Pharmacy Technology Innovation Has a New Leader... Free Market Health

Brian Urban:
Yes, this is the Healthcare Rethink Podcast. I'm your host, Brian Urban, and today joining us is the Chief Commercial Officer from Free Market Health, Don Vidic. And if you haven't heard about Free Market Health, they're going to blow your mind. They're a leading pharmacy innovation technology firm that is starting to change the way a lot of drugs are being referred to and prescribed to a lot of amazing in lead patients across the US. Don, welcome to our little show.

Don Vidic:
Thanks for having me, Brian.

Brian Urban:
So, this is going to be a lot of fun. We got to know each other a little bit before the show. I got some great background on yourself, not only professionally but personally as well. So, you come with a lot of interesting stories here. I wish we had a virtual couch almost like the Johnny Carson Days or Jimmy Fallon now I guess. But you have a lot of really interesting stories that we're going to get into, and we love to start there with all of our guests on our show, Don, so let's go back before your chief commercial officer here at Free Market Health, a very innovative startup, even before your big Walgreens days as well. What took you into pharmacy in the first place, the space? Let's start there. Take us back.

Don Vidic:
Yeah, great question. My family actually owned a grocery store. It was a grocery store attached to our house. At some point in time, my dad wanted to get out of that business. We sold that and my mom missed the human interaction and she started working at a pharmacy, a local pharmacy. Believe it or not, she's still there. She works one day a week, she's 80. It's a little independent and that really kind of got me interested in pharmacy, talking to the pharmacists, seeing what happened inside of the pharmacy, and that's how I ended up going to pharmacy school.

Brian Urban:
So, that I didn't know when we started to connect earlier on and get to know each other. So well, first of all, kudos to your mother for just wanting to contribute something to others' lives in the healthcare space and working in a pharmacy, what better way to do that? So, your early days in pharmacy school, when I think so I know nothing about pharmacy school in particular coming from business public health background. So, I see pharmacy school as heavy chemistry, heavy today I would imagine patient safety, drug interaction, and then probably some interesting bedside manner, a lot of interaction, engagement, probably some training around that. But maybe what's your outlook from when you train as a pharmacist to maybe what's happening now with a lot of young pharmacists coming into the field?

Don Vidic:
Really another good question. I think it's something that we dedicated a lot of time to in prior lives and making sure that specialty was a part of the curriculum. It is difficult to fit everything into the current curriculum that is a six-year program for all pharmacy schools. Specialty often is just a portion of a class, and when you think about the import of it and the importance of specialty across the continuum of what is pharmacy, it doesn't feel like it's enough. And certainly there are folks trying to address that. I think Brian, but the core curriculum is so important, understanding the technology and clinical aspects of pharmacy that a small portion or a slice of the total pharmacy continuum that specialty is, even though it is a very expensive and drives a lot of activity, it's difficult to fit in and I think the curriculums could do more to add specialty. There's definitely a need for it to be an entire couple classes, at least as you think about the various categories and what those categories mean to today's pharmacy.

Brian Urban:
Yeah, really interesting because we talked to a lot of MDs, a lot of chief medical officers on the show here, Don. They talk a lot about how the next generation of physicians, clinicians are needing to have advanced education in alternative medicine, nutrition, wellbeing, a lot of the stuff that you as a pharmacist interact with and hear with patients over the counter, I should have said over the counter side manners, not bedside manners, but all the same in some regards. So, it's interesting to hear that from pharmacist perspective as well, because you touch and interact people and patients very different way in a very different setting. It's mostly attached to groceries, like you were saying, grocery outlets, food markets. It's a more non-threatening place to really divulge a lot of things that are happening in life and challenges you might be facing.
So, it's always been an interesting perspective I thought pharmacists have had when interacting with patients in the community. So, let's get into that. Specialty drugs have been a part of your background for a long time. These are complicated medications for more rare disease or rare cancers in particular now being found every year, and it's a high spend for health plans, big responsibility for patients. So, I want to get to understand where Free Market Health fits in now, you're trying to solve a lot of this stuff. So, give me up the speed on Free Market Health. You're a few years old now and you're starting to make some impact, so get us up to speed on Free Market Health and where you fit in the specialty drug world.

Don Vidic:
Yeah, great question. Yeah, if you think as you think about where we fit, Free Market Health is an augmentation and overlay technology that essentially offers a flexible platform that functions as a comprehensive operating system for payers to optimize their specialty drug management program. That same platform is used by the participating specialty pharmacies and to essentially effectuate a best fit of a specialty drug referral to a qualified specialty pharmacy. So, the goal that we have obviously at Free Market Health is to become the foundational operating system for payers to manage and attain a high quality value-based specialty drug program. And even more broadly become an orchestration layer in that specialty drug ecosystem. It's gotten very complex over the last probably 15 years, and it's because the product is so important to so many of the stakeholders. You've really got the four Ps, you've got the patient, the physician, the pharma, the manufacturer, and the payer.
The pharmas is a very close second as far as their effect on the ecosystem, and the payer obviously has a significant effect, but each of them with different goals. And the pharmacy, the fifth P that's out there, the specialty pharmacy has to find ways to manage through all four of those key stakeholders who have very different viewpoints. And we believe that complexity has driven to a position now where the complexity is very difficult for patients to navigate, sometimes very difficult for physicians, and the payers now have because of that have programs in place that we think we can optimize through our technology.

Brian Urban:
I think it's very helpful for our broader audience, Don, and just describing what your technology is, the stakeholders you face, the value that you can bring. That I think surface level people might say, okay, well we're trying to drive down as much cost as we can at the patient drug specific level, but not necessarily. So, the way I was looking at it, and I think you would agree is you're right sizing things and you're making things more affordable and that affordability can then have a trickle-down effect to all these other stakeholders. So I mean, I see as you're transforming things literally drug by drug, patient by patient, population by population in terms of when you take in members from different health plans. So, this seems just so fascinating and it seems like it's being really well adopted, as well at the right pace. Is that right?

Don Vidic:
Yeah, it is. I think when you think about whose adopting it, I think it's a natural match for a managed Medicaid who has any willing provider requirements to their patient base. It allows pharmacies to essentially bid on and win referrals for specialty drugs, without having to influence the physician or pharma in some way, shape, or form to gain that referral. They do it because they're the best match, right? They have all the requirements from a state licensure perspective. They are willing to handle any of the clinical requirements that the payer may put on that particular product, and then they offer the best price. It's a really nice approach. In addition, we've been able to take this to a commercial marketplace and now have a couple of blues plans that are included and it's really across their books of business. Most of their books, there's a fully insured lives flowing through as well as self-insured lives flowing through. We haven't gone to the Medicaid or Medicaid Advantage groups yet, but we are, we've done the research and believe that this is a viable product for those groups as well.

Brian Urban:
Makes sense to go across different populations because all populations have specialty drug needs, but especially now, I'm just curious to take a step back. All the work that you had done around specialty pharmacy and even being across the counter, did you ever think that the transformation that you're a part of now was ever going to happen? Did you ever think that this type of healthcare technology would exist one day or did you just think, well, hey, this model's going to continue forever when you were back in your practicing pharmacy days?

Don Vidic:
It's a great question. I've been in the business since 1992. I started with a little specialty pharmacy called Stadtlanders. It wasn't even called specialty at the time, but they were mostly in transplant, and the focus for those patients was around the complexity of billing, how hard it was to bill these particular products to Medicare. That moved then into HIV. HIV then produced one of the first limited distribution drugs Crixivan and happened to be part of the team that brought that Crixivan program to the marketplace. What I do know, within about six years, you got a sense that specialty as we knew it was changing at about every 18 months to two years, and it was due to different influences. One is drug discovery, right? New products. Another is the influence of managed care. As you got closer to the end of the nineties, managed care definitely wanted to have a say in where these products were being dispensed and at what price.
Then you kind of get into the 2000s, you start to see the PBMs starting to become part of the specialty continuum owning specialty pharmacies. You take that and then you start to see health plans and PBMs merging, chain drug, CVS, Aetna merger was a big market mover. ESI Medco another big market mover, and you started to see how all these stakeholders start to maximize their investment and maximize their approach to managing these products. And what I think I saw throughout maybe 2010 to 2018 is looking for ways to innovate, looking for new ways to be something different that's in the marketplace other than an exclusive contract with [inaudible 00:13:55] prior auth requirements.
And I think we did some of that in a prior life. Ultimately though, I think the marketplace is looking for innovative solutions to controlling drug spend and trend, and I really believe that we're one of those solutions, right? I don't know that we're the complete solution, but we are a significant contributor and frankly in a very innovative way we can combine not just controlling the spend and trend for products that obviously are continually growing and price and utilization. But also finding ways to manage the data and analytics and clinical interventions that could be meaningful to those members of those patients.

Brian Urban:
That's a great point, too. We're going into the depth of the value of this innovation, not just what the platform is that we were starting on here. So, I love that it has a very meaningful economic impact on the healthcare society. So, not only are you kind of slowing the pace in a lot of ways in terms of the cost, but you're making it more affordable and also the clinical interventions. I love that you touched on that. I have a couple of questions there, Don, and I think from what I understand, the platform allows someone who wins that referral to service that patient and there's incentives to make sure that person stays adherent. You're addressing other things with them too. So, it kind of goes beyond just having this big access affordability play between the patients, the pharmaceutical manufacturer, the retail pharmacies. Tell us a little bit that your model really goes beyond with those clinical interventions.

Don Vidic:
Sure. Yeah, I think the intervention platform we built initially to enable value case execution at the pharmacy level, and ultimately we've built it out to include clinical interventions, as you mentioned, interventions related to things like adherence, interventions around side effect management, interventions around things like SDOH, right? The social determinants of health and looking for patients that could be at risk. And then using our data collect to essentially feed case management at the plan level. What's really neat about it is it allows the plan to essentially manage their drug program. So, it's not that they're buying something off the shelf. There's plenty of times when you've heard a plan say, "I wish I could add this," and their SP provider maybe doesn't have those sort of interventions.
We have the flexibility and the platform and frankly it's configurable that allows us to add those at a patient level, right? It could be at a disease level, it could be at a drug level where there's particular interventions which they would require. It could be at a patient level and that could actually happen via the feeds we're getting from the payer, allowing us to essentially build an identifiable kind of matrix that says, "This is a patient we need to intervene on due to these factors" versus a vanilla across the board, everybody gets the same. So, we definitely feel like that's another really nice value add that we've been able to bring to the market.

Brian Urban:
I'm glad you hit on a couple of those pieces, Don, especially addressing the social determinants of health piece at the individual level. So, I feel, and you're just on the cusp of this, I think with all the different applications that your platform can have, not just with a UI/UX perspective for all the stakeholders. But for the individual patient, it's hard for them to be medication adherence because of X, Y, Z because they might have a lot of challenges financially, taking care of others in their family. They might be moving a lot, they're tough to get in touch with. There's so many different things that I think your platform is going to provide clean visibility to in the specialty pharmacy space, all the important stakeholders for helping someone advance their health stay adherent to a medication that's lifesaving at the end of it. So, this is truly fascinating. I'm curious on the prescriber or the pharmacy end, how well has this been adopted for all the different pharmacies that are participating in this? I'm sure it's been an evolution in terms of a journey here, but how has it been lately?

Don Vidic:
Yeah, it's been very positive. I think as we enter new markets, we start to procure a network of pharmacies either at the behest of that payer who already may have a network of pharmacies and wishes us to interface with them, or they like our core network and they want to add regional and local specialty pharmacies as well as the hospital system specialty pharmacies. So, I think it's a pretty wide continuum. I think there's some SPs who get it right away, and they're super excited. They recognize that they've never had access to these lives before.
They'd love to be able to show what they can do to that payer for their members. So, those are on one end of the spectrum, and I think in the middle there's folks who just aren't sure, is this going to cause more work for me? Is this another work step that I have to add to my process? They ultimately then once they're trained and up and running on the UI, adopt very quickly. Then there's some that are doubters, right? From the beginning, why do I have to go onto this platform to find these patients? I'm not sure I like it. Even they ultimately then adopt, and there are some that have just said, "You know what? This isn't for me," and that's okay. I think there are definitely going to be some SPs who decide they're not going to participate for whatever reason. Maybe it's counter to their current strategy or has some other conflict.
But nonetheless, I think those that have participated, Brian, I think what they're recognizing is this is a fair and equitable way to receive and win referrals for specialty patients from a specific payer, where they used to have to hope that their reps did the best job in front of that physician to explain their capabilities. They are now winning because they're the best fit. They've got all the requirements, they have the clinical expertise, they have the URAC accreditation that they've invested tremendously in. They have the licensure in the states where the patients live, and they're able to provide a fair and equitable rate for that particular product. So, I think it takes some time for some of those folks on the continuum to understand the value that we bring, but those that are engaged and willing to learn and continuously be trained by our customer success team, it allows for them a whole new area of growth for their business.

Brian Urban:
As you were describing this, Don, I was really thinking about one part in your earlier comment here, you're unlocking access to patients for specialty pharmacies to really show the capabilities and practice at the top of their best technology, their best services clinically, but also from a patient interaction standpoint as well. This is not just a transformation play, it's also a humanity play in a lot of ways because the model before, there's a lot of stage gates and barriers in between a specialty pharmacy and a patient, but now you're unlocking this. This is a new game, and I think it is great that you address the broader market of hesitation for doing it and jumping in and some people saying, "It's not for us right now."
I think with any kind of new technology or innovation that is coming to the market, there are those that whole bell curve of someone adopting or not. That I think those that are adopting now you're saying a couple of things. One, I mean you're saying you're in it to prove out the value of what the next iteration of our healthcare model and pharmacy has to be. I love leaders like that, like CFOs, chief pharmacy officers that are part of the value realization. So, I love that. And I'm curious of the next kind of move for Free Market Health. I know you have big news coming out too. You're growing. Are there going to be more feature enhancements, more people growth inside Free Market Health? What's down the road a little bit?

Don Vidic:
Yeah, for sure. Obviously that platform is now got some really nice proof points. So, we have a very active pipeline of new clients. And even with existing clients, I mentioned it a little bit, we really do believe we need to expand into the Medicare line of business. There's definitely some opportunity there for us. There's obviously hurdles and allowances that we need to make from a regulatory perspective and a patient choice perspective, but we believe we're heading in the right direction there. So, Medicare is definitely a growth option for us. And as I mentioned, we're already managing commercial lives, self-insured lives, fully insured lives, and certainly the Medicaid, the regulated lines of business. We're excited to grow those. I think also the platform itself does allow for a really nice flexibility that allows us to go further upstream. Right now, we're right there at approved prior auth is when our API grabs the referral.
We believe we can be upstream in the intake channels for prescription management prior to that prior auth step to allow us to expand the drugs that we're able to manage for and on behalf of our payers. So, those are exciting. Those are definitely exciting areas. And then I think as you start to look at the marketplace and where things are right now, just read the paper. There's just tons of regulatory and consumer pressure on drug pricing, and we believe some of the next steps for Free Market Health are going to be forward-thinking payers taking action in those arenas and starting with specialty because it is such a high value target for them to go after. The platform does allow those forward-thinking payers, those that have innovation on their minds to really allow them to build a specialty drug program that addresses some of that consumer backlash, as well as regulatory pressure that's existing out there today.

Brian Urban:
And that's a great statement, even an understatement that 340B alone has been such a dramatic headline series, different lawsuits and perspectives, and things like that that we're not going to get into. But you're right, there's so many things that's coming around it. I see your technology is really embracing disruption and having a unifying effect in a lot of ways. And with that, I am curious too, take me of the culture, a little bit of Free Market Health, a lot of young kind of vibes coming out, a very techy feel, a lot of pharmacists behind a lot of the strategy here too. So, what's the culture been like in your experience at Free Market Health?

Don Vidic:
Yeah, Brian, it's been great. It's really a fun environment. It is a mix, right? You've got young hungry technologists that really want to make a difference. We've got a great technology team that's really been amazing to work with, super energizing to be around. And ultimately we mix that with a really experienced group of pharmacists and other industry experts that bring everything from PBM expertise to payer expertise, to specialty pharmacy expertise, to clinical expertise, a really nice blend. And it's really a fun place to work. There's great energy there every day in the strip, and we do have a remote workforce that's really across the country where we're leveraging folks who have been able to work at some of the large PBMs and or payers where that expertise is just added fuel to the mix that we already have. So, it's a lot of fun.

Brian Urban:
Well, I'm excited for the continued growth for Free Market Health and the continued impact. I think not only do you have a very well-defined model in terms of ROI and value realization, but the human value of this, the interaction that specialty pharmacies now are unlocked to have with patients to really improve their lives. And I think this is going to be such a meaningful part of transformation across the healthcare ecosystem. So, excited. Don, thank you so much for joining our little show here today. This was a lot of fun.

Don Vidic:
Thanks, Brian. Really appreciate it. I enjoyed it.

Brian Urban:
And for more exciting excerpts and insights, please visit us at finthrive.com.