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Pharmaceutical Commerce readers with long memories might recall a cover-story interview with Nitin Sahney, then COO of Omnicare and the Omnicare Specialty Care Group, in 2013. Omnicare was acquired by CVS Health in 2015, and Mr. Sahney chose not to go along with the acquisition. After spending some time consulting and working with private equity groups, he has jumped back into the fray with PharmaCord, a patient support and hub services provider, which opened its doors in early 2017 and, as of today, has a team in place, pharmacy licenses in 50 states, and the first few manufacturer clients.
You’ve got a long history in the patient support field; tell us about it.
One of my earliest jobs was as a reimbursement specialist at Caremark in the 1980s. In 1993, I was recruited by Cardinal Health to help build a pharma portal business unit called Nexus Health. At the time Nexus was a small part of a $2-billion company; by 2000, it was an even smaller part of a $60-billion company. While the business I was running had tremendous potential, Cardinal was going in a different direction. At the time, the first few specialty products like human growth hormone and multiple sclerosis drugs, were coming on the market, and they needed reimbursement support, special handling and other complications. I left Cardinal at the end of 2000 and started RxCrossroads in 2001 to meet that need.
As president of the Specialty Care group, and between then and 2015, grew the business unit from $600 million to $2.4 billion. In 2015, CVS Health came knocking. Over these years the patient support space has grown and become very competitive, with the big PBMs and big wholesalers all jumping in. I still had the entrepreneurial drive and chose not to continue with CVS Health.
Now, with PharmaCord, I and my team—many of whom have been with me since the RxCrossroads days—have a blank slate to address patient support the way I believe it should be done. I feel passionate about this space.
What will make PharmaCord different from its competitors?
After leaving CVS Health, I’ve spent a good bit of time talking with people in the industry, and with manufacturers. Although there are many players in this space, my opinion is that they present limited options to manufacturers. Our approach is very straightforward: First, my partner and I own the company—there is no outside capital. That means that we will not be beholden to private equity investors, and can grow at our own pace. Second, we will serve manufacturer clients exclusively in the various disease states. The big PBMs and wholesaler-operated hub services are set up to handle competing products; we believe our clients are better served with exclusive arrangements. Third, we’ve built our company foundation to enable it to scale up and serve major products from top pharma companies; some of our competitors are well positioned to handle orphan drugs (which we plan to do as well) with limited patient populations—but scale up poorly. Finally, we have an experienced team with a proven track record; this is a business where it’s easy to perform poorly and we don’t plan to do that.
These characteristics are what differentiates us. At the same time, we will provide many of the standard hub services: a closed-door pharmacy from which we will deliver prescriptions daily; benefit investigation and verification; free drug and fast-start programs; copay coupons; and adherence programs. An intriguing possibility is to combine our IT capabilities with our patient engagement—it should be possible to service some patients, or some programs, with automated systems that lower costs to the manufacturer. We will not provide 3PL (third-party logistics) services; there are plenty of 3PL providers we can work with, and we don’t need to re-invent the wheel.
To sum up, I like to say that “We’re built to scale, and we’re not for sale.”
Isn’t scale simply a matter of how large the company’s call center and case management staff is?
First of all, I think everyone in this business needs to give better recognition to their case managers, because that’s where the high-quality patient service happens. In any case, we currently have capacity for 250 case managers, and are able to double that when business volume justifies it. While we’re currently in offices in downtown Louisville, KY, our plan is to build our own campus in the future.
But the key factor in being able to scale is to have the IT system that allows it to happen. We’ve invested millions in a proprietary It system, and it’s designed to address some of the current limitations in this field. Being able to aggregate and report data is critical. Many of the systems in the market today were built several years ago, and in my opinion, are not built for real-time reporting, and do no scale up easily. We’ve addressed both of those concerns; in addition, the system enables connectivity to obtain data from hospital electronic health systems, pharmacy automation systems and other sources. It is tailored to the workflow of our internal operations, and the reporting requirements of pharma clients.
Pharma clients will be able to get reporting, in near real time, of prescriptions and patient status, broken down by ZIP code or sales territory, and perform analytics on that data. And as the system is cloud-based, clients will be able to access data, based on permissions, with their smartphone or mobile device.
What do you see down the road for hub services?
In terms of the drug pipeline, we see lots of opportunity in coming years. Large-molecule biologics will continue to be introduced; biosimilars are coming along, as are orphan and ultra-orphan drugs. The major obstacle the entire industry is dealing with is connectivity—getting patient information to and from hospitals, pharmacies, payers, manufacturers and patients. That is the crucial role of hub services going forward. We all need better cost efficiency in delivering drug therapies to patients; lower cost will enable better patient access.