We spoke with the senior director of clinical shared services, Nancy Costlow, to discuss her background, journey at Accolade, and how pharmacists are revolutionizing the future of healthcare. Read below to also learn how pharmacists drive employer savings and elevate patient care.

Q: You’ve had a very interesting pharmacy career. Can you tell us more about your background and what led you to Accolade?

I graduated with my Doctor of Pharmacy degree from Purdue University and started my career with Walgreens, where I had a very rewarding job as a retail pharmacist. I then went to work for a large veterinary compounding pharmacy, where I worked for 11 years. For seven of those years, I was a staff pharmacist and the last four, I spent in leadership. It was during those last four years that the Drug Quality and Security Act was put into action by President Obama, creating a new field of pharmacy called 503b Outsourcing Facilities, where large batches of sterile medications can be made.  I was asked to build an outsourcing facility for my company, which forced me to once again be a student to learn about the requirements. When the company was bought and went public, I managed the teams through it all, serving as the Director of that facility. This was my first taste of operational leadership.

Once the pandemic hit, I decided that as a trained healthcare practitioner, I needed to be back on the front lines. I accepted a position with Humana as a specialty pharmacist. It was an intense time that felt like a year of residency. It was during my time at Humana that they became a customer of Accolade, and I was fortunate to have my own Accolade care advocate, who helped me immensely with a medical concern. Coincidentally, when I decided to pursue my passion and look for an operational leadership position, the first role I came across was director of pharmacy at Accolade. Since I was familiar with Accolade and valued the service I received, I knew I had to apply.

I began my Accolade journey as the director of pharmacy, was promoted to senior director of pharmacy, and now my role has expanded to senior director of clinical shared services. In my new role, I oversee an interdisciplinary team that includes pharmacy, women's health, behavioral health, social work, and nutrition.

Q: Can you tell us more about the role of a pharmacy team in employer-sponsored healthcare?

A pharmacist is the most accessible healthcare practitioner. Some studies I’ve read say that 9 out of 10 Americans live within five miles of a pharmacy. Pharmacists are typically the last healthcare practitioner that a patient will see before they go home to start self-administered therapy. This is an immensely powerful place to be. We are truly on the front lines when it comes to healthcare.

By being an extension of our colleagues in the field, the Accolade pharmacy team is able to help close gaps that occur due to the healthcare practitioner crisis. Our team is equipped with technology to view and analyze claims data and work through barriers that may be blocking a member from receiving their medications. While we are not in direct communication with our members, we serve as an extension to our care advocates and Nurses who are. Essentially, we are an extra level of pharmacy-related support.

I have a lot of respect for any employer who brings on an Accolade solution that includes pharmacy support. We can help their members in a way that may not be accessible right now because of the demand for community pharmacists that has resulted from the pandemic.

Q: According to some surveys, the rising cost of prescription drugs is worrying employers, and they expect it to be a major contributor to a 6-8% cost trend increase in the coming year. Is there anything they can do to influence that trend spike?

Employers must look at the health needs of their population and make sure that they are supporting those members who need it the most. The needs should be viewed across their population to help decide where to spend their money.

This is why a strategic approach to medication spending is so important. Looking at their total population to see what they are managing helps decide if and what additional partners or programs should be put in place, such as a healthy lifestyle program or exercise benefits. Medications are not the end-all for treating some of these diseases. They need to go hand-in-hand with healthy choices and a healthy lifestyle.

Q: How significant is the counseling role of pharmacists in guiding patients through their medication regimen?

In certain states, like Arizona where I live, it is mandatory under state law that a patient must be counseled on any new or changed prescription. These consultations are not only about teaching them about their medication but making sure they understand how and when to take them and possible interactions with over-the-counter products.

It is also an opportunity to screen for errors. Prescribers use electronic systems that feature a drop-down tool, and it is possible the wrong medication could inadvertently be selected. We can be a safety net when the patients are willing to have that conversation.

I remember an instance where one of my retail customers had TMJ. Her doctor thought they had prescribed a muscle relaxer. However, the next medication in the ordering system was an antifungal, and she had been prescribed that instead. After a while, she questioned why the medication wasn’t helping her jaw pain, and we realized she had been prescribed the wrong medication. That is why it is so important for patients to be counseled on their medications because we are the last person that a patient is going to see before they go home and start their medication therapy.

Q: What role do pharmacists play in preventive healthcare, particularly in educating patients about lifestyle modifications and disease prevention?

When you look at pharmacist counseling, an extensive part of that is health literacy, making sure the patients know why they are taking the medication for what condition and how adherence makes such a difference. Adherence is defined as taking your medication correctly 80% of the time, which is surprising. We should be shooting for 100%. We need to ensure we are addressing any questions or concerns patients have. That all goes into health literacy and preventative care.

With preventative care comes vaccines. Between 2020 and 2021, there has been an increase in adult vaccines administered by pharmacies compared to non-pharmacy settings. We need to make a point to talk about vaccines, teach about vaccines, administer vaccines, and make it easy for patients to get vaccines. That is an important part of community pharmacy today.

Q: What is a memorable engagement you have personally had with a member? A moment where you knew you made a difference in someone's life?

I was working at an overnight pharmacy, and a woman came in with her husband and their baby. The woman had shorts on, and I could see her left thigh had a wound that was turning black. She told me that while cooking the night before she spilled boiling water on her leg and asked where she could find burn cream.

I was very concerned about what I saw, and since this was almost 24 hours later, I strongly encouraged her to go to the emergency room. She brushed me off, and while she went to look for the cream, I pulled her husband aside and told him he had to take her to the emergency room immediately. I even offered to watch their baby. The next morning, he came back in to tell me she was admitted to the burn unit. He thanked me and told me I saved her life.

Q: How do you foresee the role of pharmacists evolving in the future of healthcare?

This is a hot topic right now because we are experiencing a crisis in a lack of providers, and many different healthcare professions are now having to step up in new ways because we have a lot of people in our population who are not healthy.

Patients need to be overseen by a physician to help manage these conditions, but we do not have enough physicians. Different allied health professionals, like pharmacists, are helping in new ways to support the physicians because their workload is unmanageable. As of 2004, all pharmacists have a Doctor of Pharmacy degree, which involves more direct patient clinical training than ever before. There are also optional pharmacy residency programs that can further develop specific clinical skills. This is allowing pharmacists to work out of clinics in new and innovative ways to be an additional healthcare resource within a traditional medical space.

Q: What strategies would you recommend to employers to handle rising pharmacy costs without compromising the quality of healthcare provided to their employees?

I would recommend taking a look at the population to determine the health conditions that are present and then finding partner programs that offer support. There is a large amount of data about hospital admissions due to medication complications, so a pharmacy program would be helpful. It is important to make sure that people fully understand how to take their medications. We want to ensure they are armed with the best information so they can self-administer safely and advocate for themselves. All of that will help to decrease healthcare spending. The healthcare system is so complicated that it has taken power away from patients and extra support is warranted. On the flip side, patients need to be willing to access this additional support.

Q: Do you have any closing thoughts?

There is nothing like Accolade. We understand that the healthcare system needs help, and we are trying to help where we can. Working for Accolade gives us the opportunity to help our members get the care they need. It is a great evolution of the practice of pharmacy to do this type of work and have meaningful, interdisciplinary conversations, and member-facing conversations. I am very happy to have the opportunity to work for Accolade and excited about what we will do in the future!

Nancy Costlow, PharmD, senior director, clinical shared services, Accolade

Nancy Costlow is a pharmacist and operations professional with 20 years of experience in various clinical and leadership roles. Currently, she serves as the senior director of clinical shared services for Accolade, which includes an interdisciplinary team of health professionals who specialize in behavioral health, nutrition, pharmacy, social work, and women’s health.

Nancy earned her Doctor of Pharmacy degree at Purdue University and pursued a Board Certification in Sterile Compounding Pharmacy and a Pharmaceutical Regulatory Specialist certification post-graduation. She has experience in retail, population health, advocacy, health plan, community, specialty, veterinary, compounding, and 503B settings.