Expert: Mark Cuban’s Pharmacy Has Shown ‘There’s No Silver Bullet’ to Disrupt the Pharmacy Value Chain

Pharmacy Times interviewed Yoona Kim, PharmD, PhD, co-founder and CEO of Arine, on how Mark Cuban’s pharmacy may help to change the paradigm for Medicare.

Alana Hippensteele: Hi, I’m Alana Hippensteele with Pharmacy Times. Joining me is Yoona Kim, PharmD, PhD, a pharmacist, health economist, and co-founder and CEO of medication intelligence company Arine, who is here to discuss some of the insight that can be gleaned from Mark Cuban’s pharmacy and its potential to change the paradigm for Medicare.

So, in your view, what are some of the key takeaways we have learned from the launch of Mark Cuban's pharmacy Mark Cuban Cost Plus Drug Co?

Yoona Kim: Well, first, I think it's tremendous progress. If patients can have a more affordable solution to get key chronic medications, especially for those who are underinsured and uninsured, it is great progress, and if Mark Cuban can put his name on it and get the word out there, that's also great.

When it comes to medications, of course, medications and dealing with medications and everything that comes with it is an ongoing and complex issue. What we learned is that there's no silver bullet. There are so many parts of the pharmacy value chain that need to be disrupted, from ensuring that patients are prescribed the right medications, to a low-cost solution like Mark Cuban's pharmacy, to adherence and engagement solutions that ensure that patients take their medications correctly. So again, huge progress, but still more to be made, especially in light that most of Mark Cuban's pharmacy is dispensing more generics today.

Alana Hippensteele: Right. Media coverage has been both positive and negative regarding the impact of Mark Cuban's pharmacy on the health care market. In your view, why have there been such mixed reactions to the launch of his pharmacy?

Yoona Kim: I think there are mixed reactions probably because right now they're focused on generics, and probably because this concept has been around—Walmart many years ago came up with 4-dollar generics. But again, the good thing here is that Mark Cuban has hundreds of generics that he's offering at lower cost, and there's price transparency around it. He also talks about getting branded medications on board, which would be huge. We know that already, nearly 10% of our population is uninsured. That's more than 30 million people. So, this presents a good option for those that that need an affordable solution.

However, when you think about the patient populations that are seeking low-cost options and are taking these chronic conditions, they need ongoing clinical care. They probably have comorbidities, are probably struggling to get the right medications appropriate for their conditions. So I think the first step is ensuring the right medications are prescribed and then secondarily ensuring that patients have access to medications.

Then another concern I know that Scott brought up in the media is that with this new pharmacy, we are potentially fragmenting care because now patients are getting some medications from one pharmacy, other medications from another pharmacy, and we all know that patients do develop relationships with their community pharmacies. And so, that can cause confusion. We, as pharmacists, often talk about medication synchronization as being a key intervention to improve adherence and continuity of care.

Then, there is no data feedback in this case from Mark Cuban's pharmacy back to the payers or providers, because this is typically a cash pay option today. So great option, but still some limitations.

Alana Hippensteele: Right. Cuban has stated that he aims to turn the drug market in the country upside down. How effective has he been toward this goal?

Yoona Kim: It remains to be seen whether he can turn the market upside down. There's been some talk that he can change the way that payers cover prescription drugs, and it'll be interesting to see how this model will disrupt the PBM model, where there's many loopholes and ways that PBMs make money off of dispensing drugs.

There was one intriguing article that was published in LA Times by a group of health economists, Peter Newman being one of them, and the title was “Mark Cuban won't fix our drug pricing problem.” And the point was that this was mostly generics and not branded medications that are even more expensive and really leading to high drug costs. The authors ask policymakers to consider value-based pricing models instead, which tie pricing to the benefits of the drug and asked for cost-effectiveness studies that compare drug costs to its benefits.

I think this makes a whole great deal of sense and is a great idea. But when I look at the problem in general, we're siloing drugs. And it's not just about the cost of the drugs, but it's about how getting patients on the right therapies can impact total cost of care. Most of us, as pharmacists, are probably familiar with the article from Scripps, that talks about the cost of non-optimized drugs being a $530 billion problem. Most of this is on the medical side of the equation. Patients not being on the right medication therapy is leading to unnecessarily 33 million hospitalizations a year and 275,000 deaths a year, and all this is 100% preventable. And this is why I started Arine to address this core issue of getting patients on the right medications considering the whole patient picture.

Alana Hippensteele: Right. What are some of the other existing technologies that can help curb the costs of drugs? And are these technologies being fully utilized by Medicare?

Yoona Kim: There are a lot of AI-driven technologies out there revolutionizing all aspects of healthcare, but especially around drugs. There's AI drug discovery, companies that can help identify drug targets faster and really accelerate the drug development process. There are precision medicine solutions out there, using AI that can help pinpoint the right therapies up front without so much trial and error—same with pharmacogenomics companies. And then there's technologies like Arine, ensuring safe and effective medication therapy, that are really focused on not just reducing drug costs alone but looking at the full picture and reducing total cost of care by getting patients on the right medication. So, lots of interesting technologies out there that can really move the needle on quality and cost of care.

Alana Hippensteele: How can pharmacies tap into existing systems to help to curb cost not only for patients, but for the pharmacies as well?

Yoona Kim: I feel for the pharmacies, because I think the current margins on the pharmacy business are already thin. I do think the way that the pharmacies can benefit is actually by increasing their revenue streams and going beyond dispensing. I believe, too, that payers are starting to see the value of this and reimbursing pharmacists for these types of solutions. We have a payer client that is reimbursing pharmacists in the community setting to use Arine’s platform, conduct comprehensive medication management services when a patient picks up their medications at the pharmacy. We've shown huge improvements in health due to this: 40% reduction in hospitalizations, total cost of care savings. Arine’s platform really helps to scale these clinical services because in a busy dispensing environment, it's hard to do these clinical programs along with dispensing the medications, but by having a platform-based approach that automates recommendation delivery and turns the data into actionable recommendations, that allows the pharmacist to then do what they do best and spend time on patient counseling instead. I do think that, even within the pharmacy setting, there are a lot of opportunities to go beyond dispensing.

Alana Hippensteele: What are your predictions for how Mark Cuban's pharmacy will impact the healthcare economy in the long term?

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Yoona Kim: Again, if I look at the numbers, as a health economist, I think that article stated that Mark Cuban's pharmacy could save up to $3.6 billion annually, and when I look at the cost of non-optimized medications, that's a $530 billion problem. Just by getting patients on the right medications, again, I think that is what can move the needle even more. When we think about just drugs in general, I mean, they're powerful. They have the ability to get almost all medical conditions under control. Some drugs even lead to cure, but it's getting patients on the right medications, and then secondarily, moving toward increasing access and getting patients access to these medications. I think in the end, it'll take all these different parts of the solution coming together from those like Mark Cuban's pharmacy, focused on an affordability angle, to those like adherence solutions like GlowCaps, and those like Arine, looking at safe and effective medication therapy, and other companies doing remote monitoring to continue to monitor disease progression. I think all these pieces coming together will move the needle in the long term.

Alana Hippensteele: Any closing thoughts?

Yoona Kim: I am very bullish about the future, especially with pharmacists. I believe that pharmacists play a key role in all of this. They know how to counsel patients to take their medications, they know which medications are the right choices and how to speak with prescribers on how to ensure that the right medication choices and the right dosing is made. Pharmacists have numerous touchpoints with patients, especially in settings like the community pharmacy setting, and it's with the help of different technologies that will help make these types of clinical services more scalable, and that's the passion that I have that enticed me to start Arine and motivated me to start Arine, and I see many other innovations in pharmacy as well to elevate the role of the pharmacist. I think the future is very bright.