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Although the COVID-19 vaccine rollout has had a successful start, major health inequities still exist in vaccine access for underserved communities and underrepresented minorities. 2 million Americans are being vaccinated a day, but less than 20% are underrepresented minorities. In this episode, guest host Claire Winiarek sits down with Dr. Elena Rios, President and CEO of the National Hispanic Medical Association (NHMA), and Dr. Sree Chaguturu, Senior Vice President and Chief Medical Officer of CVS Caremark. Claire, Dr. Rios, and Dr. Chaguturu discuss the unique social determinants for why these inequities exist, why it’s important to reframe COVID-19 vaccination campaigns for specific demographic groups, and how PBMs are working to educate underserved populations on the safety and efficacy of the COVID-19 vaccine.
JC Scott, President & CEO of the Pharmaceutical Care Management Association, discusses the latest trends, public policy developments, and political challenges impacting drug pricing and healthcare.
You'll hear the nation's top thought leaders, policy experts, and political analysts on topics like how employers, unions, and others use Pharmacy Benefit Managers (PBMs) to drive value for their members in the face of growing healthcare costs. You'll also learn about advancements in gene therapy, biologics, other cutting edge therapies, and the patient benefits and cost challenges that come with them.
The Pharmacy Benefit will also analyze the latest news from inside the industry and give you an educated perspective on where things currently stand and where we think they're headed.
Claire Wolf:
Welcome to The Pharmacy Benefit, a podcast that highlights the role of PBMs in serving millions of patients and consumers throughout the country. I'm Claire [Wolfen Yarik 00:00:17] sitting in for JC Scott. Since the beginning of the COVID-19 pandemic, PBMs have been helping Americans practice social distancing, while continuing to have convenient, reliable access to the medications they need. Now with multiple COVID-19 vaccines available, PBMs are working with employers and other plan sponsors to ensure that all Americans have easy access to authorized vaccines, free of cost. Visit PCMAnet.org, to learn more about what PBMs are doing to help Americans get vaccinated.
Claire Wolf:
Since the COVID-19 vaccine distribution started in December, more than 129 million vaccines have been administered in the United States, fully vaccinating, more than 44 million people, or about 13 and a half percent of the U.S. population. That's an incredible accomplishment considering where we were only a few months ago, let alone a year ago, but this accomplishment has been uneven and inequitable.
Claire Wolf:
Although the rollout of vaccines continue, distribution access inequities combined with deeply rooted mistrust have hampered widespread vaccine uptake. On this episode, we're going to discuss what's being done right now to achieve widespread vaccination in our communities, and in particular, black and brown communities. Joining me for this important conversation are Dr. Elena Rios, president and CEO of the National Hispanic Medical Association or the NHMA and Dr. Sree Chaguturu, senior vice president and chief medical officer of CVS Caremark.
Claire Wolf:
From the very beginning of her training in medicine, Dr. Elena Rio's life work has been devoted to transforming the health system to meet the needs and challenges of the future America, which includes a growing Hispanic population. Dr. Rios is not only president and CEO of the NHMA, but one of its founders and a career spanning health policy research administration, and medical school recruitment, as well as medical practice. Dr. Rios served on the 1993 White House National Healthcare Reform Task Force as a senior advisor to the U.S. Department of Health and Human Services and as a delegate to the World Health Assembly. She also is extensively published and has been noted for leadership on these issues by HHS, as well as the Congressional Black, Hispanic, Asian, And Native American Caucuses, the American Public Health Association, Stanford University, and many others.
Claire Wolf:
As senior vice president and chief medical officer of CVS Caremark, Dr. Sree Chaguturu focuses on ensuring patients have access to safe and affordable prescriptions while also contributing to the overall mission of CVS Health. Dr. Chaguturu joined CVS in 2019 from Mass General Brigham formerly Partners Healthcare, where he was chief population health officer responsible for leading the integrated health systems population health and accountable care efforts. Dr. Chaguturu also is a practicing internal medicine physician at Massachusetts General, a lecturer at Harvard Medical School and extensively published, including in the New England Journal of Medicine, JAMA and Health Affairs. Elena and Sree, thanks so much for joining me today. Before we get started, just a quick check-in. How are you both doing? We'll start with Elena. How are you doing?
Elena Rios:
Oh, I'm doing fine. I got my two vaccinations over two weeks ago. So I feel much better.
Claire Wolf:
Oh, congratulations. That's a big milestone. Hopefully we'll all be joining in your footsteps soon and Sree, how are you?
Sree Chaguturu:
I'm doing great. Thank you so much. Our family is doing very well. We're healthy and safe here outside of Boston.
Claire Wolf:
So good to hear. Well, let's jump right in. Of course we are continuing to focus on COVID-19, particular the vaccine rollout. And this question goes out to the both of you, but Elena, we're going to start with you first. How is the rollout going overall as well as for the particular underserved communities?
Elena Rios:
I think the rollout is going great in terms of expansion and reaching out to local communities, not just major communities, but going into more smaller communities, rural communities, et cetera, but in terms of the areas that Latinos live in, for example, there are still lots of issues and inequities in the access to vaccines. And I think that a lot has to do with the barriers that we're going to discuss and Hispanics being essential workers and living in multiple households and holding different jobs and just not having the support needed to actually find the vaccine, make the appointments, having the technology to be first in line in those appointments as people scramble to get appointments. And I think as time goes on, we have learned that there are lots of things that have been done by the Biden administration, through the American Rescue Plan and also through our local public health departments, finding new ways to get to these communities.
Claire Wolf:
Now, Sree, same question goes to you. How do you think we're doing overall?
Sree Chaguturu:
I would echo a lot of what Dr. Rios has said. As a country, across many facets of American healthcare, we have pockets of excellence and then as we look deeper, there're incredible inequities in how that excellence has unfolded. So we now have over 50 million people that have been vaccinated. That's something to be incredibly proud of. We're vaccinating over 2 million people per day. And that is also an incredible achievement on the global scale. But when we look at the percentage of patients who have been vaccinated, who come from underrepresented minority communities, we see that it's less than 20%, which is lower than the demographics of underrepresented minorities in America. And so again, excellence with inequities is the storyline that we have here.
Claire Wolf:
Elena, you have been a leader personally and professionally in looking at these questions of health inequities and health disparities for all of your career and medically from the administration standpoint as well. How do you think we can work on addressing these issues through the lens of COVID and perhaps how can we help bring awareness to access and confidence barriers?
Elena Rios:
There are lots of barriers that have never gone away, that have been there historically in our poor communities, whether urban or rural and it has to do with social determinants of health within our communities that we have never really focused on in a big way. And I think that's the problem. That poverty... There's a cycle of poverty generation after generation who don't know how to get out of poverty and they need extra help. There are environmental conditions that our communities live in that need to be changed. And then there are just education problems, limited education, people not having the technical skills to get high level jobs. So they are in labor or skilled labor jobs. And then you have big families thinking that the more kids you have the more help you'll have for the family. And that creates poor housing, substandard housing and less funding to go buy health insurance.
Elena Rios:
So we have a picture of an underserved community. And I think one of the major barriers is not having information to know more about public health and prevention. People tend to wait until they're really sick to go see the doctor and/or go to the emergency room. So when it comes to COVID-19 and the importance of a public health measures to decrease the transmission of the disease, you're looking at a perfect storm of people in poor communities that don't have time or the understanding, or even the interest to know what to do. So then when it comes to getting vaccine, the vaccine access issue is even higher in these communities because they don't have that information and they don't have the technology to get accessible appointments.
Elena Rios:
So let me just say that one of the things that we've been doing is looking at the concept of having trusted messengers through a campaign that we're getting supported by the CDC and Johnson and Johnson, and a few other... AARP is going to come on board soon to develop a campaign that we're calling Vaccinate For All. Too often, campaigns are looking at just get your shot or it's up to you, which is fine and we are very supportive of all the vaccine campaigns. But we think in our communities, we need to give the message that all the families should get vaccinated and that people should go together to get vaccinated, the adults and their parents. And then again, the other barrier in our community is just that we have a lot of underlying conditions like diabetes, heart disease, asthma, and our communities are more prone to getting COVID-19 and need to understand how important it is to get the vaccine.
Claire Wolf:
So Elena, between the Vaccinate For All Campaign, I think what we're hearing you say is, we have very particular barriers that are unique to family demographics and family circumstances. These are just really particular to these individuals, and it strikes me that we really need to meet them where they are, acknowledge the particular needs that they may have, and really frame our campaigns and our outreach accordingly. So Sree, turning to you, how do we sort of actualize what Elena has articulated? How are PBMs, health plan sponsors and others working with pharmacies and providers to achieve that kind of really tailored messaging and approach?
Sree Chaguturu:
Claire, thanks for the question. So, CVS Health has been honored to play our role in providing vaccinations across the country, initially with the long-term care program with nearly 5 million vaccinations for over 45,000 skilled nursing facilities and assisted living facilities across the country. And now throughout our pharmacies, that continue to expand the number of stores through the Federal Pharmacy Partnership for the general population, according to state specific criteria. As a PBM, we have been working with plan sponsors, employers, and health plans to help promote both payment for vaccination services, as well as education to our clients. And part of our education was informed by our ongoing research that was understanding drivers of vaccine acceptance and hesitancy and we've conducted multiple surveys over the course of the past couple of months to understand baseline as well as changing trends. And so I'd like to take a moment to really talk through some of our findings in the surveys.
Sree Chaguturu:
Briefly, we started the survey in December and we had mirrored the demographics of America in the surveys and we repeated it again in January, and then again in March. And so we've published two of these and I'll talk about also the third. What we see is that there was a very large movable middle. So there was bookends of those who were interested and those who were hesitant, but over 50% were, understandably, just wanted to see. Either they were willing to wait or were unsure. And what we've seen over time is that the movable middle has decreased, and we've seen more people who are willing to, and more people who are hesitant. And we see that this varies by race and ethnicity as well, with greater hesitancy in underrepresented minorities.
Sree Chaguturu:
What is reassuring in our data is that we see that there's been a bit of stabilization in the most recent data from early March, where some of the hesitancy has receded across most populations. And then when we ask what is the driver of your desire to get vaccinated, for those who are in top box, who are interested, it is a desire to return to a life that is normal.
Sree Chaguturu:
When we asked that specifically by race and ethnicity, one of the things that Dr Rios talked about was family and the importance of family, and what we see in Hispanic community is that the number two reason in the Hispanic community, for wanting to get the vaccine, and this is in our most recent data, is that they knew somebody who had been vaccinated and it was okay. And when we ask questions of those who are hesitant, uniformly across community, the concerns are about safety and efficacy. And so, as we think about the messaging that PBMs can play, that health plans can play, that provider organizations can play, that communities can play, it is about emphasizing the safety and efficacy and providing education around safety and efficacy, and the importance that the vaccine has in getting us back to a life that is some semblance of normal or new normal that is more sustainable than what we have today.
Sree Chaguturu:
And the other key piece is, who should be telling that story? And uniformly what we heard was that clinicians matter. Emphasizing and amplifying the role of nurses, pharmacists, nurse practitioners, physicians in the community is critically important. Amplifying those messages with politicians, celebrities, actors is okay, but the most important piece is the language and messaging from physicians. So again, the role of PBMs is amplifying clinical messages around safety and efficacy with physicians, clinicians, pharmacists first, is really important.
Claire Wolf:
Thank you both, Sree and Elena for being our guests to talk about this very important topic. I want to let our listeners know that this conversation is going to continue in our next episode of The Pharmacy Benefit where we will dig a little deeper into the vaccine disparity issue and what solutions are being worked on in this area. I hope you'll join us for that in the next few days. I'm Claire Wolfen Yarik. Thanks for listening to The Pharmacy Benefit.