Easing Prior Auth Pain Points for Specialty Pharmacies with Develop Health | NASP Specialty Pharmacy Podcast

Sheila Arquette (0:05)

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SPEAKER_3 (0:25)

You're listening to the NASP Specialty Pharmacy Podcast, a collaboration between the National Association of Specialty Pharmacy and The Pharmacy Podcast Network. Each episode dives deep into trends, challenges, innovations, and patient-centric practices shaping the future of this dynamic and rapidly evolving industry. Whether you're a pharmacist or health care provider, patient advocate or industry leader, you'll hear expert insights, real world evidence, and thought provoking discussion that highlights all that makes specialty pharmacy special.

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In support of NASP's mission to empower specialty pharmacy stakeholders to advance the standard of patient care, NASP supports a free market health care system in which all specialty pharmacies compete on the same fair and level playing field, because that is in the best interest of the patients we collectively serve. NASP is committed to working with all stakeholders and policy makers to ensure that all patients have access to the life-saving medications they need and the high-touch patient care and support services they deserve from the pharmacy of their choosing.

Sheila Arquette (1:30)

Hello, my name is Sheila Arquette and I am the President and CEO of the National Association of Specialty Pharmacy. I am delighted to welcome my special guest, Nico Kernick, to this episode of the NASP Podcast. Nico leads growth and operations at Develop Health. A theoretical physicist by training, he moved from the UK to the US for his MBA at Harvard Business School, where he graduated as a Baker Scholar. He has spent the last few years in health care, building AI workflows that span pharmacy providers, manufacturers, PDMs and patients. He lives in Seattle with his wife and three kids, with a fourth on the way.

Nico, you're a busy guy. Thanks so much for joining us today.

Nico Kernick (2:12)

Sheila, thank you for having me. I'm very excited to chat and to be part of your network.

Sheila Arquette (2:18)

So tell me a little bit about the history of Develop Health, how did you get it all started?

Nico Kernick (2:24)

Yes, so Develop Health was started about three years ago. Initially, the founders, Mel and Ben, were kind of researching what pain points were the most acute for providers. And the problem that they just kept on being pointed back to was what you do once you have a script and how you actually get the medication that you prescribe to patients. And so they really set to solve that. At first, they kind of built on existing tools and existing workflows that existed, that were in the market. And then they just decided to rip it all out and build our own workflows. So since then, we've served over three million patients, automating their prior authorizations, helping understand benefit coverage and eligibility.

And generally just trying to reduce the friction and the lack of transparency that exists in the world that we live in between prescribers and what they might prescribe for a patient and how that patient can actually pick it up in pharmacy.

Sheila Arquette (3:25)

That's awesome. So I think I shared with you before, I was pharmacy director for a health plan for about 14 years and prior authorization was definitely something that we heard an awful lot about and even, you know, how the prior authorization requirements could be different with the same insurance company, right, or the same managed care provider. Just it was dependent upon the line of business and how, you know, crazy that used to make the office staff, which you can totally understand because we were just one insurer.

Nico Kernick (3:55)

Totally. Yeah. There's such variety and it's really hard to keep on top of all of it. Especially when you think about, you know, traditional provider office or pharmacy and the fact that they're seeing so many different patients on so many different plans, with so many different medications. We handle thousands of different medications a day, across hundreds of different plans, and their requirements are constantly changing. So you need to have a way to be sure about what is going to be covered for a patient, and then to make sure that if that patient should be eligible, that you get the right information in the right place to get them the authorization that they deserve. And so the way I think about it is that, you know, there is a certain set of rules that exists, and that I think is a design of the US health care system, which is going to hang around for a while. Prior authorizations aren't going anywhere. But there's two key elements that I think we can really improve. One is the friction that's caused by those rules.