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Specialty Pharmacy, NASP with Sheila Arquette
Spencer Health Solutions was founded knowing that pharmacies are an integral part of the patient’s health journey. Hi, I’m Tom Rhoads, CEO of Spencer Health Solutions. Pharmacy partners are key to supporting Spencer in patient homes for clinical trials and commercial programs, especially specialty pharmacy partners. To dig deeper in the specialty pharmacy and learn about some of the challenges and changes coming to the industry, we invited Sheila Arquette, CEO of the National Association of Specialty Pharmacy to come onto the podcast. I hope you enjoy this conversation with Sheila and our host, Janet Kennedy, on People Always, Patients Sometimes.
Janet Kennedy: (00:43)
We are honored to have as our guest, Sheila Arquette. She is the president and CEO of the National Association of Specialty Pharmacy. She joined NASP in 2017 and has been focused on increasing the value of the NASP membership. Some of her initiatives under her tenure have resulted in a substantial increase in their membership, also in member benefits and value, and she’s expanded the annual meeting at expo that’s held every year in the fall. Specialty pharmacy has a critical role to play in helping patients live their best lives, and I’m thrilled to have her on the People Always, Patients Sometimes podcast. Welcome Sheila!
Sheila Arquette: (01:24)
Thank you so much, Janet. It’s a pleasure to be here with you today.
Janet Kennedy: (01:27)
Now I gave a very quick high level look at your background, and I’d love for you to fill it in a little bit more for us. Your relationship with NASP didn’t start in 2017, did it?
Sheila Arquette: (01:37)
No, it didn’t. I started in a volunteer capacity with NASP way back in 2013, in 2014, and I started off volunteering to serve on the membership committee. And then I was asked to co-chair our government affairs committee and just really loved the mission of this organization and the incredible group of people that were so passionate about specialty pharmacy and patient care. And so I started to get more and more involved and then helped with our first ever specialty pharmacy law conference. And one of our board members, Rebecca Shanahan, it was her vision to establish the Specialty Pharmacy Law Conference and provide continuing legal education credits for lawyers and specialty pharmacy, because it was really challenging to try to find those credits. And then she was also incoming president of the NASP board. And so she knew at the time that she was gonna need help running the organization. And so that’s when they reached out to me and asked if I would consider coming on board, full-time.
Janet Kennedy: (02:38)
You know, Spencer joined in the not-too-distant past, and we’re now members of NASP, and one of the first and frequent emails I get is about what’s happening in Congress. And that is amazing, all the work that you’re doing there. So what are the big topics that you’re covering in the political affairs and government committee?
Sheila Arquette: (02:58)
We’re very, very focused on ensuring that we have a competitive landscape in a fair imbalanced marketplace. That specialty pharmacy patients have access to the medications that they need and appropriate access, meaning that it’s the right drug for that patient at the right time during their clinical treatment. But we also want it to be from the pharmacy of their choosing, right? So we wanna make sure that our pharmacies have access to networks. That reimbursement is fair, and it’s not being used to keep them from participating in different payer networks. And we wanna make sure that patients have access and choice. And we’re very focused on pharmacy DIR fee reform, right? And ensuring that pharmacies are compensated or paid for their performance and that, you know, that we’re all driving to the same end goal, right? We’re looking at enhanced clinical outcomes. And we also wanna decrease total cost of care because it’s a huge issue, right? We don’t have an infinite amount of money or resources.
Janet Kennedy: (04:01)
And do you feel like the pharmacy section of healthcare has got a voice that they need to have, or is this something you’re trying to build and sustain to a higher level?
Sheila Arquette: (04:13)
So with respect to specialty pharmacy, it is something that, you know, we had to start from ground zero, right? When we would meet with members of Congress or, you know, different offices of the administration, or even CMS, when we would talk about specialty pharmacy, there really was a huge learning curve and a lot of education that we had to do because fortunately not very many folks still to this day are treated with specialty medications. It’s only still around two or two and a half percent of the total number of prescriptions that are dispensed. So when you would talk about pharmacy, the image that comes to everybody’s mind is that corner drug store, right? Your community pharmacy in the middle of town, or that you’ve always frequented. Then when you started talking to them about, you know, specialty pharmacy and the nuances and the distinctions, there was this kind of scratching of their head. Like, no, not sure what they’re talking about. So we really had to start and lay the foundation about, you know, this is what specialty pharmacy is. This is why it’s different. And pretty much, this is why you should care about it.
Janet Kennedy: (05:11)
Is that NASP’s primary goal, or do you have multiple goals for the organization?
Sheila Arquette: (05:17)
We have multiple goals, Janet. We have four foundational pillars. One of which is advocacy, but then we also are focused on education, certification, and then also on the membership. And what I mean by the membership is providing all of the resources, the tools, fostering the connections and the networking that leads to enhanced patient care, right? It takes a village, right, to make a specialty pharmacy patient. So we wanna make sure that our members have at their fingertips, everything that they need to better care for their patients.
Janet Kennedy: (05:51)
So I am a layperson in the conversation. I don’t come with a pharmacy background. I’ve more of a marketing background. So I’m gonna ask a couple of questions because I know there are a few other folks out there like me who need to ask this deeper level of question. So a ‘specialty drug’ is something that I couldn’t walk into my corner drug store and get?
Sheila Arquette: (06:10)
Well, and this is a challenge because we don’t yet, still we don’t have an established definition of specialty drug. And typically what happens is it’s the payers, right? It’s the health insurance companies, it’s the PBMs. They determine what medications are in their specialty drug program. So back in 2016, members of Congress approached NASP and asked for us to put forth some definitions that they could use as a reference. So with respect to specialty drug, what we focused on was complexity. Specialty medications are complex. It’s either in the way that they’re administered, dosed, their side effect profile; it could be in the insurance coverage process, that’s required to gain approval for patients to receive these medications. There can also be financial barriers that have to be overcome. So typically specialty medications are complex. They may have to be stored or handled in a particular way. Oftentimes you can’t get what we consider a specialty drug at your local community pharmacy. However, there are always exceptions to the rule, and as the payers continue to redefine what medications they include in their specialty drug program, sometimes then all of a sudden, you know, these medications are available at your community pharmacy. But typically no, they’re restricted to these pharmacies that, you know, manufacturers have selected to work with because of the capabilities, the inherent capabilities that specialty pharmacies have.
Janet Kennedy: (07:38)
So how does it work out numbers wise? Is there a specialty pharmacy in everyone’s community?
Sheila Arquette: (07:44)
No, there’s not. And typically most of these pharmacies are closed door. And what I mean by that is patients don’t walk in and out, right? There’s not a transaction at a pharmacy counter. Most of these patients are managed remotely. You may have a specialty pharmacy with a central fill location where all of the prescriptions are dispensed. And then they have an enormous patient service center type area where all of the patient management services are carried out. So we have folks that will take care of the insurance verification and the benefits investigation, and helping you to understand as a specialty patient, what is your copay for this medication? And if you can’t afford it, what are the available options? Then we also will have folks reach out to you to schedule your delivery of the medication and help you with refill reminders. Pharmacists and nurses will also counsel patients, right?
Sheila Arquette: (08:33)
Review the medication, take a detailed history, talk about your disease process, make sure that that patient understands what it is they’re being treated for and why it’s so important to take this medication as prescribed. And what do you do if you have side effects and what are the side effects to look out for? And then specialty pharmacies will also help to coordinate all of this information and interact with other members of the patient’s healthcare delivery team. Also, caregivers are really important too. And specialty pharmacist and pharmacy personnel will also interact with those caregivers. So oftentimes no, there isn’t going to be a specialty pharmacy in your community, but you will have access to the medications that you need and the support services that you need.
Janet Kennedy: (09:13)
Here I was gonna ask my next question about “Gee, are specialty pharmacies patient centric?” and that actually sounds like the very definition of a specialty pharmacy.
Sheila Arquette: (09:24)
Absolutely. The patient is at the center of all that specialty pharmacy does. And it’s with that mindset that I often say, you know, to my members, you know, you’re the reason that specialty pharmacy is special, right? But it is with that patient at the center of all that they do. And that’s what drives all of the service offerings, all of the patient counseling, all of the interactions. And it’s really interesting because when I took this job at NASP and started learning more about the relationships that develop, you wouldn’t think that folks would develop such a fondness for their pharmacist and the pharmacist for the patient, when a lot of this is done telephonically, right? Or now, you know, since COVID, you know, either via zoom, some patients have even elected to be supported through text messaging and emails, but they do develop these relationships.
Sheila Arquette: (10:11)
I would tour some of our specialty pharmacy members and, you know, the patient service representatives in their cubicle, they would have pictures that patients sent to them. You know, that they reached a milestone because they were able to be successfully managed on a therapy and get part of their life back. They were able to see their granddaughter graduate from high school, or they were able to attend a wedding or some special event. There’d be Christmas cards. But it was just really interesting just to see how that relationship develops and how important it is. And, you know, most specialty pharmacies have dedicated representatives in patient service folks who will interact with that same patient month after month after month. So they really do develop a deep and personal relationship.
Janet Kennedy: (10:49)
You know, while my parents are in their nineties, now, they don’t necessarily have any unique medications. And for many years they got their medications at the grocery store. But at this point, their medications are switching up with frequency; It’s difficult to keep track of it all. And when they finally said they moved to a specialty pharmacy, I felt so much more relief knowing that they were at an organization that had that administrative functioning that could support them with this deeper level of support. I was always a little bit worried that when they were with a more traditional type of pharmacy, that it was just about, well, what am I feeling right now, as opposed to having a group that was really focused on this big picture, kind of a care management focus of their medications.
Sheila Arquette: (11:40)
I’m a pharmacist by training as well. And so I think our community pharmacies do a tremendous job, right, of trying to manage the patient. And oftentimes some of these medication changes are as a result of insurance requirements, formulary decisions. And so sometimes have to wonder, geez, how do they keep it all straight? So I think specialty pharmacy does a really, really great job of managing those patients with these life altering – and oftentimes life threatening – conditions and these specialized medications that perhaps our colleagues in, you know, our community pharmacies, they’re just not as familiar with, right? Because they don’t see them all the time either. They don’t have access to the medication because of a manufacturer restriction or it could be due to a payer restriction. So I think there’s a lot of synergy that happens and that we can continue to build on between specialty pharmacists in our community counterparts.
Janet Kennedy: (12:31)
You mentioned that certification is a big part of what NASP does, and I’m curious, do you need a higher level of certification expertise, education in order to be a specialty pharmacist?
Sheila Arquette: (12:44)
Currently, Janet, that’s not required. However, when NASP was founded, the visionaries who knew enough way back in 2012 – because next year we’re coming up on our 10th anniversary – they knew that specialty pharmacy was something, right? Nobody knew to the extent at which it was going to grow, but they knew that the pharmacists that were practicing needed access to more education and more resources and more tools to manage these specialty pharmacy patients, because again, right, the incidence is low. So, you know, if you fill a hundred prescriptions, maybe you might have one specialty medication, while the folks who started NASP, they were very focused on the educational component. They also saw a major role for certification and in wanting to be able to demonstrate that pharmacists taking care of these specialty patients did have that level of competency and expertise and knowledge to effectively manage these patients. And so we are the only association that offers a credential, the Certified Specialty Pharmacist Credential, that allows those pharmacists to demonstrate that proficiency.
Janet Kennedy: (13:48)
Well, let’s talk a little bit about the certification and the programs that you do. How is the patient journey folded into the mission and the activities of NASP?
Sheila Arquette: (14:00)
So I like to tell people that our role here at NASP is to provide the educational tools and the resources and the support that our members need so that then they can focus on caring for their patients, right? That’s our number one goal. Sometimes, you know, when I’m talking to my team and they talk about our patients and, you know, the patients that we serve, I try to remind them, well, we don’t really take care of any patients, right? But we are the support arm of this model, right? Where we’re trying to provide what our pharmacies need so that they can better care for patients and try to lessen the load on them, right? Have this information available at their fingertips. So that they can always ensure that their patients are getting best in class care.
Janet Kennedy: (14:39)
Well, I know that next year you are going to actually have an award to recognize a caregiver of the year. What is that?
Sheila Arquette: (14:48)
It was an idea from our membership committee. And we realized that, like I said, you know, a little bit tongue in cheek, but it really does take a village to help manage these specialty pharmacy patients. And while it is amazing that a lot of these patients, maybe 10 or 15 years ago, they would’ve been treated in a hospital, or maybe an outpatient clinic or an infusion center. But because of all of the new medications that have been improved, and a lot of them are able to be self administered, either orally or through, you know, an injection that somebody can do at home, these patients are managing these life threatening, life altering conditions at home. And so oftentimes have to rely on caregivers and that support structure around them to manage day to day. So we just really wanna shine the spotlight on the incredible job that our caregivers do. And I think sometimes it’s harder to be the caregiver than to be the patient. So we are going to have our first ever caregiver of the year award next year at our annual meeting and expo in September.
Janet Kennedy: (15:48)
Oh, that’s so deserved and so important because the caregiving role is exhausting and huge burnout. It’s something you can’t literally walk away from in many cases.
Sheila Arquette: (16:02)
No. And, they’re oftentimes, you know, they’re balancing being that caregiver perhaps with employment, right? And the responsibility of being either a full-time or a part-time employee somewhere, and then their own, you know, other family responsibilities; if they have children or maybe elderly parents. So yes, it is. It just never turns off for them. And so definitely want them to know how very much appreciated they really are.
Janet Kennedy: (16:25)
I am curious about the pharmacist patient relationship. When I think about how often I see my doctor – could be three times a year if I’m having a healthy year. Whereas I see my pharmacist every single month. How has that changed in the last 10 years? What kind of things have evolved in pharmacy and the business of pharmacy and the relationship of the pharmacist to the patient?
Sheila Arquette: (16:49)
So I think especially, you know, with respect to specialty medications, we’ve had a boom in specialty drug approvals over the past few years. Like I said, we have now cancer patients being treated in the comfort and convenience of their own home when maybe just 10 short years ago, that would not have been possible just because of the available treatments. So I think we now have a deeper appreciation of the role, the vital role that the pharmacist and specialty pharmacist plays in that healthcare delivery team. As I said, they’re responsible for ensuring that this patient receives the maximum benefit from this medication and knows what to do in the event that there’s, you know, a side effect or there’s some type of issue; the patient’s not feeling well, they need a dosage reduction. Also, a lot of these medications – we hear lots about this in the news – are very, very expensive, and patients have difficulty affording them. So specialty pharmacists, step in and try to bridge that gap. And not only do you want a patient to start on their medication, but you want them to be able to afford to stay on their medication. And, you know, not having to choose between some of the other things that they have to spend money on, like rent or heat or food and their medications. So I think that we continue to see that, that important pharmacist patient relationship, and it just continues to grow. It’s an exciting time to be in specialty pharmacy.
Janet Kennedy: (18:08)
I’m curious about some of the changes coming outside the industry being, in essence, pushed toward pharmacy: things like digital health, and the ability to capture a lot more data than we’ve ever been able to have in the past. So for instance, the collection of patient reported outcome data and pharmacists’ role in monitoring that information. What kind of things are happening in the industry and what are you excited about and what are you concerned about?
Sheila Arquette: (18:36)
Sure so I think, you know, patient reported outcome data is critical. You can take, you know, not only the data on the surface, but then as you kind of peel back the layers of the onion and you can see what’s driving patient behavior. And then how, how do I use that information to tailor my approach to this patient, right, with respect to medication adherence and compliance, and what can I do better to help this patient along their journey? And so I, I really find it fascinating. And as we continue to see such a focus on personalized and precision medicine, I think the way that we approach patients right, has to be that as well, because what works for you may not work for me. And so I think just taking some of what patients report back to you and really studying it and trying to get at what they’re telling you is very, very impactful.
Sheila Arquette: (19:22)
And I think it’s exciting, right? We’re, we’re gonna treat patients as the individuals that they are. We continue to learn more and more about the human genome, right? What medications you might respond to, and I’m not going to respond to. And it’s really just gonna turn healthcare upside down, right? No longer will we be requiring that people try and fail a medication because we think it may work for you. We’re gonna know that it’s gonna work or it’s not gonna work. And if it’s not gonna work, why would we subject you to it? So I think there’s tremendous opportunity to do things differently and to really enhance some of the processes and some of the things that we do in healthcare that aren’t so efficient right now.
Janet Kennedy: (19:57)
Have you looked at an opportunity to bring more awareness of digital health initiatives to your annual conference?
Sheila Arquette: (20:05)
We do. You know, I continue to focus on how do I diversify my membership? And right now we’re close to 150 corporate members, 2100 members in total with our individuals. But again, how do I bring more organizations into NASP, into our community, so that our specialty pharmacies know what’s available to them and who can they engage with to make their jobs easier? We hear all the time, you know, we want you to practice at the top of your license. Well, that’s what I’m trying to do. I’m trying to put in front of them resources and organizations that have come up with just incredible technology, right? To help them so that they can work smarter, not harder.
Janet Kennedy: (20:42)
So tell me a little bit about some of the other programs and benefits that NASP offers your members.
Sheila Arquette: (20:47)
All of our benefits tie back in some way to those four foundational pillars on which our organization is built; those being advocacy, education, certification, and the needs of our membership. Then our annual meeting that we’ve talked about a little bit is the opportunity to bring together all of the industries, the best and the brightest, just kind of share best practices and to network and to participate in educational sessions, and just shine the spotlight on what makes specialty pharmacy special. So, as you said, since I joined NASP back in 2017, I’ve been very focused on how do I increase the value of NASP membership, both for our corporate members, and then also our individuals. So we now have a plethora of membership benefits that in my opinion, we do offer something for everybody. So we have best in class educational programs and we offer CE credit for pharmacists nurses and pharmacy technicians.
Sheila Arquette: (21:41)
We also have a specialty pharmacy law conference that we host. I mentioned to you, that’s how I got brought into the fold here at NASP. And we also offer continuing legal education credits in conjunction with that pre-conference workshop. We offer our members annual meeting discounts for registration and sponsorship and exhibitor packages. Also preferential speaking opportunities at our annual meeting that goes to members, that always applies to members. Next year, something new: part of our certified specialty pharmacist credential, part of earning that is taking an exam. And you have to submit an application, or we’re gonna have discounts on those fees for members for new applications, and then recertifications. We also have federal and state opportunities to advocate and to get involved, to meet with your elected officials. We also have grassroots advocacy tools that make that easier. And we try to amplify our collective voice and make sure that our elected officials know that these are our issues, and we really need your help with them.
Sheila Arquette: (22:43)
And we also have ways that we try to increase our members’ visibility, not only, only with other NASP members, but across the industry. So we have lunch and learn programs. We have our corporate member of the month program. We have our round table webinar series. Something new that we’re starting next year is our lunch with the lawyer webinar series. We have six or seven law firms that are members of NASP who are so willing to share experience and their expertise with our members. We also have a student chapter program and a scholarship program just demonstrating our commitment and our investment in our future leaders of specialty pharmacy. We have a job board. We have the NASP marketplace, which is a forum for NASP members to showcase their product and service offering and offer other NASP members a discount. Next year, we’re starting our own women’s leadership book club. So there’s so much that we have available for our members and that’s not all of it.
Janet Kennedy: (23:41)
Well, and you couldn’t have all of that if your members weren’t engaging. And I think that’s key to any professional organization. Is it just something where you can put a logo on your website, or are you actually going to grow and improve your skills and network with other people and really make it a valuable membership?
Sheila Arquette: (24:00)
Oh, absolutely, Janet. Right now we have nine active committees and we have close to 300 members that volunteer to serve on one or more committees. And it’s really this volunteer army of folks that we have these members who are so passionate and dedicated and committed. It’s the backbone of our association. It’s the reason why we get done what we do: because of their support and their involvement.
Janet Kennedy: (24:24)
I did think it was neat that when we joined earlier in the fall, you actually have a member who kind of walks you through the process. And it’s really neat to feel like you’re being welcomed into the fold.
Sheila Arquette: (24:35)
Absolutely. It’s called our membership buddy program. Another idea of our membership committee. And I think something that’s unique to NASP too, is if you join NSAP and you, you sit on a committee, you really do have the ability to not only shape the future of the industry, but of our organization. And the membership buddy program was, again, our membership committee said, “Well, geez, what more could we do to make people feel welcome and to make sure that they have an additional point of contact?” People can always reach out to me. And, you know, I love to chat with our members and to get to know them just helps me to better serve on their behalf. But sometimes it’s nice to know somebody who’s not an NASP team member. And so, you know, the membership buddy program has been wildly successful.
Janet Kennedy: (25:15)
Well, that’s great. Well, now let’s get people excited about joining. How do they find out more about the Organization?
Sheila Arquette: (25:20)
They can visit our website, www.naspnet.org, or they can always reach out to me directly. I’m always happy to chat as you know. Love to chat with folks, love to learn more about them and just to discuss the benefits that we have and what I feel that would be helpful to them. So they can reach me at sheila.arquette@naspnet.org.
Janet Kennedy: (25:45)
And to make it easier for everyone, we will have your email, your social media profiles, and the website in the show notes. Well, Sheila, thank you so very much for joining us. It has been a wonderful conversation and I look forward to an exciting year in 2022 being a member of NASP!
Sheila Arquette: (26:03)
Oh, and thank you so much, Janet, for not only inviting me to join the podcast today, but for your support and for your membership. And I’m very excited as well for you to be part of NASP, and to leave your handprint on the organization and help us to move our initiatives forward.
Janet Kennedy: (26:17)
Thank you. You’ve been listening to People Always, Patients Sometimes. This is Janet Kennedy, and I look forward to speaking with you on a future episode.