Latest / Becker’s Healthcare Podcast / Rethinking Pharmacy Choice at the Point of Prescribing: What Greater Visibility & Control Can Mean for Patients & Health Systems

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Rethinking Pharmacy Choice at the Point of Prescribing: What Greater Visibility & Control Can Mean for Patients & Health Systems · Becker’s Healthcare Podcast

• 0:00
  - Hello, everyone. This is Erica Spicer Mason with
• 0:02
  - Becker's Healthcare. Thank you so much for tuning
• 0:04
  - in to the Becker's Healthcare podcast series.
• 0:08
  - Today, we're going to talk about rethinking pharmacy
• 0:10
  - choice at the point of prescribing
• 0:12
  - and what greater visibility and control can mean
• 0:15
  - for patients and also health systems.
• 0:17
  - And joining me for this conversation, we have
• 0:19
  - Otto Seipp, the cofounder and CEO of Photon
• 0:22
  - Health.
• 0:23
  - Otto, welcome to the podcast. So glad to
• 0:25
  - have you with us today. Hey, Erica. Thanks
• 0:27
  - for having me. We're we're really happy to
• 0:29
  - have you with us. And just to get
• 0:31
  - us started, in case any listeners aren't familiar
• 0:33
  - with Photon Health, can you just share a
• 0:36
  - little bit more about your role and what
• 0:38
  - your teams have been focused on lately?
• 0:40
  - Yeah. Of course. So,
• 0:42
  - we're in the business of helping patients get
• 0:44
  - medicine.
• 0:45
  - So in in between the the clinical visit
• 0:48
  - and the time that a patient spends at
• 0:49
  - a pharmacy
• 0:51
  - is sort of an antiquated experience
• 0:53
  - where, like, let's say in the nineties when
• 0:55
  - you received a prescription, which is the business
• 0:57
  - that we're in, it was on paper, and
• 0:59
  - you could see it in your hands. And
• 1:00
  - as a patient, you could walk to the
• 1:01
  - pharmacy. Something wasn't right there. They didn't have
• 1:03
  - your medication. You can go to the next
• 1:05
  - pharmacy. It had this very visceral,
• 1:07
  - literal interface.
• 1:09
  - Over the last thirty years,
• 1:11
  - for a lot of reasons, we made things
• 1:13
  - electronic, but we kind of cut out the
• 1:14
  - core most important user from that transaction, the
• 1:17
  - person who's, you know, actually usually spending money
• 1:19
  - to acquire that medicine, etcetera. So what this
• 1:22
  - has done is put on an enormous amount
• 1:25
  - of operational and fulfillment,
• 1:27
  - ownership for clinicians because clinicians are the ones
• 1:29
  - that have to choose the pharmacy. If something
• 1:30
  - goes wrong, they're the ones that get the
• 1:32
  - phone call to say, hey. This this isn't
• 1:34
  - covered, yada yada yada.
• 1:36
  - So what we've designed is a system where
• 1:38
  - a prescription can be sent on a network
• 1:40
  - where the patient owns the prescription as opposed
• 1:43
  - to kind of this... You know, really, the
• 1:45
  - clinician is the one in the driver's seat
• 1:46
  - once a prescription is sent,
• 1:49
  - until it's it's fulfilled at the pharmacy. So
• 1:50
  - there's sort of this, like, liminal space that's
• 1:52
  - confusing for everybody. So if you can make
• 1:54
  - that modern, you know, vis a vis an
• 1:57
  - Uber experience or a DoorDash experience or all
• 1:59
  - the different consumer experiences that we're all used
• 2:01
  - to,
• 2:02
  - you can do a lot of good, especially
• 2:04
  - for actually helping patients get medicine,
• 2:06
  - which is supposed to be what we're all
• 2:08
  - doing here.
• 2:09
  - Yeah. Great opening, Otto. Thank you so much.
• 2:11
  - And I've get... I've gotten this nice kind
• 2:13
  - of high level sense of some of the
• 2:15
  - challenges that that you're seeing in the space
• 2:17
  - in making that switch from paper prescriptions
• 2:21
  - to electronic
• 2:22
  - processes, which I'm sure have efficiencies in many
• 2:25
  - ways. But it sounds like there are some
• 2:27
  - crucial
• 2:28
  - changes of roles and stakeholders and ownership, and
• 2:30
  - that's making things quite challenging. So
• 2:32
  - I wanna get your ground level perspective now
• 2:35
  - on what this looks like patient interaction.
• 2:39
  - We know that patients are often asked to
• 2:41
  - name a pharmacy before they even know what
• 2:43
  - they've been prescribed.
• 2:45
  - So when patients do have that information in
• 2:48
  - front of them, what actually drives the choice
• 2:51
  - that they make? And how well does that
• 2:53
  - match what health systems assume the patient wants?
• 2:57
  - Yeah. So a couple thing... Couple nuances here.
• 2:59
  - Like, you know, for your average day to
• 3:00
  - day generic medications, like, this works pretty well.
• 3:03
  - So that's why the system, you know, has
• 3:05
  - sort of worked this way for a while.
• 3:07
  - And pharmacy...
• 3:08
  - If you look at pharmacy in the last
• 3:10
  - hundred years, it has gone from... You know,
• 3:13
  - we have a handful of basic molecules that
• 3:15
  - treat, you know, a couple different conditions with
• 3:17
  - with some incredible inventions even more before a
• 3:20
  - hundred years ago, you know, penicillin,
• 3:22
  - to the last ten years even, the number
• 3:25
  - of complex,
• 3:26
  - extremely expensive,
• 3:28
  - even, like, patient specific medications that pharmacies are
• 3:31
  - now dealing with. Like, I can't even pretend
• 3:32
  - to understand
• 3:34
  - some of the, you know, fancy cell therapies
• 3:36
  - that that have come out. So pharmacy has
• 3:38
  - become enormously complicated, but the technology that we
• 3:40
  - use under the hood really hasn't evolved at
• 3:43
  - the same pace.
• 3:44
  - So what this means for pharmacy choice is
• 3:46
  - you're still selecting a pharmacy
• 3:48
  - as if it's, you know, any pharmacy in
• 3:50
  - the world can fill any drug, which has
• 3:52
  - just not been true for a long time.
• 3:54
  - So that means clinicians now need to understand,
• 3:57
  - like, fulfillment level what's going on at each
• 3:59
  - pharmacy.
• 4:01
  - So if I'm on a medication,
• 4:03
  - the easiest example is GLP ones just because
• 4:05
  - they're so commonly prescribed now and so complicated
• 4:08
  - from a payments perspective.
• 4:10
  - I might wanna just pay cash for a
• 4:12
  - GLP one as a patient. That requires my
• 4:14
  - clinician to know about a completely separate pharmacy
• 4:17
  - and a completely separate
• 4:18
  - NDC to prescribe to make that happen. So
• 4:21
  - it's an example of how, like, the complexity
• 4:23
  - of the supply chain is sort of poking
• 4:25
  - out into the consumer and the provider experience.
• 4:28
  - So we work out this model where you
• 4:30
  - should just be able to, like, walk down
• 4:31
  - the street for everything and you can't.
• 4:33
  - So we're both sort of tackling the nuance
• 4:36
  - of it should work like paper back in
• 4:37
  - the day, but we were not saying it
• 4:39
  - should go back to paper because that also
• 4:40
  - wouldn't solve all these really complex specialty
• 4:43
  - and access problems. So the reality is if
• 4:46
  - you just let the patient choose and you
• 4:48
  - can put a bunch more information into that
• 4:50
  - decision, the the information that the clinician doesn't
• 4:52
  - necessarily
• 4:53
  - have the time to go navigate.
• 4:55
  - Imagine if every clinician in the country went
• 4:57
  - and navigated
• 4:59
  - all the different pharmacy prices every time they
• 5:01
  - prescribe something. They just simply don't have the
• 5:03
  - time for that. It also is something that
• 5:05
  - consumers want to do. They they... They're price
• 5:07
  - conscious by nature, especially for expensive medications. So
• 5:10
  - that introduces this, like, really great moment to
• 5:12
  - introduce,
• 5:13
  - like a patient experience where, you know, quite
• 5:16
  - literally, patients on Photon.
• 5:18
  - In a health system setting, doctor writes a
• 5:21
  - prescription like normal in Epic. They hit send.
• 5:24
  - Patient receives a text within five seconds, and
• 5:26
  - they can see
• 5:27
  - information about their medication.
• 5:29
  - They can see information about their benefits, and
• 5:31
  - they can see information about when they can
• 5:32
  - actually get that medication.
• 5:34
  - And that's,
• 5:35
  - you know, chain... Completely changes the game, especially
• 5:37
  - for these complex
• 5:39
  - access pathways or whatever we call them.
• 5:41
  - Yeah. Absolutely. And I definitely wanna learn a
• 5:44
  - little bit more about what that visibility
• 5:48
  - at the prescribing point of care, what that
• 5:50
  - means. But before we get into that, Otto,
• 5:52
  - I just wanna go a little deeper on
• 5:54
  - something you said.
• 5:55
  - You had mentioned that
• 5:57
  - there's kind of this assumption that any pharmacy
• 6:00
  - will carry any medication at any time,
• 6:03
  - which for generic
• 6:04
  - or, you know, highly prescribed, you know, more
• 6:06
  - common medications that might be the case, but
• 6:08
  - not for for all. So when the pharmacy
• 6:11
  - choice turns out to be the wrong choice,
• 6:14
  - where are you seeing that friction usually surface
• 6:16
  - in the system? And how much of that
• 6:18
  - gets... How much of that is traced back
• 6:20
  - to that prescribing moment?
• 6:22
  - Yeah. So it's it's a mixture. Right? So
• 6:23
  - there's there's two major exceptions at a pharmacy
• 6:26
  - that are, in my view, completely avoidable. One,
• 6:29
  - something is out of stock. Like, they literally
• 6:30
  - just do not carry it or do not
• 6:32
  - have it. And and this happens in two
• 6:33
  - ways. One, they should have it, but they
• 6:35
  - don't have it, and this happens during shortages
• 6:36
  - or whatever.
• 6:38
  - Or two, they just can't fill that medication.
• 6:40
  - The more common one is actually prior auth,
• 6:43
  - sometimes even for medications that really have no
• 6:45
  - business being in prior auth. For example, the
• 6:48
  - wrong dosage of a generic
• 6:50
  - is or isn't covered by a formulary.
• 6:52
  - So if you can sort of optimize those
• 6:54
  - things upstream and help the consumer see that,
• 6:57
  - it's a huge advantage.
• 6:58
  - But, yeah, I think I think the the
• 7:00
  - general gist is we have all the data
• 7:03
  - available in different systems to make this possible,
• 7:06
  - but it exists in these, like, huge silos.
• 7:09
  - And we've spent the last decade trying to
• 7:10
  - push all that data into the EMR, which
• 7:13
  - has had a lot of merits in some
• 7:14
  - ways, but I just think clinicians have the
• 7:17
  - view, like, I don't have the time to
• 7:18
  - sit here and navigate
• 7:19
  - a patient's pharmacy benefits,
• 7:21
  - which have also become increasingly complicated. So,
• 7:25
  - yeah, I think there's just increasing complexity
• 7:28
  - for health systems to navigate.
• 7:30
  - And, you know, in in reality, these health
• 7:33
  - system pharmacies
• 7:34
  - are under the gun to modernize very quickly,
• 7:37
  - especially as new cell therapies come out or
• 7:39
  - whatever whatever new technologies,
• 7:41
  - you know, new ways of paying for drugs
• 7:43
  - even is is is a trend.
• 7:45
  - But, yeah, that's that's kinda like the business
• 7:47
  - that we're in. There's plenty of problems that
• 7:49
  - we have not solved
• 7:50
  - as well. So it's it's cool to be
• 7:51
  - building in a space where
• 7:53
  - our partners are coming to us with with
• 7:55
  - new ideas,
• 7:57
  - especially for specialty workflows or prior off workflows
• 7:59
  - that we can we can do stuff that
• 8:00
  - other folks haven't even done in the market
• 8:02
  - yet. Mhmm. Yeah.
• 8:04
  - And, Oda, that brings me back to
• 8:07
  - what you had mentioned earlier, and that's this
• 8:09
  - idea of having visibility to the prescription,
• 8:13
  - insurance information and coverage, and things of that
• 8:16
  - nature
• 8:17
  - at the point of prescribing. And I believe
• 8:20
  - you mentioned that patients can receive that via
• 8:21
  - text message even.
• 8:23
  - So if a health system moves the decision
• 8:25
  - into that moment, what have you seen change
• 8:28
  - downstream, both for the patient, but also for
• 8:30
  - the health system?
• 8:32
  - Couple different things. One, we see fewer transfers,
• 8:35
  - and we see higher sell through rate for
• 8:38
  - our pharmacy partners,
• 8:39
  - which which is super cool. So that means
• 8:41
  - we get a prescription to the right pharmacy
• 8:43
  - more often, and the pharmacy gets that prescription
• 8:46
  - paid for more often. We're working on, you
• 8:49
  - know, proving this from, like, a data perspective,
• 8:51
  - and it's quite hard to do on a
• 8:53
  - controlled basis. But still, the the point is
• 8:56
  - we're actually optimizing
• 8:57
  - where prescriptions go.
• 8:59
  - And at the end of the day, if
• 9:01
  - you imagine just like a a flow of
• 9:03
  - prescriptions and everything needs to get filled, there
• 9:04
  - is kind of a right place and most
• 9:06
  - optimal choice for all of those different prescriptions.
• 9:09
  - Most of them are pretty basic consumer decisions.
• 9:12
  - Like, this is cheaper with this coupon. Great.
• 9:14
  - Or I'm gonna apply my insurance and throw
• 9:16
  - a pharma manufacturer coupon on the back end.
• 9:18
  - Great. Like, those are very consumer led. What
• 9:20
  - we're really starting to think about is the
• 9:22
  - the types of nuances that... Especially that health
• 9:25
  - system pharmacies deal with where
• 9:27
  - it it could be a consumer decision. But
• 9:29
  - generally speaking, some consumers
• 9:31
  - aren't necessarily that well equipped to navigate extremely
• 9:34
  - complex payment scenarios,
• 9:35
  - or there's a clinical approval in the in
• 9:37
  - the workflow. So what we're really starting to
• 9:39
  - do is use all the tech that enabled
• 9:41
  - transparency and liquidity and being able to move
• 9:43
  - prescriptions around
• 9:44
  - between pharmacies even before they were sent the
• 9:46
  - first time
• 9:47
  - to do the same thing for health systems.
• 9:49
  - But there's way more advanced use case that
• 9:51
  - cover prior auth, that cover financial assistance, that
• 9:54
  - cover, you know, all the really amazing benefits
• 9:56
  - analysis stuff that usually is being done by
• 9:59
  - hand still
• 10:00
  - for for health system pharmacies. So I think
• 10:02
  - there's... It's kinda cool to see the tech
• 10:03
  - that has made our consumer experience possible be
• 10:06
  - highly relevant to these
• 10:08
  - super complex workflows that our system partners have
• 10:10
  - already... They've been doing for years, quite frankly,
• 10:13
  - even as benefits get more complicated,
• 10:15
  - even as regulations change, like, feels like every
• 10:18
  - few months, there's a whole new thing that's
• 10:20
  - health systems need to figure out how to
• 10:21
  - navigate. So we're trying to make sure that
• 10:23
  - the tech under the hood
• 10:25
  - is
• 10:26
  - programmable almost so that... I I kinda think
• 10:29
  - of it like air traffic control for prescriptions
• 10:31
  - so that that our system partners can actually
• 10:33
  - see what's going on under the hood.
• 10:35
  - Well, it's exciting work and some really interesting
• 10:37
  - innovations that you have applied here to these
• 10:40
  - very complex workflows as you've mentioned, Otto.
• 10:43
  - I'm curious as you look ahead to the
• 10:45
  - next few years, what's on your mind about
• 10:48
  - where pharmacy fulfillment is headed maybe that we
• 10:51
  - haven't touched on yet?
• 10:53
  - So couple things. I'll respond to the first
• 10:54
  - part first. Like,
• 10:56
  - the nature of our team at Photon is,
• 10:59
  - you know, this is not a problem that
• 11:01
  - a lot of people work on truly. Like,
• 11:03
  - the pharmacy technology space is so tiny,
• 11:06
  - and
• 11:07
  - quite frankly, most of the tech in the
• 11:09
  - space is,
• 11:10
  - you know, kind of attached to some other
• 11:13
  - organization or incentive.
• 11:15
  - Our belief is that, like, doing something that
• 11:17
  - genuinely is in the interest of the patient
• 11:19
  - is the best way to solve these, like,
• 11:21
  - classic
• 11:22
  - trade off problems that make pharmacy so complicated,
• 11:24
  - especially for pharmacies.
• 11:26
  - Like, you have pharma companies, employers,
• 11:29
  - PBMs,
• 11:30
  - plans,
• 11:31
  - you know, three forty b, all of these
• 11:33
  - things sort of intention with each other, not
• 11:35
  - not to mention financial assistance and all the
• 11:37
  - different regulatory requirements to make sure that the
• 11:39
  - patient's getting the right medication. Extremely complex stuff
• 11:42
  - that I think the network itself could just
• 11:44
  - do more,
• 11:45
  - for the system and and really take a
• 11:47
  - lot of work away from...
• 11:49
  - In pharmacy fulfillment and move it up into
• 11:51
  - the network. So I think the point I'm
• 11:53
  - making is
• 11:54
  - we've got a team at Photon that for
• 11:55
  - some odd reason is really obsessed with this
• 11:58
  - problem
• 11:59
  - and trying to think about it from a
• 12:01
  - first principles perspective as opposed to just sort
• 12:02
  - of stitching together what already exists.
• 12:05
  - So that...
• 12:06
  - What I wanna really point out is, like,
• 12:08
  - we've found some stuff that is kind of
• 12:10
  - experimental. Like, we we didn't just wake up
• 12:12
  - and say, hey. We're gonna build a system
• 12:14
  - where patients can choose a pharmacy via text.
• 12:16
  - It it wasn't really like a blueprint,
• 12:19
  - but it's it's it's... We have discovered sort
• 12:22
  - of emergent behavior of patients as a result
• 12:24
  - of giving them this ability.
• 12:26
  - One huge one is,
• 12:28
  - you know, in our our first
• 12:30
  - few large system rollouts, we are seeing a
• 12:33
  - huge uptick in the likelihood of a patient
• 12:35
  - choosing a mail order pharmacy simply by telling
• 12:37
  - them, hey. You can go to this mail
• 12:38
  - order. Hey. We can offer free delivery. So
• 12:41
  - that... That's a small example, but we've also
• 12:42
  - seen, you know, patients
• 12:45
  - understand a lot more and behave much more
• 12:47
  - rationally than I think a lot of people
• 12:49
  - assume,
• 12:50
  - which is, like, kind of cool from a
• 12:52
  - consumer lens. But there's still so much more
• 12:54
  - we could do in terms of answering your
• 12:55
  - questions.
• 12:57
  - We have really loved working super super closely
• 13:00
  - with a couple of our, health system partners.
• 13:02
  - They're bringing really neat ideas to us. And
• 13:05
  - an example that I can share, the idea
• 13:07
  - of, like, taking this text based experience
• 13:10
  - and making it end to end voice, because
• 13:12
  - not everyone has a phone. Not everyone has
• 13:14
  - a phone with a smart... You know, not
• 13:16
  - everyone can read. Right? There's there's all sorts
• 13:18
  - of cool, like, accessibility things that we're starting
• 13:20
  - to think about where... Imagine if you just
• 13:22
  - got a phone call that said, hey, what's
• 13:24
  - the best pharmacy for you? Here's a couple
• 13:26
  - options. This is what this is gonna cost.
• 13:27
  - Here's why this isn't covered by your insurance.
• 13:29
  - Here's what's going on with this prior off.
• 13:30
  - Like, there's a lot of really cool stuff
• 13:32
  - that, you know, we're realizing our underlying tech
• 13:35
  - also enables.
• 13:36
  - So the, yeah, the larger thing here is
• 13:38
  - we're kinda trying to take pieces and put
• 13:40
  - them together in different shapes.
• 13:42
  - And not a lot of folks have done
• 13:44
  - that in pharmacy. It's been a lot of
• 13:45
  - the same shapes.
• 13:46
  - It's a lot of hub services that do
• 13:48
  - x. It's a lot of, you know, discount
• 13:50
  - cards that do y. And it's a lot
• 13:52
  - of, like, you know, AI for this. So
• 13:54
  - I think, sort of, first principally, like, what
• 13:57
  - is the way to solve this with whatever
• 13:58
  - tech is available has been, like, a really
• 14:00
  - sort of fun way to look at the
• 14:01
  - space. And it's a greenfield out here.
• 14:04
  - I think there's so many more problems that
• 14:05
  - I don't even think we're gonna be able
• 14:07
  - to get to that I think still exists
• 14:08
  - for these pharmacies. So this is sort of
• 14:10
  - a call to action that I think this
• 14:12
  - is a very meaningful and impactful space to
• 14:14
  - build technology for us and a lot of
• 14:15
  - other partners.
• 14:17
  - Well, Otto, the the passion for the work
• 14:18
  - that you do has really shown through in
• 14:20
  - this episode. So I wanna thank you for
• 14:23
  - sharing
• 14:24
  - more about Photon with our listeners and also
• 14:26
  - what you see ahead. Such interesting points that
• 14:28
  - you mentioned, by the way, about the possibilities
• 14:30
  - with accessibility,
• 14:32
  - not just from a medication standpoint, but interacting
• 14:34
  - with patients and ensuring they understand
• 14:36
  - all the important information about their prescriptions. So
• 14:39
  - I just wanna thank you again for the
• 14:41
  - time and, and all the thoughts that you've
• 14:43
  - shared with Becker's today. Cool. Thanks, Erica. I
• 14:45
  - had fun.
• 14:46
  - Likewise.
• 14:47
  - And we also wanna thank our podcast sponsor
• 14:49
  - for today, Photon Health.
• 14:51
  - Listeners, be sure to tune in to more
• 14:53
  - podcasts from Becker's by visiting our podcast page
• 14:56
  - at beckershospitalreview.com.