3. Breaking Down Barriers: An Interview with Peyton Howell
This episode features an interview with Peyton Howell discussing the evolution of patient access over the past three decades, the creation of the hub industry, and the continuing challenges faced by pharma companies and service providers in supporting patient access to medications.
Podcast: Prescription for Better Access
Episode: Ep 3
Welcome to Prescription for Better Access, a new interview-focused podcast brought to you by two healthcare industry veterans aimed to help shape the future of patient access and affordability! In this episode, co-hosts Mark Hansan and Dr. Scott Howell interview Peyton Howell, an early leader in the industry, about the evolution of patient access, the hub industry and where things are headed in terms of patient access.
To begin, Peyton shares about her career background. She has always loved the healthcare field and worked in hospital administration to pay her way through college. While earning a Masters Degree in health administration at Ohio State University, she had the opportunity to work directly with the COO of the hospital on projects related to patient access. Thus, she was offered an early view into how to correct treatment therapies and improve patient access. After grad school she focused on the consulting side, helping hospitals and sites. She was approached by office administrators to join in on the creation of Lash Group, a practice group focused on the pharma industry.
Peyton sold Lash Group in 1998 during the early stages of her career. At AmerisourceBergen, she had the opportunity to grow the business for nearly a decade and was able to buy other access-related consulting businesses. Here, she was able to see the whole cycle of access from pharmaceutical treatments to how they work on all sides of care. Then, she was approached to work in clinical trials at Parexel, where she is now the COO. Among the major launches Peyton has played a role in, she highlights her very first one related to cystic fibrosis. She also touches on a project at Lash Group which created an explosive group and created a new model of looking holistically at patients rather than just at free drug programs.
The first launches of multiple sclerosis and rheumatoid arthritis are where the industry began to see the real challenges with payers in terms of prior authorization, certificates of medical necessity and other barriers delaying accessibility to care. This changed everything in terms of how to support patients and the new required investments of pharma companies. Looking back on her career, Peyton feels that those urgent moments are the ones she is most proud of. 20 years ago, she never would have guessed that there would be as many challenges for patients as we see today. As an industry, we need to get patients more comfortable talking about these hurdles to make people aware that they are not alone in facing them.
Payton is credited with coming up with the term “hub industry”, which is critically important for the launch of new healthcare products. It is all about efficiently removing barriers for patients and sites. Building on that, she shares her perspective on the evolution of the hub industry over the years. Today, there are so many more pieces to the puzzle and challenges to overcome than there were in decades past. Additionally, it doesn’t help that healthcare is still a very conservative industry.
Shifting gears, Peyton explains how various legislation and the government has influenced the industry overall. All of the OIG opinions that were intended to be helpful, she has found, were sometimes just more confusing for pharma companies to interpret and rely upon. We see that in the limits on the type of support pharma sponsors will typically provide. This makes the patient experience redundant, frustrating and confusing. Another major change driver has been the consolidation of major industry players, which we are seeing even more of now with vertical consolidation. Peyton’s main areas of concern are the consolidation of players and PBMs.
Next, Payton unpacks her perspective on the state of the industry today and the obstacles we are currently facing. What attracted her to clinical trials in the first place, she reveals, is the opportunity to put more of the evidence towards the next wave of breakthrough products. The only way to truly take costs out of the system is to let the data show us where it is not helping us. Before wrapping up, Peyton shares her own advice for the future of the podcast and the areas she might like to hear discussed in the future. Her desire is that things are made simple for the average family to understand how to navigate the system. Peyton, identifies the areas which make her feel hopeful about the future. The interest and awareness we are currently seeing are the major factors contributing to this hopefulness. In closing, she shares her own prescription for better access. We should all be better educated consumers for ourselves and for those patients who don’t have a voice of their own.
1:14 – Introduction to today’s episode.
2:55 – Peyton’s journey in the healthcare field.
5:15 – Peyton’s time at AmerisourceBergen.
7:20 – The early career launches which stand out for Peyton.
9:37 – The evolution of biologics.
15:30 – The history of the hub industry.
20:33 – How legislation and the government has influenced the overall industry.
22:19 – The consolidation of major players.
23:23 – What are we seeing in the industry today?
26:02 – Peyton’s advice for the future of the podcast.
27:42 – How copays have evolved.
32:47 – Areas of hope in the industry today.
34:!9 – Peyton’s prescription for better access.
Learn more about Dr. Scott Howell.
Learn more about Mark Hansan.
Comments or suggestions for Mark or Scott: firstname.lastname@example.org
Learn more about Peyton Howell.
12: How Alternative Funding Programs Exploit Patient Assistance Programs
In this episode, we investigate the rise of Alternative Funding Programs (AFPs) that bypass coverage for vital specialty drugs. Kyle Crowell, an expert consultant on AFPs, discusses how payers avoid their responsibility for costs by collaborating with third-party companies to exclude specific drug coverage and directing patients towards manufacturer-sponsored patient assistance programs (PAPs). Patient advocate, Amy Niles from the PAN Foundation, describes how the mounting tension caused by AFPs are leaving patients to navigate the uncertain waters of their medication coverage and access, potentially risking their health and even their lives.
Like this episode and want to hear more? Listen to past episodes here!
Do you have a prescription for better access? Share your comments and episode ideas with us at:
11. Obesity Week 2023: An Interview with Dr. Angela Fitch, President, OMA
Patients are experiencing remarkable weight loss thanks to the new generation of GLP-1’s and the downstream health benefits may go well beyond diabetes. In spite of the dramatic results for patients, insurance plans have started to put up more barriers and are even denying the drugs on a more consistent basis. For this special Obesity Week 2023 episode, we interview Dr. Angela Fitch, President of the Obesity Medicine Association, a faculty member at Harvard Medical School and most recently a Co-Founder and Chief Medical Officer for knownwell, a new obesity-focused primary care company.
Dr. Fitch’s patient care center: Knownwell
The drugs discussed in this episode:
An article on the use of “bootlegged” Semaglitude: Demand Rising for ‘Bootlegged’ Weight-Loss Drug | MedPage Today
Questions or comments?
Email us at email@example.com.
10: Empowering Employers to Improve Patient Access
Employers are discovering this fall that they are expected to shoulder a 6% health insurance increase for 2024. What can employers do to combat the accelerating cost of health insurance without jeopardizing access to vital drugs? In this podcast episode, we talk with Matt Ohrt, a former HR executive who achieved a 20% reduction in health insurance costs for his employer. Matt has a new book and new company to help other self-funded employers strategically lower their sponsored health insurance costs for 2024 while ensuring employees have optimal access to care and treatments. This is an essential listen for employers seeking to balance cost-efficiency with the provision of comprehensive, high-quality healthcare benefits to their employees.
9. Physician Offices: Fighting for Patient Access
Many of the most beneficial therapies are prescribed or administered within physician offices yet these providers face a multitude of challenges attempting to get authorization and coverage. In this podcast, we interview a practice manager who is not only on the frontlines of the battle to help patients but is also an award-winning advocate for access. This episode will explore the barriers faced by providers and their offices and what can be done to win the day-to-day battles with insurance companies and PBM’s so patients can access and remain on treatment.
8. Washington’s Influence on Patient Access
This episode delves into the intricate web of Washington’s influence on patient access, exploring the multifaceted factors that shape healthcare legislation, policies and their impact on patients, other key stakeholders and drug pricing. With an insightful interview from one of Washington’s top healthcare experts, listeners gain insight to the complexities of legislation, such as the Affordable Care Act and Inflation Reduction Act. This is certainly the “wonkiest” podcast episode as we attempt to provide an understanding of the current landscape of patient access and look ahead to how Washington’s decisions will shape the future of patient access.
7. Tackling Copay Accumulators and Maximizers
In this podcast, we interview a consultant and a leading patient advocate to better understand and explore the challenges of copay accumulator and maximizer programs for specialty drugs. We discuss the difference between the two programs and their impact on the various stakeholders including the overwhelming burden placed on patients. We also discuss the legal issues and potential policy changes that could eliminate these programs or minimize their impact on patients. Ultimately, our goal is to shed light on this important issue and identify strategies for improving access to critical medications for patients who need them.
6. PBM Perspective: An Interview with Industry Veteran Mesfin Tegenu
Pharmacy benefit managers (PBM’s) manage the drug benefits for millions of Americans and as a result, they can have a positive or negative impact on patient access. Mesfin Tegenu, an early pioneer in the PBM industry, is interviewed by Scott and Mark and offers his candid perspective on what PBM’s do, their impact on stakeholders and how the PBM industry could evolve over the next few years to better serve patients, employers, health plans and government payers.
5. Understanding ICER: An interview with founder Dr. Steven Pearson
In this episode, we interview Dr. Steven Pearson, the founder and President of the Institute for Clinical and Economic Review (ICER). Over the past 16 years, ICER has evolved from a Harvard research program to the independent authority on cost-effectiveness and value of new drugs. Dr. Pearson has been an advocate of “Fair Pricing for Fair Access” and in January 2023, ICER published their 2nd Annual Assessment of Barriers to Fair Access Within US Commercial Insurance Prescription Drug Coverage.