>> Maisha Draves, MD, MPH, Medical Director of Pharmacy: Thank you for your interest
in Kaiser Permanente's Approach
to Pharmaceutical Detailing as an Integrated System.
I'm Dr. Maisha Draves,
a Practicing Physician in family medicine
and the Medical Director of Pharmacy in Northern California.
Kaiser Permanente.
Kaiser Permanente has an internal approach
to academic detailing.
Our evidence-based process
is conducted by clinical pharmacist experts
who through independent and thorough reviews
determine the best evidence-based information.
This is done in collaboration with physician specialists
who are actively practicing in their field.
At Kaiser Permanente we then develop our own
evidence-based material and processes
to educate physicians and other prescribers.
We leverage our physician and pharmacy partnership.
We have strong collaborative partnerships
with physicians and pharmacists
to support internal academic detailing.
We identify thought leaders and experts
to work together and create a circle of support.
The engagement and participation allows us
to co-design together
from beginning to end and solidify our unified commitment
and responsibility to evidence-based medicine.
We also limit the influence of sales representatives.
Kaiser Permanente discourages pharmaceutical representatives
and other paid clinicians from entering our facilities.
Any requested information provided
is closely scrutinized
to maintain our strict focus on evidence.
Physicians are strongly discouraged
from accepting free samples or gifts.
We also have very strong conflict of interest policies
for our pharmacists and physicians
that engage in evidence-based reviews
of medication and academic detailing.
It's important that all materials, reviews,
and recommendations are unbiased and evidence-based.
Once our pharmacists and physician experts
have reviewed the evidence and developed recommendations,
documents and tools are developed for use
in academic detailing and for use during clinical care.
We have materials for physicians and other prescribers
such as flyers, posters, FAQs, presentations,
pocket guides, newsletters, and even utilization data.
We also have materials for our patients
such as letters, handouts, posters, and news articles.
We've adapted our dissemination of academic detailing
to match the new technology world around us
and the advancement of telehealth.
We continue to provide academic detailing to physicians
and other prescribers in the traditional in-person venues.
But we also now provide academic detailing
through the virtual spaces, both audio and video.
Our pharmacy and physician team of experts
will meet with broad groups
the achieves groups of specific specialties
at department meetings and with clinical pharmacists.
We also continue to meet in group and one on one.
We also use lunch and learn sessions.
Our evidence-based process is a virtuous cycle
of continuous learning and refining.
We review existing evidence, gather specialty input
and we continue to monitor additional clinical trials,
real world data on safety and efficacy.
And we look at our own internal data.
We revise our evidence-based materials
and education as needed
based on new learnings and as the evidence evolves.
As a result of our committed evidence-based process
and commitment to the physician, pharmacy, partnership
that's conflict of interest fee,
you can see our rates of adherence.
We're successful with our formulary at 97.5%,
generics at 99.77%.
And our biosimilars at 88 to 98%.
A great example of our successful evidence-based
academic detailing process in Kaiser Permanente
are our biosimilars.
We have a commitment with our pharmacy physician partnership
over the past six years to create endorsements
that are evidence-based with key stakeholders.
To develop and negotiate contracts that meet our needs
to vet our biosimilar process for formulary
through our P&T Committee.
To utilize our education to communicate
and provide information to all of our prescribers.
Operationally, we can embed these materials
in our electronic health record
and at direct points of care.
And we're able to implement inventory strategies.
And finally, we're able to track utilization.
We're also able to reeducate and provide academic detailing
when needed and monitor for safety and efficacy.
At Kaiser Permanente
we have the ability to move market share.
This process allows us to deliver at our promise
and great care with over 90% of the given market share
in the biosimilars over a very short period of time.
Kaiser Permanente has 12.4 million members
that represents about 4%
of the covered lives in the United States.
We take very seriously providing
an evidence-based care model
and our internal academic detailing supports this.
Finally, in closing,
some thoughts of of what we need to continue our success
in assessing a drugs value.
On the clinical practice side,
we feel that Kaiser Permanente success
really is by maintaining our strong
physician pharmacy partnership,
promoting evidence-based medicine
and our physician resolve
to avoid the pressures of experimenting
in clinical practice.
On the regulatory side and areas of improvement
that would continue to make our job
of assessing value easier would be tighter standards
on expedited review pathways
to ensure we have adequate evidence on the efficacy
and the safety of a new drug coming to market
without leaving clinicians and patients
with more questions than answers.
A judicious use a of the real-world evidence
in the drug approval process.
Real-world evidence that would compliment
but not replace the data
from adequately designed clinical trials.
And increase oversight over post-market studies.
Ensuring there are no delays
and ensuring that it answers the unanswered questions
so that we can continue to deliver, high value,
high efficacious, and safety care to our patients.
And finally, to deter abuse from the Orphan Drug Act,
we value the great innovations,
but we do wanna make sure
that they are efficacious and safe
when they come to market.
With these changes and our clinical approach,
we feel these are successful principles
to create a fair and balanced method
toward determining value.
Thank you for letting us share our story
at Kaiser Permanente on Internal Academic Detailing.