On January 12th, National Pharmacist Day, we honor the vital contributions of pharmacists nationwide. At CarelonRx, our pharmacists are essential to providing quality care and support to our members. They serve as accessible healthcare providers, offering expert advice and managing medications with precision.
To celebrate their dedication, we interviewed a few of our pharmacists from the CarelonRx Clinical Pharmacy Care Center (CPCC), who were specially nominated to share insights into their roles. At the CPCC, more than 400 pharmacists and technicians are working every day to answer questions from our members, consult on newly prescribed treatments, provide education on medications, and more. For all of us, these truly are the moments that matter in pharmacy care.
Our pharmacists’ responses highlight the personalized nature of their work and the dynamic approaches they use to help improve outcomes, increase adherence, and enhance safety. Join us as we explore their perspectives and recognize the excellence they bring to their work in supporting each member's whole-health journey.
Meet the pharmacists:
Jennifer D,, Pharmacist Consultant, Clinical Pharmacy Care Center
10 years working in pharmacy; 6.5 years with CarelonRx
Philip H., Pharmacist Consultant, Clinical Pharmacy Care Center
18 years working in pharmacy; 2.5 years with CarelonRx
Jihan H., PharmD, AAHIVP, Clinical Pharmacy Operations Manager
14 years working in pharmacy; 5 years with CarelonRx
Samuel R., Pharmacist Consultant, Clinical Pharmacy Care Center
8 years working in pharmacy; 2 years with CarelonRx
Q: How do you work to support the whole health needs of members, beyond the use of their pharmacy benefit? Please feel free to share a specific example.
Samuel: I have talked to several members about their diabetes. Beyond just discussing their medications and how to take them, I discuss their diabetes and how lifestyle choices can affect it. I take the time to review their diet and find areas in which they may benefit from some moderation.
For example, I have talked to patients who were drinking 24 cans of soda a week. They were shocked when I told them they were drinking 2.3 pounds of sugar a week just in their soda. I find that by going deeper into these topics, I can help the member make better informed decisions about their health.
Jihan: Our teams address not only medication-related concerns but also provide resources to bridge gaps in care. For example, we’ve helped members access transportation for medical appointments, connect with in-home nursing services, and utilize telehealth platforms. When dealing with food insecurities, we direct members to local food pantries or facilitate conversations about benefits they might not be aware of. By taking a holistic approach, we ensure members’ overall health needs are met alongside their medication care.
Q: What is the scope of pharmacy care and counsel that you provide on a daily basis?
Jennifer: I am part of the Medicaid Drug Management Program. We call opioid providers to engage in clinical discussions when we are concerned that their patients may be exhibiting signs of potential opioid overutilization. During the calls we discuss the importance of a pain contract, the member’s pain diagnoses, monitoring and compliance issues, the current opioid regimen, MMEs (morphine milligram equivalents), and drug interactions.
We collaborate closely with providers to discuss whether a referral to pain management would benefit the member, what non-opioid options are available to assist with reducing their pain, and the importance of Naloxone availability. Finally, we work in partnership with the opioid providers to determine whether a pharmacy lock-in, prescriber lock-in, assistance from a behavioral health nurse, or physical case management would benefit the member.
Our goal is to confirm that opioids are being used in a safe, appropriate, and medically necessary manner. These discussions are always beneficial, and I enjoy the collaborative approach we take to ensure that our members are safe!
Q: Can you tell us about a defining moment in your work that reinforces the value of connected pharmacy care?
Philip: I recently reached out to one of our members, a schoolteacher, who had been missing a day of teaching every two weeks to visit a hospital-based infusion clinic for her Nexviazyme infusion, a medication used to treat Pompe Disease, a rare congenital condition. I informed her that she could save significant time and money by opting for home infusions, provided her healthcare provider deemed it clinically appropriate.
She was thrilled at the prospect of receiving her medication at home with the assistance of a home infusion nurse on weekends, rather than during the week. With her consent, I discussed this option with her provider, who was more than willing to facilitate an easier arrangement for her. She now receives her bi-weekly infusions at home on Saturdays. Since then, she has joined an Anthem Blue Cross/Blue Shield advisory panel to offer her valuable feedback and insights to the company.
Q: What advice do you offer for members who struggle with medication access?
Jihan: Time to treatment is crucial in preventing disease progression. For members experiencing medication access issues, I recommend reaching out to their provider to explore suitable alternatives that may be more accessible. Additionally, we assist by collaborating with our prior authorization and home delivery business partners to resolve coverage issues or by directing members to manufacturer assistance programs, community resources, or discount services to minimize barriers to treatment. Ensuring timely access to medications is a top priority for our team.
Q: Which aspect of your job would you say is the biggest reason you love what you do?
Samuel: I love working on my team because I get to take the time to look at members with a holistic approach. I can see how appropriate their medication list is, whether they have gaps in care, and provide education about their disease states and medications. I have the opportunity to discuss medication adherence as well as lifestyle changes. Those changes can make their medications more effective or possibly reduce their medication burden in the future.
Jihan: I love to mentor, lead, inspire, and develop future leaders while driving patient-centered care. Helping individuals grow in their careers and seeing how their contributions positively impact patients’ lives is deeply rewarding. Leadership gives me the opportunity to create an environment where collaboration, innovation, and compassion flourish, ultimately leading to improved patient outcomes and team success.
Q: What is one of the most valuable tools or resources that you use to provide effective pharmacy care and how is it relied upon?
Philip: In addition to relying on my own knowledge and intuition, which remain my most trusted resources, I also value technology that helps me to validate, compile, and organize information.
For instance, a key aspect of my role involves identifying alternative in-network care sites for our members to receive their specialty infusion drugs. By finding local sites outside of traditional hospital settings, we can save our members both time and money. Typically, I locate several in-network care sites for a member, near their address, so when I contact the member, I can easily reference the closest options for them.
Q: If you were a medication, what would you be and why?
Jennifer: An antidepressant, because I like to put a smile on peoples’ faces!
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