Nicole Raleigh 0:00

Welcome to the Pharmaporum Podcast. This is web editor Nicole Raleigh, and today I have with me Dean Erhardt, founder of D2 Solutions for a conversation on patient access. Welcome, Dean.

Dean Erhardt 0:18

Thank you so much for having me, Nicole. It's a pleasure to be here

Nicole Raleigh 0:21

Now, pharma and tech companies are working more closely together than ever, as proven by the news of Merck and Nvidia's new partnership, for example. But while the idea of using AI for drug discovery has been around for a while now, patient access has an awfully long way to catch up to the promise of these new therapies. But before we sink our teeth into this central topic, Dean, perhaps you could introduce yourself a little bit for listeners and describe the journey that led you to doing what you do today at D2 Solutions.

Dean Erhardt 0:57

Yes, it would be a pleasure. So I started in the industry, you know, a long, long time ago, going on almost 40 years. And I started with a company called US Healthcare, which was a staff model, HMO. From there, I moved to a distributor, Cardinal Health, and my last corporate job was with a company called Express Scripts. So I had about 20 years in corporate America coming through the payer side, the distributor side and the PBM side of the business. So as it happened, I had the opportunity to start in the consulting space with a small consulting firm in 2004 and in 2008 myself and a couple of other people started D2 and we've been, initially D2 Consulting, and then ultimately D2 Solutions, as we've moved from exclusively in the consulting space to moving into both consulting and technology solutions across a variety of different aspects. So D2 at its core, really focuses on three simple things, right? Distribution, how to get the product into the market and enable access for that patient in a comfortable fashion. Reimbursement. So how does the product get reimbursed? Is that a pharmacy benefit? Is it a medical benefit? Is it a preferred product? Is it a non-preferred product? Does it have a co pay card, and all the nuances that go into determining what that might need to look like, and also helping the manufacturers to actually set up the partnerships they have in the marketplace to be able to support that. And then ultimately what we call Patient Services. So as you very well know, Nicole, for patients who particularly are on specialty products, many times, those specialty products include reimbursement support, include a call center, include Nurse Case Management, and so we help the manufacturers both define what that patient journey might look like, as well as determine and set up the partners that they use for those services, in some cases, using some of the D2 technologies as well. So that's, that's a little bit of history of myself as well as kind of the D2 focus areas.

Nicole Raleigh 3:13

Thank you, Dean. So just to run over for listeners, a little bit of what you've just shared about D2 Solutions a company is an end-to-end strategic partner, delivering industry leading consulting and purpose built technologies to pharma manufacturers, hospitals, pharmacies, payers and PBMs. So to begin with, I want to discuss the disconnect that exists yet between, as you've been listing, distributions and reimbursements and patient services, these different aspects of what D2 Solutions provides for. So going to that disconnect, what can you tell us there, Dean, particularly when it comes to specialty medicines?

Dean Erhardt 3:57

Well, what we've seen historically many times Nicole, is that organizations operate in silos. So they might have a group working on distribution, they might have a separate market access group working in reimbursement or their payer strategy. They might have a third group working in patient services, and those groups don't always interact in a way that enables the organization to see how decision A might be impacted when it goes down the path. And now somebody needs to make decision B. We've seen organizations where, you know, between their distribution costs, between their reimbursement rebates at the payer side, between their copay card programs, they end up in a place where, as as a product, the drug isn't really making any money. And as we know, pharmaceutical companies can't survive if the drug isn't at least somewhat profitable. So our goal in bringing these things together is to help organizations see across the spectrum of what's happening when they're making the decisions for distribution, the decisions for reimbursement and the decisions for patient services, and make sure that, A: those decisions can enable the patient to flow through that environment, to be able to access the product, afford the product and receive services, and B: do it in a way that doesn't negatively impact the organization from a financial perspective.

Nicole Raleigh 5:21

Thank you, Dean. So in terms of this sort of decision-making flow across the spectrum, what has been the impact of artificial intelligence or AI thus far?

Speaker 3 5:33

Well, Nicole, I think it's still a little bit early to be able to see where AI is going to take us. I know in my conversations with manufacturers, there's really a hesitancy by some that says, "Well, I don't want an AI to talk to my patients." There are others who are much more on the, let's call it "cutting edge" of that experience. Now, what I think is going to happen is as all of us get more experience with AI, get more comfortable talking to AI bots, you know, we're going to see this accelerate. It's not going to be two or three or four years from now. It's going to be six to 12 months from now. We've already seen experiences, well, experiments, I should say, coming out of Japan, where they're using mini robots to talk to kids that are in for pediatric care, and they're finding these children will be more honest in terms of how they're feeling with the robot than they will with the doctor. Now that's an n-of-1 in terms of an example, but I think we're very quickly also going to be in a situation where people are more comfortable giving the information to an anonymous source, so to speak, than telling the doctor something that they may seem, may feel like, is a little bit embarrassing. So I think we're going to see this evolution of AI happen very quickly and clearly on the other side of the coin, you know, we're starting to see where AI is being involved in diagnosis and other things. And, you know, we've, we all talk about, you know, the Apple Watch and and the health monitoring. I think it's going to be very quick when the AI technology is going to be able to help organizations to be able to capture the information from the patient that enables them to better diagnose that patient and do it quicker and probably coming just in the right time when you're reading about the shortage of doctors, the shortage of nurses and just the shortage of healthcare personnel in total that we're facing between now and call it 2030, 2031.

Nicole Raleigh 7:39

Thank you, Dean. Yes, as you say, there's not just an evolution in the technology itself in AI, but this evolution in trust of AI still ongoing and changing. So you mentioned the personnel there at the end, I was wondering if you could speak to how a combination of technology and outsourcing can help to improve healthcare wait times.

Dean Erhardt 8:03

Yeah. I think the issue here is that you're going to have certain population, call it people, you know, under 50 years old, that are extremely adept at technology and comfortable with technology. And then you may have another segment of the population, you know, 70-80 years old that still want to have that human touch. And so I think we're going to see a combination of both of these, but what we're seeing, as an example on some of the activities we're involved in is we're actually using technology to enroll patients into care programs, and we're able to do that right in the physician office. We're able to do that in direct-to-consumer advertising. We're able to do that in programs by capturing patients, even at a retail store. Sometimes it's as simple as, "hey, here's the information on product snap on this QR code", and we can enroll them into the program. Sometimes, under a direct-to-consumer model, it's as easy as, "hey, go to this website and sign up." And what's interesting about that is we can then help guide that patient, you know, through a series of questions, depending on the product type, as to if this product is of interest, and we can push them then back to, you know, meet with your physician to have a discussion. But what's interesting is, we're also seeing about 30% of the patients that get enrolled in these various programs don't have a primary care doctor. So in that case, you know, we're also facilitating that discussion between patient and a Teladoc who can help diagnose and or take care of that patient because they simply don't have access, or have not had regular access to a primary care physician.

Nicole Raleigh 9:43

Thank you, Dean, yes, that's an interesting point that you raised there about Telehealth. So let's move to the pricing issue as well. Now, what can you tell us about the benefit or otherwise of price protection guarantees with PBMs or pharmacy benefit managers? When it comes to new therapies and the cost pressures entailed there.

Dean Erhardt 10:05

Well, of course, everybody talks about the cost of product, and if you take a look at the FDA pipeline, Nicole, the FDA pipeline is stocked full of specialty drugs. I just came back from a conference last week that you know a lot of people are talking about, this is an unsustainable model for health plans to be able to continue to afford these products, and therefore they need to come in at a lower price. Now the catch 22 there is that the PBMs are still asking for rebates. And as we all know, the more competitive the category, the deeper the rebates they look for. So there's going to be able to be a flash point in time where the organizations across the industry have to kind of get into the same mindset. But right now, we're still seeing where the organizations are, I should say more the categories of organizations are still at a little bit of odds. So the pharmaceutical companies are thinking one thing, the PBMs are thinking another, and their downstream clients are thinking another. So I think how some manufacturers are getting across or away from the whole Price Protection or price pressure is they're actually going directly to the health plan and contracting directly with the health plan. So instead of even going through a PBM model, they're just going to go directly to the health plan. Now that doesn't mean they're going to contract with 10,000 health plans, but it might mean they select a region or select the target and have direct contracts and be able to drive volume in that way by effectively giving those discounts directly to the health plan versus running it through various intermediaries.

Nicole Raleigh 11:48

Interesting. Okay, so that brings us to our closing question of the day, Dean, patient access today versus the state of patient access tomorrow. What has yet to change, and how can it be changed for the better? And by when, in your opinion?

Dean Erhardt 12:06

Well, I'll go back to my earlier example of being able to capture the patient earlier in that healthcare experience, in that in that patient journey, and again, getting that done within the construct of you're standing in the physician office, we can enroll you into a program. IQVIA, via which obviously is a major data player in the marketplace. I was watching a presentation by one of the IQVIA execs recently, and he talked about how only 49% of the products that end up at retail are actually picked up by the patient and in that specifically in the specialty category, and of those, only 29% of those patients are on therapy after 12 months. That's really horrendous when you're talking about many of the specialty drugs, if not life saving or at least, be able to be able to extend your life, or extend your quality of life. So the real issue here is to be able to not just capture that patient, but educate that patient. And I think that education is going to be really the key to be able to access, but you can't allow the patient to walk out of a physician office and then get bombarded by phone calls from individuals or organizations they don't know, and then expect them to navigate their own health care. Because health care is, as we know, very, very, very complex. And the other issue here is that with regard to that access, the more you can enable that patient to understand what's going on, the better they're going to be able to access the medication. Because if you think about particularly in the specialty world, Nicole, I've just been diagnosed with a disease I'm scared to death. Now I have been told by my doctor that this drug that I'm on is going to cost $100,000 a year. Many times, they just stop there and accept what they think is the inevitable, which is not a good outcome. So the faster and more diligent we can be about capturing the patient early, enabling that patient to get adequately informed about what their options are and guide them through the options of how to get that product is going to be the key, in my opinion, to be able to enable that patient to have a better access and, frankly, a better patient journey.

Nicole Raleigh 14:22

I'm going to throw you an addendum question, if I may. Dean,

Dean Erhardt 14:25

yes, yes.

Nicole Raleigh 14:26

Pertains to the news today that came from the Gallup West Health survey about the sort of sacrifices, if you will, that patients are making when it comes to medication adherence and the cost of that medication. So education knowledge is all good and well, but when it comes to cost of living, say, and having to make decisions, even in full knowledge of what those decisions might result in, I know you can't provide a crystal ball panacea answer to this curve ball question. But what needs to change in order to ameliorate the situation, not just on the grounds of education, but real everyday life, cost of living when it comes to healthcare?

Dean Erhardt 15:14

Yeah, that's a great question, Nicole, and I think this is where technology and AI particularly, can really help to facilitate some downstream issues. Now, I don't think necessarily we can solve for all of them, but part of that education isn't just, hey, here's what you need to know about your drug and your disease, but it's, you know, there's a copay program here that can offset, you know, $1,000 a month in your cost. There is a foundation that specifically works with this disease state, then can help to offset some of your costs. So most patients don't even know that these type of vehicles are in the market and available to them. So I think part of that education process, and again, doesn't mean we can solve for everything, but enable them to at least know what those options are in the marketplace and how to access those options. Now, that doesn't mean a person may not still get a medical bill or have a cost of a product that they can't afford, and I'm not, don't know that there's any clear, easy answers, but at least they have all of the information at their fingertips to be able to say, I know that I've now, instead of, you know, paying $2,000 a month, I've gotten it down to $200 a month. And again, $200 a month may still be too much, but at least they know what their options are to be able to create more affordability.

Nicole Raleigh 16:34

Thank you, Dean, it's been a pleasure.

Dean Erhardt 16:36

Thank you very much, Nicole, thank you.

Nicole Raleigh 16:40

And that concludes another episode of the Pharmaphorum Podcast. You can find more information about this episode, including a download link and information about previous installments at pharmaphorum.com/podcasts. The Pharmaphorum Podcast is also available on Apple Podcasts, Spotify, overcast, Pocket Casts, pod bean and pretty much wherever else you download your other podcasts from, just search for Pharmaphorum and follow and hit subscribe. Of course, don't forget to visit our website itself, where you can sign up for daily and weekly news and analysis bulletins and do follow us on blue sky and LinkedIn at Pharmaphorum. That's all for now. Thank you for listening.