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

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