The Benefits Playbook

Pharmacogenomics and Personalized Pharmacy Care with Jessica Lea, Founder & CEO of Tria Health

Episode Summary

This episode features an interview with Jessica Lea, founder and CEO of Tria Health. Jessica is passionate about pharmacists providing patient-centered care to improve the health outcomes of patients. She has a Doctor of Pharmacy degree from the University of Missouri-Kansas City, maintains board certification in psychiatric pharmacy, and has an Executive Masters in Business from Rockhurst University. Jessica is a healthcare innovator and has been recognized as one of the PharmaVOICE100. In this episode, Sasha sits down with Jessica to discuss the revolutionary study of pharmacogenomics, the craze around weight loss drugs, and how Tria Health supports its members.

Episode Notes

This episode features an interview with Jessica Lea, founder and CEO of Tria Health. Jessica is passionate about pharmacists providing patient-centered care to improve the health outcomes of patients. She has a Doctor of Pharmacy degree from the University of Missouri-Kansas City, maintains board certification in psychiatric pharmacy, and has an Executive Masters in Business from Rockhurst University. Jessica is a healthcare innovator and has been recognized as one of the PharmaVOICE100.

In this episode, Sasha sits down with Jessica to discuss the revolutionary study of pharmacogenomics, the craze around weight loss drugs, and how Tria Health supports its members.


“We're starting to get to a place where we have a better understanding of more medications that we know are affected by the way in which your body may metabolize or not metabolize the medicine, as it relates specifically to your DNA. The other thing is that not only have we gained more understanding of more medications, but we've also gotten to a place where it's a little more cost-effective in testing the right people who we believe would benefit from this.” – Jessica Lea


Episode Timestamps:

*(01:24): Jessica’s career background 

*(04:31): How Tria Health supports members

*(14:51): Jessica dives into pharmacogenomics

*(27:50): How pharmacy and medical interact 

*(32:07): Jessica’s thoughts on weight loss drugs

*(41:32): Jessica’s advice for those starting their own businesses



Learn more about Tria Health

Follow Tria Health on LinkedIn

Connect with Jessica on LinkedIn

Connect with Sasha on LinkedIn

Learn more about Collective Health

Episode Transcription

Sasha Yamaguchi: Let's face it, healthcare is confusing and costs are continuing to rise. Employers are looking for ways to improve the health of their people and their bottom lines. The good news? Many leading companies are leveraging self funded health plans and innovative benefit solutions to do just that. Learn from some of the best minds in employee health.

Sasha Yamaguchi: Welcome to the Benefits Playbook, strategies for self-funded health plans. I'm your host, Sasha Yamaguchi, commercial leader at Collective Health. On today's episode, we are joined by Dr. Jessica Lea, founder and CEO of Tria Health. Jessica is passionate about pharmacists providing patient centered care to improve the health outcomes of patients.

Sasha Yamaguchi: She has a doctor of pharmacy degree from University of Missouri, Kansas City. maintains board certification in psychiatric pharmacy, and has an executive master's in business from Rockhurst University. Jessica is a healthcare innovator and has been recognized as one of the Pharma Voice 100. Thank you so much for being with us here today, Jessica.

Sasha Yamaguchi: I'm really excited to have you.

Jessica Lea: Thanks for having me. I'm excited for today's conversation. 

Sasha Yamaguchi: Great. So I always love to start, you've been in the industry for over 20 years. I would love to hear a little bit about your career journey. And then of course, how did you get to where you're at today?

Jessica Lea: Sure. Yeah. I, um, actually graduated from pharmacy school and decided to pursue some additional training.

Jessica Lea: So I did residency and fellowship training in the psychiatric world, which was my passion when I first left school. And that sort of parlayed me into the world of education. I've always been. Big on the more you learn, the more you know, the better off things can be. And so that, that kind of moved me into a world where I went into academia and I was teaching pharmacy students.

Jessica Lea: And I had the opportunity during that time to work alongside physicians and have pharmacy students. be able to, you know, work with me and work with physicians to work with people who had multiple medication problems. And so I was always getting the challenging patients who had like 10 plus medications, were really struggling with understanding how their medications worked.

Jessica Lea: And that opportunity really parlayed me into sort of where Tria Health is today. I took a little stint working in the managed care industry and worked and a Pharmacy Benefit Manager. And that was where Tria Health was born. I was working with a small municipality at the time. That small municipality back in 2008 and 2009 was really struggling with the launch of what was happening during that time in the diabetes management arena, was there some very expensive diabetes medications that were launching.

Jessica Lea: Sort of funny to say that now because we're seeing even more expensive. drugs launching into that category. But what they were struggling with was people still having challenges in ensuring that their diabetes is well controlled despite the cost of the medications being spent and whatnot. So that really sort of became what Tria Health is today, which is using pharmacists in the role of helping patients ensure that they get the best outcomes from their medications and really helping to recognize that employers are Largely responsible in this sort of market in the United States of paying for this.

Jessica Lea: And obviously human capital is really important to employers, but how can we help at Tria work alongside the employers who are trying to provide good benefits to their employees? but also work alongside the patient who really needs to have more understanding and education how their medications work, how their disease states work, and how they can achieve healthier lives not just with medications but lifestyle changes.

Jessica Lea: So that's kind of where Tria began. 

Sasha Yamaguchi: Well, that, that's amazing. And I feel like that ties to what you said in the beginning about why you started in the more people know and the more they learn, the better off they are. And sounds like this ties straight to Tria of, you know, understanding your medications and the combination.

Sasha Yamaguchi: And I'm excited to talk a bit more about that because I definitely know people that are taking multiple and I will hear them say. You know, I'm on a new medication, and so my old one's not working the same, and so I'm excited to dive into that a little bit more. So I love that you jumped into why you created Tria.

Sasha Yamaguchi: I would love to, do you share a bit more about really how you're supporting patients and members? And I also want to talk about the employer aspect, but how is Tria supporting the patient and the member? 

Jessica Lea: Sure. Well, we're really trying to reach out and find the members that are, you know, really on multiple medications, multiple chronic conditions, multiple problems.

Jessica Lea: And you know, it's kind of cliche, but we always talk about, you know, the 80 20 rule with 20 percent costing. And sometimes it's, some people argue that it's a 10 percent rule, but 10 to 20 percent of your spend comes from a very small portion of your people. But the reality is that we have, you know, people who have multiple.

Jessica Lea: chronic conditions and multiple medications, it becomes very confusing and challenging. At TriaA, our average patient has 10 medications and that sometimes does and doesn't include the over the counter and supplements that they're taking in addition. And so I think what we are hoping to do for people is to begin to sort of clarify where they're at.

Jessica Lea: And where they're going. So making sure we, they understand each of their medications and how it works and how they're trying to achieve the goals of what they want to achieve and the physicians want to achieve with the disease states. When you talk about complexities with diabetes, with heart disease, with hypertension, we know that about 50 percent of the time people are getting the outcomes they expect with their medications.

Jessica Lea: We shouldn't be settling for 50%, you know, if you're going to take an expensive medication or even a cheap one, you want to make sure you're getting that blood sugar reduction. or your blood pressure reduction or stroke reduction. So, really what we're doing is pairing up with these members, working alongside them, helping them to understand and spend 40 plus minutes with them, understanding their medications.

Jessica Lea: You know, physicians have about seven minutes to prescribe and diagnose. That's not long. 

Sasha Yamaguchi: To that point, I was just about to say providers, right? So a member is on 10 medications. Within that, on average, how many providers are they working with? Probably at least three or four, right? 

Jessica Lea: Yes, you've got it. Three or four, like three or four.

Jessica Lea: And what happens is that you sometimes will have a primary care provider, and then you'll have a specialist, like a cardiologist. And then you might have endocrinologist or rheumatologist and the challenge is that they all have their own silo that they're working in and everyone's sort of So, I wouldn't say afraid, but everyone's sort of uncertain about stepping on other toes.

Jessica Lea: And so what we do a lot for these members is try to help them piece the puzzles together, the puzzle pieces together, so that they can really understand how to ask the right questions and how we can maybe act on their behalf as an advocate of, you know, gosh, this medication is actually interacting with this medication and therefore you're not getting, you're not the outcomes you expect.

Jessica Lea: You're not getting the blood pressure lowering or you're having side effects and that's why we need to do it. And so we can really help the member, make sure they're armed with the right questions. But then we're also sort of helping the physicians understand from the pharmacology range what's going on.

Jessica Lea: You know, physicians are, they're challenged with lots of things. You know, pharmacists spend, Six years in pharmacy school learning pharmacology and how medicines work and physicians get a short stint of about a year. And so we're really medication experts designed to be alongside this provider, a prescriber, whatever is particularly going on to make sure that that member is really getting where they need to be.

Jessica Lea: And it's becoming more complex. 

Sasha Yamaguchi: No, I agree and I just listening to you cover this and for the audience, you know, those out there that aren't on multiple medications. I mean, again, you've got patients, members taking multiple medications, multiple providers to navigate, the pharmacist. also can't take the time to combine it all and then help a member decide what's going on.

Sasha Yamaguchi: So it's pretty amazing to hear how Tria is kind of that overarching, right? That one area that can help a member navigate All of it. Hey, go talk to provider A and let them know this. And I think that's so important because people, I mean, to have to manage multiple medications, understand how they're working while still dealing with however they're feeling.

Sasha Yamaguchi: I mean, that's a lot to put on somebody. 

Jessica Lea: For sure. And it's just complex. They get, you know, prescribed a med and they're kind of sent on their way. And then, unfortunately, you know, the way in which we've sort of, Set up dispensing processes in this country. You don't get to spend a lot of time with the pharmacist there.

Jessica Lea: So that's really why we do what we do, because the other thing that I think is really important is if you are diagnosed with, for example, diabetes and maybe, you know, two people have the same diagnosis, the thing is that they're so individual and different. Because of their attitude, their beliefs, their behaviors, their lifestyle, the different other conditions they have, the different medications they have, the reality is, is that it has to be so individualized, which is the other layer that I think Tria really emphasizes is that you can leverage technology to understand data around people, leverage understanding what medications people are on and run algorithms.

Jessica Lea: But at the end of the day, I need to talk to you to figure out what's going on with you so that we can begin to piece through this. Plus, I think people really love to, to be cared for and feel that, and that's still really important part of healthcare. So Trey Health's emphasis is. Putting a pharmacist in the role of advocating for you but also educating you and also providing the care you need to achieve the outcomes related to your health.

Sasha Yamaguchi: No, and it sounds like, I mean, members quite literally get a personal pharmacy advocate, medication advocate, right? 

Jessica Lea: Exactly, yeah. 

Sasha Yamaguchi: And so do you ever see somebody needs a, maybe they need to switch a medication, have you found that if you notice there's one they're not on that they need, do you also give them that advice of, go back to your provider, we think this may also help you?

Jessica Lea: Yeah, for sure. I would say that that kind of recommendation and then coaching happens not only with the member, but also we will on behalf of the member, if they choose, call the prescriber to discuss maybe options. But you know, the thing that I think no one remembers that we do a lot of, and it's important to, to remind people is that we're also helping people get off medications.

Jessica Lea: You know, I think a lot of times people think pharmacists are all about pushing the meds. And I think. You know, intuitively, ironically, we as healthcare providers and in our disciplines and backgrounds believe that, you know, medications have a role, but the less medications and the more simplified your regimen is, the better off you are.

Jessica Lea: So we're doing a lot of what we call deprescribing, you know, especially when you can work alongside somebody, for example, with diabetes and help them to potentially lose weight and they're losing weight and they're making better choices with their nutrition. That allows. It's us to maybe consider, hey, physician, like endocrinologist, let's move back on one of these medications because this person's doing the lifestyle things that they need to do now.

Jessica Lea: It's been a fun journey over the last 15 years, being able to say that we also contribute to a lot of deprescribing. The other thing that happens is sometimes a side effect will occur with your medication and then a doctor will add another medication. So then you have, A medication and a side effect medication.

Jessica Lea: And so we're also helping people understand how those side effects can be reduced or maybe other alternative medications that don't have side effects. There's a lot of that that occurs as well. So I appreciate that sometimes that's not something people think about, but that is really important part of what we do.

Sasha Yamaguchi: I think that's a huge part of what you do, deprescribing. I mean, I, cause I'm thinking, you know, again, providers have only so much time. I don't think they're. proactively able to say, Hey, how do we get you off this? Right. They're just going to most likely check in and say, how's it working? How are you feeling?

Sasha Yamaguchi: But if you all see that maybe it's okay to step back from one, I think that's great that you're working with members on that as well. 

Jessica Lea: Yeah, that's also where we leverage maybe some of the technology, being able to like watch an individual who's maybe testing their blood sugar and we're getting the readings on a regular basis and we're helping them to understand their trends or even blood pressure, you know, watching your blood pressure trends.

Jessica Lea: We get the cellular readings back to the pharmacist and they're able to really help the member understand what their readings are meaning and then also navigate the conversations with the prescriber. Yeah. Yeah. 

Sasha Yamaguchi: Amazing. And I know we'll get into this a bit, but from an employer standpoint, from an HR standpoint, I would think this is so valuable so that employees, just knowing they have this extra support, but also for the employer to know that.

Sasha Yamaguchi: It's going to help their employees, help their dependents, but also, you know, just the utilization of the plan, right? Making sure the right medications are being used, and I could see this being a huge value for companies to have this as a offering.

Jessica Lea: Yeah, I mean, I think for us, a couple things. One, I think what we pride ourselves at Tria Health in doing is also trying to understand the challenges that the employers are facing.

Jessica Lea: And we know over the years. And you obviously are well aware of this as well. There's varying degrees of things that come up as challenges for employers. You know, several years ago, we talked a lot about specialty medications and the rising costs of these specialty medications that were really targeted and biologic and expensive.

Jessica Lea: And we were Trying to figure out how to solve that problem. And now we're leading into this world of obesity medications and the high cost around obesity medications. And then a few years ago when COVID was hitting, we were really talking about mental health and how to make sure that we were taking care of our members as it related to their mental health.

Jessica Lea: And so, Each of those times that those conversations come up, sometimes it's not cost related. A lot of times it is cost related, but sometimes it's just how do we begin to understand how to help our members use these medications for the right people in the right time and being able to hear our employers say that and then understanding how we can help them educate their membership on that is really important.

Sasha Yamaguchi: No, definitely. I mean, again, more education, it just helps the members so much. So I want to get into a topic that I will say I'm not super knowledgeable on. It's new to me and I can't wait for you to share with the audience about it. But I want to talk a little bit about pharmacogenomics, which audience, it's a interesting word to say, and I can't wait for Jessica to share with everyone about pharmacogenomics.

Sasha Yamaguchi: But you recently wrote about it. And I know it's very important, so can you touch on what it is and then, of course, how does it tie into everything that we're talking about today?

Jessica Lea: Sure. Well, first of all, pharmacogenomics is a word that is complex and scary, but reality is it's, it's a concept that as pharmacists, we've talked about for years, and it's really like leveraging people's individual DNA and how.

Jessica Lea: It affects the way in which your body responds, interacts, or processes medications or over the counter things. And so, you know, it's been around for a long time. There's been many years where we understood that certain people metabolize drugs differently and maybe had a different response. But it wasn't until probably the last several years that The testing for the genetics and then the number of meds that we were able to understand how it worked due to the large work of some amazing people working on the, the human genome project and understanding how pharmacogenomics interacts with medications, we're starting to get to a place where we have a better understanding of more medications that we know are affected by, um, the way in which your body may metabolize or not metabolize the medicine.

Jessica Lea: As you relate. specifically to your DNA. And, you know, the other thing is, is that, so not only did we, have we gained more understanding of more medications, but we've also kind of gotten to a place where it's a little more cost effective in testing the right. people who we believe would benefit from this.

Jessica Lea: And so it's, it behooves certain individuals to consider testing so that they can improve their outcomes. And so cardiovascular was a big area. It's probably one of the first areas that we sort of parlayed into for pharmacogenomics, particularly around a drug called Plavix. Plavix is a drug that we utilize.

Jessica Lea: To thin the blood to prevent clotting after risk of stroke or around risk of stroke or clotting related diseases. And we know inherently that some people, when you take that, it's basically like taking a sugar pill because your genetics don't process it. But the way we handled it before we were very familiar with pharmacogenomics is we would just.

Jessica Lea: Ensure that you run multiple blood thinners, which may increase your risk. Or you may be the person that that just didn't work for. We just didn't know it. The other disease state that we do a lot of this in is mental health. And I think for anybody that has known someone with severe depression or anxiety, it's not uncommon for that individual to have been on a journey of three to four or five different.

Jessica Lea: medications in the arena of treating depression and anxiety. And the reality is we know that people process mental health medications differently and they respond differently. And there may be one drug they respond to, and there may be five that they don't. And historically what we've done is we've just done trial and error and try to med, see how it works for four to six weeks.

Jessica Lea: If it doesn't improve, we make. Change meds or add meds. And that is where sort of sometimes the complexity of polypharmacy and psychiatry has always been a challenge. And so obviously this is a huge passion of mine because when I first worked in psychiatry, we had people on six to seven medications for depression and that is just ridiculous.

Jessica Lea: So. 

Sasha Yamaguchi: Yeah, that's a lot. 

Jessica Lea: Yeah, so it's been good to be able to utilize, so someone who's had multiple failures of antidepressants would be a great person to invest money in genetic testing on so that we can look at the way their body processes these medications and be able to make sure that when they get prescribed the medication, they're getting the right medication for them and hopefully the response is faster and therefore they feel better faster, they're more productive and we're in a situation where we're not waiting years and years and years to get a response.

Sasha Yamaguchi: You just hit on something that really got my attention, because you think about somebody, right, they're struggling, and so let's take the mental health example, they're struggling and they want to feel better as quick as possible, and yet they could go months of trying drugs or prescriptions that aren't helping, and so I can only imagine the frustration, right, and then Just, it's not working, so then they're even more stressed, and so it sounds like something like this, which is able to get a member to the right prescription, or at least closer to the right one, very, very early on, I would think would be just so impactful, because I can't imagine somebody having to try even one year of trying to get the right medication and still feeling off, right?

Jessica Lea: Right, for sure. So that's huge. Yeah. Yeah, and I would be remiss to not, like, say that I'm kind of focusing on, like, the efficacy of medications, but the other thing that we can do with these drugs is really focus on if there's a drug that maybe someone can't metabolize and it's a toxic drug, you know, that's, those are the people that are going to the ER because they're having some type of event and it really ends up being related to the medication.

Jessica Lea: I mean, there's toxicity. Hypersensitivity, efficacy are all around this. Now, I would say that at the end of the day, I'm not a big advocate on everybody. I mean, if cost was never an issue and you wanted to be tested for pharmacogenomics, I think that's great. But I think in terms of looking at an employer's protection to the plan, in my opinion, focusing on the right people, Population where you can get the best bang for your buck is really important here.

Jessica Lea: And that's what we focus on here at Tria Health is just making sure that if we recommend testing, it's because the person has the right combination of either medications or situations or conditions to make sure it happens. That's another important component of it as well.

Sasha Yamaguchi: That makes sense. And I would love to touch on the employer aspect a bit more.

Sasha Yamaguchi: We're obviously talking about, and you started the company to help people with their medication, but let's touch on the employer side, because I think, especially for our audience, there's a lot of employers, a lot of brokers, consultants, so Talk about the testing a little bit and then how it helps employers not just reach their population, but how does it help the employer plan, the health plan that they're running year after year?

Jessica Lea: Yeah, so this is the way that we at ATria Health administers like the pharmacogenomics testing. We're really looking at the opportunity one to utilize someone who's already got an established relationship with the pharmacist. So they've established a relationship with one of our ATria Health pharmacists, the pharmacist in in the adventure of and the discovery of So, um, I'm going to go ahead and get started.

Jessica Lea: Service for the right person, right? So instead of going across a population and saying, we're going to test everybody and then tell everybody what they may or may not be able to process, let's start where we really can focus on making actionable items and actionable steps. So, you know, if you have someone who is on multiple antidepressants and they have been suffering from depression uncontrolled for some period of time, that's a great target for educating them on that opportunity.

Jessica Lea: It's a simple test that gets shipped to your home where you do a cheek swab. And then that gets returned. And then what Tria Health also does is, unfortunately, the good news is, is you get provided a large amount of data about every medication that could ever potentially affect you. 

Sasha Yamaguchi: Wow. Wow. That's great.

Jessica Lea: The bad side is there's like, you know, millions of pages that are really hard for anyone to process. So what Tria Health does is obviously give you the access to it. So, we're working with you to understand which pieces of that puzzle of your DNA are going to be actionable now, and how can we continue to watch for you and protect you as you move forward.

Jessica Lea: So, watching medications that come down the pipeline, or understand which disease states maybe you have medications that are targeted or affected. The other piece that we're really doing a lot of is helping the physicians understand the pharmacogenomics. interpretations as well. Not every physician has the time or has the capability or capacity to read a, you know, 35 page report on genetic testing.

Jessica Lea: And so we're really helping have conversations. I mean, we've got examples of situations where we got on a conference call with You know, the psychiatrist and the member to help them understand where the information was coming from. And it resulted in an outcome of the member achieving the goal of remission with their depression.

Jessica Lea: So, that's the kind of stuff that's kind of tedious and hand holding, but really important to achieve the outcomes. And at the end of the day, ATria Health's Focus is really that we need to do what we have to do to make sure that people get what they need. 

Sasha Yamaguchi: That's great. And I was going to ask you to share a real example.

Sasha Yamaguchi: So, got the psychiatrist, the member on the phone. How are you interacting with the pharmacist? So, let's say that you need to reach out and to your point, there's so much information out there. So, you're trying to help them. Is that a phone call? Are you sending them a report? Is it by member? 

Jessica Lea: So, after someone's testing information comes back.

Jessica Lea: We will have another consultation with that member to kind of go over the results, just high level results. And if there's any actionable things, obviously we want to discuss whether or not that's something that the member wants to tackle or approach, you know, sometimes it's like, okay, you're on this particular medication and it appears as if your body is not metabolizing it correctly, are you having any problems?

Jessica Lea: And if you're not having any problems, then. Sometimes it doesn't make sense to fix something that isn't broken, right? So helping them to interpret the information and then if they want us to talk to their doctor on their behalf, we will, but we also sort of, chop that information into bite size, snackable things that they can actually do actionably, so that it's kind of one step at a time.

Jessica Lea: Cause the other thing is, is that you don't ever want to rock somebody's medication regimen by the tune of three to four things. You want to, you know, Stepwise approach to it, yeah, because otherwise then you don't know what worked and what didn't work. So, yeah. 

Sasha Yamaguchi: It reminds me of when I had my babies, right?

Sasha Yamaguchi: And when they started eating food and, you know, give them a little at a time or back out so that you know what they're reacting to, right? 

Jessica Lea: Exactly. That's exactly it. Yeah. 

Sasha Yamaguchi: Yeah, as you're sharing more and more, it's just, in my mind, I'm thinking how helpful this is for people to really understand what they're taking, how it's interacting, and just, this could not be more impactful to members as I, So, this is great work that you're doing with employers, with patients, with pharmacists.

Sasha Yamaguchi: So if I'm an employer, and this is interesting to me, do you meet with them and look through their data and say, yes, our program would help? 

Jessica Lea: Yeah, I would say that with pharmacogenomics specifically, we can always sort of give an estimation of the number of individuals that we would be focusing on based on what we experience and even running data to understand that. But I would say that with most employers, you know, you start with the whole pharmacy advocacy program being the first.

Jessica Lea: The fundamental portion of what you do and then have the opportunity for the pharmacist to leverage maybe pharmacogenomics if they're talking to someone that they need that with. That really also helps us to funnel through to ensure that we're getting the best outcomes for that member as well. Once again, I'm not a fan of line everybody up and test everybody.

Jessica Lea: And throw a bunch of data at people, that's just not very protective of the plan dollars at the end of the day. But, you know, we would be happy to, one, educate the employers more on how this works for them in terms of how we approach it, and then also consider sort of really what it means for them in terms of the number of people that we really believe we will touch and drive outcomes on as it relates to their population and their drug mix too, their disease and drug mix.

Sasha Yamaguchi: Yeah. That's great. One thing that you and I have spoken about that I want to hit on before I get into some industry trends is we talk so much about pharmacy and obviously over the years, it's become, I would say, the main topic in meeting with employers and talking about their plans, but share with the audience how You know, you've got the medical side of it, and you've got the pharmacy side of it.

Sasha Yamaguchi: And it completely interacts and is tied to each other. I would love for you to share just for a moment about how you look at a member and their pharmacy and their medical, you know, interact with each other and affect, right, affect both sides.

Jessica Lea: Yeah. I mean, when I started in managed care, you know, about 17 years ago, I think one of the things that I was really charged and focused on at that time was really focusing on cost of pharmacy, right?

Jessica Lea: Medications, finding the lowest costing medication with the best outcomes was really what I was focused on. And at the time when I was working with employers, I think we really talked about pharmacy rising costs and how we could. Utilize utilization management programs to try to, you know, ensure the right drug for the right person, you know, so quantity limits and prior authorization and things like that.

Jessica Lea: But I think the piece that we're seeing more and more is how intertwined the utilization of medical and pharmacy is. Now, obviously, taking aside that Right now, you and I are not going to solve all of the challenges around pricing with pharmacy, right? Like, we're not going to solve the pharma pricing challenges or even get into that discussion today.

Jessica Lea: But what I think is important for employers to consider is that if you do have someone who has a chronic disease, them being on the right medication for them, That gets them the goal of reducing their symptoms or achieving the goal of reduction of blood pressure or reduction of blood sugar if they're diabetic.

Jessica Lea: That is what leads to the member utilizing less medical, right? If you can get that person to goals. Which I know goal is such a big word, right? And it's individualized. Everybody has a different goal. But if you can get them to achieve outcomes related to their disease state, then you are going to help that person utilize the medical system less.

Jessica Lea: So, it's this combination of diagnosing and getting the right diagnosis, and then getting the right medication and the right nutrition and exercise and non pharmacological approach to that member that leads to overall success. Health. And then health plan health, right? Like, we need to try to continue to work on achieving the goal of healthy individuals in your plan.

Jessica Lea: And it's one step at a time, but you can't look at those silos separately. They're so intertwined. And at the end of the day, if you got rid of a big class of drugs because they were expensive, but they were the ones that were curing a disease, then you're missing out on the point of, you Reducing your medical costs potentially with that.

Sasha Yamaguchi: That's such a great point, and I feel like I could be wrong, but years ago, the hepatitis C drug would fall into that, right? Employers did not want to cover it because it was very expensive, but that drug could save someone's life, right? Or obviously drastically reduce their symptoms over the years. 

Jessica Lea: Yeah, for sure.

Jessica Lea: And that's a, you hit the nail on the head with a great example. Now I think the challenge is, is that we are going to start seeing in the pipeline and people are starting to talk about it. I don't know if you've heard about this, these like gene targeted therapies where they're saying these drugs are going to truly like, Cure the disease.

Jessica Lea: And the problem is, is that the dollar signs that are being attached to that are so unfathomable for employers. So there's gonna be a balance of understanding, like what's truly curative, what's not curative. There's a balance of all of this, and I'm not, Trying to just, you know, dismiss the fact that things are expensive, but there is a balance of ensuring that the right medications are being utilized for people.

Jessica Lea: And sometimes it's not expensive meds, but just giving them what they need to achieve the outcomes so that you aren't having that reoccurring hospitalization or that reoccurring ER visit. So, yeah, I mean, it's complex for sure. Isn't it? 

Sasha Yamaguchi: No, it definitely is. And I think, Just, you can have a drug and promote that it is, right, it'll cure and put whatever price tag on it, but is it true?

Sasha Yamaguchi: You definitely need to look at that balance. I think, ironically, this is a perfect segue into our next topic of expensive drugs and how effective and who should be on them. I think everybody listening is probably very familiar with this latest trend. Best industry trend, just trend in general, of Ozempic, Wegovy.

Sasha Yamaguchi: I know some people have really, really benefited from these medications, but curious for you to share, you know, your thoughts on these prescriptions, these drugs. What are you seeing and how are you handling this? I'm sure you also get asked about it all the time, but what are your thoughts on these medications?

Jessica Lea: Yeah, it's a conversation I get asked both at work and at home all the time. I'm sure, I'm sure. Yeah. So, you know, here's the thing, like we, so GLP-1s have been around for some time. Like we've had them, we've had versions of the GLP-1 hormone targeting medication for some time, but a couple of things have caused it to gain notoriety.

Jessica Lea: One, obviously, uniquely these drugs work in diabetes and that's where we got our first sort of foray of these drugs is that we noticed they were helping to reduce blood pressure. blood sugar, and, but they were also having a side effect or a consequence, for lack of a better term, of significant weight loss and cardiovascular pretension, protection.

Jessica Lea: And so in 2021, the American Diabetes Association changed their guidelines to, to move up GLP-1s in the line of therapy. So, you know, it was no longer like, last choice resort, they were moving it up because of the efficacy. And I think that sort of launched a larger utilization of those drugs in diabetics.

Jessica Lea: So we started to see the climb of the utilization of those drugs in 2021 for employers. But then the other phenomena that we had was one, obviously, the approval by the FDA of the drug. Ozempic, sister, the same drug, semaglutide, to approve Wegovy, which was now for the treatment of obesity, simultaneously with this media phenomena of celebrities having phenomenal results.

Jessica Lea: And here's the thing. These drugs work for the right people in the right situation. But every drug, no matter what we talk about, has consequences and side effects and the balance of what the good is with the bad. The pros and the cons have to be weighed and they should be done. With that goal in mind of what we want to achieve, and I think for employers, a couple things are going on.

Jessica Lea: One, you know, the coverage of obesity medications is variable across self insured plans, for sure, right? Some even weren't even aware that they were covering this category of drugs because up until this point, the anti obesity drugs that we had were not very effective. They weren't really achieving these 15 to 20%.

Jessica Lea: weight loss reductions for people, and so people weren't really taking them because they weren't really effective and they had tons of side effects related to cardiovascular issues and whatnot, and so they may have been covering them and had no idea because the utilization just wasn't there. So then when we get this media craze and everybody and their friends out in the community have tried it or taken it, then it becomes like a conversation that we're now talking about on Irregular Racist, and so some employers are really struggling with.

Jessica Lea: Now we have this huge utilization increase related to these drugs. How do we handle it? And here's the thing, you know, I think we would be remissed to recognize that obesity is a complex disease. It is not a one size fits all, nor any disease states, right? Like you can't just say, Oh, well, you need to just eat better and exercise better.

Jessica Lea: Well, that's a component of it. But for some people, there are other components to their obesity challenge or their obesity journey. Sometimes there's psychological dependence or, um, psychological relationships with food. Sometimes there's truly the lack of the hormones that you need in your body to say, you're full, you need to stop.

Jessica Lea: And so, I think for employers, they need to consider having a program that allows for members to understand the ways to. Make choices related to nutrition and exercise and how to have a lifestyle change related to that, that comes with some of the behavioral changes that are necessary, but there is going to be a need at some point to maybe for some of these employers who have the ability to maybe put this into their budget, giving access to these obesity medications for some people, and that's the key.

Jessica Lea: Who are the right people? And there's no right answer for any employer because at the end of the day, it kind of comes down to what your budget allows. Let's be honest. We all at home think about that, right? What we have in terms of our budget and what we can and can't afford. But I do think the right obesity management program for an employer is one that has sort of a component of, for everyone, whether you go on meds or not, of, Lifestyle changes and the need to choose the right foods, choose the right quantity of foods, learn about your body and how that reacts.

Jessica Lea: And then also what movement goals we need to do to achieve the best outcomes. And then maybe for some people who are in that highest obesity category, Who've tried that for some time, maybe access to the medications if that plan can afford it. And I think at the end of the day, these are not like easy button drugs.

Jessica Lea: And I think people think they are. Oh, they definitely think they are. Oh, I mean, we think that's the, that's the magic bullet and it's not. It's, they have so many side effects. I think I'm also, as a pharmacist, extremely worried about the number of off label uses. And I mean, I don't know about you, Sasha, but like, you can get these drugs

Jessica Lea: for cash through almost any medical spa. And what I'm probably most worried about as a pharmacist is people recognizing that these are still drugs that have challenges and problems to them. And the easy button isn't the way for long term success. So the other question that I get all the time is, do you have to be on these drugs forever?

Jessica Lea: Here's the answer. I don't know that we know the full answer yet, but I as a pharmacist would hate to believe that a drug has to be forever. So it's really approaching these medications with the mindset of, I need to learn how to eat right for my body to control my weight in a way, and these drugs are going to help me maybe get the launch to lose the weight, and then I need to change and continue to focus on lifestyle changes.

Jessica Lea: So, lifestyle along with the medications is the only way that these can be successful, and if that's not happening, then we're gonna, we're setting ourselves up for a recipe for these people being on these meds for a long time. 

Sasha Yamaguchi: Yeah, and I, I feel like to that point, two things. One, People don't realize how they're going to feel when they stop taking them.

Sasha Yamaguchi: They could feel terrible, right? Yes, you've lost the weight, you know, you feel better in the moment, but some medications, once you stop taking them, you go through something then. And then the other thing you said that I feel is important is lifestyle changes, but also, and I think you hit on it a few minutes ago, There's emotional reasons why people eat and do things and comfort.

Sasha Yamaguchi: And so that has to be figured out as well. Otherwise, you're just going to go back to the way it was, right? 

Jessica Lea: For sure. And, you know, I think the pieces that are not getting talked about with these medications is we're just seeing all the successes, right? We're hearing of all the success. And then sometimes in the media, you hear like the really scary stuff too, right?

Jessica Lea: So that's, you know, kind of the way media is. But with these medications, when they were studied and we saw the great results that we saw from being studied, these people were on controlled diets. Like they were in a research study where they were on very controlled food intake. They were delivered food that was very prescribed to them and they were exercising a certain way.

Jessica Lea: And then guess what? They lost weight because of this combination of the three things. And if we don't try to sort of mimic that along with conversations about Does this work for you, Sasha, long term? Like, I don't know about you, but I know that I probably need to eat vegetables and lean meats all the time and exercise and get 10, 000 steps every day.

Jessica Lea: But sometimes that's not real. So how can you combine real with nutritional to make it a long term journey is really, really important. And no one's thinking about the fact that the way these drugs were studied was very much like a laboratory, right? That's how they're studied. 

Sasha Yamaguchi: So, well, and this isn't going to be a very professional way to say it, but very unreal life, right?

Jessica Lea: Right. 

Sasha Yamaguchi: They were tested in situations that is not real life for most people. So, oh, man. Well, I love that we hit on this because I think it's important for people that are hearing about the drugs. I think the employer side is where it's creeping up so much in our industry. And I know a lot of employers are Looking at their annual utilization, and this is probably in the top three topics that are being discussed right now, so.

Jessica Lea: For sure. I think we're going to see that this year and next, the diabetes category is going to be the largest cost for employers, or this obesity diabetes category, because they're really feeling it and we understand it, so. 

Sasha Yamaguchi: Yeah. Agree. So, I would love to end kind of going back to the beginning of founding Tria Health.

Sasha Yamaguchi: I'm always in awe of founders that start companies that have such a big impact. And so I would love to wrap up with you sharing a little bit about starting it, but really if there's anyone listening that's getting started in their career or they work at a company or they're founding a company, what advice would you give just because you've gone through it now to anybody listening that's trying to start a business or their career in our industry?

Jessica Lea: Sure, yeah. I think the words that come to mind, like, first of all, passion is a big piece of it, right? Like, I believe that some of my success has been because I've been so passionate about what we do here at Tria Health, and it's sort of ingrained in who I am, that we're educating people, we're educating employers, we're making people healthier, and at the end of the day, fundamentally, like, we're taking care of people, and that's what drives us.

Jessica Lea: All of us here at Tria Health. And so passion for that cause is really, really important. But obviously the other word that comes to mind for me is just sheer determination and grit. Um, so we've been in business for 15 years and there's been a lot of employer solutions that have come and gone during that time.

Jessica Lea: And I think what makes us different is that fundamentally, when we add Something new on a product, we'd still tie ourselves back to what we are fundamentally at Tria, which is pharmacists helping take care of patients in the role of working with their physicians and then to educate them to achieve the best outcomes on behalf of the employers.

Jessica Lea: And so I think just being able to understand your why. And sticking to your why and then re grounding yourself to why all the time is probably what has made it successful. And I want to be clear too that there have been years where it was really, really tough. Healthcare is such an up and down world, right?

Jessica Lea: Like things change so rapidly, but yet they don't. I don't know how to say it other than, you know, you think that. An administration change is going to completely flip the way we all do insurance and we all prepare for that. And then the next thing you know, we're kind of doing things the way we used to do them five years ago or whatever.

Jessica Lea: That is so true. Does it feel that way? 

Sasha Yamaguchi: Oh, it's, I mean, I've been doing it 25 plus years and you just explained it perfectly. That is absolutely 

Jessica Lea: true. Yeah. So anyway, just loving what I do and I think is, is key to it. And I, I would say anyone who has an idea that wants to blossom, you know, find the right mentors, but have grit and passion and just believe in what you do is the biggest key. So. 

Sasha Yamaguchi: Well, I love that. And by the way, grit is just the word that always comes to my mind of just, you know, Just hard work, grit. I love that. Determination. Cause it's hard. It's a lot, right? You have to put in a lot of work, a lot of time, but it's all worth it. So well, I was so excited to have you today. The things that we covered, I think are so, so important in our industry.

Sasha Yamaguchi: I know our listeners are going to appreciate all the information and hearing from you. So I appreciate that. Please share with everyone, because I think they will want to reach out to you, look into Tria, share for a minute about where they can find both you and Tria Health. 

Jessica Lea: Well, Tria Health, is our website, and I highly encourage individuals and employers to consider looking at our website.

Jessica Lea: There's a lot of opportunity there, and you can also contact us. That's anyone at my company there who you may need to get information from. But I would also say that I am on LinkedIn at Jessica Lea at Tria Health and, you know, hopefully people can find me there and on all the social media sites we have a representation as well.

Sasha Yamaguchi: Great. Well, thank you so much for joining us. Really excited to have you and appreciate your time today.

Jessica Lea: Thank you so much for having me. It was a great conversation. 

Producer: This podcast is brought to you by Collective Health. A health benefit solution that guides employees toward healthier lives and companies toward healthier bottom lines. Check us out at