OR_Sempre Health_ Harry Travis: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Rich Prest:
Well, hello everybody, and welcome to the Sempre Health Podcast, Rich Prest here. I am very excited today to have with me a good friend and a remarkable character in the history of pharma, especially pharmaceuticals, Harry Travis. And he has a long and distinguished career in this space and looking forward to him sharing some of his wisdom with us all today and definitely to the conversation, as always. So, Harry, welcome aboard. Thank you so much for joining us today.
Harry Travis:
Hi, Rich, and thanks a lot for having me. It’s great to talk to you.
Rich Prest:
Likewise, yeah. So, Harry, you’ve had quite a remarkable career. I’m curious maybe just to start with, did you have like a dream career when you’re growing up? Were you one of these guys who wanted to be an astronaut or what was sort of, what you imagined yourself being when you were younger?
Harry Travis:
Yeah. I don’t know how you read my mind, but I did want to be an astronaut. In fact, I said to somebody the other day, I think I can name the seven original Gemini astronauts, … Carpenter and Wally Sharon, I don’t know who else. Yeah, that was my youth. But my mother was a nurse and I like science in high school, and she worked in a hospital and ran me around the hospital meeting all of the department heads, and the pharmacist was just the nicest guy I met. So I’m like, okay, I want to be like him.
Rich Prest:
So you went to pharmacy school, became a pharmacist, and then where did life take you after that?
Harry Travis:
Yeah, I’m a proud graduate of the University of Pittsburgh School of Pharmacy. My first job out of pharmacy school was working for people’s drug stores in Washington, D.C., which eventually got rolled up in the CVS, which turns out hit my career again. So it’s like, you know, life runs in circles. Then I went to the University of Virginia to get an MBA and really tracked my career through kind of corporate, a little bit of medical devices. First job out of Virginia was with Baxter in their IV Solutions Division and then kind of into specialty pharmacy through Cardinal or Accredo, Aetna specialty pharmacy, well, actually at Accredo, Medco, Aetna, specialty pharmacy, CVS. Just recently finished as senior vice president at CVS Caremark, where I ran all of the customer service operations and specialty in mail order pharmacy for Caremark, a mere 22,000 people on my payroll so that was a great run.
Rich Prest:
No, extraordinary, and when you look back over all those roles, do you have a sort of one that stands out as a favorite to you or?
Harry Travis:
The favorite was probably, although they were all great and great people all along the way, and I consider myself very fortunate, kind of, as Steve Jobs famously says, you can’t connect the dots going forward, you just look back and you can see how the dots all connect to get you where you are. His famous Stanford commencement address, I recommend everybody listen to that. But there was one interesting job I had, as you know, I left Aetna to run a startup that invented a microchip that you could swallow. So we, it was a spin out of the University of Florida, a microchip that could actually be ingested, powered up in your stomach, and sent a radio signal out of your stomach, like one meter out of your stomach. I’m the only person that you will ever meet who has eaten 100 computer chips. So I participate in all of our clinical trials. We got the product cleared by the FDA, but then COVID kind of slowed us down a little and I moved over into CVS, but that was probably the most fascinating job I’ve ever had, the CEO of etectRx, which is still alive and running and running clinical trials in different NIH sites.
Rich Prest:
Yeah, I actually had the pleasure of catching up with Eric Buffkin the other day and we actually recorded an episode for this podcast.
Harry Travis:
Oh, good!
Rich Prest:
So that’ll be going live soon.
Harry Travis:
We will have to see you at JPMorgan. Most of us are going to be at JPMorgan in January.
Rich Prest:
That would be awesome, Yeah, be glad to have that event be, actually happened.
Harry Travis:
Yeah, right, right, right.
Rich Prest:
Oh, cool, and then in terms of are there any particular career accomplishments that stand out to you as ones that you’re most proud of?
Harry Travis:
Yeah, oh, the Accredo. Just my time at Accredo at the very early stage of specialty pharmacy. So when I was Accredo, we had maybe four products, we had, we were literally launching Biogen’s, Avonex, Genzyme, Sarazin, Genentech, …, when, PBMs had no idea. Well, even PBMs were in the early stage, this was the early aughts. This is ’01 and ’02, so using FedEx to deliver high-cost meds to patients’ homes every day was an adventure in terms of reimbursement, logistics, and all of that. And again, at the time, we were just doing what we thought we needed to do, had no idea that this would become the mouse that ate the industry. At the time, specialty pharmacy, it was like, what are you guys doing over there? We’re not paying attention to you. Who the heck are you? And now look at specialty, so that was one of the really interesting points to look back on and say, you really, everybody needs to kind of be in the moment and understand essentially what’s going on and how pivotal what you’re doing really could be.
Rich Prest:
Yeah, absolutely. Yeah, it’s remarkable to think that it’s actually a relatively very short history that specialty has been around for, and just amazing to see it grow to 50% of drug revenue. So I think it’d be interesting to think about for your, as you continue on your career now, are there things you still want to do in healthcare, or is there what’s sort of the current focus?
Harry Travis:
There is a lot I want to do, and one of the things I need to determine is what I want to do. You think anyone who is in healthcare, regardless of your profession or your niche, is fortunate in that you are in an industry that is just constantly growing, just the demographics, the tailwind is there. Now, there’s lots of challenges and lots of frustrations, but the foundational concept of trying to help people lead better, healthier lives is great, and the aging population is just driving this industry to need more and more services, more and more innovation. So one of the things that I’m trying to do is collect all my, where I’ve been, what I’ve done, I kind of jokingly refer to myself as, I know a little bit about a lot, and how do I do that? And one of the things you and I talked about is I’m going back to school to take formal training on how to be an executive coach. Anybody can hang their shingle out and call themselves an executive coach, but Brown University has a very good executive coach development program, so I’ve got the time to do that, so I’m going to do that, and that starts in September. And hopefully, I can help some young CEOs guide, I can show them the scars, and maybe have a more disciplined approach to help them along the way.
Rich Prest:
Fantastic, now that’s, that’s very exciting. Yeah, I think coaching is being, yeah, there are so many folks out there doing it, and yet I think there is enough now to know there’s a little bit of a science behind it, and getting some proper qualifications is a great thing. So awesome, well, wish you all the best with that. So let’s pivot a little to the enormous topic of US healthcare, and is there anything that you think is something that perhaps the general public doesn’t really understand about US healthcare? I mean, I think there’s a lot of public debate focused around drug prices, but you think there’s things that people are just missing in terms of an understanding about what’s really driving US healthcare and class inequality? Yeah.
Harry Travis:
I guess I would pick, as one topic, I mean, like I say, we could spend all day, lots of people do spend days, so I was trying to figure this out. I would pick the topic that so much of healthcare is paid for by somebody else. Now, unlike practically every other market of services or products that you buy, healthcare is this interesting market where there is a third-party payer, there’s somebody else that’s in the middle, and that just creates so much confusion, obscurity, lack of transparency in every market, whether it’s a medical market or a pharmacy market. Bring it around the pharmacy, and it’s, it really is a jungle for the average person to understand. And that’s really where I’m going to try to spend my time helping where wherever hand companies, whoever, navigate that space.
Rich Prest:
Yeah, no, I think you’re right. It’s, I mean, we certainly find that to, the, with respect to patients, they almost think the price of the drug is what they have to pay out of pocket at the pharmacy, not the actual cost of the drug, and yeah, so it’s really I think to your point, we have a third-party payer. People tend to, it creates some interesting incentives, and many of that, much of that probably contributes to the shape of the industry today.
Harry Travis:
Right. Not to, just kind of stay on this point for one second, not to bring up a competitive podcast, but there’s room for everybody. I was listening to the 46 Brooklyn broadcast.
Rich Prest:
Oh, they’re great, those guys.
Harry Travis:
A nine-part series just on the nine different prices a drug can have. Each podcast is a different, …, AWP, …., ASP, UNC, just, that in and of itself just tells you how bad things are, that we have to have nine podcasts to explain pricing.
Rich Prest:
That could almost be a sort of a semester course at a university, couldn’t it? Just that section alone, yeah, fascinating. So if you had the ability to sort of wave the magic wand and change anything in the healthcare scene, what do you think would be the area that you would target?
Harry Travis:
My, and it would be a small magic wand and I would just target it on one little area, and it’s just an area of personal interest right now. It’s, I’m really intrigued by these cash-only pharmacies that are popping up. And, you know, is there enough kind of juice in that squeeze for that niche to develop a transparent model for drugs? Are there enough generic drugs? Well, I think there are, yeah. Are there enough patients who want to kind of go that route? And how do you connect the two dots? How how do you get those patients to understand there is a market, there are payers or providers out there, be it anybody from little old blueberry pharmacy in Pittsburgh to Mark Cuban. And where is it? There was something on NBC, just recently, I just saw an NBC news clip on, at some other pharmacies in Ohio, there’s, somebody’s got side-by-side pharmacies. It’s kind of like, go back to your chemistry days. You got L-isomer, and R and R isomer of your pharmacy. One is in plan and the other is out of plan. Door A or door B, do you want the red pill or do you want the blue pill?
Rich Prest:
Yeah, no, it is fascinating, right? And I think we’ve seen a lot of these other start-ups, but the HIMSS and ROE and all these others, like taking little niches of health where people are willing to spend the money themselves to deal with it. And then I think good Rx has been another interesting area of sort of showing that sometimes the non-insurance price can be better than the insurance out-of-pocket, and so I think yeah, really interesting to see how far that whole area can go. And I think as we see more and more deductibles and cost-sharing being pushed onto patients and commercial insurance, I think there’s going to be lots of folks trying to work out, Is there a cheaper way for me to get access to my meds?
Harry Travis:
There is an argument that, okay, in total, there are somewhere around 6 billion prescriptions written in the United States. If you normalize to a 30-day supply, say, each 30-day supply is a prescription. There’s somewhere around 6 billion prescriptions. Easily 4 billion of those prescriptions are generic and most of them are really cheap, and it’s not worth the processing to run a claim.
Rich Prest:
Yeah.
Harry Travis:
So you can make the argument that 4 billion prescriptions are non-insurable events, run of this cash. Now, how do we capture adherence and how do we do medication therapy management? It’s not just as easy as saying make it a free for all, but there’s other ways that that could be done as well for maybe a service fee where you’re actually getting a fee for the service of a pharmacist, which kind of takes us to the whole area of pharmacist provider status rather than getting paid on the margin of the drug, So there’s so many different forces. Kind of a play in this market right now, generics, pharmacy provider status, the fragmentation, like you say, ROEs, hers, HIMSS, etc., etc., etc.
Rich Prest:
Yeah, yeah, no, it’ll be really interesting to see how that sort of consumerization of healthcare continues to continue to develop, but yeah, it will be interesting times. So obviously you’ve had through the experience, some experience of trying to scale innovation in the industry, and I’m wondering what you see as some of the sort of key challenges to bring in innovation into the industry and scaling it, and some lessons learned from that, yeah.
Harry Travis:
The most important question, I think, to any innovator, entrepreneur going into healthcare is who’s going to pay for it? Who is going to pay for it? Like I said, this is such a jungle of a payer environment in terms of, okay, is the patient going to pay for it? Is the physician going to pay for it? Is pharma going to pay for it? Is the health plan going to pay for it? And if it’s the health plan, is it the plan, or is it the plan sponsor? Is it the employer? I think that that question vexes everybody. And it’s easy as an, at least in my experience, what I’ve seen, it’s very easy to get pilots in a pilot study, and then you can enter this cycle of death and you’re in pilot hell for God knows, and everyone loves your pilot, but wait a minute, I’ve got to make some money on this. That I would say is what I would tell people to focus on. Who’s going to pay for it?
Rich Prest:
I think that’s very sage advice. So many of these digital health startups have failed because they just thought, well, we’ll bring in good technology and that’s all that matters and it’s helping people and yeah.
Harry Travis:
Right, right, right. The logic of it is sound. This is just got to work, you know? Sorry. I talked to the people at Betamax.
Rich Prest:
Yeah, exactly, exactly. Well, we’ve touched on some of the, I think this definitely sounds like that’s one area that you’re focusing on in terms of sort of key trends and developments. Are there any other sort of trends, developments, regulations that you’ve got your eye on that you think will have a very significant impact in the next few years?
Harry Travis:
Well, one trend that everyone’s kind of watching is the gene therapy trend. I think that we’re standing at a very interesting space in history right now. It’s almost like we’re at the dawn of antibiotics or the dawn of steroids with the first patients have just been dosed in New Zealand on this gene therapy that knocks out or somehow or another, edits the base for the PCSK9 gene. So Verve Therapeutics, Cambridge based, has just dosed their first patient or maybe multiple patients. So imagine a world where a one-hour infusion one time will permanently lower your cholesterol. Just think about what that’s going to do. I mean, and these guys and gals at these gene therapy companies now have the technology to edit a single base pair on your DNA.
Rich Prest:
That’s extraordinary.
Harry Travis:
Right, it’s really early stage, it’s not getting a lot of press, but wow, just think about what that means. So that’s one area that I’m just paying attention to, to learn as much as I can each day. And the information is really flowing fast as these, it’s almost like you need to walk the streets of Cambridge, Massachusetts, and, you know, you sit in a couple of Starbucks because so much of it is going on up there.
Rich Prest:
Yeah, yeah, I think certainly all these sort of single gene conditions that are out there seem like obvious first targets, and then I gather there’s some thoughts about what’s the best way to handle the sort of the transport issue within the body. But yeah, I think, it’s fascinating, and of course, we’re back to who pays for it again, right? Because all of these things.
Harry Travis:
Exactly, it was bluebird who just got the approval for the beta thalassemia drug. It was a bluebird, two-plus billion or two-plus million, four? And … said that’s economically reasonable. I was just reading an article where they said, okay, a beta thal patient is going to chew up 6 million dollars in drug and medical costs over their life, two and one-half million or whatever it is, I’m guessing that the number is two plus million, is kind of reasonable. Okay, so are we ready for all of those patients that the system at once?
Rich Prest:
Yeah, yeah, well, I do remember the stories about, with the first spinal muscular atrophy drug that it was messing up the economics for hospitals because they were banking on being able to, you know, squeeze the commercial side, and the problem was most of the patients were coming in as Medicaid patients, and so they were losing their shirt on these drugs. So you couldn’t, there weren’t enough commercial patients to do the multiplication to make the money back, and so, yeah, crazy stuff.
Harry Travis:
There are multiple laws of unintended consequences that will get played out here.
Rich Prest:
Totally, totally.
Harry Travis:
The other, at the other end of the spectrum, you asked the question what am I interested in? One is just kind of following gene therapy, the other is just the PBM market in general and the potential for either incremental or radical change from either market forces, the innovators coming in and creating something really innovative, or the regulators. You’ve got an FTC inquiry started now on Big five or six PBMs. Practically every state attorney general is trying to get a notch or a scalp on their wall of doing something to the PBMs. So having been inside one and I’m not speaking specifically to CVS Caremark, but all of them, I believe, feel like they’re, you know, it’s death by a thousand cuts with all these states going after them. So as always, in healthcare, you got to keep an eye on the regulators because who knows what one election will bring in terms of moving the needle one way or the other?
Rich Prest:
Yes, yes, indeed. Yeah, we, it’s getting hotter and hotter to predict what will happen in the future, that’s for sure. Great, well, Harry, this has been super fun to have this conversation. I’m wondering if you have any recommendations for someone wanting to start a career in life sciences or healthcare? What would you say to someone?
Harry Travis:
I would tell them the more you are willing to be a lifelong learner, the better you will be, the more fun you will have, because this is an industry that is constantly changing. It’s driven by technology and innovation, and if you want to kind of get ahead, you’ve got to almost allocate a certain percentage of your time. So I just got to X percent, whether it’s 5 to 8, 10%, I’ve got to just be reading and learning and talking to people because there’s no straightforward path. Of course, there’s lots of people who say, okay, I’m a 30-year veteran of X, Y, Z company, that’s rare and kudos to those who are those individuals. But on the other hand, it’s usually you’re connecting, you’re looking back over your career and there’s four or five, six, seven, eight stops. So if you’re going to get into the business, make sure you’re ready to learn as much as you can. Do not be intimidated by the technology. As you and I know there’s lots of people who’ve done spectacularly well in the pharmacy business, and they’re not a pharmacist or they’re not a nurse. And there’s room, plenty of room in this business, where smart people who are willing to learn and apply kind of their inherent skills. So my advice would be a lifelong learner.
Rich Prest:
Yeah, I think that’s, for any path you go to, a very, very good advice. Are there any particular books or podcasts that you’d recommend, maybe you’ve recommended the most, or would point people to, you think are great resources? Yeah.
Harry Travis:
You know, one of my favorite management books that I’ve always used is Patrick Lencioni’s The Five Dysfunctions of a Team.
Rich Prest:
It’s a great read, yeah, yeah.
Harry Travis:
Easy, real simple, you know, kind of highlighting the value of trust from a management standpoint. And as you know, I’m a big fan of podcasts, it’s just kind of growing.
Rich Prest:
Yeah.
Harry Travis:
Oh man, yeah, yeah. So another, a couple in this in this field, the Pharmacy Podcast Network is kind of a cool, eclectic mix of people in pharmacy. The, if you want to go to the other end, you and I are fans of the All-In Podcast, a bunch of billionaire tech entrepreneurs talking about lots of startups. If you can sift through the politics, there’s good startup advice in that one.
Rich Prest:
And good global macro trend analysis as well.
Harry Travis:
And stats podcast, … podcast, the Read Out Loud. It’s a great weekly podcast for kind of watching FDA in biotech and pharma and it’s just kind of irreverent enough that it’s not really dry. They are, they don’t take themselves too seriously, which I really like.
Rich Prest:
Indeed, indeed, awesome. Now, where can listeners find and connect with you? Where’s the best place for them to get in touch if they want?
Harry Travis:
It’s easy to find Harry Travis on LinkedIn. That’s probably the easiest to reach out to find me on LinkedIn or at Harry@TravisGroupLLC.com, but LinkedIn is a lot easier.
Rich Prest:
Awesome, well, thank you so much, Harry. As always, it’s a total joy to have a conversation, and I hope we’ll have many more going forward, but yeah.
Harry Travis:
Likewise, this was a lot of fun, thank you.
Rich Prest:
You’re welcome, now, I really appreciate having you on. And thank you to all the listeners for paying attention, and I hope you got something out of this conversation with Harry, and we look forward to seeing you again online. Okay, thank you, everybody.
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