Episode 32: Increasing Clinical Trials Access: Ramita Tandon, Walgreens Chief Clinical Trials Ofc.  

Ramita Tandon discusses how Walgreens is aiming to redefine the patient experience and increase patient access and retention in drug development research.

Chris Riback: Ramita, thanks for joining us. We've been looking forward to the conversation.

Ramita Tandon: Thanks for having me, Chris.

Chris Riback: Before we get into the specific topics at hand, I think it'd be helpful if you could give us the overview and your role as chief clinical trials officer. What does that mean? What does that do? It sounds like an incredible amount of responsibility, probably more than I could emotionally deal with. Describe that role for us, please.

Ramita Tandon: I joined Walgreens in 2021, right around the time our CEO, Ros Brewer, joined. We've kicked off this journey as we move into healthcare and continue to build the healthcare store as we transition from retail into healthcare, and the desire was to get into clinical trials. And so, I've spent about 25 plus years in the clinical trial, life sciences space. Started my career here in Boston, Massachusetts in academia, and then moved across a number of clinical research organizations, like CROs, where I've had the opportunity to either build startups within large organizations or lead divisions within CROs, very focused on using innovative technologies or emerging innovations that would accelerate the drug development process, and getting to patients faster and more effectively.

So, that's been my platform throughout my career, and so when Walgreens reached out and said, "Look, we're looking to move into the clinical trial space," I thought it was a fantastic opportunity, given the access, the breadth, the national footprint, and we'll talk more about that. But for me, it was such a fantastic personal endeavor to help Ros and the rest of the organization to build out this healthcare continuum, and see clinical trials as a care option.

Chris Riback: I know Alex is going to have a follow-up, but could you just clarify that? Because most of us, when we think of Walgreens, drugstore at the corner, I get my prescriptions, I buy other toiletries or whatever I need, I mean groceries, they sell a bunch of stuff. Most of us laypeople don't think of Walgreens as a place that's doing clinical trials, where I guess drugs are being manufactured. So, could you talk about that? Is it a new business for Walgreens, and what are you doing clinical trials on?

Ramita Tandon: Good question. So, if you step back and think about Walgreens from a footprint perspective, we've got 9,000 stores and pharmacies across the nation. 78% of the US population is within five miles of a Walgreens. We service roughly around anywhere from 110 to 120 million lives across our nation. And so, as we think about our move and our journey into healthcare and delivering healthcare services more locally, especially with the established trust and presence that we've had over 120 years with our local pharmacies from our pharmacists and the pharmacy care teams, it's a natural inclination to be able to offer clinical trials as part of the services or a healthcare option for patients that historically have never been invited, don't even know what a clinical trial is, or have some historical misperceptions, trust or fear around the notion of research.

Certainly, we can get into more details, but we're opening up our physical footprint. We're using the entire Walgreens horsepower, whether it's the trust, the brand, the footprint to be able to, one, educate our patients and consumers on what a clinical trial is, and then two, open up our doors to be able to have clinical trial visits completed. And we call them low-acuity services, so screening, diagnostic or lab draws. So, rather than having patients drive 30, 40, 50 miles to an academic institution that's happening today, we're making it more convenient and accessible.

Dr. Alexandria White: Ramita, you are talking my language. This question was going to be later, but you brought it up. When you talk about your patient experience, who are your patients, and who are you getting to come to these trials? Before you answer that, I have to talk about the history of black people in medical services and trials. We are very familiar with the Tuskegee syphilis study. That was from 1932 to 1972, when they unknowingly tested on black people and gave them syphilis, and told them that it was just bad blood. This has created skepticism. This has created that lack of trust in black and brown communities because we don't want to be tested on. There's a history of people testing on us, and not telling us what's going on. And so one, I want you to talk about that patient experience, and then I would love for you to talk about what you are doing to increase that communication for black and brown communities.

Ramita Tandon: I love that question, Alexandria, because it's sort of the why and the impetus of why we got into clinical trials. As you know, less than 5% of this nation participates in clinical trials. And those that do participate, 75% are white. What that's telling us today is that a lion's share of this nation are not part of this research ecosystem, and the drugs that are being approved in the marketplace and being dispensed through our local pharmacies are not representative of the US population. So, as black, brown populations pick up the drug from a pharmacy, it will have different variation and reactions for those patient populations.

Part of our why of getting into clinical trials is that we want to make sure that clinical trials is accessible to everyone. We're doing this in a couple ways. Number one, our physical footprint, as I mentioned earlier, is serving as a welcome entry point. During the COVID-19 pandemic, we gained tremendous amount of learnings in insights, right? When everything was shut down in the healthcare ecosystem, retail pharmacies were tasked and rose to the challenge to administer the vaccinations across the US. We quickly realized it was not a one-size-fits-all strategy because of some of those sentiments that you've just raised. There's mistrust, there's fear, there was misinformation that was going out there. And so our pharmacies became the welcome entry points to be educated, to be enabled and empowered to make the decision to get shots in the arms.

And so, those learnings became valuable as we've implemented in our clinical trial enterprise. Part of it is to make sure that we can start to educate our black, brown populations on what a clinical trial is, the value it brings to their health, and even parts of the communities that they belong to. But more importantly, answer those questions based on what they've heard or firsthand experienced. So, that's number one. The community engagement activation is absolutely critical for us first because simply just sending out an email or a text or something to say, "Hey, listen, we've got this great clinical trial. Can you participate?" And that's what's happening today. I can tell you, if you've got those misperceptions or those trust issues or fear, no matter how much information comes your way in terms of letter of asks or what have you, you're not going to join. We are trying to build the right highway into our communities, and that starts with community engagement and activation.

Dr. Alexandria White: Yes, to all of this. As a Walgreens customer, I vividly remember going into Walgreens and the pharmacist was taking so much care, especially for the older patients, when you all were implementing the vaccination. I remember her coming from behind the counter and talking to people and rubbing their shoulder and saying, "This is what's going on." I vividly remember that. I don't know if that was just her, but I remember it being comfortable in that Walgreens and being welcoming, your welcoming point.

Ramita Tandon: That is representative of our clinical pharmacists, right? Our pharmacists are trained for patient care. And I think people firsthand saw the attention and that high-touch engagement that was needed during that healthcare crisis that we all experienced. The same goes for clinical trials. In order for us to move the needle on the number of people that participate, particularly from black, brown populations, it's going to require that high touch engagement to start to tackle some of those system level barriers that exist, that have impeded people from participating in the past.

Chris Riback: Ramita, could you talk to us about some of your tactics to get that type of activation to motivate and gain the trust of the communities that you are describing? What are some of the tactics that you employed and how did they scale? Because as other business leaders think about similar, maybe not exactly the same, but similar type goals in whatever divisions they run or goals that they have, the question that we frequently get is not only around tactics, but how do you get them to scale? And then, how did you think about measuring results and measuring or confirming that your tactics were doing what you wanted them to do?

Ramita Tandon: Yeah, it's a great question. When I launched the business June of last year, it was very important to make sure that we had the right KPIs that were established for the business early on, because as you can imagine, being part of a broader, large organization like Walgreens, we have to be able to get the broader organization to help support and unlock. And certainly, as we think about our retail business, our pharmacy operations business, all of it is so vital for us to be able to execute the clinical trial business model within the large Walgreens organization.

And so, we launched in three areas. Number one is around just the patient identification and acquisition process, or AKA, patient recruitment, and that's really around finding the right patients and matching them to clinical trials. And part of that process includes the community engagement and activation. And so, a couple ways that we've been addressing community engagement. Number one, we've activated our physical footprint to serve as those welcome entry points that I referenced earlier, where pharmacists are being trained, number one on clinical trials, certainly on the regulations that are associated with the research enterprise because we are highly governed by a number of rules and regulations to ensure we protect the integrity as well as the safety of the patient as they participate.

But the in-store activities that we do, for example, is a great first step, where patients that are coming in in one of our designated clinical trial centers, if they're coming in to pick up a script and they get flagged to be eligible for a clinical trial, the pharmacist will see that in the system. The pharmacist will get the flag and say, "You know what? You could be a candidate for a cholesterol-lowering clinical trial. Would you be interested to learn more?" So, that's one example to kick off that dialogue, and the education engagement piece, number one.

Dr. Alexandria White: That's so important because if my Walgreens pharmacist, because I like her, if she were to come to me and say, "Hey, Alex, you've been flagged to participate in this clinical trial," I'm more prone to do that because I like her and I trust her. So, I think that's really important.

Ramita Tandon: And so we're building off of the Walgreens, again, that trusted relationship that exists with our patient communities, to serve in that education and engagement model.

The other piece is, we learned this during the COVID-19 pandemic, we can't do this alone. And we've been very intentional about the partnerships at the community level. So, whether it's local faith-based organizations, schools, churches, we are partnering at a local level to help us unlock that engagement and get people to understand, number one, what is a clinical trial and the benefits of participating, and answering questions that they may have. So, that first vertical that I mentioned about deploying around patient recruitment, so when we're ready to send out an invitation to a particular community, that community should have been primed. And I call that the community surround sound.

They should have already been primed about what a clinical trial is, answering their questions so they don't feel like they're a Guinea pig or being taken advantage based on some of the historical issues. Opportunity to ask the questions. So, we're using a number of channels beyond just the physical footprint, partnering with local organizations to help us, Chris and Alexandria, on that engagement piece. Then it becomes a lot easier for us, as we then send out the invitations to potential candidates to participate. Then it's like, "Oh, you know what? I did participate in that form, where they helped me understand what a clinical trial is. This makes sense for me. I'm going to join to learn more and carry forward."

Dr. Alexandria White: So, I'm listening to this, I'm listening to the touchpoint, the community engagement, recruiting the patients and not just recruiting them and making them feel like a number. All great, this sounds wonderful, but I have to push back. What are some of the hurdles that you've encountered in doing these, in disrupting clinical trials?

Ramita Tandon: This is the hard work that needs to be done, right? Because this is an industry for the last 20, 30 years that have been working through a traditional model where you use the healthcare system, provider organizations who are extremely busy. Physicians generally are very busy, and then all of a sudden they're being asked, "Hey, can you participate in a trial and can you find 15 patients in your ecosystem to participate?" And it's tough. And so, as we're building this highway into our communities, the biggest challenge right now is to ensure that our black, brown populations understand what a clinical trial is and understand the benefits because we want them to respond to a call to action. And so, when they get some kind of invitation from a Walgreens, they can immediately feel comfortable and empowered to make that decision.

Now, is it going to happen overnight? No. And to the point about scaling, as we start to do this community by community, we're building the body of evidence, we're showing the effectiveness. We use that information and socialize it with other communities. And we'll say, "Hey, listen, we were in South Florida, a largely Hispanic population. This is what the patient experience was like. This is the effectiveness of the model." And then we take that information or those insights and socialize that with other communities, and that's how we start to scale and go broad across the nation.

Dr. Alexandria White: Great plan. Love that.

Chris Riback: What's the internal reaction been? You've only been doing this it sounds like for about a year, but is there any internal cultural impact that you feel you might be making?

Ramita Tandon: Yeah. Look, I think as we are on this massive transformation within Walgreens, as we move into a healthcare organization, everybody is very focused on thinking about the stakeholder, the patient, our stakeholders like our payers, healthcare systems, and certainly, biopharmaceutical companies that partner with Walgreens to help to deliver these healthcare services, including clinical trials. And certainly, the clinical trials model is a B2B service model. It is about selling services to our customers who would want to use the different assets that we have within Walgreens to help support their objectives.

And each manufacturer, for example, have specific objectives in mind for their clinical trials. And so, when we launched the business, it was very important to me early days before the launch to make sure that we got full support from the entire organization to be able to execute against this model. Because this model relies on our pharmacy operations, our retail operations. And certainly, all the other functions to be able to unlock and execute with speed and agility. And so, that support comes all the way from Ros, our CEO, the board, the entire leadership team that is 100% behind and committed to making sure clinical trials is a success. It's been a fantastic internal support that we've received.

Chris Riback: Congratulations on that, and securing and maintaining the internal support. For other leaders, how are you doing that? Is it a communications effort? It sounds like you're having to do it multi-directionally. You're doing it with top leadership across Walgreens. You're doing it with other vertical groups for which you do not, I think, have direct responsibility. So, you're doing it horizontally. You're also surely doing it vertically within your own group and all of the team members for whom you're responsible. Can you take us through any tactical communications? Is it about tone? Is it about frequency? Is it about messaging? Is it about tying it to internal cultural touchstones or other leadership efforts? What tactics can you help advise the rest of us on?

Ramita Tandon: Yeah, that's a great question. Look, when you're trying to build a startup, especially in a large-size organization like Walgreens, it's never easy. And so, when I joined the organization, it was about building the story first and foremost about the why. Why would Walgreens get into clinical trials? What's our why to the industry? And what's our value differentiation, not just for the clinical trials business, but for all the stakeholders within Walgreens that would be supporting the business model, what is in it for them? And so, that was important for me, first and foremost, to get that story right. And as I started to socialize the why, the mission and the vision of this business, that message and that communication, all the way from the top to folks that are leading the functions, was very important to have that early days.

As people understood the why and the story of the value differentiation, not just for their own respective functions, but what it would mean into the marketplace. It became much easier for people to rally behind me and support the business model. And so, it allowed me to launch these three different verticals based on those early communications. And then, since the launch, I would say post-launch, I've hired a very, very stellar leadership team from the industry that come from this space that understand clinical trials, that are trialists by nature.

And so, by having that team come on board as they work with the respective functions. So, the channels that I established early days pre-launch was very critical. So, as the team then came thereafter, leveraged those channels, continue to build those relationships, and made sure that relationship was bi-directional. So, as we continue to carry forward this business and we execute on trials, we are providing output back to each of those functions or those areas of the organization that are supporting us, so they understand the value that they're bringing to our business and the output. So, again, it's a bi-directional relationship that we've established, each of those internal stakeholders.

Dr. Alexandria White: Excellent. Excellent strategy. So, I have one of the hardest questions for you. You have a motto called, "Keep pushing the envelope to stay creative." We want to know what does that mean to you?

Ramita Tandon: Well, actually, my motto has been updated a bit. It's about, "Talk less, do more," but I-

Dr. Alexandria White: Ooh, I like that one too.

Ramita Tandon: Because I think certainly early days in my career was all about pushing the envelope and never challenging the status quo. And I think for clinical trials, we've all been talking about the issues around access, diversity and health equity. Every conference forum that I go to in any setting, everybody is saying the same thing. And so my motto has been, "Let's talk less, and let's do more." And so, when I launched the business, it was about Walgreens putting a stake in the ground and saying, "Here's how we can help and do our parts to move the needle around access, equity and diversity for clinical trials."

Now, I've been very upfront, we're not here to solve all the problems, but we believe by using our scale, our footprint, and all the assets that we've made investments in in building our healthcare continuum, we believe we can help support the endeavors that we're seeing in the industry, the need for accessibility and convenience in clinical trials. So, Alexandria, it's all about talk less and do more. And so for me, it's about building a body of evidence, and providing those proof points out to the industry around the effectiveness of our model, not just for our partners, but also for our patients as they participate in clinical trials.

Dr. Alexandria White: Thank you for talking less and being more actionable. I appreciate that. I know my communities that look like me, appreciate that. So thank you for your work.

Chris Riback: And I would close by asking Ramita, Dr. White and I have only known you for about 20 minutes now, but my guess is that you're something of a tough grader. How are you doing so far? Not just in this conversation, I mean in the broader efforts. In the conversation, I'll tell you, you've got an A plus. But in the rest of your work, is it where you would hope it would be? That's a bad question for someone like you because I bet it's not where you would want it to be. I bet you're always wanting more, but you know what I'm asking. How's it going?

Ramita Tandon: Yeah, it's a great question. The KPIs laid out for the business model is very critical for me. And if I reflect on the first year post-launch, it surpassed all of my expectations because it is a non-traditional model that we're bringing into the industry. But early days, we understood what the consumers wanted, what the gaps were in the industry. So, as we created the solution set, it was around responding to those gaps and responding to how consumers would buy Walgreens services. But even as you launch any business, there's always that unknown. And so the feedback that we've received from the industry has been absolutely incredible. Number one, the commitment that people want to bring trials into communities that have historically been left behind is amazing. So, the support has been incredible.

The trials that we're undertaking across different disease areas, whether it's in diabetes, Alzheimer's, cardiovascular outcomes, and many more, it's been tremendous in terms of seeing the output. We've reached over 2 million patients already in the first year. We are surpassing the US census in terms of the diversification of patients, the black, brown populations that are participating in clinical trials. So, for me, I'm checking the box because I'm bringing black, brown populations into this research ecosystem. Do we have to do more? Absolutely. But I think if I reflect on the first year and the body of evidence that we've created so far, I'm impressed and I'm grateful for the leadership team and the team that's been supporting the clinical trials business. It's been impressive.

Chris Riback: Well, congratulations on that. We are grateful for your time and your insights, and for this conversation. Thank you, Ramita.

Ramita Tandon: Thank you.