Zack Contreras, Pharmacy Innovator

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Zack Contreras has been in the pharmacy industry for decades. He got his start in the retail environment at twenty-two and jokes that he was too naïve and young to have such a large responsibility of dispensing medications. Looking back decades later as the director of pharmacy benefits for San Diego-based Sharp Health Plan, he reflects on how much has changed since he was personally filling prescriptions for patients.

Contreras has had a hand in pharmacy innovation for longer than most healthcare professionals have had a career. Similar to Healthcare Effectiveness Data and Information Set (HEDIS), Contreras was assembling the logic, coding, and programming for pharmacy measures for a similar system that was ahead of its time. He would give demos of the system to clinicians, pharmacists, and healthcare professionals, impressing them with how his team could collect, input, and synthesize such a high volume of data.

“There are a few times in my career that I’ve realized I was working on projects well ahead of the game,” Contreras says. “I was running reporting on fraud, waste, and abuse based on FICO score reporting, which was unheard of at the time. It’s been a cool journey thus far.”

Contreras spent time at IMS Health, Blue Shield of California, Sutter Health, and MedImpact Healthcare Systems prior to coming to Sharp Health Plan in 2020, just a few months after the onset of the pandemic. Contreras says the move was the right one because of a high-performing team and strong leadership that allowed him to focus on strategy and growth instead of putting out fires.

The strategy Contreras employs is backed by wide-ranging experience and leadership roles, but even his retail pharmacy experience comes in handy. The director remembers that when he just started, pharmacy formularies were in their infancy. Over the course of five years, Contreras saw the cash-to-insurance ratio completely reverse from 70/30 to 95 percent paid by insurance. Contreras and his organizations have had to evolve time and time again to establish new norms, forecasting methods, and ways of ensuring healthcare can sustain itself financially.

As new drugs like gene therapies and biological treatments come to market, Contreras says health organizations need to keep finding ways to locate, educate, and help treat the populations who may benefit without inflating pharmacy costs.

“We see pharmacy costs sometimes make up between 27 percent and 30 percent of overall spends,” the director explains. “My role now is about finding a way to manage the costs along with all the regulatory challenges that come with it. We all need to figure out how to stay viable and get our members the medications that they need.”

“You learn that different people need to be motivated in different ways. Sometimes people need a kick in the pants, and other times they need a hug.”

Zack Contreras

Contreras says creativity is a must. No traditional model will solve this complex and multifaceted issue. The director says he regularly speaks with drug company representatives about value-based contracting. This payment model directly ties reimbursement for drugs or treatments to its real-world performance. It has been shown to improve patient outcomes, control spend, and help stakeholders collectively share risk.

“It’s a ‘Put your money where your mouth is’ moment, and we find that a lot of drug companies aren’t willing to think differently,” Contreras explains. “I’d like to see a little more push from that side of the street. You can’t just continue to increase copays and premiums. Patients cannot handle that burden.”

Whatever the strategy, Contreras says his leadership style is easy to explain. He’s been playing soccer longer than he’s been in pharmacy, and he has the heart of a coach. He’s coached at the high school level for years, even winning some championships, and he brings the same coaching mindset to his work team.

“You learn that different people need to be motivated in different ways,” Contreras says. “Sometimes people need a kick in the pants, and other times they need a hug. You’ve gotta figure that out to create a high-performing team, whether it’s sports or your career. You figure out how to bring the best parts of personalities together to thrive.”

The coach has also learned the value of creating buy-in and vision. When others are allowed to be part of building that vision, the buy-in comes naturally. You won’t find Contreras laying down the law on how things need to be; it’s just not his style.

Contreras may be deep into his career, but he doesn’t seem to be slowing down. He and his wife (also a pharmacist) recently moved to the San Diego area and Contreras says he’s looking for more ways to get involved in his new hometown. The civic-minded drive comes naturally; now he just needs to figure out where the energy will go. As always, he’ll find a way to let his inner coach shine through.

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