Latest / Pharmacy Podcast Network / The TrumpRx Playbook for Independent Pharmacies - with MatchRX | TWIRx

Transcript

The TrumpRx Playbook for Independent Pharmacies - with MatchRX | TWIRx · Pharmacy Podcast Network

• 0:01
  Speaker 1: Huge, big old Twerks. Today we are Twerks and big time.
• 0:06
  Speaker 1: We got a lawyer that's also a pharmacist, doctor day
• 0:11
  Speaker 1: Y Lee, talking with Johnny Kello. We're going to be
• 0:15
  Speaker 1: digging into the Trump Our ex Playbook for independent Pharmacies.
• 0:21
  Speaker 1: We're also going to be talking about gene and cell therapy.
• 0:24
  Speaker 1: I'm sorry, I always say it backwards, sell and gene
• 0:28
  Speaker 1: therapy with Joe depinto Joe's back. Joe is such a
• 0:33
  Speaker 1: great resource. Thank you so much for being on twerks
• 0:35
  Speaker 1: This week. We have a special message from Katrina Azer.
• 0:40
  Speaker 1: Doctor Jessica Daily will be here talking with us and
• 0:45
  Speaker 1: digging into ways to mitigate drugs that you can't access
• 0:52
  Speaker 1: in twenty twenty six. And a special message from my
• 0:57
  Speaker 1: friend Greg Ribold. He's a champion for PBM reform. He's
• 1:03
  Speaker 1: a lawyer and advocate working for APCI who supports the
• 1:07
  Speaker 1: PBM Reform podcast. All this and more coming up on twerqus.
• 1:31
  Speaker 1: Hope your week's been good. Hope you guys are ready
• 1:34
  Speaker 1: for Christmas. I am not sure if I'm ready yet.
• 1:37
  Speaker 2: Still, it's out for debate.
• 1:40
  Speaker 1: Today is December nineteenth, twenty twenty five. Can you believe it?
• 1:47
  Speaker 1: This year has gone by record fast. We have a
• 1:52
  Speaker 1: lot going on in our pharmacy industry. You know you're
• 1:55
  Speaker 1: in it, and we are excited about what's happening in
• 2:00
  Speaker 1: our industry. Twerk's News. We're going to start right out
• 2:05
  Speaker 1: the gate with an article from Pharmacy Times, who does
• 2:11
  Speaker 1: an absolute amazing job at reporting the I always call
• 2:16
  Speaker 1: them the great grandfather of pharmacy publishing. They have an
• 2:20
  Speaker 1: article it comes out o TC case study supplements for
• 2:23
  Speaker 1: aging comes in at number one case one vitamin D
• 2:29
  Speaker 1: goes through the case. Read this, Read through this gives
• 2:31
  Speaker 1: kind of an answer overall based on the case for
• 2:35
  Speaker 1: for people that are that are seniors. We have a
• 2:39
  Speaker 1: podcast all about aging from doctor Tamar Rugels. A shout
• 2:42
  Speaker 1: out to her case one vitamin D, case two calcium,
• 2:49
  Speaker 1: case three melatonin. I'm gonna definitely read up on that
• 2:52
  Speaker 1: one case for a multi vitamin. It gives some really
• 2:56
  Speaker 1: good references. Shout out you guys, but Pharmacy Times, you
• 3:01
  Speaker 1: guys are the best at what you do. Thanks for
• 3:04
  Speaker 1: reporting and keeping our pharmacist up to date. But even
• 3:07
  Speaker 1: if you have family members, older family members, I'm gonna
• 3:11
  Speaker 1: send this article to my father and my mom.
• 3:14
  Speaker 2: They're at that age.
• 3:15
  Speaker 1: We really want to pay attention to the best of
• 3:17
  Speaker 1: the otcs out there. All right, good news coming out
• 3:22
  Speaker 1: of Arkansas. They're in a war right now. At the
• 3:26
  Speaker 1: title of this article from ktlo dot com, it says
• 3:31
  Speaker 1: Arkansas law targeting pharmacy benefit managers blocked as legal fight continues.
• 3:37
  Speaker 1: And this is just a bunch of craft of the
• 3:40
  Speaker 1: fight that they're putting up. But basically it says, hey,
• 3:42
  Speaker 1: if you own a PBM, you should not own a
• 3:45
  Speaker 1: pharmacy And I absolutely agree with that. PBMs, Express Scripts,
• 3:50
  Speaker 1: CVS and Optimrx. That has all the money in the
• 3:53
  Speaker 1: world to throw at fines. They don't care about the fines.
• 3:57
  Speaker 1: They don't care about what's best for America or how
• 4:00
  Speaker 1: healthcare it says, along with their national trade group, they
• 4:03
  Speaker 1: have sued the state, claiming that the law interferes with
• 4:05
  Speaker 1: interstate commerce and would disrupt prescription drug access. A federal
• 4:11
  Speaker 1: judge has temporarily blocked the law from taking effect January first,
• 4:16
  Speaker 1: through Arkansas. It has appealed the ruling to the Eighth
• 4:20
  Speaker 1: US Circuit Court of Appeals, so the fight is still
• 4:27
  Speaker 1: in place. But goodness gracious, why is that not a
• 4:32
  Speaker 1: conflict of interest for insurance companies not allowed to own
• 4:37
  Speaker 1: distribution of medications through pharmacies. It's like a node to me.
• 4:43
  Speaker 1: Also from healthcare finance reporting. Just today, optimrx expands pharmacy
• 4:48
  Speaker 1: payment model. It says all community and independent pharmacies in
• 4:53
  Speaker 1: the optomarx network are transitioning to cost based contracts. This
• 4:58
  Speaker 1: was forced on them. Don't let anybody fool you. They
• 5:01
  Speaker 1: did not make this up themselves. There are too many
• 5:04
  Speaker 1: things happening. Optim rx is the future. They see that
• 5:08
  Speaker 1: they're going to be knocked out of the position that
• 5:11
  Speaker 1: they were in based on PBM reform, and they're racing
• 5:15
  Speaker 1: ahead trying to come up with something they're calling cost
• 5:19
  Speaker 1: based Pharmacy reimbursement. By partnering with three additional pharmacy service
• 5:25
  Speaker 1: administrator organizations representing more than seventeen thousand community pharmacies with
• 5:31
  Speaker 1: an additional one hundred percent of community and independent pharmacies
• 5:34
  Speaker 1: in the optimarx network, they've transitioned to the new predictable
• 5:38
  Speaker 1: pricing model using cost based contracts, and optimrx seeks full
• 5:44
  Speaker 1: implementation by January twenty twenty eight, and by then they'll
• 5:49
  Speaker 1: come up with a new scheme. I don't trust it.
• 5:52
  Speaker 1: I think they'll probably get away with paying our independent
• 5:57
  Speaker 1: community pharmacies and pharmacies in general. It's very upsetting, but
• 6:01
  Speaker 1: nonetheless we're going to fight. We're going to continue to
• 6:05
  Speaker 1: partner with the organizations that are trying to save our local,
• 6:10
  Speaker 1: independent community pharmacies. Our chain pharmacies. Walgreens has suffered from
• 6:15
  Speaker 1: this debacle. They've been closing stores. We see a lot
• 6:18
  Speaker 1: going on, but just wanted to give you those three
• 6:20
  Speaker 1: quick hits. We do have special features today and our
• 6:25
  Speaker 1: first one comes from match our X and it's a
• 6:30
  Speaker 1: good interview. You do not want to miss this interview
• 6:32
  Speaker 1: with Daily and Johnny Kello. And before that, we have
• 6:37
  Speaker 1: a quick message from our sponsor, Match your X.
• 6:42
  Speaker 3: Running of pharmacy means juggling a lot, patient care, inventory
• 6:46
  Speaker 3: and now compliance. That's where match our X comes in.
• 6:49
  Speaker 3: Match our x is the online marketplace where independent pharmacies
• 6:53
  Speaker 3: buy and sell their overstocks safely, quickly, and affordably. You
• 6:57
  Speaker 3: can also shop from eleven plus trusted secondary home salers,
• 7:00
  Speaker 3: all in one place. We're here to make pharmacy ownership easier,
• 7:04
  Speaker 3: connecting you to savings, trusted partners, and simple tools that
• 7:08
  Speaker 3: help you stay compliant with confidence. Match our x where
• 7:11
  Speaker 3: pharmacy meets trust, compliance and opportunity. Visit match ourx dot
• 7:16
  Speaker 3: com to learn more.
• 7:18
  Speaker 4: That's match ourx dot com.
• 7:30
  Speaker 5: Hey, this is Johnny Keller with match our x and
• 7:33
  Speaker 5: you're listening to this week and Pharmacy.
• 7:43
  Speaker 1: Welcome back to this Week in Pharmacy. I have a
• 7:46
  Speaker 1: special guest back. We're gonna have to start tracking who's
• 7:50
  Speaker 1: the most Twitter or listen to me Twitter Twark's guests.
• 7:54
  Speaker 1: It's Joe Depentto's back on Twarus.
• 7:57
  Speaker 6: How are you, Joe, I'm great, Todd, thanks for having
• 8:00
  Speaker 6: me back.
• 8:01
  Speaker 1: It's nice to have you back, and you're my go
• 8:03
  Speaker 1: to for updates on the very mysterious in some ways
• 8:09
  Speaker 1: world of cell gene therapy and what that means for
• 8:13
  Speaker 1: the future of the pharmacy industry and also pharmacists. How
• 8:16
  Speaker 1: many We just heard from doctor Mark Garrafoley, who's one
• 8:20
  Speaker 1: of our podcasters. He works on a WVU School of
• 8:23
  Speaker 1: Pharmacy as a professor and he commands the whole space
• 8:27
  Speaker 1: of pain management. The Board of Specialties is now making
• 8:32
  Speaker 1: pain management a specific specialty, and I see in the
• 8:36
  Speaker 1: future pharmacogenomics becoming a specialty and I also see celling
• 8:40
  Speaker 1: gene therapy becoming a center where we have pharmacists who
• 8:44
  Speaker 1: are really dialed into this. And that's why I'm glad
• 8:49
  Speaker 1: to talk to you again and see you and get
• 8:51
  Speaker 1: some updates from me.
• 8:53
  Speaker 7: Glad to be here.
• 8:54
  Speaker 6: And I agree, I think it's an exciting time in
• 8:56
  Speaker 6: selling gene therapy, no doubt.
• 8:59
  Speaker 1: An article came out just this week in Pharmacy came
• 9:03
  Speaker 1: from Pharmalive dot com and it basically was reporting where
• 9:08
  Speaker 1: sellingen therapy sector and the venture funding that was being
• 9:11
  Speaker 1: put into this is significant, and how the selengen therapy
• 9:17
  Speaker 1: is now commanding an investment portfolio of about three point
• 9:21
  Speaker 1: five billion just in this space. And it really opens
• 9:24
  Speaker 1: my eyes up where you have Johnson and Johnson, Astrozeneca
• 9:28
  Speaker 1: and nov Artist Bristol Myers, squib Eli Lilly always moving.
• 9:33
  Speaker 1: They're all driving towards these early stages and strategies around
• 9:39
  Speaker 1: sell gene therapy. And you were the first person at
• 9:42
  Speaker 1: one of the conferences I'm not sure if it was
• 9:45
  Speaker 1: a symbia or nasp Joe to really help our listeners
• 9:49
  Speaker 1: start dialing into what does this mean for better health
• 9:53
  Speaker 1: care or more options for our physicians to choose for
• 9:56
  Speaker 1: the specific condition and better my Faceavorite spot to talk
• 10:01
  Speaker 1: about is how pharmacists are going to become bigger, bigger providers,
• 10:05
  Speaker 1: and bigger touch points in the realm of selling gene therapy.
• 10:10
  Speaker 1: So give us kind of like a I have some
• 10:13
  Speaker 1: questions specifically for you about the report, but before we
• 10:16
  Speaker 1: get onto the report, give us a state of the
• 10:18
  Speaker 1: nation of where are we at right now?
• 10:21
  Speaker 6: Yeah, So to your point, the Alliance for Regenitive Medicine
• 10:25
  Speaker 6: recently reported out and looking at the top twenty pharmaceutical
• 10:29
  Speaker 6: companies by market cap, and they really looked at who
• 10:33
  Speaker 6: were engaged in selling gene therapy, and fifteen out of
• 10:37
  Speaker 6: the twenty top market cap companies had either a commercialized
• 10:41
  Speaker 6: product or pipeline products and sell and gene or just
• 10:45
  Speaker 6: sell or gene.
• 10:46
  Speaker 7: So you're seeing the big.
• 10:48
  Speaker 6: Players putting a lot of effort dollars into the space.
• 10:52
  Speaker 6: The science is unbelievable, right, and we continue to learn
• 10:55
  Speaker 6: more about sells and how they work in the micro
• 10:58
  Speaker 6: environment of sells and the human genome and gene therapies
• 11:01
  Speaker 6: and pharmacists certainly will practice at the top of their
• 11:05
  Speaker 6: license and helping to navigate the complexities of delivery to
• 11:08
  Speaker 6: these products, and it's a great opportunity for pharmacists, it's
• 11:12
  Speaker 6: a great opportunity for the care delivery team as these
• 11:15
  Speaker 6: products go from clinical to commercial and how we optimize
• 11:19
  Speaker 6: the navigating the value chaine so that these products can
• 11:23
  Speaker 6: go to patients and they can have expanded access to
• 11:25
  Speaker 6: these products. So it certainly is an exciting time and
• 11:29
  Speaker 6: the science continues to evolve nicely.
• 11:33
  Speaker 1: So I also appreciate the investment and time that you're
• 11:38
  Speaker 1: putting into data and reporting for the market at large.
• 11:43
  Speaker 1: And the twenty twenty five Sell and Gene Therapy Report
• 11:48
  Speaker 1: has come out and it's really while you're Why you
• 11:51
  Speaker 1: are here today for sure for us is because once
• 11:54
  Speaker 1: again we kind of wanted to pick a couple parts
• 11:58
  Speaker 1: of this, but just just as an opening, just give
• 12:01
  Speaker 1: us an idea of where the advance the advancement of
• 12:05
  Speaker 1: cell and gene therapy, where that's going and that's how's
• 12:08
  Speaker 1: that going to impact patient care?
• 12:12
  Speaker 6: Yeah, thanks for asking and thanks for taking a look
• 12:14
  Speaker 6: at the report. We're really excited about. This is the
• 12:16
  Speaker 6: second year we've done the report. Last year was our
• 12:19
  Speaker 6: inaugural report and we tried to build off.
• 12:21
  Speaker 7: Of ammentum from last year.
• 12:24
  Speaker 6: This report has primary research with oncologists as well as
• 12:28
  Speaker 6: with payers. Then we also look at the pipeline and
• 12:32
  Speaker 6: look at how the pipeline is evolving, and it certainly
• 12:37
  Speaker 6: is evolving quite nicely. Then what we do is we
• 12:40
  Speaker 6: bring in thought leaders throughout the United States to talk
• 12:44
  Speaker 6: about practical ways in which they are really tackling some
• 12:50
  Speaker 6: of the access barriers or challenges that are identified in
• 12:54
  Speaker 6: the report.
• 12:55
  Speaker 7: What we've seen is significant.
• 12:56
  Speaker 6: Progress in certain areas, in slower progress in other areas, right,
• 13:00
  Speaker 6: And we'll continue to do this on a yearly fashion
• 13:02
  Speaker 6: to really help our readers understand how to navigate optimally
• 13:09
  Speaker 6: the value chain. Where in spiro genepowered by McKesson sits
• 13:13
  Speaker 6: in the value chain, we have unique assets that are
• 13:15
  Speaker 6: well positioned to help a variety of those barriers be eliminated.
• 13:20
  Speaker 6: And that's our goal, right. Our goal ultimately is to
• 13:23
  Speaker 6: have more patients have commercial access to these products. And
• 13:26
  Speaker 6: we do it with research, we do it with data,
• 13:30
  Speaker 6: and we do it with a targeted, focused approach of
• 13:32
  Speaker 6: eliminating barriers.
• 13:36
  Speaker 1: So how are you right now engaged with pharmacists at
• 13:40
  Speaker 1: either health systems or specialty or disease state management and
• 13:46
  Speaker 1: at what point do they get involved after a clinical trial?
• 13:50
  Speaker 1: After maybe it is during clinical trial, but where do
• 13:54
  Speaker 1: you see pharmacists coming in? Because you know as well
• 13:56
  Speaker 1: as I do, the role of the pharmacist it's expanding,
• 14:00
  Speaker 1: and now pharmacists are becoming subject matter experts. You know,
• 14:03
  Speaker 1: we have more than twelve of them on our network
• 14:07
  Speaker 1: that are pediatrics, geriatrics clinical trials.
• 14:10
  Speaker 2: So talk to me about where does the.
• 14:12
  Speaker 1: Pharmacist come in and the pharmacists listening who are like,
• 14:15
  Speaker 1: I'm fascinated by this, at what point should they start
• 14:19
  Speaker 1: engaging the realm of selling.
• 14:20
  Speaker 6: Gen I think the pharmacist comes in in the clinical
• 14:24
  Speaker 6: phase as these clinical trials get up and running. Typically
• 14:28
  Speaker 6: there are clinical there are treatment teams that work with
• 14:31
  Speaker 6: these clinical trials to make sure that the centers have
• 14:35
  Speaker 6: a selection of the right patient, that the delivery of
• 14:38
  Speaker 6: the product is accurate and consistent with high quality and safety.
• 14:43
  Speaker 6: And I think they play a critical role all the
• 14:46
  Speaker 6: way in the clinical and as more of these products
• 14:48
  Speaker 6: become approved, those pharmacists will also be involved in the
• 14:53
  Speaker 6: clinical to commercial transition and actually in our rapport, Doctor
• 14:59
  Speaker 6: Navint maj a haul from Sarah Cannon Research Institute talks
• 15:03
  Speaker 6: a little bit about clinical to commercial, some of the
• 15:06
  Speaker 6: challenges and some of how him and the team at
• 15:09
  Speaker 6: Sarah Cannon really approach that, and it is a team effort.
• 15:16
  Speaker 1: I love it and I like how the examples are
• 15:19
  Speaker 1: being given this report. The stories are being shared so
• 15:22
  Speaker 1: that we're getting hard data, which is wonderful this piece does.
• 15:26
  Speaker 1: But then we get to hear from these clinicians and
• 15:29
  Speaker 1: these providers that are actually out there doing it, and
• 15:33
  Speaker 1: that helps to blend this. That's why I'm glad that
• 15:35
  Speaker 1: you're on a podcast, because if someone's listening, you're driving
• 15:38
  Speaker 1: right now, you're walking, you're doing something. You don't worry
• 15:41
  Speaker 1: about this. We're going to have links to accessing this information.
• 15:46
  Speaker 1: There's a main site that you can go to which
• 15:48
  Speaker 1: is in spurogene dot com or it might be pronounced
• 15:52
  Speaker 1: in spyrogene dot com. But we're going to have that
• 15:55
  Speaker 1: link in the show notes. What else do you want
• 15:58
  Speaker 1: to highlight on this report? That really jew after because
• 16:01
  Speaker 1: I'm sure you weren't out there collecting all this data
• 16:03
  Speaker 1: by yourself, Joe, but when you saw it come through,
• 16:06
  Speaker 1: what were you like?
• 16:06
  Speaker 2: Holy cow? This is pretty exciting so two.
• 16:10
  Speaker 6: Areas that I think, one very exciting, one a bit
• 16:14
  Speaker 6: of a watch out. So let's talk about the very
• 16:16
  Speaker 6: exciting first. The good news is that as you look
• 16:19
  Speaker 6: at the clinical work, we continue to see year over
• 16:22
  Speaker 6: year progress in clinical pipelines getting towards maturation, more towards
• 16:28
  Speaker 6: clinical to commercial approvals. What we did is we saw
• 16:32
  Speaker 6: two key areas of growth. We saw selling gene therapy,
• 16:36
  Speaker 6: clinical trials expanding in oncology and hematology, and also autoimmune disease.
• 16:41
  Speaker 6: We saw a very large growth in both those areas
• 16:46
  Speaker 6: as products continue to evolve to late stage therapies now
• 16:51
  Speaker 6: late stage four. Selling gene is typically phase two and
• 16:54
  Speaker 6: phase three. Some of these products get approved with phase
• 16:58
  Speaker 6: two data and oncology hematology being a big component, but
• 17:03
  Speaker 6: autoimmune made a significant increase this year.
• 17:06
  Speaker 7: When you look at.
• 17:07
  Speaker 6: These subcategories and you break them out and you look
• 17:09
  Speaker 6: at the autoimmune subcategory, we started to see quite a
• 17:13
  Speaker 6: bit of movement there and that's highlighted.
• 17:15
  Speaker 7: In the report as well.
• 17:18
  Speaker 2: Love that's the good news.
• 17:20
  Speaker 6: One of the challenges that we saw, I guess a
• 17:23
  Speaker 6: bit of a slight disappointment to me is we've continued
• 17:28
  Speaker 6: to see selling gene therapy commercially be given at these
• 17:33
  Speaker 6: large academic centers. In the report for the second year
• 17:36
  Speaker 6: in a row, we have a map by geographic metropolitan
• 17:39
  Speaker 6: area where.
• 17:40
  Speaker 7: These products are delivered.
• 17:42
  Speaker 6: We believe at inspiro Gene that the best care is
• 17:44
  Speaker 6: local care. Patients need to be treated locally, they don't
• 17:47
  Speaker 6: need to travel for an extended period of time, and
• 17:49
  Speaker 6: we were disappointed to see the year over year growth
• 17:52
  Speaker 6: in sites. We didn't see as many sites. So we
• 17:56
  Speaker 6: still believe that there are based on this map and
• 17:59
  Speaker 6: the extensive work we've done and looking at this geographic
• 18:01
  Speaker 6: metropolitan area treatment deserts that exist, and we know that
• 18:05
  Speaker 6: when a patient has to travel greater than two hours,
• 18:08
  Speaker 6: they typically opt out and choose another alternative treatment. And
• 18:13
  Speaker 6: we want to make sure that treatment is available locally
• 18:16
  Speaker 6: because we believe that's the best treatment that can be done,
• 18:20
  Speaker 6: and we believe that the market will continue to evolve
• 18:23
  Speaker 6: with community migration. Look, these academic centers are great, but
• 18:28
  Speaker 6: they're doing clinical trials, they're doing commercial patients, and there's
• 18:31
  Speaker 6: a capacity.
• 18:32
  Speaker 7: Issue at these trial at these places.
• 18:34
  Speaker 6: And the fact that travel is a challenge as well
• 18:37
  Speaker 6: for not only the patient but the caregiver for an
• 18:40
  Speaker 6: extended period of.
• 18:41
  Speaker 7: Time is a challenge. So that was one of.
• 18:44
  Speaker 6: The takeaways that I was a bit disappointed that we
• 18:47
  Speaker 6: didn't have more migration to community sites, but I know
• 18:51
  Speaker 6: that there's a focused effort to make sure that more
• 18:53
  Speaker 6: sites get up and running and deliver these groundbreaking therapeutic
• 18:57
  Speaker 6: interventions locally.
• 19:00
  Speaker 1: Know, this map just screams to me that there's such
• 19:03
  Speaker 1: opportunity to become a subject matter expert in a community
• 19:07
  Speaker 1: around cell and gene and educating other providers, educating the community,
• 19:13
  Speaker 1: educating sites that you'd like to open up a collection
• 19:17
  Speaker 1: of data for clinical trials or whatever they might be.
• 19:20
  Speaker 1: But this is excellent, excellent data. Our shout out to
• 19:25
  Speaker 1: our listeners if if you're interested in this. Once again,
• 19:28
  Speaker 1: it's it's in spirogene dot com.
• 19:31
  Speaker 2: I like I said, it's going to be in our
• 19:33
  Speaker 2: show notes.
• 19:34
  Speaker 1: And then thinking about the future, thinking about twenty twenty six.
• 19:40
  Speaker 1: First of all, Joe, are you going to Assembia twenty
• 19:43
  Speaker 1: twenty six?
• 19:45
  Speaker 7: Always never miss it, never miss it. I'll always be there.
• 19:49
  Speaker 1: All right, We're going to get you on the show.
• 19:51
  Speaker 1: We're going to get an update from you there. Bring
• 19:53
  Speaker 1: us a couple friends of yours or colleagues of yours.
• 19:56
  Speaker 1: If they're a pharmacists, you get a bonus bonus prize.
• 20:02
  Speaker 1: But when I'm thinking of the meetups, are we doing
• 20:06
  Speaker 1: any kind of education specifically to pharmacists in each of
• 20:10
  Speaker 1: these disease state categories where you can really drill down
• 20:14
  Speaker 1: into specifics and are some of those things aligned with
• 20:18
  Speaker 1: either CE or at least just general education.
• 20:24
  Speaker 6: I think a lot of the manufacture the biopharmac companies
• 20:28
  Speaker 6: are doing more and more disease area expertise training education
• 20:35
  Speaker 6: as they prepare for selling gene therapy to enter new
• 20:38
  Speaker 6: areas like lupis myasthenial graves, which are different than the
• 20:45
  Speaker 6: typical hematology patients that get selling gene therapy. So I
• 20:48
  Speaker 6: think there are a lot of activity there from a
• 20:51
  Speaker 6: disease area and look, as these products go to new specialties,
• 20:56
  Speaker 6: there's going to need to be more and more of
• 20:57
  Speaker 6: that activity being done.
• 21:00
  Speaker 7: I think we'll start to see more and more of.
• 21:01
  Speaker 6: That evolved in the year ahead, and I hope as
• 21:06
  Speaker 6: well to see some of that activity at a s MBIA.
• 21:09
  Speaker 6: They've always been really open to having a sealinging therapy
• 21:14
  Speaker 6: track that I've been fortunate enough to be engaged with. So, look,
• 21:18
  Speaker 6: it's a great opportunity for all of us in the
• 21:22
  Speaker 6: pharmacy area. That's really to meet like minded people and
• 21:27
  Speaker 6: discuss some of the opportunities and challenges ahead in the year.
• 21:31
  Speaker 6: And I would imagine much of the same will happen
• 21:34
  Speaker 6: in twenty twenty six in Las Vegas.
• 21:37
  Speaker 1: Hey, Joe, just out of curiosity, this is something I
• 21:40
  Speaker 1: just thought of as you were talking. One of the
• 21:44
  Speaker 1: roles that we see pharmacists being sought after is the
• 21:48
  Speaker 1: medical science liaison, especially if they have experience in a
• 21:51
  Speaker 1: specific condition, blood disorder, pediatrics, or whatever it is. So
• 21:57
  Speaker 1: is it the MSL that will go to the physicians
• 22:01
  Speaker 1: and kind of educate them to the new options that
• 22:04
  Speaker 1: sell gene therapy in each of these categories? What options
• 22:08
  Speaker 1: are coming out? Like, who's the individual that is reaching
• 22:11
  Speaker 1: out to these physicians.
• 22:13
  Speaker 6: Yeah, a lot of the pre commercial work is done
• 22:15
  Speaker 6: by msls, and I'm not surprised that a lot of
• 22:18
  Speaker 6: these msls are pharmacists, right. The clinical complexity here is high,
• 22:23
  Speaker 6: and the ability to synthesize the complex to the simple
• 22:27
  Speaker 6: and to clearly explain it fits well with the background
• 22:31
  Speaker 6: of the pharmacist. The pharm D and I believe that
• 22:35
  Speaker 6: I'm not surprised at all. And actually, if you think
• 22:38
  Speaker 6: about some of the data we've seen about eighty plus
• 22:42
  Speaker 6: percent of the emerging biotechs I'm sorry, eighty plus percent
• 22:47
  Speaker 6: of the pipeline sits in these emerging biotechs, so they're
• 22:51
  Speaker 6: going to need personnel like MSL.
• 22:53
  Speaker 7: So it doesn't surprise me that that's.
• 22:55
  Speaker 6: An opportunity for someone to go into industry. It all
• 22:59
  Speaker 6: matters what you want to do with your career. But
• 23:02
  Speaker 6: I'm not shocked at the msl's position is a destination
• 23:06
  Speaker 6: that many pharmacists want to go to.
• 23:09
  Speaker 1: Yeah, if you go on LinkedIn and you go onto
• 23:11
  Speaker 1: their career section, just the keyword selling gene therapy, and
• 23:16
  Speaker 1: then you do a cross reference pharmacist. There's twenty four
• 23:20
  Speaker 1: positions that are just listed just this month of medical
• 23:24
  Speaker 1: science liaisons that are attached to that. So absolutely a
• 23:27
  Speaker 1: shout out to our pharmacists that are thinking of making
• 23:31
  Speaker 1: a career change. Reach out to PPN, reach out to
• 23:35
  Speaker 1: Pharmacy Podcast Network. I'll connect you into some of these
• 23:39
  Speaker 1: leads that we've developed, and then if you're interested in
• 23:42
  Speaker 1: selling gene specifically, please look at this report once again.
• 23:46
  Speaker 1: It's going to be in the show notes. Reach Out
• 23:49
  Speaker 1: to Joe de Pinto on LinkedIn. He's active on LinkedIn.
• 23:53
  Speaker 1: Connect with him, ask questions, and if you're going to Assembia,
• 23:56
  Speaker 1: if you're going to some of these conferences, reach out
• 23:59
  Speaker 1: and if you can't schedule some time with Joe. And
• 24:02
  Speaker 1: you're such a resource, Joe, you're so your time is
• 24:05
  Speaker 1: so valuable and you've given us a lot of your
• 24:08
  Speaker 1: time through twerks. We love having you here as an update.
• 24:12
  Speaker 1: And you know, Merry Christmas by the way, And I
• 24:16
  Speaker 1: mean we're on the I think one more week or
• 24:19
  Speaker 1: what's how many.
• 24:20
  Speaker 2: More days still Christmas? It's Friday, that's like less than fourteen.
• 24:24
  Speaker 7: So we got home stretch. Home stretch, all right?
• 24:29
  Speaker 2: So last question. You've got a Steelers fan, are you?
• 24:33
  Speaker 7: No?
• 24:34
  Speaker 2: I am not, all right?
• 24:36
  Speaker 1: So what dog is in the fight in the football
• 24:39
  Speaker 1: world right now? Since we're entering almost almost playoffs?
• 24:43
  Speaker 7: Oh wow.
• 24:45
  Speaker 6: Having come off of the American Society of Hematology this weekend,
• 24:49
  Speaker 6: I didn't watch much football, but but certainly the Colts
• 24:55
  Speaker 6: chances with Daniel Jones going down really got hurt.
• 25:00
  Speaker 7: I liked what they were doing until he got hurt,
• 25:02
  Speaker 7: so it'll be interesting to see.
• 25:04
  Speaker 6: There's always one dog that sneaks in, you know, and
• 25:06
  Speaker 6: then they're dangerous in the playoffs.
• 25:09
  Speaker 2: It's so true. It is so true.
• 25:11
  Speaker 1: I'm still excited about the Steelers, just barely, you know,
• 25:16
  Speaker 1: staying in first place last week.
• 25:18
  Speaker 2: So we'll see what happens this weekend.
• 25:20
  Speaker 1: Hey, pharmacists, take a look in spyrogene dot com. You
• 25:24
  Speaker 1: see it on your screen right now if you're watching
• 25:26
  Speaker 1: us live on LinkedIn or Twitter, or if you're watching
• 25:32
  Speaker 1: us on YouTube. But if you want to listen to
• 25:36
  Speaker 1: the podcast, this podcast is available as all TWRKS episodes
• 25:40
  Speaker 1: on any of your favorite platforms, Apple, Spotify, any podcast directory.
• 25:45
  Speaker 1: Joe promised me we're going to do at least one
• 25:48
  Speaker 1: more trus before Assembia, and then I'll make sure that
• 25:51
  Speaker 1: we schedule with you with your people to get you
• 25:54
  Speaker 1: on the Assembia ship.
• 25:56
  Speaker 7: Sounds good.
• 25:57
  Speaker 6: Always always enjoy being with your Good luck to your Steelers.
• 26:00
  Speaker 2: And have a great holiday, all right, Joe, We'll see
• 26:03
  Speaker 2: us in all right. Bye bye.
• 26:10
  Speaker 8: As frontline healthcare providers, pharmacists like you understand the importance
• 26:14
  Speaker 8: of personalized care, especially in acute pain management. Euryal Pharma
• 26:18
  Speaker 8: is dedicated to providing high quality generic products tailored to
• 26:22
  Speaker 8: meet your patient's needs. The company aims to serve a
• 26:25
  Speaker 8: diverse range of patient populations, including athletes recovering from intense training,
• 26:31
  Speaker 8: weekend warriors, managing minor injuries, and those seeking a practical
• 26:35
  Speaker 8: and mess free option for acute pain management. Keep your
• 26:38
  Speaker 8: all in your toolbox of pain management options and join
• 26:41
  Speaker 8: the ranks of pharmacists leading away in personalized care. To
• 26:45
  Speaker 8: learn more about Euryl Pharma and its products, including full
• 26:49
  Speaker 8: prescribing information, boxed warnings, and important safety information, visit Eurylpharma
• 26:54
  Speaker 8: dot com That's why Aurl Pharma dot com and connect
• 27:00
  Speaker 8: them on LinkedIn.
• 27:03
  Speaker 1: That's right, this is a special episode of This Week
• 27:07
  Speaker 1: in Pharmacy. And you know, we get such great guests
• 27:12
  Speaker 1: and people that are driving content, people that are driving expertise.
• 27:17
  Speaker 1: I'm very lucky to be able to rely on experts
• 27:19
  Speaker 1: that can bring us in information to present demystifying of
• 27:25
  Speaker 1: certain issues. I really appreciated the update on DSCSA from
• 27:32
  Speaker 1: Johnny Kello from the match X team. I'm welcoming back
• 27:36
  Speaker 1: to twerks for our second part of this deep dive.
• 27:40
  Speaker 1: Deep Mystifying Series. Johnny Kello, Hey Todd, how you doing good.
• 27:51
  Speaker 1: Welcome back to twerks.
• 27:53
  Speaker 5: Thanks, thanks very much, thanks for having me again.
• 27:55
  Speaker 2: This is awesome.
• 27:56
  Speaker 1: Yeah, and you've been such a good resource for us
• 28:00
  Speaker 1: because you really help to set the stage with Elisa Bernstein,
• 28:04
  Speaker 1: Doctor Bernstein dug down into DSSA, really helped to refine.
• 28:09
  Speaker 1: We've received a ton of downloads on that podcast. The
• 28:12
  Speaker 1: podcast is doing really well. If you haven't listened to it,
• 28:15
  Speaker 1: please go to part one and it'll be in the
• 28:18
  Speaker 1: show notes. But today we're going to demistify trump our
• 28:21
  Speaker 1: X and the federal to direct consumer cash Pay portal.
• 28:25
  Speaker 1: It's expected to launch in twenty twenty six, tied to
• 28:28
  Speaker 1: the most favored nation, pricing and routing patients to participating
• 28:32
  Speaker 1: manufacturers and direct to consumer purchase programs that are often
• 28:38
  Speaker 1: outside of insurance and PBMs. And guess what water runs downhill.
• 28:42
  Speaker 1: It's the force of the economy. It's the force of
• 28:45
  Speaker 1: entrepreneurs that are going to get out of the way
• 28:48
  Speaker 1: of things that are keeping them from being prosperous and profitable.
• 28:53
  Speaker 1: And that means better health care for our communities that
• 28:56
  Speaker 1: have these independent community pharmacies in them. That are having
• 28:59
  Speaker 1: to do jiu jitsu just to stay open. But give
• 29:03
  Speaker 1: us just a little bit of background in this before
• 29:06
  Speaker 1: before we welcome our special guest.
• 29:09
  Speaker 5: You know, we're surprised with every like everybody else was
• 29:13
  Speaker 5: with regards to the Trump our X announcement back a
• 29:15
  Speaker 5: couple of months back. And what we're doing here is
• 29:18
  Speaker 5: just to bring on an expert like Day to help
• 29:21
  Speaker 5: us walk through it, because frankly, I think everybody's kind
• 29:25
  Speaker 5: of scratching their head, including myself, saying.
• 29:28
  Speaker 2: Well, how is this going to affect us?
• 29:30
  Speaker 5: How does this affect independent pharmacy, and where could independent
• 29:33
  Speaker 5: pharmacy take advantage of it where it's possible. So again,
• 29:38
  Speaker 5: I'm learning on this podcast like you are. I've got
• 29:41
  Speaker 5: a few questions myself, and I'm excited because Day, you know,
• 29:45
  Speaker 5: Daily over at Buchanan, who's law firm out of New Jersey,
• 29:50
  Speaker 5: has been in pharma. He's a pharmacist himself, and he's
• 29:55
  Speaker 5: been involved on many many PBM matters, auditing and just
• 30:00
  Speaker 5: helping pharmacies in general. So excited to have them on
• 30:03
  Speaker 5: here and now again this is a learning process for me.
• 30:06
  Speaker 5: So without further ado, let's let's bring.
• 30:09
  Speaker 2: Dian Hey Don, Hey Donnie, Hey Dave. Thanks for making it.
• 30:16
  Speaker 2: Welcome Don, thanks for having me today. Welcome. It's good
• 30:20
  Speaker 2: to see you.
• 30:20
  Speaker 1: I've always liked talking to you at the pharmacy conferences
• 30:24
  Speaker 1: and you've always brought a lot of good information to
• 30:27
  Speaker 1: our listeners. So thanks again for being part of the
• 30:31
  Speaker 1: Pharmacy Podcast Network and being our guest on Twerks today.
• 30:34
  Speaker 1: I'm not going to make you twerks, by the way,
• 30:36
  Speaker 1: but if if you can't, I can't even do it,
• 30:38
  Speaker 1: Like I can't get my muscles to even do that
• 30:41
  Speaker 1: twerks and goes.
• 30:42
  Speaker 2: But I'm not going to make you do that. Okay,
• 30:45
  Speaker 2: make any don't make an interested okay please.
• 30:48
  Speaker 1: Okay, So let's just jump into this. This is exciting
• 30:53
  Speaker 1: that we get to demystify once again. Just set the
• 30:56
  Speaker 1: stage for us to day and just tell us a
• 31:00
  Speaker 1: little bit about yourself and what we're going to be
• 31:02
  Speaker 1: talking about today.
• 31:03
  Speaker 2: Sure again, my name is Daily.
• 31:06
  Speaker 9: I'm a pharmacist attorney shareholder at buchanan Angosa. Roney might
• 31:11
  Speaker 9: represent independent pharmacies as well as employers in their dealings
• 31:16
  Speaker 9: with pharmacy benefit managers, mainly the Big three pharmacy benefit managers.
• 31:21
  Speaker 9: In the country. Trump URX is a government run program
• 31:28
  Speaker 9: well the right now, it is not open yet. It's
• 31:31
  Speaker 9: going to be launching sometime in twenty twenty six. The
• 31:35
  Speaker 9: whole purpose of trump RX is to connect the customers
• 31:40
  Speaker 9: meaning patients directly with the manufacturers at a lower price.
• 31:46
  Speaker 2: And that is the whole purpose of the.
• 31:48
  Speaker 9: Trump RX is essentially a director to consumer model and
• 31:53
  Speaker 9: which is unfortunately has become necessary given the given our
• 32:00
  Speaker 9: pharmacy benefit industry and how it is operating right now.
• 32:09
  Speaker 5: They let me ask you something, what are the risks
• 32:12
  Speaker 5: and the potential benefits and to independent pharmacies, what kind
• 32:16
  Speaker 5: of disruptions could they expect to have?
• 32:19
  Speaker 9: So as with the many direct to consumer model in
• 32:23
  Speaker 9: short DTC model that are out there right now, independent
• 32:28
  Speaker 9: pharmacies are being displaced, displaced from the whole supply chain.
• 32:34
  Speaker 9: Usually in a traditional pharmacy setting, patient goes see a doctor,
• 32:39
  Speaker 9: patient receive a prescription, or patient have the prescribers send
• 32:43
  Speaker 9: the prescription directly to the pharmacy of the patient's choosing
• 32:48
  Speaker 9: and then patient goes to the pharmacy, sign the signature log,
• 32:53
  Speaker 9: pay the copay and then picks up the medication and
• 32:57
  Speaker 9: take the medication now here, there's no independent pharmacies are
• 33:05
  Speaker 9: included in the director consumer model. The manufacturer directs the prescriptions,
• 33:12
  Speaker 9: or manufacturer directs the patients to see certain prescribers or whatnot.
• 33:16
  Speaker 9: As long as the patient has a prescription, manufacturer directs
• 33:20
  Speaker 9: that prescription to be sent to manufacturers owned network pharmacies,
• 33:25
  Speaker 9: and then the patient received the medication uh via mail
• 33:30
  Speaker 9: or delivery, whichever it is.
• 33:33
  Speaker 5: So a lot of these independent pharmacies can be blocked
• 33:35
  Speaker 5: out with this directed or rather director manufacturer model.
• 33:41
  Speaker 2: So where does.
• 33:42
  Speaker 5: This you know, is there like a special type of drugs,
• 33:45
  Speaker 5: specialty drugs, high cost branded drugs that are going to
• 33:48
  Speaker 5: be more affected by trump RX or is this kind
• 33:51
  Speaker 5: of the lowbrow, you know, no money making drugs that
• 33:55
  Speaker 5: independents don't even want to prescribe but take them on
• 33:59
  Speaker 5: because of you know, subsequent business with that particular patient.
• 34:04
  Speaker 9: The thing right now, h DTC model is including trump
• 34:08
  Speaker 9: r X are focusing on uh the highly reversible drugs
• 34:12
  Speaker 9: or high cost dollar dollar cost drugs, specialty drugs. But again,
• 34:18
  Speaker 9: like I want to make sure that the listeners understand,
• 34:22
  Speaker 9: there's no legal definition of specialty medication. So specialty medication
• 34:28
  Speaker 9: can be just anything that is very expensive. So it
• 34:33
  Speaker 9: could be ozempic, or it could be you know, GLP
• 34:37
  Speaker 9: ones such as ozembic, or he could be cancer drugs,
• 34:41
  Speaker 9: or it could be HIV drugs or even if suppressant drugs.
• 34:45
  Speaker 5: So not only is it taking the business away from
• 34:47
  Speaker 5: these independents, taking traffic out of their pharmacy just the
• 34:50
  Speaker 5: same then.
• 34:51
  Speaker 9: Correct, because once the patient started receiving prescriptions from direct
• 34:57
  Speaker 9: to consumer model or any other internet or on online pharmacies,
• 35:01
  Speaker 9: then the patient will shift entire set of prescriptions to
• 35:05
  Speaker 9: those pharmacies and independent for independent is a loss opportunity. Well,
• 35:11
  Speaker 9: I don't want to say loss opportunity. It's going to be
• 35:13
  Speaker 9: a loss in terms of the whole set of prescription
• 35:16
  Speaker 9: for a given patient.
• 35:18
  Speaker 5: Yeah, I'm just thinking about this in like real practice. Right,
• 35:22
  Speaker 5: I'm a patient. I've got four prescriptions. Two of them
• 35:26
  Speaker 5: might be on trump r X, the other two aren't.
• 35:29
  Speaker 5: Now how is that going to work? Are they going
• 35:31
  Speaker 5: to continue to go to their pharmacy for the other
• 35:33
  Speaker 5: two scripts or will they just say again, I think
• 35:37
  Speaker 5: every patient's going to be different, right, we can't just
• 35:39
  Speaker 5: bunch them all the same. But some famousists are going
• 35:42
  Speaker 5: to say, well, I'll get my two with my pharmacists,
• 35:45
  Speaker 5: or I'm not going to even bother with trump our X.
• 35:48
  Speaker 5: I'm still going to get all of my independent as
• 35:51
  Speaker 5: long as my independent can charge me the same cash
• 35:54
  Speaker 5: based rate. And these are primarily cash customers or is
• 35:58
  Speaker 5: this also cover plans as well?
• 36:02
  Speaker 9: Right now, the trump RX model is not specified whether
• 36:06
  Speaker 9: it's going to be only for a cash model or
• 36:09
  Speaker 9: is it going to include the insurance model, But most
• 36:12
  Speaker 9: likely it's going to be straight cash based model where
• 36:15
  Speaker 9: patients try to buy those highly high, highly reversible drugs
• 36:21
  Speaker 9: at a lower price, not using their insurance.
• 36:24
  Speaker 5: I say, okay, great, So so tell us, like, so,
• 36:27
  Speaker 5: where are the opportunities for independence because right now, what
• 36:30
  Speaker 5: you've told me is that they're they're they're getting like
• 36:34
  Speaker 5: locked out of almost every opportunity. As it relates to
• 36:37
  Speaker 5: this trump RX model, there's got to be a way
• 36:40
  Speaker 5: for the administration to, you know, consider independent farmers because
• 36:45
  Speaker 5: they talk about saving independent farmacies all the time, but
• 36:47
  Speaker 5: when you look at this model, this model says we're
• 36:50
  Speaker 5: going to put a little hurt on these guys, so
• 36:52
  Speaker 5: help help us out. And you know, is there a
• 36:55
  Speaker 5: way for the independence to say, uh, yeah, that we
• 36:58
  Speaker 5: we're losing in one area, but here's how we can
• 37:00
  Speaker 5: gain in another area.
• 37:02
  Speaker 9: So in the event that trump X decides to include
• 37:07
  Speaker 9: network of independent pharmacies or maintain a network of independent pharmacies,
• 37:12
  Speaker 9: and of course that's going to be a business, huge
• 37:16
  Speaker 9: business opportunity for the independent pharmacies because all of a
• 37:19
  Speaker 9: sudden they will be receiving those medications at a lower price,
• 37:24
  Speaker 9: lower acquisition costs, and then this banks to the patients
• 37:27
  Speaker 9: and then they will continue to treat or even gain
• 37:29
  Speaker 9: patient population or whole set of a new patient population.
• 37:33
  Speaker 9: But on the other hand, if trump REX does not
• 37:36
  Speaker 9: include those independent pharmacies, it also creates opportunity for independent
• 37:40
  Speaker 9: pharmacies to really look at their patient population drug mix
• 37:46
  Speaker 9: and then start optimizing their cash based model. Right now,
• 37:51
  Speaker 9: a lot of pharmacies or a good number of pharmacies
• 37:55
  Speaker 9: they already have cash based model, and then some pharmacies
• 37:58
  Speaker 9: turned into a undred percent cash bias model and not
• 38:02
  Speaker 9: dealing with insurance companies or insurance claims. So it will
• 38:07
  Speaker 9: create opportunities for independent pharmacies.
• 38:09
  Speaker 2: Okay, so we.
• 38:11
  Speaker 5: Hear about this all the time, right, you know, a
• 38:13
  Speaker 5: plan especially a government run plan, and you're like, Okay,
• 38:17
  Speaker 5: well we'll believe it when.
• 38:18
  Speaker 2: We see it. Number one.
• 38:19
  Speaker 5: Number two, we know how long it took for manufacturers,
• 38:24
  Speaker 5: wholesalers and now independence to get caught up with DSCSA.
• 38:28
  Speaker 5: This whole idea of manufacturers being able to handle this
• 38:32
  Speaker 5: kind of you know, script inquiry, script submittle and then
• 38:39
  Speaker 5: being able to dispense it it. You know, it sounds
• 38:43
  Speaker 5: good on paper, but in reality or in practice, it
• 38:46
  Speaker 5: sounds like there's some real challenges ahead of them. But
• 38:50
  Speaker 5: you know, I'd love to hear your take on that,
• 38:51
  Speaker 5: if that, if that makes sense or or no, they'll
• 38:54
  Speaker 5: they'll be prepared. They're not everybody's Amazon, and these manufacturers
• 38:58
  Speaker 5: definitely aren't Amazon. So tell us a little bit about
• 39:01
  Speaker 5: what your thoughts are on manufacturers actually being able to
• 39:04
  Speaker 5: execute on this.
• 39:06
  Speaker 9: I think it's gonna be there will be hurdles manufacturers.
• 39:10
  Speaker 9: I don't think they will be one hundred percent equipped
• 39:13
  Speaker 9: to handle the volume. And I'm not sure whether the
• 39:17
  Speaker 9: manufacturer even will be able to meet the demands with
• 39:22
  Speaker 9: their supplies of the medications. Like you know, a great
• 39:26
  Speaker 9: example is g LP one medications out there right Zam,
• 39:30
  Speaker 9: Big Manjaro Z boundary GOV some form, some manufacturers they
• 39:36
  Speaker 9: have direct to consumer model involving those and whether it
• 39:39
  Speaker 9: be cash based or whether it be insurance company based right,
• 39:42
  Speaker 9: insurance claims based. And these medications are you know, get
• 39:47
  Speaker 9: dispensed through manufacturer linked or affiliated pharmacies. Independent but in
• 39:54
  Speaker 9: the but you know, everybody at the FDA said there's
• 39:56
  Speaker 9: no shortage. But in reality, in practical reality, I think
• 40:01
  Speaker 9: there exists some level of shortage because not all patients
• 40:06
  Speaker 9: can get hold of those branded medications, you know, whether
• 40:11
  Speaker 9: it be through the manufacturer affiliated pharmacy or whether it
• 40:16
  Speaker 9: be through the independent pharmacy. Paige, I mean, I spoke
• 40:20
  Speaker 9: with patient, I spoke with pharmacy owners. Shortage exists, and
• 40:26
  Speaker 9: I think for the trump RX purposes, I don't think
• 40:31
  Speaker 9: manufacturer will be one hundred percent ready to handle the
• 40:35
  Speaker 9: prescription volume and the logistics.
• 40:39
  Speaker 2: Yeah.
• 40:39
  Speaker 5: Yeah, And that's where you know, you would think that
• 40:43
  Speaker 5: the you know, this model would wise up to include
• 40:47
  Speaker 5: independent pharmacies so that they become the last mile, so
• 40:50
  Speaker 5: that the script runs through the independent with that benefit
• 40:55
  Speaker 5: of a direct to I would say manufacture to pharmacy model,
• 41:00
  Speaker 5: and that pharmacy dispenses that to the independent. So I
• 41:05
  Speaker 5: know it says DTC, but it really should say DTP
• 41:09
  Speaker 5: like Detroit direct to pharmacy and the benefit goes to
• 41:14
  Speaker 5: the patient, not this, you know, you know this this
• 41:22
  Speaker 5: submittle process by the patient and then they have to
• 41:25
  Speaker 5: figure out how to do it. I mean, I'm sure
• 41:27
  Speaker 5: people can, but we also know that there's a lot
• 41:30
  Speaker 5: of people who are gonna you know, uh uh miss
• 41:33
  Speaker 5: scripts or do something that they shouldn't do in terms
• 41:36
  Speaker 5: of how to order the product. So I could see
• 41:39
  Speaker 5: where the government would want to or should want to
• 41:42
  Speaker 5: bring in the independence because of what we just discussed.
• 41:46
  Speaker 5: And not everything is going to be direct to consumer,
• 41:51
  Speaker 5: meaning not all drugs are going to be there. There's
• 41:53
  Speaker 5: so many small manufacturers in the world that are not
• 41:56
  Speaker 5: going to be a part of this. So correct, you
• 41:58
  Speaker 5: would hope that again the government wises up and says, oh,
• 42:02
  Speaker 5: you know, this is a little bit different than DCC.
• 42:04
  Speaker 5: It should be more like DTP. And how do the
• 42:08
  Speaker 5: independents get that message out to you know DC?
• 42:13
  Speaker 9: Well, independence independent pharmacies have been for many years pushing
• 42:18
  Speaker 9: the be pushing the envelope right, trying to protect their profession. Okay,
• 42:25
  Speaker 9: and as we all know independence are have gone through
• 42:28
  Speaker 9: a lot of difficult times given the lower reimbursement network access.
• 42:35
  Speaker 9: You know, I could spend the day just you know,
• 42:38
  Speaker 9: itemizing those difficulties that independent pharmacies are facing nowadays. The
• 42:44
  Speaker 9: regarding the trump RX is from on paper and financially
• 42:50
  Speaker 9: it makes sense, right providing highly brand drugs that that
• 42:57
  Speaker 9: are medically necessary to patient at a or price that
• 43:01
  Speaker 9: makes total sense. However, one thing that trump or X
• 43:05
  Speaker 9: does not account for, or or has not accounted for,
• 43:09
  Speaker 9: is the patient interaction, patient consultation, you know, patient care.
• 43:17
  Speaker 5: It feels robotic, I mean correct, and that's not that's
• 43:21
  Speaker 5: not medicine, that's not no, that's not crossing over prescriptions.
• 43:26
  Speaker 2: I mean oftentimes I've got it.
• 43:27
  Speaker 5: When I'm going to my pharmacists, I'm asking all these
• 43:30
  Speaker 5: other questions. This doesn't offer that opportunity.
• 43:33
  Speaker 2: So where do people go? Chat cheapt you know, it
• 43:37
  Speaker 2: doesn't doesn't it doesn't make sense.
• 43:39
  Speaker 9: Or called call the one eight hundred number and then
• 43:42
  Speaker 9: try to get ahold of the pharmacists. There might be
• 43:44
  Speaker 9: a pharmacist you know available. But the reason, one of
• 43:49
  Speaker 9: the main reasons that people go to independent pharmacy is
• 43:53
  Speaker 9: a human interaction. You know, it is very important and
• 43:57
  Speaker 9: you not only get the medical consultation, but you also
• 44:01
  Speaker 9: be able to interact with the your caregiver. Caregiver being
• 44:07
  Speaker 9: the pharmacists on the other side of the aisle.
• 44:10
  Speaker 5: Yep, No, totally agree with that. So let's say bypasses
• 44:14
  Speaker 5: the insurance purchased directly from Trump I Rex right, how
• 44:18
  Speaker 5: does that impact drug utilization for the plant sponsor and
• 44:23
  Speaker 5: does and does that have any effect on that independent
• 44:26
  Speaker 5: UH to reach their you know, their GCR levels and
• 44:30
  Speaker 5: what have you?
• 44:31
  Speaker 2: Correct?
• 44:32
  Speaker 9: I mean it's I mean plant sponsors like they live
• 44:34
  Speaker 9: and die by the by the data and those claims.
• 44:40
  Speaker 9: It's cash base claims, not They're not going to be captured.
• 44:44
  Speaker 9: That claim is doesn't even exist in the patient's UH
• 44:49
  Speaker 9: profile with the plant sponsor and independence, they they lose
• 44:54
  Speaker 9: that claim and it's it's going to affect their drug
• 44:58
  Speaker 9: utilization rate and know generic to brand way, well, whichever
• 45:02
  Speaker 9: it is, dispensing way, whichever it is, it's going to
• 45:05
  Speaker 9: impact the data and the ratio.
• 45:11
  Speaker 5: Pat I'll let you dive in as well. I'm sorry,
• 45:14
  Speaker 5: I've been absorbing all of day's time.
• 45:16
  Speaker 2: Heck, now, I like listening to both of you.
• 45:18
  Speaker 1: I think it's just fascinating to dig into something that
• 45:21
  Speaker 1: I find extremely unnecessarily complicated, and I don't understand. When
• 45:29
  Speaker 1: I think of PBM reform day, I always draw straight lines.
• 45:33
  Speaker 1: One of the straight lines was why are there gag
• 45:36
  Speaker 1: clauses on pharmacists Back in the day when when they
• 45:41
  Speaker 1: signed a insurance contract, a PBM contract, a pharmacist by
• 45:46
  Speaker 1: law was not allowed to tell the patient if they
• 45:48
  Speaker 1: could get the if they could get the drug less
• 45:50
  Speaker 1: expensive some other way or some other place, in order
• 45:54
  Speaker 1: to make sure that they were they were continuing the medication,
• 45:58
  Speaker 1: these life saving medications. That's very confusing, and so that
• 46:03
  Speaker 1: was a straight line for me from an understanding perspective.
• 46:06
  Speaker 1: Another one is why are we allowing insurance companies to
• 46:11
  Speaker 1: own pharmacies for PBMs to own pharmacies.
• 46:14
  Speaker 2: That's also a straight line.
• 46:16
  Speaker 1: So when I hear things come out like trump our
• 46:19
  Speaker 1: X and I start listening to what much smarter people
• 46:23
  Speaker 1: than me are giving the interpretation of what that means
• 46:26
  Speaker 1: for the consumer, I scratch my head thinking why aren't
• 46:30
  Speaker 1: things simpler and more direct than even this new system
• 46:36
  Speaker 1: the trump are X. So what happens to the patient
• 46:41
  Speaker 1: day the deductibles and the auto pocket maximums and benefits structures, Like,
• 46:46
  Speaker 1: how does that all come into play? And I'm thinking
• 46:49
  Speaker 1: of this from the consumer perspective. Even though I love
• 46:52
  Speaker 1: our independent community pharmacies, I want them to win because
• 46:55
  Speaker 1: if they win, their communities win.
• 46:57
  Speaker 2: But what about this fast of trump our X.
• 47:02
  Speaker 9: So if a patient receives prescription through trump or X
• 47:06
  Speaker 9: and pays cash for that claim, I don't think it's
• 47:10
  Speaker 9: going to count towards deductible or out of pocket maximum
• 47:15
  Speaker 9: because it's not being captured. It's not a captured claim
• 47:19
  Speaker 9: under the insurance plan. You're bypassing all that. So trump
• 47:24
  Speaker 9: our X again on paper, the intent is grade you know,
• 47:29
  Speaker 9: providing high cost medication at a lower cost to the patient.
• 47:34
  Speaker 9: But it is a band aid, it's not. It's not
• 47:39
  Speaker 9: a complete fixed to our system.
• 47:42
  Speaker 5: Yeah, it feels like it's it could be dedicated to
• 47:46
  Speaker 5: one or two drugs that a patient might be taken,
• 47:50
  Speaker 5: but not the whole you know, a group of drugs
• 47:54
  Speaker 5: that a patient might be taken, So you know, it's
• 47:58
  Speaker 5: hard to cherry pick that. And then the negative effect
• 48:01
  Speaker 5: is what you just brought up. It doesn't count against
• 48:03
  Speaker 5: their deductible. It doesn't count against their their copay and
• 48:06
  Speaker 5: so the donut hole is further and further away because
• 48:11
  Speaker 5: these purchases aren't part of that whole process.
• 48:16
  Speaker 2: Is that fair design, correct? Is not part of it.
• 48:20
  Speaker 9: It's just another it's in a different silo.
• 48:22
  Speaker 2: Yeah, right, So.
• 48:24
  Speaker 5: Let's go back to independent pharmacies, right, And so if
• 48:28
  Speaker 5: you were advising an independent pharmacist right now, would you
• 48:32
  Speaker 5: recommend for those that have a you know, cash pay
• 48:36
  Speaker 5: strategy or those who don't to diverse find some other way?
• 48:40
  Speaker 2: And what does that look like?
• 48:41
  Speaker 5: Because it seems like, you know, cash pay should be
• 48:45
  Speaker 5: a part of everybody's pharmacy at one point or another,
• 48:49
  Speaker 5: and so you know, how might this affect that or
• 48:52
  Speaker 5: what would you advise folks to do as it relates
• 48:56
  Speaker 5: to cash pay model for.
• 48:57
  Speaker 9: The cash pay model, because those are not being captured, right,
• 49:02
  Speaker 9: I would definitely advise the pharmacies to maximize the profit
• 49:07
  Speaker 9: margin through the lower acquisition costs, okay, and keep that,
• 49:13
  Speaker 9: keep that cash model strong or improve upon it. And
• 49:17
  Speaker 9: the other thing that I wanted to highlight it for
• 49:19
  Speaker 9: independent pharmacy is they have to look at the reimbursement
• 49:25
  Speaker 9: reconciliation report, pay close attention to it, okay, And a
• 49:30
  Speaker 9: lot of state, if not all of the states in
• 49:32
  Speaker 9: the country right now, have some sort of a MAC
• 49:35
  Speaker 9: appeal process okay. And those maximum level costs is of
• 49:40
  Speaker 9: course it's run by the insurance companies or the PBMs whatnot,
• 49:45
  Speaker 9: but you can appeal it and every single claim it's
• 49:49
  Speaker 9: you know, when you aggregate them, and affects your bottom line.
• 49:53
  Speaker 9: So I would definitely pursue that. And if there are
• 49:57
  Speaker 9: other opportunities to partner with, whether it be a cost
• 50:01
  Speaker 9: based uh A model or maximizing the profit buy purchasing
• 50:07
  Speaker 9: from you know, from from other suppliers, or even through
• 50:12
  Speaker 9: your company match our X, there are opportunities, I mean
• 50:17
  Speaker 9: a lot. From my point of view, there are in
• 50:20
  Speaker 9: big picture two sets of pharmacy owners. The owners who
• 50:24
  Speaker 9: are really business savvy or in the in the progress
• 50:28
  Speaker 9: in the process of becoming business savvy, or the old
• 50:32
  Speaker 9: school business owners who are used to just the reimbursement model.
• 50:41
  Speaker 5: Yeah, and and and back in the day for you know,
• 50:43
  Speaker 5: for as long as up till about maybe seven or
• 50:46
  Speaker 5: eight years ago. Uh, that model worked, It worked great, right, right,
• 50:50
  Speaker 5: But when you know PBMs started, uh you know, uh,
• 50:56
  Speaker 5: you know, uh you know, discounting the the payback, here's
• 51:03
  Speaker 5: here's you know, you have to change and and if
• 51:06
  Speaker 5: you haven't changed, you'll see a lot of those pharmacies
• 51:09
  Speaker 5: have gone away and the ones that have been more progressive,
• 51:13
  Speaker 5: I think, continue to survive and some of them are thriving.
• 51:17
  Speaker 5: But this, you know, this cash model should be a
• 51:21
  Speaker 5: part of I think everybody's day to day business at
• 51:24
  Speaker 5: some point or another.
• 51:26
  Speaker 9: Yes, I mean, look, maybe a lot of folks say, oh,
• 51:30
  Speaker 9: independent pharmacy business is difficult. The number of pharmacies are
• 51:35
  Speaker 9: going down. Yes, that's true. But on the flip side,
• 51:39
  Speaker 9: there are multi store owners are out there, many, I
• 51:44
  Speaker 9: know many of them, and some pharmacies are being purchased
• 51:47
  Speaker 9: by private equity backed companies at a very very high
• 51:53
  Speaker 9: sales price. So in any in any field, you have
• 51:58
  Speaker 9: to adapt. Just cannot stay oh, complaining about what's going
• 52:03
  Speaker 9: on around the world.
• 52:04
  Speaker 2: You have to act.
• 52:05
  Speaker 9: And some owners are are are are being very proactive
• 52:10
  Speaker 9: and protecting their business.
• 52:12
  Speaker 2: And that's part of the reason.
• 52:13
  Speaker 5: I think, you know Todd's show, this advice from guys
• 52:16
  Speaker 5: like you is so important because you know, a lot
• 52:19
  Speaker 5: of people are kind of just stuck sometimes and where
• 52:21
  Speaker 5: do I go, what do I do? And it's not
• 52:24
  Speaker 5: about just you know, trump RAX or the DSCSA or whatever.
• 52:29
  Speaker 5: The newest piece of the puzzle is. It's being prepared
• 52:32
  Speaker 5: for these things. And so this interview for us today
• 52:35
  Speaker 5: at least, was just to kind of scratch the surface understand,
• 52:39
  Speaker 5: you know, what the effects are going to be or
• 52:41
  Speaker 5: could be if this actually comes to fruition. I mean again,
• 52:46
  Speaker 5: you know they say it's twenty six. Who knows and
• 52:49
  Speaker 5: even when it does launch, or if it does launch,
• 52:51
  Speaker 5: what kind of effect it'll have immediately for independence, at
• 52:55
  Speaker 5: a minimum, one be aware of it to understand how
• 53:00
  Speaker 5: you can benefit from it or mitigate the losses from it.
• 53:03
  Speaker 5: And I think that's what we're trying to do here,
• 53:06
  Speaker 5: is to raise awareness to pharmacies to be prepared any
• 53:11
  Speaker 5: and anything, whether like I said, whether it's the strump
• 53:14
  Speaker 5: r X piece of it, whether it's the DSCSA.
• 53:17
  Speaker 2: Don't be a laggard on these on these matters.
• 53:20
  Speaker 5: Just make sure that you're consulting with whether it's a
• 53:23
  Speaker 5: listening to a podcast, talking to your attorney. I mean,
• 53:27
  Speaker 5: day is a great resources that Buchan and I'm not
• 53:30
  Speaker 5: giving you a free pitch, but but Day really is
• 53:33
  Speaker 5: a great source of information him and his entire team,
• 53:37
  Speaker 5: But there's other attorneys out there that are just as qualified.
• 53:40
  Speaker 5: But the bottom line is be prepared for whatever is
• 53:45
  Speaker 5: coming up, not in a week or a month, but
• 53:48
  Speaker 5: the next six months, twelve months, and you know, keep
• 53:50
  Speaker 5: your eye on the uh, you know, on the horizon.
• 53:54
  Speaker 1: That's a good lead in for a question to just
• 53:57
  Speaker 1: wrap up, to wrap up from your perspective, Day, and
• 54:00
  Speaker 1: that is, you know, what is the outlook that you
• 54:03
  Speaker 1: have as a as a legal counsel, as a strategist,
• 54:06
  Speaker 1: as a pharmacist for twenty twenty six and twenty twenty seven,
• 54:10
  Speaker 1: and how that ties into trump our X.
• 54:13
  Speaker 9: I think it's very bright. It's brighter than you know
• 54:16
  Speaker 9: several years ago. Independent pharmacies are adapting more independent pharmacies
• 54:20
  Speaker 9: are adapting, being prepared, being proactive. Government is looking into.
• 54:25
  Speaker 2: The current reimbursement model.
• 54:26
  Speaker 9: That's why they're coming up with They came up with
• 54:28
  Speaker 9: trump our X and the other DTC models out there.
• 54:33
  Speaker 9: So I want to say the outlook is bright for
• 54:36
  Speaker 9: independent pharmacies.
• 54:39
  Speaker 1: Thank you, Day, it's been good to have you on Day, Johnny.
• 54:44
  Speaker 1: It's been wonderful to talk with you and co host
• 54:47
  Speaker 1: again with you. You're always bringing, like I said, great guests
• 54:50
  Speaker 1: and great topics that really demystify the business of pharmacy
• 54:54
  Speaker 1: and how important it is to stay up to date.
• 54:57
  Speaker 1: I want to give a shout out to our listeners.
• 55:00
  Speaker 1: There's going to be some links in our show notes
• 55:01
  Speaker 1: who If you don't have a pencil where you're driving
• 55:04
  Speaker 1: or doing something, you can't write this down, don't worry
• 55:06
  Speaker 1: about it. Just go to any of any of the
• 55:09
  Speaker 1: podcast players Spotify, Apple, You can go to matchurx dot
• 55:13
  Speaker 1: com for example, ask questions from people that understand what's
• 55:17
  Speaker 1: going on and if they don't have the answer. If
• 55:19
  Speaker 1: match your X's team didn't have the answer that you
• 55:21
  Speaker 1: were looking for, they're going to help you find that answer.
• 55:24
  Speaker 1: They're going to be able to network with you, open
• 55:26
  Speaker 1: up their network and do exactly that same with us
• 55:29
  Speaker 1: at Pharmacy Podcast Network. We have a network of thousands
• 55:34
  Speaker 1: of people that are tied into us as expertise on
• 55:37
  Speaker 1: different facets of the business of pharmacy. Day you have
• 55:40
  Speaker 1: to promise that you're going to come back to Torqus
• 55:43
  Speaker 1: sooner than later and give us additional insights that cross
• 55:46
  Speaker 1: the crossroads of Pharmacy and Law.
• 55:51
  Speaker 9: Oh definitely.
• 55:53
  Speaker 1: Well right, well you've been listening to this week in
• 55:56
  Speaker 1: Pharmacy today's episode. Thank you to match your X for
• 56:00
  Speaker 1: being our sponsor, and Johnny Kello and team, thank you
• 56:02
  Speaker 1: so much for bringing us once again a great episode
• 56:05
  Speaker 1: of tworks. Hey as we kick off this week in
• 56:11
  Speaker 1: Pharmacy December nineteenth, Holy smokies.
• 56:14
  Speaker 2: I am not ready. I'm not ready for Christmas. Greg
• 56:18
  Speaker 2: Ribold is here from APCI. He has a special message.
• 56:22
  Speaker 1: That's why we're jumping in this week and Pharmacist works
• 56:25
  Speaker 1: right out of the gate with a message from Greg Ribold.
• 56:28
  Speaker 2: How are you, my brother. It's so good to see you, Todd,
• 56:31
  Speaker 2: so good.
• 56:31
  Speaker 7: To see you as well.
• 56:33
  Speaker 10: I appreciate you having me on.
• 56:36
  Speaker 11: You know, I think I was just telling you a
• 56:37
  Speaker 11: few minutes ago it was a big fan of the
• 56:40
  Speaker 11: episode you guys released last week. But you know, just
• 56:42
  Speaker 11: great discussions on the IRA and you know, and implementation,
• 56:49
  Speaker 11: you know what's going on in medicare with pricing and anyways,
• 56:53
  Speaker 11: great episode.
• 56:54
  Speaker 2: Thank you so much. Yeah, so that's what this is
• 56:57
  Speaker 2: all about.
• 56:57
  Speaker 1: If you're listening, you think you have something to share
• 57:01
  Speaker 1: about our profession. I mean, this is it we talk
• 57:03
  Speaker 1: about what's happening this week in pharmacy. It's where torks
• 57:07
  Speaker 1: and and so hey, you and I were part of
• 57:11
  Speaker 1: something pretty special last week on Thursday, the Pharmacist Fight
• 57:15
  Speaker 1: Back Act.
• 57:16
  Speaker 2: It was a.
• 57:17
  Speaker 1: Convergence of twenty five thirty different organizations and state organizations
• 57:23
  Speaker 1: and politicians and it was an amazing time. Give our
• 57:27
  Speaker 1: Torqus listeners a rundown what's going on?
• 57:30
  Speaker 2: Like, what is this? What is the act? What happens next?
• 57:34
  Speaker 7: Yes?
• 57:34
  Speaker 11: Absolutely, and so yeah, so we had well, I think
• 57:38
  Speaker 11: over fifty five pharmacists come in from don't quote me
• 57:41
  Speaker 11: on this, you know, twenty twenty one states on really
• 57:44
  Speaker 11: short notice for the reintroduction of the Pharmacists Fight Back Act.
• 57:47
  Speaker 11: And we had pharmacists from cities, from small towns, from
• 57:51
  Speaker 11: the East coast, West coast, the South, and they all
• 57:55
  Speaker 11: sort of converged on DC on incredibly short notice for
• 58:00
  Speaker 11: the reintroduction of Pharmacists.
• 58:01
  Speaker 10: Fight Back Act because you know, frankly, this is it's
• 58:04
  Speaker 10: just that important. And so what we saw is, you know,
• 58:07
  Speaker 10: in twenty twenty four, the Pharmacist.
• 58:10
  Speaker 11: Fight Back Act was introduced, and really, I think surprised
• 58:14
  Speaker 11: a lot of people, right, maybe it was a sleeper bill,
• 58:16
  Speaker 11: but it got well over fifty I think it had
• 58:18
  Speaker 11: around fifty six to fifty eight co sponsors in twenty
• 58:22
  Speaker 11: twenty four. And it was reintroduced just last week as
• 58:27
  Speaker 11: two separate bills. And so the first bill, HR. Sixty
• 58:31
  Speaker 11: six nine was introduced by Congressman Auchincloss.
• 58:35
  Speaker 12: And Harshbarger, who is who you know obviously every day
• 58:38
  Speaker 12: was represented. Harsbarger is a pharmacist as well, and so
• 58:42
  Speaker 12: that you know, that's that's really important that she was
• 58:44
  Speaker 12: willing to be a co lead. That bill acts in
• 58:47
  Speaker 12: Madicare and in Medicaid managed care plans. And then the
• 58:50
  Speaker 12: second bill was introduced by representatives of Auchincloss and Comer,
• 58:56
  Speaker 12: and Comber is the Chairman of Oversight. That bill acts
• 58:59
  Speaker 12: in the Federal Boy Health Benefits Program, and that bill
• 59:02
  Speaker 12: will be assigned to the Oversight Committee. And like cannot
• 59:07
  Speaker 12: stress like how unbelievable it is to have the chairman
• 59:11
  Speaker 12: of the Committee of Jurisdiction willing to be a co
• 59:15
  Speaker 12: lead on Pharmacists Fight Back Act, Right, I mean, you know,
• 59:19
  Speaker 12: from my.
• 59:19
  Speaker 10: Perspective, it's just such a such a such a powerful.
• 59:22
  Speaker 11: Message and the import of this really can't be overstated.
• 59:27
  Speaker 10: It is a really big deal.
• 59:29
  Speaker 11: And both of these bills, you know, there's there's some
• 59:31
  Speaker 11: technical differences, but but in broad strokes, here's what these
• 59:35
  Speaker 11: bills do. They take away the ability of PBMs to
• 59:40
  Speaker 11: essentially set, manipulate and fix drug prices in these large
• 59:45
  Speaker 11: federal healthcare programs.
• 59:47
  Speaker 10: And these are big ones, right.
• 59:48
  Speaker 11: Medicare party obviously is is you know, probably the biggest
• 59:51
  Speaker 11: prescription drug program in the country. Federal employee health benefits
• 59:54
  Speaker 11: program is the largest self funded employer plan in the country.
• 59:59
  Speaker 11: So these are these are massive federal programs along with
• 1:00:03
  Speaker 11: Medicaid managed care, and so this is going to take
• 1:00:06
  Speaker 11: away the ability of pdms as government contractors to exploit
• 1:00:10
  Speaker 11: and manipulate drug crisis.
• 1:00:12
  Speaker 10: And it moves to a market based model, a market
• 1:00:15
  Speaker 10: based model using national average drug acquisition costs plus four
• 1:00:18
  Speaker 10: percent up to fifty dollars, as well as a dispensing
• 1:00:23
  Speaker 10: feed It's in line with state Medicaid feed whose service
• 1:00:26
  Speaker 10: dispensing and so huge, right, no more PBM manipulating drug prices.
• 1:00:33
  Speaker 10: It also ends patients steering to PBM owned pharmacies, prohibits
• 1:00:39
  Speaker 10: fees and clawbacks and pricing manipulations that way and does
• 1:00:44
  Speaker 10: another really powerful thing that's very much in line with
• 1:00:46
  Speaker 10: what President Trump tried to do in his first term
• 1:00:49
  Speaker 10: with the rebate rule in twenty twenty. But it looks
• 1:00:52
  Speaker 10: to reduce drug costs at the counter for patients in
• 1:00:55
  Speaker 10: these federal plans by mandating the PBM's share all of
• 1:00:59
  Speaker 10: discount and rebates and that those are calculated into patient
• 1:01:04
  Speaker 10: cost share. And so this is going to align drug prices,
• 1:01:07
  Speaker 10: remove drug pricing variability, ensure that retail pharmacies that aren't
• 1:01:12
  Speaker 10: affiliated with PBMs are reimbursed fairly, while also ending massive
• 1:01:18
  Speaker 10: PBM markups at their own affiliated pharmacies, and then prohibit
• 1:01:22
  Speaker 10: the self interested steer.
• 1:01:25
  Speaker 2: All right, so waitch a lot.
• 1:01:27
  Speaker 1: We're going to drop your email address. You're if you're
• 1:01:30
  Speaker 1: looking on your screen, you're going to see Greg's email
• 1:01:33
  Speaker 1: address over at APCI. Reach out to Greg, ask him
• 1:01:39
  Speaker 1: how to help. This is a collective. If we all
• 1:01:43
  Speaker 1: help a little bit, this is going.
• 1:01:44
  Speaker 2: To go crazy.
• 1:01:45
  Speaker 1: So this is the kind this is the kind of
• 1:01:47
  Speaker 1: those times as we let's celebrate the holidays, Let's let's relax.
• 1:01:52
  Speaker 1: I'm not done Christmas shopping. I don't think you are
• 1:01:56
  Speaker 1: your your internet and power, your Internet went down, high
• 1:02:00
  Speaker 1: power went down. It's disrupted this recording twice. I mean,
• 1:02:05
  Speaker 1: there's fighting forces against us in multiple paths. Even if
• 1:02:09
  Speaker 1: you pray, even if you pray for PBM reform, at
• 1:02:12
  Speaker 1: least you do something. But literally, reach out to your
• 1:02:16
  Speaker 1: state representatives. If you're listening right now, invite them in
• 1:02:20
  Speaker 1: the new year. Say hey, listen, make a commitment in
• 1:02:23
  Speaker 1: the first quarter of twenty twenty six to invite a
• 1:02:29
  Speaker 1: state representative to your pharmacy, your long term care pharmacy,
• 1:02:34
  Speaker 1: your specialty pharmacy, your community independently owned pharmacy, your giant eagle,
• 1:02:40
  Speaker 1: your publics. Invite your state representative to your operations and
• 1:02:45
  Speaker 1: explain to them because they do not understand your white coat.
• 1:02:50
  Speaker 2: You count pills. That's all they're thinking about.
• 1:02:52
  Speaker 1: No, show them your automation, show them your Oh, have
• 1:02:55
  Speaker 1: them sign a non disclosure reform or whatever that form
• 1:02:59
  Speaker 1: is that you can give tours.
• 1:03:01
  Speaker 2: Make sure you do.
• 1:03:01
  Speaker 1: That as a lawyer, right, Greg, That's it, and then
• 1:03:05
  Speaker 1: tour them. Tore them through your pharmacy and tell the story.
• 1:03:09
  Speaker 1: Here's what we do. You don't have to be super grandular.
• 1:03:12
  Speaker 1: Here's what we do as a pharmacy operation. Here's how
• 1:03:16
  Speaker 1: that impacts patient health. Here are issues that can come
• 1:03:20
  Speaker 1: up with medication management. Here are issues that can come
• 1:03:23
  Speaker 1: up with billing and prior authorization, sticky tape that doesn't
• 1:03:26
  Speaker 1: make any sense whatsoever other than just to deny the claim,
• 1:03:30
  Speaker 1: you know, tell the story, and when the visualization comes
• 1:03:35
  Speaker 1: to their minds, that kind of lights this on fire,
• 1:03:38
  Speaker 1: so that we can keep this going into twenty twenty six.
• 1:03:42
  Speaker 10: Yeah, and I think i'd look, I think that's great advice, Todd.
• 1:03:45
  Speaker 11: You know, you know, invite your US representative for your
• 1:03:49
  Speaker 11: state to the pharmacy and at the state level.
• 1:03:52
  Speaker 10: You know, invite your state representative. What we have seen
• 1:03:54
  Speaker 10: is so many pharmacy.
• 1:03:56
  Speaker 11: Champions, you know, legislators at the state level and level
• 1:04:00
  Speaker 11: who visited pharmacies and and you know, spend thirty minutes
• 1:04:05
  Speaker 11: an hour sometimes sure it's fifteen minutes in a pharmacy
• 1:04:09
  Speaker 11: and walked out determined to help fight, you know, to
• 1:04:12
  Speaker 11: help fight for pharmacy. And like that's how that is
• 1:04:16
  Speaker 11: how pharmacy champions are made. And so right, there's no
• 1:04:19
  Speaker 11: there's if there is a secret sauce, it's getting it's
• 1:04:22
  Speaker 11: getting legislators into your pharmacy showing them what you do,
• 1:04:26
  Speaker 11: showing them how you care for people, and showing them
• 1:04:28
  Speaker 11: what your business and profession is up against by you know,
• 1:04:33
  Speaker 11: self self interested, conflicted, large pharmacy benefit managers, and you
• 1:04:38
  Speaker 11: know they're and they're unfair practices that they engage in.
• 1:04:41
  Speaker 10: So absolutely all.
• 1:04:44
  Speaker 1: Right, Well, where you probably won't talk until after Santa comes,
• 1:04:48
  Speaker 1: and I wish you a very merry Christmas and a
• 1:04:52
  Speaker 1: very happy time with your family.
• 1:04:54
  Speaker 2: Get some rest. I am hypocritical in.
• 1:04:56
  Speaker 1: Saying that because I like I love to work, so
• 1:04:59
  Speaker 1: I'm sure or that you're gonna sneak sneak an email
• 1:05:02
  Speaker 1: in or two, because it's just in our blood to
• 1:05:04
  Speaker 1: do so.
• 1:05:05
  Speaker 2: But I appreciate your friendship.
• 1:05:08
  Speaker 1: I appreciate the support that you guys have given to
• 1:05:11
  Speaker 1: us to get more news out and get more information out.
• 1:05:14
  Speaker 2: You're invited back on twerks. You can tworx with me
• 1:05:18
  Speaker 2: as much as you want, but I don't really want
• 1:05:19
  Speaker 2: to watch you tworks. To tell you the truth, Greg.
• 1:05:22
  Speaker 11: That wouldn't be good for anybody.
• 1:05:23
  Speaker 7: Tod, that wouldn't be good for anybody.
• 1:05:25
  Speaker 10: But hey, we have appreciate.
• 1:05:27
  Speaker 1: We have a big show, so we have to go.
• 1:05:29
  Speaker 1: We got to get things going. But I do want
• 1:05:30
  Speaker 1: to read something to you. This is a quote the
• 1:05:34
  Speaker 1: Pharmacists Fight Back Act bill strengthens the entire healthcare system,
• 1:05:40
  Speaker 1: said APCI CEO Tim Hammerck. And and this is the
• 1:05:45
  Speaker 1: part that gets me. When patients pay less and federal
• 1:05:49
  Speaker 1: programs operate more efficiently, every taxpayer benefits. I hate taxes, Greg,
• 1:05:58
  Speaker 1: I hate taxes. I hate them, and and his philosophy
• 1:06:01
  Speaker 1: and what Tim said is literally the truth. And then
• 1:06:06
  Speaker 1: by the way, that was a nonpartisan quote that was like,
• 1:06:09
  Speaker 1: it's a machine. It works just like computers, just like
• 1:06:13
  Speaker 1: a program, just like a factory. If you abuse the system,
• 1:06:18
  Speaker 1: you weaken the system, it weakens the entire nation. So
• 1:06:22
  Speaker 1: this is really to me. This the reason why I
• 1:06:25
  Speaker 1: put so much time and effort into our network and
• 1:06:27
  Speaker 1: into our podcasts is because I know that this is
• 1:06:30
  Speaker 1: impacting people's lives based on us supporting You are the professional,
• 1:06:36
  Speaker 1: you pharmacist, and you pharmacy operator, and you PBM builder.
• 1:06:42
  Speaker 1: These brand new PBMs that are being built that are
• 1:06:44
  Speaker 1: going to be the future of how PBMs run because
• 1:06:48
  Speaker 1: the destruction of the of the Grandpa system that was
• 1:06:53
  Speaker 1: you know, decrepit and built for only one reason that's
• 1:06:58
  Speaker 1: coming down finally, and we're building a brand new system
• 1:07:01
  Speaker 1: and it's actually leading more with pharmacists because pharmacists will
• 1:07:06
  Speaker 1: be doing less dispensing of an actual medication and really
• 1:07:10
  Speaker 1: digging into disease state management.
• 1:07:13
  Speaker 11: Yeah, there's so much, There's so much that pharmacists can
• 1:07:15
  Speaker 11: be doing. But I'm glad you read that quote. I
• 1:07:17
  Speaker 11: think you know, I think Tim absolutely Center punched it.
• 1:07:20
  Speaker 11: And the reality is, you know, right now, big PBMs
• 1:07:23
  Speaker 11: are using their position as government contractors right who had
• 1:07:29
  Speaker 11: the trust of the federal government, and they're using that
• 1:07:32
  Speaker 11: position to overcharge federal beneficiaries, federal patients, including senior citizens,
• 1:07:38
  Speaker 11: while at the same time under reimbursing non affiliate retail
• 1:07:42
  Speaker 11: pharmacies and then marking medications up at their pharmacies thousands
• 1:07:47
  Speaker 11: and thousands of percent. And this is going to reduce
• 1:07:50
  Speaker 11: costs and lead to increased efficiencies, improved access to care,
• 1:07:55
  Speaker 11: and sustainability for pharmacies, all while saving tax player's money.
• 1:08:00
  Speaker 11: I'm I'm glad you point it out. I think Tim
• 1:08:02
  Speaker 11: Senter punched it and just can't thank you Ton enough
• 1:08:05
  Speaker 11: for all the work you're doing and the attention you're
• 1:08:07
  Speaker 11: bringing to the role of pharmacists play just in the
• 1:08:09
  Speaker 11: broader healthcare system.
• 1:08:10
  Speaker 10: That's awesome.
• 1:08:11
  Speaker 1: Hey, you As much as we can get out there
• 1:08:14
  Speaker 1: and reach people is the better.
• 1:08:16
  Speaker 2: Hey, that's it. We got to get going. We got
• 1:08:19
  Speaker 2: a big show today.
• 1:08:20
  Speaker 1: Quick message from our sponsor and we'll be right back
• 1:08:23
  Speaker 1: with more toworks.
• 1:08:27
  Speaker 3: Running of pharmacy means juggling a lot patient care, inventory,
• 1:08:31
  Speaker 3: and now compliance. That's where match our x comes in.
• 1:08:34
  Speaker 3: Match our x is the online marketplace where independent pharmacies
• 1:08:37
  Speaker 3: buy and sell their overstocks safely, quickly, and affordably. You
• 1:08:41
  Speaker 3: can also shop from eleven plus trusted secondary wholesalers, all
• 1:08:45
  Speaker 3: in one place. We're here to make pharmacy ownership easier,
• 1:08:49
  Speaker 3: connecting you to savings, trusted partners, and simple tools that
• 1:08:52
  Speaker 3: help you stay compliant with confidence. Match our x where
• 1:08:56
  Speaker 3: pharmacy meets trust, compliance and opportunity.
• 1:09:00
  Speaker 7: What is it?
• 1:09:00
  Speaker 3: Match rex dot com to learn more.
• 1:09:03
  Speaker 4: That's matcharx dot com.
• 1:09:10
  Speaker 1: We're here on Twerks this week in Pharmacy. Got someone
• 1:09:14
  Speaker 1: in the studio with me. I want to introduce doctor
• 1:09:19
  Speaker 1: Jessica Daily to twerks.
• 1:09:21
  Speaker 13: Thanks Todd. This is exciting. We had our first session
• 1:09:24
  Speaker 13: just a few weeks ago and now I've already been
• 1:09:26
  Speaker 13: invited into the studio. I'm very excited.
• 1:09:29
  Speaker 1: Into the inner circle of the twerks Land absolutely, So
• 1:09:33
  Speaker 1: introduce our yourself to the listeners. Just in case people
• 1:09:36
  Speaker 1: don't know who Jessica Daily is.
• 1:09:37
  Speaker 13: Sure, so Hi Jessica Daily. Pharmacist by training, but I've
• 1:09:41
  Speaker 13: spent the majority of my career in the pharmacy supply chain,
• 1:09:45
  Speaker 13: so not practicing with patients, but really focusing more on
• 1:09:49
  Speaker 13: getting drugs to the patients that need them. So I've
• 1:09:52
  Speaker 13: worked in the healthcare arena responsibility for a large integrated
• 1:09:55
  Speaker 13: delivery network and then also for one of the largest
• 1:09:59
  Speaker 13: acute GPOs and ran the pharmacy program for them as well.
• 1:10:03
  Speaker 1: Yeah it was from Premiere, Yeah, yeah, I remember Premiere
• 1:10:08
  Speaker 1: when I was in my long term care realm and
• 1:10:11
  Speaker 1: we worked with MHA, we worked with Premiere, we worked with.
• 1:10:15
  Speaker 2: Innovados, ELEVADEX exactly.
• 1:10:18
  Speaker 1: And it's it's making me now feel old where I
• 1:10:21
  Speaker 1: see companies merging or I see things major changes happening.
• 1:10:26
  Speaker 1: The reason why that you're here today is exactly that
• 1:10:28
  Speaker 1: there's a lot of changes coming up in twenty twenty
• 1:10:31
  Speaker 1: six just for everybody. Today's tworks is Friday, December nineteenth.
• 1:10:37
  Speaker 2: We have what is that.
• 1:10:41
  Speaker 1: Fourteen days before it's twenty twenty six.
• 1:10:45
  Speaker 13: That's crazy, it's crazy.
• 1:10:46
  Speaker 2: I don't know where twenty twenty five went.
• 1:10:48
  Speaker 1: But we were talking to Alec Ginsburg, known as the
• 1:10:52
  Speaker 1: Drugstore Cowboy, and Antonio Chacha who's the Jedi master of
• 1:10:58
  Speaker 1: PBM reform and annalys that are coming into that. We
• 1:11:01
  Speaker 1: just had them on twerks last last week, and they
• 1:11:04
  Speaker 1: were talking about the changes to Medicare and the disruption
• 1:11:07
  Speaker 1: to a list of medications that are going to potentially
• 1:11:12
  Speaker 1: be major issues for some of our independent pharmacies because
• 1:11:15
  Speaker 1: of the expense.
• 1:11:16
  Speaker 2: Kind of dial in and talk to us about that.
• 1:11:19
  Speaker 13: From your perspective, sure, so, I think what's really interesting
• 1:11:22
  Speaker 13: about these Medicare changes, and I'm sure what you talked
• 1:11:27
  Speaker 13: about with the guys last week is really focused on
• 1:11:29
  Speaker 13: the independent pharmacies PBMs and how those changes impact that
• 1:11:34
  Speaker 13: segment of the pharmacy delivery network. What's really interesting about
• 1:11:40
  Speaker 13: these Medicare changes is that they have the potential, especially
• 1:11:43
  Speaker 13: in coupled with another change that is coming on January first,
• 1:11:48
  Speaker 13: with the three P forty B rebate pilot. Those two
• 1:11:51
  Speaker 13: together have incredible potential to disrupt and change the way
• 1:11:55
  Speaker 13: that pharmacy distribution and pharmacy administration happens across the entire
• 1:12:02
  Speaker 13: supply chain. So yes, there's absolutely the impacts that you
• 1:12:05
  Speaker 13: talked about last week. But where I focus is how
• 1:12:09
  Speaker 13: did these changes impact the way that health systems and
• 1:12:12
  Speaker 13: distributors and GPOs and other stakeholders in the market make decisions,
• 1:12:16
  Speaker 13: and how does that impact the long term health and
• 1:12:19
  Speaker 13: stability of the market, especially when we talk about generic
• 1:12:23
  Speaker 13: drugs and biosimilars.
• 1:12:27
  Speaker 1: The government, in different levels obviously state, but federal, have
• 1:12:33
  Speaker 1: really the federal government has really tried, and I applaud
• 1:12:38
  Speaker 1: them for trying. But then every time one of our
• 1:12:41
  Speaker 1: Antonio Chuchas dissect the domino effect of what they're going
• 1:12:46
  Speaker 1: to do, Trump our X for example, number one, he
• 1:12:48
  Speaker 1: had to name it after himself. Of course he's got
• 1:12:50
  Speaker 1: his Trump watches and everything, and I just think that's,
• 1:12:54
  Speaker 1: I guess, silly my libertarian viewpoint. But every time they
• 1:12:59
  Speaker 1: try something, it's never I mean, it's some of the
• 1:13:03
  Speaker 1: PBM reform things that they're bringing to attention, I think's wonderful.
• 1:13:07
  Speaker 2: Why doesn't it feel like it ever really hits the spot.
• 1:13:10
  Speaker 1: It's almost like you just missed it by you know,
• 1:13:13
  Speaker 1: this side or this side, Like talk to us a
• 1:13:16
  Speaker 1: little bit about that too.
• 1:13:17
  Speaker 13: Yeah. I think the problem with our healthcare system in
• 1:13:23
  Speaker 13: the United States is it is just so complex that
• 1:13:27
  Speaker 13: every little tweak that is made it ripples in unintended consequences.
• 1:13:32
  Speaker 13: So something that seems like it's a you know, it
• 1:13:35
  Speaker 13: makes sense, it's an easy fix, it's something that will
• 1:13:38
  Speaker 13: bring value to the market. Inevitably, it's going to and
• 1:13:41
  Speaker 13: I used this phrase recently and got someone to chuckle, Right,
• 1:13:45
  Speaker 13: it's going to move someone's cheese, right, Someone, some stakeholder
• 1:13:48
  Speaker 13: in the market is going to have to change the
• 1:13:50
  Speaker 13: way that they approach their business practices to respond to
• 1:13:54
  Speaker 13: those changes. And you know, I think I am I'm can.
• 1:14:00
  Speaker 13: I can certainly sit here and talk more about the
• 1:14:03
  Speaker 13: supply chain focus and how the pharmaceutical industry and distribution
• 1:14:08
  Speaker 13: and GPOs play a role in the market. The Gentleman
• 1:14:12
  Speaker 13: that you had on before, Antonio, right, their focus is
• 1:14:15
  Speaker 13: in independent pharmacies and retail pharmacies and PBMs collectively. This
• 1:14:20
  Speaker 13: market is so complex, with so many different facets that
• 1:14:26
  Speaker 13: it's nearly impossible for any one person to understand in
• 1:14:31
  Speaker 13: great detail and workable detail every aspect of the market.
• 1:14:35
  Speaker 13: So a change that makes sense to one individual myself
• 1:14:40
  Speaker 13: or intel, right or you, may not make sense in
• 1:14:43
  Speaker 13: a different part of the market. And it's really hard
• 1:14:45
  Speaker 13: to have the foresight and forethought to make those changes
• 1:14:50
  Speaker 13: and make adjustments that are not going to have unintended consequences.
• 1:14:54
  Speaker 13: I think that's one of the challenges. And we see that,
• 1:14:56
  Speaker 13: and we have seen that over and over with government
• 1:14:59
  Speaker 13: intervention into health care. Something sounds great, we make a change,
• 1:15:03
  Speaker 13: but the ripple effect and how that impacts the market
• 1:15:06
  Speaker 13: in totality is very different. And a lot of these changes,
• 1:15:11
  Speaker 13: I like to say, they're kind of their band aids, right,
• 1:15:13
  Speaker 13: it's band aids on top of band aids on top
• 1:15:15
  Speaker 13: of band aids. When we are making these changes to
• 1:15:18
  Speaker 13: address a specific issue, more than likely we're not actually
• 1:15:22
  Speaker 13: addressing the underlying issue that is creating the problem. Right,
• 1:15:27
  Speaker 13: We're not necessarily truly addressing the market forces that are
• 1:15:32
  Speaker 13: incentivizing the market to behave the way that it does.
• 1:15:36
  Speaker 13: We're making a slight tweak, but without fixing that underlying problem.
• 1:15:41
  Speaker 13: The underlying dysfunction in the healthcare delivery market You're not
• 1:15:46
  Speaker 13: going to see those kind of magic bullets, the magic
• 1:15:51
  Speaker 13: change that will make things better. It's just going to
• 1:15:55
  Speaker 13: create a new set of challenges that we'll have to
• 1:15:57
  Speaker 13: band aid over later.
• 1:15:59
  Speaker 2: It creates.
• 1:16:00
  Speaker 1: It's a lot of mystery and not understanding what's going on.
• 1:16:04
  Speaker 1: If I'm a pharmacy owner and I'm worried about my clients,
• 1:16:08
  Speaker 1: I'm worried about my patients.
• 1:16:09
  Speaker 2: I'm trying to grow in my market. I have a right.
• 1:16:12
  Speaker 1: Aid in my community that just shut down. Nick Men's
• 1:16:17
  Speaker 1: Drugs took it over, which is wonderful independent community pharmacy
• 1:16:22
  Speaker 1: that level, I'm like, do they really understand what's going on?
• 1:16:27
  Speaker 1: It's hard to understand, it's hard to track. How do
• 1:16:31
  Speaker 1: we get this information out? And how do we get
• 1:16:33
  Speaker 1: a playbook out to our independent community pharmacists, pharmacies, the
• 1:16:38
  Speaker 1: chain pharmacies shout out to giant Eagle right here in
• 1:16:40
  Speaker 1: our backyard in Pittsburgh. How do we how do we
• 1:16:44
  Speaker 1: get the right information to them. I keep thinking of
• 1:16:47
  Speaker 1: people like you working with the buying groups, or working
• 1:16:51
  Speaker 1: with the state associations, or doing something to help the
• 1:16:55
  Speaker 1: operators understand how they should be pivoting right.
• 1:16:59
  Speaker 13: I think a lot of it is just we focus
• 1:17:02
  Speaker 13: every two years as a pharmacist on getting our continuing
• 1:17:05
  Speaker 13: Education credits, and most of those CE credits are really
• 1:17:09
  Speaker 13: founded in clinical knowledge and clinical application. These business topics,
• 1:17:15
  Speaker 13: how you run your business, that the changes that are
• 1:17:18
  Speaker 13: coming from federal regulation, state regulations, even competition with other
• 1:17:25
  Speaker 13: stakeholders in your market. Those are all business questions. And
• 1:17:28
  Speaker 13: so what's really important for independent pharmacies and again, really
• 1:17:33
  Speaker 13: anybody me as a pharmacist with a focus in supply chain,
• 1:17:37
  Speaker 13: I only get better. I only get closer to having
• 1:17:40
  Speaker 13: a more comprehensive understanding of how healthcare in the United
• 1:17:44
  Speaker 13: States works if I continue to expand my knowledge. May
• 1:17:49
  Speaker 13: not be through CE credits and clinical topics, but it's
• 1:17:52
  Speaker 13: things like listening to podcasts like the Twork's podcast. It's
• 1:17:55
  Speaker 13: listening to and meeting other experts in the market that
• 1:17:58
  Speaker 13: can teach you a little bit about out to different aspects,
• 1:18:02
  Speaker 13: different aspect of pharmacy, a different aspect of the business implications.
• 1:18:07
  Speaker 13: And that's I think that's how we get better. No
• 1:18:10
  Speaker 13: one really has a lot of time, and certainly independent
• 1:18:13
  Speaker 13: pharmacies and even chain pharmacies pharmacists don't have a lot
• 1:18:16
  Speaker 13: of time, but even setting aside a few a few
• 1:18:19
  Speaker 13: minutes a week just to learn a little bit about
• 1:18:23
  Speaker 13: a different part of the business of pharmacy can really
• 1:18:26
  Speaker 13: help to kind of grow that base of knowledge and
• 1:18:28
  Speaker 13: grow and understanding of how all of these different changes
• 1:18:31
  Speaker 13: can impact your business.
• 1:18:34
  Speaker 1: And it's knowing who to trust, what they're talking about,
• 1:18:38
  Speaker 1: what kind of experience they have to be able to
• 1:18:41
  Speaker 1: say what they're saying, and then connect that. That's why
• 1:18:44
  Speaker 1: I love the podcast that we've gathered about forty in
• 1:18:48
  Speaker 1: the network. There's one called PBM Reform APCI, who's a
• 1:18:53
  Speaker 1: large buying group, has two thousand something members. Greg Ribald's
• 1:19:00
  Speaker 1: a lawyer for them. He's government relations. We met him
• 1:19:05
  Speaker 1: last week at the Pharmacists Fight Backed gathering in Washington,
• 1:19:09
  Speaker 1: d C. It's those kinds of organizations that I want
• 1:19:13
  Speaker 1: to get you connected with because they know things because
• 1:19:18
  Speaker 1: they're having to collect, they're having to source, they're having
• 1:19:21
  Speaker 1: to go out and try to pay attention to what's
• 1:19:24
  Speaker 1: going on. Talk to us about what you do for
• 1:19:28
  Speaker 1: organizations and how they might connect into what you're doing
• 1:19:33
  Speaker 1: to give them a different, different level of vision.
• 1:19:36
  Speaker 13: Sure, so you know, I think you started this with
• 1:19:39
  Speaker 13: the thought around who do you trust? Right, It's very
• 1:19:42
  Speaker 13: it can be hard to weed through the information that
• 1:19:47
  Speaker 13: you're gathering because every segment, every person right there going
• 1:19:51
  Speaker 13: to have. It sounds maybe sounds a little negative to
• 1:19:55
  Speaker 13: say this, but everyone has an agenda, right, They've got
• 1:19:57
  Speaker 13: an agenda built on their knowledge, on their understanding, on
• 1:20:00
  Speaker 13: their goals and what they're trying to accomplish. I think
• 1:20:03
  Speaker 13: what's unique, especially with where I'm at right now, I'm
• 1:20:07
  Speaker 13: an independent consultant, so I am not tied to any
• 1:20:11
  Speaker 13: one employer where I have to toe the line and
• 1:20:15
  Speaker 13: really parent what they need me to parent. So the
• 1:20:18
  Speaker 13: way that I approach the market is maybe radical transparency
• 1:20:24
  Speaker 13: on what I know and how the supply chain works.
• 1:20:29
  Speaker 13: What are our manufacturers, what decision points are they facing,
• 1:20:34
  Speaker 13: the GPOs, the wholesalers, all of these different stakeholders are
• 1:20:40
  Speaker 13: businesses trying to make it through what we know as
• 1:20:44
  Speaker 13: US health care delivery, and there are important aspects of
• 1:20:49
  Speaker 13: how they function, How those businesses function, the decisions they
• 1:20:53
  Speaker 13: need to make, the goals that they need to achieve.
• 1:20:56
  Speaker 13: That may you know, they may be in alignment with
• 1:20:58
  Speaker 13: each other, and they may be in conflict with each other.
• 1:21:01
  Speaker 13: So what I bring to the table is really that
• 1:21:03
  Speaker 13: sort of an unusual understanding from a pharmacy perspective. So
• 1:21:07
  Speaker 13: we didn't talk about it before, but at the beginning
• 1:21:09
  Speaker 13: of my career actually started with a pharmaceutical manufacturer on
• 1:21:12
  Speaker 13: the commercial side of the business. So I bring a
• 1:21:15
  Speaker 13: very different focus around how the commercial pharmaceutical market works,
• 1:21:19
  Speaker 13: the decisions that are made, how they do what they do,
• 1:21:23
  Speaker 13: and then how that feeds into the distribution of drugs
• 1:21:25
  Speaker 13: so where they're being purchased. The crazy thing about our
• 1:21:30
  Speaker 13: distribution world is that there's no simple here's your price,
• 1:21:34
  Speaker 13: and this is the price you're going to pay, and
• 1:21:36
  Speaker 13: everybody's going to pay this price. Right, There's a lot
• 1:21:38
  Speaker 13: of different levers that you have to be able to
• 1:21:41
  Speaker 13: exercise to get the best deal in the market. So
• 1:21:44
  Speaker 13: how do you leverage that, How do you address your contracts,
• 1:21:48
  Speaker 13: How do you approach gaining new business and gaining new
• 1:21:52
  Speaker 13: clients and customers so that you can grow your footprint
• 1:21:56
  Speaker 13: as whoever you are, whether it's in the distribution side
• 1:22:00
  Speaker 13: the market or whether it's another stakeholder that has to
• 1:22:02
  Speaker 13: interact with the distribution market, how do we make that
• 1:22:06
  Speaker 13: more favorable and allow you to be successful as you
• 1:22:09
  Speaker 13: engage with all of these different stakeholders that have very
• 1:22:12
  Speaker 13: specific needs and business objectives that they're trying to meet
• 1:22:16
  Speaker 13: that may or may not be in alignment with yours.
• 1:22:19
  Speaker 1: Yeah, the new models that are sprouting, I'm seeing manufacturers
• 1:22:24
  Speaker 1: increase direct access to pharmacies bypassing PBMs, bypassing the buying groups.
• 1:22:32
  Speaker 1: That's making a lot of people nervous. Then I see
• 1:22:34
  Speaker 1: the models. A shout out to doctor Kyle McCormick right
• 1:22:38
  Speaker 1: here at Pittsburgh Blueberry Pharmacy for saying, hell with it.
• 1:22:42
  Speaker 1: I'm doing direct to my consumer, to my patient. They're
• 1:22:46
  Speaker 1: going to pay a small club member fee for the
• 1:22:49
  Speaker 1: MTM side of things, and then it's going to be
• 1:22:52
  Speaker 1: cost plus over, very transparent. I love that model. And
• 1:22:58
  Speaker 1: then those are sprouting up across the kind. There's more
• 1:23:00
  Speaker 1: and more of them. We're going to see more and
• 1:23:02
  Speaker 1: more of them happening in twenty twenty six. Going back
• 1:23:05
  Speaker 1: to the old fashioned way of whatever that was seventies
• 1:23:09
  Speaker 1: or eighties, where they just paid the pharmacy for their
• 1:23:13
  Speaker 1: meds and for the consultation and it was all baked in.
• 1:23:17
  Speaker 1: But realism brings me back to the status quo. And
• 1:23:22
  Speaker 1: that is for twenty twenty six. If you were to
• 1:23:26
  Speaker 1: give a shout out to our listeners, pharmacy owners, buying groups,
• 1:23:32
  Speaker 1: maybe even a politician, what is the check and balance
• 1:23:38
  Speaker 1: list of you saying, hey, listen in a world that
• 1:23:42
  Speaker 1: is pretty confusing in our healthcare system. You advise them
• 1:23:47
  Speaker 1: to go here, here, and here to just double check things.
• 1:23:51
  Speaker 1: And that sounds like a lot of work. They should
• 1:23:54
  Speaker 1: just reach out to you and ask you to help,
• 1:23:56
  Speaker 1: but talk to us about maybe three points or or
• 1:24:00
  Speaker 1: advice points of here's what, here's the information you should
• 1:24:03
  Speaker 1: be double checking to assure that your or access you're
• 1:24:09
  Speaker 1: buying is not whack well.
• 1:24:13
  Speaker 13: And so in more weights than one, you don't want
• 1:24:16
  Speaker 13: to buy it whack. So it is what whack is wack?
• 1:24:18
  Speaker 13: Whack is whack? Absolutely, you know. I think there's a
• 1:24:21
  Speaker 13: couple of things that as a pharmacist leading a pharmacy
• 1:24:26
  Speaker 13: that you need to do routinely, whether it's because it's
• 1:24:29
  Speaker 13: twenty twenty six and you're refreshing your view or it's
• 1:24:32
  Speaker 13: just any any year. Twenty twenty six is particularly interesting.
• 1:24:37
  Speaker 13: We talked about the Medicare price changes, the three forty
• 1:24:39
  Speaker 13: B rebate program pilot, that's that's they're both going into
• 1:24:43
  Speaker 13: effect on January first, So major shift in the way
• 1:24:47
  Speaker 13: the market is going to be.
• 1:24:50
  Speaker 2: Managed.
• 1:24:51
  Speaker 13: Now focusing primarily again in that medicare Part D space
• 1:24:55
  Speaker 13: for right now three forty B, but it's going to
• 1:24:58
  Speaker 13: shift the way that a lot of the market interacts.
• 1:25:01
  Speaker 13: So your PBM agreements, the agreements that you have with
• 1:25:05
  Speaker 13: your health plans, with your PBMs, you have to watch
• 1:25:09
  Speaker 13: those because those are all going to change. As we
• 1:25:11
  Speaker 13: see some of the list priced reductions, we're going to
• 1:25:15
  Speaker 13: see reductions in margin and payments for administration and distribution
• 1:25:20
  Speaker 13: of those products that are impacted by these rule changes
• 1:25:23
  Speaker 13: in January. So if you're not watching your PBM contracts
• 1:25:27
  Speaker 13: making sure that you are tracking, that's going to be
• 1:25:30
  Speaker 13: a challenge. Now that's not my area of expertise, so
• 1:25:33
  Speaker 13: i'd encourage you to go somewhere else to really dig
• 1:25:36
  Speaker 13: into those contracts. But if you're looking at your distribution agreements,
• 1:25:39
  Speaker 13: this is another space where you really need to be
• 1:25:43
  Speaker 13: well aware of what these changes mean and how that
• 1:25:47
  Speaker 13: could impact your ability to purchase drugs. Right the majority
• 1:25:50
  Speaker 13: of drugs in this country are all purchased through our
• 1:25:53
  Speaker 13: Big three wholesale distributors. They are shipping and distributing almost
• 1:25:58
  Speaker 13: every product that have patient going to receive here in
• 1:26:01
  Speaker 13: the United States. Your agreement as a pharmacy owner with
• 1:26:06
  Speaker 13: that distributor is based on the mix of drugs that
• 1:26:09
  Speaker 13: you're purchasing and the profitability of those drugs and the
• 1:26:12
  Speaker 13: distribution of those drugs to your distributor. So as we
• 1:26:17
  Speaker 13: see some of these changes happening January first, that is
• 1:26:20
  Speaker 13: absolutely going to impact the profitability for the distributor for
• 1:26:25
  Speaker 13: those products. So the terms of your distribution agreement, you
• 1:26:28
  Speaker 13: have to watch them very closely to make sure that
• 1:26:31
  Speaker 13: you don't see any changes in your cost minus discounts
• 1:26:33
  Speaker 13: or in the products that you're able to cover. We
• 1:26:37
  Speaker 13: see things happening, especially as if you're getting ready to
• 1:26:40
  Speaker 13: review your distribution agreement with your primary wholesaler, you really
• 1:26:45
  Speaker 13: want to go through. There's important terms and conditions that
• 1:26:48
  Speaker 13: we've seen changes have been proposed from distributors. Unless you
• 1:26:53
  Speaker 13: know what you're looking for, you may not realize that
• 1:26:56
  Speaker 13: some of your terms, your shipping terms, your COGS terms,
• 1:27:00
  Speaker 13: in your returns terms could be changing. And that's really important.
• 1:27:04
  Speaker 13: As we see some of these list prices dropping, your
• 1:27:07
  Speaker 13: terms for return very much could change because the distributor
• 1:27:11
  Speaker 13: is not going to want to accept returns at a
• 1:27:14
  Speaker 13: higher cost and then resell those products at the new
• 1:27:18
  Speaker 13: lower acquisition costs. So there's a lot of things that
• 1:27:22
  Speaker 13: you need to watch when you're looking at your contracts,
• 1:27:25
  Speaker 13: making sure that the terms are consistent, that you're getting
• 1:27:27
  Speaker 13: the best value, and that if you do have an
• 1:27:29
  Speaker 13: opportunity to renegotiate your distribution contracts, you're looking for those
• 1:27:34
  Speaker 13: areas where you can push to get a little bit
• 1:27:37
  Speaker 13: more favorable treatment from your distributor. The other thing that
• 1:27:41
  Speaker 13: you really can be looking at is how you're purchasing.
• 1:27:45
  Speaker 13: This feeds into so many different aspects of the way
• 1:27:48
  Speaker 13: that you manage your business. So whether it's how much
• 1:27:51
  Speaker 13: product you're purchasing, what your terms look like, do you
• 1:27:54
  Speaker 13: have inventory data that is in a perpetual inventory system
• 1:27:57
  Speaker 13: that's easily accessible. Are you purchasing everything that you can
• 1:28:01
  Speaker 13: through your primary distributor, or are you leveraging the terms
• 1:28:05
  Speaker 13: of that distribution agreement and other secondary channels for purchasing
• 1:28:10
  Speaker 13: to get the best deal and make the most value
• 1:28:13
  Speaker 13: out of your purchasing strategy. It's not always easy to
• 1:28:17
  Speaker 13: manage because typically a lot of this has been manual lift.
• 1:28:21
  Speaker 13: There's a buyer sitting in a terminal that's purchasing products
• 1:28:24
  Speaker 13: based on the way they've always done it. There's ways, though,
• 1:28:27
  Speaker 13: that you can refresh your purchasing strategy, refresh your inventory
• 1:28:31
  Speaker 13: strategy so that you are buying the right products through
• 1:28:35
  Speaker 13: the right channel to maximize the financial value of all
• 1:28:38
  Speaker 13: of your distribution contracts. But at the same time taking
• 1:28:42
  Speaker 13: into account some of the challenges that are pervasive in
• 1:28:46
  Speaker 13: the country right now with drug shortages, Do you have
• 1:28:50
  Speaker 13: the right strategy for your critical products to make sure
• 1:28:53
  Speaker 13: that you are well positioned to weather any future disruptions
• 1:28:58
  Speaker 13: that may happen, and to make sure that your purchasing
• 1:29:01
  Speaker 13: patterns and your strategies are not actually contributing to the
• 1:29:05
  Speaker 13: problem of drug shortages. So there's a lot of different
• 1:29:07
  Speaker 13: ways that you can look at again any of your
• 1:29:10
  Speaker 13: existing agreements or contracts and how some of these, especially
• 1:29:14
  Speaker 13: the January first changes, could impact them. But then looking
• 1:29:17
  Speaker 13: at your purchasing strategy overall, where are you buying from,
• 1:29:21
  Speaker 13: How do you tweak your purchasing strategy to make sure
• 1:29:25
  Speaker 13: that you're getting the best value and future proof in
• 1:29:28
  Speaker 13: your supply chain.
• 1:29:29
  Speaker 1: Jessica, have you helped organizations like pharmacies, large pharmacies change
• 1:29:35
  Speaker 1: negotiate contracts.
• 1:29:37
  Speaker 13: So it's a big part of the work that I did.
• 1:29:40
  Speaker 13: I mentioned I've worked for a health system, so I
• 1:29:43
  Speaker 13: was here right here at UPMC where I ran the
• 1:29:46
  Speaker 13: pharmacy supply chain, and a big part of our daily
• 1:29:50
  Speaker 13: work was managing the negotiation of contracts, and so we
• 1:29:54
  Speaker 13: did everything from negotiating the massive distribution contracts to individual
• 1:29:59
  Speaker 13: manufacture contracts and sort of the local impact. Same thing
• 1:30:03
  Speaker 13: with my time at Premiers negotiating and leading the team
• 1:30:07
  Speaker 13: that did negotiations for all of the GPO contracts. I
• 1:30:12
  Speaker 13: have not gone in personally to help independent pharmacies negotiate
• 1:30:17
  Speaker 13: these contracts, but the terms and conditions and really the
• 1:30:21
  Speaker 13: detail that we got into from a GPO and from
• 1:30:23
  Speaker 13: a major health system level are it's very granular, and
• 1:30:29
  Speaker 13: so that concept the concepts that the distributors are using
• 1:30:33
  Speaker 13: in writing terms and conditions for larger entities, it's very
• 1:30:37
  Speaker 13: similar to the concepts and the terms that they're looking
• 1:30:40
  Speaker 13: to insert into some of these other independent pharmacy contracts
• 1:30:43
  Speaker 13: as well. So it's very easy to port those ideas.
• 1:30:46
  Speaker 13: Look for those terms and conditions. And again what we
• 1:30:50
  Speaker 13: did was was true supply chain RFP, multiple vendors, right,
• 1:30:56
  Speaker 13: and the rigor around running a process like that is
• 1:31:01
  Speaker 13: very much portable over to any pharmacy setting. And so
• 1:31:04
  Speaker 13: that's something that I can do absolutely have done for Yeah.
• 1:31:08
  Speaker 1: I think of our We've worked with Key Source Real
• 1:31:11
  Speaker 1: Value Value.
• 1:31:14
  Speaker 2: Drug JERRYMED.
• 1:31:17
  Speaker 1: All these organizations that are MHA who are positioned to
• 1:31:22
  Speaker 1: concentrate on pharmacy outlets pharmacy pharmacies and then start to
• 1:31:30
  Speaker 1: divide out a very specific section when we're working with
• 1:31:34
  Speaker 1: we go to ASSEMBIA and working in specialty versus going
• 1:31:39
  Speaker 1: to the ASP and working just in long term care.
• 1:31:42
  Speaker 1: Is there is there anything that is going to impact
• 1:31:46
  Speaker 1: long term care pharmacies coming up January first? Is I
• 1:31:50
  Speaker 1: know that there's a list of drugs that Alec Ginsberg
• 1:31:54
  Speaker 1: and Antonio Chucha talked about, But is there bigger things
• 1:31:58
  Speaker 1: that could kind of slide out of the changes that
• 1:32:01
  Speaker 1: are happening to long term care pharmacy specifically? Sure?
• 1:32:05
  Speaker 13: So I think the and as I mentioned earlier, these changes,
• 1:32:09
  Speaker 13: although we are focusing on them for medicare Part D
• 1:32:13
  Speaker 13: for those ten drugs where we're going to see the
• 1:32:15
  Speaker 13: maximum fare prices that are implementing January first. What we've
• 1:32:21
  Speaker 13: seen as a part of that process is that many
• 1:32:24
  Speaker 13: of the manufacturers that are subject to these MFPs have
• 1:32:29
  Speaker 13: started to think about reducing their list price right so
• 1:32:36
  Speaker 13: list price or whack price, they're looking to bring it
• 1:32:39
  Speaker 13: a little closer to where the net price is going
• 1:32:41
  Speaker 13: to be. So we've seen some of those shifts. So
• 1:32:43
  Speaker 13: whether you're purchasing the product through or or reimbursing through
• 1:32:48
  Speaker 13: a Medicare Part D plan, which could happen. Ultimately, that
• 1:32:53
  Speaker 13: decrease in list price will make a difference for pharmacies
• 1:32:57
  Speaker 13: and settings across the country. So whether it's long term
• 1:33:00
  Speaker 13: care or retail or hospital pharmacy, there will be a
• 1:33:04
  Speaker 13: change in en list price. We're going to see more
• 1:33:08
  Speaker 13: of an impact over the next coming years. So this
• 1:33:12
  Speaker 13: first group of drugs, we're going to see what happens
• 1:33:14
  Speaker 13: come January first, and over the next year. January first
• 1:33:17
  Speaker 13: of twenty twenty seven we see the next group and
• 1:33:19
  Speaker 13: those who are announced just before Thanksgiving fifteen drugs that
• 1:33:23
  Speaker 13: will be included in that next round, and then going
• 1:33:26
  Speaker 13: forward from there, the program is going to expand to
• 1:33:30
  Speaker 13: include more Part B and Part D drugs, So we
• 1:33:34
  Speaker 13: focus very much on Part D right now, but the
• 1:33:36
  Speaker 13: program will continue to expand, so we'll see more of
• 1:33:39
  Speaker 13: those Part B drugs that will have broader impact in
• 1:33:42
  Speaker 13: pharmacy settings or in inpatient or long term care settings
• 1:33:46
  Speaker 13: that that will come and so we'll see over the
• 1:33:49
  Speaker 13: next couple of years what the changes, what changes result
• 1:33:53
  Speaker 13: from these first price decreases, and how that impacts the
• 1:33:56
  Speaker 13: market overall.
• 1:33:58
  Speaker 7: All.
• 1:33:58
  Speaker 1: Right, So a shot out to organizations that are out there.
• 1:34:02
  Speaker 1: You're listening right now, you want an opportunity to talk
• 1:34:05
  Speaker 1: with Jessica. I'm going to have a link into Jessica's
• 1:34:09
  Speaker 1: LinkedIn also, it's called Daily Consulting Services LLC. That's your consultancy.
• 1:34:18
  Speaker 1: Many big plans for the holidays. I mean we're on
• 1:34:21
  Speaker 1: it's December nineteenth, so what it's five more days till Christmas?
• 1:34:27
  Speaker 13: Right, Yeah, it's holidays are always busy. So fortunately right
• 1:34:32
  Speaker 13: Pittsburgh based just like you are, and most of our
• 1:34:34
  Speaker 13: family is here also. But we do like to sneak
• 1:34:37
  Speaker 13: out a little bit and take a quick trip down
• 1:34:40
  Speaker 13: to Florida to get a little bit of sun before
• 1:34:42
  Speaker 13: Santa shows up. So we'll be leaving tonight heading down
• 1:34:46
  Speaker 13: there for a little bit and you know, we't tan
• 1:34:49
  Speaker 13: very much, but that's okay, and then come back Christmas
• 1:34:54
  Speaker 13: and then head up north to ski. So we like
• 1:34:56
  Speaker 13: to go extremes when we When we get near the holidays.
• 1:34:59
  Speaker 1: We have to promise to come back to twerks. Let's
• 1:35:02
  Speaker 1: either you come down to the studio, we'd love to
• 1:35:04
  Speaker 1: have you, or just pipe you in from your North
• 1:35:07
  Speaker 1: Hills offices up there. But it's just been so good
• 1:35:12
  Speaker 1: to reconnect with you. We originally got to meet at
• 1:35:16
  Speaker 1: the Sure Cost event. A shout out to Shir Costs
• 1:35:18
  Speaker 1: and Insights. It's it's been wonderful to re engage and
• 1:35:22
  Speaker 1: work with them. I worked with them originally way back
• 1:35:25
  Speaker 1: in my Framework LTC days, and we built an API.
• 1:35:28
  Speaker 2: To their system.
• 1:35:29
  Speaker 1: And now they're with the advent of leveraging more of
• 1:35:33
  Speaker 1: artificial intelligence through their analytics company. It's it's crazy what
• 1:35:37
  Speaker 1: they're doing. I love it now.
• 1:35:39
  Speaker 13: They their model is very exciting to me as a
• 1:35:43
  Speaker 13: supply chain NERD because, as I mentioned earlier, one of
• 1:35:47
  Speaker 13: the big things that pharmacies can do is get strategic
• 1:35:51
  Speaker 13: with their purchasing and how and where they buy their
• 1:35:54
  Speaker 13: drugs from. Because it makes a difference. You can maximize
• 1:35:57
  Speaker 13: your prime vendor, you can you know, you can bring
• 1:36:00
  Speaker 13: in secondary vendors to help build value and build access.
• 1:36:04
  Speaker 13: And that's what's so beautiful about the shir Cost product
• 1:36:06
  Speaker 13: is they really started as a tool to help long
• 1:36:11
  Speaker 13: term care and retail pharmacies do that better, make smarter
• 1:36:15
  Speaker 13: decisions and automate some of their purchasing process so that
• 1:36:18
  Speaker 13: they could standardize. And what they've built now is getting
• 1:36:22
  Speaker 13: farther into my area of interest, which is around drug
• 1:36:25
  Speaker 13: shortages and leveraging AI to build out some of these
• 1:36:29
  Speaker 13: really unique capabilities. So that's definitely you ever want to
• 1:36:33
  Speaker 13: talk about supply chain drug shortages, any of these components,
• 1:36:36
  Speaker 13: That's where I really get excited.
• 1:36:38
  Speaker 2: Yeah, well, we'll have you back for that.
• 1:36:40
  Speaker 1: I think this is good education, good business education for
• 1:36:44
  Speaker 1: our listeners. Shout out to our listeners. Hope you guys
• 1:36:47
  Speaker 1: are doing well. Wishing everyone a very very merry Christmas,
• 1:36:51
  Speaker 1: and Jessica, doctor Jessica Daily, make sure that you come
• 1:36:54
  Speaker 1: back to.
• 1:36:55
  Speaker 13: Twerks happy to thank you so much for having me.
• 1:36:58
  Speaker 2: All right, we'll be right back for mark Tware.
• 1:37:03
  Speaker 8: Feeling lost with the complexities of pharmacy accounting.
• 1:37:06
  Speaker 14: And in pharmacy today, there's so many different variables and
• 1:37:11
  Speaker 14: issues that impact the pharmacy, books, records, accounting, the profitabilities,
• 1:37:15
  Speaker 14: so or so forth. There's different components of pharmacy that
• 1:37:18
  Speaker 14: have its own nuances from an accounting standpoint, and so
• 1:37:22
  Speaker 14: it's it's tricky, there's no doubt about it.
• 1:37:24
  Speaker 8: Ready to take your pharmacy to the next level, but
• 1:37:27
  Speaker 8: don't know where to start. Psychs and Company is here
• 1:37:29
  Speaker 8: to help, introducing the RX Assessment. With the RX Assessment,
• 1:37:34
  Speaker 8: the pharmacy CPAs and advisors at PSYCHS will do a
• 1:37:37
  Speaker 8: deep dive into your accounting and tax situation and give
• 1:37:40
  Speaker 8: you the action steps you need to take to take
• 1:37:43
  Speaker 8: your pharmacy to the next level.
• 1:37:45
  Speaker 14: If you're interested in, you know, working with a team
• 1:37:48
  Speaker 14: who understands the industry and how the accounting and tax
• 1:37:52
  Speaker 14: should really be in a pharmacy, this is your chance
• 1:37:55
  Speaker 14: to get under the hood check of what's going on
• 1:37:58
  Speaker 14: and getting the feedback if any issues or concerns or
• 1:38:01
  Speaker 14: again things we think you're doing really well.
• 1:38:03
  Speaker 8: Get the financial check up your pharmacy needs and head
• 1:38:06
  Speaker 8: over to Seychs HYPHENCPA dot com or call two five
• 1:38:10
  Speaker 8: to two four eight two seven six four four.
• 1:38:26
  Speaker 2: Hey, welcome back to TWERX.
• 1:38:29
  Speaker 1: What a good week it has been December nineteenth, twenty
• 1:38:33
  Speaker 1: twenty five. I hope you're ready for Christmas. I am
• 1:38:36
  Speaker 1: a hypocrite because I am not ready yet. I always
• 1:38:39
  Speaker 1: wait to the last minute. I'm on the last minute shopper.
• 1:38:43
  Speaker 1: I mean, I have my kids picked out. I even
• 1:38:45
  Speaker 1: have something from our wife, God bless her heart. But
• 1:38:49
  Speaker 1: I'm just not ready. I think twenty twenty five has
• 1:38:52
  Speaker 1: been a surprise. Everything snuck up on me. The conference
• 1:38:57
  Speaker 1: season just kind of wrecks everything. And now it's time
• 1:39:01
  Speaker 1: to just chill out with family and I have to
• 1:39:03
  Speaker 1: turn off. I got to turn things off from a
• 1:39:06
  Speaker 1: professional perspective. I'm not sure if you feel that way,
• 1:39:09
  Speaker 1: but I want to take time just to be with
• 1:39:11
  Speaker 1: the family. And so this week coming up, we're going
• 1:39:14
  Speaker 1: to work until December twenty third. We're not going to
• 1:39:18
  Speaker 1: have a TWRQUS the week of Christmas. So just an
• 1:39:21
  Speaker 1: announcement to let you know what an amazing episode that
• 1:39:25
  Speaker 1: we had with Johnny Kello and the matro X team.
• 1:39:29
  Speaker 1: Thank you so much to Matrox and doctor day Lee
• 1:39:33
  Speaker 1: farm d Esquire Pharmacist, and that he calls himself the
• 1:39:37
  Speaker 1: pharmacist lawyer, which is great, so much appreciate you. Before
• 1:39:42
  Speaker 1: we get into our next segment, I have a special friend,
• 1:39:45
  Speaker 1: a Pharmacy fifty Award winner, somebody who's standing out, somebody
• 1:39:49
  Speaker 1: who's international throughout the world and is really making a
• 1:39:55
  Speaker 1: huge difference to the profession of pharmacy, Katrina Azer.
• 1:39:59
  Speaker 2: I want to welcome you to works.
• 1:40:02
  Speaker 15: Todd Uriy, my great friends. Thank you so much for
• 1:40:04
  Speaker 15: inviting me on this show. I am so excited about
• 1:40:07
  Speaker 15: this episode and I am thrilled to be here and
• 1:40:11
  Speaker 15: to feature on TOUS this week. Like you, I'm not
• 1:40:15
  Speaker 15: really that ready for Christmas either. I've been deep in
• 1:40:19
  Speaker 15: the trenches launching my book and I couldn't launch it
• 1:40:23
  Speaker 15: at a bit of time. I'm not heavily promoting it at
• 1:40:25
  Speaker 15: the moment because I know people are really busy. But
• 1:40:27
  Speaker 15: once I get into January, I'm going to go all
• 1:40:29
  Speaker 15: in on heavy promotion of the book, which is something
• 1:40:33
  Speaker 15: that I'm really looking forward to.
• 1:40:35
  Speaker 1: If you're watching us on LinkedIn, if you're watching us
• 1:40:38
  Speaker 1: streaming on YouTube or even Twitter, you'll see on the
• 1:40:42
  Speaker 1: screen it says unscripted on purpose. This is a book
• 1:40:45
  Speaker 1: that Katrina has been thinking about and working on for
• 1:40:49
  Speaker 1: nearly three years, and really started heavy about six months ago.
• 1:40:55
  Speaker 1: I've been tracking Katrina's work. I'm so honored to be
• 1:41:00
  Speaker 1: mentioned in the book. I love the fact that she
• 1:41:03
  Speaker 1: cultivates a whole bunch of people that she's consulted with.
• 1:41:07
  Speaker 1: This isn't like a book that came out on an island,
• 1:41:10
  Speaker 1: but it's the journey.
• 1:41:12
  Speaker 15: And kind of did Todd We are an island.
• 1:41:15
  Speaker 1: An island, an islandmacist misfits. But tell us about the
• 1:41:20
  Speaker 1: whole purpose and where your heart was when when you
• 1:41:23
  Speaker 1: thought of Unscripted on Purpose.
• 1:41:26
  Speaker 15: So Unscripted on Purpose, as it is called, a journey
• 1:41:30
  Speaker 15: and purpose driven guide for pharmacists who feel called to more,
• 1:41:33
  Speaker 15: is really every pharmacist's gateway to finding their identity beyond
• 1:41:38
  Speaker 15: the script, the script that is handed to them by society,
• 1:41:41
  Speaker 15: by their parents, by the profession, by universities. Just to
• 1:41:45
  Speaker 15: find themselves beyond that. What is my purpose in life?
• 1:41:49
  Speaker 15: Why am I here? For what am I called to do?
• 1:41:51
  Speaker 15: And no matter what stage a pharmacist is at, I
• 1:41:55
  Speaker 15: am one hundred percent certain that at every point in
• 1:41:58
  Speaker 15: their life, no matter how successful, they've had a brick
• 1:42:01
  Speaker 15: wall when they've asked themselves, is this it? Is this
• 1:42:05
  Speaker 15: really what life is about? Even you might have got
• 1:42:09
  Speaker 15: to that point. So there are moments of pause when
• 1:42:12
  Speaker 15: you just think, oh my gosh, like what is this?
• 1:42:14
  Speaker 15: What am I doing? Why am I even here. We've
• 1:42:16
  Speaker 15: had those moments, specifically on our rides back from work
• 1:42:19
  Speaker 15: on Sunday evening when we have a lot of I
• 1:42:22
  Speaker 15: Hate Monday energy. So the book is really aimed at
• 1:42:27
  Speaker 15: pharmacists from all stages of their career, no matter how successful,
• 1:42:30
  Speaker 15: and no matter how burnt out you are or misaligned,
• 1:42:33
  Speaker 15: You're going to find yourselves and yourself and the stories
• 1:42:36
  Speaker 15: because it is coming from someone or from me from
• 1:42:40
  Speaker 15: my journey, and I pretty much just hand your story
• 1:42:44
  Speaker 15: back to you through my words. You're going to see
• 1:42:47
  Speaker 15: yourselves seen and heard through the stories that I share
• 1:42:50
  Speaker 15: from my career, from starting at rock bottom, you know,
• 1:42:53
  Speaker 15: a failing pharmacist who's made mistakes that nearly killed some patients,
• 1:42:58
  Speaker 15: to a pharmacist who's stood on the top of the mountain,
• 1:43:01
  Speaker 15: got all the awards and recognitions that I possibly get
• 1:43:04
  Speaker 15: my hands on and all the credentials, just to realize
• 1:43:06
  Speaker 15: I'm still not happy. I'm still feeling hollow. Is this
• 1:43:09
  Speaker 15: really what life has come through? Because if all of
• 1:43:11
  Speaker 15: these things are meant to fulfill me, if money is it,
• 1:43:14
  Speaker 15: well it hasn't. So then I decided to go back
• 1:43:18
  Speaker 15: down the mountain and had a little existential crisis back
• 1:43:21
  Speaker 15: and during this year when I stepped away from everything,
• 1:43:24
  Speaker 15: I thought, you know what you know, God, if you
• 1:43:25
  Speaker 15: want me to write this book, you need to send
• 1:43:27
  Speaker 15: me the answer, because I I have no idea why
• 1:43:30
  Speaker 15: I'm here. Like I thought this was it. I thought
• 1:43:32
  Speaker 15: I chased the right purpose to get to the top
• 1:43:35
  Speaker 15: of the mountain, but I still feel really hollow. Helped
• 1:43:37
  Speaker 15: me to continue the story, and it was then that
• 1:43:39
  Speaker 15: I just went on a journey of self discovery. And
• 1:43:41
  Speaker 15: you've followed alongside of the journey. You've even told me
• 1:43:44
  Speaker 15: that you're finding myself through the stories that I've been cheering.
• 1:43:48
  Speaker 15: So it's really how to just find yourself on the
• 1:43:51
  Speaker 15: balls amidst it all and find your real identity beyond
• 1:43:54
  Speaker 15: a just a pharmacist. And and just interestingly enough, someone's
• 1:43:57
  Speaker 15: heared a people with me, which I'm happy to linked
• 1:44:00
  Speaker 15: to in the episode, which was published by ACCP or
• 1:44:03
  Speaker 15: journals that looked at pharmacists who are happy with the
• 1:44:08
  Speaker 15: profession but are feeling lacking, feeling unfulfilled, feeling lacking purpose.
• 1:44:13
  Speaker 15: And I think sadly the article doesn't address finding yourself
• 1:44:18
  Speaker 15: beyond the profession. I think we get so entangled and
• 1:44:23
  Speaker 15: clustered and box ourselves in and pharmacy that we just
• 1:44:26
  Speaker 15: fail to see we have an identity, and there's a
• 1:44:29
  Speaker 15: human being who cherishes and finds jay and connection and
• 1:44:34
  Speaker 15: travel and creativity. You'd know me. I'm a creative person.
• 1:44:38
  Speaker 15: I dance, I write, I do all these things and
• 1:44:40
  Speaker 15: think it is these things that actually make me a
• 1:44:42
  Speaker 15: better pharmacist, more effective at my role, not the other
• 1:44:46
  Speaker 15: way around. And weaving that story, I talk about my
• 1:44:49
  Speaker 15: career and the height of the successes I've achieved, and
• 1:44:52
  Speaker 15: I weave your story in Todd with the Pharmacy Podcast
• 1:44:56
  Speaker 15: Network and the amazing, amazing contribution that the network has
• 1:45:00
  Speaker 15: provided me in gaining exposure and connections to not just
• 1:45:05
  Speaker 15: being a farmer, this little pharmacist on a little island
• 1:45:08
  Speaker 15: called New Zealand, which by the way, is not Australia.
• 1:45:12
  Speaker 15: We're not Australia. And yeah, and just yeah, getting exposure
• 1:45:17
  Speaker 15: through the network and through my podcast and making me
• 1:45:20
  Speaker 15: reach international audience, and this is pretty much how I've
• 1:45:23
  Speaker 15: One of the dimensions of my career that has allowed
• 1:45:26
  Speaker 15: me to grow and flourish or social media is just
• 1:45:29
  Speaker 15: exposure that the network has provided me with in that
• 1:45:32
  Speaker 15: time and the amazing connections I've gained just through being
• 1:45:36
  Speaker 15: on the network and for your amazing support. So yeah,
• 1:45:38
  Speaker 15: you get a mention in chapter twelve, page one hundred
• 1:45:40
  Speaker 15: and forty nine and also in the acknowledgment section because honestly,
• 1:45:44
  Speaker 15: the work of the network is really really underestimated, and
• 1:45:49
  Speaker 15: I think every pharmacist should collaborate with Todd to get
• 1:45:55
  Speaker 15: their their voice out there because each and every person,
• 1:45:59
  Speaker 15: every pharmacist the platform has a journey and it's through
• 1:46:03
  Speaker 15: sharing our journeys that it's through showing up that we
• 1:46:07
  Speaker 15: become better versions of ourselves, because our life is not
• 1:46:10
  Speaker 15: about us alone, it's about other people. And I feel
• 1:46:13
  Speaker 15: like when I've risen, when I've when I've shared my
• 1:46:15
  Speaker 15: journey online, this is really what made me find you
• 1:46:18
  Speaker 15: and you found me, and you know we've increased exposure
• 1:46:20
  Speaker 15: to the content. We need more journeys, we need more
• 1:46:23
  Speaker 15: stories and pharmacy and all that you've provided me with
• 1:46:27
  Speaker 15: is just allowing me to increase exposure to my story.
• 1:46:30
  Speaker 15: So that's also something that I talk about in the
• 1:46:32
  Speaker 15: book as well. So yeah, that's what the book is about.
• 1:46:36
  Speaker 1: There is a quote from Frederick N. Niels Chi or
• 1:46:43
  Speaker 1: how do you say his name? Yes, and it says
• 1:46:48
  Speaker 1: he who has a why to live can bear almost anyhow.
• 1:46:55
  Speaker 1: And I absolutely love that quote, and I love the
• 1:46:59
  Speaker 1: fact that you are so down to earth.
• 1:47:03
  Speaker 2: No, there's no.
• 1:47:06
  Speaker 1: Preconceivedness about you. You don't have an ego where you
• 1:47:13
  Speaker 1: feel like you're better than people. I remember when you
• 1:47:15
  Speaker 1: won the Pharmacy fifty most Influential People in the pharmacy industry,
• 1:47:21
  Speaker 1: which was amazing because you're internationals, You're not just in
• 1:47:25
  Speaker 1: the United States. And I know our network concentrates more
• 1:47:28
  Speaker 1: on content that comes from the United States, about eighty
• 1:47:32
  Speaker 1: two percent of our content is coming from the United States.
• 1:47:35
  Speaker 1: But for someone to be in New Zealand and have
• 1:47:40
  Speaker 1: an impact on a world stage, but you still don't.
• 1:47:44
  Speaker 1: I still don't think you recognize the impact that you've
• 1:47:47
  Speaker 1: had on the profession because that's not the way you
• 1:47:50
  Speaker 1: see yourself. You see yourself as a servant leader and
• 1:47:53
  Speaker 1: someone that has to continue to move and continue to
• 1:47:57
  Speaker 1: kind of work and do what you do, and you're
• 1:48:01
  Speaker 1: mission based. But Katrina, you have had a significant impact
• 1:48:05
  Speaker 1: on the profession already and people have recognized that. I
• 1:48:08
  Speaker 1: think that's the reason that they brought your name to
• 1:48:11
  Speaker 1: the platform of the pharmacy fifty last year. And now
• 1:48:14
  Speaker 1: this Unscripted on Purpose is kind of like, I see
• 1:48:17
  Speaker 1: this as a gift from you to the profession of
• 1:48:21
  Speaker 1: saying time out people. You know, you guys are human beings,
• 1:48:25
  Speaker 1: your mothers. You've suffered divorce, you've suffered relationships, You've suffered
• 1:48:30
  Speaker 1: you know, growth and good times and bad times, and
• 1:48:34
  Speaker 1: where are you at and what do.
• 1:48:35
  Speaker 2: You want to do?
• 1:48:36
  Speaker 1: And just because you're a pharmacist or just because you're
• 1:48:39
  Speaker 1: a technician, or just because you're an administrator of some
• 1:48:44
  Speaker 1: large hospital system pharmacy, that doesn't define you. And so
• 1:48:50
  Speaker 1: I want everybody to look up Unscripted on Purpose. It's
• 1:48:55
  Speaker 1: available on Amazon right now. I've ordered the copy. You
• 1:48:59
  Speaker 1: can't wait to get it and read it. But I'm
• 1:49:01
  Speaker 1: very proud of you, and I'm proud that you are
• 1:49:04
  Speaker 1: a servant leader. You're not looking for fame, You're not
• 1:49:07
  Speaker 1: looking for you know, all this clicks and bits, and
• 1:49:11
  Speaker 1: I can just tell by your personality because every time
• 1:49:13
  Speaker 1: you get involved in a project. You covered the FIP
• 1:49:17
  Speaker 1: event in twenty twenty five, and every time you're there,
• 1:49:20
  Speaker 1: it's all about you know what you can do to
• 1:49:23
  Speaker 1: support the profession, and I think coming at the profession
• 1:49:27
  Speaker 1: that way is the way that pharmacists think anyway. It's
• 1:49:30
  Speaker 1: the way pharmacists want to save people's lives, to keep
• 1:49:33
  Speaker 1: them from overdosing or doing something interchange drugs to drug
• 1:49:37
  Speaker 1: or whatever, drug allergy or whatever. But the attitude that
• 1:49:41
  Speaker 1: you have has been immensely meaningful to me because you
• 1:49:47
  Speaker 1: practice what you preach.
• 1:49:49
  Speaker 15: Todd, these are just amazing words that are almost bringing
• 1:49:52
  Speaker 15: me to tears. So I don't have much and response
• 1:49:55
  Speaker 15: apart from I honestly couldn't have done it with the
• 1:49:58
  Speaker 15: support of everyone who has engaged, like commented, done anything
• 1:50:03
  Speaker 15: to do with me in the last you know, two
• 1:50:05
  Speaker 15: to three years. Your exposure has been paramount the way
• 1:50:08
  Speaker 15: that you've supported me. I owe the Pharmacy Podcast Network
• 1:50:11
  Speaker 15: a lot, and most of all, I owe it to
• 1:50:14
  Speaker 15: Jesus to God because you know, when I wrote this book,
• 1:50:17
  Speaker 15: I was like, I just want this to get into
• 1:50:19
  Speaker 15: the hands of people who really really needed, who are
• 1:50:22
  Speaker 15: not thriving, just surviving, who are existing instead of living,
• 1:50:26
  Speaker 15: who just can't find themselves beyond pharmacy. And the reason
• 1:50:30
  Speaker 15: I say it's so important is because if you find
• 1:50:32
  Speaker 15: yourself beyond pharmacy, you're going to be a much more
• 1:50:35
  Speaker 15: effective pharmacist. I guarantee it one hundred percent. There is
• 1:50:39
  Speaker 15: so much power in pharmacy. There's so much power in
• 1:50:41
  Speaker 15: this profession. And I think when we find ourselves beyond
• 1:50:45
  Speaker 15: our professional titles, our jobs, we become better versions, We
• 1:50:49
  Speaker 15: can better support this profession, we can be even more united.
• 1:50:53
  Speaker 15: The reason pharmacy is so factured is because we are
• 1:50:56
  Speaker 15: finding ourselves too much in the profession that we become
• 1:50:58
  Speaker 15: so fragmented because this it becomes our only purpose. But
• 1:51:01
  Speaker 15: if we have a live outside the profession, we become
• 1:51:05
  Speaker 15: more cohesive, We find ourselves as a human beings, we
• 1:51:07
  Speaker 15: support each other more. And that's really the tangent that
• 1:51:10
  Speaker 15: I've always approached life from, especially in the last six
• 1:51:13
  Speaker 15: months when I've had the awakening that really led to
• 1:51:16
  Speaker 15: this book. So yes, I do, I do show up
• 1:51:19
  Speaker 15: with my full being, with my chaos and dancing and
• 1:51:22
  Speaker 15: crazy things that I do but I think that makes
• 1:51:25
  Speaker 15: me who I am, and I think authenticity, just like you, Todd,
• 1:51:30
  Speaker 15: is what really attracts people to you. And I think
• 1:51:32
  Speaker 15: we need more authentic voices and pharmacy, and I have
• 1:51:34
  Speaker 15: no doubt that you do great work in that space,
• 1:51:36
  Speaker 15: and the Pharmacy podcast Network really elevates the voices of
• 1:51:41
  Speaker 15: authentic leaders and pharmacy. So I all much gratitude to
• 1:51:44
  Speaker 15: all the work that you're doing as well.
• 1:51:46
  Speaker 1: I didn't get the chance to ask you this. I'll
• 1:51:49
  Speaker 1: ask you publicly to put you on the spot, make
• 1:51:51
  Speaker 1: you a little bit nervous. But what was it like
• 1:51:54
  Speaker 1: to travel internationally by yourself? And here's the reason why
• 1:51:59
  Speaker 1: I've asked that. I have never ever traveled one time
• 1:52:03
  Speaker 1: anywhere internationally like by myself, like when I went to
• 1:52:08
  Speaker 1: Cuba and when I went to Haiti, I was with
• 1:52:12
  Speaker 1: the Coast Guard way back when I was like nineteen
• 1:52:15
  Speaker 1: or twenty years old or something like that. But other
• 1:52:17
  Speaker 1: than that, I've never traveled abroad or to another country
• 1:52:21
  Speaker 1: by myself.
• 1:52:21
  Speaker 2: What was that like when you did that this summer?
• 1:52:25
  Speaker 15: I think you're going to think I'm really, really weird,
• 1:52:28
  Speaker 15: And not that you don't think that already. I know
• 1:52:32
  Speaker 15: I've come to terms of embracing weird as you know,
• 1:52:38
  Speaker 15: so I'm very comfortable with that. But I honestly think
• 1:52:43
  Speaker 15: it's I just I didn't even feel scared like I
• 1:52:46
  Speaker 15: always think, even when I left the past version of
• 1:52:49
  Speaker 15: me as a community pharmacist, which by the way, I'm
• 1:52:51
  Speaker 15: returning to as well, very very shortly for a few
• 1:52:55
  Speaker 15: hours a week. But I always, like I've always had
• 1:52:59
  Speaker 15: the mindset that what is the worst that could happen? Like,
• 1:53:02
  Speaker 15: am I gonna get kidnapped? Maybe, Like I mean, they
• 1:53:08
  Speaker 15: will regret it.
• 1:53:09
  Speaker 2: Yeah, they would.
• 1:53:14
  Speaker 1: It'd be like trying to capture Aninja exactly, Like they.
• 1:53:18
  Speaker 15: Have no idea what I'm made of. So but I
• 1:53:21
  Speaker 15: just think fear has never been something that stopped me
• 1:53:24
  Speaker 15: todd only because when I do the thing that I'm
• 1:53:26
  Speaker 15: going to do, I always think, what is the worst
• 1:53:28
  Speaker 15: that could happen here? Like when I left my role
• 1:53:29
  Speaker 15: with that no backups, And I talk about that in
• 1:53:31
  Speaker 15: the book. It's like, you know, it's not gonna I'm
• 1:53:33
  Speaker 15: not gonna fall apart. I'll just return back to whatever
• 1:53:35
  Speaker 15: it is. Yeah, there are some situation you think, well, yeah,
• 1:53:38
  Speaker 15: there is potential for kidnap obviously, but I think we
• 1:53:41
  Speaker 15: over estimate risks in our lives, and I have a
• 1:53:44
  Speaker 15: whole chapter on that in our book because, honestly, Todd,
• 1:53:47
  Speaker 15: one of the biggest, biggest things, in fact, the biggest
• 1:53:50
  Speaker 15: thing in your life is how you think people will
• 1:53:53
  Speaker 15: view you when you fail, and the narratives we talk
• 1:53:57
  Speaker 15: to like, we talk about in our minds. So when
• 1:54:00
  Speaker 15: I traveled, it was I was scared. I'm not going
• 1:54:03
  Speaker 15: to deny that. I was like, oh my gosh, what
• 1:54:04
  Speaker 15: if I do this? What if this happens? What if
• 1:54:06
  Speaker 15: I get kidnapped? But what are the chances of these
• 1:54:08
  Speaker 15: things happening? I mean, yeah, they are there, but one percent?
• 1:54:11
  Speaker 15: But should they be the reason that you don't live
• 1:54:13
  Speaker 15: your life? This is often the reason that stops us
• 1:54:15
  Speaker 15: from pursuing so many things is that we think, what
• 1:54:18
  Speaker 15: if it feels But what if it does succeed? What
• 1:54:21
  Speaker 15: if that trip becomes a thing that healed me? And
• 1:54:23
  Speaker 15: it did? So, Yes, it was scary, but I'm gonna
• 1:54:27
  Speaker 15: say this, every pharmacist listening needs to travel alone and
• 1:54:32
  Speaker 15: just enjoy their life. This could be the one thing,
• 1:54:35
  Speaker 15: the one thing in your career that completely not just
• 1:54:38
  Speaker 15: your career, your life that can completely transforms you. I
• 1:54:41
  Speaker 15: know you have family. I had kids that I had
• 1:54:43
  Speaker 15: to leave behind and everything, But honestly, three weeks away
• 1:54:47
  Speaker 15: from your family just doing something on your own, traveling
• 1:54:50
  Speaker 15: the world is not gonna end. It didn't end in
• 1:54:52
  Speaker 15: my case, so I highly recommend it. Yes, it was scary,
• 1:54:55
  Speaker 15: best experience ever. And as you can say, it allowed
• 1:54:59
  Speaker 15: me to publish the book because honestly, I started writing
• 1:55:01
  Speaker 15: it before traveling and I was like, God, I really
• 1:55:03
  Speaker 15: can't do it, Like I can't sit down, I can't
• 1:55:05
  Speaker 15: get the words out. My brain is just stopped functioning.
• 1:55:08
  Speaker 15: I'm burnt out. I got burnt out working for myself.
• 1:55:10
  Speaker 15: So there you go, just for those people, just for
• 1:55:13
  Speaker 15: those people like you work for themselves. You can't actually
• 1:55:16
  Speaker 15: bring yourself out working for yourself too, So even that
• 1:55:19
  Speaker 15: is not the answer. For all those people you know
• 1:55:21
  Speaker 15: glorifying entrepreneurship. It's amazing that you get to work for
• 1:55:24
  Speaker 15: your own. I couldn't have traveled if I didn't work
• 1:55:26
  Speaker 15: for a moment. But you can bring yourself out work
• 1:55:28
  Speaker 15: for your own. So it speaks to the thing that
• 1:55:30
  Speaker 15: having a purpose, being intentional and your steps is so important.
• 1:55:34
  Speaker 15: And taking time out to build the human in you
• 1:55:37
  Speaker 15: before anything else. If you're a grounded human, nothing and
• 1:55:41
  Speaker 15: I mean nothing is going to stand in your way.
• 1:55:43
  Speaker 2: I love it.
• 1:55:44
  Speaker 1: I love it all right, listeners, if you are driving,
• 1:55:47
  Speaker 1: if you're jogging, do not worry about it. There's going
• 1:55:49
  Speaker 1: to be a link in the show notes. If you
• 1:55:51
  Speaker 1: went to Katrina A. A Zer Katrina Azer dot com,
• 1:55:57
  Speaker 1: go to her book section. It's unscripted on purpose is
• 1:56:01
  Speaker 1: the book. Katrina. Congratulations, so proud of what you've done,
• 1:56:05
  Speaker 1: so proud of your impact on the on the world.
• 1:56:09
  Speaker 1: End of our profession. And I'm so I'm so just
• 1:56:13
  Speaker 1: blown away. I love calling you a friend. I appreciate you.
• 1:56:17
  Speaker 1: Merry Christmas. By the way, are you I said at
• 1:56:20
  Speaker 1: the beginning of the show, I'm not ready for Christmas?
• 1:56:22
  Speaker 2: Are you ready?
• 1:56:24
  Speaker 15: I haven't got a single present under the Christmas tree,
• 1:56:26
  Speaker 15: and I've got to I've got to teens, and well,
• 1:56:30
  Speaker 15: they are very very difficult to buy for. I got
• 1:56:33
  Speaker 15: myself socks and I've bread them because I've been The
• 1:56:37
  Speaker 15: reason is I've been shuffling and I glide through the
• 1:56:41
  Speaker 15: house and I'm wearing out socks like there's no tomorrow.
• 1:56:43
  Speaker 15: So if you wanted to give me presents for Christmas,
• 1:56:46
  Speaker 15: feed free to send socks my way.
• 1:56:47
  Speaker 2: Socks for.
• 1:56:50
  Speaker 1: All right, Well, we'll be right hang on, we'll be
• 1:56:55
  Speaker 1: right back with more twerks.
• 1:56:57
  Speaker 2: I'll talk to you seeing Katrina.
• 1:56:59
  Speaker 15: Thank you, Tom pleased to be here.