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PBM Impact on Independent Pharmacy Owners | PBM Reform · Pharmacy Podcast Network

0:05
Speaker 1: You are listening to the global network of podcasters dedicated
0:09
Speaker 1: to the pharmacy profession. Welcome to the Pharmacy Podcast Network.
0:34
Speaker 2: Welcome to the PBM Reform Podcast, where we dive deep
0:38
Speaker 2: into the world of pharmaceutical benefit management, cutting through the
0:41
Speaker 2: noise to uncover the truth. Since 2019, we've been your
0:46
Speaker 2: go-to source for the latest on how PBMs impact patient care,
0:51
Speaker 2: drug pricing, and the very future of pharmacy. Here, we
0:55
Speaker 2: champion the role of pharmacists, the most knowledgeable advocates for
0:59
Speaker 2: medication safety and expertise. Join us as we expose and
1:04
Speaker 2: generate discussions that are reshaping healthcare and explore how we
1:08
Speaker 2: build a better payment system which focuses on advancing pharmacy care.
1:19
Speaker 3: Welcome, everybody, to the PBM Reform Podcast here on the
1:22
Speaker 3: Pharmacy Podcast Network. My name is Brett Grice. Today, we're
1:26
Speaker 3: going to take the conversation about pharmacy benefit managers. We're
1:32
Speaker 3: going to take it out of the boardroom. We're going
1:35
Speaker 3: to take it out of Washington, D.C. We're going to
1:38
Speaker 3: take it off of the spreadsheets and all the documents,
1:40
Speaker 3: and we're going to bring it right to the pharmacy counter.
1:44
Speaker 3: So because when you're talking about PBM reform, it's real
1:50
Speaker 3: easy to talk about all the major things that we
1:52
Speaker 3: always cover, reimbursement rates, DIR fees, formularies, the clawbacks, you know,
1:59
Speaker 3: network and who can participate and who can't and the contracting.
2:04
Speaker 3: But behind every one of those issues, there's something much
2:08
Speaker 3: more important, and that's the patient. And so today, we
2:13
Speaker 3: want to really look at how the decisions that are
2:17
Speaker 3: made by pharmacy benefit managers, by PBMs, their policies can
2:22
Speaker 3: really not just affect the patient, but the community pharmacies,
2:27
Speaker 3: especially the independent pharmacies that are supporting those patients. So
2:33
Speaker 3: we want to look at it from that perspective today
2:35
Speaker 3: of a community pharmacy owner. and about what it's actually
2:41
Speaker 3: like to operate an independent pharmacy and deal with PBM influences.
2:47
Speaker 3: And again, most importantly, how PBMs affect the relationship between
2:52
Speaker 3: the pharmacist and their patients. So I want to welcome
2:55
Speaker 3: to the program, Dr. Fair Jones. Hi, Dr.
2:59
Speaker 1: Jones.
2:59
Speaker 3: How are you?
3:00
Speaker 1: I'm good. How are you? Thank you so much for
3:02
Speaker 1: having me.
3:03
Speaker 3: This is a pleasure. I've been following your posts and
3:08
Speaker 3: you're saying all the right things. And so I was like,
3:11
Speaker 3: we've got to have you on this show and get
3:14
Speaker 3: to know you a little more and get down to
3:16
Speaker 3: the trenches and just see really what you're dealing with.
3:20
Speaker 3: on a day-to-day basis. So let's start with your own story.
3:23
Speaker 3: Tell us about your own pharmacy, how long you've had
3:26
Speaker 3: the business, and what makes you different than maybe a
3:30
Speaker 3: chain or even a mail order pharmacy that's out there.
3:34
Speaker 1: Yeah, so I have owned my pharmacy since 2019. It
3:37
Speaker 1: was an existing pharmacy here in my hometown in Mississippi,
3:41
Speaker 1: and my husband and I were lucky enough to get
3:44
Speaker 1: the opportunity to purchase that pharmacy. So we did and
3:48
Speaker 1: we have been here ever since. You know, Save More,
3:53
Speaker 1: like I said, it's been here for, you know, 50
3:56
Speaker 1: plus years. And so people just know that it's kind
3:59
Speaker 1: of one of those places that's just part of Grenada.
4:02
Speaker 1: But I would say what's different for us is that
4:06
Speaker 1: we're really like a family, you know, not only my staff,
4:10
Speaker 1: but also our customers. We, of course, know what medications
4:14
Speaker 1: they're taking, but we also know, you know, when their
4:17
Speaker 1: kids are playing baseball or, you know, when someone had
4:20
Speaker 1: a surgery or, you know, what church they go to,
4:23
Speaker 1: you know, and we just have these small town connections that,
4:28
Speaker 1: really resonate with a lot of people. They're not just
4:31
Speaker 1: a number coming in, you know, another metric to check
4:36
Speaker 1: off the list. They're our family. And so, you know,
4:41
Speaker 1: a lot of these people, I was born and raised
4:42
Speaker 1: here in Grenada. And so it's people I've known my
4:45
Speaker 1: whole life. And, you know, I've known their kids or
4:48
Speaker 1: their grandkids. And, you know, it's really cool for me
4:52
Speaker 1: to get to help take care of those people that
4:54
Speaker 1: I feel like raised me when I was here. So,
4:58
Speaker 1: I try to take that with how I do my job.
5:01
Speaker 1: And I just think, you know, you can't beat a
5:05
Speaker 1: small independent pharmacy. It's the best.
5:08
Speaker 3: It really is. So I'm sure everyone in your community
5:12
Speaker 3: already knows you and knows how to find your pharmacy.
5:14
Speaker 3: But just in case, where are you located?
5:18
Speaker 1: So we're in Grenada, Mississippi, and we are on Commerce
5:22
Speaker 1: Street right across from Grenada High School, right down the
5:26
Speaker 1: way from Sonic. So just kind of the main drag
5:28
Speaker 1: right in Grenada. You can't miss this.
5:31
Speaker 3: Okay, excellent. All right. And so when you think back
5:36
Speaker 3: at your career going to pharmacy school, you didn't jump
5:40
Speaker 3: right directly into an independent pharmacy. So where did your
5:45
Speaker 3: career path take you to this point today?
5:47
Speaker 1: Yeah, so when I got out of pharmacy school, I
5:50
Speaker 1: actually started working for Rite Aid. And I was living
5:54
Speaker 1: in Alabama at the time. I moved there right after graduation.
5:58
Speaker 1: And so I started with Rite Aid. And then after
6:02
Speaker 1: about a year, we ended up coming back to Mississippi.
6:05
Speaker 1: And I worked for Walgreens in Eupora.
6:11
Speaker 4: Which is this tiny little town in Mississippi, where And
6:14
Speaker 4: then I ended up.
6:15
Speaker 1: After a couple of years there, I went to Kroger Pharmacy.
6:19
Speaker 1: And from Kroger, I came here to save more. So
6:22
Speaker 1: I really feel like I have a really good understanding
6:26
Speaker 1: of the corporate chain side of community pharmacy as well,
6:31
Speaker 1: the good and the bad. And so that has helped
6:33
Speaker 1: me know what I did and didn't want to do
6:36
Speaker 1: when I had my own store. And I'm super thankful
6:40
Speaker 1: for that time there. in those places because I learned
6:43
Speaker 1: just so much about pharmacy as a whole.
6:45
Speaker 3: Yeah. Was that always the goal? Do you think to,
6:49
Speaker 3: to have your own store, be able to do it
6:51
Speaker 3: your own way someday?
6:53
Speaker 1: You know, in the beginning I would say not necessarily. Um,
6:58
Speaker 1: it kind of seemed like a pipe dream, like just
7:00
Speaker 1: something that would be too far out of reach for
7:04
Speaker 1: me for whatever reason. I thought that, um, And I
7:07
Speaker 1: was content in the beginning to do what I was doing.
7:10
Speaker 1: But as I kind of progressed through my career in
7:14
Speaker 1: those early years, I realized pretty quickly that there was
7:18
Speaker 1: so much more that I could do. And there were
7:20
Speaker 1: so many more ways that I could impact my patients
7:24
Speaker 1: and that I could really be a pharmacist and not
7:27
Speaker 1: just like a robot behind a counter. And I had
7:30
Speaker 1: small children and You know, it was just kind of
7:36
Speaker 1: like this just life moment where it was like, is
7:39
Speaker 1: this really what we're going to do for the rest
7:42
Speaker 1: of our life? You know, and and then this opportunity
7:46
Speaker 1: just kind of kind of fell into our lap. I mean, honestly,
7:50
Speaker 1: it was not something we were we were looking for,
7:54
Speaker 1: but it was just the best, the biggest blessing. And
7:57
Speaker 1: I knew then that this is really what I wanted
8:01
Speaker 1: to do. Yeah.
8:02
Speaker 3: Now, is your husband in the pharmacy industry also?
8:07
Speaker 1: He is not. He is in construction, construction background. And
8:11
Speaker 1: so he has he does help me in the pharmacy
8:14
Speaker 1: now as far as some of the business side of it.
8:17
Speaker 1: But his he has no pharmacy training or anything like that.
8:21
Speaker 1: Just business stuff.
8:23
Speaker 3: Yeah. Yeah, that's excellent. So, yeah, I can see some
8:27
Speaker 3: beautiful pictures in your background there of your little family.
8:31
Speaker 3: So happy little couple and a couple of kids. Is
8:35
Speaker 3: that you just have one boy and one girl?
8:38
Speaker 1: Yes, two kids. They've grown a little bit since this picture,
8:41
Speaker 1: seventh grade and fourth grade. So in the midst of
8:45
Speaker 1: the middle school years, which. Yeah.
8:48
Speaker 3: And you evened up the teams with your daughter, so
8:50
Speaker 3: you got two boys and two girls in the household.
8:53
Speaker 3: That's perfect.
8:54
Speaker 1: Yeah.
8:54
Speaker 3: So when you think about your patients, you know, and
8:58
Speaker 3: you've already given a really good detail of how well
9:01
Speaker 3: you know them, I mean, beyond just dispensing or filling
9:04
Speaker 3: a script, what is your pharmacy to them as a
9:08
Speaker 3: general health care? Yeah.
9:10
Speaker 1: Yeah. You know, for us, you know, we're a small
9:13
Speaker 1: town in rural Mississippi. And for a lot of our patients,
9:18
Speaker 1: they don't always have the means to get to the doctor,
9:22
Speaker 1: you know. we're kind of that place that they are
9:26
Speaker 1: going to call us first. If it's kind of borderline,
9:29
Speaker 1: do I go, do I not go? Or if it's
9:31
Speaker 1: an emergency type thing, a lot of times they'll call
9:34
Speaker 1: us and they'll say, hey, this is what's going on.
9:37
Speaker 1: What do you think? Is there anything I can do
9:38
Speaker 1: before I go to the doctor? And we do what
9:43
Speaker 1: we can to help them in that situation. I think
9:45
Speaker 1: for us, people really trust us. And so, and I
9:51
Speaker 1: think that goes for any pharmacy. I mean, your pharmacies are,
9:54
Speaker 1: their pharmacists are trusted. And we have people come in
9:58
Speaker 1: all the time that just want to talk about stuff
10:02
Speaker 1: going on with their health, whether it's medication related or not.
10:06
Speaker 1: And so sometimes when we can just kind of take
10:08
Speaker 1: those few minutes and talk through it with them. they
10:11
Speaker 1: feel better. A lot of times they're given lots of
10:15
Speaker 1: information when they go to the doctor and we can
10:18
Speaker 1: kind of just help them understand that a little better.
10:21
Speaker 1: And even if we're not doing anything clinically for them
10:25
Speaker 1: in that moment, just being that, that avenue that can
10:29
Speaker 1: come in and talk it through, I think really goes
10:31
Speaker 1: a long way with a lot of them. And that's
10:35
Speaker 1: my fear of, you know, I'm sure we'll get into this,
10:38
Speaker 1: but that's my fear. If we weren't here is who
10:40
Speaker 1: was going to, who's going to do that for these people?
10:43
Speaker 1: Because we, again, we're, we're in small town, Mississippi. There's
10:46
Speaker 1: not a lot of options and you know, having access
10:51
Speaker 1: to healthcare is a big deal. And, you know, we
10:55
Speaker 1: just try to be there whenever we can for them. Yeah.
10:58
Speaker 3: Do you think your patients would get that same level
11:03
Speaker 3: of support from a chain or a national mail order pharmacy?
11:10
Speaker 1: Absolutely not. You know, and I worked in a chain.
11:14
Speaker 1: And so I always say like, They are really doing
11:17
Speaker 1: the best they can, those people that are in the
11:19
Speaker 1: pharmacy working, for what conditions they are working in. I
11:24
Speaker 1: don't feel like patients should suffer because of that, because
11:29
Speaker 1: of the corporate makeup and the things that they're the
11:32
Speaker 1: way they're having to work. And so I do feel
11:35
Speaker 1: like not that those people wouldn't be totally qualified to
11:38
Speaker 1: do what I do or to be there for people
11:40
Speaker 1: in that way, but.
11:42
Speaker 4: They don't have the time and they're not going to
11:44
Speaker 4: always take the time to do that.
11:46
Speaker 1: And, you know, for us, we might be busy, too, but.
11:50
Speaker 1: we're going to stop and we're going to, we're going
11:52
Speaker 1: to make sure that person is taken care of. And,
11:55
Speaker 1: you know, definitely not at a mail order. Goodness gracious.
11:58
Speaker 1: They're never going to get, they might not even talk
12:00
Speaker 1: to a live human being ever, you know? So. Right. Yeah.
12:05
Speaker 3: I know all of our pharmacists and those in the
12:09
Speaker 3: industry know this, but for anyone that's picking up the
12:12
Speaker 3: audio of this podcast and just discovered it for the
12:16
Speaker 3: first time, You know, our community pharmacists are the most
12:20
Speaker 3: accessible healthcare providers in the country, been recognized as the
12:28
Speaker 3: most trusted healthcare provider for the last 10 years running.
12:33
Speaker 3: You're just accessible. They can walk up to the counter
12:35
Speaker 3: and ask you a question when they've got a scratchy
12:37
Speaker 3: throat or they're congested or they've got some weird skin rash,
12:41
Speaker 3: and they're not going to get that kind of level
12:44
Speaker 3: of service anywhere else. They certainly can't walk into a
12:48
Speaker 3: doctor's office and ask those simple questions without an appointment.
12:52
Speaker 3: But yeah, you're there for them every day that your
12:55
Speaker 3: pharmacy is open. So that's amazing. Yeah, appreciate that. So
13:00
Speaker 3: we want to get to know you a little bit
13:02
Speaker 3: better about your personal preferences. Just some rapid fire here.
13:06
Speaker 3: Are you an early bird or a night owl?
13:08
Speaker 1: Oh, I'm more of an early bird.
13:10
Speaker 3: Okay. And do you prefer the mountains or the beach?
13:15
Speaker 1: More of a beach girl.
13:17
Speaker 3: Okay. Yeah, you're a little closer to the beach than
13:18
Speaker 3: the mountains there. And do you prefer coffee, tea, or
13:22
Speaker 3: something else?
13:25
Speaker 1: I love coffee in the mornings, but there's nothing better
13:28
Speaker 1: than a Coke on ice from somewhere. So just a
13:31
Speaker 1: real Coke.
13:32
Speaker 3: Okay, yeah. Just down the road, Sonic there, do you
13:36
Speaker 3: ever add any flavor and get some vanilla or something
13:38
Speaker 3: like that when you're really feeling crazy?
13:40
Speaker 1: If I'm feeling crazy, I'll get a little cherry in
13:42
Speaker 1: there from time to time.
13:43
Speaker 3: Okay. Yeah, it reminds me of my mom when she
13:48
Speaker 3: was a teenager. was a soda jerk at a community pharmacy,
13:53
Speaker 3: and she helped mix people's drinks way back before all
13:56
Speaker 3: of these fancy places that do your whatever they're called,
14:01
Speaker 3: dirty Dr. Peppers or whatever you get now with the
14:03
Speaker 3: cream and all that and the cherry flavoring. So, yeah.
14:06
Speaker 3: All right. I appreciate you letting me get to know
14:10
Speaker 3: you a little better that way. Let's get into now
14:12
Speaker 3: kind of the elephant in the room. That's the PBMs.
14:14
Speaker 3: And when you first realized that PBMs had a significant
14:19
Speaker 3: impact on how you could serve your patients, tell us
14:23
Speaker 3: about that experience.
14:25
Speaker 1: Yeah, I think, you know, when we became owners, it
14:28
Speaker 1: was kind of a weird time because it was right
14:31
Speaker 1: before COVID.
14:32
Speaker 4: And so that first year I was just getting my.
14:35
Speaker 1: Feet wet, trying to figure out really what I was
14:37
Speaker 1: doing as far as being a pharmacy business owner. And
14:40
Speaker 1: then we had COVID and it was just like, we're
14:43
Speaker 1: just trying to make it from day to day. And
14:45
Speaker 1: so I feel like I kind of was blinded by
14:49
Speaker 1: those things and not really focusing on the PBMs that
14:52
Speaker 1: were stealing from me all that time. And so when
14:56
Speaker 1: I finally, you know, was able to breathe again and
14:59
Speaker 1: realized what was happening, it was right in the middle
15:01
Speaker 1: of all the DIRs fees that were just astronomical. And
15:06
Speaker 1: so when I started calculating and looking at my reports
15:10
Speaker 1: and seeing how much we had been paying in those
15:12
Speaker 1: DLR fees over the past several years, I was just,
15:16
Speaker 1: I couldn't believe it. I mean, it was shocking. And
15:19
Speaker 1: to see how much they had increased year over year.
15:23
Speaker 1: And so that's really when I started kind of just
15:27
Speaker 1: looking despising what was happening and really kind of trying
15:32
Speaker 1: to learn as much as I could about what was
15:35
Speaker 1: going on. You know, and then after that, it really,
15:41
Speaker 1: when the DIR fee, when those became where you couldn't
15:45
Speaker 1: do them, you know, retroactively and it was all done
15:47
Speaker 1: at the point of sale. And then we just started
15:49
Speaker 1: seeing all these underwater payments and it just kind of
15:53
Speaker 1: flip-flopped how they were, how they were doing it. And
15:57
Speaker 1: it just was, maddening to me and that really is
16:03
Speaker 1: probably when I really sucked my heels in and said
16:07
Speaker 1: we're not going down without a fight and I'm not
16:09
Speaker 1: gonna you know I'm not gonna sit here and not
16:12
Speaker 1: try to do something about it but it just you
16:17
Speaker 1: know it's tough I mean they they change the game
16:21
Speaker 1: daily and it's like we're learning as we go but
16:24
Speaker 1: you know I feel like we're just doing what we
16:27
Speaker 1: can to try to try to make a difference.
16:30
Speaker 3: Yeah. So did you isolate any specific medication that you
16:35
Speaker 3: were dispensing regularly that was being dispensed below your, you know,
16:40
Speaker 3: where you were losing money?
16:41
Speaker 1: Yeah, we really, you know, of course, like with GLP-1s,
16:46
Speaker 1: when those kind of hit the scene, you know, that...
16:50
Speaker 1: really kind of put us in a hole, um, to
16:52
Speaker 1: be just quite honest with you for many different reasons. Um,
16:56
Speaker 1: you know, we weren't being paid for six to eight
16:58
Speaker 1: weeks after we would fill them. And, um, then when
17:02
Speaker 1: insurance did start picking them up, they're underpaying you a
17:05
Speaker 1: hundred dollars on it, you know? And so we, I mean,
17:08
Speaker 1: we basically, except for a couple of insurance insurances, we
17:12
Speaker 1: stopped filling those period, you know, and it was, um,
17:16
Speaker 1: it stinks because it's these great medications that people were
17:19
Speaker 1: seeing a lot of success on, but we just couldn't
17:21
Speaker 1: afford to do it. And we basically, most name brand medications, we,
17:29
Speaker 1: all of my patients that are on name brands, we
17:31
Speaker 1: have them synced. So we do MedSync and we don't
17:36
Speaker 1: order those until it's time for them to, to have
17:39
Speaker 1: them again. We make sure that we're, that we're profitable
17:42
Speaker 1: on them. And if we're not, we have to have
17:45
Speaker 1: that hard conversation with our patients and say, Hey, like
17:48
Speaker 1: this is what's happening. And this is the truth about
17:51
Speaker 1: what's happening. And, you know, I can help you get
17:54
Speaker 1: it somewhere else, but I can't fill it for you here.
17:57
Speaker 1: And that's a really, that's a really hard conversation to
18:01
Speaker 1: have with someone that trusts you and that you want
18:05
Speaker 1: to help, but you just can't, you can't, you can't.
18:08
Speaker 1: And it's, It's awful.
18:11
Speaker 3: Yeah. So, I mean, let's look at the reality of this.
18:14
Speaker 3: You're asked as a pharmacist to dispense any prescription that
18:19
Speaker 3: comes in, regardless of what you're going to get reimbursed
18:23
Speaker 3: for that. But take that to any other small business.
18:26
Speaker 3: If they were selling shovels and the People paying for
18:31
Speaker 3: the shovel paid only half the cost of the shovel.
18:35
Speaker 3: How long can they stay in business? I mean, it
18:37
Speaker 3: just doesn't make sense whatsoever. But yet you as a
18:40
Speaker 3: community pharmacy, you're expected to go ahead and dispense those
18:43
Speaker 3: medications below your acquisition cost. Do you have a system
18:48
Speaker 3: in place now that kind of helps you identify that
18:51
Speaker 3: right at the point of sale where you can say, sorry,
18:54
Speaker 3: I can't dispense this?
18:56
Speaker 1: Yeah, so in our pharmacy system, I have a block
19:00
Speaker 1: set up for anything that is below a certain threshold
19:05
Speaker 1: that we take a second look at. That doesn't always
19:09
Speaker 1: mean that I'm not going to dispense it or that
19:11
Speaker 1: I am. It's just another kind of stop so that
19:16
Speaker 1: we can look at it and see, does this make
19:18
Speaker 1: sense or not to do it? And that has really
19:22
Speaker 1: helped just kind of really to know what's really happening.
19:26
Speaker 1: Because in a pharmacy, I mean, you're working 90 to
19:28
Speaker 1: nothing sometimes and you're just pushing stuff out. And a
19:32
Speaker 1: lot of that can kind of get by if you're
19:35
Speaker 1: not being very diligent. And so that really helps us
19:40
Speaker 1: kind of take a second look at it. I also
19:42
Speaker 1: run reports every day that have anything that was dispensed
19:46
Speaker 1: and filled below cost so that we can then go
19:49
Speaker 1: and file MAC appeals with the ones that we're allowed
19:53
Speaker 1: to in Mississippi. So we'll do that. I try to
19:57
Speaker 1: do that daily or weekly as much as I can.
20:00
Speaker 1: But again, that's tedious work. That takes a lot to do, too.
20:04
Speaker 3: And it's putting a bandaid on the bullet hole, right?
20:07
Speaker 3: Because it's only bringing you back up to the cost.
20:11
Speaker 3: It doesn't cover any of your overhead whatsoever, just the
20:15
Speaker 3: acquisition cost of the medication itself. You still have labor.
20:19
Speaker 3: You still have your building that you're paying for, your utilities.
20:24
Speaker 1: It's not making you whole, that's for sure. It's making
20:28
Speaker 1: maybe you whole on the medication itself, but it's definitely
20:32
Speaker 1: not making you whole all the way.
20:34
Speaker 3: Plus your time. You're making negative dollars per hour when
20:39
Speaker 3: you have to go do all that research and do
20:41
Speaker 3: those appeals. Right.
20:43
Speaker 1: Absolutely. Absolutely.
20:44
Speaker 3: Wow. So again, you know, no other business is expected
20:48
Speaker 3: to do that. You know, you look at just about
20:54
Speaker 3: that same time that you bought your pharmacy was about
20:58
Speaker 3: the time that a big PBM took over all of
21:01
Speaker 3: the Department of Labor, DOL claims. So all those rural
21:06
Speaker 3: postal workers in your area that may need a prescription
21:10
Speaker 3: that maybe because they were walking for so many years
21:18
Speaker 3: doing their mail delivery in the downtown area and they've
21:21
Speaker 3: wore out their feet, that will fall under workers' comp. Well,
21:24
Speaker 3: that reimbursement on DOL, Department of Labor, is minus 88%.
21:29
Speaker 3: I mean, how can a pharmacy dispense that medication at
21:34
Speaker 3: minus 88% of AWP? So I'm sure there's an access
21:39
Speaker 3: issue too if pharmacists are smart like you and have
21:43
Speaker 3: put those blocks in place and just say, hey, we
21:45
Speaker 3: can no longer allow and dispense a medication at a loss.
21:49
Speaker 1: Right. I think a lot of pharmacies, you know, for
21:53
Speaker 1: a while we didn't want to, we just wanted to
21:56
Speaker 1: push through and to say, well, it's going to be,
21:58
Speaker 1: it's going to get better and it's going to be okay.
22:00
Speaker 1: And nobody really wanted to talk about it or tell
22:03
Speaker 1: your patients really what was happening with that. But, you know,
22:07
Speaker 1: I think as time's gone on, we've all realized it's
22:11
Speaker 1: not sustainable anymore. And we have to do these things
22:16
Speaker 1: to make better decisions in our business.
22:20
Speaker 3: Yeah, I brought up one example of access, right? So
22:24
Speaker 3: these decisions that pharmacy benefit managers are making and how
22:30
Speaker 3: that trickles down and affects the patients that they're supposed
22:33
Speaker 3: to be serving. So access is one. Do you have
22:36
Speaker 3: any other examples of real life situations where a patient
22:42
Speaker 3: is now being affected by the policy of a PBM?
22:46
Speaker 1: Yeah, I have one in particular that kind of sticks
22:49
Speaker 1: out to me. I had a guy who has COPD
22:53
Speaker 1: and he's on one of these expensive name brand inhalers.
22:57
Speaker 1: We've been filling it for him every month. I think
23:00
Speaker 1: his copay was around $ 60 a Um, he works here
23:04
Speaker 1: in town at a factory, so he has commercial insurance
23:07
Speaker 1: or his employer. Um, and we were fine. We were,
23:10
Speaker 1: we were making a little money on it. Wasn't a
23:12
Speaker 1: big deal. Um, one day he comes in and, you know,
23:16
Speaker 1: we refill it and his copay had jumped to, I
23:20
Speaker 1: believe it was like almost $ 500, like 486 or something
23:24
Speaker 1: like that. And so I'm like, this does not make
23:27
Speaker 1: any sense. So I start, you know, digging around, um,
23:31
Speaker 1: Something had changed with his plan design and now he
23:34
Speaker 1: was being penalized for using our pharmacy. He was going
23:38
Speaker 1: to have to go to a chain in town or
23:40
Speaker 1: get it through the mail. It was also the summer
23:42
Speaker 1: and we're in Mississippi and it is hot in here.
23:45
Speaker 1: And so nobody wants any mail, anything coming through the
23:49
Speaker 1: mail that you really don't want to be melted, you know?
23:52
Speaker 1: And so, but when all this kind of happened the
23:56
Speaker 1: first time, it was a Friday and He was out,
24:00
Speaker 1: and so he needed his medication. So he put that
24:03
Speaker 1: $ 500 and something copay on his credit card. He could
24:08
Speaker 1: not afford that. This is not the kind of guy
24:11
Speaker 1: who has an extra $ 500 laying around. But it was
24:15
Speaker 1: either that or I don't breathe. And so he bought
24:19
Speaker 1: that inhaler and we ended up transferring it to the
24:22
Speaker 1: other pharmacy once we realized where he could get it.
24:26
Speaker 1: But what was he supposed to do in that situation?
24:30
Speaker 1: It was either, you know, go without and risk, you know,
24:36
Speaker 1: not being able to breathe literally or, you know, go
24:39
Speaker 1: in the hole, this money that you don't have and
24:41
Speaker 1: you may not be able to pay back. And, you know,
24:44
Speaker 1: the funny thing is that even after we did all that,
24:46
Speaker 1: we were now like $ 15 in the hole. We had,
24:50
Speaker 1: we were still not, we still didn't profit enough to
24:53
Speaker 1: cover the cost of the medication. And it's just like
24:57
Speaker 1: makes you want to scream because, you know, it puts
25:00
Speaker 1: the patient out. It puts us out. But ultimately, now
25:04
Speaker 1: you have this patient who is scrambling, trying to figure
25:07
Speaker 1: out what to do. And, you know, I'm sure that
25:11
Speaker 1: employer and that insurance company, they were trying to do
25:14
Speaker 1: the best they could to keep their costs low.
25:17
Speaker 4: And sending that to that other pharmacy was the way
25:20
Speaker 4: they were going to keep that cost low.
25:22
Speaker 1: But what they don't get is that people don't want
25:24
Speaker 1: to go to those other pharmacies. And in that moment,
25:27
Speaker 1: he was going to pay that money because he had
25:29
Speaker 1: to have it. And he knew he'd wait two days
25:31
Speaker 1: going down the road. And so it just stuff like
25:36
Speaker 1: that happens over and over all day long. And it's
25:39
Speaker 1: just it's infuriating.
25:42
Speaker 3: Yeah. So how much time do you think you and
25:44
Speaker 3: your staff actually spend dealing with, you know, prior authorizations
25:48
Speaker 3: or formulary issues or rejections?
25:52
Speaker 1: So much time. I mean, it's, you know, there's never
25:55
Speaker 1: really a quick fix. If you come, if something like
25:57
Speaker 1: that happens, it's not really a simple, a simple deal.
26:01
Speaker 1: I mean, you're spending 30 minutes trying to get something
26:05
Speaker 1: resolved that may or may not be profitable or it
26:09
Speaker 1: may not, may or may not even be affordable for
26:11
Speaker 1: the patient either, you know. But I would say hours
26:15
Speaker 1: a week where we're doing stuff like that. Yeah.
26:18
Speaker 3: Yeah. And now what about audits? Have you had to
26:22
Speaker 3: go through a PBM audit?
26:24
Speaker 1: Yes. Yes. We've had, I've had several like desktop audits.
26:30
Speaker 1: I had a big onsite audit last year. That was
26:32
Speaker 1: my first real onsite audit. I have another one that
26:37
Speaker 1: I was just hit with about a week ago, which
26:42
Speaker 1: was very interesting timing, but that's a desktop audit, but
26:48
Speaker 1: you know, it's, like the one I had last year
26:50
Speaker 1: that was the on-site, the discrepancies that they found were
26:55
Speaker 1: all clerical in nature where, you know, you, a doctor
26:59
Speaker 1: writes for a quantity of one box. We know a
27:03
Speaker 1: one box of insulin pens is 15 milliliters. You change
27:06
Speaker 1: it to 15. We didn't write a note. We should have,
27:09
Speaker 1: but we did not. And so now it's, you know, that's,
27:13
Speaker 1: that's not okay. Um, I think total it would have
27:17
Speaker 1: been about $ 50, 000 if they would have gotten back all
27:20
Speaker 1: that they had audited us on. Luckily, I think we
27:24
Speaker 1: got it down to about $ 1, 200. We were able to
27:26
Speaker 1: appeal the majority of it. But, yeah, these audits, they're
27:31
Speaker 1: not for what they say they are. They are a
27:36
Speaker 1: way for them to make some money back on these
27:38
Speaker 1: expensive medications that they're paying for.
27:40
Speaker 3: Yeah, yeah. Yeah, that's, you know, all in the taking
27:46
Speaker 3: care of the patient, right?
27:48
Speaker 4: Right, right.
27:49
Speaker 3: Speaking of taking care of the patient, how often have
27:52
Speaker 3: you been, you know, filling a prescription for someone and
27:56
Speaker 3: now it's not on formulary any longer? And do those
28:00
Speaker 3: patients understand or do they think it's your fault?
28:04
Speaker 1: You know, most times they do think that it's our
28:08
Speaker 1: fault or that we've done something that now all of
28:10
Speaker 1: a sudden it's not covered. you know, and it's hard
28:13
Speaker 1: to explain. It's like, it was covered last month, but
28:16
Speaker 1: I don't know why it's not covered this month, you know?
28:19
Speaker 1: And I have gotten to now where I try to
28:22
Speaker 1: really dig into it as much as time will allow
28:25
Speaker 1: so that I can inform the patient exactly what's happening
28:28
Speaker 1: so that if they feel like they need to go
28:30
Speaker 1: complain to their employer or to, you know, their insurance company,
28:35
Speaker 1: they feel empowered to do that. But it's, You know,
28:39
Speaker 1: it's hard for someone who doesn't work in it every
28:42
Speaker 1: day and they don't understand the jargon and the steps
28:47
Speaker 1: and the nuances of an insurance claim. It's hard to
28:51
Speaker 1: make it make sense because it does not make sense
28:55
Speaker 1: a lot of times. I mean, even for us, it's
28:56
Speaker 1: like this makes no sense whatsoever, but this is where
29:01
Speaker 1: we are. So it's hard.
29:03
Speaker 3: Let's put on the patient's shoes for just a minute.
29:05
Speaker 3: You know, patient walks into the pharmacy. that they trust
29:09
Speaker 3: and they know you tell them, Hey, we're here to
29:12
Speaker 3: take care of this for you. And then you have
29:16
Speaker 3: to tell them your insurance won't let us fill this anymore.
29:19
Speaker 3: So what does that, what kind of strain does that
29:22
Speaker 3: put on the pharmacy patient relationship?
29:25
Speaker 1: It's, I mean, yeah, it's hard. I mean, they, you know,
29:30
Speaker 1: They want to be there for you and understand, but
29:34
Speaker 1: at the same time, they're still inconvenienced and they're still
29:37
Speaker 1: not getting something that they need. And so, you know,
29:41
Speaker 1: like us, as we've kind of been going through this
29:45
Speaker 1: period of really advocating for our store and for our profession,
29:50
Speaker 1: I've been very transparent with my patients about, hey, this
29:54
Speaker 1: is what's going on. This is why certain things are happening.
29:58
Speaker 1: And That helps for people to understand, but it doesn't
30:04
Speaker 1: take away the bottom line, which is people need their medication.
30:09
Speaker 1: And so as much as they may want to support
30:11
Speaker 1: us and understand us, they're still going to be a
30:15
Speaker 1: little irritated that they can't get something from us. And so,
30:18
Speaker 1: you know, it's really, it's tough. And as an owner,
30:23
Speaker 1: and I'm kind of an emotional type person and I
30:27
Speaker 1: feel all the things all the time, but it makes
30:31
Speaker 1: you wonder like, okay, well, I couldn't do this. Are
30:34
Speaker 1: they going to take everything over here? Are they going
30:36
Speaker 1: to be upset because we had to handle it this way?
30:39
Speaker 1: And when you're a small business owner, you want to
30:43
Speaker 1: help people and you want to to provide the service
30:46
Speaker 1: that you say you can provide, especially if you're in
30:49
Speaker 1: healthcare and you're a pharmacist. And when you can't do that,
30:53
Speaker 1: you start wondering, okay, well, what does this mean for
30:56
Speaker 1: future times that they come into the store? You know,
31:00
Speaker 1: it's hard.
31:01
Speaker 3: Yeah, it's the human cost, right? Not just to the patient,
31:05
Speaker 3: but to the pharmacy. And when you look at, you know, the...
31:12
Speaker 3: you know, the margin that used to be quite profitable
31:16
Speaker 3: for a community pharmacy to dispense and that being eroded
31:21
Speaker 3: away to being, you know, razor thin now, that means
31:27
Speaker 3: that you have to start cutting some of the other
31:29
Speaker 3: services just to survive. Maybe you have to reduce the
31:32
Speaker 3: hours that you're open or the hours that you have
31:35
Speaker 3: help so you're not the only one behind the bench
31:39
Speaker 3: running your own business, but, you know, you want to pay...
31:42
Speaker 3: for a tech to help occasionally, but now you got
31:44
Speaker 3: to reduce those hours. Or even ultimately what I see
31:49
Speaker 3: on a daily basis, and that's pharmacies closing because they
31:54
Speaker 3: cannot survive any longer at these low margins. That becomes
32:02
Speaker 3: a bigger effect on human capital than just the pharmacy,
32:06
Speaker 3: but now those patients that they serve. You're in an
32:10
Speaker 3: area where your pharmacy isn't around, where do your patients go?
32:16
Speaker 3: Is there one other option or do they have to
32:18
Speaker 3: go to the next town over? Yeah.
32:21
Speaker 1: So, you know, we do have several pharmacies. To be
32:24
Speaker 1: a small town, we do have several. But in saying that,
32:30
Speaker 1: the independents, we're all in the same boat. You know,
32:33
Speaker 1: we're all fighting the same fight. And, you know, we
32:39
Speaker 1: have Two chains, one of them, sometimes there's not even
32:43
Speaker 1: a pharmacist there. I mean, they can't keep it staffed,
32:45
Speaker 1: you know, and they're days behind. And, you know, we
32:50
Speaker 1: have a lot of smaller, even smaller communities outside of
32:55
Speaker 1: our town that come to us because there aren't pharmacies
32:58
Speaker 1: in their town. And so if we're gone, they're going
33:02
Speaker 1: to be driving even further. And a lot of times
33:06
Speaker 1: they're already driving 15 miles, 15, 20 miles to get here.
33:11
Speaker 1: And so then it's now where do they go? You know,
33:14
Speaker 1: we're in the Mississippi Delta. There are some counties that
33:17
Speaker 1: don't have a pharmacy, period, or they have one. And,
33:20
Speaker 1: you know, that is, what are they going to do?
33:24
Speaker 1: I mean, we have, I mean, there's a story of
33:27
Speaker 1: a guy in this small Delta town around here. He
33:33
Speaker 1: walks 45 minutes to his pharmacy every day or when
33:38
Speaker 1: he needs to come to the pharmacy because He doesn't
33:41
Speaker 1: have transportation. It's the closest pharmacy. And he walks to it.
33:46
Speaker 1: And that is what it looks like in Mississippi is
33:49
Speaker 1: that there are people who are walking to get their medication.
33:52
Speaker 1: And when that pharmacy is not there, he literally has
33:56
Speaker 1: no other option. And it just it's it's awful. Wow.
34:01
Speaker 3: Then you pointed out that the summer months, it can
34:04
Speaker 3: be brutal. Not just the heat, but the humidity just
34:08
Speaker 3: cuts right through you.
34:09
Speaker 1: Yeah. Yeah.
34:12
Speaker 3: Spent 12 years in the Delta area, a little further
34:16
Speaker 3: north than you up in Germantown, Tennessee. But I've never
34:21
Speaker 3: been colder in the winter because of the moisture or
34:25
Speaker 3: hotter in the summer. And I, you know, I live
34:28
Speaker 3: in Phoenix, Arizona now. So it's like, OK, wait a minute.
34:32
Speaker 3: But it's a different heat, totally different heat.
34:34
Speaker 1: Totally. It's hard to make people understand. That humidity and
34:38
Speaker 1: that wetness does something to all of us.
34:40
Speaker 3: Yeah, it cuts right to the bone, as they say.
34:44
Speaker 3: The FTC reported that the three largest PBMs process nearly
34:51
Speaker 3: 80% of the prescriptions by design, right? So there's quite
34:56
Speaker 3: a monopoly there. And when you look at competing against that,
35:02
Speaker 3: especially when it comes to steering, How many times have
35:05
Speaker 3: you seen patients bring a letter in because they may
35:10
Speaker 3: be on a maintenance medication and it looks like they
35:12
Speaker 3: can't pick that up from your pharmacy anymore? Does that
35:15
Speaker 3: happen regularly?
35:16
Speaker 4: Oh, yes.
35:17
Speaker 1: All the time. All the time. We'll hear they'll get
35:20
Speaker 1: a letter or, you know, we'll even get a rejection
35:24
Speaker 1: at the store that says they've maxed out how many
35:26
Speaker 1: times they can fill it here. You know, we see it.
35:31
Speaker 4: All every day.
35:33
Speaker 3: Wow. Yeah, I, for a while, was on a, I
35:36
Speaker 3: like spicy foods, and so I was on a nomeprazole
35:40
Speaker 3: to kind of help keep the acid reflux down, not
35:44
Speaker 3: realizing that it was also deteriorating my bones, so I
35:47
Speaker 3: had to do something different. But yeah, for that short
35:51
Speaker 3: little while, you know, I got the letter from my
35:55
Speaker 3: PBM stating that my only option, it looked like it was,
36:00
Speaker 3: my only option was to get through their mail order pharmacy.
36:05
Speaker 3: And it took me four phone calls and a couple
36:09
Speaker 3: of hours of my time that I'll never get back
36:12
Speaker 3: just to get that removed and say, no, I will not.
36:15
Speaker 3: And I'll continue to use my community pharmacy to get
36:18
Speaker 3: my refills. But they made it painful, very painful to
36:22
Speaker 3: get out, to opt out of that drop ship. Yeah.
36:28
Speaker 1: Makes no sense, but yeah. perfect sense when you own
36:31
Speaker 1: 80% of the market share.
36:32
Speaker 3: So. Do you think that patients understand that, or is
36:36
Speaker 3: there an opportunity here to help educate patients about that monopolistic, um,
36:41
Speaker 3: directing or steering that, that PBMs are doing?
36:45
Speaker 1: I don't think that patients fully understand, um, you know,
36:49
Speaker 1: all the different ways that they are being influenced one
36:53
Speaker 1: way or the other to, to go to certain pharmacies. Um,
36:57
Speaker 1: You know, I know like around here, they know PBM
36:59
Speaker 1: reform and kind of, you know, we need PBM reform
37:03
Speaker 1: to stay alive and to keep our doors open. But
37:06
Speaker 1: knowing kind of what that is and what is happening
37:10
Speaker 1: to need that, they don't understand that, you know. And
37:14
Speaker 1: a lot of times, you know, we'll have patients who
37:16
Speaker 1: do get those letters. And they don't know they can
37:19
Speaker 1: call me and say, hey, is this for real? Like,
37:22
Speaker 1: can I still use you and let us talk them
37:25
Speaker 1: through it? They'll just transfer their stuff because, again, people
37:30
Speaker 1: need their medications and they won't. I mean, they they're
37:33
Speaker 1: living paycheck to paycheck and they need to save what
37:36
Speaker 1: money they can. And they think that's their only option, which.
37:41
Speaker 1: It's very frustrating but understandable to a degree, too, because
37:44
Speaker 1: they don't know that sometimes they have other options. And
37:48
Speaker 1: they surely don't understand that there's just three companies that
37:53
Speaker 1: are making all the rules for all of us. They
37:56
Speaker 1: don't fully get that.
37:58
Speaker 3: Is Mississippi a directing state or can patients not be
38:03
Speaker 3: steered in your state?
38:05
Speaker 1: They can be steered.
38:06
Speaker 3: They can be.
38:07
Speaker 1: Okay. Okay.
38:08
Speaker 3: Yeah, so that's another thing when we get into what
38:11
Speaker 3: I want to talk about next, what does real reform
38:14
Speaker 3: look like? That steering is one of those issues, I'm sure. So,
38:20
Speaker 3: you know, let's assume Congress and your state representatives actually
38:25
Speaker 3: do want to fix PBMs. What are the top three
38:28
Speaker 3: things on your bucket list that need to be done
38:32
Speaker 3: for accomplishing PBM reform for you personally and in your state?
38:38
Speaker 1: Yeah. I think number one is being paid a fair,
38:43
Speaker 1: transparent price that includes a professional dispensing fee. That is
38:51
Speaker 1: a big buzzword here in Mississippi. Dispensing fee really makes
38:55
Speaker 1: people angry. But I do feel like that having a
39:01
Speaker 1: standardized price structure that is transparent is critical for us
39:07
Speaker 1: to move forward. Also, I mean, steering is huge. I
39:11
Speaker 1: think that patients having the freedom to choose the pharmacy
39:17
Speaker 1: of their choice and not be penalized for it, that
39:21
Speaker 1: not only helps the pharmacy, but that also helps the
39:23
Speaker 1: patient be able to use who they want to. And
39:26
Speaker 1: I do think that, you know, for here in Mississippi,
39:33
Speaker 1: you know, there's some audit language that I would like
39:35
Speaker 1: to see kind of tightened up as far as, excuse me,
39:40
Speaker 1: not audit language, but appeal language, MAC appeal language that
39:47
Speaker 1: would help kind of close those loopholes, I guess, on
39:52
Speaker 1: some of the MAC appeal process where, you know, you
39:55
Speaker 1: don't have to appeal it every single time you fill it,
39:59
Speaker 1: that we would maybe get a, you know, a little
40:02
Speaker 1: bit of reimbursement for a one appeal to kind of
40:05
Speaker 1: pay you back for your time and your labor and
40:09
Speaker 1: your rent and all the things we talked about earlier.
40:12
Speaker 1: Those would probably be my biggest, you know, My biggest things,
40:19
Speaker 1: I could go on and on, but I would take
40:22
Speaker 1: those and be okay for a little while.
40:24
Speaker 3: Yeah. If you could sit across the table from the
40:29
Speaker 3: ultimate decision maker at a PBM, what would be your
40:33
Speaker 3: message to them? What would you want to accomplish in
40:35
Speaker 3: that meeting?
40:36
Speaker 1: Oh, gosh. I think that.
40:42
Speaker 1: I try to bring my perspective from the human side
40:46
Speaker 1: and from the real life, what's actually happening, emotional side
40:52
Speaker 1: of things. And it's not about protecting me and my pharmacy.
40:59
Speaker 1: It's not about making sure that I make a profit
41:01
Speaker 1: and making a guarantee that I'm going to be profitable
41:04
Speaker 1: in my business. It's about... putting me on the same
41:11
Speaker 1: playing field as every other pharmacy so that we can compete,
41:16
Speaker 1: that we can, you know, show ways why patients want
41:20
Speaker 1: to come to us that's outside of pricing and outside of,
41:23
Speaker 1: you know, how we're being reimbursed. It's the service that
41:27
Speaker 1: we can provide. You know, we just want to have
41:31
Speaker 1: the opportunity to, to compete and to win people's business
41:35
Speaker 1: and to take care of them. And, you know, That's
41:39
Speaker 1: really what it boils down to because there's patients out
41:42
Speaker 1: there who trust us, who need us, and when they're
41:45
Speaker 1: making decisions that only benefit themselves, you're going to end
41:50
Speaker 1: up with zero pharmacies in towns and a whole lot
41:55
Speaker 1: of people who aren't taking their medications because they can't
42:00
Speaker 1: get them. Their health is going to decline. Not to
42:04
Speaker 1: mention the employer that has hired that PBM, their costs
42:06
Speaker 1: are probably going to go way up because now they're
42:08
Speaker 1: paying for hospital visits and doctor visits and all the things.
42:12
Speaker 1: And so it's a slippery slope, and we're not trying
42:15
Speaker 1: to gain any kind of advantage. We just want it
42:20
Speaker 1: to be fair and in a marketplace that we actually
42:24
Speaker 1: can compete in.
42:26
Speaker 3: Yeah, beautifully said. I appreciate you covering that. And, you know,
42:30
Speaker 3: when you look at it, especially from the patient perspective,
42:33
Speaker 3: standpoint and best taking care of them instead of the financial,
42:37
Speaker 3: which is what, you know, unfortunately, these multi-billion dollar PBMs
42:41
Speaker 3: are looking at the financial side of it, not the
42:44
Speaker 3: individual patient. So for patients who want access to medication
42:48
Speaker 3: from a pharmacy that they trust, I guess the question
42:52
Speaker 3: here that that's kind of the $ 65 million question, right?
42:57
Speaker 3: Does the current PBM system help that relationship or do
43:01
Speaker 3: they just get in the way?
43:05
Speaker 1: You know, I feel like I've never been closer to
43:09
Speaker 1: my patients because they're supporting us right now and they
43:12
Speaker 1: have our back. But at the end of the day,
43:16
Speaker 1: the PBMs are not letting us take care of people
43:21
Speaker 1: the way that they deserve to be taken care of.
43:24
Speaker 1: And that's a shame.
43:26
Speaker 4: And I, as a healthcare provider, all I want to
43:29
Speaker 4: do is take care of people.
43:30
Speaker 1: That's why I got into this business. But we are
43:33
Speaker 1: being forced to make decisions that are maybe business-like in
43:39
Speaker 1: nature that totally disregards what it's going to do to
43:43
Speaker 1: the patient.
43:44
Speaker 4: But you're left feeling like those are your only options.
43:47
Speaker 1: Either you do this and you keep your lights on
43:49
Speaker 1: another month, or you do this, and what's really better
43:52
Speaker 1: for the patient, but it's going to do you under.
43:55
Speaker 3: Yeah.
43:56
Speaker 1: We shouldn't be put in that position. We haven't just
43:59
Speaker 1: all of a sudden forgotten how to run a business.
44:02
Speaker 1: I mean, I've talked to pharmacists all the time who've
44:04
Speaker 1: been in business 40, 50 years that are ready to
44:09
Speaker 1: retire and they can't now because they've used all of
44:13
Speaker 1: their savings to keep their business afloat. They knew how
44:16
Speaker 1: to run a business, but it's an impossible situation. And
44:22
Speaker 1: it just isn't right. It's not right. I could go
44:27
Speaker 1: forever about it.
44:28
Speaker 3: Well, in closing, is there any other point that you'd
44:31
Speaker 3: hope to cover on today's podcast that we haven't gotten to?
44:36
Speaker 1: I think the only thing is that, you know, people
44:40
Speaker 1: who know me outside of kind of my little pharmacy bubble,
44:44
Speaker 1: you know, speaking out about what was going on was not,
44:48
Speaker 1: was very outside of my normal kind of thing that
44:51
Speaker 1: I normally do. But I think that it's really important
44:55
Speaker 1: that we have a voice and we need to use it.
44:59
Speaker 1: We need to be part of the solution. You know,
45:02
Speaker 1: if we're just sitting around hoping that somebody else is
45:04
Speaker 1: going to fix the problem, you know, we can't, we
45:07
Speaker 1: can't do that anymore. We can't afford to be on
45:09
Speaker 1: the sidelines. And so while pharmacists are naturally kind of
45:14
Speaker 1: more introverted and, you know, like to just kind of people, please,
45:20
Speaker 1: we've got to, we've got to do what we can.
45:21
Speaker 1: And so I would just encourage folks to, you know,
45:25
Speaker 1: to use your voice in whatever way suits you, but
45:28
Speaker 1: being quiet about it is not going to make it
45:30
Speaker 1: go away. Yeah. Well, Dr.
45:32
Speaker 3: Jones, thank you so much for being our guest today
45:35
Speaker 3: and coming on the PBM reform podcast and visiting with me.
45:38
Speaker 3: It's been great to get to know you better and
45:40
Speaker 3: appreciate your insights. Keep doing what you're doing. I keep
45:44
Speaker 3: being vocal because I know it does take you out
45:46
Speaker 3: of your comfort zone, but you're doing good work. So
45:49
Speaker 3: thank you so much.
45:51
Speaker 1: I appreciate it so much.
45:52
Speaker 3: And I want to thank everybody for joining the PBM
45:55
Speaker 3: Reform podcast here on the Pharmacy Podcast Network. And to
45:59
Speaker 3: everyone listening, if you're a pharmacy owner, a pharmacist, or
46:02
Speaker 3: a patient who has had an experience that you've been
46:05
Speaker 3: impacted by PBM firsthand, we want to hear your story
46:10
Speaker 3: because reform starts by making those stories impossible to ignore.
46:16
Speaker 3: Thanks again, everyone, and have a wonderful rest of your day.