A conversation with Gerry Gleeson, Walgreens Specialty Pharmacy

Walgreens, founded in 1901, is now one of the leading drugstore chains in the US, and, through its parent, Walgreens Boots Alliance, Inc., serves as “the first global pharmacy-led, health and well-being enterprise.” It operates nearly 8,200 pharmacies in the US and Puerto Rico, and indirectly with thousands more operating in 11 countries globally under the Boots, Alliance Healthcare and other brandnames. In addition, it provides multichannel access to millions of patients through digital businesses (Walgreens.com and others).

Gerry Gleeson is group vice president for Walgreens Specialty Pharmacy. In this position, he is responsible for Walgreens US Enterprise Specialty Business, which includes the Central & Local Specialty business units, the 340B program, provider and health system sales, payer marketing, and pharmaceutical quality. As part of his role, Gleeson also sits on the Boards of Option Care, Caremetx and the National Association of Specialty Pharmacy. Gleeson has 20 years of experience in the US managed markets, global market access, retail trade and pharmaceutical marketing fields. He joined Walgreens in 2010 as divisional VP of pharmaceutical development, optimizing Walgreens relationships with pharma manufacturers.

Pharmaceutical Commerce sat down with Mr. Gleeson to find out what trends are occurring in the dynamic specialty pharmacy arena. Here’s what he had to say.

1) To start, let’s characterize Walgreens Specialty Pharmacy in the context of the overall Walgreens Boots Alliance structure.

Walgreens Specialty Pharmacy is the largest, non-PBM owned, specialty provider in the country and operates as a division of Walgreen Co., which is a subsidiary of Walgreens Boots Alliance, Inc. (WBA). WBA was created through the combination of Walgreens and Alliance Boots in December 2014.

WBA is organized into three divisions: Retail Pharmacy USA (Walgreens and Duane Reade), Retail Pharmacy International and Pharmaceutical Wholesale. Walgreens Specialty Pharmacy is part of our Retail Pharmacy USA division, although we don’t break out revenue for our specialty business.

Walgreens Specialty Pharmacy consists of the following 1,100+ sites:

• 5 central-fill specialty pharmacy sites
• 900+ specialized pharmacies within our 8,100+ retail locations, including:- 800+ HIV specialized sites, and- 100+ Hepatitis specialized sites
• 240+ local specialty pharmacies, including:- Stand-alone “Community” specialty pharmacies- Walgreens specialty pharmacies located in hospitals and medical office buildings- 3 specialty pharmacies focused on cystic fibrosis

The main four disease states we focus on are virology (HIV/AIDS and Hepatitis), oncology, transplant, and cystic fibrosis and other rare diseases.

2) How would you characterize the range of conditions for which Walgreens Specialty Pharmacy has expertise and offers services for?

Walgreens Specialty Pharmacy helps to empower patients who have complex conditions with easy access to their specialty and traditional medications, and helps them navigate the complexities of their treatment, providing comprehensive support when and where they need it most. Therapy management accompanies every medication we dispense, as appropriate for each individual patient. Our approach to assisting patients in managing their health is not a one-time intervention. Walgreens provides patient management throughout the patients’ course of therapy.

Beyond our therapy management services—which provide adherence monitoring, side effect management, adherence/compliance calls, maintenance of a complete patient profile (including medication history) and physician outreach when appropriate—we developed our Connected Care clinical programs designed to educate and assist patients who are dealing with delicate disease states. We help these patients remain adherent to their prescribed medications. Our Connected Care programs aide patients with treatment regimens for complex illnesses, which involve high-touch, often high-cost specialty prescriptions.

In addition to HIV/AIDS, hepatitis, cystic fibrosis, cancer and transplant, Walgreens Specialty Pharmacy provides patient care for more than 20 conditions, including anemia/neutropenia, asthma, Crohn’s disease, enzyme deficiencies, growth hormone deficiency, hemophilia, immune deficiency/IVIG, infertility, macular degeneration, multiple sclerosis, osteoarthritis, psoriasis, psoriatic arthritis, pulmonary arterial hypertension, respiratory syncytial virus, rheumatoid arthritis, urological conditions, and ulcerative colitis. And even if a patient’s condition is not on this list, we may still be able to offer support for them. Patients can contact us any time at (888) 782-8443 to discuss their condition, and potential services and support that we may offer.

3) What is the relationship between pharma manufacturers and Walgreens Specialty Pharmacy? Do you buy the drugs directly from manufacturers, or through the general-purpose arrangement with a wholesaler? Do you participate in limited-distribution arrangements, or even exclusive distribution ones? Does Walgreens Specialty Pharmacy seek and receive compensation from manufacturers for bona fide specialty care services to patients and physicians?

The Walgreens Specialty Pharmacy supply channel architecture is designed to purchase directly from manufacturers as well as national wholesalers, including AmerisourceBergen Corp.

In March 2013, Walgreens entered into a long-term distribution agreement with AmerisourceBergen. Our 10-year, comprehensive primary distribution agreement allows AmerisourceBergen to distribute both brand and generic pharmaceutical products for Walgreens. The agreement also provides substantial operational benefits for Walgreens, including an enhanced supply chain with daily deliveries.

Walgreens benefits from AmerisourceBergen’s expertise in its specialty and manufacturer services businesses, as well as its wholesale distribution to health systems across the US. Our Pharmaceutical Wholesale division’s strong international expertise in distribution and wholesaling opens avenues for collaboration on new projects and services.

Walgreens Specialty Pharmacy participates in limited distribution networks for many specialty drugs and has sole distribution for certain other drugs approved to treat rare diseases. Patients benefit from Walgreens access to limited and select sole distribution medications.

Yes, specific to services provided beyond our normal scope, Walgreens maintains service relationships by contracting with pharmaceutical manufacturers. These additional services include enhanced patient outreach, enhanced supply chain functions and data reporting.

4) There are many independent or quasi-independent “hub services” providers, who typically are positioned between the manufacturer and the patient, managing benefit investigations, running adherence programs and generally supporting the patient. Does Walgreens Specialty Pharmacy consider itself an equivalent hub services provider?

We have the expertise and resources to provide excellent service as an exclusive pharmacy provider. Walgreens Specialty Pharmacy is able to provide all of the services that a typical hub would provide. We currently serve as an exclusive provider for several payers, delivering custom solutions, comprehensive client support, and high-touch patient care and service.

Research and verification-reimbursement specialists verify all patients’ insurance coverage and benefit options, and research a patient’s drug coverage benefit on a drug-by-drug basis against benefit options. Through a coordination of benefits process, we identify savings options for both the patient and the plan. Our reimbursement specialists also confirm various aspects of the patient’s care and the client’s program, including the plan’s benefit design; product coverage eligibility under the medical or pharmacy benefit; identification of the medication as an office- or self-injectable; plan billing requirements; and coinsurance, copay or deductible information.

In terms of financial assistance, we fully coordinate with outside financial resources for patients who financially qualify for assistance or have exhausted benefits, as allowed by the specific plan. We help find suitable coverage for our patients through the available manufacturer, charitable and non-profit assistance resources. We regularly work with many programs including: Angel Care Foundation, Cancer Care, Caring Voices, Chronic Disease Fund (CDF), HealthWell, Leukemia & Lymphoma Society, MS Society, NORD, Opus, Patient Access Network Foundation, Patient Advocate Foundation, Patient Services Inc., Red Cross, and the Salvation Army. In our Fiscal Year 2015, we helped patients across all disease categories secure more than $200 million in financial assistance (central, local and retail dispensing channels).

We also work with all applicable manufacturer-sponsored programs.

5) Walgreens Specialty Pharmacy literature refers to the SP “network” of “retail pharmacies, condition-specific specialized pharmacies, health system pharmacies and centralized patient support services.” Is each of these a distinct “flavor” of Specialty Pharmacy?

Walgreens Specialty Pharmacy has a network of patient support powered by central dispensing specialty services for patients to get their questions answered and their medication distributed to their homes, as well as local specialty and retail pharmacy options for patients who prefer and can benefit from in-person pharmacy services—personalized care and support that can help our patients achieve better outcomes. At all sites of care, Walgreens offers patient support that promotes adherence and verifies appropriateness of therapy, reducing medical costs while improving therapy outcomes.

One example of a Walgreens Specialty Pharmacy is our network of 800+ HIV Specialized Pharmacies. Launched in the spring of 2010, the HIV Specialized Pharmacy program was created to address the challenges faced by people living with HIV. At these locations, every touch point in a patient’s pharmacy experience is addressed by our professionals who strive to understand each patient’s condition and are well-versed in the cultural values, beliefs and health conditions of the population. One thing that sets Walgreens HIV Specialized Pharmacies apart is the level of HIV expertise we offer. All of our pharmacists are required to complete 25 credit hours of course work from a curriculum developed by the National Alliance for HIV Education and Workforce Development and the American Academy of HIV Medicine.

6) In line with question #4, is the arrangement with the Cystic Fibrosis Foundation a unique partnership within Walgreens Specialty Pharmacy?

Walgreens’ partnership with the Cystic Fibrosis (CF) Foundation is unique to Walgreens Specialty Pharmacy. In December of 2012, we took a significant ownership stake in the Cystic Fibrosis Foundation’s Cystic Fibrosis Services, Inc., a specialty pharmacy for CF patients and their families—one that provides access to cystic fibrosis medications, as well as assistance with the complex insurance issues faced in obtaining these medications. More than just a pharmacy, CF Services provides personalized service, patient advocacy, patient education and reimbursement support to the cystic fibrosis community.

Through the ownership of CF Services, Walgreens and the Cystic Fibrosis Foundation are working toward improving the quality of life for individuals with cystic fibrosis. Patients benefit from Walgreens expertise in cystic fibrosis, its access to limited distribution drugs and personalized therapy management support through the Walgreens Connected Care Cystic Fibrosis program. Insurance verification, help identifying financial assistance options and other support services are also made available to support the CF community.

Walgreens also works with other patient advocacy groups related to other complex conditions beyond cystic fibrosis. Examples include our HIV-related work with the Greater Than AIDs organization and within oncology, we have a partnership with the Leukemia & Lymphoma Society.

7) Since Walgreens Specialty Pharmacy is actively competing against other specialty pharmacies for winning pharma-industry business, what are your competitive advantages?

Some of the other specialty pharmacies are limited to centralized fulfillment. However, at Walgreens we manage specialty medications across multiple fulfillment channels. We offer greater access to patients via multiple options, including mail distribution from our ACHC- and URAC-accredited central-fill facilities to patients’ preferred delivery locations, as well as coordination of care through our community pharmacies and specialty pharmacies located in hospitals and medical office buildings.

In addition to our national footprint of service locations, there are other areas that differentiate us from PBMs and other specialty pharmacies, including our access to the majority of limited distribution drugs. We provide direct access to more than 140 limited distribution drugs, making us one of the market leaders. Also, we handle referrals from several leading pharmacy and payer sources to meet patient medication fulfillment needs.

In the last few years, we have had great success securing access to new-to-market and existing limited distribution products through our specialty pharmacy solutions. We go to great lengths to work with insurers on benefits determinations to help ensure continuity of care for our patients.

With Option Care, we still maintain a commercial partnership to coordinate patient care solutions for payers, providers and biopharma manufacturers for infusion services as part of our healthcare value proposition.

8) Looking ahead, where is the Specialty pharmacy business going and what role is it playing in US healthcare?

Specialty pharmacy is the fastest growing segment of pharmacy. US specialty drug spending is predicted to more than double from 2016–2020, per PwC Health Research Institute. Health plans are challenged every day to control specialty pharmacy costs. Continued growth in specialty medication use and availability will require increased drug cost management. This trend in specialty benefit management will also necessitate active clinical and utilization management along with a detailed reporting program. New drugs will be introduced to the specialty pipeline and existing drugs will be used for an increasing number of indications. Alerting health plans about market trends and guiding decisions in this area will play a critical role in managing costs.

Walgreens has expertise monitoring emerging therapeutics and is well prepared for upcoming trends. Our Specialty Pipeline Consulting service identifies key specialty pharmaceuticals in development and the economic impact these products may have on specialty trends. Our long-term strategy is to continually refine our approach to help payers support patients, control utilization and prepare for the future cost of specialty pharmacy.

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