Expert Discusses Medication Access and Innovative Medication

Jon Mahrt, president of PBM and Chief Operating Officer at Optum Rx, discusses key challenges and strategies for improving patient access to medications. He covers the growth of GLP-1 drugs for diabetes and upcoming indications, highlighting the need for utilization management and supply chain strategies to meet demand. Ensuring drug affordability is also identified as critical, as 1 in 5 patients lose adherence due to cost.

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Q: To start, how could the popularity of GLP-1 medications impact future drug trends?

Jon Mahrt: So first, I would say it's both the popularity and frankly, the efficacy of these drugs. These drugs work, highly effective. What we're seeing first on the market with diabetes, and they're becoming essentially first line, and so that's driving double digit trend. In fact, it's now GLP-1 42% of overall trends, 77% of traditional drug trends. As we look at what's ahead, roughly half of the US adults are, according the label, eligible to qualify for a GLP-1 from an obesity perspective. Layer in then the other 5 indications will come to market with data over the next 2 years, and you have the potential for a significant impact to utilization, which in turn will translate to trends, so incredibly important that you're deeply engaged in utilization management cost management strategies.

Q: As we have seen, availability of GLP-1 medications has been an issue for some patients. Do you think availability will still be an issue for other innovative medications in the pipeline?
Jon Mahrt: Look at that through really a couple of lenses. I think, first, we expect that there's significant demand, as I said, before with new indications coming on label, so expect that GLP-1 supply will be stretched for a bit into the future. I think it will normalize if we look out a year or so, but it really depends on new indications and demand, if I look past GLP-1, there are more drug shortages now in this country than ever before, and so I think it's very important to examine formulary strategy of supply chain strategies to ensure the availability of generics, I get a little less concerned about, new to market drugs, the great work being done working closely with pharmacy and supply chain to bring them into the market and bring them in in a scalable way. I think GLP-1, given the wide range of demand, and the demographic that's eligible for the drug created a very unique supply chain challenge.

Q: How do drug prices and affordability impact access and medication adherence for patients? What are some of the biggest challenges?
Jon Mahrt: Affordability, top of the list from an access perspective, right? So 83% of Americans would say that drug prices are too expensive. But if you look past just kind of the grousing, and high costs, the reality is that, 1 in 5 Americans lose adherence, they skip a dose, they lose adherence to medication directly attributable to cost. That's double the rate than in peer country. So affordability has a significant impact on access. It's incredibly important to have a robust suite of services that you wrap around the consumer, so you can see both the claim activity and guide them to cost look at their medicine cabinet guide them to cost saving strategy so that they can afford the full regimen of medications that might be on but also to see the claim that doesn't exist, meaning the claim where maybe they're losing adherence. It could be that they're struggling with side effects or could be they couldn't afford the refill and have a way to engage that consumer to ensure they stay on therapy awhile.

Q: What role can pharmacists play in advocating for patient access to affordable, innovative medications?
Jon Mahrt: Wow, the heart of the health care system there the pharmacist incredibly important. So and we see this every day, I would say a couple of things. One, the the role the pharmacist plays in guiding the patient while at the pharmacy counter assuming that hasn't happened upstream, guiding them to the lowest cost alternative also helping them with copay assistance programs. So guiding to and advocating for that that programming, I think second is, at Optum Rx we're eager to engage these pharmacies and these pharmacists in care routines, right so so reimbursing pharmacies and finding mechanisms to pay pharmacist for the health care they're providing, which again will result in in cost of care savings both for the consumer and the plan.