Charley Zhang currently serves as Manager of Pharmacy Services at Pacific Blue Cross. The 2015 University of British Columbia graduate spent most of his early career in community pharmacies before broadening his interest towards policy development through a role on the Drug Benefit Council for the provincial Ministry of Health in 2019. He joined Pacific Blue Cross in 2022.
What encouraged you to pursue a career outside of the dispensary?
Like many of our colleagues I started working in the community after graduation. I was working mostly in the Lower Mainland, in both independent pharmacies and corporate pharmacies.
As a dedicated pharmacist passionate about my community, I always sought ways to expand my impact on patient care. A few years into my practice, an opportunity arose to serve as a member on B.C.’s Drug Benefit Council for the Ministry of Health. The position involved up to 12 meetings per year. I got to learn about the provincial drug review process, about the Canadian Agency for Drugs and Technologies in Health, and it was around this time that I came to the realization that this path is another way pharmacists can serve patients beyond the dispensary.
Serving patients directly in the community is one way, but we can also make meaningful, impactful changes at the policy-making level. This realization inspired me to look for further opportunities in this area.
I served on the Council from 2019 to 2021 and joined Pacific Blue Cross in 2022.
What does your day to day look like as Manager of Pharmacy Services at Pacific Blue Cross?
It’s very different from community practice. My main focus is managing drug formularies, using evidence-based principles. This means making sure the medications are safe and effective, having evidence to support their use and providing plan sustainability. After reviewing the evidence, we present it to our internal teams. In addition, we may also reach out to local, national and international experts to help guide our decisions. We map out the patient journey, try to make it as simple as possible, and we also map out the prescriber and the pharmacy experience, striving to simplify a very complicated and convoluted drug reimbursement system due to many historical practices.
We also focus on education, both internally within Pacific Blue Cross and externally with our stakeholders. For example, internally we will work with our claims teams and the call center to educate them on the biosimilar initiative. Externally, we inform and educate our members, advisors, consultants, brokers and plan sponsors on various aspects of therapeutics including the value of using evidence-based principles to make formulary decisions, analyzing drug trends and utilization, and keeping up with legislative changes such as national pharmacare.
In making our decisions, we’re looking to make sure that we provide drug coverage that looks after patients, while keeping health and drug benefit programs sustainable for our plan sponsors.
We take a comprehensive approach to optimizing various aspects of drug coverage. We analyze drug trends including drug spend and utilization, and work with various internal teams such as our actuarial team to help inform future policy decisions. We work with our coding team to ensure a good member experience when looking up drug coverage via the drug look up tool. Additionally, we work with our digitization team to see if we can automate to improve efficiency for all our stakeholders. We also work closely with our marketing team to ensure that our drug-related information is easy to read and understand on our website and in our newsletters.
Do you work alone, or as part of a team?
We work in a team. I report to the Director of Pharmacy Services, who is also a pharmacist, and I oversee a team of two pharmacy services analysts, who are a mix of pharmacists and pharmacy technicians.
Our team connects daily, and we work in a hybrid model, where some days we meet in the office and some days we connect remotely.
We’re all from the pharmacy profession, but we come from different backgrounds. Some of us have experience in hospitals or have worked with different public health agencies, while others have community pharmacy experience. Our diverse background helps to enhance the team’s expertise.
Meet the Pharmacy Services team at Pacific Blue Cross: Pharmacy Services Manager Charley Zhang, Pharmacy Services Analysts Kelsey Mallar and Cody Horne, and Director, Pharmacy Services, Anar Dossa.
Why do you think it is important to have clinical expertise represented at the policy-making level?
There is perhaps a misconception that insurance is here to cover everything: that if government coverage is not available that private insurance is there to cover it.
But the reality is that not all drugs provide value. For example, in the autoimmune space, biosimilars provide more value than originator biologics. The drug landscape has changed so much in recent years; one out of every two drugs is a high-cost drug. Stewardship and oversight are needed to keep drug plans sustainable, and this is why clinical expertise is needed at the policy level. Without this expertise, private drug plans could become more restrictive or even get terminated, which leaves patients on the receiving end of the consequences.
So it’s crucial to have someone like a pharmacist with prior experience in critical appraisal and drug review, as well as an evidence-based mindset to do this work. Doing our job well means patients are getting care that’s evidence-based, cost-effective and sustainable. I think that’s something significant and often overlooked. Our guiding principle is to ensure people have access to the right medication at the right time, for the right indication, at the right dose, and finally, at the right price.
Was there anything that surprised you about the private insurance sector?
Before entering the health benefits industry, I shared the misconception that insurance companies primarily seek profit. However, my experience at Pacific Blue Cross has significantly changed my perspective. I’ve come to understand that Pacific Blue Cross is unique, we operate as a not-for-profit entity, unlike many competitors, and we are committed to ensuring that the right medication reaches the right patient. This principle guides our work. We emphasize evidence-based drug listings where only medications that are efficacious, safe and cost effective are included. This approach allows insurance plans to be sustainable, which means patients can consistently benefit from reliable coverage and access to necessary medications that have evidence and will benefit them. We also ensure plans integrate with provincial coverage. We are very lucky in B.C. to have access to good drug coverage and we integrate where possible to ensure plan sustainability, to ensure our members have access to drugs well into the future.
If you were speaking with pharmacy students interested in a career in private insurance, what advice would you give them?
If you wish to pursue a career in policy-making, learn and practice evidence-based medicine. Take opportunities to participate in journal clubs or drug reviews to sharpen your skills. Share your learnings with your patients and other stakeholders and ask questions. RxFiles has some great resources, they also have an annual conference. Therapeutics Initiative also has good information and conferences.
I think most of us pharmacists who go into the profession have very strong compassion for the patients that we serve. We want to do something for the health and wellbeing of our patients, and we’re moved and compelled by the stories our patients tell us.
With this kind of role, you get to do that at a broader level, at a population level, and at an individual level.
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