Innovation and Value in Pharmacy with Chronis Manolis, Chief Pharmacy Officer at the University of Pittsburgh Medical Center Health Plan: Audio automatically transcribed by Sonix
Innovation and Value in Pharmacy with Chronis Manolis, Chief Pharmacy Officer at the University of Pittsburgh Medical Center Health Plan: 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. In the Pharma podcast, we dive into all the nuances of the pharmaceutical value chain. We will be highlighting and speaking with leaders across the entities that comprise the pharma value chain – health plans, PBM’s manufacturers, wholesalers, pharmacies, innovative pharma tech companies – discussing the current trends and the opportunities in the value chain that they see today. My goal is to give you, the listener, the opportunity to hear from the individuals that are shaping the pharmaceutical value chain. And with that, I’m very excited to be sharing these conversations with industry leaders and especially excited for our first guest, the formidable Chronis Manolis, Chief Pharmacy Officer at the University of Pittsburgh Medical Center Health Plan. Chronis oversees the pharmacy’s programs for health plans, Medicare, medical assistance, and commercial products. He has more than 30 years of experience in the pharmacy-managed care industry. He previously held management positions with Medco Health Solutions, Stadtlander’s Specialty Pharmacy Services, and Chronis is also an adjunct instructor at the University of Pittsburgh School of Pharmacy. Here’s a thought leader, a natural innovator, and I’m very excited to have him as our first guest on the Outcomes Rocket Pharma Podcast. So, Chronis, welcome to the podcast.
Chronis Manolis:
Thanks, Kyle, and happy to be here. Excited!
Kyle Wildnauer-Haigney:
Great. So maybe to kick things off, I’d love you if you could just tell me about yourself and specifically what drew you to working in the pharmaceutical industry.
Chronis Manolis:
So I’ve been in the pharmaceutical industry obviously for over 30 years. And what kind of drew me there was just wanted to be in health care and I wanted to be in service and my father was in the restaurant business. Pretty amazing. I got to work side by side with him to see how that service industry can make a difference in people’s lives. But I also was really, really interested in health care. And I had an uncle that owned a pharmacy and got the hang out there. And it was amazing to see the relationship between the pharmacist and the patient. And back in those days, probably still to some extent, patients looked at their pharmacists as just maybe as a substitute as their doctor or a proxy for their doc. And so it really drew to me. And so I went into health care. I went to the University of Pittsburgh School Pharmacy of my native Pittsburgh my whole life. And really, That’s kind of what drew me into the pharmaceutical industry.
Kyle Wildnauer-Haigney:
That’s so true. And you hear it a lot today that the pharmacists really act as that key individual in the patient’s life to help them coordinate some of their health care needs. Makes a lot of sense.
Chronis Manolis:
And so what’s interesting, I just add that I think COVID re-energizes the spotlight on pharmacy. We think about during the lockdown while procedures, elective procedures, hospitals, a lot of that was shut down, drugs and the importance of taking your drugs and even encouraged to make sure you have enough on hand in case you have to quarantine really put the pharmacy back in the spotlight and then you add the vaccines on top of that. And I think you really start to gain an appreciation back again for that pharmacists. So I’m really excited about that as well.
Kyle Wildnauer-Haigney:
Yeah. And would you say that’s kind of the main driver of what excites you with your work today? Is that the primary goal?.
Chronis Manolis:
You know, I mean, certainly, my early work and I work as a pharmacist on the south side of Pittsburgh, and it was one of those neighborhoods where people really did seek you out. And so that ability to help people one on one and that kind of community were really enriching to me. But what I do today is really just help a whole lot more people at the population level. Right? If you think about the type of drugs that we have today, the transformative nature of what our pipeline is, it is going to be curious and how do you make sure that people can afford them, people have access to them, not only patients but providers as well. And so I get to kind of help, but I get the help on a much broader scale to make sure that our blocks of membership have access to these therapies and really just make sure that the services we provide are always value add. And we kind of have the backs of our members and our providers.
Kyle Wildnauer-Haigney:
That makes a lot of sense. And so switching to UPMC Health Plan, what is it that UPMC does different than other plans perhaps in the market and across the country?
Chronis Manolis:
Well, I think managing pharmacy, managing a pharmacy benefit, all of that. So the product of pharmacy has had its traditional tools for a long time, and often those tools can be perceived as very straight, so things like prior authorization or high co-pays or things like that. Look, I’m not going to say that they aren’t necessary, they are because there’s only one dollar, and how do we make sure that people have access to the highest value products, the highest clinical profile product? But what we’re doing differently at UPMC is we are really driving towards what I call value, access, and engagement. So everything we do, value is at the center of it because we want to make sure today’s drugs are as important as ever. Just take a quick second and talk about COVID again, because it really shines the spotlight. Who was disproportionately affected by COVID? Communities, low socio-economic communities, diabetes, hypertension, cholesterol? And so those drugs having access to those drugs and having more. You think about diabetes drugs today. We have some of the best diabetes drugs we’ve ever had. Yet our outcome in diabetes is probably the number one risk factor for outcomes in COVID. So what is it that we’re not doing right there? So when I talk about access, how do we make sure that our members have access to the drugs that matter? And then engagement, right? So first it’s value, then it’s access, but then it’s engagement. So wrapping our pharmacies around those patients, those numbers, looking at it from a whole-person perspective. So not just can you afford med, but med education, you understand the importance of it. You know, you may not feel any different at all, but it’s really important that you continue to take it every day. Looking at the whole person, making sure we’re looking at the social determinants of health, looking at other barriers, all the things that I think get in the way of med adherence. I mean, we like the blame cost, but there are lots of other factors. And I think that that’s what we’re really trying to do differently because we think those other tools that I talked about, those are table stakes. But to be innovative and to get engagement, you really have to look at the patient, look at the member in the whole person sort of way.
Kyle Wildnauer-Haigney:
I love that. I always enjoy a good framework and value, access and engagement is certainly a nice, healthy way to really articulate how UPMC is innovative. I really do.
Chronis Manolis:
And I’ll tell you, we’re pretty fortunate. The ecosystem that UPMC has is pretty amazing. Right? So I’m part of a large health plan that has all of the products, everything from commercial to Medicare to exchanges to children’s health to special needs plans. But then we’ve got our health system, right? We’ve got 40 some plus hospitals and a whole provider network that I have access to. And then outside of that, we have an academic medical center attached to the University of Pittsburgh Medical School and School of Sciences. It’s quite An ecosystem. So I’m very fortunate. I’m living in an ecosystem that allows me to innovate. So we have that advantage. In our pharmacy area here, we created a center for Value-Based Pharmacy Initiatives back in 2017, and that center helps us with research, with decision support that actually takes pharmacy benefit management up a notch from a value and from an innovation perspective. So, again, very fortunate at UPMC to be able to be a part of this community, to be a part of this ecosystem. Now, it’s about really how do we engage and how do we allow access and value.
Kyle Wildnauer-Haigney:
And so looking forward, not just where you are, but in the future, kind of what excites you most about where the pharma value chain is today?
Chronis Manolis:
Well, I can tell you first and foremost, it is two things, right? One is this transformative drug pipeline. We are going to see cures. We’re going to have drugs that are going to change people’s lives. Providers, physicians, specialists are going to want access to these tools. And, of course, patients and our members will want access. It’s really exciting to think about drugs for hemophilia. Just look at the COVID vaccine. Where would we be without that innovation, right? But that innovation is going to come with a price tag. And we have this enormous responsibility for all of our clients, all of our stakeholders to make sure that we do the due diligence and make sure access to those drugs makes sense, make sure that they’re affordable, they’re accessible, that they’re safe. And so I think tomorrow’s brand of pharmacy is going to be much different than today’s brand.
Chronis Manolis:
I’ll tell you an interesting story. The five biggest drug categories in the world in the early 2000s were SSRI for depression, ACES for blood pressure statins for cholesterol, non-sedating antihistamines for allergies, and PPIs for gastric ulcer disease. If you think about that, they were the five biggest drug categories at a time when our pharmacy costs were through the roof. And if you look at those classes today, we give them away. They’re all generic. They’re all still very effective, but we give them away. So if you look at what’s driving today’s pharmacy costs, I think 20 years from now we’ll look back and we’ll say, wow. Because we didn’t have any specialty drugs in the early 2000s. And now half of our cost is being driven by one to two percent of our membership on high-cost specialty drugs that are for rare and chronic disease. And they are life-changing and life-sustaining. 20 years from now, we’re going to have cures. We’re going to have technology that we’ve never dreamt about.
Chronis Manolis:
And so how do we position our pharmacy management strategy to make sure that people have access to them and that we’re able to afford them because we’re not going to have what we have today with COVID, where the government is funding vaccines. It’s a pandemic. It’s an emergency authorization period. We’re not gonna have that. And so that’s really the exciting but very intimidating kind of thought about what the future is. But I look at polls where we’re engaging members. I look at technology. We’ve got a partner in Sempre Health that uses texting to give people refill reminders and to help them for their drug. We have digital therapeutics that are just on the cutting edge where patients can actually track their insulin dosing. We’ve got technology that does continuous glucose monitoring and patients are now so educated about what triggers are the drives their spikes in blood sugar. How do we just take all that burgeoning technology, which again, you couple that with a population of young folks that grew up with this and it’s not going to be an option? They’re going to want it. Look at the wearables that we’re having today. How many people look at their iPhones, see how many steps they use because it’s built-in. So it’s just really exciting to think about can we leverage these technologies in a way, again, that’s affordable, but also where patients and members want to use them. So I don’t have to. How do you get engagement and I keep using that word? But I think we’re going to grow so much smarter about what drives our diseases and it’s going to be aided by technology and digital therapeutics, and it’s going to be treated by drugs that are going to be truly innovative, personalized. And it’s just so different than where we are today from where we came from. And I think that’s what really excites me about the future.
Kyle Wildnauer-Haigney:
And so these new transformative and curative drugs in the pipeline, how will UPMC have to adjust to be able to support those high-cost prescriptions and ensure that their members get access to those?
Chronis Manolis:
Well, I mean, that could be a whole separate podcast, but let me try to sum it up fairly quickly. Right. So pharmacy and this may be a little bit more detail than our audience wants, but I think it’s important. Pharmacy, unlike medical. Think about the pharmacists that I talked about myself, right, so all those years ago, how I got paid was on drug margin. So drugs at a good price and I get paid at a decent price, that’s what keeps the lights on and pays the pharmacist salaries. If you look at what’s happening on the medical side of the equation, there’s been more value-based reimbursement. There’s more pay for value instead of pay for widget. And we’ve been really working hard at UPMC. Fortunate again to have leadership that supports me on this is how do we transform pharmacy from pay for widgets to pay value? I talked about those pharmacists again. The reason why pharmacists went into a dark place as a profession is because payers and everybody else in the supply chain made them feel more and more and more prescriptions to be able to make the same amount of money. And we ignored a clinical stakeholder because they were heads down in the back of the pharmacy just cranking out more volume. So how do we get away from pay for volume and pay for value? And I think that’s what we’re really excited about. We’re starting to do lots of those kinds of pilots with our retail partners. And so if you can get the pharmacy to kind of shift a little bit and go towards pay for value, and then we can partner with industry to do more value-based contracts. Let’s face it. These cures, we already have one. We have a drug that’s a two-million-dollar drug for SMA. The data we have, one that probably spans a couple of years. So it’s priced like a lifetime cure. We don’t have any data more than a few years, the science tells you that if you replace the gene or you replace the gene, you should have a lifetime of cure. But we don’t know that. So essentially, at the end of the day, what we need to do is we need payment reform for transformative therapies. We need warranty contracts that basically say, look, if the drug fails 10 years out, we’re entitled to this. If it fails 15 years out, we’re entitled to that. And if you get 15 years, we’ll call it a day. We don’t have anything like that today. We also need value pricing. Today, pricing is based on what the market will bear. Tomorrow, we need pricing that’s based on what it took to need all of those kinds of things. And at the end of the day, we also need to look at the supply chain and the site of care. And so much today in our supply chain is built on a thousand dollar drugs, not five hundred thousand dollar drugs. So how do we rightsize the supply chain? So there isn’t someone that’s making way too much because they’re leveraging a drug that is super expensive.
Kyle Wildnauer-Haigney:
That makes sense. And then when you’re thinking about let’s come more what we’ve just discussed, what kind of future-looking. But even today, what is top of your mind around the biggest challenges that you’re working on right now from your perspective?
Chronis Manolis:
I think, look specialty drug is all the headlines. But if you think about it, we have an aging population. We’re living longer. We do not want to be in nursing homes. And so everybody is incented to kind of keep people at home. There are a lot of data that they’re better off at home. But these patients, a huge amount of these members, they take greater than eight to 10 meds every month. And they’re often uncoordinated. They have multiple specialists and sometimes multiple pharmacies. And so UPMC, we started what we call high touch pharmacy services. And it’s specifically built for these kinds of numbers where we package them up, so we have the whole breakfast, lunch, and dinner pouches. So we know that when you organize your meds and you think your meds so as much as you can, all the refills happen at the same time. And then you organize them for people and then you surround them with what I call a micro-management pharmacy perspective. A pharmacist calls every month and says, hey, are you still taking your meds? Are you Ok? Have you fallen?
Chronis Manolis:
Have you gone out of the house? Do you have food? Do you have heat? If we can do that service, we know for our most medically vulnerable and highest-risk people, we will make a difference in outcomes, in member satisfaction, etc. So that’s just a microcosm.
Kyle Wildnauer-Haigney:
Sure.
Chronis Manolis:
When you think about one of the biggest challenges we’ve got that population, the specialty drug population. To me. it all goes back to engagement. How do we get closer to our members? Use technology in a way that supports it and plug them into the right service model? We know and we attract younger Medicare Advantage members. They’re generally healthy. And for them, gym memberships and other things are really what matters. But we’ve got a whole different set of patients across that continuum. And really it’s around engagement and access and value. So I keep going back to that. But really, I think that that’s it.
Kyle Wildnauer-Haigney:
And it’s unique to the patient population that you’re serving. So a one size fits all approach just doesn’t work in health care like we see across pharmacy and also health care services.
Chronis Manolis:
There is no substitute when pharmacists get engaged and take an interest in patients beyond drugs. Bring it full circle Kyle, one of the things that made me so successful in my first retail jobs and why I enjoyed it so much wasn’t that I was so successful, I just enjoyed my job was because you got to know your patient and you got to know them on multiple levels and you could understand what was going on with them and you could help them. I don’t think it’s much different. Twenty, thirty years later, we’re asking people to engage, get to know people better, take an interest because often their docs are super busy. They may not get the time. And so we know these. Drugs are a strong connection and pharmacies should be as well. So I’m excited about just bringing that all back from my purchase of payer. I have a responsibility to try to make that happen. And so typically providers, whether they’re pharmacists, etc., they have an adversarial relationship. But we want a partnership relationship because we know that stakeholder, we’ve ignored them for too long and I think we provide too much value.
Kyle Wildnauer-Haigney:
It’s this alignment right. It’s everyone working together to support the patient and doing what’s best for themselves and also the larger health care ecosystem.
Chronis Manolis:
It’s the care continuum, right? Seamless and everybody has incentives and everybody has a stake in that in the game.
Kyle Wildnauer-Haigney:
Well, Chronis, we have to wrap things up. You give us a closing thought and the best place for listeners to collaborate with you.
Chronis Manolis:
Well, certainly it is enormously exciting how pharmacies going to change and how the quality of life-changing all of those things are going to be, I believe, materially different going forward. And from my perspective, we’ve got to make sure that we take the values-centered approach to make sure people have access to these treatments and we don’t break the bank. So I think that that is an exciting and daunting challenge. We’re certainly up for it and we think we’ve got the right infrastructure here at UPMC to be able to tackle that challenge. So look forward to coming back again if you want to deeper into any one of these topics. But again, thanks for having me.
Kyle Wildnauer-Haigney:
Thank you Chronis for joining us today. And it was a great conversation, like always.
Chronis Manolis:
All right. Take care.
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