TRANSCRIPT: Episode 3 of The Front Porch: "Health on the Move," Featuring Lee Ann Stember

The following is a transcript of "Health on the Move," the third episode of ScriptDrop's podcast The Front Porch: Where Pharmacy and Healthcare Access Meet.

Part 1

[LAUREN] Welcome to “Health on the Move,” the third episode in ScriptDrop’s podcast series, which now has a name: “The Front Porch: Where Pharmacy and Healthcare Access Meet.” Today our old friend Perry Lewis will return to talk to his dear friend Lee Ann Stember, President and CEO of the National Council for Prescription Drug Programs, or NCPDP. If that sounds familiar, it should – NCPDP is one of the foremost pharmacy standard organizations in the business. They are really important and they've done a lot of really cool and useful things for the industry of pharmacy and for providers and patients. We’ll touch on all of that, but there's so much to talk about that we've split this episode into two parts for your listening convenience.

So please note: this is part one of two.

If you're a new listener to The Front Porch, let me introduce us, first. ScriptDrop is the only healthcare IT company specializing in prescription access that serves patients in all fifty states. Since 2016, ScriptDrop has been improving drug adherence by delivering medication access opportunities through a robust platform, long term data storage, multiple service levels and first class customer service.

I'm Lauren Carpenter, the Writer/Research here at ScriptDrop. In case you missed our first two episodes, let me introduce our really good friend and industry expert, Perry Lewis. Perry is ScriptDrop’s industry relations consultant. He has worked in the pharmacy industry for over thirty-five years. He was on NCPDP’s board for twelve years and he was Lee Ann’s boss while he served as chair of the NCPDP board for four years. But to be fair, that's a blink of an eye compared to Lee Ann’s tenure with the organization.

Lee Ann is President and CEO of NCPDP. She is a very important figure in the pharmacy industry and a very busy person. In addition to having led NCPDP for four decades, she serves on over half a dozen boards and is a member of just about every notable pharmacy organization. We’re really honored that she is on our Advisory Council and she made the time to talk with us today. It's really an honor.

So, with introductions squared away, I will hand it over to Perry.

[PERRY] Well thanks, Lauren, for those introductions. It's great to be on this podcast again with ScriptDrop. Really looking for our conversation with Lee Ann. Obviously Lee Ann and I have known each other a very long time. She is so passionate about NCPDP’s mission that I would surmise that she will be working on completing all of her strategic plans initiatives well into her 90s.

So I'm really looking forward to having this conversation with Lee Ann. I know a lot about her background, but not a lot of people know of what her background was before NCPDP.

So, Lee Ann, tell us a little bit about your background. I know that you grew up on a on a ranch. I can't imagine what that was like. Can you give us a little idea of what that was like for you?

[LEE ANN] Absolutely. Thank you, Perry. I was born in Yuma, Arizona, and was brought up in a family that were big cattle ranchers. Growing up, we would go to our ranch in Mexico as well as our other ranch, which was in Tucson, during the summer and sometimes even during the holidays, which was quite a lot of fun for us as young people and was also very memorable experience as a young person.

One of the family ranches did not have electricity, running water, or gas, and we used an outhouse, which was one of my least favorite memories. We had a water well that the cattle would use and it had all this lovely green stuff growing in it, but that was the place where we brushed our teeth and we bathed. All meals were made on wood-burning stoves. It was absolutely delicious for whatever strange reason.

One memory that comes to mind is when I was ten years old, I went on a roundup, which were all day events. We worked hard rounding up the cattle with the end goal of bringing them all into the corrals for branding, castrating and did an overall check up on each one of them. On this particular roundup, my grandfather told me that if I were ever to get lost or get separated, as I was on the horse for the very first time during this roundup, that I should not panic and just let the reins go and eventually the horse will take me back to the ranch house. This was, of course, pre- cell phones, GPS and all the other great technologies that we are all so dependent on today.

So I did get separated from the cowboys and family members and it was getting dark and, of course, I was triple scared, but I did what I was told and prayed for a solid eight hours. My horse did get me back to the ranch very early the next morning and my family was so happy to see me. Fortunately for me, it was a full moon that night, so I could see where we were going. But truly my horse, Nacosadie, which translates to “Sweetheart,” was in charge of this big adventure.

Today, both ranches have been sold, and something that I truly miss. But I could go on and on about my life as a cowgirl, and we can save that definitely for another time.

[PERRY] Yeah, we may need to talk about that at another time. But I have definitely seen a side of you during your discussion here that I haven't heard before… So it reminds me that I should not get on your wrong side on a stressful day. I would not want the same thing to happen to me that happened to the cattle!

[Lee Ann laughs]

So remind me if – if I'm accurate here and I've got a good memory, you're somewhat of a daredevil. Can you provide the audience an example of something that most people would not have experienced in their lifetime?

[LEE ANN] Sure. As I previously mentioned, I was brought up riding horses and was taught to barrel race at a very young age, so I did that at the Yuma Rodeos, which was quite a lot of fun.

I also like to run half marathons and completed about four dozen of them, with my best time being one hour, forty-one minutes and forty-two seconds. I recently have enjoyed jumping out of perfectly good airplanes and was hoping to someday get certified so that I could jump solo instead of in tandem.

Another little factoid is that I love to drive really, really fast, and just recently returned from a five country Autobahn adventure tour and hit a top speed on the Autobahn of about 178 miles per hour. The sad part of this was that while I was on the Autobahn, there are certain protocols that you have to adhere to, and if someone comes up on you really fast and they flash their lights, you need to pull over to the next lane so that they can pass. I felt like I was Mr. Magoo! They passed me by so fast I couldn't even see what kind of vehicle they were driving.

[PERRY] So Mrs. Magoo, I will have to say I witnessed your driving style and admit you do like to be a daredevil, fast and furious. God help those in Scottsdale, Arizona. Anyway, you earned your bachelor of science from the University of Arizona College of Business. How did you end up in the pharmacy world after coming from the ranch down in Yuma?

[LEE ANN] Great question, Perry. My original plan when I entered college was to consider becoming a pharmacist, so I began my journey discovering my options in my curriculum. I became a pharmacy technician, or back then, an intern, at the local Walgreens pharmacy and discovered that after about two and a half years behind the counter, I realized that this was not what I really wanted to do for the rest of my life. So I switched my major to the business – to the College of Business and was able to utilize both of my pharmacy knowledge and what I learned in business. After many interviews with Ben Ward, the founder of NCPDP which was formerly known as PCS, I was fortunate to become named the Corporate Secretary for a very small not-for-profit organization that is now known as NCPDP. Of course, being the astute person that I was right out of college, it was my plan to learn the business and broaden my network with hopes of moving on to a career in pharmacy. And, as you know, forty years later, I am still very, very passionate about all that we do as an organization and there's still so much more that I would like to see us get accomplished.

[PERRY] So, for listeners who don't know, could you give us a brief overview of NCPDP and what the organization does?

[LEE ANN] NCPDP is a not-for-profit, multi-stakeholder forum for developing and promoting standards for real-time electronic exchange of healthcare information that improves patient safety and health outcomes while also decreasing cost. NCPDP standards are accredited by the American National Standards Institute, also known as ANSI.

The standards development work of NCPDP is accomplished through its members, who bring high level expertise and diverse perspectives to the forum. Our consensus process provides a model for creating health information technology solutions essential to connect all the stakeholders in delivering quality healthcare for better patient health outcomes. NCDPD has been a leader in standards development for nearly forty-five years and one of our top strategic goals is to continue that leadership in an ever-changing healthcare environment.

[PERRY] Lee Ann, this discussion could get technical pretty quickly. As you know, I'm not all that technical, but the audience should know that the standards are rooted in real-world applications. What are some of the healthcare challenges that NCPDP standards are meant to solve for pharmacists, providers, payers and patients?

[LEE ANN] Great question, Perry. In general, our standards are meant to streamline business operations and exchange of timely and reliable healthcare information among all those involved in providing prescription drug therapies. The ultimate benefit is to patients. We are focused on fortifying patient safety and improving access to medications.

For example, it's been proven that the NCPDP SCRIPT standard that facilitates e-prescribing can reduce medication errors by at least 55%, which reduces unnecessary hospitalization and therefore healthcare cost by approximately 2.8 billion dollars in annual savings. The SCRIPT standard also enables a real time electronic process for prior authorization. This streamlines what was a manual process that often causes delays in patients getting needed medications.

Another NCPDP standard provides an electronic solution to help pharmacists efficiently educate patients about high-risk drugs, as required in Risk Evaluation and Mitigation Strategies (REMS) mandated by the FDA.

Most recently, NCPDP standards made it possible for pharmacists to electronically exchange data required for ordering, administering and filing claims for COVID-19 tests and vaccines. As a result, pharmacies made it possible for millions of Americans to get these vital services close to home.

NCPDP also has standards to improve electronic communication for medication therapy management services provided to patients with chronic health conditions. As a result, pharmacists can more fully utilize their professional training to to care for patients, be reimbursed for their specialized services, and collaborate with positions in patient care. As part of our strategic plan, we're looking at how our existing standards or new ones can support better coordinated care and health outcomes through value-based models of care and the evolving use of precision medicine.

[PERRY] As a Standards Development Organization (SDO), how has NCPDP been successful informing and educating stakeholders on your standards and the importance of standards in healthcare?

[LEE ANN] Well, Perry, to begin with, industry stakeholders from nearly every segment of the pharmacy industry are involved in developing our standards, so they recognize their importance. They understand the “why” behind how standards are developed and are used and are intimately familiar with the standards. These engaged stakeholders then take that knowledge back to their companies. Our collaborative consensus-building process and the learning that comes along with participating in the process helps engender adoption. Beyond that, NCPDP has always participated in industry educational events, sharing knowledge about our standards and the benefit to business operations as well as to the patients.

About eight years ago we launched a very focused effort to educate not only the industry but also healthcare policy makers. We coined the term “EDvocacy” to appropriately describe our initiative to increase knowledge of NCPDP standards and our proven track record in developing solutions to improve operational efficiencies, reduce unnecessary cost, and protect patient health and safety. We visit with legislators and regulatory agencies in Washington, D.C. three times a year to educate them on our problem-solving forum and our standard solutions that can help address some of today's healthcare challenges. We have become a valued resource as bills are being drafted and regulations are being proposed.

[PERRY] Lee Ann, as you know, I wholeheartedly agree NCPDP has become a valued resource in D.C., but also with agencies and at some states as well. I have personally experienced the EDvocacy tours and they were a highlight in my many years working with NCPDP.

So now I'd like to do a recap, turn it back over to Lauren and she'll provide some points as to what we've discussed here this morning before we move on to our next.

[LAUREN] Thanks, Perry. Before we go, let me take a moment to recap this conversation. First of all, let it be known that Lee Ann has been a bold, barrier-breaking leader ever since childhood and she's brought that energy to NCPDP for the past forty years.

Now regarding NCPDP itself, the members collaborate to develop standards for the exchange of healthcare information, which might sound abstract, but if you think about it, it's simple. Information about patients – their disease states, their prescriptions, their labs, so on – that needs to be exchanged every day between providers, pharmacists, insurance payers, etc. And if every healthcare entity translated that information into their own format and sent it via their own code, things would get complicated fast. There'd be a lot of mistranslation. So having NCPDP’s standards reduces errors and increases efficiency throughout the industry.

Part of what makes these standards effective is the fact that NCPDP’s members include stakeholders from every segment of the pharmacy industry. That helps ensure that the standards work for everyone and that they'll actually be adopted throughout the industry.

And finally, NCPDP makes a concerted effort to educate legislators on the standards. As we learned an episode two with Sloane Salzburg, it's important for legislators to understand the scope of the healthcare industry in order to make effective laws about it.

Now let's give a big thank you to Perry and Lee Ann for spending time with us today, and thank you to all of you for catching “Health on the Move,” part one. We hope you'll join us here at the Front Porch for part two, which will drop one week from today.

Now if you’re a member of the healthcare industry and would like to learn more about ScriptDrop’s healthcare access solutions, please reach out to us at info@scriptdrop.co.

And finally, if you liked what you heard today and would like to join us on the Front Porch again, please subscribe on Apple Podcasts, Spotify, Stitcher, Tune In or wherever you get your podcasts, so you'll be sure to catch our next episode.

The Front Porch: Where Pharmacy and Healthcare Access Meet is a healthcare podcast created by the ScriptDrop team. This episode was produced in partnership with Perry Lewis, Lee Ann Stember, Janet Cabibbo and Maggie Bruce. Our theme music is “River Meditation” by Jason Shaw, licensed through Creative Commons.

Part 2

[LAUREN] Welcome to The Front Porch: Where Pharmacy and Healthcare Access Meet. Pull up a chair and get ready – today we're continuing the conversation with Lee Ann Stember in “Health on the Move,” part two. If you missed part one, please go back to the previous episode and get caught up.

Today, Perry Lewis and Lee Ann Stember continue their conversation about the National Council for Prescription Drug Programs, or NCPDP. They'll explore the Real-Time Benefit check standard and consider NCPDP's role in expanding interoperability.

As always, for those who don't know us, ScriptDrop is the only healthcare IT company specializing in prescription access that serves patients in all fifty states. Since 2016, ScriptDrop has been improving drug adherence by delivering medication excess opportunities through a robust platform, long term data storage, multiple service levels, and first class customer service.

I'm Lauren Carpenter, the Writer/Researcher here at ScriptDrop. I'm sure you remember Perry and Lee Ann from the previous episode, but just in case, let's do a quick intro. Perry is ScriptDrop’s industry relations consultant. Perry worked in the pharmacy industry for over thirty-five years and has spent over a decade working with NCPDP. He's been our interviewer through all of our previous podcast episodes. Lee Ann Stember is the President and CEO of NCPDP. We’re really honored that she chose to join ScriptDrop’s advisory council and that she made the time to talk with us.

Without further ado, let’s dive back in.

[PERRY] Well, thank you, Lauren, and welcome back to the “Health on the Move: How NCPDP Standards Support Interoperability.” We've been talking previously in podcast number one with Lee Ann Stember, President and CEO of NCPDP, and we really appreciate the time and the effort and attention, Lee Ann, that you've given to these podcasts. I've greatly appreciated it and enjoyed all of our conversations.

So I'd like to dive right back into where we left off previously with our podcast on NCPDP standards. As mentioned last time, NCPDP has many standards, such as the Telecommunication Standard, which completes electronic transactions from the pharmacy to the prescription benefit manager (PBM) and SCRIPT, that initiates the electronic prescription from the physician's office to the pharmacy. These and all other NCPDP standards benefit the patient in that they enable real-time, efficient, and accurate exchange of data that ultimately helps patients access the medications they need in a timely way and adhere to the medication regimen.

So, Lee Ann, can you provide information on the recently published Real-Time Prescription Benefit standard and what that means for providers and patients?

[LEE ANN] Sure Perry, the Real-Time Prescription Benefit standard is a game changer with big benefits to both the providers and the patients. The standard gives physicians fast, real-time electronic access to medication cost estimates based on the individual patient’s benefit plan before a medication is prescribed. Physicians then have the opportunity to prescribe the lowest cost medication that is clinically appropriate for the patient, and patients know what they will pay for their medications before they even get to the pharmacy. The standard brings an unprecedented level of transparency and actionable information to healthcare providers at the point of prescribing. This is a critical juncture that can make all the difference in a patient's adherence to a treatment regimen and therefore their health outcomes.

Numerous studies have shown that the cost of prescriptions is a key cause of people failing to continue or begin their prescription drug therapies. Failures to start on a prescription often occurs when a patient doesn't know what it will cost and faces sticker shock at the pharmacy counter. Widespread adoption of the Real-Time Prescription Benefit standard can reduce abandonment of prescriptions at the pharmacy.

[PERRY] So true, Lee Ann, and I know firsthand that my healthcare provider has not embraced his standard yet, but with new rules and regulations, hopefully this will take off. It will most certainly assist consumers in determining what they could afford while in the physician's office.

Lee Ann, in order for Real-Time Prescription Benefits to be utilized and implemented, are there other opportunities or avenues to engage and incorporate other methods for success?

[LEE ANN] Excellent question, Perry. Collaboration and speed to standards are two of our strategic initiatives for NCPDP. To that end, we have been, we have been and will continue to collaborate with the Carin Alliance and HL7 on a consumer-facing real-time prescription benefit standard. The Carin Alliance developed the consumer-facing standard and FHIR. NCPDP’s standard is used by the prescriber and pharmacist. The FHIR-based consumer-facing standard is loosely based on NCPDP’s Real-Time Prescription Benefits Standard, beta version. The HL7 pharmacy work group and NCPDP members are now involved in a project to update the FHIR standard on the latest version of NCPDP standard. NCPDP also has a consumer-facing task – subtask – group that will monitor the work of HL7.

NCPDP supports transparency in healthcare, which includes providing decision-making information to the patients. Our goal is to support patient/physician conversations that lead to selecting the right medication to support adherence.

Overall, NCPDP has a strategic goal to increase collaboration and alignment of interest with other Standards Development Organizations. This is just one example of that goal in action.

[PERRY] Great, Lee Ann. But before we move off of Real-Time Prescription Benefit, let me ask you a two-part question. I know the creation of the NCPDP foundation was a major passion of yours for many years, and now the foundation is well established and seeing results of its grants. Can you provide background on the foundation, its mission, and the results of the Johns Hopkins Medicine Grant?

[LEE ANN] You are absolutely correct, Perry. I had a vision for many, many years for NCPDP to foster a foundation, and this was achieved in 2012. The NCPDP Foundation, which is a 501(c)(3) nonprofit, funds research that can help transform the way healthcare providers communicate with one another and with patients, leading to better healthcare. As a partner to NCPDP, the NCPDP Foundation’s funding focus is on validating the benefits of NCPDP standards and solutions that improve medication safety, timely access to needed medications, and adherence to medication therapies, leading to better and safer healthcare.

The NCPDP Foundation funded a research study by Johns Hopkins Medicine to assess the value of NCPDP’s Real-Time Prescription Benefit standard. First, the study confirmed that the standard delivers accurate out of pocket medication cost estimates based on the individual patient’s benefit plan. That means physicians can trust the information, which empowers them to prescribe the lowest cost medication that is clinically appropriate for the patient.

The second phase of the research proved that patients can save on their medication cost and sometimes acquire medications in a more timely fashion when physicians and pharmacy industry technology partners implement NCPDP’s Real-Time Prescription Benefit standard. When physicians choose an alternative medication for their patients based on the point of care estimate, it resulted in cost savings for patients at the pharmacy. Results of the study, which have been published, showed an average out of pocket medication cost savings for the patient at the time of dispensing was twenty-one dollars and forty cents, with the highest cost savings at dispensing being more than a thousand dollars.

[PERRY] Lee Ann that’s great Information, and we both know NCPDP standards have been evolving for over forty years – and one of the first to address data exchange between vendors. In today's world, consumers are demanding quick access to exchange of patient information and other services like rides in-home health care, simple lab work, and prescription delivery services. Can NCPDP standards, along with collaboration with other solutions, be a catalyst to achieving interoperability?

[LEE ANN] Perry, I could simply answer with a yes, but there is no – there is so much required for interoperability that makes it easier for patients to access their medications, which supports adherence, for example. One of the reasons why I was interested in serving as a member of the ScriptDrop council is ScriptDrop’s mission to improve medication adherence via delivery services. However, I would have to say the majority of physician providers do not realize that via their EHR and the NCPDP SCRIPT standard, there is a flag that could be triggered to alert the pharmacy that the patient/consumer would like to utilize an at-home delivery service.

[PERRY] Well, Lee Ann, obviously ScriptDrop is interested in participating in NCPDP and exploring how our solutions interact with NCPDP standards, but many healthcare startups don't even know that standards exist. Why does it benefit healthcare information technology companies to understand the standards and take an interest in NCPDP?

[LEE ANN] Yes, I have mentioned recently that oftentimes healthcare startups do not know about NCPDP, about our standards, and how we collaborate with other healthcare vendors and standards development organizations. However, our members who are active in the work of NCPDP do interact with the new startups and are amazing advocates for us. A detriment for us in outreach has been COVID-19. The majority of industry events have been virtual, thus taking away from the personal interaction of conferences and smaller venues.

We have a strategic priority to collaborate with technology innovators like ScriptDrop to provide standards that allow innovations to successfully support the healthcare ecosystem and improve patient care. To that end, we launched a pharmacy technology innovation accelerator this past year to bring innovators together to explore how technology and standards can improve healthcare. As a part of the initiative, we are able to educate technology innovators on the value and the availability of existing standards.

[PERRY] Lee Ann, I've been involved with the tech – technology innovation accelerator this past year and I think it's a great service and opportunity for vendors to get engaged.

We've covered an awful lot in the – in the last two podcast sessions. Always enjoy spending time just talking about where we've been in the past with NCPDP, what does the future look like as we move forward.

I do understand that NCPDP has an – their annual conference coming up pretty soon, May 2 - 4 in Scottsdale, Arizona, at the Kierland Resort, a fantastic venue. The topic this year is “Be Bold, Break Barriers,” which I think we've covered some of that during, ah, podcast 1 and 2. So we – I look forward to seeing you there, along with several other individuals that are watching these podcasts in the – in the next few weeks. So thank you so much for your time and attention and I'll turn it back over to Lauren.

[LAUREN] Thank you, Perry.

Before we go, I'll recap the conversation.

So first of all, one of NCPDP’s most unique standards is the Real-Time Benefit standard. Usually, when a patient is prescribed a medication, the doctor writes the prescription and sends it to the pharmacy, but no one – not the doctor, not the pharmacist, not the patient – knows how much that medication will cost until the patient is standing at the pharmacy counter. With the Real-Time Benefit standard, doctors could look up a patient's insurance benefits and figure out the cost right there on the spot in the office. This would help prescribers offer the most affordable medication and reduce the sticker shock that can keep patients from ever starting the medication that they need.

That said, despite highly positive results from the Johns Hopkins study, Real-Time Benefit standard hasn't been widely adopted. NCPDP is currently working with the Carin Alliance and another standards organization, HL7, to create a consumer-facing version of the standard.

The standard and many others have the power to make healthcare far more interoperable. But, as Lee Ann pointed out, there are a lot of elements to interoperability. NCPDP is a part of that, but stakeholders throughout the healthcare industry need to participate in order for information to flow easily between different points.

Finally, it's well worth it for healthcare companies of any size to educate themselves about NCPDP. ScriptDrop is pleased to count ourselves among its members. We’re especially honored to be presenting at the annual conference this spring.

Now I'd like to say thank you to all of you for catching “Health on the Move,” parts 1 and 2. We hope you'll join us here at The Front Porch for our future episodes. If you're a member of the healthcare industry and would like to learn more about ScriptDrop’s healthcare access solutions, please reach out to us at info@scriptdrop.co.

Finally, if you liked what you heard today, please subscribe on Apple Podcasts, Spotify, Stitcher, Tune In, or wherever you get your podcasts, so you'll be sure to catch our next episode.

The Front Porch: Where Pharmacy and Healthcare Access Meet is a healthcare podcast created by the ScriptDrop team. This episode was produced in partnership with Perry Lewis, Lee Ann Stember, Janet Cabibbo, and Maggie Bruce. Our theme music is “River Meditation” by Jason Shaw, licensed through Creative Commons.