Working In Oncology
Working In Oncology

Episode · 1 year ago

The Oncology Sales Ecosystem: How It Works & How It’s Changing w/ Richard Stein

ABOUT THIS EPISODE

Oncology office staff might find themselves asking: “Who are all these reps? What’s the deal with these emails, calls, pamphlets, and visits?”

The umbrella of oncology sales can be complex. It includes several roles and touchpoints, from securing sales to guiding physicians and nurses to helping educate patients.

Richard Stein, Former Senior Manager, Inside Sales at Amgen, joins us to provide a deep dive into how the oncology sales ecosystem works, as well as the relationships between sales and practices.

We talked about the specifics of each position, how these positions can overlap with others, and how COVID-19 has impacted the way everyone communicates and works together.

 

Here are the show highlights:

- The difference between inside and outside oncology sales reps (4:00)

- How COVID-19 has affected relationships and sales processes (20:16)

- A rep’s guide to setting expectations with physicians and office staff (28:58)

- How can we empower patients to advocate for themselves? (33:17)

- Tools and resources to help patients pay for their treatment (41:21)

To hear more interviews like this one, subscribe to Working In Oncology on Apple Podcasts, Spotify, or your preferred podcast platform.

You're listening to working in oncology, a podcast and video show that spotlights oncology practice staff and industry influencers who work behind the scenes to shape the future of oncology. The more knowledge the oncology community shares with each other, the more we all ground. Let's get into the show. Welcome to working in oncology. I'm your host for the day, alsia Evans. I'm joined by Richard Stein, former senior manager and of inside sales at am Jen Lil Shay, everybody. Hey Richard, welcome to the show. I've been really looking forward to our conversation today. You have twenty plus years of oncology sales, sales management and sales training experience and I know our listeners are going to find so much value and what you are going to share today. I hope so. So, before we jump into the conversation, can you tell our listeners and viewers a little about a little bit about you, your background and what you do? Sure. So I've been in, as you said, I've been in oncology sales and I've been an oncology manager and national sales trainer and oncology trainer for over two thousand and twenty five years and started out selling Adria Mayson. Believe it or not, I'm aging myself a little bit. So branded Adrea Mayson and specialized in a lot of solid tumors through the years. So breast cancer, colorectal cancer, prostate lung, Glioblastoma, ovarian head neck, really the gambit of solid tumors and and a little bit of liquid tumors as well. It's been a wonderful career and it's been really great being able to help patients find therapies that work for them and so just happy to be here and help out and it. We're glad to have you here. Richard. Can you tell me a little bit more of why you went into oncology? Well, I mean it was kind of very serendipitous. I started off with a very, very small company called Cobby Pharmacia and one thing led to another and cobby pharmacy a purchased Adrea labs, which had the oncology side, and just, you know, stayed in oncology and had, you know, a lot of success with it. So my mother is a breast cancer survivor. She's been thirty plus years out and so for me this is kind of personal. It's a I love being able to help people who've had loved ones who've been affected by cancer and talking to their physicians and providing information in the science to help the physician make a great treatment, therapy that is best for them so that they can, you know, although you can't say it in a clinical discussion, to help them live longer, have a good quality of life, etc. All about back to the patient, advocate for everything that's for the everything has to be about the patient. Awesome. So you have a long record in the sales industry and as an office staff, sometimes you're overwhelmed by the different people who come in the office. Sure, who are they? What are they do? Why are they all sending the emails? Why are they all sending me pamphlets? Could you help us kind of parse out, like, who is who are all these people coming to visit me? Because we all love visitors, we all love oak like the cat to you. But who are they and what are they doing on my phone? Yeah, sure, so. So, basically, who are they and what is there? What is their purpose in the office? Yeah, yeah, so, with that being said, depending upon the sales organization or the the sales company they may be, and now, post covid it's very possible that they're using more of the the the sales arm of an inside sales program and those sometimes are used the inside sales people are used to promote legacy products that may...

...not be promoted by the outside sales representative but still has a used within the office. A great example would be like new LASTA, which is heavily used to prevent any kind of Februle Newtropenia, which can be life threatening, but isn't necessarily something that's talked about by an outside sales representative. So you have representatives like that who are still promoting and trying to maintain market share for older products. Then you have the outside sales representative that actually you are knocking on doors and calling on the physicians and within oncology, the Chemo nurses. If the office or facility like a hospital or a large clinic, they may have their own pharmacy. So they're going to speak to pharmacists as far as a dosing, an administration, okay. They'll speak to the nurses about side effect and therapeutic benefit and they'll speak to, obviously, the doctors about therapy, therapeutic benefit who are the right patients, who are the wrong patients? And then also you may have an outside representative talked to somebody who the office manager regarding reimbursement, you know, making sure that they get their coating the medication correctly so that the office or the physicians getting paid. So Jake codes whatnot. And then there's also again, depending upon the the company and what they're going to do. So we talked about inside say we talked about outside sales. Then there's a key account manager. If the office is part of a large franchise of medical offices, like in the state of Florida you have Florida cancer specialists, that would can be considered a key account because they influence many, many difference satellite offices. So you would make sure that if there were contracts within a particular product there is pulled through with that etc. Then also, if you're talking about a very large pharmaceutical company, they may have nurse educators who would go in and educate nurses about side effect management, drug adherents and compliance, making sure that the nurses are because nurses, whether it's a chemo nurse or an oncology, a OCN an oncology certified nurse or sometimes nurses. The turnover is can be high, so they're constantly educating the nurses about side effects and or about a treatment protocol that or your drug is part of. So there's constant education and and other programs. And then also you might have a reimbursement specialist that would go into the office and make sure and educate the office manager to make sure that they're getting reimbursed from insurance, they're doing j codes correctly, ask answering questions. If something is denied, they may help the office to a certain extent on making sure that there's pull through. If, let's say, something is denied and it's being let's say it's a brand new drug and it has brand new drugs, they have a interim j d ninety nine code and that takes a while for a permanent code to be assigned to that drug. So they may help with that. You know, some time of three thousand and sixty ninety type of thing, or if it's being challenged, okay, and the insurance company. That's a lot. I also hear the medical science fly's on. So that's the term that. Yes, thank you. Yeah, I bet you almost slipt the our conversation. So a medical science liaison would obviously work on the medical side. That's conversations that an outside sales rep can't talk about. So the outside sales representative is is bound by what the the the prescribing information says that has been approved by the FTI. Medical Science Liaison may get into conversations that are medical and also...

...talk about clinical trials that an office may participate in or a large practice may be part of. So a medical science liaison would cover like an entire state or states and they would handle that. So they're part of metic of the medical side and not sales. So that's why they're separate and and and thanks for bringing that up and almost passed my mind. No worry. So if you want to talk, you want to ask someone about kind of the medical details. There any upcoming trials, you want to speak to the medical science lead. The medical person knows things that the outside sales person may know about but can't discuss. But sometimes they don't know to detail what an MSL does know. And so let's say a physician, you have a drug that's for breast cancer, but there's clinical data that has been presented at Asco or or as. Oh, and those are all medical study groups that actually put together, you know, conventions and everything like that for medical information exchange. And the doctor says, Hey, I've heard about your drug. That's that's approved for breast cancer, but I heard that it's it has good clinical benefit in, let's say, lung or another tumor. Time an outside sales representative cannot discuss that. They're they're really they're. The only responses is that. You know, Doctor, I I've also heard of that, but clinically I can't discuss that clinical outcome with you. Let me transfer you to our medical department and that's where an MSL may come in or somebody from the medical side will then approach or contact the physician, either by email or by phone call, and give them that information. So, Richard, it sounds like if I want to have a deep scied's research conversation, the person I want to speak to is the medical science leas. Yes, that's right, exactly like I said, the salesperson can only discuss with a physician the prescribing information that was approved by the FDA for that drug and the disease state that it was that the FDA approved in it anything outside or what's called off label, has to go through medical okay, and there's a reason for that. I mean you don't want someone in sales to talk about something that isn't approved. That would be illegal and I would be very bad. And you know, the a medical side is going to have all the INS and outs regarding the clinical trial, the patient types. Now it's very possible that the once that sometime in the future that drug may get approve for that other disease state, but until that happens, that's all medical information. Got It. Okay. So they are the sales reps are kind of bound within what's previously that have legal that is a legal conversation that you cannot deviate from. Okay, if your drug was approved for, let's say, breast cancer, you can only speak about breast cancer and how it was used in the clinical trial. Okay. That's good information for everyone to have. And so if I have a question about reimbursement or a question about billing or cocoding, right, and the reimbursement specialist is the person that I need to exactly. Well, I mean the representative may have some information, okay, and the information that the outside sales representative has maybe just be enough. You know, what is the new Ja Code? It's this okay, boom done. But if it's something you know, sometimes the outside sales representative will work in conjunction with the reimbursement specialists and if the reimbursement specialist, you know, it's an added layer of value for the office. You know, obviously the outside sales representative is going to be in that office more so than may be the reimbursement specialist, because that reimbursement specialist...

...by you know, for the most parts, probably going to have a larger territory or cover a larger area. Okay. So again sometimes, you know, the reimbursement specialist usually comes in when you know someone's thrown a wrench into the wheels of of getting things done and it's maybe a little bit more difficult or more advanced than maybe outside sales representative has a knowledge of. They call in the reimburses specialist for backup, help me and table little bent. The reinsverse reimbursement specialist has detailed in a depth of knowledge and regards to the negotiating and navigating through the insurance reimbursement process. Got It okay, and then the nursing education specialist. This is if I have a question about the actual treatment protocol. So it would be treatment protocols. It would be some and some offices that the oncology certified nurse will mix and administer the drug. So it's making sure that they understand how to how to mix if the drug needs to be reconstituted or prepared in any way prior to delivery to the patient. So there's that. There's also side effect management. What to look out for, making sure that the nurse is educated enough to discuss side effect management with the patient. So you know, there's you know, there was a drug that I once sold a long time ago and one of its major side effects was really bad diarrhea. So and so for the patient it was a drug for colorectal cancer, which, you know, kind of makes sense that if you have a tumor in the colon those cells that are obliterated by the chemotherapy have to go somewhere, and so diarrhea is is a you know, a common kind of you know, kind of like an Ahah. Yeah, it's going to go somewhere and be eliminated by the body. But there were two types of diarrhea, there was a colonergic which was an effect that happened during administration of the medication, and then there was a secret Tory which happened after the the administration of the drug and after the patient went home. So there was how to manage that. And you know, trust me, when you when you mentioned the word diary, everybody's ears perk up and anobody wants diarrhea. So it was educating nurses over and over and over again, because you could say something five, six, ten times and until somebody got it correct, they would forget something or leave something out. So it was a constant education. And then you also have to put into into consideration the patient, you know, whereas you may have spoken to the nurse Twenty five times making that number up, but the patient's hearing it for the first time and you know the patient. You have to, you know, take in consideration the patient. Maybe this is their first time. I'm getting chemotherapy. Chances are probably is. They're scared. It's an unknown. It's regardless of what the side effect profile of a drug. Maybe they're scared, they're anxious, they maybe have a family member with them and then also, depending upon the patient. May they may not be all there. They may have all their witch dittracted, yeah, distracted about everything, stress, stress, exactly. So. And you know, they may be very they may be older and May, you know, you know, may just not. You know, the lights are on but no one's home. But but they need to have they need to have the therapy. So it's a constant education. It's making sure that patients are comfortable and it's setting expectations. If you if a patient took aspirin and didn't know the side effect of Aspirin and then something happened, they'd be very alarmed. Oh yes, so it's it's kind of trying to put a patient at ease and saying, Hey, listen, you're going to be taking...

...a medication, this is what we're doing, this is why we're doing it and this is what could happen and if it does happen, this is how you deal with it and you manage it and putting that patients fears at ease as much as you can. But it's setting expectations as opposed to not telling the patient anything and having them go through this, you know, this journey, and that's where you have these really bad these really bad stories of people saying, Oh, you know, you so and so to chemo therapy and they got really sick. And you know that ever happened to me? I don't. I would never do it. So it's it's really conditioning that patient to to be to be a self advocate and say, listen, you know, you know, you've got to, you got to take charge of your own not only of your own health, but also how to deal with the side effects that you're going to have so you have a good experience and as much as one could have by getting chemotherapy. And also, you know, not only drug compliance but drug adherents. So you don't want someone to get chemo therapy once and say I'll never do it again. You want to make sure that they because the longer they stay on therapy and and and complete it, they're better chances of them of having a good outcome or a better outcome. Okay, so if we want to talk about keeping patients on therapy, the nurse education specialists who we want to speak to it. They can provide a ticket and the key to that, along with the outside sales represent okay, gray, may partner together and maybe do a lunch just for the nurses and and just, you know, make sure that they are that there are and the key, the oncology nurse educator will probably have slide decks and more information than an outside sales representative would have to make sure that those nurses are are in the loop and in the know. Kind it so, way long ago, before coronavirus times, we used to have these meetings in person and we used to each of Popley together and learn about the newest drugs. Now we can't do that as much. So can you tell me how has a coronavirus affected the relationship that you see between, know, all these different people inside, outside sales, the key account contact with the nurse educator? Have you see that relationship change now that we can't do so much in person interact or yeah, I know coronavirus is put a you know, put a halt to a lot of different sales and a lot of different industries and a lot of different businesses and everything we got, you know, and and and pharmaceutical sales as well, has been affected by it. So, like you said, you know, prior to covid you know, outside reps were welcomed and you knock on the door and and you know, you you schedule something or lunch, you get to see the doctor and you'd speak to hit, to he or she and the nurses etc. Now with, you know, things like zoom and Webbax and and other, depending upon what company you work for and what deal they've worked out with whatever video meeting supplier, zoom has been, you know, and in programs like it, have been definitely a way of maybe the future the you know, you've had a number of doctors and doctors will the doctors will literally dictate in the future how detailing and talking to them will be. I think you're going to have some doctors who love the interaction, the facetoface, and now that people are being vaccinated and and everything like that, I think you will have some doctors who will start to open up their offices again and and then that's going to be wonderful, you know, because that's clearly the best way to do it, face to face interaction, having and building that that relationship with a physician and knowing exactly how they...

...treat their physic their patients, based on their tumor types that they have and how they present, because everybody presents differently. And some patients are are great candidates for a medication that one might be selling in some patients are not, and that's why there's so many different kinds of medicines out there. With that being said, you have physicians who have gotten used to not having reps in the office and they probably enjoy it and like it. They probably get to see more patients and and whatnot. That's SAIR enough. Yeah, I mean, and you know and that's and that's all good. If that's what's works for that doctor, fantastic, but there is there're still in need for drug reps. they're still a need for that interaction and I don't know what that is going to look like in the future. I think it's way too early to tell, but I think inside sales programs will grow and outside sales representatives are going to have to be very, very nimble on being able to utilize the technology that's out there and whether it's a phone conversation, an email, a zoom presentation and out. An outside sales representative is going to have to adapt to that technology and adapt to those that those different ways of, for lack of a better way of saying it, of selling and educating their physicians on their medication. So I think there's going to be a shift. I just don't know to what degree. And the other thing is is that if you're a sales representative who's a little bit older and set in their ways, I think they're going to struggle with it. You know, I know people who are not much younger or older than I am and hate computers. I'm afraid, I don't know what to do. I don't know how to open up a PDF and III and I think those people, if they are in industry, they're going to have a real tough time adapting. The one thing that we know in the universe that is constant is change. This is going to be another piece that is going to change in people are going to have to change with it. So, like me, you may want to clean up the back background of your house and not see my refrigerator if I'm talking to a physician on zoom. But but yeah, I think the video conferencing like like a zoom and then having your clinical presentation and then go and because that clearly people learn by that. Are visue visual as well as verbal. So if you can provide a visual content to your presentation, it's always going to be a benefit to you. Got It. Okay. So you think that a lot of the changes that were necessitated by Covid are going to stay? I think to a certain degree. Yes, again, I think it's early. I don't know to what degree, but yes, I think you will find that physicians will do more learning online. Physicians had had that with Cmese and an other other type of medical education and the past few years. But I think the role of an outside sales representative will definitely be embracing online learning as well as the pharmaceutical industry will be presenting more content to physicians online. So existing sales reps are going to need to maybe listen to their physicians and where where they're more comfortable. Yeah, I mean honestly, what I would always do when I would when I would go and meet with a physician the first time, would be, you know, Doctor, tell me how you like to have a pharmacutical representative detail you, and then that's how I would go and do it. You know, a rep should never go in with their own agenda. It's always the doctor, it's always the staff and you need to adjust your your sales presentation to them and how they meet, how they want to learn and how they accept information. As opposed to just...

...going in with your own agenda, you'll you'll never be successful long term. So, you know, Dr Tell me how you like to have a sales representative discuss medication and the science or clinical trials with you. Tell me, and that's how I'm going to present to you going forward. And if the physician wants more of a you know, hey, listen, I like after I've seen all my patients, at thirty six o'clock. Will, you know, send me a link and I'll give you fifteen minutes. Perfect fine. Some physicians will say, you know what, you know, I like the the daybreak and at lunch. You know, give me a sandwich and I'll talk to you and we'll do it that way. Some physicians you send me an email and you know, as a representative, as you're building a relationship with that physician, you'll start to say, hey, listen, you know what I'm going to be by next week. I'd love to stop by on Tuesday. Is At a good time for me just to take five minutes? Yeah, sure, and you'll be able to blend in face to face. And maybe, but I think that the the video presentation will be part of something. To what degree I don't know. As far as you know what percentage of detailing will be, but you know video presentations, you know, you got to go with the flow. As technology gets more advanced, people will adapt to it. Got It, and as a sales sales staff, I think have a right to expect that that. Yes, nothing about that existed within your day of seeing patients. Yeah, and again it's setting expectation with the physician. Hey, look, you know, if this is how you like to be, how you like to discuss clinical information, that's how I'm going to discussed clinical information with you. You know, if somebody is more vert, you know some doctors don't like the slick. Will you call Madison Avenue sales presentation booklets to have all the league meet charts and everything like that and the bullet points? Some doctors just want you to take out a clinical trial and talk to him about it. Hey, Dr you know, let's let's go. Let me talk to you about the methods of the trial. Who are the demographics in the trial? Who Were there? What the what the clinical outcome was? This was the side effect profile, and it's all right there in science. It's facts. Some doctors don't like the Madison am because they don't they feel you're only cherry picking out certain information. So if you give them an if you discuss the trial with them from the clinical treeprint, some doctors love that. that. It's all about what works best for absolutely it always comes down to what is best for the patient and discussing what patient group. You know, Doctor, you see breast cancer patients. Let's talk about those type of patients that work that I want to talk to you about that were in this clinical trials. They were, let's say er positive PR negative. They had a lymph nodes that were three three centimeters larger or or more, and patient times were between thirty seven and forty five. I'm making up all of these demographic things, but you know, doctor, you do you have patients who present with breast cancer like that, and they may say yes or they may say no. If they say yes, you'd say, you know, okay, that's great. Are you using my product in that patient population? If they say no, how come? Why? And then get into that conversation, that clinical conversation. Dr Let me show you this clinical reprint. You may be aware of it, and let's talk about what the clinical benefit was for those patients. You know, and then you get into you get into a conversation and then, you know, doctor, after our conversation, will you now use my product in those patients? If they say no, then you got to go back and kind of understand why. If they say yes, that you know, you get a commitment. You know, okay, I might. I want to come back in a couple weeks. You have a patient in mind? Yes, okay, I want to come back a couple weeks and talk about how that patients do them. You know. If no, well, you know, I'm going...

...to come back and I'm going to talk to your nurses and and I want to make sure that you know if, if they do have a patient, doctor, is it okay if I talk to your nurses to make sure that when you put them on my product they're educated to know how to use use it and discuss side effect management with the patient? Yeah, OPE, sure, go ahead, talk to my nurse. Is Great, okay, and then maybe on the way out I'll trying to talk to the office manager about reimbursement. Okay, Oh, I see, and that's that's what that's what's known in the industry is a total office call. You talk to the doctor, you gain commitment from the physician, then you educate the nurses and then you talk to the office manager and anybody else. Sometimes there are social workers and it may be hospitals that may talk to patients about the anxiety of product or about the benefit of therapy and whatnot, and you talk to anybody and everybody that touches that patient so that the ever the patient has along the way all the tools that they need to get the best tools, all the support from the clinical side. I mean they you know, obviously it's it's always best for a patient to have support at home and you know and have people around them that you know are going to make sure that they're doing what they need to do to take care of themselves while they're on therapy and everything like that. So there needs to be a support system and again it comes down to setting expectations. Absolutely. So you want to make sure that the patients certain therapy and stay on therapy and have all the support that they need to be successful in that way. Yes, so we already talked about kind of setting expectations for side effects. Can you tell us a little bit more. are some kind of roadblocks that you see sometimes in your work for patients starting and staying on therapy. Sure, can you know? How can we empower our patients? So, yeah, you're used to advocate for themselves. So it's one. It's really important for the outside sales representative and sometimes the inside, the inside remote representative, to educate the nurse or whoever is going to administer the medication to the patient. And a lot of the newer therapies that are coming out are pills, chemotherapy in the form of an oral medication. So that is where also the specialty representative comes into play, if the medication is a pill or an oral oral therapy, and if it's infusion drug, where a patient is going to go to a clinic and then sit down to it in a in a chair and get infused. So it's extremely important that those representatives educate the nurses consistently over time about the side effects. Okay, so this is a different group of people. So the infusion and also specialty PSI and it's so the specialty will all address them separately. So the infusion nurse is going to give a patient and you got to remember it's not just one drug. Usually it's a combination of drugs. So and each drug in that combination is going to have a potential side effect. So it's making sure and you know, and there are different drugs. So you may have one patient in share a that is getting a certain protocol and and share B is for a different tumor type or different a tumor and a chair see again a different tumor and different problems and different different drugs. So that nurse has to know a lot of information and is juggling a lot of side effect management information that they have to they have to verbally tell the patient and those patients may have a language barrier. They you know, you may have patients like you know down in south Florida, maybe primarily Spanish, so that nurse has to be bilingual to be able to talk and educate those patients and there may be cultural barriers. There may be a lot of different things. Bottom line is...

...that information has to be given and the patient has to understand what it means for them getting that protocol or combination of drugs and what therapies or side effects they're going to potentially experience. We've all heard stories of so and so new somebody or head a family member that had breast cancer and they lost all their hair. Well, if you didn't know that you were going to lose all your hair and you woke up one day and most of your hair was still on the pillow, it'd be very shocking and scary and you have a lot of anxiety and and it's a physical manifestation of your disease and you'd be scared and you probably wouldn't want to do it again. Absolutely. So it's you know, that's you know. That's why it's so important for the nurse, prior are to therapy, to say this is what could happen. Chances of you losing your hair is very high. Expect to lose it. If you don't, you're lucky, but expect to lose all your hair. Expect to be nauseous and if you're nauseous we have medicine to make sure that you're okay. And so we're going to write your prescription so you can, before you go home, get it filled. Will call it in for you, so it'll be at the CVS or the walgreens on your way home. Let's go. So what you're encouraging is a frank, culturally relevant explanation of what the side effects are. Absolutely every time, to your every pattern and sometimes the patient all got. Look, I know, I know, and I am but sometimes the there's a caregiver there that never heard it before, so I guess it over with the caregiver. Hey, looks, I've already talked to your father, your mother, your brother, your sister, your husband, your wife about this, but I want to tell you this is what you should look out for. So I see some patients have grown up. You know, you don't bother the doctor unless you know you're going to die. HMM, you know. And and some like I was mentioning before, there's there's a very high chance, when you get chemotherapy with a portion of products that are out there, to get Newtropenia, which is a dropping or having your your white blood cells dropped were very, very low, and your white blood cells are there to fight off, you know, bacterial infections and keep you healthy. So if you get Neutropenia, you're going to get you're going to get a fever, and that's called Febrile Neutropenia. And if you have a fever post therapy, that's a bad thing and it's life threatening. And if you have a fever, you know, and the chills, Oh, I maybe I have I am have the flu, or maybe I'm getting sick or I have a cold, it's it isn't anything related to chemo therapy. So I'm not going to call the doctor. That's a mistake and they need to know that because, you know, God forbid, you get Febrile Neutropenia, which is life threatening, and then and then the patient starts to crash and then all of a sudden they're going to the hospital. That make you know it could be too late or that might delay another round of chemotherapy, which could be problematic. So so, yeah, so it's it's always you always have to make sure that the patient understands. Sometimes you may want to have the patient repeat it back to you. Okay, what did I just say? You know, I just want to make sure that you understand the severity regarding you know, if you lose your hair, it's not the end of the world. It's going to grow back. If you know, if you are nauseous or nauseated, we have medication that can help you not feel that way. You don't have to be suffering. There are things there. You know, if you have diarrhea, there there's a protocol regarding some over the counter anti diarrheal medication that can help you so that you don't get because, you know, if you have really bad diarrhea, and this isn't kind...

...of diarrhea that you went to a restaurant and the Cook, you know, didn't wash his hands, this is really bad diary. It's a lot worse than that. It's delicating. You can get you know, if someone's older and they don't have the best eating habits and they don't drink maybe gatorator this or that, they're going to get dehydrated really fast. And if you get dehydrated there's a whole, a whole list of things that can happen that can, you know, be detrimental to that patient's health. So it's just constant communication, it's constant expectation setting and it's a constant education process actually. So we talked about side effects. Another barrier to patients accessing information or accessing drugs rather, is money. It's a major concern, right. How am I going to pay for these drugs? Sure so. So what tools and resources are available to patients. And that's a, you know, great question and I you know, I hear this by, you know, some people in my own family. Well, you know, I so and so wanted to get this but it was so expensive and so they can get it or, you know, they're spending a so much amount of money. Well, if you have private insurance, I would say pretty much any in every pharmaceutical company has a private insurance program for the patient to get with which would pay the gap or the the coke co co payment part of that. So a lot of companies will issue the patient a credit card which will cover that out of pocket. Okay. And then if you are if you don't have private insurance and let's say you're on Medicare or Medicaid, then there is there are foundations for your disease, you know, through the American cancers society, there's a pancreatic society. There's so many different foundations that you can apply to and there there when you apply, the criteria is very liberal. I knew one of that if even if you made two hundred fifty thousand dollars or more, you still were eligible to get money from the foundation to pay that copayment. So when I was a sales manager, there was a, I believe, a physician who had cancer and the physician got money. So it's a very liberal it's a very liberal the programs are usually very, very liberal. I've never heard anybody be denied, but I'm sure it happens. I mean, I'm not the end all be all of information on these things, but there are a ton of information and a ton of things and all the patient really has to do is ask their nurse or their doctor. It isn't something that that is usually something that they, you know, freely discussed or will bring up because, you know, if you have private insurance, you have private insurance and everybody just thinks that okay, it's going to get covered. Well, sometimes it doesn't or sometimes it's going to be, you know, depending upon the insurance that the patient has. Some insurance doesn't cover what's what? What are what's called catastrophic injuries? Some insurance doesn't cover but cancer, and it all depends on what their employer has chosen for their employees. Okay, so, as office staff, would you encourage us to be impact, sorry proactive if weard sorry for to be proactive and say hey, if you have problems paying for this medication, there are resources available to you. Yes, and I think as an office, as the office manager, should be asking those probing questions regarding insurance and they will know what their insurance will or will not cover based on the insurance information that they've given them when they've signed in. So if and when they need to have any kind of chemotherapy, that that conversation should be a detail conversation and asked a lot of probing questions and sometimes...

...it's a very easy fix. You know, you know hair fill out this form and the like I said, if you're if you have private insurance, sometimes the the the drug company will will issue you a credit card that is only good for that that office at or are that that medical medical therapy be and it's a visa card and it's but it's by the company. And then the company is basically funding it through a foundation that they set up. And so the company's, you know, gives the money constantly, but the company's out of it because the foundation manages it. God it okay. So, so, yeah, so the company can't say, well, we as a company, we denied you. It's not us, it's the foundation and they're they're the ones that either are are accepting it or denying it, but the company is constantly funding it because the companies are aware. If you know, outside of oncology, there's a there's a there's a medication therapy for Hepatitis C. that's a cure. Well, it's a very, very expensive cure and you know a lot of times you'll hear now on commercials if you can't afford this medication, the company has programs to help you do that so that the patients are getting educated. So yeah, so that would be the that would be the office manager. It could be also the nurse that would say, listen, you want to talk to the office manager about this, and it might be about a foundation, it might be about a reimbursement program that the company's offering. So there are programs out there for patients, absolutely, and patient should not be should not be shy about asking. Okay, so I for on both sides. So patient should be proactive and office staff should be bringing up these conversations with patients. And it sounds like the process for applying is it's pretty straightforward. Yeah, the requirements are pretty liberal and actually use the benefit. Sounds like it's pretty easy, I mean but, like I said, you know every year, I'm sure we all have gone like for a physical or everything in the beginning of the year and one of the first things out of their mouth when you check in as has your insurance changed, and yes or no, and if it has, you know, let's you know. Do you have your insurance card? Yeah, here, here you go. And the other thing is is that if you're if you are put if you are a patient and you are participating in a financial reimbursement program, at the at the end of every year, the beginning of every every New Year, you're going to need, if you're still getting therapy, you're going to need to update your information and real and basically reapply and and go from there. And once you we the process is extremely simple. It's not hard. If you have your own computer, an office might say when you get home, just you know, here's the webling fill it out and you're done. Or sometimes they'll say, listen, you know, let's do it right now, while I'll do it for you and the Oomen. It's finished. Awesome, so easy. Richard, you have given us so much great information. This has been a great conversation I think all so much for joining us, Alicia. Thank you so much for asking me, and it was I'm very grateful to have been asked and thanks again for the opportunity. You are so welcome for. So, for any of our listeners who want to reach out to you with any follow up questions, what's the best way for them to do that? The best way to reach out to me is I'm on Linkedin, Richard Stein, and you know that would be the best place to reach me. Is On linkedin. You see my face, I got it, I got this picture and and would be more than happy to help out anybody as much as I can within my ability. Awesome. So I will leave a link, or at a link to your linkedin in the show notes. Perfect, Richard. Again, thank you so much for sharing your insights with us today. We really appreciate you being a guest on the show. Thank you so much, Alicia, and I look forward to if you ever...

...need anything or any other help, you want to ask me to join again, I'm more than happy to do so. Are You satisfied with your patients currentsy to therapy, or are you just settling? You can improve patient outcomes with bioplus specialty pharmacies. Power of to the first ever two hour, two day to gather. Promise it's faster and easier for you and your patients to learn more. Visit bioplus R xcom you've been listening to working in oncology. To ensure that you never miss an episode, subscribe to the show in your favorite podcast player. If you're listening in Apple Podcast, we'd love for you to leave a quick rating of the show. Just have the number of stars you get the podcast deserves. Thank you so much for listening. Until next time,.

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