Prescription for Better Access

Podcast: Prescription for Better Access Episode 3: Breaking Down Barriers: An Interview with Peyton Howell 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 creation of the hub industry and where things are headed. To begin, Peyton shares her career journey in healthcare started while an undergraduate. While earning her master’s degree at Ohio State University, she had the opportunity to work directly with the COO of a hospital on projects related to patient access. After completing graduate school she started consulting, helping hospitals and other clients. She was approached by a group of hospital administrators to help create the Lash Group, a pharm-focused consulting firm, just as new biologics were emerging. 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 and had opportunity to lead access globally. Then, she was approached to work in clinical trials at Parexel, where she is now the COO. Peyton describes the major drug launches that she is proud to have supported including her very first one for Genentech’s launch of Pulmozyme for cystic fibrosis. She also touches on a program for a client that was generous with free drug but had not looked holistically at the patient and as a result was not solving the key problem which was the lack of insurance coverage. Peyton describes how the challenges with payers in terms of prior authorization, certificates of medical necessity and other barriers delaying accessibility to care were first seen with the launches of multiple sclerosis and rheumatoid arthritis drugs. This changed everything in terms of the type of support required for patients and the subsequent additional investments needed from pharma companies. These launches, along with the drugs for HIV, demonstrated the considerable value to patients and in looking back at her career, she remains most proud of because of the urgent need. Peyton describes how she never would have expected that there would be as many challenges for patients as we see today. As an industry, she believes we need to get patients more comfortable talking about these hurdles so that other patients realize they are not alone and to ensure physicians and the patients themselves have the understanding they need so they don’t give up fighting for better access. She spends time discussing the challenges with various sites of care and how it can be another barrier to access. Payton is credited with coming up with the term “hub industry” and talks about how the term may in fact be too simple for the critically important and complex nature of what they do to help patients access drugs. 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. She talks about how today there remain so many challenges to overcome than there were in decades past including that pharma, being regulated, has to be more conservative in their approach and services which unfortunately can be another type of barrier. She describes the importance of staying connected to the patient, with human interaction, as more efforts are implemented to automate or use technology to facilitate the services for patients. Peyton explains how the industry has had navigate various legislation and the government to provide the services needed for patients. How the government’s efforts, including OIG opinions, that were intended to be helpful, were sometimes just more confusing for pharma companies to interpret and rely upon and created unintended consequences that limit pharma services and 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 payers and PBMs and that the consolidation has not reduced barriers. Next, Peyton unpacks her perspective on the state of the industry today and the obstacles we are currently facing. She explains that what attracted her to join Parexel was the opportunity to work on clinical trials and how they can help gather more of the evidence towards the value of the next wave of breakthrough products. She describes the need to start thinking earlier about access and patient support including having patient navigation tools and being able to collect data to understand what drugs work which is a key to helping to take costs out of the system. She is encouraged by more studies about access including a recent ICER study on health equity because she is confident if we can solve access for the person who needs it the most, we will solve it for all patients. Peyton shares the importance of each patient looking at their own insurance, evaluating the services available to them from multiple sources and investing in understanding the benefits and limitations of your coverage. This leads to a discussion around copays and how they have evolved to be such a significant barrier today for patients. She explains that she sees the conflict that will occur between what she sees coming out of the pipelines of pharma and the copay requirements of payers including the expanding copay accumulator programs. When asked about potential new programs or ideas that pharma may consider, she worries about the impact of the Inflation Reduction Act. But she is hopeful because there have been huge wins such as the elimination of pre-existing conditions. She is hopeful about the focus on value, outcomes and health equity. She is hopeful that more companies are focused on patient access and more people are coming together to think about solutions because we don’t want to lose the innovative strength of our pharma industry. In closing, she shares her own prescription for better access. We should all be better educated consumers for ourselves and that we focus on transparency and simplicity for those patients who don’t have a voice of their own. Timestamps: 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. Links: Learn more about Peyton Howell. Learn more about Dr. Scott Howell. Learn more about Mark Hansan. Comments or suggestions for Mark or Scott: comments@prescriptionforbetteraccess.com