Three Minutes with Kelly Pokuta

Dr. Kelly Pokuta is vice president, trade relations & strategy and chief trade relations officer for Prime. Her team is responsible for pharmacy and medical rebates, manufacturer contracting, value-based care initiatives, and trade client strategy services. Before joining Prime, she worked for the largest independent specialty pharmacy in the U.S. and multiple pharmacy benefit managers (PBMs) and led product development and brand strategy at various pharmaceutical manufacturer organizations. Kelly earned her Doctor of Pharmacy at the University of Illinois College of Pharmacy, where she has also served as an assistant professor. She joined Prime in 2019.

How does pharma view Prime?

In the past, we believe pharma viewed Prime as managing custom formularies and rebate programs for individual clients. They didn’t have confidence that formulary alignment could happen. But back in 2020, when we launched our partnership with Ascent and Express Scripts we looked at some high-volume drug categories where we knew our clients could benefit by aligning strategies. One focus area was the autoimmune category. Our clients were able to align to the strategies and now every quarter we are presenting additional therapy categories for consideration.

Prime is a longtime proponent of value-based contracts (VBCs). How can Prime differentiate in our use of VBCs?

VBCs are undergoing a metamorphosis. Historically, VBCs have been focused on adherence and persistency and other specified outcomes such as hospitalizations and ER visits. Prime wants to improve VBCs to focus on relevant outcomes and endpoints that provide financial support to patients and payers. In addition, we want to layer in proactive interventions that set patients up for success rather than waiting for treatment failure.

As an example, in the multiple sclerosis space, we don’t want to wait four years to assess clinical results such as relapses or hospitalizations to receive a VBC payment. What are we doing in years 1, 2 and 3 to get the member in the best situation possible so that they are more successful with their therapy? How do we leverage manufacturers to provide compensation for patient outreach services in the first few years? That’s part of our VBC focus right now.

We’re also carefully looking across the continuum of pharmacy and medical drugs and how therapies interplay. We see this with oncology treatments. A patient might receive some medications covered under the medical benefit, with other drugs under the pharmacy benefit. We’re working to improve how we serve patients and clients across the total drug management continuum to make sure we’re managing all access to products appropriately.

What other improvement areas is your team focused on?

Everything in health care is driven by data. Having accurate, accessible and actionable data is critical to our clients and Prime.

We’re continually working to improve our analytic and data capabilities. We’re enhancing how we aggregate and collate data in a way that’s useable by various groups throughout Prime.

What else is on your to-do list for the rest of the rest of 2022?

As I mentioned, we’re working on our overall approach in the value-based arena. What can we do with our clients to bring new, high-quality, impactful value-based arrangements to the industry? What can we do to benefit our clients and better position them for success in the markets they serve?

We’re also focused on the medical side and how we can engage the providers. For example, instead of the traditional white-bagging services from specialty pharmacies, where they ship the drug to the provider, how do we get medical benefit drugs covered that are dispensed and administered by the provider at the point of service through their in-house pharmacy or clinic? Since we’re agnostic to where the product gets filled, we believe we can make a sizeable impact on the market by engaging the provider more effectively. And we know that will also improve the patient experience at their site of care.

We’re working on these and other innovative programs that continue to position Prime and our clients for success.

Prime recently agreed to acquire Magellan Rx, a respected specialty pharmacy association and PBM. What are the implications for Prime’s work?

The acquisition is expected to close by the end of 2022. Magellan Rx will function as a stand-alone business unit under Prime for the foreseeable future. Working together in the future, Prime and Magellan Rx will develop next-generation pharmacy services for the specialty market, where drug complexity and costs are dramatically increasing. We believe this will benefit our clients and their members, as well as providers and our manufacturer partners.