How PBMs Use Data to Help Patients During COVID-19

Host JC Scott speaks with two guests from Humana Pharmacy Solutions. The first, Dr. Mona Siddiqui, is senior vice president of clinical strategy and quality at Humana. Her background is in public service, especially with HHS and the Center for Medicaid and Medicare Innovation. The second is Dr. Scott Greenwell, senior vice president of pharmacy solutions at Humana, who played an integral role in launching Humana’s Medicare Part D program. The discussion is around innovation in service delivery both before, during, and after the pandemic.

Analyzing Trends to Improve Programs: Data-driven program design utilizing almost-real-time data from CMS or FDA can have an enormous impact on end users. Bringing together data assets from Humana’s insurance side, home segment, and pharmacy segment has provided insight into differing needs of pharmacy customers, most recently during the pandemic.

Social Determinants During the Pandemic: During Covid social determinants of health are of paramount interest. Humana focused on listening to customer needs, including food scarcity, loneliness, transportation access, early prescription refills, mail delivery, and allowing periodic lab requirements to be postponed.

Will Changes Made During the Pandemic Last?: You can’t put the genie back in the bottle. Consumers will expect changes like mail delivery to remain in place even after the pandemic is under control. Surprisingly, even seniors preferred an end-to-end digital experience; they are used to seamless digital experiences now because of entities like Amazon.

Meeting Consumer Expectations with Technology: Humana began in 2015 with the real-time benefit check transaction as an early transparent digital process. This was integrated into the physician’s existing workflow and the response was that this was just what had already been expected. Even those who have been uncomfortable with digital tools approve of them when the experience is frictionless for patients and providers.

Specialty Drugs in Disease-specific Clinical Initiatives: Where traditional rebate tools will not work, as with specialty drugs, Humana sometimes uses value-based contracting. The company also has a program called UM Ultra, which creates personalized utilization management, such as looking at dose optimization, so that patient value is balanced with drug cost.

Promoting Covid Testing: In addition to covering testing costs, Humana has also made at-home testing kits available. And it created a drive-thru PCR test partnership with Wal-Mart that delivers results digitally and refers out as well, when necessary. And, again, the purely digital process has proved more popular than the drive-thru process, counterintuitively for some.

You can subscribe to The Pharmacy Benefit on Spotify, Google Podcasts, Apple Podcasts, and all other major platforms.