Perspectives on the pharmacy landscape with Mike Einodshofer

What key challenges in the pharmacy space have you focused on addressing for patients and the healthcare system throughout your career?

 One thing I’m focused on right now is helping establish a meaningful and real discussion on drug prices in the US. There’s a lot of rhetoric around “skyrocketing drug prices”, but reality is most patients have access to affordable prescription medications in the US.

But we really need to focus on improving benefit designs that insulate patients from excessively high financial responsibilities associated with certain benefit designs in relation to many  brand and most specialty drugs.   Patients don’t choose to get cancer or psoriatic arthritis or multiple sclerosis or cystic fibrosis – diseases that are often treated with higher cost specialty medications. We need to make sure patients  can afford these life-changing therapies.

We have a very complex healthcare system in the United States. Reality is it works for most people, but there are some people, especially those that need more expensive drugs, that have a very difficult time understanding how to afford and even access these medications.

Our insurance marketplaces have evolved in a way that oftentimes puts patients who need a higher cost therapy  in a very difficult position due to very high deductibles.  Understandably, plans try to keep already high medical premiums as low as possible by offering plans with high copays and deductibles.  But these high deductibles can create a massive issue for patients in need of higher cost care.  Some ACA plans have family deductibles over $18,000 in 2025!

Yes, we need to hold manufacturers accountable for responsibly pricing their medications, but also respect the innovation that they bring and risks they take.  The more important conversation, to me, is improving benefit designs and patient protections, not drug price controls.

What are the most exciting trends currently shaping the pharmacy industry, and how do you see these evolving over the next few years?

I see pharmacy practice expanding in a lot of ways.  I hope to see more states allowing pharmacists to get more involved in prescribing decisions including test to treat programs, and other billable clinical services pharmacists can provide beyond medication dispensing and vaccine administration.

Also, I see a continuing shift of specialty pharmacy to health systems. As health systems increasingly enter the specialty pharmacy marketplace, they will need to build sophisticated patient clinical support programs within their outpatient pharmacy.

I also see increasing asymmetry on how drug costs are distributed throughout a population. The majority of drug costs emanate from a very small percentage of the population. We must be careful to make sure that patients that need high cost drugs continue to have access to them, as it isn’t unusual to see over half of a small employer’s drug costs be related to just one or two employees who are living with a chronic, rare disease

As the pharmacy landscape continues to evolve, how do you envision a company like Sempre making an impact from your perspective

I’ve seen a lot of attempts at value based types of pharmacy programs such as adherence calls, MTM pharmacist interventions at the pharmacy, mobile apps, etc., over the years. While they are all well-intentioned, most fall short of the success the creators envisioned.

Reasons for medication non-adherence can be very complex, but we shouldn’t ever get too far removed from simple basic human psychology.  Most people are motivated by rewards and penalties.  Even when people are managing a chronic disease, they may not see the reward or penalty of taking their medication as prescribed in the short term. 

On a day-to-day basis, patients often don’t realize whether they’re taking their medication on time every day. While timely refill reminders can help, they often get ignored. 

However – clear financial incentives tied to a patient’s behavior, e.g. medication adherence, that dynamically change with improved behavior, can be really effective.

We are bombarded with calls, messages, and emails.  Motivating a patient financially to get their next refill on time goes a lot farther than simply a reminder via text or phone call.

This also works very elegantly for manufacturers, allowing them to set a specific budget for patient adherence services, understand how it’s being deployed, and monitor to understand the value of their investment in patient adherence and copay solutions. And plans can provide their members a service that aligns with their clinical and affordability goals.

Reality is that due to the high copay and deductibles I mentioned earlier, manufacturer’s have stepped in to alleviate financial barriers that are often created due to these benefit designs.  Sempre’s approach gives patients a tool that lets them save money on their brand medications and improve adherence, while manufacturers gain control over how their patient assistance funds are utilized.