S02 E04

Patient Support Programs During the Pandemic


Nicole Serena

Vice President of PSP Systems and Solutions

Waldron & Associates

In the fourth episode of our second season, Peter Brenders, Founder & President of Kontollo Health, talks with Nicole Serena, Vice President of PSP Systems and Solutions at Waldron & Associates, about publishing a white paper on the effect of Covid-19 on patient support programs.

The Executive Summary of the first White Paper and future White Papers referenced in the episode can be found here.





Thank you for downloading the NPC Podcast from the National Pharmaceutical Congress for October 7, 2020. This program is all about discussing and considering the purpose, process and people of the pharma industry during the Age of Covid. Each week, we continue the health care conversation by answering questions from listeners like you. 


This program is proudly presented in cooperation with Impres, Impres best in class commercial solutions offer top line and bottom line growth with maximum sales force, flexibility, speed and efficiency. Learn more about their next generation commercial model at www.impres.com


On today's podcast, our guest is Nicole Serena, Vice President of Patient Support Systems at Waldron & Associates. Stuck inside of Fredericton with the Moncton Blues again is your host Peter Brenders of Kontollo Health. 


But first, here's that renowned Dylanologist: Mitch Shannon of Chronicle companies.




Thanks Liona. 


I guess I'm guilty as charged. I like Bob. If anyone wants to quote more Dylan lyrics leave them anytime on our comment line at 647-875-9011, where the answers are always blowing in the wind. 


Something else that was left blowing in the wind during the Covid pandemic is patient support systems. Drug companies use PSPs to assist patients and doctors with services that are supposed to reduce barriers to accessing medication. But Covid has disrupted nearly every aspect of our lives and PSPs are not an exception. 


Nicole Serena of the consultancy Waldron & Associates recently co-wrote a White Paper on this subject. 


Here she is to talk about it with Peter.




Welcome to the NPC Podcast. I'm Peter Brenders, your host. 


In our continuing look at the impact of Covid-19 on the purpose, process and people in pharma. This episode dives deeper into the pharma process for patient support. 


Joining me today is Nicole Serena, Vice President of Patient Support Programs at Walden & Associates. 


Welcome Nicole.




Hi, Peter.




Nicole, you recently published results of a survey you conducted on the impact of Covid-19 on patient support programs. Now, before you tell us about the results of your survey, perhaps you could take a moment to explain what are patient support programs or these PSPs that you surveyed about?




That's a great question. So patient support programs are programs that the pharmaceutical manufacturers have created to support patients accessing medication. 


So, for example if, we all know, for an oncology product, sometimes they're really expensive. And even if you have great private insurance, there may be a co-pay. So, you could be paying $6,000 a month. 20% of $6,000 is still a significant amount. Could be a mortgage payment, or a very fancy car payment. So, programs have been put in place to help support patients with those types of support. Also, if there's an injection drug, and patients need to learn how to do a self-injection, there may be a nurse that would go to their home, or these days virtually, through a video call to train the patient on how they would inject the medication. So in the end of the day, they become independent, but they have that further support. 


Because, you know, we all know that physicians and clinics and hospitals are really busy. And they sometimes don't have the same amount of time that say one of these programs can do to support patients to really ensure that they're administrating the product properly and safely and also that that will help them with their adherence. So over time, they take your medication when they're supposed to and they're comfortable administering it.




So, who's paying for this nurse to go and help the patient figure out how to inject or to help administer the drug?




The pharmaceutical manufacturer would be.




So, if these are so important, how can or can our health system deliver patient care without support programs? Would you say patient support programs are medically necessary?




They seem to have become. And it's interesting because a lot of companies think that Canadian health care is fully covered on everything. And drugs are one area that they're not. A lot of patients, especially if they're outside of the hospital, they have to pay for their own medications. And with the level of care that we have, and that it's publicly funded, you may not get to the same level of care depending on where you live. If you live in a remote area, you may have to travel hours to the hospital where your specialist is. 


So these programs kind of fill gaps so that patients can can access the medication and access the support they need, without maybe making their lives more difficult by having to travel, say three hours each way to see their specialist who may only be able to see them a couple times a year. So, this way they get added support to help them along the way.


Long answer to your question.




No, but it's an important answer to the question out there, if healthcare is more than just drugs, it's actually being able to receive the drug, to be administered that drug. And that important health care is actually provided by these companies sponsored patient support programs, you got to wonder in terms of why they aren't part of the health system today.




Yeah, and I think over time, you know, we see, especially when there's new medications, that there's never been out there, they have new so if there's higher titrations. 


So, in the past, you take a pill twice a day. Now, there's some medications where you take a pill twice a day, for the first week, three times the next week, four times the next week, and then they may change it. And so it gets more complicated. 


And with that complication, at the beginning, companies are supporting the health care system, because they're kind of bringing that complication to the market. And so they're supporting them, while the health care system sort of catches up to those. And once they've caught up, that service is no longer needed. So they don't need to support it. But then usually, there's a new drug with a new complication that they'll support until the healthcare catches up again.




So really, so it's not just the medications that companies are bringing out. It's the innovation to actually help healthcare be at the cutting edge.




Agreed, yes.




Alright, let's talk about the big pandemic elephant in the room. What is Covid-19 done to these programs?




What's been interesting there is, you know, patient support programs probably run in the background, a lot of people don't really know about them that much. And they've become a bit more of a forefront, with both patients and health care practitioners, because they've been helping to fill some gaps, again, with Covid-19. And so I'd say, the employees that are supporting these programs, probably working longer hours than ever before, where some other employees haven't. 


So, for example, if a patient had to go into the hospital for an oncology infusion, during the, especially the beginning, in the end of March and April, they weren't able to, even into May. And so, physicians were looking for alternatives. So, could they switch that patient to an oral medication or an injectable. And so, these patient support programs could help with that transition, because you would need to have them see if there's any kind of private payer insurer support, or public payer. And these programs have what they call reimbursement specialists, who would help the patient and the health care practitioner, see if there's some kind of financial support for these patients so they can get that change in their medication, and then also support them with some further education. That's one example how they were able to help. 


We also saw with the survey we did that more patients in programs, about 70% saw an increase in financial assistance requests. So, some patients maybe were furloughed off of jobs, or even lost jobs. And so, then they were reaching out to these programs to see if there was financial assistance available to help them out.




You're listening to the NPC Podcast. I'm your host, Peter Brenders. 


So, would you say then the pandemic has increased that gap in healthcare, sort of the problem that the health care system has where there was a stronger reach to the patient support programs to fill that gap?




Yes, definitely. And I'd say it would, it highlighted areas of maybe wider gaps or new gaps, because patients were no longer able to access clinics or hospitals for certain things. We also saw a delay in surgery. 


So, physicians were looking especially for oncology and some other ones, what type of treatment via medication, could they help to delay the progress or progression of people's, you know, disease until they could get their surgery. And again, if it was a biologic or specialty medication, these programs could support them either in accessing the medication or also teaching the patient or finding a way to administer the medication outside of say, a hospital or a doctor's office.




So, if patients can't come in to see the nurse and the nurses aren't going out to see the patient. What's the approach? Is telehealth or virtual engagement taking place to support programs and are these sort of things working?




Well, that's the interesting thing is they're starting to do that but they also still had nurses going into patients homes. So, if the patient was comfortable with it, the nurse would have full PPE on, they would offer the patient, so every, you know, nurse visit at home would take longer, they would ensure their safety on both sides. But that was actually an added value that some companies were able to offer, they may have already offered that kind of training already. And then some patients, you know, who couldn't go to a hospital for training could have this alternative. 


They also were looking at digital solutions. So, a number of companies switch from an in-person or an in-clinic training to a digital training. So, for example, injection training, maybe they had a video, so they would send the patient the video. And then they follow up either with a phone call or a zoom meeting, to discuss if they had questions, and to help them that way.




So, the pandemic is dragging on longer, how sustainable are these changes?




And that's something that I talk about when I did a webinar on this is that we've added new programs, are you communicating are they temporary? Or are they permanent? 


We originally thought this was what two or three weeks long, we're now in month six or seven. And it's going on longer. So, I think planning, and really looking at forecasts and budgets is really key right now. Because this isn't going to change in the next two weeks, it could be months, it could be a year. So budget is going to be impacted. Because as you can imagine, these are very expensive programs, sending a nurse into someone's house, or doing financial assistance for high cost medication is expensive and the sustainability is a key. 


So, I recommend if you're adding in services, really communicate that they're temporary. You can always extend a timeline, it's really hard, especially from a reputation standpoint, taking away services, especially during a time like this. So, communicating with patients and healthcare practitioners, you're adding on these services short term, and temporary to support everyone. And then you know, if you have to you can extend them. But that way they know it's not something that they'll get for the next five years, it may only be for the next six months.




Are you seeing or hearing about any companies that might be scaling back these patient support programs?




No, not yet. Some companies are really looking carefully at their budgets. What I suggest that they do is look at all the different services pre-Covid and right now, what are the ones that are being used? Are there some that maybe aren't being used right now? And those are the ones that can scale back that aren't being impacted, but maybe costing some money and that can free up some budgets. 


They may also look at other budgets that aren't being used. No one's traveling the same way in other ways. So, are there other budgets that they can access really keep key communication with their senior leadership on these budgets? I would say the communication is so important right now.




What are you hearing from patients and healthcare practitioners on these programs and their changes? What's the feedback like out there?




Well, there's been a number of studies that myself, I haven't been in contact with patients, and healthcare practitioners. But another other surveys are out there. And what's interesting is they're all saying we need that support, please continue to support especially financial assistance and their support. 


They also want to know more about Covid-19 and how it may affect their therapies or their access to services. So that's another area that I've seen manufacturers in their programs, is they're adding some specific information for patients on Covid-19 and their services.




And the government's a large player. Is the government speaking up at all or are we hearing any messaging coming from government on these programs and, and how important they are? Or are they creating expectations of manufacturers to sustain these programs?




What's interesting is we asked a question about collaboration. And so a lot of companies are collaborating, and part of that is that they're having discussions with the physicians, with the public payers and the private payers to really, you know, discuss how they can support and yet not become that first payer.




You're listening to the NPC Podcast, our guest is Nicole Serena, Vice President Patient Support Programs at Waldron & Associates. 


So, the recent federal speech from the throne talked about the commitment to a national universal pharmacare program. When you hear about sort of the necessity of PSPs in terms of supporting drugs, how should psps become part of a pharmacare program? How do they become part of the conversation?




I think that's a great question. And part of that is really looking at the current gaps in health care, like why do we have patient support programs to begin with, you know, you hear other countries saying well Canada has free health care, why would you need to have a patient support program? It's because there's gaps. 


So, it would be great if there were conversations between the federal government and the manufacturers. So, when there's not a duplication and two, we don't know what National pharmacare if they're going to cover a basic level of health care, or a full level of health care, that's the real question that we don't know.




Okay Nicole, now it's time to look into the future. What do PSP programs look like a year from now?




It's an interesting question, because we don't know what the future is going to look like are we still going to be in Covid-19? I think we're going to see innovation, we're going to see more digital services out there, we may see some services that no one have thought of a year ago today. 


For example, testing. So one thing we're hearing is when patients have renewal for their medication, for say, their public plan, say I'm covered in Ontario, for my plan, but I have a what they call a special authorization because it's expensive, the physician needs to fill out a form, I may need to have a blood test or some kind of a test. So normally, I would go into the hospital, or I'd go into a lab. And right now that might not be available. So a nurse could come into my home and administer that test. Or maybe a local pharmacy could administer that test. So you could have Patient Support Program administer or set up the scheduling to find you that test. And that could be an added service in the future. 


I think we'll see more face to face changing to digital. So how, how do PSPs become more digitally innovative? How do we streamline the data that we get? So that it's actually helpful to not only the pharma manufacturers, but to the physicians who are supporting the patients as well?




So, what advice would you give to either manufacturers or PSP providers out there in terms of preparing for that future?




I think planning is key, developing short term and long-term plans. And part of that short term is like three to six months, what's going to happen now, and then look out 12 to 24 months. In our survey, what was really interesting is the first survey people were really looking out three to six months, we just finished our last survey, which was in September, people are now looking at 12 and 24 months, it was a real interesting change. 


So, having the short term as well as a long term plan, knowing those long term plans need to be flexible. I think, second: communicate. Communicate externally with your provider, and with your patients and healthcare practitioners, as well as internally to your cross functional, as well as your senior management. And finally, to be flexible. These programs are big. There's a lot of compliance and governance over them. 


But at the same time, right now, we need to be flexible. How do you try something? And what we all say is fail fast. And if it doesn't work, how do you change it, but you do it in the right way so that you're updating and ensuring that you've got that governance oversight as well. And then the final thing I'd say, is the employees, especially your provider ones, the nurses, the nurse case managers, pharmacies, everyone who's working on these programs, they've been working nonstop, is to watch for burnout. Watch out for burnout, especially for people going into patients homes. They have an added level of anxiety already with a pandemic, and then they're going into patients homes, so watch for burnout with these teams as well.




And the goal I understand, you've also completed a couple of other surveys more recently on PSPs and future directions. When will these results be available?




So, we just finished our September survey a couple of weeks ago. And we'll be publishing the White Paper probably sometime in October. There'll be a link on the website.




So, for NPC Podcast audience, look for it on the NPC website. Great thoughts, great comments from Nicole Serena from Waldron & Associates, you've been listening to the NPC podcast.




Thanks to Nicole and Peter. 


As Nicole notes in her White Paper. Although the pandemic has drastically impacted and challenged the pharmaceutical industry, the new normal provides the perfect opportunity to reshape the pharmaceutical landscape for the better. 


We're here every Wednesday on the NPC Podcast encouraging the effort to make things better you can catch up with any episode you may have missed through Google Podcasts, Apple iTunes, Stitcher, Spotify, or wherever you get your podcast fix. 


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We're now only two weeks away from this year's virtual National Pharmaceutical Congress. It's a series of weekly 90 minute webinars featuring the best minds and the most vital subjects, starting Wednesday, October 21. 


If you haven't registered yet, quit dragging your feet sign up at pharmacongress.info. Use the discount code POD20. Save your organization some serious cash. Do you have any questions and comments from this week's episode? Send them by email to health@chronicle.org or call our comment line and ask for Liona. She's there to take your name, a callback number and the question you'd like to ask. Call 647-875-9011. 


The NPC Podcast was presented in cooperation with Impres, Canada's next generation commercial partner. Learn more at www.impres.com


This is Mitch Shannon of Chronicle companies. Your producer is Jeremy Visser. The announcer was Liona Von Droid. 


To our Canadian listeners: Happy Thanksgiving. Have a great week and stay safe.