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Becker’s Healthcare Podcast
Michael Evans, RPh, MBA, FASHP, Chief Pharmacy Officer for Enterprise Pharmacy at Geisinger,
00:14:04
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- [00:00]
A
Welcome to the Beckers Pharmacy Leadership Podcast. I'm Ella Jeffries, pharmacy reporter with Becker's Healthcare. Today I'm joined by Michael Evans, chief pharmacy Officer at Geisinger. In this episode, we'll be talking about key pharmacy initiatives from the past year. The priorities and headwinds leaders are navigating as they plan for 2026 and where opportunities for organizational growth are emerging. Michael, thank you so much for joining me today. To start us off, can you introduce yourself and share a bit about your role in Geisinger's pharmacy organization?
- [00:30]
B
Sure. Thank you, Ella. And good afternoon, everybody. So, Mike Evans. I'm a pharmacist by training, currently serve as Geisinger's chief pharmacy officer. I've been here at Geisinger for a long time, over 30 years in multiple roles and truly lead a team of over 500 pharmacists and over a thousand technicians and, you know, in the care of patients and our communities, which Geisinger serves. Little bit about Geisinger. So we are an integrated delivery network. We have 11 hospitals, primary care, specialty clinics, and we are spread across northeastern and central Pennsylvania. From a pharmacy services perspective, we have about everything you can think of from delivering pharmaceutical services. So we have retail pharmacies, specialty pharmacies, home infusion pharmacies, n mail order pharmacy. We have clinical pharmacists embedded in primary care and specialty clinics involved in direct patient care, obviously infusion pharmacists. And we have pharmacists embedded in our hospitals and rounding and so forth. And, you know, truly blessed to have the support of our leaders at Geisinger to have such a robust team of pharmacy experts to serve our patients and our communities.
- [01:51]
A
Great. Thank you so much for that context. Now, looking back over the past year, what was the most important initiative that you led? What did you focus on and what results did you see?
- [02:01]
B
Oh, my gosh. I know 2025 was just another year of complexity in managing pharmacy services. I think you're a little more complex as being an IDN. You know, 2025, you know, we had the Inflation Reduction act from a payer perspective and how that impacted, you know, our managed care portfolio, particularly our Medicare population, you know, and thinking about what we had to do from a benefit structure to understand the risk, the risk to the patients, the risk to Geisinger as a HMO organization and what that would mean moving forward. So I would say the Reflation Reduction act would be one changing the formulary and tiering of medications. We really essentially reset our Medicare product almost back to what it was in 2003. And, you know, so that would be one initiative and I think the. Probably the second initiative. And we'd had many initiatives, were really a biosimilar initiative. We had biosimilars, and we're moving to adopt the humiro biosimilars in 2024. But when we stepped into 2025, we set up ourselves to be biosimilar first and independent of our line of business, whether it be Medicare, Medicaid, commercial TPA and so forth, or aca. So we did transition all of our patients for any of the available biosimilars. Two biosimilars. I'll say that, you know, from a product perspective, we were quite successful moving all of our lines of business. Over 90% of our members are on the biosimilar Humira for Stelara. Same thing, you know, moving, you know, moving our patients, you know, from the brand Stelara to the biosimilar, and then also with our wet macular degeneration, moving to the IAH biosimilar of PAV Blue and working with our retinal specialists for that adoption and that transition. So I would say there are two initiatives that were very important. There are several others, but I'll highlight those two.
- [04:25]
A
Great. Thank you so much for sharing those examples. I'd love to hear more about what prompted you guys to take on that biosimilar first initiative.
- [04:34]
B
Yeah, well, really, it's making healthcare affordable to our members and to our communities and looking at the substantial difference in pricing between the reference product or the biologic to the biosimilars, and really what the cost sharing is now with our members, particularly, you know, in Medicare as an example, or, you know, any of our commercial plans that, you know, we look at clinical efficacy first. And looking at the efficacy of those biosimilars, they were as efficacious and not harmful to any of our members. And so we, you know, we took on the task of making the transition to make health care affordable for our patients and communities.
- [05:18]
A
That's great. Thank you for sharing. Now, looking ahead, what are the big priorities and headwinds you're focused on as you plan for 2026?
- [05:27]
B
Gosh, you know, looking at headwinds, I'll say first. So headwinds are, you know, again, the Inflation reduction act now second year. So 2026, you know, for the first 10 drugs that have the negotiated government pricing. So that would be one which is very much coincides with the implementation of the rebate model for the 340B program for the first 10 drugs, which obviously there was a federal judge in Maine that put the program on, the rebate program on hold for right now. But it's more, you know, definitely in front of us, the MFP pricing, you know, for pharmaceuticals at point of sale, you know, I would say, you know, are truly in front of us. And then thirdly is really the, the transition of from small molecule therapy to now cell and gene therapy and just the complexity of administration, making sure that we have a rev management process around cell and gene therapy. When we administer that, we're going to get paid on the clinical enterprise side because these therapies, as we know, are half a million to 7, 8, 9, $10 million per application. And then lastly, you know, from a cell and gene therapy is from a payer perspective, making sure that we're able to manage risk, the risk of the expense, risk of the outcome and ensuring that members are getting the outcome if we're paying for that cell and gene therapy. So I would call those the big priorities, kind of the headwinds that we're focused on for 2026 and you know, many different moving pieces in each of those initiatives.
- [07:15]
A
Definitely. And along with those priorities do come some tough decisions. What's the hardest thing that you'll have to tackle in the coming year as a pharmacy leader?
- [07:25]
B
Gosh, what is the hardest thing in the coming year? I think everything we're doing is difficult and it's becoming more and more complex. You know, the hardest thing we may have to do is, you know, in these cell and gene therapies and looking at the subpopulations and making sure if we're going to, or if we're not going to administer the product. The hardest decision is going to say no to someone when we know the therapy is life saving, but we know that they have a version or a variation of the disease that the product does not cure or does not alter. Hard decision to tell the patient no. Right. And that's not who we at Geisinger are. We are, you know, wanting to service all of our patients to the highest quality. We can and not have to say no. Whether, you know, it's financial, whether it's clinical, whether it's access, you know, we try to, we pride ourselves on making sure we can care for patients. So the hardest thing would probably be saying no because the patient, you know, heard that there's a cure for X disease, but their, their genetic mutation or their variation of disease or their age is beyond where we see efficacy of administering the therapy.
- [08:47]
A
Yeah, that's definitely a difficult part of the job. Now, within all of these headwinds, how are you preparing your team to tackle them?
- [08:57]
B
Yeah, I think the key for organizations to tackle or be able to respond and to operation, have the operations to manage is having a leadership team that is obviously focused on their specific areas, but working across the entire enterprise. So I'm truly blessed to have an enterprise pharmacy leadership team that is quite skilled, whether it be our hospital based programs, whether it's our ambulatory based programs, whether it's our managed care programs, whether it's our strategy and planning area, whether, you know, it's our 340B programs and so forth. I have leaders that are well versed in all of those areas that will be positioned or be leaders that are involved in driving any of the initiatives or priorities that we spoke of or responding to any future headwinds that come upon us through the calendar year.
- [09:56]
A
Gotcha. It's great that you have a team to be prepared for those. Now even with those challenges, there are still areas for growth. Where do you see the best opportunities for organizational growth moving forward?
- [10:08]
B
Yeah, so I think I'll answer this question in two different ways. So I think one is I never thought in my career I would see pharmacy deserts not only in the Geisinger geography, but in the country. So, you know, over the past two years or maybe two and a half years now in Pennsylvania, we've had approximately 600 pharmacies close. And you know, we are a rural delivery system. And because of that we have pharmacy deserts. In other words, we have patients that are not within 50 miles of a retail pharmacy. And so, you know, we are going to have to respond, you know, as a payer and a provider respond in ways for us to get medications to the patient, whether it's a retail pharmacy and you know, and it's a tablet or a capsule or you know, an oral retail medication that we have to get to a member or utilizing our mail order services, or using our specialty pharmacy services, or using our home infusion services to essentially get and be able to have availability of our patient members in our communities have them, have they have access, you know, to, to the appropriate medication in different delivery methods. So I see as an opportunity for integrated delivery networks that are a payer and provider to build pharmacy distribution channels because the value that we gain, and I'll use retail as an example by having a retail pharmacy is not just any margin that is made from dispensing the prescription. It's about keeping the patient compliant. With the medication to control their disease. So they're not having to go to the emergency room or having their disease progress where they need a hospital admission. So it's preventing that in the first place. So there's other value of making sure a patient has access or is adherent to their medications to prevent that disease exacerbation disease progression. So that would be one that I would say. The other I would say is and it goes back to my cell and gene therapy comment and really around high dollar medically covered medications or therapies and to make sure that we have an end to end revenue integrity process around pharmaceuticals and essentially making sure from contracting with payers through the prior auth process, making sure we dot the I and cross the T that we're going to get paid for the therapy, make sure we're then purchasing the therapy at the appropriate cost, making sure then we're administering the medication safely to the right patient at the right time, make sure we're submitting for payment, making sure we're getting payment per contract, having that entire revenue integrity from end to end. Most systems have a great rev management team, but from a pharmaceutical perspective and all the complexities and the loopholes that we have to jump through, from a payer perspective, having the expertise in pharmacy revenue integrity is going to be vital. 2026 and forward.
- [13:37]
A
Those are great opportunities. Thank you so much for sharing. It was really excited to hear and looking forward to what can be accomplished in 2026. Well Michael, this has been such a great conversation. Thank you for sharing your perspective and insights with us. That's all for today's episode of the Becker's Pharmacy Leadership Podcast. A big thank you to Michael Evans again for joining us to discuss pharmacy priorities, challenges and opportunities at Geisinger. Thanks for listening and we'll see you next time.