Making Healthcare Affordable, Predictable and Simple with Rajesh Manglani, VP of Pharmacy Product Strategy at Cigna: Audio automatically transcribed by Sonix
Making Healthcare Affordable, Predictable and Simple with Rajesh Manglani, VP of Pharmacy Product Strategy at Cigna: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Kyle Wildnauer-Haigney:
Hey everyone! This is Kyle Wildnauer-Haigney, your host for the Outcomes Rocket Pharma podcast. Today, I have the distinct pleasure of welcoming Rajesh Manglani to the show. Rajesh leads Pharmacy Product Strategy reporting for Cigna Integrated Medical. In this role, Rajesh specializes in the ideation and evaluation phases of the product lifecycle. His focus is on net new ideas and offerings, as well as pharmacy innovation that strengthens Cigna’s integrated value proposition. He has over 20 years of experience across product management, product strategy, and M&A. He joins Cigna from Nuance Communications, where he was the Director of Strategy and New Business Development for their health care division. In this role, he was responsible for all aspects of Nuance Healthcare’s growth strategy. This included forming long term strategy based upon analysis of health care industry trends, identifying M&A opportunities, and owning the innovation portfolio. Brajesh earned a Bachelor’s Degree in Electronics Engineering from Mumbai University and an MBA from Cornell University with a concentration in finance. He lives and home offices in Massachusetts with his wife and two daughters. Thank you, Rajesh for joining the show. It’s a pleasure to have you here.
Rajesh Manglani:
Thank you, Kyle.
Kyle Wildnauer-Haigney:
Maybe to kick things off and introduce yourself to the listeners, I’d love it if you could just tell us about yourself and maybe what drew you to working in the pharmaceutical value chain.
Rajesh Manglani:
First of all, again, thank you so much for having me on your show. As we’ve talked about before, I’ve taken a rather long and roundabout way to get to where I am. If I think about my career today, I think of it in three acts. The first act was your standard engineering arc. Programmer, engineering manager, engineering director, and so on. Did that for about nine years, stopped, went back to school full time, did a short stint at Wall Street for about two or so years, purely on investment management, so private equity, private debt for renewable energy. And then 2008 happened and I happened to enter healthcare just by chance. And I always joke that if you’d asked my 10-year-old self when you grow up, would PBM or pharmacy or electronic prescribing be something that you’d be excited about, I don’t think the answer would be yes. But if you ask me today, is there anything else I’d rather do other than health care and health care innovation, the answer is no. This is the only thing I want to do. One last thing about my background. I always talk about it in three acts, and my wife is always quick to point out that the standard typical Shakespearean play is five acts, which is a nice way of telling me that kind of over the hill. I haven’t chalked up the courage to ask if it’s a tragedy or a comedy, so far that’s TBD. But that’s my background.
Kyle Wildnauer-Haigney:
I love that. And thank you for doing that overview. I’d be interested to meet a 10-year-old that gets excited about pharmacy benefit managers and the pharmaceutical value chain. I’d be quite the interesting 10-year-old, but maybe we’ll have him in the show. Well, that’s great. And so one thing I’d love to understand a little bit more specifically, kind of in your current role, what are you most excited about, and kind of how do you think about the impact that you have?
Kyle Wildnauer-Haigney:
So it’s a great question, right? I mean, I want to start with the broadest picture. You sit down and you look at health care and you look forward and say, what are the big forces that are impacting health care? What do they do? What’s going to cause change? And the way I think about it is two or three things. One, front and foremost, innovation. And it could be my picking, this is the world that I live in. I truly believe. For example, pharmacological innovation represents the next decade, the future of health care, if you ask me. Think about it in terms of specialty medication. Vaccines. I mean, the number of vaccines. Gene therapy. I mean, you could think about them in terms of curative or coping medications, right? So innovation, digital health innovation, another piece of it. The other part from the three big forces is we’re really starting to get a better understanding of the connection between mental and physical health and how the environment, we call them social determinants of health, how that shapes and affects the person’s overall health. We are started to focus on that. And finally, the pandemic has played some part in it is the rapid changes to how care is accessed, how care is being democratized if you may. These are three big pictures, right, so that’s what’s happening. So let’s talk about within that context, the company that I work for, Cigna. And if you look at our latest Wall Street messaging or the way we practice our vision, it’s growth with purpose. What does that mean? We focus on three big tasks for our clients, our customers, which are to make health care affordable, predictable, and simple, and very deliberately using these words. I’m going to talk about affordability for a minute. Everyone wants affordable health care, right? So what does that really mean when someone like Cigna talks about affordable health care? For one, we’ve committed to delivering sustainable both medical and pharmacy trends at or below CPI level over time. which is a big commitment, and here are three or four ways of thinking about it. Number one is how do we think about the end-to-end clinical solutions? So remember how we talked about thinking about the whole person? So when you think about the whole person, you think about the internal political solutions for them. So early behavioral lifestyle interventions, help individuals either stay healthy in the first place or lower the risk of becoming sick. Second, if they do need help, find effective types of care for them. So timely cost-effective access to virtual care, digital tools, remote monitoring. Third, if they do need to go see a doctor, help them identify the highest quality medical professionals, so high performing providers. Finally lowering costs for them, drug costs as an example. So we talked about the big forces that are shaping health care within that how Cigna’s position them. What excites me? My particular fear of influence, which is the integrated pharmacy. Again, these are eight million people, eight million lives that get both medical and pharmacy benefits to us. And how do we focus on keeping them healthy? And there’s so much to unpack. But that’s what excites me.
Kyle Wildnauer-Haigney:
And that’s a fantastic thing for companies. Through that overview, the integrated pharmacy, that’s something that seems so critical. Right? Because if you’re just looking at the medical expense or just pharmacy expense, you don’t have the whole picture. So how can you even approach addressing the patient holistically?
Rajesh Manglani:
Totally. I was just going to say as one small point to that, what you just talked about. One thing is medication. But if you and these are not my statistics, they are not CDC statistics. 60 percent of adult patients in the US are prescribed some medication. 11 percent of them don’t fill it. Out of pocket costs or high costs is the primary reason. How do you help them there? This is not just health. Another CDC statistic. It’s in I may not be exact on the number, but about 80 percent or so of the people don’t have the health literacy to actually manage their own care. About 12 to 15 percent of people actually have health literacy, can read, can follow directions, and take care of their own health. So how do you help them? And again, this is not about just getting them the right drugs or even from a medical and pharmacy perspective, not just about some of the things that we talked about, but it’s about looking at the whole patient. How do we make sure they have access to health literacy? How do we make sure they have access to some of the medicines? And how do we help them make it affordable and make it simple for them and make it predictable?
Kyle Wildnauer-Haigney:
Sure. From a patient’s perspective. I mean, all those items that you highlighted – affordable, predictable, easy to access make so much sense. I love to hear specifically how Cigna differentiates compared from other companies. How do you guys view that? Whether it’s in these three dimensions or some other way.
Rajesh Manglani:
You could build on that. So first, let’s talk about our clients’. Our clients and our customers. They have been through unprecedented challenges like no other time in recent history. And again, let me say this again is probably an understatement. Not only has it disrupted the way our clients have done business, but it also disrupted the way they engaged with their employees, who are the end customers for us. And if you look at the employees themselves and their families, they’ve been tremendously affected not only physically, financially, but also emotionally and socially. So to bring that point home, in just the first few months of the pandemic, we saw a 30 percent increase in prescriptions for anxiety medication, 20 percent for antidepressants. I may be off by a percentage point here and there, but that should tell you something, right?
Kyle Wildnauer-Haigney:
Absolutely.
Rajesh Manglani:
Let’s talk about Cigna pharmacy. We work with our clients again that, like us, believe in the power of connected vantage. Meaning not only just pharmacy but also pharmacy and medical and pharmacy, medical, behavioral and wellness, integrating that to improve customer health indicators like medication adherence or engagement and coaching programs. What does that mean? To give you an example, when customers call Cigna whether it’s on the main number or they call the Cigna pharmacy about their prescription, we’ll use our integrated data to alert reps care managers to help fill the important gap in care. So suggests coordinated medications like generic if needed, if that can help them save some money or to guide them to wellness or mental health counseling if needed. All part of the benefit. All part of our plan to help the whole person. And then it’s nice and fine to say that, oh, we’re doing this, but we don’t do this alone. We work closely with providers, nurses, doctors, specialists, and then that’s the next local pharmacist and I shouldn’t miss that. The other thing is, so when the patient calls up the other part of it during a medical appointment when our customers are sitting across from the doctor and the doctors are taking notes on a laptop and maybe they’re submitting a prescription. We make sure that they can see the actual medication on the plan, like real-time pharmacy benefits. They can see the drug is covered. Is there a generic alternative? Is there a therapeutic alternative? If our home delivery pharmacy can save money and offer a 90 day supply? So again, it’s all these touchpoints and all these products, because of the data integration and because of the benefits integration.
Kyle Wildnauer-Haigney:
Right. It’s really blending the innovative data solutions with high-quality health care services like care. It’s a combination. I feel we have so much going on in health care today. Some of these startups are only focused on providing some new app or some new data that feedback’s to a health care provider. But it’s really the combination of the two, the innovation on the technical front with high-quality care and a strong network like what CIGNA has that allows high-quality service. I guess I have one question for you is when you’re thinking about where the pharmaceutical value chain and really I should say that everything comes at encompassing or touching pharmacy, what are you most excited for in the future? I know there’s tons of challenges and change with some of these specialty medications and gene therapies. What are you kind of looking forward to the next five, 10 years?
Rajesh Manglani:
What excites me from now. It can be about the pharmaceutical marketplace and I’ll talk about that for then I want to broaden it to the whole house. It’s always a good thing, but it can be extensive. What I’m excited about is that more and more that are options for our customers and also provider side, typically multiple drugs that are used for the same condition, same outcomes. Not just generics. You probably know better than I do about the branded alternatives. And we’ll take every opportunity to tell our customers’ providers about these options as often as we can, online through coaches’, providers. Let’s bring that home. Let’s talk about people that are managing diabetes. And, you know, one of the things that I should have mentioned earlier when you asked why health care is one of the things that I always think about is every person I meet that I work in health care, it’s personal for them. It’s a unique industry. And not everybody either is already an active user or will be. So this is personal for us. So let’s talk about diabetes. Genetically, I come from a part of the world where we’re predisposed to diabetes. It runs in the family. So let’s talk about the US. The numbers in the US are alarming. Thirty-four point two million Americans, if I am not mistaken, are living with diabetes. One in five Americans, I still have a hard time believing this, but one in five Americans have diabetes. Many are undiagnosed. I think they may be having symptoms, but they haven’t seen a doctor or they haven’t gone through the regular blood work. And this is even prior to the pandemic. So let’s think about diabetes. The average annual cost for insulin is about five thousand seventy dollars, give or take, and about one in four people will ration their insulin because it costs. The issue with that is in the short term, first of all, they’re not taking of their health. In the longer term, it increases their health risk, increases the potential for E.R. visits and hospitalization. And so so what does that mean for us? We’ll take every customer interaction and we’ll try to make it count. When they call us or we call them. Always an opportunity to discuss more than just the drug. And we talk about cost. How can we help them? Cigna introduced the Patient Assurance Program, I think 2019, 30 is out-of-pocket costs. Certain drugs like insulin by an average of 40 percent. And our goal was to offer a 30 day supply for just twenty-five dollars. So remove that cost as a barrier for people. And ultimately, Health and medication decisions are between doctor and patient. We truly believe that. What I’m excited about is that there are choices on where to get care, what medications to take, ours is to provide all of these options in the most convenient, compelling way to our customers and the provider system so that there is no surprise at the pharmacy counter.
Kyle Wildnauer-Haigney:
And it sounds like you’re not only providing options but also information, data to help with that health literacy that you were touching on earlier. So enabling the customer to make an informed decision.
Rajesh Manglani:
Well, I was just going to say that. People don’t see their medical care and medications on mental health as desperate. It may be different benefit plans, but they don’t see it differently. They see a connector and they expect us and the employer to see that way, too. And this is where when a little bit of a soapbox and different carriers, it does have an impact. And again, I know I’m saying that because I’m on the integrated medical and pharmacy side of the house, but here’s an example. And if a customer qualifies for health coaching and they call out for our home delivery to ask about their drug, the visible verify the auto call, we can bring them to a health coach if we have that data, as you said. And of course, screen them for certain distress, certain other issues because of that data integration, because of the benefits integration. So, again, it does have an impact. Another thing that we and I’ll briefly touch on this is if you think about bad actors. Doctors writing prescriptions for a customer or the customer has no relationship with their doctor. You know, we can step in and investigate if we have that end-to-end viewpoint. And we do.
Kyle Wildnauer-Haigney:
That’s fantastic. And so, as you think about where the industry is today, especially from your role, kind of what are the biggest challenges that you are facing today? What keeps you up at night?
Rajesh Manglani:
Yeah, I’m going to go back to ask for a minute. Right. Pharmacy is currently the number one driver of health care costs. Sixty six percent of that is due to specialty medication. These are drugs that treat rare and chronic conditions, as you know, like M.S., rheumatoid arthritis cancer, or cancer for a second. These are often injectable drugs that are often injected or infused by a medical professional, not only specialty drugs expensive and growing rapidly, but patients who use them typically require complex clinical management. So multiple comorbidities. The good part of it is advances in drug therapy allow many patients with conditions created by specialty drugs to live decades longer. I’ll give you a personal example here. My grandmother, my maternal grandmother died of leukemia in her mid 50s, and it wasn’t even that long ago. About 25 to 30 years back. And again, if you think about it today, this wouldn’t happen. These advances in therapy, repeating myself will allow patients to live decades longer. But then there’s a cost to it. So how do you think about how about making it again, making it affordable, make predictable for our customers? Most specialty drugs don’t have generic alternatives. So when you think about the options that I talk to for these options are limited for someone with a complex condition. But one way we help is by offering biosimilars that are coming to market. These are generics in the same way that the chemically rather, but they are similar to costly, especially drugs in the market. So it’s exciting that biosimilars are beginning to have a meaningful impact. But how do you make the adoption of that happen? So when you think about making biosimilars the first-line treatment option, how do you move the needle on the back? How do we create a plan that drives affordability? How do we again, going back to what I said earlier, right site of care, ensuring that our patients are members or customers get the right treatment with the best outcomes at the best possible price. So how can we promote infusions in homes and doctor’s offices that coffee places? And again, I’ll just say this. You can treat one thing. You have to focus on all the conditions and mental health issues that can debilitate these customers. And also it’s just about making sure that they have access. So how do you bring this all together? That’s the work ahead of us, so to speak.
Rajesh Manglani:
Yeah, especially as pharmacy is the number one driver of costs, as you put it, with especially medications driving. It really sounds like that Right. treatment, the right side in the right price is really going to be key to making sure that as many patients can afford their medications and get the help that they need.
Rajesh Manglani:
Yes, it is a balancing act. It is putting the customer, the patient first, and looking at the whole person.
Kyle Wildnauer-Haigney:
That’s fantastic. And so maybe to wrap things up, if you could give us a closing thought and the best place that listeners can reach out to you and collaborate with you again.
Rajesh Manglani:
As I said, we go a little bit into pharmacy, but let me step back and zoom out a little bit. So this one view of the world that’s really, which says, oh, eventually there’s just too many of us. We’re all getting older, sicker, and costlier. And there aren’t that many resources. And to be honest, this is not in prior lives. I’ve looked at international markets. It’s not just a US-specific problem. You look at the UK or some of the other developed economies or even emerging economies like the Middle East, you do see this trend that we’re all getting sicker, older, and it’s going to get costlier to manage. And that’s one way of thinking about it. I completely reject that. Like the way, I think about if this is an opportunity for us to go back to what we’ve said, help patients stay healthy in the first place and make it easier for them and make the right connections between, you know, medical pharmacy, behavioural, mental health, social determinants of health. And you can take the horrible as it has been the pandemic. I’ll take that as an example of how it has shaved off years and years of adoption codes for some of some technologies or some innovations which will help being one of them. So by closing part is super optimistic about the future, super excited to be in this place and excited to be in the environment, or at a point in time where we’re starting to make those connections and actually starting to use our connections to help. The other part of the question of how and when listeners can collaborate with me, I believe that they might be LinkedIn. So I’m at LinkedIn.com/manglani. That might be the best way to connect with great overjust.
Kyle Wildnauer-Haigney:
Thank you so much for joining us on the podcast today. Have a wonderful day and hope to speak to you soon. Thank you.
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