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Advocacy CSI Pharmacy stories

It’s Our Turn

As a member of CSI Pharmacy’s patient advocacy team, it’s my job to create materials for our campaign to increase plasma donations. We’re working to encourage people, especially family members and friends of those who rely on immune globulin therapy, to roll up their sleeves and give back by giving their plasma.

The coronavirus crisis has slowed donations of this life-saving serum from which immune globulin (IG) therapies are made. Together with the Immune Globulin National Society (IgNS), CSI Pharmacy is supporting the #ItsMyTurn campaign, encouraging those of us who are not on the front lines of the battle against COVID-19 to consider this opportunity to be a hero in a different way.

While I sat safely socially isolating in my home, organizing webinars, writing patient stories, and creating social media memes, this voice kept nagging at the back of my head: You could donate, it said.

I could, I thought. But the closest plasma donation center is an hour away from where I live in Central Virginia. But it would take me half the day to donate. But I’d have to do it on a regular basis; a one-time shot won’t work.

Still, I just couldn’t sit here urging others to do this important work if I weren’t willing to get off my “buts” and do my part too. I work remotely all the time anyway, and I could bring my laptop and check social media while I donated. I could commit to donating once a week. So I made an appointment and started donating.

But I’m not the only member of the CSI Pharmacy staff getting out of the workplace to donate plasma. Our leadership is making this a movement by encouraging all employees to become plasma donor heroes. And CSI Pharmacy CEO James Sheets is leading the way to the donation center.

“This is an opportunity for us to give back to our community of patients who depend on this life-saving therapy,” James says. “Our patients are our family, and we can’t let them down. We have to do what we can to be sure they can get the treatments they need.”

For my colleagues who work at the pharmacy headquarters in Wake Village, Texas, there is a certified plasma donation center just three miles away in Texarkana. CSI Pharmacy team members are given time to donate during working hours. Those who donate receive a special #ItsMyTurn t-shirt. James has even created a contest to encourage employees to make donating a routine part of their week.

“Our team members are motivated to this cause, because they’re so connected to our patients and their therapies,” James says. “They know how challenging it can be for folks when IG products are in short supply.”

With seven donations under his belt so far, delivery technician Justin McNeill is leading in donations among the CSI Pharmacy employees. He’s grateful for the time to give, but for him it’s not really about the contest or the modest payment he receives as a donor. 

“If there’s a shortage on our IG products, our patients aren’t going to get the medicine they need,” Justin says. “I figure I’ve got it to give, so I might as well.”

Roxanne Ward, CSI Pharmacy’s Regional Nursing Supervisor in Little Rock, Arkansas got three of her nurses together to make an event of their trip to the plasma donation center. Knowing that plasma donations are down right now is what made her want to take this extra step for her patients.

“I treat so many people who rely on this,” she says. “I felt like donating is the least I can do to help the people I care for.”

Not everyone at CSI Pharmacy will qualify to donate plasma, though. Eligibility guidelines are strict, so those with certain medical conditions, those who take certain medications, or those who may have been exposed certain blood-borne pathogens won’t be able to give. These team members can still participate in our program, however, by recruiting someone else to donate in their place.

“I really wanted to be a plasma donor because it’s so important that we have enough plasma for those who need these therapies,” says VP of Patient Advocacy and Provider Relations Michelle Vogel. “Unfortunately, I’ve used blood products (platelets) in the last year, so I don’t qualify. So I asked my family to help.”

Michelle’s brother-in-law, who was among the four members of her family to volunteer, knows intimately how important IG therapies can be. His mother has myasthenia gravis and has been treated for many years with IVIG.

“We’re really proud of the response from our team members,” James says. “It’s an important effort, and we’d like to invite other businesses and organizations to join this effort to short-circuit an IG shortage by encouraging their employees to donate plasma. Together we can make a difference.”

#ItsMyTurn

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CSI Pharmacy stories

Therapies Unique as Fingerprints

When James Sheets and his partners decided to create a business that focused on home immune globulin therapy, they didn’t really know what to call it. The traditional dispensing pharmacy they already operated had a name: North Heights Pharmacy. But they felt this local focus would limit this new venture, which they expected to expand beyond their current Texas/Arkansas/Louisiana area.

“When I was presented with the challenge of coming up with a name, I didn’t really have any ideas,” James says.

At the time in late 2013, specialty pharmacies were just starting to emerge from other fields of pharmacy, so James decided “specialty” would be part of the name. He also wanted the word “clinical” to be in there, because with a team of outstanding pharmacists with decades of infusion experience, he and his business partner Barry Buls felt it was their commitment to providing comprehensive clinical services that set this new business apart.

Then one night in the middle of the night James woke up from a dead sleep with a picture of the whole plan.

“I sat up in bed and said, ‘Wait a minute. We’re going to call this thing Clinical Specialty Infusions, and we’ll use the name CSI Pharmacy,’” he says. “People will remember it, because they will think of the TV show Crime Scene Investigation.”

The logo would be a thumbprint overlaid with a magnifying glass, also tying in the idea of the detective. And the motto would be “Individualized therapies designed to be as unique as you,” because, like one’s fingerprint, CSI Pharmacy’s treatments are designed for the specific needs of each patient.

CSI Pharmacy is now licensed in 39 states and the District of Columbia with plans to acquire licenses in all 50 states. North Heights Pharmacy is still part of the business, filling retail prescriptions in Texarkana, Arkansas.  The headquarters, which includes an infusion center, are based at a second physical location in Wake Village, Texas. Soon CSI plans to expand their individualized care by acquiring new bricks-and-mortar locations in at least two additional states.

“We are truly focused on making a difference in people’s lives,” James says. “And I’ve always said if we take care of patients, if we are there for the prescribers, and if we take good care of our employees, the rest will take care of itself.”

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Caring for and about Patients

When Michelle Vogel joined CSI Pharmacy as Vice President for Advocacy and Provider Relations in 2016, one of the first things she did was take owner James Sheets to a support group for myositis patients.

From the very beginning, CSI had been committed to caring for patients, not just filling prescriptions. But until this point, the only interactions the pharmacists, nurses, and staff had with patients was when they provided their infusions.

“He didn’t really know about working with patient communities, so I took him to participate in The Myositis Association support group in Houston,” Michelle says. “That’s when James became dedicated to helping patient communities.”

“I went there to talk about IVIG ,” James says. “I went in there thinking this will be great. I can really help this community learn a lot. But when I heard some of what patients were experiencing, I realized I had so much more to learn. That’s really where my passion for building relationships with the rare disease community came from.”

James and Michelle and some other staff started making a habit of attending support group meetings, not just for myositis, but for myasthenia gravis and other rare diseases that are part of CSI’s patient community.

These support groups are a place where people who live with a rare disease can get together with others who have the same disease. At the meetings, patients and caregivers share their experiences of dealing with the challenges of things like symptoms, treatments, and living with chronic or disabling conditions. When they participate in these gatherings, the CSI staff gain valuable insight into what their patients deal with on a daily basis. It makes a difference in how the pharmacy works with patients.

Knowing more about myositis as a disease, for example, and the sorts of challenges patients face in dealing with it gives CSI much more ammunition in helping them access treatments, most of which are used “off label” and can be very expensive.

“When we’re working to get approvals from insurance companies,” Michelle says, “we’re able to ensure that the patient meets the diagnostic criteria of their individual health insurance plan. There is no reason why these lifesaving therapies should be denied when we can submit it to insurance appropriately.”

Having an advocacy program also supports the physicians who prescribe treatments like immune globulin therapy, infused and injected immune suppressants, and cutting-edge biologic treatments.

In addition to advocating for patient access with insurance providers, Michelle can also help people find copay assistance programs to help cover the expenses insurance doesn’t. There are also some financial assistance programs that can help patients with extraordinary medical expenses. And if a person’s insurance is too restrictive, she can help them choose a plan that works more to their advantage.

And then there are the times when CSI just needs to bend over backwards to get the patient their treatments. Michelle tells a story, for example, of an uninsured patient who had been diagnosed with myasthenia gravis. She had applied for social security disability and was waiting for approval, so she would be eligible for Medicare, but it would be three or four months before her hearing with a judge. Meanwhile, she needed IVIG treatment to live.

Michelle was sure the judge would approve the patient for social security disability, making her eligible for Medicare. She also knew Medicare would cover the treatment retroactively. So, CSI agreed to provide all the patient’s medications while she awaited approval. Michelle even contacted the patient’s physicians to ask if they would waive their fees during that waiting period. (They could always bill Medicare later.) Three months later, the patient was approved, and the physicians and the pharmacy all got paid.

“We had to pay for everything in advance, but in the end it all worked out,” Michelle says. “I don’t know of any other specialty pharmacy that would do that. There’s that trust, that extra step for patients. That’s really what you need, because if you do things right, it all comes back tenfold.”

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CSI Pharmacy stories

CSI: A Special Specialty Pharmacy

“I’d always had a dream of owning a little mom-and-pop pharmacy,” says James Sheets, CEO of CSI Pharmacy. He’d had a number of jobs working in both big box pharmacies and smaller shops in and around his hometown of Texarkana, Texas, and he preferred a small, local business where he and his staff could get to know their customers.

In 2013, James’s dream came true when he and two other pharmacist friends, Barry Buls and Mark McMurry, had the opportunity to partner up and purchase North Heights Pharmacy, a shop that had been in business in Texarkana since 1975.

North Heights was doing some retail sales, but they also provided medications for some local hospice services. They also did compounding, mixing up specialized medications for individualized patient needs. The plan, when James took over as chief pharmacist, was to build on these services, with outstanding customer service as their main goal.

In a previous job, however, James had started a successful home infusion program. The service provided treatments such as intravenous antibiotics, cardiac medications, and intravenous nutrition. It was a way for patients to receive these intensive treatments at home, rather than having to go to the hospital or stay in a nursing home.

He wasn’t really trying to get back into home infusion services at North Heights, but one day James got a call from a local neurologist who had several patients who were desperate for someone to provide intravenous immune globulin (IVIG) therapy in the home. These were people with chronic inflammatory demyelinating polyneuropathy (CIDP) who had been cut off from this service because the big national pharmacy chain that once provided it had decided it wasn’t getting paid enough by the patients’ health insurance.

“These were patients who were stable on IVIG, who had been doing well for years, yet they were losing their home infusion services,” James says. “Naturally we wanted to take care of them. Some of these patients we knew from our previous experience, so we already had a personal relationship with them.”

So James and his partners decided to go all in with home infusions, especially IVIG. They made some infrastructure changes to add the necessary facilities at North Heights, and they hired Tracy Knox, a nurse who specializes in infusion therapies, to work just with these patients. They also hired several other staff members who were experienced with the processes necessary to administer infusions, including pharmacy technician Natalie Edwards, IV technician Jet Richardson, intake coordinator Vanessa Noble, and Abe Cardenas, who serves as warehouse manager.

The pharmacy also needed a new name, one that more accurately reflected this new focus.  Clinical Specialty Infusions was born and immediately became CSI Pharmacy.

“What really sets us apart is that we’ve developed clinical programs around the different types of patients we serve,” James says.

In addition to people with CIDP, CSI also has patient communities for those with myositis and myasthenia gravis, both rare, autoimmune neuromuscular diseases. A new patient community is also developing with people who live with pemphigus and pemphigoid, which are rare autoimmune diseases that affect the skin and/or mucus membranes.

In caring for these patients, James and his team don’t just take an order from a physician and give the customer the medication. CSI hires or contracts with infusion nurses who know how best to administer immune globulin and how to monitor the patient during and after the treatment. More than that, though, they work with the whole CSI team, including physicians, pharmacists, patient advocates, and insurance staff to be sure the patient receives the individualized care they need.

More importantly, because staff spend so much time with patients, both administering the medications and working to get insurance coverage for these expensive treatments, they get to know them as friends not just patients. Staff and patients exchange personal stories, check in with each other, and share the success when the patient’s condition improves.

Infusion nurse Tracy Knox, for example, has been working with James since the beginning. “I can see the difference I’ve made in people’s lives, and I like that,” she says. “I’ve been doing infusions for this one patient for many years now. She used to have to use a wheelchair, but now I see her in Walmart and she’ll say, ‘Look! I can walk with a cane now!’”

Over the past few years, CSI has grown from a small, hometown pharmacy into a thriving nationwide specialty pharmacy with two physical locations and plans for more and a mission to make sure every patient receives the care she or he needs regardless of how much they get paid for it.