Latest / Becker’s Healthcare Podcast / Michael Evans, RPh, MBA, FASHP, Chief Pharmacy Officer for Enterprise Pharmacy at Geisinger

Transcript

Michael Evans, RPh, MBA, FASHP, Chief Pharmacy Officer for Enterprise Pharmacy at Geisinger · Becker’s Healthcare Podcast

• 0:00
  Welcome to the Becker's pharmacy leadership podcast. I'm
• 0:03
  Ella Jeffries, pharmacy reporter with Becker's Healthcare.
• 0:06
  Today, I'm joined by Michael Evans, chief pharmacy
• 0:09
  officer at Geisinger.
• 0:10
  In this episode, we'll be talking about key
• 0:12
  pharmacy initiatives from the past year, the priorities
• 0:15
  and headwinds leaders are navigating as they plan
• 0:17
  for 2026,
• 0:18
  and where opportunities for organizational growth are emerging.
• 0:22
  Michael, thank you so much for joining me
• 0:23
  today. To start us off, can you introduce
• 0:26
  yourself and share a bit about your role
• 0:27
  in Geisinger's pharmacy organization?
• 0:30
  Sure. Thank you, Ella, and good afternoon, everybody.
• 0:32
  So Mike Evans, I'm a pharmacist by training,
• 0:36
  currently serve as Geisinger's chief pharmacy officer. I've
• 0:39
  been here at Geisinger for a long time,
• 0:40
  over thirty years in multiple roles,
• 0:43
  and truly lead a team
• 0:46
  of over 500 pharmacists
• 0:48
  and,
• 0:49
  over a thousand technicians
• 0:51
  and, you know, in the care of of
• 0:54
  patients and our communities, which Geisinger serves. A
• 0:57
  little bit about Geisinger, so we are an
• 0:59
  integrated delivery network. We have 11 hospitals,
• 1:03
  primary care specialty clinics,
• 1:05
  and, we are spread across Northeastern And Central
• 1:09
  Pennsylvania.
• 1:10
  From a pharmacy services perspective,
• 1:13
  we have about everything you can think of,
• 1:16
  from delivering pharmaceutical services. So we have retail
• 1:19
  pharmacies,
• 1:20
  specialty pharmacies,
• 1:21
  home infusion pharmacies,
• 1:23
  mail order pharmacy.
• 1:25
  We have clinical pharmacists embedded in primary care
• 1:28
  and specialty clinics,
• 1:30
  on in involved in direct patient care, obviously,
• 1:33
  infusion pharmacists, and and, we have pharmacists,
• 1:36
  embedded in our hospitals and rounding and so
• 1:38
  forth. And,
• 1:40
  you know, truly blessed, to have the support
• 1:42
  of our leaders at Geisinger to have such
• 1:44
  a robust team,
• 1:45
  of pharmacy experts,
• 1:47
  to serve our patients in our communities.
• 1:50
  Great. Thank you so much for that context.
• 1:52
  Now looking back over the past year, what
• 1:55
  was the most important initiative that you led?
• 1:57
  What did you focus on and what results
• 1:59
  did you see?
• 2:01
  Oh my gosh. I know,
• 2:03
  2025
• 2:03
  was,
• 2:04
  you know, just, another year,
• 2:08
  of complexity
• 2:09
  in managing,
• 2:11
  pharmacy services.
• 2:12
  I think you're a little more complex as
• 2:15
  being an IDN.
• 2:16
  You know, 2025,
• 2:19
  you know, we had the Inflation Reduction Act,
• 2:21
  from a payer perspective,
• 2:23
  and how that impacted,
• 2:25
  you know, our managed care portfolio, particularly our
• 2:29
  Medicare population.
• 2:31
  You know, and thinking about what we had
• 2:33
  to do from a benefit structure,
• 2:36
  to
• 2:37
  understand the risk, the risk to the patients,
• 2:40
  the risk to
• 2:42
  Geisinger as a HMO
• 2:44
  organization,
• 2:46
  and what that would mean moving forward. So,
• 2:49
  I would say the Reflation Reduction Act would
• 2:50
  be one, changing the formulary and tiering of
• 2:53
  medications.
• 2:54
  We really essentially reset our Medicare
• 2:57
  product
• 2:58
  almost back to what it was in 2003.
• 3:02
  And, you know, so that would be one
• 3:03
  initiative.
• 3:04
  And, I think the
• 3:06
  probably the second initiative,
• 3:10
  and we'd had many initiatives,
• 3:12
  were really a biosimilar initiative.
• 3:15
  We had biosimilars and we're, you know, moving,
• 3:18
  to adopt the Humira biosimilars in 2024.
• 3:22
  But when we stepped into 2025,
• 3:24
  we, we set up ourselves to be biosimilar
• 3:27
  first,
• 3:28
  and independent
• 3:30
  of our line of business, whether it be
• 3:32
  Medicare,
• 3:33
  Medicaid, commercial, TPA, and so forth or ACA.
• 3:36
  So we did,
• 3:38
  transition,
• 3:40
  all of our patients for any of the
• 3:41
  available bio biosimilars to biosimilars.
• 3:44
  I'll say that, you know, from a product
• 3:47
  perspective, we were quite,
• 3:50
  successful
• 3:51
  moving moving all all of our lines of
• 3:53
  business. Over 90% of our members are on
• 3:56
  the biosimilar Humira.
• 3:58
  For Stelara, same thing, you know, moving,
• 4:01
  you know, moving our patients, you know, from
• 4:03
  the brand Stelara to the biosimilar.
• 4:05
  And then also with,
• 4:07
  you know, our wet macular degeneration, you know,
• 4:10
  moving,
• 4:11
  to the Eylea biosimilar of PavBlue,
• 4:14
  and, you know, working with our retinal specialists,
• 4:16
  you know, for that adoption and that transition.
• 4:18
  So I would say there are two initiatives
• 4:20
  that were very important. There are several others,
• 4:22
  but, I'll highlight those two.
• 4:25
  Great. Thank you so much for sharing those
• 4:27
  examples.
• 4:28
  I'd love to hear more about what prompted
• 4:29
  you guys to take on that biosimilar
• 4:32
  first, you know, initiative.
• 4:34
  Yeah. Well, really, it's making health care affordable
• 4:36
  to our members and to our communities. And,
• 4:40
  looking at the substantial difference in pricing between
• 4:43
  the
• 4:44
  reference product or the biologic,
• 4:46
  to the biosimilars,
• 4:48
  and really what the cost sharing is now
• 4:50
  with our members, particularly,
• 4:52
  you know, in Medicare,
• 4:54
  as an example,
• 4:56
  or any of our commercial plans
• 4:58
  that
• 4:59
  we look at clinical efficacy first and looking
• 5:01
  at the efficacy of those biosimilars,
• 5:04
  they were as efficacious
• 5:05
  and not harmful to any of our members.
• 5:08
  And, so we, you know, we took on
• 5:10
  the the task of making the transition,
• 5:13
  to to make health care affordable for for
• 5:15
  our patients and communities.
• 5:17
  That's great. Thank you for sharing.
• 5:20
  Now looking ahead, what are the big priorities
• 5:22
  and headwinds you're focused on as you plan
• 5:24
  for 2026?
• 5:26
  Gosh.
• 5:27
  You know, looking at headwinds,
• 5:29
  I'll say first. So headwinds are,
• 5:32
  you know, again, the Inflation Reduction Act, now
• 5:36
  second year, so 2026,
• 5:38
  you know, for the first 10 drugs,
• 5:42
  that have the negotiated government pricing.
• 5:44
  So that would be one, which is very
• 5:47
  much coincides with
• 5:50
  the implementation
• 5:51
  of the rebate model for the three forty
• 5:54
  b program,
• 5:55
  for the first 10 drugs, which, obviously, there
• 5:58
  was a,
• 5:59
  federal,
• 6:00
  judge in, Maine that,
• 6:02
  put the program on the rebate program on
• 6:04
  hold right now, but it's more, you know,
• 6:06
  definitely in front of us, the MFP pricing,
• 6:09
  you know, for pharmaceuticals
• 6:10
  at point of sale,
• 6:12
  you know, I would say, you know, are
• 6:14
  truly in front of us. And then thirdly,
• 6:17
  is really
• 6:18
  the transition
• 6:20
  of,
• 6:21
  from small molecule therapy,
• 6:24
  to now cell and gene therapy and just
• 6:26
  the
• 6:27
  complexity of administration,
• 6:29
  making sure that we have a rev management
• 6:32
  process around cell and gene therapy when we
• 6:34
  administer, that we're going to get paid on
• 6:36
  the clinical enterprise side,
• 6:38
  because these therapies, as we know, are half
• 6:40
  1,000,000 to $7.08, $9.10000000
• 6:43
  per application.
• 6:45
  And then lastly, you know, from a cell
• 6:46
  and gene therapy is, is from a payer
• 6:49
  perspective,
• 6:50
  making sure that we're able to manage risk,
• 6:54
  the risk of the expense, risk of the
• 6:56
  outcome and ensuring that members are getting the
• 6:59
  outcome, if we're paying for that cell and
• 7:01
  gene therapy. So I would call those the
• 7:04
  big priorities,
• 7:05
  kind of the headwinds that we're focused on
• 7:07
  for 2026
• 7:09
  and,
• 7:10
  you know, many, different moving pieces in each
• 7:12
  of those initiatives.
• 7:15
  Definitely.
• 7:16
  And along with those priorities do come some
• 7:18
  tough decisions. What's the hardest thing that you'll
• 7:21
  have to tackle in the coming year as
• 7:22
  a pharmacy leader?
• 7:24
  Gosh.
• 7:25
  What is the hardest thing in the coming
• 7:28
  year? I think everything we're doing is difficult.
• 7:31
  And it's becoming more and more complex.
• 7:34
  You know, the hardest thing we may have
• 7:36
  to do is,
• 7:38
  you know, in these cell and gene therapies
• 7:41
  and looking at the sub populations
• 7:44
  and making sure if we're going to or
• 7:47
  if we're not going to administer the product,
• 7:50
  the hardest decision is going to say no
• 7:53
  to someone
• 7:54
  when we know the therapy is
• 7:56
  life saving,
• 7:57
  but we know that they have a version
• 8:00
  or a variation
• 8:02
  of the disease
• 8:03
  that the
• 8:05
  product
• 8:05
  does not cure or does not alter.
• 8:08
  Hard decision to tell a patient no. Right?
• 8:10
  And, that's not who we at Geisinger are.
• 8:14
  We are,
• 8:15
  you know, wanting to service all of our
• 8:17
  patients,
• 8:18
  to the highest quality we can and not
• 8:21
  have to say no, whether, you know, it's
• 8:23
  financial, whether it's clinical, whether it's access.
• 8:26
  You know, we try to we pride ourselves
• 8:28
  on making sure we can care for patients.
• 8:31
  So the hardest thing would probably be saying
• 8:33
  no because the patient, you know, heard that
• 8:35
  there's a cure for x disease,
• 8:37
  but their, their genetic mutation or their variation
• 8:41
  of disease or their age is beyond,
• 8:43
  where we see efficacy of administering the therapy.
• 8:47
  Yeah. That's definitely a difficult part of the
• 8:49
  job. Now within all of these headwinds,
• 8:53
  how are you preparing your team to tackle
• 8:55
  them?
• 8:56
  Yeah. I think the key and and,
• 8:59
  for
• 8:59
  organizations
• 9:00
  to tackle or be able to respond
• 9:03
  and to operation
• 9:04
  have the operations to,
• 9:06
  to manage
• 9:08
  is having a leadership team,
• 9:10
  that is,
• 9:11
  obviously focused on their specific areas, but working
• 9:14
  across,
• 9:15
  the entire enterprise. So,
• 9:18
  I'm truly blessed to have an enterprise pharmacy
• 9:21
  leadership team that is quite skilled,
• 9:24
  whether it be our hospital based programs, whether
• 9:27
  it's our ambulatory based programs, whether it's our
• 9:29
  managed care programs,
• 9:31
  whether it's our strategy and planning area,
• 9:34
  whether, you know, it's our three forty b
• 9:36
  programs and so forth. I have leaders that
• 9:39
  are well versed in all of those areas,
• 9:42
  that will,
• 9:43
  be positioned or be be leaders that are
• 9:45
  involved
• 9:46
  in driving, any of the initiatives or priorities
• 9:48
  that we spoke of or responding to any
• 9:51
  future headwinds that come upon us through the
• 9:53
  calendar year.
• 9:55
  Gotcha. It's great that you have a team
• 9:57
  to be prepared for those.
• 9:59
  Now even with those challenges, there are still
• 10:01
  areas for growth. Where do you see the
• 10:03
  best opportunities for organizational growth moving forward?
• 10:07
  Yeah. So, I think I'll I'll answer this
• 10:10
  question in two different ways. So I think
• 10:12
  one is,
• 10:13
  I never thought in my career I would
• 10:15
  see
• 10:17
  pharmacy deserts,
• 10:19
  not only in the Geisinger geography, but in
• 10:22
  the country.
• 10:23
  So,
• 10:24
  you know, over the past two years or
• 10:27
  maybe two and a half years now,
• 10:29
  in Pennsylvania,
• 10:30
  we've had approximately
• 10:31
  600 pharmacies close.
• 10:34
  And,
• 10:35
  you know, we are a rural delivery system.
• 10:38
  And,
• 10:39
  because of that,
• 10:40
  we have pharmacy deserts.
• 10:42
  In other words, we have patients that are
• 10:44
  not within 50 miles of a retail pharmacy.
• 10:48
  And,
• 10:49
  so, you know, we are going to have
• 10:52
  to respond,
• 10:53
  you know, as a payer and a provider,
• 10:57
  respond in ways,
• 10:59
  for us to get medications
• 11:01
  to the patient.
• 11:03
  Whether it's a retail pharmacy,
• 11:06
  and, you know, and it's a tablet or
• 11:08
  a capsule or, you know, an oral retail
• 11:10
  medication that we have to get to a
• 11:11
  member, or,
• 11:13
  utilizing
• 11:14
  our mail order services,
• 11:16
  or using our specialty pharmacy services
• 11:19
  or using our home infusion services,
• 11:23
  to essentially get,
• 11:25
  and
• 11:26
  be able to have availability
• 11:28
  of our patient members in our communities, have
• 11:31
  them have they have access,
• 11:33
  you know, to to the appropriate medication in
• 11:35
  in different delivery methods. So,
• 11:37
  I see it as an opportunity
• 11:39
  for integrated delivery networks that are a payer
• 11:42
  and provider
• 11:43
  to build pharmacy distribution channels,
• 11:46
  because the value that we gain, and I'll
• 11:49
  use retail as an example,
• 11:50
  by having a retail pharmacy
• 11:52
  is not just any margin that is made
• 11:56
  from dispensing the prescription.
• 11:58
  It's about keeping the patient compliant with the
• 12:01
  medication to control their disease,
• 12:03
  so they're not having to go to the
• 12:05
  emergency room or having their disease progress
• 12:08
  where they need a hospital admission. So it's
• 12:10
  preventing that in the first place. So there's
• 12:11
  other value,
• 12:13
  of of making sure a patient has access
• 12:15
  and or is adherent to their medications,
• 12:18
  to prevent that disease exacerbation, disease progression. So
• 12:21
  that would be one, Ella, that I would
• 12:23
  say.
• 12:24
  The other I would say is and it
• 12:26
  goes back to my cell and gene therapy
• 12:29
  comment
• 12:29
  and really around
• 12:31
  high dollar medically covered medications
• 12:34
  or therapies.
• 12:35
  And to make sure
• 12:37
  that you we have an end to end
• 12:40
  revenue integrity
• 12:42
  process
• 12:44
  around pharmaceuticals.
• 12:46
  And essentially making sure from
• 12:49
  contracting with payers
• 12:51
  through the prior auth process, making sure we
• 12:55
  dot the I and cross the t that
• 12:56
  we're gonna get paid for the therapy, make
• 12:58
  sure we're then purchasing the therapy at the
• 13:01
  appropriate
• 13:02
  cost,
• 13:04
  making sure then we're
• 13:06
  administering the medication safely to the right patient
• 13:09
  at the right time,
• 13:10
  make sure we're submitting for payment, making sure
• 13:12
  we're getting payment per contract, having that entire
• 13:15
  revenue integrity from end to end.
• 13:18
  Most systems have a great rev management team,
• 13:21
  but from a pharmacy pharmaceutical perspective
• 13:24
  and all the complexities
• 13:25
  and the loopholes,
• 13:27
  that we have to jump through from a
• 13:28
  payer perspective,
• 13:30
  having
• 13:31
  the expertise in pharmacy revenue integrity is gonna
• 13:34
  be vital 2026 and forward.
• 13:36
  Those are great opportunities. Thank you so much
• 13:38
  for sharing. It was really exciting to hear
• 13:40
  and looking forward to what can be accomplished
• 13:42
  in 2026.
• 13:44
  Well, Michael, this has been such a great
• 13:45
  conversation. Thank you for sharing your perspective and
• 13:48
  insights with us. That's all for today's episode
• 13:50
  of the Becker's pharmacy leadership podcast. A big
• 13:53
  thank you to Michael Evans again for joining
• 13:55
  us to discuss pharmacy priorities, challenges, and opportunities
• 13:58
  at Geisinger.
• 13:59
  Thanks for listening, and we'll see you next
• 14:00
  time.