Dr Tim Mok: A Pharmacist's Perspective on Balancing Costs and Outcomes

Tim Mok, PharmD, BCPS, BCOP, malignant hematology pharmacy research analyst at Kaiser Permanente, was the featured moderator of “Pharmacy Decision-Making in Value-Based Care,” a panel conducted at a recent Institute for Value-Based Medicine event in Seattle, Washington. As the panelists explored the intricacies of multidisciplinary collaboration and pharmacy decision making, Mok joined for an interview to discuss his perspective on how to best strike a balance between clinical outcomes and cost considerations. Here, he highlights the value of real-world evidence, prominent challenges in the field, and more.

This transcript has been lightly edited.

Transcript

In your experience, how do pharmacy decision-makers balance cost considerations alongside clinical outcomes?

There's a lot of factors that we that we consider. First of all is absolutely patient outcomes and patient experience. We want to make sure that we're going to get the best clinical outcomes wherever possible, but also that patients aren't having any detriments to their life. Secondly, we also look at experience and safety. And by experience, it's our provider experience. So, whether our providers have used the medication before or were part of the clinical trial, their confidence really helps everybody else. It helps the nurses, it helps the pharmacists as well, just to make sure that we have all the checklists covered. And again, it enhances that patient experience, too. It helps our patients feel more confident about their therapy. Lastly is safety, right? Managing side effects, especially new medications, can be very costly, and so we're making sure that we're getting everything in place. We're not overspending on things that we need to help manage those side effects, but we're also making sure that the side effects are managed correctly, so that we don't land the patient in unnecessary harm, going to the emergency room, getting admitted, et cetera, et cetera. So, there are many facets that we have to consider, and I think finding that balance is key.

How does real-world evidence factor into pharmacy decision-making, especially when considering newer therapeutics?

Real-world evidence is really important, to me, at least. I think that right now, our registry trials that the FDA approves on is this perfect patient population. They don't necessarily have the comorbidities we see with the real-world patients that we're using it in, and patients often do not mirror the everyday patient that are coming through our clinics or in the hospital. And so, we have to turn to some real-world experience to make sure that the medication we're using it on, or the patient we're using the medication on is going to be doing well. I think many times there's no great standard for real-world evidence. There's different ways that people are doing it. Some of them are retrospective, some of them are prospective, and I think we need to set a better standard moving forward, so that we know that the real-world evidence being published, being shown is one that we feel like is up to par.

What would you say are some of the bigger challenges pharmacies face when transitioning to value-based care? How can these be addressed to optimize patient care and outcomes?

Pharmacists, because we think about finances so much, 1 of the big things we have to do is educate. We have to educate our providers, we have to educate patients, we have to educate everyone on the team. And of course, when we're talking about health care, nobody likes to talk about cost. Cost is coming in as second, but in reality nowadays, we really have to consider it, because the cost of therapies have outgrown their value, unfortunately. Before, we could really treat patients without having to think about insurances as much. It's very streamlined. Now, because a medication that comes out, although they may have an efficacy improvement of 20% the cost is an increase of, like, 3 times, right? So you can see it's not proportional, and that's why I think for our pharmacists and teams transitioning to value based care, there is going to be a fine balance of, how do you get physicians and providers to think about cost and not be turned away from it, and eventually to accept that we need to turn into a value-based framework—and think in that framework—to deliver care.