmacists are in a great position to be the healthcare professional to really have an impact here. Not only can we help monitor the patients’ conditions at home, we can be there to answer any questions they may have and also recommend changes to therapy based on results.
The last thing I wanted to mention is that there was a large presence of drug information companies at this conference. What’s interesting to think about is every pharmacy and/or healthcare company usually needs to have a drug resource. And there isn’t many of these companies out there but their products offerings can be endless and I’m sure can always be made better. Drug information is a solid niche to get into. It is away from patient care, but a field many can be excited about.
All in all, it was an eventful few weeks for me. I learned so many new things and had a lot of fun experiences. I hope this recap brought some value and would love to hear your thoughts.
Thanks for reading.
Richard Waithe, PharmD | Richard@vucahealth.com