ORLANDO, Florida — Pharmacy benefit management executives took the stage at HIMSS19 on Wednesday to tout their ability to cut costs for patients amid a wider debate about the role of PBMs in the drug supply chain.
The panel of heavyweights from CVS Health, fresh off scooping up payer giant Aetna, Cigna, which just gobbled PBM Express Scripts, and the CEO of Surescripts came as policymakers in Washington and other players — most loudly, big pharma — trade blame over the biggest driver of healthcare costs.
The industry is playing defense. Earlier this month the Trump administration proposed eliminating safe harbor protections for drug rebates through PBMs, a blow to the sector and a win for drugmakers pushing the focus on skyrocketing drug costs elsewhere.
The execs made the pitch that they are well-placed to help drive down costs, given patients interact far more often with pharmacists than other healthcare providers.
"Pharmacy is the gateway for most patients. Most patients will go to a hospital less than once a year. They'll go to a doctor less than twice a year. But the average person uses a pharmacy 12 times a year," Steve Miller, chief clinical officer at Cigna, who served as Express Scripts CMO for years, said.
Of course, pharmacy as the proverbial front door for healthcare was one of the justifications the retail giant gave for its purchase of Aetna.
"We're trying to take advantage of [retail pharmacy] as an opportunity to be able to reach patients on a face-to-face basis," said Troy Brennan, the executive vice president and chief medical officer of healthcare behemoth CVS Health.
The CVS exec talked up the conglomerate's new HUB stores in Houston, noting the company has identified 30-40% of its customers who come in to get tested have high blood pressure, and that 80% of them had been previously undiagnosed.
Many solutions will come from "basic blocking and tackling" such as this, Brennan thinks — from measures "we consider to be relatively below the level of primary care in this country."
Perhaps unintentionally, the healthcare system is at fault for the current issues plaguing it, the executives said.
"The system's giving us the results that we created," Miller said. "You go to see your doctor, I'm making love to the keyboard, I don't make eye contact with you … the patient is looking at this and saying, why am I paying all this money and why did I wait so long for this appointment if this is the experience I’m going to have?"
"It's a situation where we all collectively have an obligation" to work to change the tone and tenor of treatment, Surescripts CEO Tom Skelton said.
Interoperability, realigning perverted data incentives will help
It's widely known consumers can get more information about their cars or toasters with a quick Internet search than they can get after hours researching a healthcare provider.
"The part that's on us is to provide people with the information that they need," Brennan said.
A key roadblock is the long-running lack of interoperability among providers and payers, along with perverse financial incentives.
"We have an enormous amount of legacy systems out there," Brennan noted — more than 300 EHR platforms. "And once you've invested in that [system] you never want to let it go" due to the sunk costs.
On point, the three spoke favorably of the proposed rules released earlier this week to push the industry to prioritize interoperability, with Miller noting it's imperative to give data back to the patient.
"We have got to liberalize the data so that those patients can not only access it themselves but the people they trust to access it, the providers they choose, actually have full access to that data," he said.
Other areas that need work in health IT are alert fatigue, hoisting overwhelming data on providers and a lack of consideration for human factors, they said.
"What are the things that people really want in their workflow that really makes this a better experience?" Miller asked.
Electronic prescribing is a good comparison for the industry's current shift to a greater focus on health IT, according to CVS' EVP and CMO. "It took 10 years to get to 50% market penetration on electronic prescribing," Brennan said — but we're getting there.
"When a doctor knows which is the covered product and what the price of that product is and they can share it with their patient, they can make the right decision the first time." Miller added.
Correction: A previous version of this article listed Steve Miller's title as COO at Cigna. He is chief clinical officer.