Named as Neighborhood Health Plan of Rhode Island’s vice president of pharmacy in January, Casey Stockman collaborates with other department heads to coordinate and oversee the pharmacy department.
Stockman joined Neighborhood in early 2019 as a specialty drug consultant before moving on to become vice president of specialty pharmacy. She discusses her new position and shares some insight on the pharmacy industry.
PBN: Do you have any priorities as you settle into your new role?
STOCKMAN: Yes, I’ve been focused on a number of exciting opportunities in my new role, both short- and long-term, and am thrilled to be leading the execution of this work for Neighborhood. For 25 years, Neighborhood has ensured that everyone in the state has access to high-quality, affordable health care, especially at-risk populations. Working for such a mission-driven organization gives me the chance to do what I’ve always wanted to do: apply my skills and experience at a health plan that cares deeply about its members and their quality of care.
Short-term priorities initiated in 2019 ran the gamut from creating team development and career growth opportunities for my staff to ensuring regulatory compliance in the face of evolving state and federal rules, to implementing specialty drug-management strategies such as hemophilia assay management, biosimilar first initiatives and dose optimization.
Long-term priorities include, first and foremost, collaborating with Rhode Island’s federally qualified community health centers – Neighborhood’s founders – to improve health outcomes for members.
Other areas of focus that will take time to bring to fruition but are critically important include developing a holistic approach to oncology management, keeping a watchful eye on emerging gene therapies to evaluate mechanisms for coverage and access, and expanding our clinical and quality programs.
PBN: Have you had any opportunities to create savings for members during your time at Neighborhood?
STOCKMAN: Yes, and this is something I’m very proud of in light of the skyrocketing costs of many medications. I’m passionate about ensuring clinically appropriate access to affordable products for our members.
To best explain how I achieved significant savings for our members, it’s important to highlight the structure of our health plan. Neighborhood is comprised of three types of products – Managed Medicaid [146,000 members], Exchange [26,000 members who purchase insurance through HealthSource RI] and Medicare-Medicaid [14,000 members].
Our Medicaid and Medicare-Medicaid members do not have out-of-pocket expenses for drugs; however, our Exchange members do. For these members, in 2019 we implemented several initiatives to improve the utilization of high-quality, cost-effective, provider-administered medications such as autoimmune, cancer and cancer-support drugs, working collaboratively with members and their providers. This included recommending biosimilar drugs that are a lower cost to members. We enacted several tailored dose optimization initiatives, which maximized varying inventories of quantities and package sizes that arrive at the same therapeutic dose for the member but at the most cost-effective rate – sometimes $10,000 less per month per patient.
Lastly, we ensured all new generic launches were quickly made available to members so they could realize immediate savings on their out-of-pocket costs.
PBN: You joined Neighborhood as vice president of specialty pharmacy; can you explain a bit about what that is?
STOCKMAN: My work experience has been focused on understanding and managing “specialty pharmacy,” or high-cost drugs that require special handling, storage or administration. Definitions vary among payers, but generally these drugs cost more than $1,000 per month and although some may be oral, many are self-administered or provider-administered infusions or injections. Many specialty medications have to be refrigerated or even compounded under regulated policies and procedures.
Additionally, there are multiple considerations for how specialty drugs are obtained, dispensed, prescribed, administered, monitored and reimbursed, and my role as vice president of specialty pharmacy was to ensure our members had access to these drugs and at the lowest cost possible.
Due to the high cost and special considerations around these specialty medications, plans and pharmacy-benefit managers typically have dedicated resources who have experience with and understanding in this space. Specialty drugs account for 40-50% of all drug spend, but only 1-2% of patients are prescribed a specialty drug. Plus, the Federal Food and Drug Administration is approving more drugs annually in recent years than it had previously and the majority of the medications approved are specialty drugs used to treat cancer, autoimmune diseases, genetic disorders, rare diseases and much more. This has made having a specialty pharmacy expert on staff imperative for all payers – to ensure appropriate access and manage costs.
PBN: How did working in that division prepare you to oversee the entire pharmacy program at Neighborhood?
STOCKMAN: Since specialty drug spend has neared and, for some payers, even surpassed traditional drug spend, having 10 years of exclusive specialty drug experience has positioned me to successfully lead the pharmacy department as we actively prepare for this evolving drug marketplace.
Our team focuses on pipeline management, forecasting, securing access to limited distribution drugs, offering clinical programs to members with evidence to support their performance, and ensuring the affordability and sustainability of drug benefits for our members and customers for years to come.
Additionally, spending time working with my predecessor, who has very strong health plan, [pharmacy benefit manager], consulting, retail and regulatory experience, helped me evaluate Neighborhood’s specialty drug-management approaches and drug spend in context of their overall drug-management goals and member needs.
Our Pharmacy Department has a regulatory and operations expert, a clinical expert, as well as excellent pharmacist and technician bench strength. Having the opportunity to combine our individual experiences, strengths and skill sets has created a synergistic effect that benefits the entire team and the members and providers we serve.
I am also lucky to have my predecessor still at Neighborhood in her new role as vice president of integrated care strategies; we often consult on historical knowledge or emerging unique challenges. It is a rare and much appreciated privilege.
PBN: What are some of the most expensive drugs that are commonly prescribed, and is there a chance that prices will decrease in the future?
STOCKMAN: The most expensive drugs that are commonly prescribed include drugs used to treat HIV; hepatitis C; autoimmune disorders – e.g. rheumatoid arthritis, plaque psoriasis and Crohn’s disease; cancer; and multiple sclerosis. And, yes, the impact of competition and rebating has caused some price reductions. For example, medications to treat hepatitis C have dramatically decreased in cost over the last five years. On the other hand, since HIV and cancer are protected classes, this dynamic has not been observed as greatly, but the introduction of oncology biosimilars in the second half of 2019 has begun to reduce prices.
Likewise, for autoimmune on the medical benefit, the most commonly prescribed infusion drug now has biosimilars available, which has decreased prices. Patent litigation and other factors will determine how soon we will see this price relief on the pharmacy benefit with self-injectable immunomodulating drugs.
Lastly, multiple sclerosis specialty drugs saw the introduction of some generics over the last several years, which has brought some prices down. As with all of these classes, the goal is for pharmaceutical manufacturers to bring innovative and higher-performing drugs to market.
In all classes mentioned above, although some drugs have gone generic, some new drugs in each class have been introduced with better efficacy and/or less side effects and correspondingly with higher price tags. The role of health plans and PBMs is to ensure competition among like-products to decrease prices, while evaluating and securing access to new and innovative therapies that are truly life-changing for members.
Elizabeth Graham is a PBN staff writer. She can be reached at Graham@PBN.com.
