Hot Topics in Pharmacotherapeutic Advances
Rajul Gandhi discusses the latest trends and hot topics in Pharmacotherapeutic Advances.
Featuring:
Rajul Gandhi
Rajul Gandhi is a Pharmacy Manager. He has partnered with stakeholders to create strategies and measure outcomes that improve the health for the most number of patients. His experiences have provided him with a deeper understanding of the interconnectedness of the various facets within healthcare and its extensions into the government and the economy.
Transcription:
Melanie Cole, MS: Expert insights is an ongoing medical education podcast. The Carle Division of Continuing Education designates that each episode of this enduring material is worth a maximum of .25 AMA PRA Category 1 credit. To collect credit, please click on the link and complete the episode’s post-test.
Advances in drug discovery have identified novel therapeutic approaches to treat so many disorders and conditions. Here to tell us about some of the hot topics in pharmacotherapeutic advances is my quest, Dr. Rajul Gandhi. He’s the pharmacy manager at the Carle Foundation Hospital. Dr. Gandhi explain a little big about how pharmacotherapeutic advances have changed over the years. What’s different now?
Rajul Gandhi: Well I think the biggest thing is the explosion of the specialty drug market. I mean specialty drugs have been around for a long time. Probably the last 15 years. But back then, we only have three or four. Today with the impact of cancer and new medications coming out to treat cancer, we get maybe three or four per month that are coming out that you're learning about. You have to kind of figure out where that fits in the treatment scheme. So, some of these are for cancer. Some of them are called like immunotherapy, biologics. There’s a lot ramping up in that group alone. I think we’re closing in on about $200 billion worth of drugs in that category.
Melanie: Wow. So why don’t we delve a little bit more into immunotherapy and biologics. Some of the recent cancer drugs that other providers should probably know what’s going on. Tell us a little bit about some of the hot topics.
Dr. Gandhi: I mean I think the biggest thing is anything that ends in like -mumab. All these monoclonal antibodies, those are the things. A lot of them are oral. So traditionally you think about a drug that’s a pill form, or you’re thinking about cancer that was given IV, some of that stuff is now given orally. With respect to biologics, they're bigger molecules. So, we were always used to smaller molecules that are sort of you're taking as a pill, but these are larger molecules—the ones that we’re infusing. So, they're also more expensive. I think that’s really what has impacted the pharmacy world and healthcare in general in the cost of drugs is this explosion of not only the number of drugs, but then the expense. So, it’s not sort of a vertical line. It’s an increasing at a very rapid pace.
Melanie: And chemotherapy drugs are now even available orally, aren’t they?
Dr. Gandhi: Correct, yeah. Oral chemotherapy is becoming more and more prevalent.
Melanie: So as long as you're mentioning drug costs and the rising costs of pharmacotherapeutic agents, speak out some of that and what you're seeing as a pharmacist? Also, the drug shortages and where other companies are jumping in to try and take up some of that shortage.
Dr. Gandhi: I mean drug costs are going up. Part of that is the drug shortages. Because honestly what happens is you used to have maybe four or five manufacturers making one drug. Well, you're down to one manufacturer and sometimes they hike the price of the drug. So, you're trying to figure out alternative therapies. You're looking back at well what did we used to do 10 years ago if we don’t have this drug today.
Drug shortages are a huge issue because you're just trying to take care of patients on a day to day basis in a hospital setting or an ambulatory setting where you're giving infusions there, but you may not have simple medications like Zofran for nausea at your disposal anymore. Sometimes its life saving drugs and sometimes it’s convenience medications, but regardless on average, we hold a weekly meeting regarding just drug shortages alone. So, it’s a huge issue. It’s not just drugs, but it’s also fluids. If you can't get the fluids to put the drugs in, then it’s hard to do that. Sometimes if you have fluids and you have drugs, you don’t have the bags. You need empty bags. So, we’ve gone through all sorts of things. It’s supply and drugs all together. When you look at that, it’s increasing the cost of healthcare.
Melanie: Where would Amazon and other companies come in to help with this? Where do you see that going?
Dr. Gandhi: Well, this interest by Amazon to get involved in pharmacy will be something to watch definitely over the next five years or so. I think with them buying PillPack, that is something that we need to look at and see what they're actually going to do. The way that I understand it, that’s generally more in having medications and packages put together for specific patient populations. So, I think there is certainly a need there that traditionally community pharmacies have not done that because there is not a whole lot of benefit or margin in that space. So, if Amazon is able to do that because they're doing it at a large scale, they may be able to help with that aspect of it.
Patients are having more and more medications mailed to them because a lot of the specialty drugs are mailed to them directly or they have to have specific temperature requirements. So, patients are seeing more and more drugs sent to them as opposed to going to a pharmacy to pick them up.
Melanie: How interesting. And along those lines, Dr. Gandhi, is adherence. As a pharmacist, you discuss this with patients. You discuss with other providers about adherence to blood pressure, cholesterol medication, to any of these things. Where do you see that being a trend or a topic to discuss adherence to the medications?
Dr. Gandhi: Yeah. Adherence to the medications has definitely been around for a long time, even when I worked in a PBM. Adherence was a big thing that we were looking at to see how can we get patients to take their medications on a consistent basis over a long period of time. So, they're pretty good at doing that for the short term if you ask them to but doing it over the long-haul numbers still drop to 50%. That is even in cases of oral chemotherapy or things. So, it’s really hard to push for adherence. When we have so many patients with hypertension and diabetes that could lead to heart attacks and strokes and renal disease, then we need to figure out how to have patients stay compliant and adherent over a really long period of time. That is really the place to do research. That’s actually one of the things that I'm working on with the University of Iowa. We’re looking at a study where we’re trying to determine how to have young females even do healthy habits or stay compliant or adhere to a healthy lifestyle before they even get hypertension.
Melanie: So, in your opinion, what do you feel the role of a pharmacist or another provider is in keeping an eye on adherence? What is their role?
Dr. Gandhi: I think the biggest thing for pharmacists is that every time that a patient comes into the pharmacy to pick up meds is if you're noticing that they're not picking certain meds up— and they're long term medications like for cholesterol or diabetes or hypertension— that’s when you need to step in and talk to them and have a conversation about why they're not taking them. What is the barrier? And breaking down those barriers and making them understand. If they don’t, why they really need to take those medications. Since pharmacists are sort of the medication experts, that’s really the role and function on a day to day basis that they should be talking about.
Physicians and other providers, obviously, when they're prescribing that medication for the first time, it’s really important to talk to the patient about why they're starting them on that medication. Then if they have questions, obviously when they get that filled at the pharmacy, they should be talking to the pharmacy about that. With the new pharmacy counselling laws, especially in Illinois, the pharmacists should be counselling those patients right off the bat.
Melanie: What a fascinating topic and what a fascinating exciting field that you’re in. Dr. Gandhi wrap it up for us. What you’d like other providers to know, other pharmacists and primary care providers about some of these pharmacotherapeutic advances and adherence and drug shortage. Kind of put it all together for us in a way of how you would like them to be involved in all of this.
Dr. Gandhi: I mean I think the biggest thing right now is it’s becoming more complex. Each patient is becoming more complex. There are more and more medications, new medications, different drug interactions. So, I think for providers if they're trouble with that, reach out to your pharmacist. Ask them questions. Even your local pharmacists. Get to know who your local pharmacist is and send your patients that way. Try and get as many of the medications for your patients in one place if you can. Sometimes that’s not possible, but the more you do that the more chances that a pharmacist is going to catch those drug interactions.
The other thing that when you're partnering with a pharmacy and you have the same patient and you have that triad going, that’s what really helps the patient over a long period of time stay adherent. They know that their pharmacists and physicians are talking about their health in the background. Doing the best that they both can in order to promote the patient’s health. A very simple thing to start doing for providers is when you're prescribing a medication, put right on there what it’s for. So, if you're giving a patient Lisinopril, tell them it’s for high blood pressure. That way they know, and they read that everyday on their bottle. They're likely to remember why they're taking it. If they know why they're taking it, they're more likely to take it over the long haul.
Melanie: That’s great advice. Dr. Gandhi, thank you so much for being with us today. Really such an interesting field and interesting topic. Thank you again. You're listening to Expert Insights with Carle Foundation Hospital. For a listing of Carle providers and to view Carle sponsored educational activities, please visit carleconnect.com. That’s carleconnect.com. We hope the information gained will be applicable to your work and life. This is Melanie Cole. Thanks for listening.
Melanie Cole, MS: Expert insights is an ongoing medical education podcast. The Carle Division of Continuing Education designates that each episode of this enduring material is worth a maximum of .25 AMA PRA Category 1 credit. To collect credit, please click on the link and complete the episode’s post-test.
Advances in drug discovery have identified novel therapeutic approaches to treat so many disorders and conditions. Here to tell us about some of the hot topics in pharmacotherapeutic advances is my quest, Dr. Rajul Gandhi. He’s the pharmacy manager at the Carle Foundation Hospital. Dr. Gandhi explain a little big about how pharmacotherapeutic advances have changed over the years. What’s different now?
Rajul Gandhi: Well I think the biggest thing is the explosion of the specialty drug market. I mean specialty drugs have been around for a long time. Probably the last 15 years. But back then, we only have three or four. Today with the impact of cancer and new medications coming out to treat cancer, we get maybe three or four per month that are coming out that you're learning about. You have to kind of figure out where that fits in the treatment scheme. So, some of these are for cancer. Some of them are called like immunotherapy, biologics. There’s a lot ramping up in that group alone. I think we’re closing in on about $200 billion worth of drugs in that category.
Melanie: Wow. So why don’t we delve a little bit more into immunotherapy and biologics. Some of the recent cancer drugs that other providers should probably know what’s going on. Tell us a little bit about some of the hot topics.
Dr. Gandhi: I mean I think the biggest thing is anything that ends in like -mumab. All these monoclonal antibodies, those are the things. A lot of them are oral. So traditionally you think about a drug that’s a pill form, or you’re thinking about cancer that was given IV, some of that stuff is now given orally. With respect to biologics, they're bigger molecules. So, we were always used to smaller molecules that are sort of you're taking as a pill, but these are larger molecules—the ones that we’re infusing. So, they're also more expensive. I think that’s really what has impacted the pharmacy world and healthcare in general in the cost of drugs is this explosion of not only the number of drugs, but then the expense. So, it’s not sort of a vertical line. It’s an increasing at a very rapid pace.
Melanie: And chemotherapy drugs are now even available orally, aren’t they?
Dr. Gandhi: Correct, yeah. Oral chemotherapy is becoming more and more prevalent.
Melanie: So as long as you're mentioning drug costs and the rising costs of pharmacotherapeutic agents, speak out some of that and what you're seeing as a pharmacist? Also, the drug shortages and where other companies are jumping in to try and take up some of that shortage.
Dr. Gandhi: I mean drug costs are going up. Part of that is the drug shortages. Because honestly what happens is you used to have maybe four or five manufacturers making one drug. Well, you're down to one manufacturer and sometimes they hike the price of the drug. So, you're trying to figure out alternative therapies. You're looking back at well what did we used to do 10 years ago if we don’t have this drug today.
Drug shortages are a huge issue because you're just trying to take care of patients on a day to day basis in a hospital setting or an ambulatory setting where you're giving infusions there, but you may not have simple medications like Zofran for nausea at your disposal anymore. Sometimes its life saving drugs and sometimes it’s convenience medications, but regardless on average, we hold a weekly meeting regarding just drug shortages alone. So, it’s a huge issue. It’s not just drugs, but it’s also fluids. If you can't get the fluids to put the drugs in, then it’s hard to do that. Sometimes if you have fluids and you have drugs, you don’t have the bags. You need empty bags. So, we’ve gone through all sorts of things. It’s supply and drugs all together. When you look at that, it’s increasing the cost of healthcare.
Melanie: Where would Amazon and other companies come in to help with this? Where do you see that going?
Dr. Gandhi: Well, this interest by Amazon to get involved in pharmacy will be something to watch definitely over the next five years or so. I think with them buying PillPack, that is something that we need to look at and see what they're actually going to do. The way that I understand it, that’s generally more in having medications and packages put together for specific patient populations. So, I think there is certainly a need there that traditionally community pharmacies have not done that because there is not a whole lot of benefit or margin in that space. So, if Amazon is able to do that because they're doing it at a large scale, they may be able to help with that aspect of it.
Patients are having more and more medications mailed to them because a lot of the specialty drugs are mailed to them directly or they have to have specific temperature requirements. So, patients are seeing more and more drugs sent to them as opposed to going to a pharmacy to pick them up.
Melanie: How interesting. And along those lines, Dr. Gandhi, is adherence. As a pharmacist, you discuss this with patients. You discuss with other providers about adherence to blood pressure, cholesterol medication, to any of these things. Where do you see that being a trend or a topic to discuss adherence to the medications?
Dr. Gandhi: Yeah. Adherence to the medications has definitely been around for a long time, even when I worked in a PBM. Adherence was a big thing that we were looking at to see how can we get patients to take their medications on a consistent basis over a long period of time. So, they're pretty good at doing that for the short term if you ask them to but doing it over the long-haul numbers still drop to 50%. That is even in cases of oral chemotherapy or things. So, it’s really hard to push for adherence. When we have so many patients with hypertension and diabetes that could lead to heart attacks and strokes and renal disease, then we need to figure out how to have patients stay compliant and adherent over a really long period of time. That is really the place to do research. That’s actually one of the things that I'm working on with the University of Iowa. We’re looking at a study where we’re trying to determine how to have young females even do healthy habits or stay compliant or adhere to a healthy lifestyle before they even get hypertension.
Melanie: So, in your opinion, what do you feel the role of a pharmacist or another provider is in keeping an eye on adherence? What is their role?
Dr. Gandhi: I think the biggest thing for pharmacists is that every time that a patient comes into the pharmacy to pick up meds is if you're noticing that they're not picking certain meds up— and they're long term medications like for cholesterol or diabetes or hypertension— that’s when you need to step in and talk to them and have a conversation about why they're not taking them. What is the barrier? And breaking down those barriers and making them understand. If they don’t, why they really need to take those medications. Since pharmacists are sort of the medication experts, that’s really the role and function on a day to day basis that they should be talking about.
Physicians and other providers, obviously, when they're prescribing that medication for the first time, it’s really important to talk to the patient about why they're starting them on that medication. Then if they have questions, obviously when they get that filled at the pharmacy, they should be talking to the pharmacy about that. With the new pharmacy counselling laws, especially in Illinois, the pharmacists should be counselling those patients right off the bat.
Melanie: What a fascinating topic and what a fascinating exciting field that you’re in. Dr. Gandhi wrap it up for us. What you’d like other providers to know, other pharmacists and primary care providers about some of these pharmacotherapeutic advances and adherence and drug shortage. Kind of put it all together for us in a way of how you would like them to be involved in all of this.
Dr. Gandhi: I mean I think the biggest thing right now is it’s becoming more complex. Each patient is becoming more complex. There are more and more medications, new medications, different drug interactions. So, I think for providers if they're trouble with that, reach out to your pharmacist. Ask them questions. Even your local pharmacists. Get to know who your local pharmacist is and send your patients that way. Try and get as many of the medications for your patients in one place if you can. Sometimes that’s not possible, but the more you do that the more chances that a pharmacist is going to catch those drug interactions.
The other thing that when you're partnering with a pharmacy and you have the same patient and you have that triad going, that’s what really helps the patient over a long period of time stay adherent. They know that their pharmacists and physicians are talking about their health in the background. Doing the best that they both can in order to promote the patient’s health. A very simple thing to start doing for providers is when you're prescribing a medication, put right on there what it’s for. So, if you're giving a patient Lisinopril, tell them it’s for high blood pressure. That way they know, and they read that everyday on their bottle. They're likely to remember why they're taking it. If they know why they're taking it, they're more likely to take it over the long haul.
Melanie: That’s great advice. Dr. Gandhi, thank you so much for being with us today. Really such an interesting field and interesting topic. Thank you again. You're listening to Expert Insights with Carle Foundation Hospital. For a listing of Carle providers and to view Carle sponsored educational activities, please visit carleconnect.com. That’s carleconnect.com. We hope the information gained will be applicable to your work and life. This is Melanie Cole. Thanks for listening.