Latest / Becker’s Healthcare Podcast / Denise Scarpelli, PharmD, MBA, CPEL, Vice President and Chief Pharmacy Officer at UChicago Medicine

Transcript

Denise Scarpelli, PharmD, MBA, CPEL, Vice President and Chief Pharmacy Officer at UChicago Medicine · Becker’s Healthcare Podcast

• 0:02
  - Pharmacy has long been viewed as a cost
• 0:03
  - center, but that framing is starting to shift,
• 0:06
  - and chief pharmacy officers are driving the change.
• 0:09
  - Don Wright, pharmacy is one of the most
• 0:11
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  - has. The question is whether its leaders can
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  - that window closes.
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  - the top. You can earn up to 6.67
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  - in Chicago.
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  - Register on our events page at beckershospitalreview.com
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  - by clicking on the events tab in the
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  - upper right.
• 0:59
  - Welcome to the Becker's healthcare podcast. I'm Ella
• 1:01
  - Jeffries, reporter with Becker's healthcare.
• 1:04
  - Today, I'm joined by Denise Scarpelli,
• 1:06
  - vice president and chief pharmacy officer at UChicago.
• 1:09
  - Denise, thanks so much for joining me. To
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  - start, can you please introduce yourself and just
• 1:13
  - share a bit about your role and your
• 1:15
  - responsibilities?
• 1:17
  - Sure. Hi, everyone. I'm Denise Scarpelli. I'm the
• 1:19
  - vice president and chief pharmacy officer at University
• 1:21
  - of Chicago.
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  - I've been in this role about four years,
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  - and I'm have enterprise oversight to oversee
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  - our main hospital campus,
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  - our Comer Hospital,
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  - our Ingalls Hospital that's on in Harvey, and
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  - also our Micro Hospital, which is in Northwest
• 1:37
  - Indiana.
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  - Oversee day to day operation strategy,
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  - oversee the finances and growth,
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  - and anything that touches pharmacy is under my
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  - oversight.
• 1:49
  - Great. Thank you so much for that introduction.
• 1:52
  - Now to start the conversation, I love to
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  - look to drug spend,
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  - specifically the trajectory
• 1:58
  - of drug spend and, you know, which categories
• 2:00
  - you believe are driving it. There's been numerous
• 2:02
  - reports that drug spend is on the rise.
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  - So just curious to hear your thoughts on
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  - this.
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  - Yeah. It's funny you asked this. I just
• 2:09
  - wrote a, an editorial for another publication around
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  - drug spend.
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  - And, really, drug spend is up, but, really,
• 2:16
  - due to utilization.
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  - Everyone thinks it's due to inflation, and it's
• 2:20
  - not inflation. Inflation of drugs have been flat,
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  - but it's really it's the new therapies that
• 2:26
  - are coming to market that are expensive.
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  - GLP ones is really driving
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  - the drug spend,
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  - gene and cell therapies,
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  - biosimilars.
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  - So it's really we're seeing an increase in
• 2:37
  - utilization
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  - in clinics,
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  - retail specialty and mail,
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  - and all the new therapies that are coming
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  - to market
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  - that are very expensive is really causing
• 2:49
  - the cost of drugs to increase. And I
• 2:51
  - think last year was one of the years
• 2:53
  - that was the highest cost
• 2:55
  - increase in drug cost, and it's really due
• 2:57
  - to all the new expensive therapies coming to
• 2:59
  - market.
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  - Gotcha. And what are some ways that that's
• 3:03
  - hitting health systems directly?
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  - Obviously,
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  - GLP-one
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  - is hitting the health systems,
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  - and this is really all the drug expenses
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  - really increasing on the outpatient side. On the
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  - inpatient side, a lot of health systems have
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  - done a really good job on drug formulary
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  - management, so really keeping that drug spend down.
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  - Also the gene and cell therapies, more and
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  - more come to market. Some of those have
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  - a million to $2,000,000
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  - price tag on it. So that's really causing
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  - the increase
• 3:36
  - of drug spend in health systems.
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  - Also, a lot of the infusion drugs or
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  - biosimilars that we're administering in a lot of
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  - our clinics for infusion
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  - is also driving that increase in drug spend
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  - for health systems.
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  - Gotcha. Thank you so much for sharing. More
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  - on that.
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  - And speaking of GLP ones, I'm curious how
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  - are GLP ones landing in your budget and
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  - your formulary right now?
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  - So on the outpatient formulary, it's an open
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  - formulary.
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  - On the inpatient side, we have it restricted.
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  - We call it a non formulary request.
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  - A lot of these therapies don't need to
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  - be started on the inpatient side and the
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  - patient can be waited till they get discharged.
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  - About a year and a half ago, because
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  - we've seen such an influx of this, we
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  - started a program called pharma fit. So it's
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  - a referral that goes to our pharmacist.
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  - We have a team that manages,
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  - the GLP ones for our patients.
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  - So any clinic or provider can send a
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  - referral,
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  - and the pharmacist will work with the patient
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  - to make sure that they're getting it covered.
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  - It's the right one based on that patient's
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  - plan, and then they also track the patient
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  - if the patient's getting the GLP for weight
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  - loss. They're making sure the patient's hitting their
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  - goals.
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  - A lot of obviously, some of these patients
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  - are getting it from the other therapies such
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  - as diabetes or sleep apnea.
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  - There's so many new indications, but we have
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  - a whole program to manage it on the
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  - outpatient side,
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  - but we're not really starting therapy on the
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  - inpatient side because it's not really needed, and
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  - it helps us keep our drug spend down.
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  - Gotcha. Yeah. And a very important part to
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  - keeping drug spend down. So thank you for
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  - sharing.
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  - And you touched on biosimilars
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  - as well. I'm curious, you know, where has
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  - biosimilar adoption gone well for UChicago and, you
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  - know, where have you seen it stalled and
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  - kind of hope for it to grow more?
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  - Yeah. So biosimilars, when they first came to
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  - market, I think everyone was excited for them.
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  - And everybody it was a slow go. And
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  - I think a lot of the times what
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  - we discovered was as a health system, you
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  - might pick one biosimilar for your your drug
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  - formulary,
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  - and then you realize not every payer picked
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  - that drug for their formulary.
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  - So about two years ago, we decided that
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  - we would go back and,
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  - create a payer adaptive model. So we carry
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  - multiple biosimilars in the same class based on
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  - what Medicare, Medicaid, or commercial is paying.
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  - And so when a patient is,
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  - referred one of the biosimilars
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  - based on
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  - their payer,
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  - we pick which biosimilar
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  - is covered on their plan. It is more
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  - time consuming for us and
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  - have to keep more inventory,
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  - but it is working and we're starting to
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  - see more adoption of this. And you see
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  - this across many health systems across the country
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  - that you're starting to see the growth or
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  - utilization
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  - of biosimilars.
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  - But I would say the first couple years
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  - it was slow to go and it was
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  - really because there were so many different biosimilars
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  - and everybody was picking one and it really
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  - wasn't covered in all plans. And, you know,
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  - it's good that sometimes when all payers prefer
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  - the same one, but we're not seeing that
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  - across the board. So,
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  - we call it a payer adaptive model for
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  - biosimilars.
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  - Gotcha. Well, I'm glad to hear that it's
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  - you're starting to see some success in some
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  - areas with that.
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  - And now turning I like to turn to,
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  - you know, drug shortages, you know, coupled with
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  - the trajectory of the drug spend. It's another
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  - thing that's definitely top of mind for pharmacy
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  - leaders. So I'm curious, you know, what's the
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  - state of shortages in your opinion compared with,
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  - say, a year ago,
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  - and where do you see it going in
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  - the next year?
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  - Yeah,
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  - so to me I feel drug shortages have
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  - not improved.
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  - I would say if I look over a
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  - year ago maybe they're getting worse or there's
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  - more,
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  - I would say, life
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  - saving drugs that we're seeing that's coming on
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  - shortage.
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  - Obviously, most of them are generics and some
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  - of these were long term generics like the
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  - carboplatin,
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  - cisplatin, some of the oncology drugs.
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  - It's becoming
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  - that also is tying into drug
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  - expense because obviously now we have to find
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  - something else. Some of these don't have an
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  - equivalent. We're going back to the brand name
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  - drug of that.
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  - Now we're seeing a new surge called five
• 7:46
  - zero five b two's,
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  - which is
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  - companies that are developing drugs similar to that,
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  - that go through the
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  - can bypass the FDA approval, but they're more
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  - expensive.
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  - But these are drugs that we have to
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  - have. I mean, these patients need it to
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  - save their life,
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  - so we're seeing a higher expense with that.
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  - But my team meets three days a week,
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  - to review all the drug shortages. It's very
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  - labor intensive.
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  - We're constantly moving therapies,
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  - and keeping an eye on it. So I
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  - don't see it getting better.
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  - I actually feel that it's been pretty consistent,
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  - but this past year there's just been more
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  - concern
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  - of drugs that there's not an alternative. So
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  - we have to come up with a better
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  - solution for these patients because
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  - they are life saving drugs.
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  - Definitely. Couldn't agree more.
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  - And you mentioned, you know, meeting with your
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  - team. I'm curious, are there any other aspects
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  - of pharmacy leadership
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  - that people outside maybe never see or don't
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  - think of that are really important to the
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  - day to day for you?
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  - I think when people think that we're pharmacists,
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  - that we're just, you know, in a pharmacy
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  - pulling drugs off the shelf, filling it in,
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  - getting it to a patient.
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  - But even thinking about drug shortages, you know,
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  - you need a group of clinical pharmacists to
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  - get together
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  - to determine, you know, if we can't get
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  - this drug, what are we gonna switch to?
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  - And how do we operationalize
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  - that? And getting that drug from the manufacturer
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  - or the wholesaler and switching
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  - it in our EMR system and maybe in
• 9:21
  - our automation. So there's a lot of behind
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  - the scenes work that goes on to make
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  - sure that the right therapies are getting the
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  - patients.
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  - Also as new drugs come to market, you
• 9:31
  - know, we just don't carry them all. We
• 9:33
  - wanna make sure that they're safe and effective,
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  - that they're cost effective.
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  - So there's a lot of, work that goes
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  - behind the scenes to make sure that we
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  - are being good stewards of how we spend
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  - money and how we're procuring drugs and how
• 9:48
  - we're billing insurance companies. That's always so important
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  - for us to
• 9:52
  - move to the payer adaptive model for biosimilars
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  - because it's the right thing to do for
• 9:56
  - health care, right thing to do for patients
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  - and payers. So there's a lot of behind
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  - the scenes that I don't think people realize
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  - that goes into pharmacy.
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  - The other thing is pharmacies,
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  - probably one of the resources of health systems
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  - that are bringing in, you know, additional revenue.
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  - So expanding specialty pharmacy, building infusion centers,
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  - making retail pharmacies.
• 10:17
  - A lot of large health systems are now
• 10:19
  - in pharmacy deserts, so we become
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  - the
• 10:23
  - community pharmacy for that community that we're in
• 10:25
  - because, you know, a lot of the big
• 10:25
  - box retailers have pulled out.
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  - So pharmacy is a strategic arm for a
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  - lot of health systems
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  - to continue to service our patients in the
• 10:35
  - community.
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  - Definitely. And with that, you know, you mentioned
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  - the expansion of pharmacy including, you know, specialty
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  - and retail.
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  - And, you know, with that expansion, you need
• 10:45
  - the workforce to expand with it. I'm curious
• 10:48
  - how is the pharmacy workforce holding up in
• 10:50
  - your opinion,
• 10:52
  - and, you know, also where do you see
• 10:54
  - that trajectory going in the future?
• 10:56
  - Yeah. It's been a challenge. I would say
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  - over the last six years, it's been a
• 11:00
  - very hard to recruit pharmacists,
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  - hard to recruit technicians. We rely on technicians
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  - a lot both on the inpatient and outpatient.
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  - A lot of our technicians help our patients
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  - with med access and affordability.
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  - So it's it's been difficult to recruit. You
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  - know, we're competing with other
• 11:17
  - health care organizations, but also other health care
• 11:21
  - entities, meaning like, you know, nurse there's this
• 11:24
  - you know, it's sometimes hard to get nursing
• 11:26
  - and it's hard time to get providers. So
• 11:29
  - when you talk to a lot of the
• 11:30
  - pharmacy schools, their enrollment is down. So it
• 11:33
  - concerns me long term. Are we going to
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  - have enough pharmacists to be able to cover
• 11:38
  - everything that we need as health care continues
• 11:40
  - to grow?
• 11:41
  - But also technicians. So we look at strategies
• 11:44
  - every day of, you know, can we create
• 11:46
  - an a program internally
• 11:48
  - where we train maybe other
• 11:50
  - individuals that maybe want to be a pharmacy
• 11:53
  - tech? Can we encourage our pharmacy technicians to
• 11:55
  - go to pharmacy school? So where is the
• 11:57
  - pipeline?
• 11:58
  - But I feel that the last six years,
• 12:00
  - it's been a challenge and it's not only
• 12:02
  - in Chicago, I would say it's national and
• 12:05
  - everyone needs to figure out how do we
• 12:07
  - continue to increase the pool, but also look
• 12:10
  - at tools to create efficiencies. Can we use
• 12:13
  - automation?
• 12:14
  - Can we use AI to do some of
• 12:16
  - the the manual tasks that
• 12:18
  - that we could repurpose people to do more
• 12:20
  - clinical function? So I think that's gonna be
• 12:23
  - some of the long term solutions is really
• 12:25
  - using AI or automation,
• 12:27
  - because I think the workforce is gonna continue
• 12:29
  - to be a struggle.
• 12:31
  - Gotcha.
• 12:32
  - Well, thank you so much for sharing all
• 12:34
  - these insights with me and giving a really
• 12:36
  - nice lay of the land of the current
• 12:37
  - state of the industry right now. That's all
• 12:40
  - the time we have for today's episode of
• 12:41
  - the Becker's Healthcare podcast.
• 12:43
  - Big thank you again to Denise for joining
• 12:45
  - us. Thanks everybody for listening, and we will
• 12:47
  - see you next time.
• 12:49
  - Thank you.