Unscripted – The AMCP Podcast: JMCP at 30: Celebrating Three Decades of Impact in Managed Care Pharmacy

Fred Goldstein 0:01 

Welcome to Unscripted, the AMCP Podcast, a look inside managed care pharmacy. Listen in as experts explore the challenges, innovations and opportunities shaping healthcare for millions of patients.

Susan Cantrell 0:16 

Hello and welcome. I'm Susan Cantrell, CEO of AMCP, and I'm thrilled to have you all with us today for this episode of Unscripted the AMCP Podcast. We're celebrating a major milestone today, the 30th anniversary of the Journal of Managed Care and Specialty Pharmacy, or JMCP, as most of us know it. So joining me today are two incredible guests, Laura Happe, who's the editor in chief of JMCP, and Pat Gleason, a prolific author and a true champion of both AMCP and JMCP. So for the last three decades, JMCP has been a driving force in shaping how medications are managed, paid for and delivered. Since its founding way back in 1995 the journal has spotlighted groundbreaking research and expert insights that have helped define the profession of managed care pharmacy. In today's episode, we'll reflect on that legacy. We'll explore the impact of JMCP on policy and practice, and then we'll look ahead to the future of pharmacy and healthcare innovation. So let's dive into the journey of JMCP and explore how it's helped move the profession and healthcare forward. Pat and Laura, welcome to you both.

Pat Gleason  1:31 

Thanks, Susan, thanks for having me here today. Thank you.

Susan Cantrell 1:34 

Susan, so I'd like to start at the beginning, Laura, take us back to 1995, which I know is difficult for you because you weren't here back then. But what inspired the launch of JMCP in 1995 and also, what gap was it aiming to fill in the profession?

Laura Happe  1:52 

Yeah, so 1995, you're right. I wasn't here at the organization yet, but I sure have enjoyed looking into the history of AMCP and how JMCP came to be. And in 1995, AMCP itself was a fairly new organization. It was less than 10 years old at that time, but the organization and the profession of a managed care pharmacy were both growing rapidly, and AMCP's leaders knew that it was going to be important to have a venue to share learnings across managed care pharmacy practitioners, as well as with stakeholders that were adjacent to our field. And so JMCP was really established to enable this information sharing. 

Susan Cantrell 2:35 

Great. Thank you for that. You know, in those early years, certainly managed care pharmacy was very different than it is today. So what kind of content did the journal focus on back then, and how did it help to address educational gaps and provide those insights?

Laura Happe  2:51 

Yes, so the content has definitely changed over the years. When JMCP was first started research and forming and managed care pharmacy practice was also in its early stages, so the Journal did publish some research, but it also published a lot of educational articles. So for example, JMCP published several articles in the early years about how to conduct formulary reviews, and those articles ultimately helped to inform the development of AMCP's format for formulary submissions that so many organizations use and rely upon today. Early on, the journal also frequently published more like case reports or projects of innovative things that were happening in pharmacy benefit programs, one that stands out in my mind is the implementation of a generic substitution program, which, of course, is just kind of standard practice today, but at a time when society was generally less connected than when we are now. These articles really helped practitioners from across the country to learn from others that were working in similar managed care practice settings.

Susan Cantrell 4:04 

So it's almost a chronicle of the history of managed care pharmacy That's fascinating. Pat, you've been involved with JMCP for many years. When did you start to see the journal shift toward more rigorous research, especially around real world evidence and patient outcomes?

Pat Gleason  4:21 

That's a great question. And Susan probably did better part of the journal and honest editorial advisory board back 1015, years ago. And from what I noticed in the change of journal is when the editor became Fred Curtis in 2002 and then when Kathy Fairman joined in 2006 as an associate editor, and with Fred and Kathy, they made a concerted effort to transition the journal more from what Laura has just described of an educational sort. For managed care pharmacists to one that continued that goal, but also bringing in research, real world evidence, studies performed by managed care pharmacists and in collaboration with other researchers and really kind of encourage those that type of research, and also with the Academy of managed care pharmacy and having scientific abstracts and poster presentations at conferences to review those posters walk down the aisles. That's how I first met Fred to ask, though he he asked me specifically to submit some of the work that we had done at Prime Therapeutics back in 2008 so it was a pleasure working with Fred and Kathy over the years and and now Laura reading the journal.

Susan Cantrell 5:51 

So Laura, when you think about that, how would you describe the evolution of JMCP's editorial mission over the past 30 years?

Laura Happe  6:00 

Yeah, great, great question. Susan, so I've looked back and I've kind of studied the inaugural issue of JMCP, which is interesting exercise. And one thing that I'd pulled out of that was a quote, and it said that JMCP would solidly establish AMCP as the national voice for managed care pharmacy, and there's no doubt. And Susan, you know this best, there's no doubt that today, AMCP definitely is that national voice. And so really, since the outset, JMCP has supported and come alongside AMCP in becoming that voice. The journal itself, as Pat just kind of spoke about has evolved over the years, as science and the data have evolved and improved, and today, we publish much more research than we did in the early years, and also the challenges that face the industry have evolved as well. So we don't publish articles about generic substitution very often anymore. Instead, we're tackling other issues like high cost drugs, AI policy reform. So the evolution of the research and the scope have really gone hand in hand with AMCP's national voice for the profession.

Susan Cantrell 7:20 

So it's clear that JMCP has grown from a foundational resource into really a leading voice in managed care, pharmacy and Laura, I may borrow that quote sometime in the future, if you don't mind. But let's talk a little bit about some of the ways that JMCP has influenced policy and practice. Pat I'm guessing you can probably highlight a moment where JMCP made a clear impact on policy or practice.

Pat Gleason  7:45 

I have a few and one I distinctly remember goes back a few years to 2009 where a paper was published in JMCP by Jason Yeaw, Josh Brenner and colleagues, titled comparing adherence and persistence across six chronic medication classes. Why this was so impactful is that in 2006 as you well know, Medicare Part D formed and launched, but about that same time, CMS made an announcement that they were going to evaluate Contracts Services, service health plans providing Part D drug benefits for quality, and the pharmacy quality Alliance had developed metrics for measuring adherence that CMS adopted that were new to us as an industry, using the proportion of These covered method. You know, they had specifications documents, but there wasn't a paper out there was that took the methods of the PQA that CMS was going to adopt the star measures, and ran analytics across hundreds of 1000s of lives using those drug categories to so we could see some numbers as a PBM pharmacy benefit manager, product therapeutics, you know, we looked at that and we said, oh, here's something to grab onto. We can compare our numbers to. We have much more detail with the fact that this has been peer reviewed. And it just was so helpful that the Journal had, you know, put out this original research by these authors and published this so that we could hit the ground running when the star measures were launched back in the mid 2000s so that that was one piece. And I think you know, more recently, a couple of articles. One was a themed issue the march in 2024 on drug pricing policy and the inflation Reduction Act. CMS, you know, had a huge task to operationalize that. Ira, they didn't really weren't sure how this was going to work. JMCP, along with the pharmaceutical manufacturer and research. Association Foundation had a call for articles try to give some guidance or address some unanswered questions. So helpful. I think we'll find out for sure as we move forward in time, that the fact that that collaboration occurred and those papers were put out there very insightful, and I believe, will be hugely influential to CMS,

Susan Cantrell 10:22 

those are great examples. And you know, two really pivotal moments, I would say, in the Medicare program, as well as in the world of managed care pharmacy. So really good examples. Laura, the other thing that JMCP has played a key role in is really shaping the national conversations around value access and high cost therapies. So what do you think sets the journal apart as a platform for both scholarly and practical insights on these issues?

Laura Happe 10:51 

Well, first, I love hearing Pat talk about the articles that that he remembers and that he feels have really influenced the profession. And I also love that he can sort of spout off the month and the year of certain publications, and has that committed to memory. It's an impressive feat, Pat, but in terms of what sets us apart as a journal, I think it's first and foremost. It's our mission. So both AMCP and JMCP are focused on improving patient health through access to high quality, cost effective medications and other therapies, and we are arguably the only organizations of our nature with this explicit, explicit mission. So that sets us apart, but also beyond our mission. I think it's the fact that we publish both rigorous scientific research as well as that expert commentary and practice guidance that we sort of started publishing at the outset. And I think it's that that sets us apart as a journal as well. Everything that we publish is really actionable to managed care, pharmacy practice, and it's also held to high standards and research and publications through our rigorous peer review process.

Susan Cantrell 12:04 

So that's a really good point. And you know, just when we think about the wealth of scholarly papers that have been published in JMCP over this 30 year life span so far, I'll just ask you both Pat cited a few that really drove policy forward. But I'm wondering if there are any standout papers or contributors that you would like to mention outside of the policy realm that really move the needle in managed care pharmacy. So Laura, I'll let you speak to that first and Pat, feel free to add if you'd like.

Laura Happe 12:39 

I have a very long list of papers that stand out in my mind, but I'll pick one that just kind of,

Susan Cantrell 12:44 

That's probably not a fair question for the editor, right?

Laura Happe 12:49 

I'll talk about one that stands out in my mind, because this happened fairly recently, and it's sort of personal. So I was looking back at some of the papers that had been read the most throughout our history or cited the most. And one of these papers was titled The direct medical cost of obesity in the United States, and it was published in 2021 and it kind of struck me, when I was looking at it, that I didn't, at first glance, recognize any of the authors right away, and so I kind of started reading their affiliations, and what I noticed was that one of the authors is a professor of economics at Lafayette College, where my husband and I just sent our son to enroll as a freshman, and he's studying economics, and so it was nice to make that connection, and I reached out to him. His His name is Dr. Adam Biener, and I shared that his article is one of the most cited of all time, even though it was just published fairly recently in 2021 and he shared back with me some other ways that his paper had he and his colleagues paper had been covered, for example, in a an economic report from Congress, and this report was discussing Medicare Part D policy and debating the fact that Medicare Part D doesn't currently cover obesity drugs. And so it was nice to see that paper picked up in that context, because it honestly just brings me joy when I can see papers published in JMCP that are that are being used to influence that policy. So that was kind of fun to get that little personal connection there and bring you know, new authors into the field, maybe new authors to JMCP into into our fold.

Pat Gleason 14:37 

Yeah, that's that's a great example, Laura, I'd like to name some names, because I think there are some very influential individuals of and prolific authors, Dr Sean Sullivan out of Washington, Marion college pharmacies, Diana brixner, oncology research, real world research out of. Utah, I'm going to say again, the seminal editor, Fred Curtis, along with Kathy Fairman, and not just moving the journal forward in more of a research focus, but also just their commentaries, their editorials, very expert on over the years, Robert Navarro, and then our own Laura Happe in the work that she's done and published in the journal. So thank you, Laura. I did a little informal survey of some of my colleagues, and in asking them, What would you know their favorite JMCP articles, and they've pointed to the primers that you have put out, and how they use them to educate new employees, new residents in managed care pharmacy come to us at Prime Therapeutics, so maybe we can say some more. But the primers recently, you know, over the years, on managed care, pharmacy benefit side, Formula management, clinical programs, another one titled brand name prescription drug contracting, brand name prescription drug reimbursement in the US and explaining the supply chain, which is so complicated, and actually my personal favorite, I'll just say, is the drug co pay accumulators, co pay maximizers and alternative funding programs and how these cost shifting strategies affect patient affordability. You know how health plans and insurers can do, you know, basically a better job helping navigate patients through those so kudos.

Susan Cantrell 16:38 

That's a great example. We hear from schools of pharmacy all the time how they use these in teaching students as well. So really useful papers.

Laura Happe 16:47 

Laura, thanks for bringing that up. Pat, for the primers. Also, we'll have three new primers coming out this fall into the winter, so that will be exciting. So please keep an eye out for those. And then definitely, thank you for mentioning specific contributors. I also wanted to share that I wrote an article that was published in July of this year, and we'll share it along with this Podcast, but I listed some of the notable contributors as well there, and many of the folks that you mentioned, and of course, you were, you were on that list as well, but there's just really a large community of contributors to the journal throughout its history, as well as today, and many of those contributors are enduring, and there are so many ways to contribute to JMCP. You can contribute as an author. You can contribute as a reader, another common way that we have people get involved is through acting as a peer reviewer. We have around 1000 peer reviews conducted every year, and so we need people to conduct those peer reviews, and we have a nice way to welcome people into the peer review process. We have an online webinar that explains our How to Become a peer reviewer. We also have a mentoring program for new peer reviewers, but that's a great way to contribute to the journal and really to contribute to the profession and give back to the profession.

Susan Cantrell 18:12 

Thanks for that, Laura. I hope people are taking notes as they hear that. Let's transition a little bit from influencing policy to informing practice. We know that JMCP, clearly, over the last 30 years, has made an important mark, but the future might even hold more promise. So let's take a moment to look ahead here and Laura, I'll just turn to you and say, How is JMCP adapting to the evolving needs of managed care, especially when it comes to equity and access personalized care, high cost innovations and other related top priorities for US healthcare right now?

Laura Happe 18:55 

Sure. So. So one of the things, of course, the healthcare system is grappling with is the cost of high cost drugs to our system, and one way that we have tried to help our readers on that front is through ICER, the Institute for Clinical and Economic Review, partnering with them so ICER conducts health technology assessments of new pharmaceutical products that are coming to the market, and they issue a Health Technology Report on the topics that they review. And so we've been partnering with them for several years now, where they write a summary of that report that's accessible to pharmacy people that are working in pharmacy benefit management and managed care pharmacy and those reports also sort of emphasize what's important for managed care pharmacy stakeholders, and we've been doing that for a while, and these are some of our most highly read articles, so it's really clearly filling a gap for our readers, and they're really enjoying that content. But. You mentioned equity, and I will say that you know, a result of an ICER report can say whether a given product is cost effective or not, and a product may be deemed cost effective, but it might not necessarily mean that it's affordable or accessible to all patients. And so we are also really focused at the journal on health inequities and health disparities. So we issued a call for papers. It was written by Steve Cogan out of the University of Rhode Island, and we've solicited a lot of papers since that time on disparities in medication use, and so we just really continue to have that as a focus for our journal, and our authors and researchers have really responded to that and have really done the work to conduct those studies and share those with managed care practitioners through our journal. And so that's another way that we're trying to help make pharmaceutical products accessible to everyone.

Susan Cantrell 21:03 

Really important issue. And I remember Dr Cogut article really well, the call for papers, and then also an article that he wrote with the managed care imperative. So really useful paper that we've used as kind of a guiding light for the work that AMCP has done in the area of health equity. So thank you for that. Pat. JMCP has always promoted collaboration across researchers, practitioners and payers. So when you think about that, how do you see that role for JMCP expanding in the years ahead? 

Pat Gleason 21:39 

Well, it's extremely important. You can imagine that we can't be in isolation. We need to be collaborating with our research colleagues. Frequently, our research colleagues don't have the robust data that those that work in managed care pharmacy have, like myself. And so finding those connections to collaboratively, work together, as well as with pharmaceutical manufacturers and others, work on a way a process that the research can be done, not in isolation, but across lines of manufacturers along with the researchers and the business, we would say, the insurers, the payers, it's going to be instrumental and extremely important to ensure that the answers to these questions are not from one perspective, but from multi perspective.

Susan Cantrell 22:38 

Yes, good point, and you know, it's clear from what you've both just said, that JMCP is preparing for the future. But before we wrap up, let's take one more moment to reflect on the journey, and I'm just going to ask you, Pat, can you think of one particular memorable moment or lesson from your time with JMCP that really sticks out to you.

Pat Gleason 23:01 

It's a conversation that you and I, Susan had two years back, and it ties very nicely with what Laura just mentioned about the Institute for Clinical and Economic Review summaries that we published. I remember you coming to me and asking my opinion of whether you have a journal you know should host those short, brief summaries of letters are pretty dense report by the Institute for Clinical and Economic Review, and when they do their cost effective assessment of the drug or drug category. Now, you know you it's well known, maybe, hopefully, the the Institute for Clinical and Economic Review is the only nonprofit neutral party in America doing cost effectiveness assessments in a very transparent way. But their reports are hundreds of pages, which is probably why the reasons do orient the, you know, the summons that are five to six pages or so. You know, well read by by us in the industry and others to the and so you asked me my thoughts, Susan and whether it would be good idea for James, CP to host that. And I said, Absolutely, I'm glad you took you asked me for my opinion as well as you made the decision you and Laura to move forward on that, because they do come with them, commentaries, perspectives from stakeholders. I've written one myself, and I've, you know, I like to read the six pages summary, but also read that one page or two page perspective, opinion of others of those reports. So kudos to you for, like, for taking that step forward and putting these out there, and continuing to put these summaries out there that I started performs.

Susan Cantrell 24:43 

And we'll say kudos to you for having that vision, Pat, and advising us to move forward on that. So before we wrap up, we've talked about a lot of things, but any final thoughts or reflection on the journal's legacy?

Laura Happe 24:56 

Well, Susan, the journal itself is obviously. Be a static document. It's we still print and send out copies. There's probably copies on the shelves behind you. But I really like to think of it more as a conversation than as a as a static thing or the static document. So I've been with the journal for more than 10 years now, and I really enjoyed studying the history of the journal. Before my time, I've enjoyed reflecting on how the dialog has expanded, how new voices have been added, and how that conversation has just advanced throughout the years. So I think that our legacy as a journal has been and will continue to be facilitating that conversation that that hopefully is really unending. I think

Pat Gleason 25:48 

It was a very wise decision on top of a paywall. Individuals, anyone can get to the articles of JMCP, making that, having that access and making it easy to find the research and publications I believe, is essential for for all. I'll just comment that over the years, the continue taking on answering questions that are very hard, like, what is the value of prior authorization? What harm or benefits can come from prior authorization? Utilization management programs, step therapy, they're very challenging. Policy makers. You hear a lot from constituents about how these are barriers to care and should be eliminated, but also it's well known that they ensure safe medication use as well as more effective and cost effective medication use. So when I in our company recently took a look at like all the publications in the space of prior authorization, over half of them actually are coming from JMCP over the years. So my ask could be, you know, continue to take on those hard challenges, and I know you will, so I look forward to reading about them.

Susan Cantrell 27:10 

So that pretty much sums it up. That's a nice walk down memory lane of this wonderful legacy of JMCP asking and answering the hard questions. And I can promise you, we've been doing it for 30 years, and we'll continue doing it into the future. So I'll just wrap up by saying to our listeners, whether you're a long time reader of JMCP, a contributor, or perhaps you've just discovered JMCP, we really invite you to explore the journal, share your insights and be a part of this next chapter, Laura gave us some great ideas for how you can do that. So I want to say thank you Laura and Pat for joining me today, and also thank you to everyone who's helped shape this important journal over the last 30 years. Here's to the future of JMCP and managed care pharmacy. And thanks to everyone for joining us for this episode of Unscripted, the AMCP Podcast.