Why Patient Services Programs Fail: Field Force Empowerment and Patient Activation

Bob Miglani and Jason Grossman sit down with Rajeswari Narayan, a senior patient support leader with more than 12 years at Merck, Novartis, Roche, Astellas, and Eli Lilly, to unpack why patient services programs underperform and what it actually takes to fix them.

Rajeswari has led PSP strategy across immunology, rare disease, dermatology, rheumatology, and gastroenterology at the highest levels of global pharma. In this episode, she brings real-world data and case studies to three problems that keep surfacing for commercial and patient services teams.

Start with EMR integration, which most companies understand and many still use the wrong way. At launch, every available EMR should be activated rather than a selective handful. A phased approach can feel like a smart way to save money, but it quietly drains the momentum a brand only gets once at launch and narrows prescriber access, which undermines ROI before a program gains traction. In Canada, a single EMR upload runs $90K CAD plus roughly $20K in annual maintenance, so mid-size companies launching with a few selective EMRs are essentially guessing at reach. For a product launch, that is a risk few teams can afford.

Then there is the Quick Start question. These programs stay controversial, and Rajeswari walks through a case where one pharma company removed PSP eligibility criteria entirely, accepted the financial risk, and saw a 20% increase in annual sales, along with the downstream costs that came with it.

Underneath both sits a positioning problem. Patient support is too often sold as a free product offering when its real value is as a clinical enabler, and the space between brand strategy and field execution is exactly where patients fall through.

Leaders in patient services, commercial strategy, and market access will come away with a clearer picture of where the breakdowns happen and what empowered field teams and well-executed programs look like in practice.

The Patient Experience Podcast explores how pharma patient services leaders and patient-facing teams can navigate a growing patient confusion crisis as therapies become more complex and the industry moves Direct to Patient. Hosted by Jason Grossman, a 25-year pharma commercial, patient services, and marketing executive, and Bob Miglani, former Pfizer leader and CEO of Hoot, each episode delivers practical insights leaders can use and reps can apply in the field to better educate patients, build trust, and drive better outcomes.

New episodes are recorded live on Bob Miglani’s LinkedIn and published across major podcast platforms.

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Learn more at GetHoot.com.

Transcript

SPEAKER_00 0:00

Hello, this is Bob McGlani. I'm with Jason Grossman. And Jason and I are pharmaceutical managers of 20, 30 years of experience in sales, marketing, pricing, patient experience, patient access, patient services, commercial operations. And on this podcast, we're gonna share their latest and greatest insights to help you. Yes, you, the pharmaceutical leader, understand patient experiences and what's changing and evolving to help you deliver a beautiful experience for patients in your company, in your brand, and in your patient services program. So tune in and listen in and share and learn and ask us great questions. We look forward to hearing from you soon. Thank you. Hello, hello, hello, everyone. We are live. I was just saying it's hot in here because it's hot. It's hot. We've got some warm, delightful information with you today. My name is Bob Miglani. Welcome to our live stream. I'm super delighted to be with you today. Uh, we're going to share this is for pharmaceutical executives and marketing, patient services, commercial operations, pay uh people who run hubs, uh brand managers. And I'm thrilled, thrilled to have uh a super, super important smart guest on our show today, Rajeshvari Narayan. Uh Rajeshvari, how are you? Nice to see you.

SPEAKER_03 1:35

Nice to see you too.

SPEAKER_00 1:36

Thank you for having me. Of course, of course. And we have Jason Grossman. Jason is a biopharmacy, uh, biopharma commercial executive. How are you, Jay? I'm doing great, bud. Excellent, nice to see you. So, uh, what we're going to talk about today is something really fascinating, which is what is the evolution of patient services and why some of the programs are failing. Not all of the programs are failing, but some of them are failing. And they're failing miserably. Millions are being spent. And so we have an expert here. Uh, Raj Shari Raj is going to explain to us and share some of her past experiences on how to build patient support programs that work really, really well. Uh Rajesh Shari, welcome to the Patient Experience podcast. Uh, I'd love for you to dive in, tell us who you are, tell us how you got here. Okay. So we want to know about you a little bit. So tell us about you a little bit.

SPEAKER_03 2:35

Thank you. Thank you for having me, Bob, and uh super happy to be here. Um, so uh hi everyone, I'm Raj. Uh I started off my career uh in pharma uh more than a decade and a half ago. I started off um as a rep uh actually when I was a teenager in Buffalo. Um that's where I studied. Um I went to school at State University of New York, graduated in biological sciences and biochemistry, thereafter began my career at MERC at White House Station, New Jersey, where they were headquartered at the time. Then I moved on to working with uh Roche and Novartis. Um, at Roche was where my career in patient support began, launching uh the Blue Tree Patient Support Program for them, for their entire oncology portfolio. And thereafter, I've worked with um Estela's and Eli Lilly. Uh, most recently, I've also worked at the vendor end here in Canada. So I've had a mix of both pharma as well as vendor end and patient support services. And I've been in the PSP space for over two, uh, sorry, 12 years. Uh yeah.

SPEAKER_00 3:41

That's amazing. So you've got a lot of good stories to share with us. We want stories, we want hot stories, we want juicy gossip, we want to know the inside. Okay, so we want to know everything. So uh thank you for that, right, Rajeshri. You've seen big pharma, you've seen uh little pharma and everything in between. Yeah, um, so that's wonderful. Jason, tell us a little bit about you, please.

SPEAKER_01 4:06

Sure. So I've been in the industry for 30 years, and like Raj, I started as a sales rep and um worked my way up into different parts of the business. I've been in marketing, I've been in trade channel, I've been in market access, I've been in generics, biosimilars. Most of my career has spent in oncology, and uh my last uh bunch of years has been in startup across um oncology, hematology, cardiology, and um it's been a very rewarding time. I've seen evolutions over the years, and um the current evolution is in patients, and how do we activate them and how do we get them on life-saving products, and then how do we keep them on? And there's three real world um issues that pharma has to deal with when they think about patients, and that's the financial aspect, that's the clinical aspect, and the emotional aspect, and what we're seeing now going across the digital opportunity versus the paper opportunity that we're evolving from allows greater information, better information, more informed information across not only the patients, but the caregivers and the people that they interact with every day. So I'm excited to be here with Raj and to hear her stories.

SPEAKER_00 5:55

Wonderful. Yeah, love that, love that. Thank you, Dad. Thank you for that, Jason. And if you don't know me, my name is Bob Miglani. Uh, I spent uh a long time in Pharma. I was at Pfizer for 23 years, corporate headquarters uh from sales to pricing, market access, and a number of other patient engagement. I left about 10 years ago. Um, and uh I wrote some books and became a speaker. And today, Ron Hoot, which is a um a digital patient education uh company that helps uh pharma uh increase revenues. And how do we increase revenues is really through patient education. But I want to talk to Rajeshari today. Let's zoom out for a second. Where is patient services evolving to? Where was it 10 years ago? Where is it now, and where is it going? Give us a sense of your 30,000-foot view of seeing patient services, the evolution, if you will, over the last, let's say, 10 years or 20 years and where it's headed.

SPEAKER_03 6:51

Sure. Uh well, first to zoom out a little bit further there, Bob, uh, to go 50,000-foot. What was the original vision for patient support services? It was patient empowerment. It was to get patients started on therapy, taking down all the barriers and getting them staying on therapy to achieve the best possible patient outcomes. So we've come a long way. 10 years ago, we were giving out it was more of a bridging program, we were giving out free product, we were, it was a card program and more. Right now, we're looking at a more of a holistic situation where we're tackling the clinical aspect of the patient journey, uh, financial aspect, the reimbursement navigation still continues to be the core and bean of patient services. But we've come a long way uh from just giving out free medication and uh card programs. Where we are headed is patient empowerment. We're headed solidly towards that, geared towards that. And um, where the the roadmap to that is currently we have a very, very fragmented landscape. And how we're going to get to patient empowerment is basically the provision of patient services will be democratized. And I'll tell you how we'll get there because right now the situation is so fragmented, and of course, uh, rightfully, so many players are entering the market with different kinds of services providing uh to patients. Uh, the key players still happen to be the major uh suppliers who somehow also happen to be the distributors, go figure. Um, but um, yeah, they're they're still the major players, but you're going to see uh a mass downscaling in terms of patient volumes to these new players who are already existing in the market. There was a friendly competition before, and now we're seeing some elevated temperatures, and soon it's going to be a mush pit. And that's going to push for a need of unified CRM, a CRM currently that unifies all the other CRM and draws data. And this CRM is something that even the patients would have access to. And that would basically democratize uh the uh provision of the services. And once that happens, patients will continue to be empowered to reimburse, uh, I mean, uh, navigate the reimbursement landscape themselves. And uh, that is basically the core of the services which uh most patients would take on themselves, and that would leave room for the major players and other players to focus on the clinical aspect, digitization, providing patient materials, adherence reminders, risk stratification, and more. And then, of course, with the current market scenario, the economic landscape, we will see an increase in uptake of the financial services. So you can expect a movement. So now at the pharma end, when you look at your monthly program invoices, if you're looking at say around 80% of the costs being because of your headcount at the hub operations, you will soon see a descaling in that because these other players are going to take over your patient volumes, patient initiation and adherence is revenue. So it's it's going to be democratized all around. And then there's going to be an increase in focus, the spending on the clinical side, you know, digitizing the patient journey, providing them with the digital materials, tracking them and more. And of course, there'll be an increase in the financial services the expenses offer. So one hits your program budget, the other hits your PL. So even though you'll see a decrease in the cost and services uh in the hub operations, it doesn't mean the overall expenses are going to decrease. It's just going to go from one direction to the other.

SPEAKER_00 11:05

Yeah. So what you're saying, uh, you've said a lot here, and it's actually a little overwhelming in some sense because as a patient services leader, um, I see this future. I'm like, oh my God, it's overwhelming, it's exhausting, it's complex, it's really, really complicated because we're moving, as you said, from you know, brochures and co-pay programs to this complete revamping of the system, driven uh, I think largely by you know the patient, right? Patient demands, expectations, you know, and efficient and efficiency of markets. Uh, tell us, let's, let's, let's drill it down a little bit. I know you've you've talked to us before about three areas that you think patient service programs are are are find you know, effectiveness. You know, my view is is again, it's a it's a bolder view here, is that some patient programs are failing flat on their face. Patient services uh are not innovating as much as they should, and they could. And that's largely, you know, could be a budget issue, could be look, my boss is retiring, I don't want to rock the boat. I've seen that. Like, hey, don't do anything new because you might get let go, laid off, because hey, my boss is leaving, so I don't want to mess anything up and I wait for the new person to come in.

SPEAKER_02 12:27

Yeah.

SPEAKER_00 12:28

So there's a little bit of that. So I know there's three things you want to talk about that really lead patient services uh managers to success. So talk about one of those things. Um, if you would, if you don't mind, talk to us about your strategies, you think patient service programs, what makes them work? Let's talk about that. What does make what makes patient services work really, really well?

SPEAKER_03 12:53

Okay. So if we're if we're going to start off, let's start off with the single um most uh biggest factor in the prescriber behavior that actually enables enrollment and the uptake of the PSPs. The single biggest driver for prescribing behavior is workflow efficiency, right? Um, workflow efficiency uh it increases the clinical inertia, which makes the physician sigh and just give up. And there that therein comes in the EMR aspect. The EMRs play a critical role in providing access to the physician, um the enrollment form access to the physician. That's that's the single biggest driver. EMR also provide convenience because provided you have the patient chart open, you can auto-populate that enrollment form. So instead of the enrollment form taking at least 10 to 20 minutes to fill out, it takes lesser than minutes because of the features that the EMRs offer. So many companies currently, um, of course, EMRs don't come cheap. They're not cheap. It's a $90,000 uh fee to upload a single enrollment form across all EMRs in Canada. And there are many EMRs. Uh, I believe there are close to 60.

SPEAKER_00 14:14

Wow. $90,000 for one EMR just off the gate to uh do an enrollment form in EHR.

SPEAKER_03 14:24

Um so $90,000 to upload in all EMRs. All EMRs, okay. All EMRs uh Canada wide, which have over a 70% uh physician coverage as uh you know it's been marketed. But um yeah, there is a different approach you can take instead of doing that. You can also do a phased approach, which is the worst strategy ever, and that is done because of budget reasons. Now, $90,000 can be a huge amount to gulp, right? Uh you know, up front. And that's why many companies choose a phased approach, which is a very wrong strategy. Now, a phased approach is chosen by uploading with a cluster of EMRs or single EMRs that target your top prescribers. And that is a hit or miss because it's not a guarantee that your prescriber is using that particular cluster of EMRs. And prescribers move clinics all the time. So while they may have access to your enrollment form in one EMR, it doesn't mean that they have uh access in the other EMRs. And these EMRs don't talk to each other, right? That's why uh you're being given the option of uploading a form in one EMR for one-tenth of the cost. So the cost is a main driver. So that's that's the worst strategy because the moment the physician cannot access the form in the EMR, the physician's size goes, that's it. And there goes your uptake.

SPEAKER_00 15:50

Enrollment, yeah, yeah. But let me ask you a question. Let me push, let me let me talk about this. This is something that I actually, you know, I we work with clinics across the country, and it is very frustrating to work with EMRs um as a software company ourselves, right? And the reason is because there's some of them don't play well uh and they don't integrate with any software. Uh, then they charge you all these fees that are very you know irrelevant in one sense, uh, that are exorbitant, they're expensive, they're high. But again, also it there's a lot of burden on the doctor with EMR enrollment or the staff. So why not just take that away? Why not have a different way for the consumer for the patient to enroll themselves or with a QR code or something like that? Like, why can't we do make it simpler and take that heavy burden off their plate?

SPEAKER_03 16:42

Uh, that's a very good question. So, if you want to remove EMRs altogether, there's a lot more that EMRs do than just you know populating the enrollment form. There's other documentation there as well. So I don't think getting rid of EMRs totally will ever be an option, at least not in the near future. That's why I was suggesting the unified CRM, which would um draw the data from all the EMRs and the patient charts, and everybody would have access to it. But that's not an option. There are additional functions that the EMRs offers, and we can get rid of them.

SPEAKER_00 17:14

Um yeah, but EMRs, I mean, look, in the US, the gorilla in the room here or the elephant in the room is epic, right? Epic is has majority share, and they don't want to play well with anyone else. And then you've got hundreds and hundreds and hundreds of EMRs out there. So I totally understand the enrollment is really key and understanding the friction the doctor has in the clinic. Uh, and I I find that you know, in my conversation with some pharmaceutical executives, they're almost like, well, if you try to introduce something new, they're like, Oh, you know what, I don't know. I don't know what's gonna work. They'll almost become pessimistic about everything because they've seen it all, right? And this is one of the challenges I see is, you know, but you're talking, let's go back, let's go back into enrollment here for a second. So you found that if you have some sort of a unified uh, you know, capability that you know gets every doctor in, you know, wherever in your program to have a simple way to enroll patients, it's really powerful. I think I agree with that. I totally agree with that. Uh the question becomes you know, doesn't but isn't that normal, registry? Isn't are aren't people already doing that or they're not doing that? They're not doing this right now.

SPEAKER_03 18:31

Uh, you mean to say a unified CRM? Yeah, we we have some products in the market. Unfortunately, they've gained less than four percent traction.

SPEAKER_02 18:41

Yeah.

SPEAKER_03 18:42

So physician goes to the system that they're most familiar with, most comfortable with. So you can't put a price tag on that.

SPEAKER_02 18:50

Yeah.

SPEAKER_03 18:51

Familiarity, the convenience, the comfort levels, of course, and that still happens to be EMRs.

SPEAKER_00 18:56

Yes, yeah, yeah. Uh Jason, tell me what's in your experience been in terms of enrollment? What have you seen that works, whether it's digital or you know, traditional? Uh, talk about enrollment that Radish Ray's brought up as a very important driver of program initiation. Talk about enrollment a little bit.

SPEAKER_01 19:15

Sure. Let's talk a little bit about in the US how enrollment happens. Right. Um, typically it's through a hub, but hubs are evolving also. They're becoming digital hubs, alternative specialty like opportunities, where you're bringing distribution along with all the hub opportunities into one um one into one opportunity. And um those um vendors are actually becoming better and better at the three challenges that I mentioned up front, the emotional, the financial, and the clinical. And depending on the disease states will depend on the the age of the patient. And our parents, right? I I know from my my own experience, my parents are challenged with technology. Um, so they still need that personal touch, they need that person to talk to, or they need that paper, right? Um, so depending on the disease states, you have to diversify how you um approach those patients. It's not a one-size-fits-all, but the enhancement is as the population is aging and people are starting to get older, um, as you can tell from Bob and I, from the gray hair or lack of hair, that we are digitally savvy. And our friends and our and and our family members are coming of that age where things start to go wrong. And but we're of that digital age. Yeah. And my point is the best opportunity to get patients on drug the quickest and to keep them on is personalizing it to whatever they feel comfortable with. Digital is the least expensive to get patients the information they need, but offering them the opportunity to talk to a live person or to receive information through the mail or further digital um um materials. That's what's the enhancement, that's what's making uh, I believe, companies successful. And the vendors that we're using the the small. ones and the ones that are doing it well are employing all those. But the base of it is the digital outreach as the first part because it's the least expensive and the most amount of people can be reached with it. Yeah.

SPEAKER_03 22:16

Yeah. So Jason, that's that's a very good point. And in Canada, we are trying to get there in terms of digitization, you know, working with proxy metrics, open rates, click rates, measuring patient engagements as a result and adherence reminders and more. So we are getting there. But it's been slow. It's been slow. And how much of that, I mean, it it doesn't come cheap. Of course, there is a certain amount of expense that goes into that. And how much of that is resulting in a quantifiable ROI, that's uh that's the most uh challenging part as of right now, but we will soon get there. It's inevitable.

SPEAKER_01 22:54

Well Raj, I think the challenge is how do you measure what do you measure?

SPEAKER_02 22:59

Yeah.

SPEAKER_01 23:00

And what is the baseline? Yeah. And that's why I think digital is so important because all of the data is there for mining across multiple different aspects. Right? So that that's where the future is is here and especially with AI. Yeah um having to or having the opportunity to take digitized content and run it. We're a highly regular regulated um industry.

SPEAKER_00 23:38

Taking that information especially with AI and running it through once and then putting it out there as many times as you can that's where the opportunity is yeah the scalability is possible. I mean just you know so what one of the things we do one of the projects we're working on um is uh to educate patients uh through their mobile on video and it's the doctor's content on video I've talked about this a few times but one of the advantages of that is that you get real-time feedback real-time intelligence so whether or not the patient so the patient walks into the clinic doctor says I'm going to enroll you the patient scans a QR code and self-enrolls name email phone that's it and immediately they get a text with a video and it's the doctor explaining or a KOL whether it's a clone AI clone or the real doctor or the KOL but it's some sort of video explaining the condition. And the patient then has you know watches it and that real time watch time goes into the dashboard on the back end. So the brand owner the manager the PSP manager can see oh they can see the map of Canada map of the US and see all these videos being watched all over the country and what's the watch time. Now you can also tell seasonally I mean there's there are brands that are seasonal in nature where we see asthma products a certain way right there's so they're seasonal. So they can see okay let me change out the content based on watch time and you can do it in real time. So that's where I think there's a lot of customization opportunities is to really know the patient figure out what works and yes you're right EMRs are super important um for enrollment because we're relying on the doctor but increasingly I think as we also shift and you've seen this right Ishrady have you seen this direct to patient once yeah does a doctor matter I mean yes of course doctors matter of course you know we're all in the doctor business healthcare would not be run on that doctor but you know but the question becomes is what is as you said it yourself the role of patient in empowerment it's me the patient not the brand you know owner or or or the doctor so as you think about this Rishri how do you view you know what's worked tell us what give us let's go into now what's working in some programs. Give us an example of what's worked in terms of maybe um some programs that you've seen what are the other characteristics of what makes a program successful.

SPEAKER_03 26:15

Sure. So um the one thing uh that we want to get out of the way is uploading in all EMRs, right? Uh across Canada instead of having this based approach because you lose momentum. The momentum you don't want to lose you get one shot at enrollment at launch during a product I mean at the beginning of the product launch you take that shot and you bend it like back him that's that's my only advice over there you don't you don't have a you don't have time you don't have the luxury to have a phased uh sort of situation there. So all at once all EMRs right at launch that's the way to go you want to get that out of the way you don't want that barrier. The second most important challenge that we've seen that that gets in the way of the uptake of patient support programs is uh the eligibility criteria now eligibility criteria um some some programs have the most programs have the eligibility criteria because you don't want to be on the hook for the patient in case they don't get commercialized right we have a stringent eligibility criteria uh you can uh categorize them into three one is the severity of the disease uh and the duration of the disease that's number one number two is the prior therapies taken and their ineffectiveness as a result duration there too the third is the current quality of life and how it is suboptimal and this medication is supposed to help uh the patient so payers have these eligibility criteria so that they ensure that the medication is reaching the patient who needs it the most but that those eligibility criteria also happen to be barriers that stand in the way of patients getting enrolled into the program because only when the patient meets those eligibility criteria they're able to complete the enrollment right and that is one of the ways that the program modulates uh and ensures that this patient will be commercialized by the payers yeah yeah right that's what are the uh which therapeutic area does you think that impacts the most um uh immunology because uh especially dermatology because the derms are so sensitive and it's a very very saturated and a competitive market so uh this is a top focus for most comp many companies uh immunology dermatology and rheumatology and it's a very very competitive space so here if you go with the space launch in the EMRs you're you're going to fail miserably so uh coming back to the eligibility criteria and taking them down what one company did was uh initiate a quick start offering now this offering basically said that as long as the patient is on label they will get medication and we at our end we will try our best to commercialize this patient if by any chance this patient does not get commercialized we will still provide them free medication to no end wow that's pretty that's a big bold move very bold move very bold and one of a kind uh and another competitor also started doing that they also had success so this initiative resulted in a 20% lift in annual sales but this is not without its caveats there are other uh systemic issues that are caused by this particular offering for once um basically the patient being on label that is fine that's the only criteria but um the patient may not meet the other criteria that the payers ask for and you may never be able to commercialize them so you're on hook for those patients.

SPEAKER_00 30:00

Wow that's that's a big bet I mean that's a I mean I guess the thing is like you're in your view is that you're launching once and it's a very competitive market. So you might as well take the hit in terms of paying for some of these patients that may not be covered and just take take it as a marketing expense and just get it out the market as soon as possible.

SPEAKER_03 30:20

Yeah this was actually introduced later in the life cycle so all programs have a life cycle so it wasn't introduced at launch it was introduced somewhere in the middle of the program life cycle the product life cycle because of the most competitive landscape the situation and considering all the previous factors in mind that happened post-launch. So um when this offering is introduced and if you choose to go that way expect a mass influx of patients because you open the floodgates and uh at your vendor end you need to have the infrastructure capabilities that can handle that mass upscaling to receive that many patients. You're looking at supply distribution issues uh you're looking at increased hub operations you may have to double triple your workforce and that's a lot you will see in headcount don't be surprised if 80% of your invoice amounts are because of headcounts so um that's that's a lot um and just just to uh give a brief example say we introduce quick start the beginning of the month just just take an example you have an influx of thousand patients right 30% or 300 of those patients you couldn't commercialize just as an example so just looking at very basic costs and this is a very deflated amount just consider the dispensing fees career fees say it's a flat hundred dollars per patient right 300 times 100 you're looking at $30,000 this is every month because and this is just in the maintenance mode so you're shipping once a month you're incurring that $30,000 cost and towards the end of the year you have a $36000 cost just for those 300 patients. Yeah now patients keep coming that number is going to keep increasing you can never end this yeah by the end of three years what is your expense like and this is a very deflated amount this is just the dispensing fee and the shipping fee. We're not taking into account the training fee by the nurse we're not taking into account the increased frequency of the medication taken in the first few months we're just taking into account the maintenance part so that that is the level of cost that you will incur and add to that the cost of the free medication provided to the patients that's hitting your PL. These expenses are hitting your program budget the cost of the free medication itself is hitting your PL.

SPEAKER_00 32:59

Wow that's incredible that's incredible that's a that's a really difficult scenario here.

SPEAKER_03 33:04

Very so you you may get a lift of 20% in the annual sales but all of these aspects all of this you know you're not gonna make any profit there's no profit margin there's no margin um the gross yeah yeah but the gross to net is severely yeah so that that's severely impacted and additionally you need to look at the portfolio as a whole you have other assets in the pipeline that you are going to launch. So now if you think that the physician is going to out of goodwill emanate some sort of a halo effect onto your other products you are wrong.

SPEAKER_00 33:42

This has more of a domino effect they said you're the same company you offered quick start for this particular product now offer it for other products too and at this point very early in the life cycle yeah so there you go so you need to you need to anticipate there there needs to be a certain degree of fearlessness in leadership if you want to introduce well you gotta go you got to get approval from this you should be best friends with the CFO basically basically you know be like hey you need to give me some time to recover uh this cost here and uh overall depends on the goal sometimes you know public companies need to hit certain metrics and goals and private companies uh alike so it's it's I I think it's a good point that it's a quick start it can be really uh you can be bold but really difficult to uh to recover sometimes uh depending on how many patients sign up and you don't commercialize. So yeah.

SPEAKER_03 34:43

It's um it reminds me of that story where the person a guy wins a lottery right uh and he gets this price money and then he spends it all on his friends you know and then ends up in debt.

SPEAKER_02 34:56

Yes.

SPEAKER_03 34:56

Right. So uh before you buy that ticket you make sure you know what to do with the price money because it's an expensive ticket. Yes absolutely so this is one such scenario.

SPEAKER_00 35:07

Yeah no I I like this it's a great story. Thank you for sharing that story and quick start that's really powerful. Um I guess the thing is that you know you really have to know how much bandwidth you have internally do some really good forecasting yeah uh and then see if there's a halo effect that could be done for your other brand to really make it worth your while uh in terms of a a strategic you know way to to bet big if you will uh and then you really competitive markets that might demand that right as you said some of these immunology market and dermatology really competitive for patient services.

SPEAKER_03 35:42

Yeah but not everything is doom and gloom.

SPEAKER_00 35:44

You always have the real world evidence from these initiatives that help with peer negotiations outcomes-based agreement for the next assets you know down uh so it not everything is doom and gloom but it depends on you how you use the revenue the data uh the learnings that you get from one such initiative how you use it for your future products and your portfolio yeah that's beautiful I I I like that Jason uh walk us through if you don't mind you know some of the things you know one thing that you've seen that works really well in an effective patient services program um you know in a competitive market what have you seen that works really well is there a core theme that you're seeing uh in the marketplace uh that's more kind of sort of simpler less bigger of a bet but more like okay I know this is gonna work what's your sense of that right so having uh or currently running patient operations for a personalized medicine product uh there's different aspects of it there's getting the patient on which includes going through the benefits investigation getting the clinician to actually order it getting them scheduled getting the drug put into the patient's own cells and getting it back to them in a certain amount of time before those live cells um aren't effective anymore and back into them it's a it's a complicated process um versus the more of the the mainstream I just need to get a script I need to get the patient on the product as quick as possible and I need to get them on that product and keep them on it right personalized medicine that's the way we're going in a lot of the oldogies the oncology immunology urology um so when you think about the extra information that has to be gathered and the the complications or the the complicated therapies how they're working on a cellular level um it's a little different opportunity for companies to partner with HCPs with doctors to educate their patients on why do they need this therapy versus a pill where they can just take it what are the benefits what are the the risks what are the financial aspects and how are the they or their caregivers going to help them through the process yeah so what I've seen work best is that that hand holding all right that it's not just about personalized medicine it's about the personalized journey and where companies are succeeding is helping physicians to educate let's face it doctors have 10 to 15 minutes to deliver bad news try to help the patients understand where they are in the process and what's the right um opportunity for them to take products and the we talked about the evolution the evolution is how do pharma partner with those HCPs to make their lives easier it doesn't replace why the doctor is using that drug or that product it's enhancing their conversation where 75% of the physicians are used or not used to talking to patients they're used to talking uh on a technical level you know we've heard the term bedside manner.

SPEAKER_01 40:04

Yes a lot of them don't have it no so if Bharma can partner and make the physicians lives a little easier make the patients a little less apprehensive that's what's that's what's the enhancement and that's where I think the industry is going.

SPEAKER_00 40:24

Yeah yeah I I I I think it's a really good point. I had a I have a story to share we worked with a um a doctor a number of clinics uh ketamine clinics okay and uh he was having trouble uh with patients uh not signing up for ketamine therapy for depression anxiety uh mental health um conditions and uh uh you know working with him for a few you know for a little while uh I came to the realization that um because he had just started these clinics and uh he was you know was in a different state and he moved different states and long story but he was an anesthesiologist and then I it it hit me anesthesiologists are not used to talking to people they're asleep they put them to sleep yeah so you know his bedside manner was terrible he didn't want to spend time educating patients and when they're on a six course you know IV treat drip of ketamine a product that you know is controversial in some sense right you know with Matthew Parry you know so there's a lot of education that was needed yeah and you know our suggestion to him was listen you need to slow down you to record some video send it to them before they come and after them after they leave and then you know take a little time to educate these patients and he's like I'm like dude you're a doctor running multiple clinics you've got to spend time educating them and he just and his nature as an anesthesiologist he never learned that he never had to that he his his his most conversation he did was count to five backwards and the patient would go five four three and sleep you know and so this is a very important point is that uh we have to really think at that doctor level we go and keep going back to from enrollment that Rhishari talked about and then what you talked about Jason is this evolution of you know how do we get doctors involved in in this journey uh let's talk now about let's shift gears a little bit Rishri so let's talk about one of the things that you talk about is field force involvement in in successful patient services programs so let's now in this segment let's really focus on field force and how do you get the field force involved why get the field force uh involved uh tell us absolutely so Bob the field force basically are the lifeblood of the organization they are the closest to the customer and they are the one making the value proposition for both your brand as well as your PSP now PSP uh the program is basically helping the brand uh realize its value by helping the patients achieving those outcomes that's what the programs do they help they enable the patients to achieve those clinical outcomes it's an enabler of the product itself um now how it is currently being uh marketed is that oh here is a free drug program here is your uh you know assistance it's a PAP you know instead of patient support it's not a PAP for a reason it's not patient assistance for a reason so uh improper messaging is one of the key um uh issues uh you know standing in the way of the holistic uptake that a patient support program is supposed to have um it's uh the the clinical

SPEAKER_03 44:00

Training offered, the digital materials offered, the apps, the QR codes on the enrollment form, the financial assistance, of course, that's that's marketed again incorrectly as well. There's so many other uh holistic uh you know services offered uh from by the patient support program. So understanding the full scope of the uh of the offerings and their limitations, that's severely lacking. And that's what stands in the way of uh the proper utilization of the patient support. Now it's very easy to blame the reps, but I tell you what's happening uh, you know, that's causing this commoditized messaging. So we call this a commoditized messaging, unfortunately, and not uh a value proposition. So what's causing this is really lack of training. They're not empowered with proper training uh about the PSP. What is a PSP? What is a patient support program? It's a set of offerings, a holistic set of offerings that are supposed to provide the patient the maximum value to help them achieve those patient outcomes, the clinical outcomes. That's that's essentially the value uh messaging. And now reps need to be trained as to why a program is designed a certain way versus others. Some programs have a quick start offering, others don't. Why are they designed a certain way? Oncology programs are designed very differently from immunology programs, and I have experience in both, and they have very different value propositions. And why are they designed that way? So the rationale behind that design is very important, you know, uh training the reps on that, training the reps on the full scope of the programs offering. There are proactive and reactive services. Now, proactive services, let's take, for example, the financial services. The proactive financial offerings are the copay, the 20% flat, right? There are reactive offerings as well, such as the deductible support. The reactive offerings are not to be marketed by the reps, but having knowledge of that and the limitations of that is very important. Now, for example, uh the reactive offering is deductible support for certain public uh providers, pay payers, uh certain public payers. It's uh it's a deduct uh reactive offering as and only if the patient calls the patient support and says, Hey, I don't think I can afford my deductible this year. Uh so uh I don't think I can stay on the medication because you know I have to pay the deductible in order to get my next dose. So I'm sorry, I may not be able to continue. So in that case, the program steps in.

unknown 46:46

Yeah.

SPEAKER_03 46:47

So that's that's uh a reactive offering. Um, so here basically uh deductible support is offered uh to patients with a certain income criteria. So uh say for example in Ontario, uh the provincial payer basically would charge a deductible of 4% of your net household income. So if your net household income is say $100,000, you have an out-of-pocket expense of $4,000. And if you're unable to pay that and say you're not able to continue therapy as a reason, then the program would step in and provide. But again, this is to ensure that only those financially vulnerable, most vulnerable, get the support. So a doctor might get uh a patient complaining, hey, I actually asked for deductible support and they didn't give it to me. Why? Because your net household income was close to a million. So you're not exactly financially vulnerable. Yeah, you have other patients, maybe a single mother with three children, and her net household income is 80,000. She's not able to pay the deductible. So the program helps her. So here the physician actually complains to the rep saying that you know what, because my patient complained, I'm not going to prescribe your product anymore. Just don't even come visit me anymore. But this is an actual conversation.

SPEAKER_00 48:13

Wow, wow.

SPEAKER_03 48:14

And uh the rep just stands there. Uh, it's a very awkward situation because they didn't even know about this deductible reactive offering. All they're doing is selling the 20% flat, the copay, because that's that's the only thing they know, they haven't been educated. So the rep needs to be trained to handle these sort of situations, and for that, they need to know the limitations, the scope of the offering, the limitations of that. So if they were able to stand to the position and say, you know what, we're they're they're not exactly financially vulnerable, that's why they got rejected.

SPEAKER_00 48:52

Yeah. Um, so they know that though, I mean, I guess the thing is the company would inform the rep. I mean, I guess I don't know. Like again, it in that case, okay. Let's suppose the rep was trained, okay, and got it. Would they get the information on that particular patient from the patient services, you know, program managers or the hub, right?

SPEAKER_03 49:20

De-identified, yes, de-identified information they would get from there's a time lag, right? They they get out of the doctor's office, they are unable to manage that situation. Yes, programs perception gets impacted, brand performance gets impacted for the next one week. The doctor will not prescribe. So you see, not being able to handle that objection on your feet because you didn't have the data points, you didn't have the knowledge that this was an offering in the first place. Yes, you know, at least if you're able to say that, you know, there is a limitation like this. Let me just ensure that this patient wasn't just, you know, uh mishandled in this situation. Of course, of course. It's very likely they're not, it's very likely they're not, but just so you know, this is the situation that they may not be financially vulnerable. That's why they didn't get the offering, but the other patient did to be able to handle that. Yeah, one other example uh the physician might say, Hey, my patient wanted to go uh on a long vacation to Costa Rica, and because he's taking your medication every month, he's unable to leave the country. Fun fact this is a reactive offering. Again, we actually offer vacation supply for a certain duration of time. The patient needs to call the patient support program and then ask. The only caveat here is that if they damage the medication or if they lose the medication, it will not be replaced. But there is a certain amount that is dispensed for them to take to wherever they go for a couple of months, snowbirds especially, and they can come back. So these are the sort of conversations that rep need the data points to be able to handle that with the physician. Instead, they're getting destroyed in physicians' offices. Yes, they're unable to defend the PSP, they're unable to defend the program, it impacts your program performance, your brand performance.

SPEAKER_00 51:11

And limit your access and forget it. Your access is limited. If you screw it up, it's done. You're not welcome back in the office for any new data. You can go to Askel all you want and have great new data to present.

SPEAKER_02 51:24

Yeah.

SPEAKER_00 51:25

If your access is limited to the doctor's office because of poor communications between the rep and the doctor, forget it. It's over.

SPEAKER_03 51:33

Yeah, and that's because of lack of training. And you hit that nail on the head. We need that training because reps are actually access consultants. Yes. They're access and value consultants, not just your reps. So having that training is very important. And to be able to deal with that situation, it comes from competence. And the competence comes from empowerment through training. Free backpacks and water bottles don't do this.

SPEAKER_00 51:58

No, no, they don't. And I think you've raised a very important point. And Jason, you know, um, Jason and I talked about this recently about how the evolution of the Field Force, and you brought it up really well. Thank you, Rishri, for that for bringing this up as a as a success tool, a success um uh asset uh are the Field Force. A part of it is not just because they should be trained, but in fact, you know, to begin with, we there's a brand um we were talking about recently. It's a specialty brand, oncology. They're having really they're like third or fourth um, you know, in the market. It's a specialty product, effective, works really well, has good data, but the reps can't get in. And so, how do you get into institutions today? Oncology, I mean, yes, of course, there's a lot of uh, you know, community oncologists, hematologists, but so many are in institutions, you know, medical service organizations, health systems, and so that conversation there is not about information. It's not about, hey, doctor, let me tell you about what the poster presentation was at ASCO that talked about our drug in this specific patient population. Because the doctor's not going to see you. Yeah, they want to know in their institution how you're going to help them with bigger problems, right? This is the this is the and and it's it's not just a matter of let's train the reps, let's get the reps to ask for better patient services programs so that we can get access to doctors and to institutions where we don't, we can't even set in the door. I had a I had a I had somebody I was speaking to at a specialty pharma company, and she said these organizations don't get having they don't share any data with the pharma company. They don't tell them the usage, they don't tell them anything, they just buy and then they just just you know buy and say that's it. It's a transactional relationship. So there's no optics in intelligence of how the patients are actually utilizing the product, which is which is really bad. And so the partner relationship, the partnering program is the way to get access from a field force or keo count managers. Jason, what what's your thought on that in in terms of key count managers and what he's talking about rep training and how do you get the sales? So what is the what is your view on field force engagement in patient support programs?

SPEAKER_01 54:32

Well, that's a whole nother such session in itself, but yeah, so yeah, key account management is is now evolving to a customer engagement ecosystem. It's not just about the salesperson, and that's what key account management really focuses on. If you think about our customers, they're becoming more and more sophisticated by data, by therapy. Um, they're purchasing more and more um practices and specialties or combining specialties into single operations. So when you think about all of the different pieces of let's say in ownership, you have an HCP who goes to an address, an office, and that office is owned by some sort of network or hospital, you don't know where the influence is, you don't know where the decision makers are. Is it clinical, is it financial? Um, so if you've seen one organization, you've seen one organization, and it's the CAM can't do it all themselves. So again, think about you got pharmacy, you have the physician, you have practice management, you have allied health professionals, you have finance, you have IT, all of those different, I keep going, I can go on and on, all of those different customers are pieces of the puzzle. And if you think about what are the former companies' opportunities to put those pieces together, you have the CAM, which is sales, you have market access, or your field reimbursement people, you have your medical science liaisons, you have your nurse educators, there's four or five, you have patient operations or patient support, you have marketing, you have commercial operations. All of those have to work together, all those people have to work together, but at the same respect, you have to be able to organize them, and that's where the CAM comes in. Their job is to organize the conversations, make sure that they're moving all of those inputs to help a non-user become a user. And along that patient journey, there's the there's the customer journey and they're going together. So it's it's it's a big dance that has to be coordinated, and there's inconsistency from customer to customer. So that's why I'm saying it's now a customer engagement ecosystem, it's not just about the account management.

SPEAKER_03 57:26

Speaking of inconsistency there, Bob, as we chatted, how patient services, the provision of it, is going to be democratized. So different parties are going to be providing the same services with different quality and efficiency. And guess where all of this feedback is going to go? It's going to go to the physician, a physician from the patients, and they're all going to hit your reps.

SPEAKER_01 57:47

Yeah.

SPEAKER_03 57:48

So uh it's going to get a lot worse. And this training is going to be critical for the evolution of everyone of the entire landscape that the reps are trained.

SPEAKER_00 58:00

Yes. Yeah, yeah. So they're the front line. And if they don't have the knowledge, um uh what to say, how to say it, uh, the connections and the data to know what's going on in that practice, um, it's terrible. It's really, it's not, it's not a good, it's not it, it just shows um poor uh management uh from the company level. And that speaks volumes, as you said, Raishri, about your brand. Promise. Um so I think I think that so this is very powerful as a field force employment and deployment and training, getting that right. I think it's key. Let's zoom out and wrap up here a little bit. Now we've we've we've shared a lot of really great stories and examples. Give me, um, you know, if you will, uh your view, your advice. Okay, Jason, I'm gonna start with you first, and then we'll go to Rishari, and I'm gonna give you some advice as well. But I'd love some advice for patient services leaders who are working in specialty pharma, who are working to launch a new product this year, yeah. As they're working to launch a new product or revive a stagnant brand. Okay, Jason, what's your advice to a patient services leader right now? What do you what is the one thing or two things that you think, hey, this is what I think you ought to do because I learned it the hard way and I'm offering it to you. So tell us.

SPEAKER_01 59:21

So my advice is to be open to new opportunities and don't keep doing the same thing over and over again. Yeah, the environment is scalable due to technology and AI. And let's work smarter, not harder.

SPEAKER_00 59:47

Love it. Great, thank you for that. Rheshri, what about you? What's your advice? Same here.

SPEAKER_03 59:54

Same here. Work smarter, not harder. Uh, be open to new innovative initiatives like self-reimbursement, where the patient self-navigates themselves across a reimbursement landscape. Empower people more, empower your reps, empower uh your program managers to be able to uh deal with the current landscape. It's fairly complex, it's ambiguous, it's volatile. So uh empowerment and innovation are the two key pillars I would advise.

SPEAKER_00 1:00:25

I appreciate that. That's wonderful. I love that. Uh Peter Drucker, who was a famous um management marketing guru um back in the 60s, you know, wrote a beautiful, beautiful piece uh in the Harvard Business Review, and he said there's two success uh strategies in business. Two success. You know what they are? Innovation and marketing. Innovation and marketing. That's it. And both of you talked about that. So I'm going to close and say my piece of advice is take action. Don't just listen to webinars like this. Don't just go to you know the Las Vegas SMBI, you know, or go to you know, New York for these meetings and conferences, sit in the room and say nice things. When you go back to the office, remote or in person, okay, do something different. You've got to take action. I can tell you one thing I learned over my career at Pfizer for 25 years, 23 years, and so on, is that the ones who do not take action, you never like it because you're like you hit you kind of like dislike your job because you're being restricted for doing a lot of things. But then you know, you find yourself on the other side, hopefully not, hopefully not, of a re-org. And so those who innovate are the ones who really grow and progress in their careers. So I encourage you to progress in your careers. This has been a very valuable conversation for me, Rajeshri. Uh, thank you so much. Jason, I hope you found it also useful. Um, you know, where can we reach you, Rejesh Fri, if we want? I guess here on LinkedIn, right? Yes, absolutely. Wonderful, wonderful. And if you don't mind, I'd love for you to maybe put together like a one pager of your ideas that you have. I'm happy to share it on the on the LinkedIn post or attach it to this. But just sort of your advice for patient service leaders. Love to write about it and talk about it on a LinkedIn post or or some other way in some way, shape, or form. So um, you know, thank you for for coming in and sharing your valuable advice, Richard Sri.

SPEAKER_03 1:02:24

Thank you for including me. Thank you so much, Bob.

SPEAKER_00 1:02:26

Thank you. Thank you, Jason. Thank you very much, of course. Appreciate it, Bob. Thank you. Well, I hope we all had a great time. Uh, patient services leaders, um, brand managers, commercial executives. My name is Bob Biglani for the Patient Experience Podcast. Thank you and have a great rest of the day. Take care. Bye now.