The MSL: A COVID-19 Update

Caution & Disclosure: I do have some hyperlinks to my own resources for sale below.

What is a MSL?

To this day, the #1 area of career development I inevitably get asked about is that of the field based medical science liaison (MSL). It was the subject of my very first book, and one that I love and am passionate about, as it is a challenging and fun blend of scientific acumen, business savvy/advocacy, and networking. They are basically field based extensions of medical and drug information for pharmaceutical and biotech companies, and the majority of times, a clinician themselves (a pharmacist, physician, nurse practitioner, etc.)

In my opinion, it is still to this day one of the most critical roles for pharma to offer academic thought leaders and all of us in healthcare, really. Because, the core of the role is to provide scientific/health economic data in and around new therapies, and the data is only getting more complex (and expensive) to discern for patients.

Why are MSLs Critical?

Why is this critical? Well, have you looked at the 2020 drug approvals list from FDA lately? Furthermore, have you seen what categories of drugs and therapeutic areas are being approved in the highest numbers? Cancer/oncology. Also, if you dig deeper, you can see the prices of these drugs, and they are eye popping. Furthermore, keeping up with different treatment paradigms in oncology is dizzying. I attempted to check the landscape of CE around this space for pharmacists back in March, and stopped - because there's SO MUCH to know here! ACPE's PLAN also has a ton of oncology CE. Everyone cannot know everything in every area of practice. The good news is that there's so much educational opportunity right now too!

In full disclosure, I work for employers and payers every day now. Do I want to make sure a cancer patient in one of their plans has appropriate therapy? ABSOLUTELY! In fact, when drugs cost 5 figures a month to a plan and/or a patient, I want to make absolutely sure that they're getting an appropriate therapy, and it's being used in an optimal way for the patient and her or his treatment regimen.

Oncology, at least PC-19 (that's pre-COVID-19), was the #1 area being researched in clinical trials. These therapies are only going to get more sophisticated and expensive over time. Cancer and oncology is super tricky as well, because many therapies are used off label, in combination with other therapies, and often the literature doesn't keep up with the data for patients. That and, specialty drug spend (of which oncology is included) is now costing plans between 30-60% of their total drug spend.

For all these reasons, it's imperative to have MSLs out in the field, sharing their knowledge and expertise with thought leaders. Not every drug is appropriate for every patient. Thus, it's absolutely critical for clinicians to have several data sources in the field to talk to, inform themselves, and collaborate. The MSL is one of those key resources. And while I completely understand there may be bias for the MSL, most MSLs I know are also clinicians--pharmacists and physicians--who they themselves have worked in clinical areas prior to becoming MSLs.

I'm a little worried for the position, right now, however. With COVID-19 lockdowns, particularly for hospitals and healthcare facilities, MSLs too have been locked out of many settings. However, there were and are MSLs who have creatively navigated this situation, and some who worked in other functions who put their creativity to the test in order to serve their thought leaders during this difficult time.

How MSLs Stayed in the Game During COVID-19:

Below are some updated resources and thoughts on how the MSL can survive coming out of COVID-19:

• Creative MSLs fell into traditional drug information (DI) roles - while every pharma company has a drug info hotline, many thought leaders like a person they can call around a company. The savvy MSLs simply fell back on their drug information skills during COVID-19 and proactively reached out to their thought leaders by offering DI services. (Distinct advantage for those MSLs who came out of the drug information role at the company prior to going into the field.) And let's be honest - there was a ton of misinformation out there at the time of lockdowns, and the literature really struggled to keep up. The MSLs were key to getting the most informed, real time clinical data.
• MSLs also boned up on their own education during the lockdowns - The shelter in place orders were the perfect time to take advantage of continuing education online (many CE programs were free for pharmacists and physicians during COVID-19).
• Many Certificates & Certifications for Medical Affairs - In addition to continuing education for MSLs, there have been several certificates and certification programs that have popped up in recent years for aspiring or current MSLs: The original BCMAS from ACMA, and the newer The MSL-BC certification. Here's an article that compares the certifications/certificates right now in MA.

Certificates and Certifications right now are exploding. More on the Tracker of them for Healthcare Professionals.

A Word on HECON/HEOR Liaisons:

• Health Economics and Outcomes Research - Just like clinical MSLs, there are also health economics and outcomes research liaisons at companies as well. These are folks that are focused on disseminating the data around real world evidence and cost of outcomes via therapies. They also have amazing training opportunities that many took advantage of during the lockdown, such as The University of Washington's Certificate in Health Economics and Outcomes Research, or even pharmacoeconomics, such as courses through ISPOR.

(Below is a podcast episode with Erin Zagadailov, if you'd like to learn more about a HEOR Liaison.)

The Reset for MSLs Post COVID-19?

My hope is that the MSL role is around to stay. We need them now more than ever, especially for the fast-changing clinical trials around COVID-19 therapies and vaccines. We who work on the payer rep side in pharmacy benefits definitely need to know about the clinical and pharmacoeconomics of each and every new drug out there for our employers who are potentially purchasing these therapies, especially the high dollar therapies and specialty drugs over time.

Safe, appropriate use of these therapies is a win-win for all of us, and the best way to ensure safe, appropriate, and optimized use of new and novel therapies is to get educated on them, from a variety of sources, including the field based MSL and the HEOR liaisons. I hope they come back stronger than ever, and armed with the knowledge we all need to best care for patients moving forward.

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Erin L. Albert is a pharmacist who works for Apex Benefits as Pharmacy Benefits Practice Lead, and former MSL. She is also a writer and career coach, independently. The views above may not reflect that of her employer, and opinions are hers alone.

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