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Bypass the PBMs for More Pharmacy Profit | PBM Reform · Pharmacy Podcast Network

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Speaker 1: You are listening to the global network of podcasters dedicated
0:09
Speaker 1: to the pharmacy profession.
0:10
Speaker 2: Welcome to the Pharmacy Podcast Network.
0:32
Speaker 3: Welcome to the PBM Reform Podcast, where we dive deep
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Speaker 3: into the world of pharmaceutical benefit management, cutting through the
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Speaker 3: noise to uncover the truth. Since twenty nineteen, we've been
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Speaker 3: your go to source for the latest on how PBMs
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Speaker 3: impact patient care, drug pricing, and the very future of pharmacy.
0:53
Speaker 3: Here we champion the role of pharmacists. The most knowledgeable
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Speaker 3: advocates for medication safety and expertise. Join us as we
1:02
Speaker 3: expose and generate discussions that are reshaping healthcare and explore
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Speaker 3: how we build a better payment system which focuses on
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Speaker 3: advancing pharmacy care.
1:18
Speaker 1: Welcome to the PBM Reform Podcast here on the Pharmacy
1:21
Speaker 1: Podcast Network. My name is Brett Rice and I'll be
1:24
Speaker 1: your host today. And I have the privilege of working
1:27
Speaker 1: with community pharmacies now for over twenty years, and I
1:31
Speaker 1: love community pharmacies. I'll do everything I can to help,
1:35
Speaker 1: but I know that some of these past years have
1:38
Speaker 1: been pretty hard on community pharmacies and we have none
1:42
Speaker 1: other than the PBMs to blame for that. And so
1:46
Speaker 1: it's been my pleasure also to host the PBM Reform
1:51
Speaker 1: Podcast and bring in people who are working in the industry,
1:56
Speaker 1: people who are lawmakers, from associations that have poll in
2:03
Speaker 1: PBM reform, and it is a really important work, but
2:07
Speaker 1: it's a really slow process, it seems like to make changes.
2:12
Speaker 1: You know, some days I feel like a little guy
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Speaker 1: in a rowboat out there chiseling away at the big
2:17
Speaker 1: iceberg that the Titanic is about to run into, you know,
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Speaker 1: and I'm making progress, but it's really slow progress. And
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Speaker 1: so whenever we have the opportunity to avoid that iceberg,
2:32
Speaker 1: we're going to be better off for it. And so
2:34
Speaker 1: that's why I'm excited to talk about our visit with
2:37
Speaker 1: our guest today who has found a way to avoid
2:41
Speaker 1: some of those icebergs and make sure that his pharmacy
2:46
Speaker 1: can continue to be profitable and successful. So today I'm
2:50
Speaker 1: honored to speak with doctor Michael. Doctor Michael Immunez is
2:55
Speaker 1: the owner of my new RX Nutritional Pharmacy, compounding and
3:00
Speaker 1: health and Wellness Center. He's a committee member at IPA
3:04
Speaker 1: and the past president of the Texas Pharmacy Association. So
3:07
Speaker 1: welcome to the program, Doctor.
3:08
Speaker 4: Michael thanks reg Thanks for having me.
3:11
Speaker 1: Yeah, so tell me more about your pharmacy. This is
3:14
Speaker 1: quite the expansion beyond just a traditional retail pharmacy. You
3:21
Speaker 1: know a lot of pharmacies have stepped into compounding and
3:25
Speaker 1: custom medications, but you've taken it even a step further
3:28
Speaker 1: with nutrition and wellness. Tell me more about your pharmacy.
3:32
Speaker 4: Yeah, so we're a pharmacy.
3:35
Speaker 2: We opened up during COVID, which is a scary time
3:37
Speaker 2: for anybody to open.
3:38
Speaker 4: But we've done a lot of different things.
3:40
Speaker 2: I'm always about, you know, pushing the boundaries of what
3:43
Speaker 2: pharmacy can do. So we're cash only, no PBMs contracts here.
3:50
Speaker 2: We were working on getting some contracts with Medicaid to
3:53
Speaker 2: take care of you know, the children with some of
3:57
Speaker 2: our medicaid that we compound. It's working with vendor drug
4:04
Speaker 2: but you know, sometimes you start moving faster than it
4:07
Speaker 2: slows down, right, So we do a lot of different things.
4:11
Speaker 2: You know, a lot of hormone replacement therapy. That's always
4:13
Speaker 2: big in a combiny pharmacy.
4:14
Speaker 4: But then you know, we.
4:15
Speaker 2: Work with dentists, we work with aesthetics, clinics, we work
4:19
Speaker 2: with different types of providers to answer questions. So in
4:24
Speaker 2: addition to being a pharmacist, I actually have a fellowship
4:27
Speaker 2: in metabolic nutritional Medicine with the American Academy of Type
4:30
Speaker 2: Aging Regenerative Medicine. So a lot of the doctors that
4:33
Speaker 2: don't have that type of training contact me for help
4:36
Speaker 2: with their patients and then often refer patients over to us.
4:39
Speaker 2: So we do a lot of consultations, we make our compounds,
4:42
Speaker 2: We spend a lot more time one on one with
4:44
Speaker 2: patients so that way they understand what they're taking a
4:47
Speaker 2: white or taking it. I was doing a lot of
4:50
Speaker 2: the traditional pharmacy before and with my family's pharmacy before,
4:56
Speaker 2: but you know, never really had enough time to be
4:59
Speaker 2: able to do things that I'm doing now and actually
5:02
Speaker 2: seeing a big impact with patients. So yeah, going back
5:07
Speaker 2: to when we first started COVID HIT, I got asked
5:10
Speaker 2: to go run the COVID hospital in Opaso. So I
5:13
Speaker 2: went to go run the COVID hospital in Opaso. My
5:17
Speaker 2: business partner, who was also a pharmacist, stepped in and
5:21
Speaker 2: was covering everything. I would do a lot of the
5:23
Speaker 2: consultations remotely if I needed to. Then we were also
5:27
Speaker 2: we started doing the monoclonal antibodies such regeneron and.
5:31
Speaker 4: Bev to live them.
5:32
Speaker 2: At we're doing a lot of those different antibodies for
5:34
Speaker 2: COVID patients. You know, we oversaw the ones in Opaso.
5:39
Speaker 2: Then you know my other business partner in the clinic
5:42
Speaker 2: side of Venezekoba Rubias, she was running the infusion center
5:46
Speaker 2: here at Hartingen. And then our pharmacy was actually helping
5:50
Speaker 2: the state with the drug to be able to get
5:52
Speaker 2: it from all the different location sites and hold it
5:55
Speaker 2: and store it. And so we worked with them and
6:00
Speaker 2: total in the real Grande Valley, I think we infuse
6:02
Speaker 2: close to thirteen thousand patients with COVID. So it was
6:07
Speaker 2: a good time. We did a lot of good things.
6:08
Speaker 2: And then okay, then we okay, let's go back into
6:12
Speaker 2: functional medicine, treating patients and trying to figure out what
6:19
Speaker 2: is the common problem with all these patients right, and
6:21
Speaker 2: trying to fix them. And so that's what makes us
6:23
Speaker 2: a little bit different, is like we're not really waiting
6:26
Speaker 2: for the doctors to send us the orders. We're pretty
6:28
Speaker 2: much just signed the doctors, how can you help my patient?
6:32
Speaker 4: Then we're there. Okay, this is how we step in.
6:35
Speaker 2: So I have probably close to ten providers that send
6:37
Speaker 2: me patients on a daily basis, and they're all different
6:42
Speaker 2: types of doctors and different location sites here as well.
6:46
Speaker 2: So it's great. You know, it's a totally different type
6:48
Speaker 2: of deal. You get to do thirty or forty you know,
6:52
Speaker 2: compounds a day, and none of the compounds you're doing
6:57
Speaker 2: at a loss.
6:58
Speaker 1: Oh that's yep. Because it's cash pay. You're not having
7:01
Speaker 1: a medication walk out the door below the acquisition cost.
7:05
Speaker 4: Ye.
7:08
Speaker 2: Unfortunately, and fortunately I don't have to worry about any
7:11
Speaker 2: kind of max or anything like that. And then carrying
7:16
Speaker 2: these high price drugs. I know there's a lot of
7:18
Speaker 2: pharmacies in the area that you know, even stop carrying
7:21
Speaker 2: branding drugs just because you know the reimbursmonent rate which.
7:24
Speaker 1: Is so bad.
7:25
Speaker 4: Yeah.
7:26
Speaker 1: Yeah, So at first off, where my new RX, where
7:30
Speaker 1: you located.
7:32
Speaker 2: We're located in Hartingen, Texas, which is the southern tip
7:35
Speaker 2: of Texas.
7:36
Speaker 4: I know a lot of.
7:36
Speaker 2: People, you know, ask where it's at, so I tell
7:38
Speaker 2: them South Padre Island because we're probably about thirty forty
7:41
Speaker 2: five minutes from South Padre. Some other people think it's
7:44
Speaker 2: El Paso and I'm like, no El Paso's west of
7:47
Speaker 2: where we're at. We're like further further south, so the
7:50
Speaker 2: southern tip of Texas.
7:51
Speaker 1: Yeah. Yeah, so most people think of of, you know,
7:55
Speaker 1: the the highway, I guess Highway ten that comes through
7:59
Speaker 1: Texas and now Passo being Oh, that's right next to
8:03
Speaker 1: the border of Mexico, so that must be both southern point. No,
8:06
Speaker 1: the Gulf of Mexico comes curves all the way down
8:09
Speaker 1: another I don't know, a couple hundred miles.
8:12
Speaker 2: Right, Yeah, it's a couple hundred miles probably, I think
8:14
Speaker 2: from I mean, at least from San Antonio to Heartingen
8:18
Speaker 2: is about two hundred and seventy miles yea, And so
8:21
Speaker 2: if you think about from Houston, it's gonna be a
8:22
Speaker 2: little bit longer, maybe three.
8:23
Speaker 4: Hundred miles or so. So yeah, from.
8:26
Speaker 2: Opasso it's about a twelve hour drive down to hart Engen.
8:30
Speaker 4: From Opasso.
8:31
Speaker 1: Wow. Yeah, so Texas goes all the way down. Yeah,
8:36
Speaker 1: that's great, So so wonderful work that you've been doing
8:40
Speaker 1: helping patients. You found a way to bypass the PBMs
8:45
Speaker 1: to get the fair reimbursements that your pharmacy deserves. Tell
8:49
Speaker 1: me more about your wellness side. What are you doing
8:52
Speaker 1: in the health and wellness side, because it really is
8:56
Speaker 1: a custom medicine approach, But are you doing anything looking
9:00
Speaker 1: at like preventative health, doing any kind of screenings.
9:04
Speaker 4: Yeah, so we're doing some of that.
9:06
Speaker 2: On the wellness side, I'll talk about you know, the
9:10
Speaker 2: way we used do it before is we had a
9:12
Speaker 2: contract with one of the local labs. The local lab,
9:15
Speaker 2: we would send the patient over and since it was
9:17
Speaker 2: a pharmacist for ordering the labs, there were cash pay
9:23
Speaker 2: for the patients. That's allowed pharmacists out there can use
9:25
Speaker 2: companies like Rupa Health to kind of see what different
9:29
Speaker 2: types of labs are available. Sometimes you need to have
9:31
Speaker 2: a collaborating physician to help, but Rupa has a lot
9:35
Speaker 2: of those people on board as well to help sign
9:38
Speaker 2: off on the orders if need be. So we were
9:43
Speaker 2: doing a lot with the local lab that we set
9:45
Speaker 2: up in agreement with. Patients would go in pay their
9:48
Speaker 2: twenty five dollars for certain labs and then we would
9:51
Speaker 2: sit here and we would talk to them about it.
9:53
Speaker 2: We would do some point of care testing, but the
9:56
Speaker 2: point of care testing we did was more for infections
9:59
Speaker 2: like strip COVID. Never really did any of the A
10:04
Speaker 2: one ce's and stuff, and to me, it was just
10:06
Speaker 2: all about reimbursements and carrying the equipment the test and
10:13
Speaker 2: doing all the KHLIA stuff that's required, and if there's
10:16
Speaker 2: not enough volume, it's like there's really no point in
10:18
Speaker 2: doing it.
10:20
Speaker 4: So we just got partnered up with that local.
10:22
Speaker 2: Lab and they were giving us some really good deals
10:24
Speaker 2: for our patients, and then we would review them and
10:28
Speaker 2: then tell them like, hey, you know what, here's an issue.
10:30
Speaker 2: This is how we're going to fix it. But then
10:33
Speaker 2: we also look at things that the doctors aren't looking at,
10:36
Speaker 2: and that's another big thing, So we'll be looking at
10:39
Speaker 2: homossisting levels right. So down here we talked to some
10:44
Speaker 2: of the doctors and a lot of our doctors tell us,
10:47
Speaker 2: you know that aren't academia and they're and the ones
10:49
Speaker 2: that do like research and learn different things, they're like, man,
10:52
Speaker 2: we wish more doctors would run home assisting levels on
10:55
Speaker 2: patients because homo sisting is an inflammatory amino acid in
11:00
Speaker 2: your body naturally, and a lot of times it's elevated
11:03
Speaker 2: in patients that can't metholate. So you just start talking
11:05
Speaker 2: about like pharmacogenomics or just genetics, right, genetics in general
11:09
Speaker 2: and their body can't metabolize the homosysting down to methione
11:14
Speaker 2: in the way it should, and so then that becomes
11:16
Speaker 2: an issue, right, And so we look at those and
11:20
Speaker 2: try and help patients because every point above an eight,
11:22
Speaker 2: so there's a range I think goes up to fourteen
11:24
Speaker 2: or fifteen, but an optimal range and functional medicine is
11:28
Speaker 2: going to be under eight, sometimes under seven. And the
11:32
Speaker 2: reason you want to do that is because every point
11:35
Speaker 2: above an eight, and this has been in studies show
11:38
Speaker 2: that you have a ten percent increased risk of having
11:41
Speaker 2: a heart attack and stroke. You know, So when patients
11:44
Speaker 2: go to the hospital and they have normal cholesterol and
11:45
Speaker 2: it's like, well, where are gonna put them on a
11:47
Speaker 2: stat and it's like, wait, wait, what was our homosisting
11:49
Speaker 2: level and why aren't you addressing that? Then the other
11:52
Speaker 2: thing too is looking at one of the other big
11:56
Speaker 2: factors that are conditions that it can cause, is it
11:58
Speaker 2: can increase your risk is all Alzheimer's and dementia as well,
12:02
Speaker 2: because as it's going down and it's hitting the arterial walls,
12:07
Speaker 2: it's causing the arterial walls to clamp down and close,
12:10
Speaker 2: and by closing, you're now decreasing blood flow to the brain,
12:14
Speaker 2: so you're not getting the nutrients and all the other
12:16
Speaker 2: stuff that you need to.
12:18
Speaker 4: So you know, that's one simple lab that we do.
12:21
Speaker 2: And then there's no drug to fix it, but there's
12:25
Speaker 2: supplements that you can use to fix it right, to
12:27
Speaker 2: help with it, And so we will put patients on
12:30
Speaker 2: different types of methylated B vitamins and then what we'll
12:33
Speaker 2: do is we'll redraw their levels usually in a month
12:36
Speaker 2: to kind of see how they're doing. And we've had
12:39
Speaker 2: one patient drop from a twenty five to a nine
12:42
Speaker 2: in three weeks, so we.
12:45
Speaker 4: Know it works. You know, even though he had all
12:47
Speaker 4: the other stuff.
12:48
Speaker 2: He was on statins, he was on blood pressure mets
12:50
Speaker 2: and doing all these different things to try and prevent
12:56
Speaker 2: his risk of a heart attack. You know, they weren't
12:58
Speaker 2: looking at one of the their biggest factors that's there.
13:01
Speaker 2: And then when we looked at his genetics, well, he
13:03
Speaker 2: had an mthf arsnip, he has an mpt R snip,
13:06
Speaker 2: an mptr R snip, and all of those are red,
13:09
Speaker 2: which he was probably the first person I've seen all
13:11
Speaker 2: through of those reds. So we're like, there's no methilation
13:13
Speaker 2: really going on he needs all the support that he needs,
13:17
Speaker 2: and so by doing that we're able to see the
13:19
Speaker 2: levels come down. So looking at the wellness, there's a
13:23
Speaker 2: lot of labs that pharmacists can do, and I think
13:25
Speaker 2: if we were able to find a testing company that
13:28
Speaker 2: we could work with that will do it all based
13:30
Speaker 2: off of like a.
13:31
Speaker 4: Fingerstick and then you mail it in and get.
13:34
Speaker 2: Results within a day or two, that'd be great because
13:37
Speaker 2: a lot of these aren't.
13:40
Speaker 4: Immediate things that need to be addressed.
13:43
Speaker 2: Patients aren't coming in with chest pain and they're not
13:46
Speaker 2: coming to know. They're just going like, I want, I
13:48
Speaker 2: want to be healthy. I know there's something wrong with me.
13:50
Speaker 2: I feel there's something wrong. Helped me out right, right.
13:54
Speaker 4: And so that's what we were doing on the wellness side.
13:57
Speaker 4: You know. So back in twenty nineteen here in the
13:59
Speaker 4: state of tens.
14:01
Speaker 2: We've got a bill passed and the bill allowed pharmacists
14:04
Speaker 2: to build insurance companies for the services they perform. Right,
14:08
Speaker 2: So the bill actually said that one so you know,
14:15
Speaker 2: pharmacists can build. They put us pretty much the in
14:17
Speaker 2: the insurance code. We were in the occupations code for
14:20
Speaker 2: a while, so we were considered practitioners or providers, but
14:24
Speaker 2: we were not considered it in the insurance code.
14:27
Speaker 4: So the insurance company.
14:28
Speaker 2: Said, well, you're not on the insurance coast, we don't
14:29
Speaker 2: have to see you as that. So we've got that
14:32
Speaker 2: added into the insurance code. My local state rep was
14:36
Speaker 2: the chairman of the insurance committee, so woke with him
14:40
Speaker 2: on what pharmacy started doing and stuff, and he's like,
14:43
Speaker 2: all right, let's see what happens, see what opposition we get,
14:47
Speaker 2: and luckily there was no opposition to it. They were like, well,
14:50
Speaker 2: the pharmacists already doing these things. We're not expanding their
14:53
Speaker 2: scope of practice.
14:54
Speaker 4: Or anything like that.
14:54
Speaker 2: Like, yeah, they should be or inverse for the services
14:56
Speaker 2: they're performing. So then another bill, this is the main
15:00
Speaker 2: deal that we got passed from our site, was just
15:05
Speaker 2: mainly saying that insurance companies could not deny a service
15:10
Speaker 2: if it was performed by a pharmacist if another provider
15:13
Speaker 2: was paid for that exact same service. In other words,
15:16
Speaker 2: so an E and M visit, an office visit, if
15:19
Speaker 2: they're going to pay a doctor for that, or a
15:21
Speaker 2: nurse practitioner a PA, they're going to pay them for
15:23
Speaker 2: that visit. If a pharmacist performs that same visit that
15:27
Speaker 2: same CPT code they cannot deny because it was performed
15:30
Speaker 2: by a pharmacist. So what the insurance companies are doing
15:34
Speaker 2: now and on the medical side is they're pretty much saying, well,
15:38
Speaker 2: you're out of network, so we're not going to pay
15:40
Speaker 2: for it if the patient needs to pay for it,
15:41
Speaker 2: if we will only process the claim if you're an
15:43
Speaker 2: in network provider. And that was a Blue costsbu Shield Federal,
15:47
Speaker 2: you know, and so we're like, okay, so how do
15:49
Speaker 2: we get into network?
15:50
Speaker 4: Right?
15:50
Speaker 2: So we're always trying to find how do we get
15:53
Speaker 2: into these networks right? And so one of the latest
15:56
Speaker 2: things that we started doing was putting up a clinic
16:01
Speaker 2: and seeing, okay, how do we do it from a
16:02
Speaker 2: clinic standpoint right, and seeing, okay, how do we get
16:06
Speaker 2: pharmacists to be providers within a clinic and still be
16:11
Speaker 2: able to be in network.
16:13
Speaker 4: Through that provider's office. We're working on that right now.
16:17
Speaker 2: We have a couple of things, one with Blue Cross
16:19
Speaker 2: to try and get us in. We're still waiting for
16:22
Speaker 2: some correspondence from them so that way we can see
16:24
Speaker 2: how that goes. But once those things are up and running,
16:28
Speaker 2: of course, you know, those are things that we want
16:29
Speaker 2: to push out to all the other pharmacists, like, hey,
16:32
Speaker 2: this is how you do it, this is the blueprint,
16:34
Speaker 2: this is how you get things done. And this is
16:36
Speaker 2: all within the say that Texas, right, I know there's
16:39
Speaker 2: certain states that already have certain laws that allow things.
16:44
Speaker 2: But for here, this is what we do is just
16:47
Speaker 2: constantly trying to think, Okay, how do we move the
16:48
Speaker 2: needle or pharmacist. So the wellness side, supplements, you know,
16:54
Speaker 2: we do all those things. We sell quite a bit
16:57
Speaker 2: every day. Genetic testing is another thing we do on
17:01
Speaker 2: the wellness side. So a lot of times I'll take
17:03
Speaker 2: your genetics from twenty three or meis ancestry dot com,
17:07
Speaker 2: or we have a methyl detox test that we can do.
17:11
Speaker 2: It's just a little bit more priceier that one only
17:13
Speaker 2: gives us about five genetic snips. The good thing is genetics,
17:17
Speaker 2: you know, they're they don't have to be your destiny, right,
17:21
Speaker 2: That's what I've heard people say. It's like, no, you can,
17:23
Speaker 2: you can, you can overcome those problems. And so when
17:27
Speaker 2: we're looking at genetics, we're mainly looking at the deficiencies
17:29
Speaker 2: that your body has. Right, I don't I'm not there
17:34
Speaker 2: looking to see, oh, you have the breckaging, so you
17:36
Speaker 2: have a higher risk of get developing breast cancer. Well
17:40
Speaker 2: it's like okay, well it's decreased, the inflammation is decrease
17:42
Speaker 2: the environmental toxins you know that your body has. So
17:47
Speaker 2: instead I'm more looking like, okay, what are the nutrients
17:49
Speaker 2: that your body is going to be deficient in because
17:51
Speaker 2: genetically you can't.
17:52
Speaker 1: Do it right.
17:54
Speaker 2: And so those are the things that we start doing
17:58
Speaker 2: and when we start seeing patient and you know, with
18:01
Speaker 2: those crazy results, I can tell you about one patient.
18:04
Speaker 2: You know, she had a lot of anxiety depressions. She
18:06
Speaker 2: would not leave her house.
18:08
Speaker 4: It was bad.
18:09
Speaker 2: You know, they tried different SSRIs, they were trying to
18:12
Speaker 2: regulate her hormones or doing all this stuff. And I
18:14
Speaker 2: was working with her her husband and who's also a physician,
18:18
Speaker 2: and then I was also working with Vanessa, my business partner,
18:20
Speaker 2: on the clinic side. And what we actually did is like, hey,
18:24
Speaker 2: you know, genetically your body can't methylate. So we started
18:28
Speaker 2: giving her high dose methylate to B vitamins. And we're
18:30
Speaker 2: talking about fifteen milligrams of methylate to B nine, right,
18:35
Speaker 2: one milligram of methoday B twelve and these are things
18:39
Speaker 2: that we compound here at the pharmacy started doing this
18:41
Speaker 2: for her and within seven days she was leaving the house.
18:46
Speaker 2: Her husband was like, I've never seen something like this happen,
18:49
Speaker 2: you know. He's like, I want you to take care
18:51
Speaker 2: of my daughter because my daughter has thyroid conditions. And
18:56
Speaker 2: I'm like okay, and he goes, yeah, she had a miscarriage,
18:59
Speaker 2: just not whatever, and I'm like, okay, straight enough. She
19:01
Speaker 2: had the same genetics as her mom. So then we're like, okay,
19:04
Speaker 2: well we want you to start doing this. Her thyroid
19:08
Speaker 2: pretty much resolved no issues, you know, after doing that.
19:13
Speaker 2: Then she got pregnant probably about three months later, and
19:16
Speaker 2: she already had her baby here recently. So and it's
19:20
Speaker 2: all we did was replace the nutrient said this patient.
19:23
Speaker 2: These patients are deficient in right, and they feel the difference, right.
19:27
Speaker 2: And that's the thing. It's like, I'm not selling these
19:29
Speaker 2: things because people come in all the time. They're like, oh,
19:31
Speaker 2: well I heard that. Let's say berberine is good for
19:36
Speaker 2: controlling blood sugar. Yeah it is, but what's your blood sugar?
19:39
Speaker 1: Right?
19:40
Speaker 2: What are you doing, like are you monitoring those things?
19:42
Speaker 2: What's your insulin level? You know, Nistlin levels and other
19:45
Speaker 2: tests that we run that none of the doctors locally
19:48
Speaker 2: really run it.
19:49
Speaker 4: They run an A and C. But A one C
19:50
Speaker 4: is different from insulin, right.
19:53
Speaker 2: You can have an elevated insulin like thirty optimals should
19:56
Speaker 2: be about an eight, and your A and C is
19:58
Speaker 2: a five point two, and it's like, yeah, it's only
20:00
Speaker 2: a five point two because you're into and it's so high.
20:04
Speaker 2: And then eventually your pancreas is going to give up,
20:05
Speaker 2: your instance gonn to come down, your agency is gonna
20:07
Speaker 2: go up, and it's like, oh, you're diabetic now, and
20:09
Speaker 2: it's like yeah, but you could.
20:10
Speaker 4: Have treated these patients way before then, and.
20:13
Speaker 2: So people should come in they're like, hey, well I
20:15
Speaker 2: saw on TikTok that there was burbering works very good.
20:20
Speaker 4: I'm like yeah, but.
20:22
Speaker 2: Does it work for you? We got to look at
20:24
Speaker 2: your labs. But to me, that's that's a lab actionable.
20:28
Speaker 2: It's not a genetics actionable, right, And so when we're
20:32
Speaker 2: looking at our genetics, we're mainly looking at what are
20:35
Speaker 2: the actionables, which is different from pharmical genomics. You know,
20:38
Speaker 2: I love pharmical genomics, but at the same time too,
20:42
Speaker 2: if we can just figure out what deficiencies the patients
20:45
Speaker 2: have in themselves genetically. You know, we'd be like, look,
20:49
Speaker 2: your body can't produce methal fold eight, okay, so we're
20:53
Speaker 2: gonna give you methal fold eight for the deficiencies that
20:56
Speaker 2: your body can't produce.
20:58
Speaker 4: Okay.
20:59
Speaker 2: And no matter what we do, a lot of methylation
21:04
Speaker 2: that happens in our body is that it has to
21:05
Speaker 2: keep wheels running, and when that slows down, it slows
21:09
Speaker 2: down so many other things, like if you're not getting
21:12
Speaker 2: adequate amounts of metal fol eight, you're not going to
21:14
Speaker 2: convert your trip to fan into.
21:19
Speaker 4: Five HDP and then you need like.
21:21
Speaker 2: Some other cofactors to actually create your serotonin. And I'm
21:25
Speaker 2: the only brings that don't bring that back because we're
21:26
Speaker 2: looking at depression and so a lot of times we
21:28
Speaker 2: have people that come in they're like, look, I've been
21:31
Speaker 2: on this for a long time. This you know, lexapro
21:34
Speaker 2: or fluocatine or whatever, and they're like, you.
21:38
Speaker 4: Know what, like I have depression, Like okay, So when
21:41
Speaker 4: we look.
21:42
Speaker 2: At their genetics and well we can even run a
21:44
Speaker 2: neurotransmitter test, I'm like, well, no, you have adequate amounts
21:46
Speaker 2: of serotonin. It's not really the serotonin that's the problem.
21:50
Speaker 2: You actually have another issue over here that this is
21:54
Speaker 2: what's causing the issue. And a lot of times it's
21:56
Speaker 2: basic metal fol eight. There's a drug out they are
22:00
Speaker 2: called Depplin, but insurance companies don't cover it, so then
22:03
Speaker 2: the patients are responsible. And it's like one hundred and
22:05
Speaker 2: something dollars I think for a month's supply of depplin.
22:08
Speaker 2: So we compounded here, but we added another couple of
22:12
Speaker 2: different vitamins, and we make it sublingual to allow quicker,
22:17
Speaker 2: faster absorption as well. So sorry, I know I'm rambling
22:22
Speaker 2: because I can talk about what I do here because
22:24
Speaker 2: I love what I do here.
22:25
Speaker 1: So no, no, you've found you found a niche. And
22:28
Speaker 1: I guess what I want to know, doctor Michael, is
22:31
Speaker 1: is you know what brought you to that point to
22:35
Speaker 1: go just cash pay only and not not to go
22:38
Speaker 1: through the networks. I mean, there's there's got to be
22:41
Speaker 1: some impact that PBMs have had in your past experience
22:45
Speaker 1: that you said this is the way we're going to go.
22:47
Speaker 4: Yeah.
22:48
Speaker 2: So when I worked with the Family Pharmacy, you know
22:50
Speaker 2: they do traditional retail pharmacy. I mean they were doing
22:52
Speaker 2: close to five six, seven hundred scripts.
22:56
Speaker 1: A day, you know, really busy pharmacy.
22:58
Speaker 2: Yeah, And when ever, I would see, you know, rescriptions
23:03
Speaker 2: coming in at a loss, and then I would run
23:05
Speaker 2: reports and I'd be like, man, we're losing on this
23:07
Speaker 2: one and the biggest one at that time. This was
23:09
Speaker 2: again back in twenty eighteen, seventeen eighteen, was I was.
23:14
Speaker 2: I used to really look at a bunch of the
23:15
Speaker 2: analytics you know there and signa health Spring was pretty
23:19
Speaker 2: much paying us eleven percent on average below acquisition cost,
23:24
Speaker 2: you know. So I'm just like, you know, if this
23:27
Speaker 2: is happening now, how long before all the other ones
23:31
Speaker 2: start doing the exact same thing, Because if it's legal
23:34
Speaker 2: for them, it's going to come down to where everybody
23:36
Speaker 2: else is going to start doing it. And I'm like,
23:38
Speaker 2: my time is worth a lot more than thirty thirty cents,
23:42
Speaker 2: you know. And so I started doing consultations with patients
23:46
Speaker 2: back in twenty sixteen, and then it just started growing
23:51
Speaker 2: and growing. So in twenty eighteen, in the pharmacy, we
23:55
Speaker 2: had another business called Crave Market, and Crave Market was
23:59
Speaker 2: pretty much in nutritional store and what we were focused
24:03
Speaker 2: in on was giving people healthier food options, right, So
24:08
Speaker 2: we were carrying like Siet the chip, which is gluten free, vegan,
24:12
Speaker 2: you know, it didn't have a lot of ingredients, really
24:14
Speaker 2: good tasting as well. I would go to conferences. One
24:17
Speaker 2: conference I went to is called ketocon in Austin with
24:21
Speaker 2: ketogenic DIETSS, kind of seeing.
24:22
Speaker 4: What other products were out there.
24:26
Speaker 2: So a lot of the companies that we used at
24:29
Speaker 2: that time, actually some of them closed down during COVID
24:33
Speaker 2: because everything they couldn't sustain, you know, their market.
24:38
Speaker 4: And then HB, which is I love tremendously.
24:42
Speaker 2: I was actually trying to get them to carry a
24:45
Speaker 2: lot of the stuff that I wanted patients to have.
24:48
Speaker 4: And they never did it.
24:49
Speaker 2: So then I opened up my own and then within
24:53
Speaker 2: probably about four or five months of opening the store,
24:57
Speaker 2: managers from HIB right around the corner from I started
24:59
Speaker 2: co to shop where we're at and kind of seeing
25:03
Speaker 2: like what we're carrying, and then we started seeing them
25:05
Speaker 2: carry those products, and I'm like, all right, cool, So right,
25:11
Speaker 2: I mean, honestly, I'm probably about a block away from
25:14
Speaker 2: an HIB, and so I just told my patients like, look,
25:18
Speaker 2: we don't carry a whole lot much anymore because HIB
25:21
Speaker 2: carries a majority of it, you know, and we can
25:24
Speaker 2: we can tell you what foods work, what foods don't work,
25:28
Speaker 2: but we're always about minimally processed foods, like good, clean,
25:32
Speaker 2: whole foods if possible. But going into that, it's just like,
25:37
Speaker 2: I'm worth all this, I have all this information.
25:40
Speaker 4: I've spent a lot of money on.
25:41
Speaker 2: Training in in functional medicine. And for me to just say, Okay,
25:47
Speaker 2: well I'm gonna accept a thirty cent reimbursement from an
25:49
Speaker 2: insurance company, I was like, no, that's not I go,
25:52
Speaker 2: I don't. Doctors don't do it for thirty cents, right,
25:55
Speaker 2: you know, they're paid for their services, and a lot
25:58
Speaker 2: of times they're you know, their things are the consumables
26:01
Speaker 2: are you know, table paper, cleaning the room off the staff,
26:07
Speaker 2: you know, gloves? But that's generally about it, just depending
26:10
Speaker 2: on what kind of providers you're talking with, right, And
26:13
Speaker 2: so I'm like, if doctors aren't, you know, doing things
26:15
Speaker 2: that have lost, why are pharmacy What do pharmacies still
26:18
Speaker 2: think we have to do everything at a loss? And
26:19
Speaker 2: why do pharmacies still feel that we have to give
26:21
Speaker 2: away all our knowledge for free? And it's like, no,
26:25
Speaker 2: we don't. If you're coming to me for questions and
26:28
Speaker 2: you want answers, well I'm going to give you the answers,
26:31
Speaker 2: but I'm going to charge you just the way a
26:32
Speaker 2: doctor would charge you as well. And you know, patients
26:35
Speaker 2: have finally been able to say, you know what, Yeah,
26:37
Speaker 2: you're right, I'm okay paying you.
26:39
Speaker 4: I'm okay paying you for those things, like all right,
26:41
Speaker 4: let's go okay.
26:43
Speaker 1: So what did the what did the family pharmacy do?
26:46
Speaker 1: Did they have to make staffing changes? Did they have
26:48
Speaker 1: to make some cuts? How do you keep sustaining a
26:53
Speaker 1: loss like you experienced with the payers?
26:56
Speaker 2: Yeah, I don't know what they've done ever since I left.
27:00
Speaker 2: I mean, that's been about it. I don't do any
27:02
Speaker 2: kind of consulting work with them, but I've done some
27:06
Speaker 2: work with some other providers or some other pharmacies looking
27:09
Speaker 2: at their numbers, and a lot of them have made
27:11
Speaker 2: those cuts. A lot of them are having too closed
27:15
Speaker 2: down stores because some of them have like three or
27:18
Speaker 2: four stores.
27:21
Speaker 4: A lot of them can't carry brands.
27:23
Speaker 2: A lot of them are even losing their contracts with
27:25
Speaker 2: their GPOs because their GPOs are not hitting the metrics
27:29
Speaker 2: with their brand to generic ratio, you know, and so
27:35
Speaker 2: you know a lot of them, you know, and it
27:37
Speaker 2: sucks that, you know, PBMs are hitting the pharmacies with
27:43
Speaker 2: these things that oh, well you're too heavy on brands. Well,
27:47
Speaker 2: we're not the prescribers. If we were the prescribers, that'd
27:50
Speaker 2: be a totally different thing. But we're not the prescriber.
27:53
Speaker 2: So how can they keep dinging pharmacists for those things?
27:56
Speaker 2: I mean, the doctors are the ones prescribing. We're not right,
28:00
Speaker 2: And so when they hit you at those you know
28:03
Speaker 2: what is it called gers and stuff like that, it's
28:05
Speaker 2: just like wow, you know what, Like, it's not it's
28:10
Speaker 2: not us that are doing it. It's not the pharmacists
28:13
Speaker 2: or the pharmacies. It's your providers that are writing for
28:16
Speaker 2: the brand names. If it was not, I mean, majority
28:19
Speaker 2: of pharmacists out there will want generics. I know here
28:23
Speaker 2: at our pharmacy, I don't carry any brand name drugs.
28:26
Speaker 2: It's all generics. And the generic drugs we carry are
28:30
Speaker 2: very limited. I think I have maybe fifteen different generic
28:34
Speaker 2: drugs and it's basic acute stuff, right, And so kid,
28:38
Speaker 2: after hours, you know, the doctor's calling me like, hey man,
28:41
Speaker 2: I you know I have this patient because I work
28:43
Speaker 2: a lot with some DPC clinics direct primary care clinics.
28:46
Speaker 2: They're like, and you know, we need to get them something.
28:48
Speaker 2: The other pharmacies, clothes or TVs is charging them twenty
28:51
Speaker 2: dollars for a z pac And I'm like, all right,
28:53
Speaker 2: just come by the pharmacy. I'll go open up real
28:55
Speaker 2: quick and get them the met that they need. So
28:59
Speaker 2: we work, you know, with a lot of these providers
29:01
Speaker 2: because and I tell them, I was like, look a
29:02
Speaker 2: lot of times my price is going to be cheaper
29:05
Speaker 2: than a majority of the other people because I don't
29:07
Speaker 2: have the inflation of the insurance companies.
29:10
Speaker 1: Yeah, I was just going to ask that. That was
29:12
Speaker 1: my next question is that you know, the PBM's claim
29:16
Speaker 1: that they're lowering the cost for patients, but in your experience,
29:20
Speaker 1: is that just you know, a marketing spend.
29:23
Speaker 4: Oh yeah, it's a marketing spend.
29:24
Speaker 2: I mean honestly, patients come in and they're like, well
29:27
Speaker 2: they went to HGB and with their insurance. I think
29:31
Speaker 2: one of them was like, Olly Sartain, right, you know
29:34
Speaker 2: which is Benekar and Benicar's been generic for a while
29:37
Speaker 2: and it's multi source generic, and you know, they will
29:40
Speaker 2: go over there and they're like, oh, yeah, it was
29:41
Speaker 2: thirty dollars for a thirty day supply. I'm like what
29:44
Speaker 2: I was like, you can get a thirty day supply
29:46
Speaker 2: here with me for five dollars. You can get a
29:49
Speaker 2: ninety day supply for ten dollars. Like really, now I was.
29:52
Speaker 4: Going to come a year from now.
29:53
Speaker 2: I'm like, yeah, I don't know what they're charging you
29:55
Speaker 2: and why they're charging you so much, but yeah, they
29:58
Speaker 2: say they're saving you money, but they're not saving you
30:00
Speaker 2: money at all. And the PBMs, if you think about it,
30:04
Speaker 2: they've grown so big that they've bought insurance companies, right,
30:07
Speaker 2: so they've morphed into insurance companies. And you know, the
30:10
Speaker 2: way I tell people is like insurance companies, I hate
30:13
Speaker 2: to say it, they want to keep you sick. They
30:15
Speaker 2: want to keep you on these meds. And so if
30:16
Speaker 2: you've been diabetic, even though you've done changes to your
30:21
Speaker 2: nutrition and you're you know, making a lot of other
30:24
Speaker 2: changes of exercise, and you're like a ONEC is optimal.
30:28
Speaker 2: Now you're getting good results and you've just taken away
30:32
Speaker 2: all this food. But we have a doctor that says, well, yeah,
30:35
Speaker 2: but you never reverse diabetes. Once you're diabetic, you're always diabetic.
30:39
Speaker 2: And I'm like, yeah, well, I have a patient that
30:41
Speaker 2: was diabetic. He was on two hundred and thirty units
30:44
Speaker 2: of insulin for fifteen years. He hasn't been on insidant
30:47
Speaker 2: for the past eight years because I worked with him
30:49
Speaker 2: on his nutritional stuff.
30:51
Speaker 4: So but he's still diabetic. And they're like, well yeah,
30:55
Speaker 4: And I'm like and.
30:56
Speaker 2: Then you start looking at the reasons why buys because
31:00
Speaker 2: the insurance companies through CMS and they have these metrics
31:03
Speaker 2: and stuff, and they say, oh, well, the sickre you
31:05
Speaker 2: make a patient look on paper, the more money we
31:08
Speaker 2: get reimbursed. As a Medicare advantage plan. So well, mad
31:12
Speaker 2: which is owned by United Healthcare, they love to try
31:16
Speaker 2: and make patients look super sick on paper. The sickre
31:19
Speaker 2: we can make them look on paper, the more that
31:21
Speaker 2: they're going to get reimbursed. And then what comes along
31:23
Speaker 2: with that, Well, you know what your diabetics, So you
31:26
Speaker 2: need to be on a statin.
31:27
Speaker 4: You need to be on ACE.
31:29
Speaker 2: Inhibitor, and URB you need to be on diabetes medication. Right,
31:34
Speaker 2: so now you get patients on three different medications. Well,
31:36
Speaker 2: what did these insurance companies make their money from how
31:39
Speaker 2: did how did EDNA get bought by CBS by processing prescriptions? Right,
31:46
Speaker 2: So they don't want patients to not be on prescriptions.
31:49
Speaker 2: They want paper on prescriptions because they're going to make
31:51
Speaker 2: a lot of money on these prescriptions. And then you
31:54
Speaker 2: start coming back on the things that the PBMs are
31:57
Speaker 2: you know, hiding behind and saying, oh, we're being transparented
32:00
Speaker 2: and we're saving costs and stuff. It's like, okay, so
32:03
Speaker 2: if you reimburse a pharmacy five dollars for thirty tableism
32:08
Speaker 2: at format, what are you charging the payer? Right, the
32:12
Speaker 2: main person that's funding that for you to card? What
32:16
Speaker 2: are you what are you charging? Then well you don't
32:18
Speaker 2: know because now they're vertically integrated, so they don't got
32:22
Speaker 2: to tell you what it is. Yeah, you know, and
32:25
Speaker 2: it's oh it's proprietary information. You don't need to know
32:28
Speaker 2: that stuff. But again, if you really want real transparency,
32:32
Speaker 2: you got to work and try and get true transparency.
32:35
Speaker 2: And the PBMs right now are not being transparent at all.
32:39
Speaker 1: Now there there are you know, PBMs that claim that
32:43
Speaker 1: they are transparent. PBMs I've interviewed one had had a
32:49
Speaker 1: group on the PBM Reform podcast to try to better
32:53
Speaker 1: understand what their definition of transparent you know, PBM was.
32:59
Speaker 1: You know, so there, I know that that's the goal
33:02
Speaker 1: to try to push that, but there's just too many
33:04
Speaker 1: billions of dollars being made by not being transparent, especially
33:09
Speaker 1: if you're you know, one of the big three that
33:12
Speaker 1: is controlling eighty percent of the lives. There's there's no
33:16
Speaker 1: benefit to them to be transparent because then people will
33:20
Speaker 1: see the spread that they're that they're working off of,
33:24
Speaker 1: you know, one of the other tactics. And I just
33:26
Speaker 1: found out about this, uh you know, coming back from
33:30
Speaker 1: the National Chain drug Store meeting in San Diego just
33:35
Speaker 1: a week ago, and we found out at that conference.
33:40
Speaker 1: We didn't see anything in the news. We didn't see anything,
33:44
Speaker 1: didn't get any notification, None of our pharmacy partners had
33:48
Speaker 1: gotten notification. But one of the big three PBMs actually
33:54
Speaker 1: canceled one of their networks and then just or rolling
33:58
Speaker 1: all those patients into their managed care. Now this was
34:01
Speaker 1: on the workers compensation side, so there was a higher
34:05
Speaker 1: reimbursement that needed to be paid because it was workers
34:10
Speaker 1: comp well. By canceling that network and rolling it into
34:14
Speaker 1: to their other managed care networks, they you know, probably
34:18
Speaker 1: are capturing several million dollars more per you know, per
34:23
Speaker 1: day by doing that, right. And so there's those there's
34:28
Speaker 1: tactics and strategies that they're looking at constantly to that
34:33
Speaker 1: will take more away from community pharmacy so that they
34:36
Speaker 1: can continue to make the profits that they need to
34:39
Speaker 1: make in order to share, you know, to show their
34:42
Speaker 1: shareholders that they're being good stewards of that you know,
34:46
Speaker 1: of that investment, right. You know, A similar situation happened
34:52
Speaker 1: was probably close to ten twelve years ago where the
35:01
Speaker 1: PBM had two separate networks. They had their managed care
35:04
Speaker 1: networks for the commercial plans and Medicare, and then they
35:07
Speaker 1: had a separate work comp network and did the same thing,
35:10
Speaker 1: canceled the comp network, just rolled all those patients in.
35:14
Speaker 1: And you know, that's an area that obviously I focus
35:17
Speaker 1: on with workers Comp and seeing what is happening with
35:22
Speaker 1: the pharmacies. And usually it's a it's a a strategy
35:28
Speaker 1: that does the pharmacy doesn't even realize because they're so
35:34
Speaker 1: busy filling scripts they don't know if one is Medicare
35:38
Speaker 1: or you know, workers Comp or whatever it is until
35:42
Speaker 1: you know, until you're pulling it up up in the
35:45
Speaker 1: pharmacy system and having to send it to whatever been
35:47
Speaker 1: you're needing to send that script to. But on the
35:50
Speaker 1: reimbursement side, it doesn't show up right because it just
35:54
Speaker 1: blends right into all the other horrible reimbursements that you're
35:58
Speaker 1: getting at the pharmacy. Didn't that you just lost another
36:01
Speaker 1: fifty dollars on that script because they rolled it into
36:04
Speaker 1: the managed care network instead of paying you the you know,
36:07
Speaker 1: the workers' compensation rate for that medication. What are some
36:12
Speaker 1: other tactics that you think community pharmacies need to be
36:17
Speaker 1: aware of and be on the lookout for that that
36:22
Speaker 1: PBMs are are kind of forcing on community pharmacies today.
36:27
Speaker 2: I mean I've been out of the loop for like
36:29
Speaker 2: five years, but working with IPA, the Independent Pharmacy Association Academy,
36:35
Speaker 2: which is within the Texas Pharmacy Association, you know, talking
36:39
Speaker 2: to a lot of those members and stuff and seeing
36:41
Speaker 2: I mean a lot of them are just you know,
36:45
Speaker 2: losing a lot of just the reimbursement. I think if
36:47
Speaker 2: the reimbursment was just fair, I think in Mississippi there
36:50
Speaker 2: was an audit that was done in their managed Medicaid,
36:55
Speaker 2: and it showed that independent pharmacies were paid you know,
37:00
Speaker 2: is to say a dollar script, but all the regional
37:03
Speaker 2: chains and national chains were paid seven to eight dollars
37:07
Speaker 2: the exact same script, you know. So, I mean, we're
37:11
Speaker 2: a country of capitalism, but at the same time, we're
37:15
Speaker 2: capitalism towards corporations where we used to be all about
37:18
Speaker 2: small businesses and loving small business and being here. But
37:22
Speaker 2: within the pharmacy association, you know, pharmacy arena, I don't
37:27
Speaker 2: think it's happening. I think we're seeing more mom and
37:29
Speaker 2: pop's clothes. And you know, I remember back in the day,
37:33
Speaker 2: we would see a lot of you know, kids selling
37:37
Speaker 2: their football posters and cheerleading posters and they would come
37:40
Speaker 2: to the pharmacy and the pharmacy had X amount of
37:43
Speaker 2: money just to buy these posters for these these these kids,
37:47
Speaker 2: you know, or Little League you know jerseys, and you
37:51
Speaker 2: know even you know.
37:52
Speaker 4: Boys and Girls club.
37:53
Speaker 2: And now I don't are like, I can't afford that anymore,
37:56
Speaker 2: you know, and keeping money local is is right so
38:02
Speaker 2: to me, you know, I see that, and I'm like, well,
38:04
Speaker 2: how many people do these independents employee?
38:07
Speaker 4: Right? And they'll be employing.
38:10
Speaker 2: I know at our other location, you know, when I
38:12
Speaker 2: work there at the other pharmacy, you know, we had
38:14
Speaker 2: close to like twenty something employees where CBS. You know,
38:19
Speaker 2: they were, oh, no, we only have like ten employees.
38:22
Speaker 2: And it's like, well, yeah, then all where does all
38:25
Speaker 2: their profits go? And there are profits go back to
38:28
Speaker 2: you know, Rhode Island or whatever. And then they go
38:30
Speaker 2: to the shareholders. That's another big thing too, is you know,
38:34
Speaker 2: they're they're shoying, Oh, we're showing all these saving were
38:36
Speaker 2: doing this, We're being transparent blah.
38:37
Speaker 4: Blah blah to their shareholders.
38:39
Speaker 2: But to the patients at the end of the day
38:41
Speaker 2: and the people that are taking care of them, they're
38:44
Speaker 2: not being transparent.
38:45
Speaker 4: They're not helping them out in any way.
38:47
Speaker 2: And then they go before Congress and then Congress tries
38:51
Speaker 2: to chill them and then they tell a totally separate
38:54
Speaker 2: lie and it's just it's just bad man. You know,
38:58
Speaker 2: I think pharmacy need to just keep looking at other ways.
39:03
Speaker 2: I'm going to tell you right now, patients are looking
39:06
Speaker 2: for something new. You know, we have about fifteen patients
39:09
Speaker 2: of ours in the clinic that are physicians, right and
39:12
Speaker 2: they come to us because they're like, we're tired of
39:14
Speaker 2: traditional medicine and we want to make ourselves healthy, but
39:19
Speaker 2: we want to send you patients.
39:21
Speaker 4: So I've actually started working with.
39:22
Speaker 2: Some of these doctors like I will teach you how
39:25
Speaker 2: to do this if you want to do this right,
39:28
Speaker 2: and I will teach pharmacists how to do this so
39:31
Speaker 2: that way they can teach their providers on how to
39:33
Speaker 2: do it, and you can increase money just in your
39:36
Speaker 2: OTC supplement cells. I think I would rather get paid.
39:41
Speaker 2: And this was another big real thing I did too
39:43
Speaker 2: with TPA. They had a grant to do hypertension and
39:47
Speaker 2: I was working with a DPC clinic. So I'm like,
39:49
Speaker 2: there's really no cost to your patient, but they come in.
39:53
Speaker 2: I get paid for consultation if we need to change
39:55
Speaker 2: their meds or change their meds. He's like all right, cool,
39:59
Speaker 2: He's like, I can't control people. Say blood pressures, I'm
40:02
Speaker 2: going to send them to you. Like okay, I'll say them, okay,
40:04
Speaker 2: I need this lab, this lab, and then we would
40:06
Speaker 2: check blood pressure. And a lot of these patients were
40:08
Speaker 2: just to fish in and magnesium. I was just I
40:10
Speaker 2: was honestly treating them with a multi vitamin and magnesium,
40:14
Speaker 2: magnesium visonate, and their blood pressures were coming down. I
40:17
Speaker 2: think it probably you know it was. It wasn't the
40:20
Speaker 2: small it was in a big amount of people. So
40:22
Speaker 2: it was like twenty people. Probably like eighteen of those
40:25
Speaker 2: out of the twenty people had blood pressures jobs just
40:28
Speaker 2: based off of that, you know, some of them that
40:30
Speaker 2: had stress, and so we had to give them some
40:32
Speaker 2: you know things for stress, you know, adoptrogenic herbs, try
40:36
Speaker 2: and help them out. And you know they would do
40:38
Speaker 2: very well with that too. They were like, man, you
40:40
Speaker 2: know what, I feel great. And the doctor's like, well,
40:43
Speaker 2: I didn't know that you could just do things like that.
40:46
Speaker 2: And I'm like, well, let's start talking about you know,
40:49
Speaker 2: evidence based medicine, right, So all the doctors have to say, oh,
40:52
Speaker 2: it's evidence based medicine.
40:53
Speaker 4: That's what I'm doing, blah blah blah.
40:54
Speaker 2: Right, And you know, even pharmacists that are more like
40:58
Speaker 2: in the academia and they're or like in the the
41:02
Speaker 2: hospital settings and stuff like that, they're all like, oh,
41:04
Speaker 2: it's evidence based medicine.
41:05
Speaker 4: Yes, okay, let's go back to evidence based medicine. And
41:08
Speaker 4: majority of.
41:11
Speaker 2: You know, the guidelines out there for blood pressure for
41:13
Speaker 2: diabetes all stuff. They always say, I addressed lifetime modificatis
41:19
Speaker 2: nutritional deficiencies, but nowhere in those guidelines that tell you
41:23
Speaker 2: what nutritional deficiencies to look for, right right, And so
41:27
Speaker 2: they go straight to the med and I'm like, but
41:30
Speaker 2: you didn't address those other things, So how are you
41:32
Speaker 2: practicing evidence based medicine right right? And so that's where
41:37
Speaker 2: I'm pretty much like for myself, it's like, no, I'm
41:41
Speaker 2: gonna address the nutritional deficiencies. Yes, I may use a
41:44
Speaker 2: blood pressure met along with the other stuff, but the
41:47
Speaker 2: goal is to actually get them off of the blood
41:49
Speaker 2: pressure med right.
41:51
Speaker 4: But I'm going to use it in.
41:52
Speaker 2: The meantime as a helper and then wean them off
41:57
Speaker 2: of that blood pressure met and see if we can
41:59
Speaker 2: just maintain them with just.
42:00
Speaker 4: The deficiencies that they have.
42:02
Speaker 2: So I always tell people like, you have gas tanks
42:04
Speaker 2: in your body, and your gas tanks need to be full.
42:07
Speaker 2: Your gas tanks are empty already because you know what, Like,
42:10
Speaker 2: our food sources are crap nowadays. Everything we're eating has
42:14
Speaker 2: zero nutritional value. Even though they say, oh, there's nutritional
42:17
Speaker 2: value in this. A lot of the stuff is made
42:20
Speaker 2: from you know, plastics and whatever.
42:24
Speaker 4: Ultra process.
42:24
Speaker 2: And so we tell them like, look, as long as
42:26
Speaker 2: you can increase your gas tanks, once your gas tanks
42:29
Speaker 2: are full, you're going to feel better. And sure enough,
42:31
Speaker 2: like we have some doctors that you know, we give
42:33
Speaker 2: this multi vitamin Impact and I actually have one in my
42:36
Speaker 2: pocket and you.
42:38
Speaker 4: Know it's right here. So that's that's a basic multi
42:41
Speaker 4: that we use. Right.
42:43
Speaker 2: They take one of these every day, has method to vitamins,
42:46
Speaker 2: has all this other stuff. And the doctors that take it,
42:48
Speaker 2: they're like, man, I feel different when I take this
42:51
Speaker 2: compared to when I was taking the centrum that I
42:53
Speaker 2: was taking. It's like, well, no, because you're getting a
42:55
Speaker 2: lot of the basic nutrients that your body needs.
42:58
Speaker 1: Right.
42:58
Speaker 4: It's all about nutrients, nutrients, nutrients.
43:01
Speaker 2: Like our bodies, the way God made our bodies is amazing.
43:06
Speaker 2: You know, we can do so many different things. It's
43:07
Speaker 2: just the things that we put in our body don't
43:10
Speaker 2: help us, you know.
43:12
Speaker 4: And so once you.
43:13
Speaker 2: Start giving the proper nutrients, you start doing some of
43:16
Speaker 2: the basic things like cardio breeding, you know, little resistance training,
43:22
Speaker 2: all those different things.
43:23
Speaker 4: To make things just function. It works.
43:26
Speaker 2: It just back then we would see a lot of people.
43:27
Speaker 2: They were actually working the fields. They were, you know,
43:30
Speaker 2: trying to make this country a better place. And now
43:33
Speaker 2: the majority of us is sit in an office, right,
43:36
Speaker 2: and we're not doing the extra stuff.
43:38
Speaker 4: That we need to do, which we need to get
43:40
Speaker 4: back into doing.
43:41
Speaker 1: To use your car example, and you know, if you
43:44
Speaker 1: put bad gas in your car, it's not going to
43:46
Speaker 1: run very well, right, It's going to sputters and cough
43:49
Speaker 1: and and you know it's trying to process that bad gas. Well,
43:52
Speaker 1: that's the same thing with our our food sources. We're
43:55
Speaker 1: not getting the proper nutrition, we're not filling the tank.
43:58
Speaker 1: And you know, so I love what you're doing at
44:02
Speaker 1: your your pharmacy, doctor, Michael, amazing. We need more people
44:07
Speaker 1: as educated as you are in helping, you know, to
44:10
Speaker 1: have better patient outcomes. I want to bring you back
44:14
Speaker 1: to to an issue that that we know one state
44:20
Speaker 1: is pushing really heavily to get PBM owned pharmacies out
44:26
Speaker 1: of their state, you know, with CBS and Arkansas. Do
44:31
Speaker 1: you think that will expand to Texas at some point.
44:37
Speaker 2: I'm hopeful that it will, but I don't there's a
44:42
Speaker 2: lot of players in Texas that I don't think that
44:45
Speaker 2: that's going to happen. Those big people, the big corporations
44:51
Speaker 2: give a lot of money do a lot of the
44:54
Speaker 2: politicians here is even the higher, higher up politicians, the
44:59
Speaker 2: ones that are running the state and stuff. And I
45:02
Speaker 2: don't see that happening. It should happen. It needs to happen.
45:05
Speaker 2: You really care about business and everything in your state,
45:11
Speaker 2: and you worry about the cost of healthcare in your state.
45:15
Speaker 4: It needs to happen.
45:17
Speaker 2: I think wholeheartedly if if that wasn't the case, we'd
45:21
Speaker 2: be in a totally different situation now.
45:24
Speaker 4: Then I go back and start.
45:25
Speaker 2: Thinking about Mississippi thing again, and I'm like, okay, so
45:28
Speaker 2: they'll say, okay, we'll close all our stores, but we're
45:31
Speaker 2: going to pay the independence crap.
45:33
Speaker 4: Still, we're going to give HGB the money. We're going
45:36
Speaker 4: to give the.
45:36
Speaker 2: Other big people that are on our side the money
45:41
Speaker 2: and screw them.
45:42
Speaker 4: But at the other thing too.
45:43
Speaker 2: That happens is their mail order facilities would have to
45:45
Speaker 2: leave Texas too. Yeah, you know, And so I'm hopeful
45:50
Speaker 2: that you know, politicians actually start opening their eyes, you know,
45:56
Speaker 2: to a lot of the bad that's out there. And
45:58
Speaker 2: then they say, well, if we do that, we're cutting
45:59
Speaker 2: down own you know business, right, and we're you know,
46:04
Speaker 2: really big you know for business, you know bait you know.
46:08
Speaker 2: I'm like, yeah, but you're also killing all the other businesses.
46:11
Speaker 1: Yeah, the small businesses.
46:13
Speaker 4: Yeah, the small business that are employing a lot more people.
46:15
Speaker 2: And then you start looking at the unemployment rates going
46:17
Speaker 2: up and it's like, well, you have a lot of
46:19
Speaker 2: small businesses that are closing, and that's why your unemployment
46:22
Speaker 2: rates are going up. And because these big corporations, what
46:26
Speaker 2: do they do a lot of times they just want
46:28
Speaker 2: to make things smaller, smaller in workforce, to have bigger
46:31
Speaker 2: profits because they've got to pay all their shareholders.
46:33
Speaker 4: Yeah.
46:34
Speaker 1: Yeah, and that's one of your biggest line items on
46:38
Speaker 1: your P and L is the you know, what you're
46:41
Speaker 1: paying your employees. And some of the more employees you have,
46:44
Speaker 1: the more expense. So so you know, going talking more
46:49
Speaker 1: about the you know, the lawmakers and how they might
46:54
Speaker 1: be influenced by you know, a big PBM to not
47:00
Speaker 1: push them out of a state. I've always taken the
47:04
Speaker 1: philosophy that I think our lawmakers should adopt, you know,
47:08
Speaker 1: kind of the NASCAR approach and wear a jersey that
47:11
Speaker 1: shows who they're sponsored by. You know, so, hey, this
47:14
Speaker 1: lawmaker sponsored by CBS. We know we're not going to
47:17
Speaker 1: be able to push the right agenda through through them
47:20
Speaker 1: because that's who's you know, that's who's financially backing them.
47:25
Speaker 1: What you know, I know, there's a lot of misconceptions
47:28
Speaker 1: from the patient level that pharmacy is the one that
47:33
Speaker 1: is driving up the drug costs, you know, and that's
47:36
Speaker 1: really a you know, a misunderstanding right that that pharmacy
47:41
Speaker 1: has any control over what that cost of the medication
47:45
Speaker 1: is for the individual patient. So what would be the
47:48
Speaker 1: one thing that you would like to inform patients about
47:53
Speaker 1: and how you know, PBMs really are affecting affecting their
47:58
Speaker 1: life is you know, is it that cost? Is that
48:02
Speaker 1: how they control that and not the pharmacy or what
48:05
Speaker 1: would be the one thing that you would want to
48:06
Speaker 1: help educate you know, a non pharmacy listener to this podcast, Yeah.
48:12
Speaker 4: Not pharmacist surrounding.
48:13
Speaker 2: I would tell you, you know, contract you know, you know,
48:15
Speaker 2: Mark Cuban has this cost plus pharmacy.
48:17
Speaker 4: You can go in there and you can kind of
48:18
Speaker 4: see what it is.
48:19
Speaker 2: You know, Marty Drugs, you know, has on their website
48:25
Speaker 2: you can see what the cost of their stuff is
48:27
Speaker 2: and then you go back and you know, even looking
48:29
Speaker 2: at what it is. We have some people that will
48:32
Speaker 2: call us like, hey, man, you know, what's the cost
48:34
Speaker 2: of this? And then we tell them like, well, this
48:36
Speaker 2: is our cost, you know, and they're like, man, my
48:39
Speaker 2: pharmacy's over here is charging me x amount of dollars.
48:41
Speaker 4: And I'm like, you got to do your shopping.
48:43
Speaker 2: It's just like you wouldn't go just to you know,
48:47
Speaker 2: the Nike store looking for the best price of shoes, right,
48:49
Speaker 2: you may go to Finish Line, foot Locker all these
48:53
Speaker 2: other places looking for your shoe.
48:55
Speaker 4: Right, It's the same thing within pharmacy. You got to
48:58
Speaker 4: look around.
48:58
Speaker 2: But I'll tell you at the end of the day,
49:00
Speaker 2: just because you go to the source, Like if you're
49:03
Speaker 2: going to CBS and CBS is the insurance company, you're.
49:07
Speaker 4: Not going to get the best deal per se. Right.
49:10
Speaker 2: What they tried to do and enhance, you know, and
49:13
Speaker 2: get more patients to come is they say, well, you
49:15
Speaker 2: get a five dollars copey if you come here, but
49:17
Speaker 2: it's twenty dollars if you go over there, right, So
49:20
Speaker 2: they're steering everybody to them. Patients are gonna be like, oh, yeah,
49:23
Speaker 2: it's only five dollars to me, and then the insurance
49:26
Speaker 2: or the employer is like, man, you know what, like
49:30
Speaker 2: it's cheaper for my patients.
49:31
Speaker 4: I'm going to go there. But at the end of
49:32
Speaker 4: the day, when you look at.
49:33
Speaker 2: Your bill of what you're getting, like, yeah, you're paying
49:35
Speaker 2: a higher premium because you're sending it to the same place,
49:39
Speaker 2: you know. And I think a lot of it comes
49:43
Speaker 2: back to the employers and knowing what the employers are paying.
49:45
Speaker 2: I know, you know, they were trying to pass you know,
49:47
Speaker 2: an employer plan here in Texas this past session. I
49:53
Speaker 2: don't think it moved anywhere. But at the same time too,
49:57
Speaker 2: the problem majority of the time is it's not the pharmacies,
50:02
Speaker 2: you know, the cost of the drugs. I mean, sometimes
50:05
Speaker 2: it is, I can honestly tell you here's here's another
50:07
Speaker 2: example is you know, with the other pharmacy that I
50:10
Speaker 2: worked with, and they're using another one of the big wholesalers, right,
50:17
Speaker 2: and you know there are cost to let's say tamaflu
50:21
Speaker 2: from that wholesaler with sixty five bucks, and then you
50:24
Speaker 2: would pay it, you know, the insurance would pay you
50:27
Speaker 2: sixty seven bucks or whatever. Well for me to buy
50:31
Speaker 2: that Tama flu. It didn't cost me sixty five bucks,
50:35
Speaker 2: you know, because I don't have any contracts with any
50:36
Speaker 2: kind of wholesalers or anything like that, so I'm not
50:38
Speaker 2: getting rebate money and all this other stuff. So when
50:41
Speaker 2: you start talking about rebate money, it inflates the cost
50:44
Speaker 2: of the drugs, right because you're getting them on the
50:46
Speaker 2: back end. Well, I'm over here buying them for twenty
50:50
Speaker 2: dollars sometimes nineteen dollars a thing, selling them for twenty
50:55
Speaker 2: five bucks. When you go to CBS and all the
50:57
Speaker 2: other people, they're going to charge you eighty dollars cash
50:59
Speaker 2: for the exact same thing because there cost is a
51:01
Speaker 2: lot higher because the rebate games that they play.
51:04
Speaker 1: Yeah, most patients don't understand or have any clue about
51:07
Speaker 1: any of those rebates and the you know, the hitting
51:13
Speaker 1: your quotas with with the whole seller to make sure
51:16
Speaker 1: that you're getting those rebates back, and so that it's
51:19
Speaker 1: a it's a very complex system. Certainly, the cash pay
51:25
Speaker 1: model makes a lot of sense to a lot of people.
51:28
Speaker 1: And what you're doing, doctor Michael, and in fact, the
51:32
Speaker 1: ability to show somebody that they would pay the same
51:37
Speaker 1: out of pockets what their copay would be going to
51:39
Speaker 1: another pharmacy. Is really catching on and more and more
51:43
Speaker 1: pharmacies are are looking at that. One of the biggest
51:47
Speaker 1: obstacles that we've removed and have accomplished in PBM reform
51:52
Speaker 1: is removing those gag clauses out of the contracts so
51:56
Speaker 1: that a pharmacist can actually tell the patient, Hey, your
51:59
Speaker 1: cash price actually be below what your you know, what
52:02
Speaker 1: your cope, the insurance cope is on this medication. So
52:06
Speaker 1: we are making progress. It is taking a lot longer
52:10
Speaker 1: time than we'd like it too, but keep chiseling away
52:12
Speaker 1: at that big iceberg. So hey, doctor Michael, I want
52:15
Speaker 1: to do some fun facts with you. This is just
52:17
Speaker 1: rapid fire for our audience to get to know you
52:21
Speaker 1: personally a little more. Are you more of an early
52:23
Speaker 1: bird or a night owl?
52:25
Speaker 4: Night owl?
52:26
Speaker 2: I mean I do get up in the morning to
52:28
Speaker 2: work out occasionally, like at five in the morning, five
52:32
Speaker 2: thirty to be there at six, but I only do
52:35
Speaker 2: that maybe a few days of the week. But I'd
52:38
Speaker 2: like doing nighttime stuff.
52:40
Speaker 1: Okay, excellent. And do you prefer the mountains or the beach.
52:43
Speaker 4: The beach, I'm like forty five minutes from the beach.
52:45
Speaker 4: I love it.
52:46
Speaker 2: I'm there right around the corner. It's it's I mean,
52:49
Speaker 2: I'm there all the time.
52:51
Speaker 1: Excellent, excellent. Yeah, I love the beach as well. And
52:54
Speaker 1: do you prefer coffee, tea or something else tea?
52:57
Speaker 2: I used to like coffee, but then they started giving
52:59
Speaker 2: me at acid reflux, so I actually drink a lot
53:02
Speaker 2: more tea nowadays, and different type of teas too, not
53:05
Speaker 2: just black tea.
53:06
Speaker 4: But yeah, he's really good for you.
53:09
Speaker 2: Okay, High biscus tea is really good too, And that's
53:12
Speaker 2: one that you just boil some highbiscus leaves and it
53:15
Speaker 2: tastes delicious as well.
53:16
Speaker 1: So yeah, and there's some health benefits there too. You
53:20
Speaker 1: could certainly give a course on that. So well, thank you,
53:25
Speaker 1: doctor Michael. It's been great to have you share your
53:28
Speaker 1: knowledge and wisdom with us today here on the PBM
53:31
Speaker 1: Reform podcast on the Pharmacy Podcast Network. It's been great
53:35
Speaker 1: getting to know you better and understanding you know your
53:39
Speaker 1: philosophies and what you are doing to try to help
53:42
Speaker 1: patients have better outcomes. So my name is Breck Rice.
53:46
Speaker 1: I'm always going to advocate for the heart of our
53:50
Speaker 1: community healthcare, which is our community pharmacists, and thank you
53:55
Speaker 1: for listening to the PBM Reform podcast.
53:57
Speaker 4: Everyone, thanks for having me on Breck's Great.
54:00
Speaker 1: It's great to have you here.
54:02
Speaker 4: Talk too soon, but lie mm hmmm
54:07
Speaker 1: Mmmmm