Conversations with Perry and Friends: Susan A. Cantrell, CEO of AMCP

Ten years ago, Susan Cantrell had a strong inkling that she had found her perch. It was the run-up to the 2016 presidential election when she interviewed for the CEO position at the Academy of Managed Care Pharmacy (AMCP).

“One of the top issues that the candidates were talking about at the time was the rising cost of prescription drugs,” Cantrell recalled during her podcast interview with Perry Cohen, Pharm.D. “I realized that AMCP sat at the intersection of all of the issues around the rising cost of prescription drugs, with the organization's mission being to improve healthcare by ensuring patients have access to affordable medicines and other therapies. I thought, ‘This is exactly where I want to be,’ and I was fortunate enough to be asked to join as AMCP’s CEO. And the rest, as they say, is history.

Cantrell, who took the reins at AMCP in February 2016, and Cohen had a lively, wide-ranging discussion during the latest episode of “Conversations with Perry and Friends,” a podcast hosted by Cohen that Managed Healthcare Executive (MHE) supports and posts on its website. Cohen, a longtime member of the MHE editorial advisory board, is CEO of The Pharmacy Group.

Among the many topics that Cantrell and Cohen touched upon was the metamorphosis of pharmacists from mere dispensers of medication to providers of patient care. Cantrell, who earned her bachelor’s degree in pharmacy at the University of Mississippi, reflected on the changes in pharmacists’ education.

“I learned a lot about dispensing when I was in pharmacy school, and compounding — some of the traditional areas that are product specific,” said Cantrell. “But if you look now at what our new graduates are learning… it is very much a clinical, patient-focused profession. We've seen that evolution over the years. I'd like to see it go further, and I'm confident that it will. I think that is the major shift that I've seen — how pharmacists have evolved to be really integral parts of the healthcare team and medication use experts.” Cantrell noted that Vin Gupta, M.D., M.P.A., the former chief medical officer for Amazon Pharmacy, also referenced the transformation in his remarks as the keynote speaker at AMCP’s annual meeting last year. Cantrell said that “our world of pharmacy is changing rapidly,” noting that Amazon’s prowess as a distributor means that it now covers 50% of the country with 24-hour delivery of prescription drugs.

“What he [Gupta] talked about were the clinical services and the direct patient care services being provided by the pharmacist. I think that's how we change. I think we continue that evolution away from a product-focused, dispensing profession, which we've moved pretty far in this direction, but we need to keep that momentum going and view ourselves as partners with patients,” Cantrell told Cohen.

Cantrell said pharmacists can also be a counterweight to the growing sway of social media influencers on the public’s view of prescription drugs. Demand for glucagon-like peptide 1 drugs (GLP-1s) for weight loss soared because of social media influencers, she observed. “There are people who are paying attention to what they see on social media, and when it comes to prescription medications, they're often paying attention to the wrong people, so we need to make sure that we, as a profession, step up to play that role, and that patients understand you go to your pharmacist when you need to know something about the medication that you're taking, and not to a social media influencer who has no medical training whatsoever.”

Cantrell said that as head of AMCP, she has been struck by the “depth of knowledge and influence” of the members but also their commitment to access to patient care.

“The commitment is to be making patients get access to the medicines they need at a cost they can afford,” she said. “I think that inspires me every day — just seeing that deep commitment of our members and what they bring to the table.”

The pharmacists who work in managed care pharmacy work in a wide range of capacities and for a variety of employers, Cantrell said. During a time when many healthcare workers are burnt out or fending off that depleted outlook, Cantrell said surveys have found managed care pharmacists have pretty high job satisfaction. “They find their jobs fulfilling. They feel like they have good control over their own decision-making and a good work-life balance.”

Artificial intelligence (AI) is likely to have a major effect on managed healthcare pharmacy, Cantrell said, and she sees it paying dividends. “Data analysis, for example, is a key part of managed care pharmacy, prior authorization, and other things like that that traditionally have been part of the tools used in managed care pharmacy. AI has the potential to make those processes so much more efficient. I think that that's very exciting for all of us,” she said. Cantrell noted the “pushback from the healthcare community, from the patient community, from pretty much everybody, about some of the tools and strategies that are used in managed care pharmacy.” Technology can be used to make such tools work better, she said, but it needs “guardrails.”

“We know AI can be wrong,” Cantrell told Cohen. “AI doesn't take everything into consideration like we do as humans, so you still have to have the human involvement and oversight.”

When Cohen asked Cantrell about the challenges facing managed care pharmacy, Cantrell said she would put uncertainty at the top of the list. “When you look at how much has changed, especially in the last five years, could we have expected five years ago that Medicare would be negotiating drug prices in the Medicare program? No, we couldn't have,” said Cantrell, who listed direct-to-consumer drugs and the seven-figure cost of cell and gene therapy as adding to the uncertainty quotient.

Cantrell quipped that she can’t go a day without saying GLP-1, and that enormously popular medications are also pieces in the uncertainty puzzle, especially for managed care pharmacists, who are often positioned as stewards of healthcare spending.

“GLP-1s by themselves aren't super high-priced drugs, but they have the potential to be used in 40% or more of the US population. So how does our health care system afford that? That's a big challenge for all of us, but particularly for managed care pharmacy professionals,” Cantrell said.