Rob O’Brien, RE’s VP Specialty, has over 20 years of managed care, PBM, and specialty pharmacy experience. Over the past 2 decades at CVS Health, he has worked closely with payers across all business segments (commercial and government) and drug benefit programs (both pharmacy and medical).
At CVS Health he held a number of leadership positions of increasing responsibility. He directed the Health Plan segment clinical team for 8 years, then moved to CVS Specialty where he led a team of specialty clinical experts supporting PBM customers on managing specialty trend and patient care as well as a product development and innovation team that brought to market CVS Specialty’s innovative digital engagement tools for its specialty patients. During his tenure, the business grew to over $60 billion, serving over a million patients a year. While at CVS Health, Rob also had accountability for leading the sales efforts for medical benefit management solutions and commercialization of the PBM product portfolio. Under Rob’s leadership CVS’ Novologix hit record sales and adoption of Novologix’s medical benefit management solution, while also continuing to expand Novologix’s capabilities across integrated benefit prior authorization, oncology management, medical rebates and site of care optimization.
Rob attended Albany College of Pharmacy and is a licensed pharmacist located in New York.
The primary focus of Real Endpoints’ work with Pear has been addressing payers’ questions and concerns regarding prescription digital therapeutics (PDTs). It has been exciting for all of us at Real Endpoints to work in one of healthcare’s most innovative areas, PDTs, and with COVID-19 resetting expectations on how patients will engage in their healthcare services we feel this work is more relevant and important than ever. With all that said, there is clearly a lot of work to be done to improve payers’ understanding of PDTs, clarifying the value proposition, including clinical and economic benefits and ultimately defining a consistent pathway for PDT coverage and patient access.
Yes, the overwhelming percentage of health plans, employers, pharmacy benefit managers [PBMs] and employer benefit consultants that were screened out of the survey because they were totally unfamiliar with PDTs. This surprised me and underscores the need for basic education around PDTs across all different payer segments. I was also pleasantly surprised that a high percentage of the payers surveyed — 69% — indicated that they did not have concerns regarding data management and privacy related to the use of PDTs. To me, that was fascinating feedback derived from the survey results and should guide our efforts on focusing on educating payers/providers/patients, promoting the clinical value and defining coverage strategies to drive appropriate patient access.
Two areas the survey focused on were whether PDTs could be effective tools for treating unmet needs in specific diseases; and which therapeutic areas were best suited for PDTs. The results reinforced what I believe many already suspected – mental health disorders are clearly at the top of payers’ priorities and where they feel PDTs can be complementary to current treatment options (versus replacing current therapy plans). The pandemic has created a higher sense of urgency to support those with mental health and substance-abuse disorders – especially minority and lower-income patients. The survey results highlighted PDTs’ potential to help close disparity gaps in healthcare and enhance patient care for the most vulnerable and underserved.
Through the work Real Endpoints has done with Pear over the past several months, it has become clear that these are definitely the top challenges we have heard from a variety of stakeholder groups, including employers, benefit consultants, health plans, PBMs and others. The other challenge to access, or a top payer concern, is the potential budget impact PDTs may have. Over the past serval years, health plans and PBMs have invested heavily in strategies to control drug trend, and they closely monitoring the drug pipeline and new categories (like PDTs) to ensure they don’t negatively impact all those investments to keep drug trend stable. It is critical that PDT manufacturers work with health plans and PBMs to help them understand the budget impact, potential utilization, and management programs to ensure appropriate utilization. This is a whole new category for payers to evaluate and when they have questions on the budget impact of new therapies, they tend to implement management strategies that can limit patient access.
The survey highlighted how FDA authorization is a core differentiator when payers are evaluating coverage of PDTs compared to health/wellness apps. We see educating payers on the rigorous FDA evaluation process of PDTs being a high priority for PDT manufacturers and the Digest is a key first step on the journey. Aside from the obvious, PDTs requiring a prescription and care being directed by the prescribing physician, I see two key differentiators – first, the ability for PDTs to enhance the treatment plan the prescriber and/or patient’s care team has implemented. They improve patient engagement and unlock more ways for patients to access the care they need. Secondly, the integration PDTs have with provider and care team workflows. This integration will enable more effectively transferring real-world data back to both providers and payers. I don’t see health/wellness apps having the integration back to the patient’s provider. To me, that is a big differentiator for PDTs – to truly move the needle on patient care you need to have a link back to the patient’s provider and care team.
Absolutely. Many payers are looking at innovative and risk-based agreements as an ideal contracting strategy for PDTs. In our work with Pear over the past several months this theme of innovative contracting has definitely picked up momentum. Beyond what the survey results showed, in our discussions with payers they have stated that implementing value-based agreements (VBAs) for PDTs is a “no brainer.” With that being said, we have also heard from payers that PDT VBAs must come with significant risk sharing – not the tokenism we’ve seen in other categories.
To me, the biggest opportunity is very clear – PDTs can make it easier for patients to engage in and maximize the value of their care. And I also believe this will lead to better healthcare outcomes and we will see this proven out in the real-world data Pear and other PDT manufacturers will share. I see so many patients struggle to find the support or to access the extra services they need to fully maximize their treatment plans. PDTs can offer patients a convenient and intuitive enhancement to current standards of care – a different type of therapeutic that fits into the patient’s daily flow of life, helps them navigate a complicated healthcare system, and ultimately supports them to optimize their care. I also see value across all the key stakeholders – patients, providers, and the various payer segments. And I’d like to stress that PDTs can offer low-income and other disadvantaged patients, and the providers that care for them, an innovative tool to close the disparities in care which continue to plague our healthcare system. As I highlighted previously, the pandemic has created more urgency to support those with mental health and substance-abuse disorders. We need innovative clinical solutions to give these patients different options to access the care they require – and PDTs can be one of those important solutions. It has been exciting working with Pear and their PDTs indicated for addiction and we are seeing Employers demanding coverage through their PBMs and health plans for these innovative products.