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This week’s Making Rounds spotlights Sharon Faust, senior VP of specialty pharmacy at Lumicera Health Services, a Wisconsin-based full-service specialty pharmacy that tracks down medications for patients with rare or complex diseases.
Her team negotiates directly with drug manufacturers to get a price that might be lower than what’s otherwise available to the patient. They also work to get that person the best possible therapy, with a focus on injectables and biologics.
Once Faust and her colleagues find the right medication, they charge payers for the price of the drug plus a service charge using a business model called cost-plus pricing, which Mark Cuban’s Cost Plus Drugs venture helped popularize. Unlike traditional drug-pricing models, which can be complex, Faust said cost-plus offers a more transparent alternative. Additionally, Lumicera offers continued support to patients through medication education and adherence services.
This interview has been lightly edited for length and clarity.
How would you describe your specific job to someone who doesn’t work in healthcare?
I lead teams that help patients with chronic or difficult-to-treat conditions who tend to use products that are high cost.
My team makes sure the medication is appropriate for the patient. If there’s a lower-cost alternative that would be better suited, we connect with their physician for that. If there’s not, we help that patient with clinical education and resources to ensure the patient is utilizing that medication correctly—that they know how to use it, are adhering to it, and taking it on time—so they can get most out of it.
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What’s an exciting change you’ve seen that helps those patients?
The most exciting thing that we’ve done is really initiate the cost-plus model. Cost-plus is taking the actual acquisition cost of the drug, then you add a flat fee. And that is more transparent than traditional drug pricing models.
That’s really important because there’s a lot of healthcare dollars going into specialty pharmacy. It accounts for over 50% of the pharmacy spend for a plan. Transparency is really important so that payers know where their money is going and how their dollar is being utilized. They know they’re getting both cost savings and quality care. It can help reduce their overall costs, which in turn reduces patients’ premiums and payments.
Are there any other trends in healthcare that are making you particularly optimistic?
I think that in healthcare in general we’re seeing companies be more innovative. I think that’s always exciting. Doing things differently is thrilling to me—and always something I’ve wanted to be a part of—and then tying that back into increased transparency, fiduciary responsibility, and bringing in the ethical component of healthcare.
On the flip side, what in the world of healthcare is keeping you up at night?
Our support services, our boots on the ground. Especially as we have so many more people getting older.
When the children of baby boomers are then affected because their parents need help, I think that’s when all the middle-aged people will be like, “Wait, I can’t get anybody to help with taking care of my parents right now.”