Insights of a PSP strategist: an interview with Andrea de Jaray
January 23, 2020
As AstraZeneca’s Group Patient Support Programs (PSPs) Strategy Lead, Andrea De Jaray views PSPs through a holistic, patient-centric lens. With over 10 years’ experience working with PSPs, she has witnessed numerous changes within the PSP environment and continually seeks opportunities to “do things better.” An early career as a registered nurse in a neonatal intensive care unit has given her first-hand knowledge of how PSPs can empower patients and families to play an active role in their care. In this interview, Andrea shares her perspective on PSPs of the present and consideration for the future.
How has the PSPs landscape in Canada evolved over the past decade?
While PSPs have been evolving since their inception, the emergence of precision medicine and growing complexity in our healthcare system are facilitating a significant shift in how PSPs are developed and delivered. Precision medicines differ from standard, one-size-fits-all therapies in that they enable the treatment of those who are most likely to benefit while avoiding ‘trial and error prescribing.” The increasing prevalence of precision medicine and diagnostic testing is helping us to better target PSPs so we can provide the right medicine to the right patient at the right time. This principle informs every aspect of modern PSP design. Increasing complexity in the Canadian healthcare system, including the patient journey, has made it important to engage with key stakeholders like patient groups, public and private payers, physicians and medical institutions, so we can better support patients as they navigate the healthcare system.
How is technology helping facilitate changes?
Technology is helping us to create more efficiencies, to communicate more quickly and effectively with patients and physicians, and ultimately to deliver better patient care. While PSPs of the past heavily relied on email and fax to communicate, today’s online PSP platforms give stakeholders real-time information that can help patients start treatment more quickly.
Through healthcare apps that inform and empower patients to play an active role in their treatment, and physician portals that provide a complete view of their patient’s journey, PSPs are equipping both the patient and health providers with critical information. I believe the movement towards digital connectivity with payers will also continue to drive expedited access and timely decisions.
We’re seeing public payers increasingly focused on enhancing the patient experience through digital record keeping enabled by PSPs. For example, the Ontario Government’s SADIE [Special Authorization Digital Information Exchange] portal makes it easier to fast-track exceptional access for Ontario Drug Benefit recipients by providing patients with relevant information. Looking forward, I’m also excited about the growing application of artificial intelligence and machine learning to help better understand disease states and lead into predictive medicine. These data points give clinicians and payers a powerful lens on the patient experience, which they can use to improve treatment and access decisions.
Can you tell us more about how PSPs intersect with precision medicine?
As more precision medicines come to market, PSPs have become more targeted and frequently include the facilitation of diagnostic testing, such as biomarker or tumor testing. PSPs can now provide faster and more efficient support to physicians who need test results to make treatment decisions.
Given the pace of change you describe, how can PSPs keep up?
With the Canadian healthcare system in a state of flux, many treatment and policy decisions may not fully consider the patient experience. PSPs need to evolve accordingly to ensure the patient doesn’t get lost.
What role does data play in PSP programs?
Collection of data is an important part of the PSP value proposition—but not just any data. Modern PSPs are designed to collect real-world data (RWD), which evaluates how a treatment performs in a broad population outside a controlled clinical trial environment.
RWD are increasingly being used by payers to make reimbursement and pricing decisions—often linked to the real-world value delivered by an innovative medicine. As such, collection and security of patient data are becoming important than ever.
More broadly, PSP data will need to communicate more and more with other data sets and systems, which will require the healthcare system and industry to agree on a unified approach. While Canada still has a fragmented ecosystem of data collection, we are seeing some efforts to simplify, streamline and centralize at a provincial level. That being said, many silos still exist with continued challenges in working towards national alignment.
What value do PSPs add to patients and physicians?
PSPs aim to support both the patient and multidisciplinary healthcare team as a whole. Navigating the specialty care environment is complex and can be overwhelming for patients dealing with a difficult diagnosis like cancer. PSPs can help empower patients with education, knowledge and support mechanisms that allow them to play a more active role in their own care. Along with helping to coordinate appointments, lab tests and drug reimbursement, PSPs can inform patients about alternative access vehicles (such as not-for-profit programs) and other community resources. Providing this support to patients can also alleviate some of the pressure and time-burden on prescribing physicians and allied healthcare providers. By the same token, PSPs generally have mechanisms to provide physicians with vital information about aspects of treatment, such as patient adherence and drug reactions. This holistic view of the patient experience can help inform treatment decisions.
Any special considerations for PSPs for two growing areas of specialty medicine – biosimilars and oncology drugs?
Biosimilars are entering the market at a cost differential, so I believe their PSPs need to prioritize must-have over nice-to-have services while keeping the patient experience at the forefront With oncology treatments—or any other treatment involving a multi-disciplinary team—we need to ensure PSPs complement rather than duplicate care. To give a simple example, you wouldn’t want a patient to get an appointment reminder call from the tertiary hospital on one day and the same call from the PSP the following day.
If a manufacturer is setting up a new PSP, what can they do to “get it right” from the start?
When setting up a PSP, full understanding of the patient experience—in the current environment and foreseeable future—is critical. PSPs must have the agility to respond to changes in the ecosystem while continuing to support patients. The more time allowed for design, challenge and pressure testing, the better.
What will the PSP of the future look like?
In the coming years, PSPs will need to accommodate the expanding roles of healthcare providers such as pharmacists and evolve with policy changes that impact the flow of treatment. That said, we need to ensure future PSPs maintain a strong patient focus. No matter what changes are in store, we can’t lose sight of the patient experience.