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U.S. Congressman Jake Auchincloss | PBM Reform · Pharmacy Podcast Network

0:07
Speaker 1: Thanks for listening to the Pharmacy Podcast Network.
0:31
Speaker 2: Welcome to the PBM Reform Podcast, where we dive deep
0:35
Speaker 2: into the world of pharmaceutical benefit management, cutting through the
0:38
Speaker 2: noise to uncover the truth. Since twenty nineteen, we've been
0:43
Speaker 2: your go to source for the latest on how PBMs
0:46
Speaker 2: impact patient care, drug pricing, and the very future of pharmacy.
0:51
Speaker 2: Here we champion the role of pharmacists, the.
0:54
Speaker 3: Most knowledgeable advocates for medication safety and expertise, as we
1:00
Speaker 3: expose and generate discussions that are reshaping healthcare and explore
1:05
Speaker 3: how we build a better payment system which focuses on
1:08
Speaker 3: advancing pharmacy care.
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Speaker 4: A special episode of the PBM Reform Podcast, I'm so
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Speaker 4: excited to have a very special guest back representative of
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Speaker 4: the great State of Massachusetts, Jake Auchenclass, who is a
1:29
Speaker 4: lightning rod packed with data about PBM reform and how
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Speaker 4: critical it is to our healthcare system for everybody. This
1:37
Speaker 4: doesn't matter what side of the al you're on. This
1:40
Speaker 4: is about families. This is about supporting people throughout the
1:43
Speaker 4: country getting access to the medications that they desperately need
1:48
Speaker 4: for their health or so excited So December twentieth, twenty
1:52
Speaker 4: twenty four, Greg Ribold of APCI interviewed Jake Auchenclass on
1:58
Speaker 4: the PBM Reform Podcast. So this is a special homecoming
2:01
Speaker 4: and come back for Jake, Greg take it away.
2:05
Speaker 5: Yes, Congressman Akin Class. First of all, thank you so
2:08
Speaker 5: so much for joining us. We have a lot of
2:11
Speaker 5: big stuff to get to. It's an exciting time in pharmacy,
2:15
Speaker 5: and you obviously want to spend a lot of time
2:17
Speaker 5: talking about that. But that said, community pharmacy has been
2:22
Speaker 5: blessed with many champions over the years, at the state
2:25
Speaker 5: level as well as at the federal level. But you
2:29
Speaker 5: emerged in a way, you know, at the hearings, your
2:32
Speaker 5: line of questioning, your co sponsoring a bipartisan legislation that
2:38
Speaker 5: was moving the ball forward in terms of PBM reform.
2:41
Speaker 5: And then obviously last year with the introduction of Pharmacists
2:44
Speaker 5: Fight Back Act, just blew up in the community pharmacy world. Right,
2:49
Speaker 5: Somebody who gets the issue as much, who's willing to
2:52
Speaker 5: sort of fight the big fights, is you know, as
2:54
Speaker 5: articulate and just new wants down the issue and willing
2:57
Speaker 5: to challenge people in committee hearings. So I get questions
3:01
Speaker 5: all the time, you know, there's a lot of curiosity
3:05
Speaker 5: and just questions and interest in the work that you're doing. Obviously,
3:08
Speaker 5: a lot of our listeners are community pharmacists. Many of
3:12
Speaker 5: them know you, but if you wouldn't mind just sharing
3:14
Speaker 5: a little bit, just a little bit of background so
3:16
Speaker 5: our listeners can get to know you and sort of
3:18
Speaker 5: how you arrived at this issue.
3:21
Speaker 1: Absolutely thanks for the opportunity to be on again. So
3:25
Speaker 1: I serve on the Energy and Commerce Committee, which has
3:28
Speaker 1: jurisdiction over most sections of federal health care, and I
3:33
Speaker 1: represent the suburbs of Boston, which is one of the
3:36
Speaker 1: densest concentrations of medical and healthcare talent of anywhere in
3:41
Speaker 1: the world. Very proud to really get to go to
3:44
Speaker 1: Washington on behalf of so many people who do such
3:47
Speaker 1: important work. And one of the issues that I was
3:50
Speaker 1: most interested in from the very beginning of my tenure
3:53
Speaker 1: in Congress five years ago was drug pricing and really
3:58
Speaker 1: cutting this Gordian knot of we want biomedical innovation, we
4:03
Speaker 1: want new medicines to come to market, we want them
4:07
Speaker 1: to be affordable, and we want to fight back against
4:13
Speaker 1: the corporate capture of our healthcare system. And these were
4:15
Speaker 1: sort of three intertwining issues, and what I came to find,
4:20
Speaker 1: and I'll you know, Greg, this is a selfish journey here.
4:23
Speaker 1: As I was trying to get this right, what I
4:26
Speaker 1: came to find is that by putting pharmacists in the
4:30
Speaker 1: driver's seat of legislation, I was going to end up
4:33
Speaker 1: with the best policy to accomplish those three things. And
4:36
Speaker 1: so to a certain extent, it's not you know, just
4:38
Speaker 1: what have I done for pharmacists on capital That's what
4:40
Speaker 1: pharmacists have done for me. They've helped me best tackle
4:45
Speaker 1: a really nuanced policy issue. Sometimes the example I gave,
4:49
Speaker 1: the analogy I give is air traffic controllers. I worked
4:54
Speaker 1: for two years on the Transportation and Infrastructure Committee, and
4:57
Speaker 1: we were always being tasked with coming up with.
4:59
Speaker 6: Policy for aviation.
5:01
Speaker 1: And aviation is not as complicated as drug pricing, but
5:03
Speaker 1: boy is pretty complicated. You got you know, the pilots,
5:06
Speaker 1: You've got the Federal Aviation Administration and their regulations. You've
5:09
Speaker 1: got the airplane manufacturers, You've got the airport operations. And
5:13
Speaker 1: I always used to struggle with how do I parallax
5:16
Speaker 1: all of these different competing interests and issues. I want
5:19
Speaker 1: to get to the right answer, but everyone's coming at
5:20
Speaker 1: me with various points of view, And what I came
5:23
Speaker 1: to realize is that if I did policy that was
5:26
Speaker 1: the best for air traffic controllers, I usually ended up
5:30
Speaker 1: pretty darn close to what I thought was optimal policy.
5:32
Speaker 1: Air traffic controlers, you know, like air traffic controllers, they
5:35
Speaker 1: just want to land the plane safely.
5:37
Speaker 6: And I know my constituents agree with that.
5:41
Speaker 1: I know that that is aligned with my constituents' priorities.
5:45
Speaker 1: And so if I'm optimizing for the air traffic controller
5:47
Speaker 1: point of view, you know, still got to parallax the
5:49
Speaker 1: other opinions, but I'm getting close to the good policy.
5:52
Speaker 1: What I came to appreciate in healthcare and in drug
5:54
Speaker 1: pricing was, boy, if I put the pharmacists, the community pharmacists,
5:57
Speaker 1: at the driver's seat, I'm going to yet to a
6:00
Speaker 1: really good place on biomedical innovation, on patient access, and
6:04
Speaker 1: on pushing back against corporate capture. And again, I know
6:06
Speaker 1: that those are the three things my constituents care about.
6:09
Speaker 1: And then I'm elevating these small business owners who you
6:14
Speaker 1: really are cornerstones of their community.
6:17
Speaker 5: Okay, wow, yeah, that is that's amazing to hear one
6:20
Speaker 5: of the things, and I've always been proud to represent
6:24
Speaker 5: independent pharmacy and their interests. One of the things to
6:27
Speaker 5: me that I just think is astounding. And obviously you
6:29
Speaker 5: deal with any number of issues, and I want to
6:31
Speaker 5: talk about that a little bit in terms of your
6:33
Speaker 5: work on energy and commerce and some of the other
6:35
Speaker 5: things you work on. But one of the things that
6:37
Speaker 5: just I think is sort of this policy secret weapon
6:42
Speaker 5: is the grassroots power of independent pharmacists. And I think
6:46
Speaker 5: in many ways you activated that at the federal level
6:49
Speaker 5: in a way that we really hadn't seen.
6:55
Speaker 1: I have tried to do policy in a bipartisan way.
6:57
Speaker 1: I've tried to do policy in a partisan way.
6:59
Speaker 6: I've tried to do.
7:00
Speaker 1: Policy that is supported by you know, various think tanks
7:04
Speaker 1: or interest groups. I've tried to do policy that has
7:07
Speaker 1: you know, strong grassroots support like this one. And I
7:10
Speaker 1: can tell you there is nothing like grassroots constituent level
7:15
Speaker 1: support to get co sponsors on policy. Nothing I don't
7:20
Speaker 1: It is unique this piece of legislation, of the dozens
7:24
Speaker 1: of bills that I've worked on, in the ability of
7:27
Speaker 1: community pharmacists within the districts of various members of Congress
7:32
Speaker 1: directly advocating to their member of Congress the importance of
7:34
Speaker 1: this legislation. That is how we got to sixty co sponsor.
7:38
Speaker 1: It was not my charmer charisma on the House floor,
7:40
Speaker 1: you know, I put in the sweat equity. I did
7:42
Speaker 1: the work of you know, talking to each member about
7:45
Speaker 1: the policy. But I do that for a lot of things,
7:47
Speaker 1: and I don't get sixty co sponsors. This is about
7:50
Speaker 1: the pharmacists and their advocacy.
7:53
Speaker 5: Yeah, And I also think that that that's also what's
7:56
Speaker 5: driven success at the state level as well, right, just
7:59
Speaker 5: sort of that rassroots the relationship. They have a role
8:02
Speaker 5: they play in their communities day in, day out. But
8:06
Speaker 5: so you know, you mentioned some other legislation. I think
8:08
Speaker 5: it's always important to note that on any given day
8:13
Speaker 5: on Capitol Hill, lord knows what interests and what issues
8:17
Speaker 5: are being discussed.
8:18
Speaker 1: Right.
8:18
Speaker 5: I've been up there when there's been cattlemen, when there's
8:21
Speaker 5: been bankers, when there's been other healthcare providers. Right, like,
8:25
Speaker 5: probably hundreds to thousands of issues, and you four or
8:31
Speaker 5: five bills in twenty twenty four you introduced, if memory
8:35
Speaker 5: serves so, like, you didn't introduce a ton of bills,
8:38
Speaker 5: and you could introduce a piece of legislation on anything.
8:41
Speaker 4: Right.
8:41
Speaker 5: Obviously you've got vast healthcare experience, you know, deep policy
8:45
Speaker 5: positions on other issues, and so I think it's always
8:49
Speaker 5: important for pharmacists to recognize, I think, be grateful that
8:53
Speaker 5: you picked this issue to champion when you could have
8:56
Speaker 5: picked so many others. And you're on energy and commerce now,
9:00
Speaker 5: and just so our listeners have an idea like what
9:04
Speaker 5: are some of the range of issues that just on
9:06
Speaker 5: energy and commerce you may deal with.
9:08
Speaker 1: Sure, so energy and commerce has jurisdiction over energy, over
9:11
Speaker 1: telecom and technology, over healthcare, over the environment. So agencies
9:17
Speaker 1: like the Environmental Protection Agency, you know, the Health and
9:22
Speaker 1: Human Services Department and I h FDA, CDC, CMS all
9:27
Speaker 1: alphabet soup, so everything from companies like Meta and Google
9:31
Speaker 1: and TikTok all the way through United Health Group and
9:35
Speaker 1: of course the Secretary of Health and Human Services. So
9:38
Speaker 1: we have a wide array of issues. I'm engaged on
9:41
Speaker 1: a lot of them. I also, though Greg tried to
9:43
Speaker 1: keep in mind, you know, to borrow of sports analogy,
9:45
Speaker 1: what's my win above replacement average?
9:47
Speaker 6: Like what is what is the.
9:49
Speaker 1: Differentiated value that I can bring to Congress as me
9:53
Speaker 1: as my role and I really have come to believe
9:57
Speaker 1: that drug pricing issues is I have a.
10:00
Speaker 6: In a blood replacement average.
10:01
Speaker 1: I understand the issue in depth. I've done that work
10:04
Speaker 1: to understand it from the perspective of pharmacists, from the
10:07
Speaker 1: perspective of drug makers, from the perspective of health insurance companies.
10:10
Speaker 1: So I can see every angle and I can predict
10:14
Speaker 1: sort of concerns or rebuttals or advocacy. I'm on the
10:18
Speaker 1: Committee of Jurisdiction for this issue, and then I represent
10:21
Speaker 1: a district. Like I said earlier that one, we have
10:23
Speaker 1: a lot of community pharmacists. We also have a lot
10:25
Speaker 1: of biotech innovators, and of course always have a lot
10:27
Speaker 1: of patients and people who really care about healthcare. So
10:31
Speaker 1: this is an area where I feel like I've got
10:32
Speaker 1: to win above replacement average, and so I want to
10:36
Speaker 1: I want to be swinging at these pitches.
10:38
Speaker 6: Awesome.
10:39
Speaker 5: So one more question that I want to get to
10:41
Speaker 5: the meat of this, the real exciting part and one
10:44
Speaker 5: of the key reasons folks are tuning in, which is
10:45
Speaker 5: pharmacists Fight Back Act. But you also you did mention
10:49
Speaker 5: social media. I know in twenty twenty four you introduced
10:52
Speaker 5: a bill to protect children's privacy online. Yes, memory serves,
10:56
Speaker 5: and then you had a really interesting op ed about
10:59
Speaker 5: digital dope of mean that for me as a parent.
11:01
Speaker 5: We talked a little bit about this definitely resonated, did
11:05
Speaker 5: just such an interesting issue where he tackled it from
11:07
Speaker 5: a really interesting angle. Would you mind talking just a
11:09
Speaker 5: bit about that.
11:11
Speaker 1: Yes, i am the youngest parent and the Democratic Caucus,
11:15
Speaker 1: I've got three little kids, five, four, and two years old.
11:18
Speaker 6: You're in the thick of it. Yeah, I'm in the
11:20
Speaker 6: thick of it, and I feel like I'm in a race.
11:23
Speaker 6: I'm in a race against time.
11:25
Speaker 1: By the time he's eight or nine years old, my
11:27
Speaker 1: oldest oldest will probably be asking for a smartphone, and
11:30
Speaker 1: you know, we're going to be in that whole scrum
11:31
Speaker 1: of a bunch of parents trying to negotiate when do
11:33
Speaker 1: you get your kidd smartphone? And then we're screen time
11:36
Speaker 1: versus family time, And candidly, as a parent, I really
11:40
Speaker 1: feel powerless against these trillion dollars social media corporations who
11:44
Speaker 1: have literally thousands of engineers and behavioral user interface designers
11:50
Speaker 1: who are oriented entirely to keeping my kids scrolling. That
11:53
Speaker 1: is how they make money is screen time for adolescents.
11:57
Speaker 6: But the good news is as a.
11:59
Speaker 1: Member of the commer Gene Commerce Committee with jurisdiction over tech,
12:01
Speaker 1: I am not powerless, and so I feel an obligation
12:04
Speaker 1: on behalf of parents in particular everywhere and particularly.
12:08
Speaker 6: What I have found is those sort of.
12:10
Speaker 1: Gen X millennial parents who all of us can like
12:14
Speaker 1: vaguely remember when Facebook was first introduced and it was
12:17
Speaker 1: kind of cool and fun, and like, boy, those days
12:19
Speaker 1: are over. It has taken a very sinister turn, and
12:23
Speaker 1: I feel an obligation to fight back on their behalf
12:26
Speaker 1: because the hard truth is Washington, DC has done nothing
12:31
Speaker 1: to hold these social media corporations accountable, or these online
12:33
Speaker 1: gambling corporations, all of whom are merchants and minors of
12:36
Speaker 1: digital dopamine. What they all do is they all seek
12:41
Speaker 1: to hijack the reward system in your brain. It's a
12:44
Speaker 1: very evolutionarily old reward system that seeks out pleasure and
12:49
Speaker 1: then when it experiences something pleasurable, it reinforces that behavior.
12:53
Speaker 1: And that is what these companies are programming your neurons
12:57
Speaker 1: to do. Adolescent brains are particularly sectible to that programming
13:01
Speaker 1: by software, and we have let social media and online
13:04
Speaker 1: gambling just run riot And in fact, in the nineteen nineties,
13:07
Speaker 1: we Congress passed the law that gave them proactive.
13:09
Speaker 6: Immunity from any literation.
13:11
Speaker 1: It can't even be held liable for torts for things
13:13
Speaker 1: that journalists or typical American citizens could be sued for
13:17
Speaker 1: in a court of law. Mark Zuckerberg is totally above
13:20
Speaker 1: the law. And where we've ended up in is a
13:23
Speaker 1: situation where the three most powerful gatekeepers of the information
13:26
Speaker 1: our children consume are one Mark Zuckerberg, two Elon Musk,
13:31
Speaker 1: and three the Chinese Communist Party. The owners of TikTok TikTok.
13:36
Speaker 1: I don't know a single freaking American thinks that those
13:40
Speaker 1: three individuals, those three entities, should be the ones deciding
13:44
Speaker 1: how their children's adolescent brain develops its reinforcement learning system
13:50
Speaker 1: and how it seeks to perceive its own sense of
13:52
Speaker 1: self and society.
13:53
Speaker 6: We got to act.
13:54
Speaker 1: I'm putting forward legislation that's extremely tough on these corporations,
13:59
Speaker 1: and we've got to get ad of what, to me
14:00
Speaker 1: is an emerging cultural fault line in our society, which
14:03
Speaker 1: is between digital dopamine on one side, where everything is fast, easy, alone,
14:08
Speaker 1: on the other side, the effort of in real life,
14:10
Speaker 1: sweating and striving in real life for things that matter,
14:13
Speaker 1: building things together, housing, energy, new medicines. Right, this the
14:18
Speaker 1: kind of interactions that so many of our community pharmacists
14:21
Speaker 1: understand can't be replaced with digital is just human to human.
14:26
Speaker 5: And it sounded like you were looking to sort of leverage,
14:30
Speaker 5: sort of bridge that gap through something your policy solutions,
14:34
Speaker 5: to maybe help fund training and more hands on type
14:37
Speaker 5: opportunities for.
14:40
Speaker 6: Children. Is that yeah? So let me give you an example. Meta.
14:45
Speaker 1: Facebook's internal documentation recently stated that it was quote acceptable
14:50
Speaker 1: for a chat bought to have quote sensual conversations with
14:55
Speaker 1: a twelve year old. This was not like, in response
14:57
Speaker 1: to a query from a developer, Facebook proactively put out
15:00
Speaker 1: that guidance for their engineers, It's okay for your our
15:03
Speaker 1: chat thoughts to have sensual conversations that it's donning right.
15:07
Speaker 6: So we know that they can't be trusted.
15:09
Speaker 1: I mean, they have just totally lost the plot on
15:11
Speaker 1: what's acceptable, And the question is who, how do we
15:15
Speaker 1: do this? Because it's it's it's hard, don't I don't
15:17
Speaker 1: want the government regulating speech. That's not where I'm at.
15:21
Speaker 1: I've been quite consistent in my career in favor of
15:24
Speaker 1: the First Amendment, and so what we need to do,
15:26
Speaker 1: I think, is be very pointed about what we're trying
15:29
Speaker 1: to protect, and what we're trying to protect are those
15:32
Speaker 1: dopamine reinforcement pathways in the developing brain. What adults want
15:35
Speaker 1: to do in adults free time is up to those adults.
15:38
Speaker 1: How our children are treated by these platforms is a
15:42
Speaker 1: matter of societal concern, and so we need the Consumer
15:44
Speaker 1: Product Safety Commission. We need the National Academies of Science
15:47
Speaker 1: and Engineering to do in depth research on how the
15:50
Speaker 1: user design of these platforms warps dopamine pathways for children.
15:56
Speaker 1: And then we need regulation and labeling so that parents
15:59
Speaker 1: are in the driver's for how these kids use their apps. Right,
16:02
Speaker 1: the federal government tells you if a bicycle helmet is safe.
16:06
Speaker 1: The Consumer Product Safety Commission has a label says this
16:08
Speaker 1: bicycle helmet works, right, because you don't want to find
16:11
Speaker 1: out if it works or not after the fact.
16:12
Speaker 6: That's right.
16:13
Speaker 1: Yeah, we should do the same thing for these apps.
16:16
Speaker 1: It's not about censorship or deplatforming anybody. It's about understanding
16:20
Speaker 1: that our children are spending four to six hours online
16:23
Speaker 1: and they need guardrails and protections in the digital realm,
16:27
Speaker 1: just like we give them an in real life, and
16:29
Speaker 1: that parents need to be the ones who decide, not
16:31
Speaker 1: Mark Zuckerberg.
16:32
Speaker 5: Okay, So I appreciate that. I think that's going to
16:35
Speaker 5: be something that a lot of people are going to follow.
16:37
Speaker 5: Important work, not easy work, nuanced work against big powerful
16:42
Speaker 5: you know, you're talking about sort of the Big three
16:45
Speaker 5: on the social media side, controlling the stuff.
16:48
Speaker 6: You got another big fight with with a number big three.
16:51
Speaker 1: I got to pick my political opponents better. I've picked
16:53
Speaker 1: a fight with the United Health Group and with Meta
16:56
Speaker 1: and the two most powerful corporations in.
16:59
Speaker 6: The history of the world. But yeah, right, I mean
17:01
Speaker 6: that's right, Yeah it is.
17:03
Speaker 5: But boy, that's that's you know, you're not You're not
17:06
Speaker 5: picking easy issues there, that's for sure. And so wow,
17:10
Speaker 5: And I guess that brings us now to Pharmacists Fight Back.
17:12
Speaker 5: And so you introduced the first version of Pharmacists Fight
17:16
Speaker 5: Back in twenty twenty four, and it resonated at the
17:21
Speaker 5: federal level in a way that I've just frankly not seen.
17:24
Speaker 5: It kicked off at the Putt Summit, and I think
17:26
Speaker 5: you just really got folks pumped up but it looked
17:30
Speaker 5: to go at the core of PBM problems and solve
17:33
Speaker 5: those aggressively. And when I say resonated, obviously you know
17:37
Speaker 5: we were up close to sixty co sponsors around right
17:41
Speaker 5: somewhere in that vicinity, I mean were there were bags
17:45
Speaker 5: with HR ninety ninety six floating around trade show floors.
17:49
Speaker 5: There were buttons, there were unplanned just generic pharmacists taking
17:54
Speaker 5: pictures holding up pharmacists fight BACKAC signs. I think it
17:57
Speaker 5: started in Kentucky, but it went all over the country.
18:01
Speaker 5: I mean it was a movement.
18:04
Speaker 1: And so.
18:06
Speaker 5: Just resonated in an unbelievable way. Obviously, enter into twenty
18:11
Speaker 5: twenty five, it's a new legislative session. It's been a while, right,
18:17
Speaker 5: Obviously we're on the back end of the end of
18:19
Speaker 5: the year here, but it is here, right, and it's
18:22
Speaker 5: here in two forms. And so if you could talk
18:24
Speaker 5: a little bit, you know, folks are dying to hear
18:27
Speaker 5: about sort of where we're at and where you want
18:30
Speaker 5: to go.
18:31
Speaker 1: Absolutely so this policy, as many of our listeners will know,
18:35
Speaker 1: is the strongest PBM reform legislation introduced at the federal level,
18:39
Speaker 1: and certainly the most muscular defense of community pharmacists of
18:42
Speaker 1: any legislation at the federal level is absolutely you know,
18:46
Speaker 1: implements cost plus pricing and formed by mandatory KNATAK reporting
18:51
Speaker 1: with dispensing fees so that you know, pharmacists are able
18:56
Speaker 1: to dispense according to what's best for the patient, not
18:58
Speaker 1: subject to the clawbacks or whims of the PBMs. It
19:03
Speaker 1: cracks down on specialty steering and on self dealing by
19:10
Speaker 1: the PBM owned pharmacies, gets ahead of the problems we
19:15
Speaker 1: know we're going to continue to see from the group
19:16
Speaker 1: purchasing organizations domiciled overseas. And then it's got very tough
19:20
Speaker 1: enforcement mechanisms across these issues. And so this is a
19:25
Speaker 1: hard hitting piece of legislation. As you said, it's incited
19:28
Speaker 1: the ire of the health insurance corporations.
19:31
Speaker 6: A little bit.
19:32
Speaker 1: A little bit, yeah, and so we've done a few
19:35
Speaker 1: things here. So one, you know, we introduced it last
19:38
Speaker 1: Congress in the form of one bill as a way
19:41
Speaker 1: to demonstrate really strong bipartisans support even before the more
19:45
Speaker 1: basic PBM reform package had passed this Congress. We're introducing
19:50
Speaker 1: it in two forms scoped to the two different committees
19:53
Speaker 1: of jurisdiction. I don't want to get two in the
19:55
Speaker 1: weeds here. But basically there's at least two, arguably up
19:58
Speaker 1: to four committees that have some jurisdic over this right,
20:01
Speaker 1: and by scoping legislation to entirely within the jurisdiction of
20:05
Speaker 1: a committee, you make it a lot easier and more
20:08
Speaker 1: legible and digestible for that committee to move it. You
20:11
Speaker 1: will also, and this is underappreciated, it created a little
20:14
Speaker 1: bit of competition. You want the committee chairs and staff
20:17
Speaker 1: flicking over each other's shoulders and seeing what the other
20:19
Speaker 1: committee is doing. People for acres, Yeah, yeah, people think
20:22
Speaker 1: Congress is all about D versus are Yes, Definitely, that's
20:25
Speaker 1: part of it. There's also a lot of jurisdictional sharp elbows,
20:28
Speaker 1: So I think.
20:29
Speaker 6: Who's gonna who's gonna lead on on the issue one.
20:31
Speaker 1: Hundred percent, So we're gonna we're dropping it into Energy
20:34
Speaker 1: and Commerce my committee and into the House Oversight and
20:37
Speaker 1: Government Reform Committee, bipartisan in both places, and seeking to
20:43
Speaker 1: move it there again with a lot of strong co sponsorship.
20:46
Speaker 1: We are also inoculating other members and staffers against what
20:53
Speaker 1: we know is going to be the arguments against it.
20:54
Speaker 1: That's an important element to this strategy, the health insurance
20:57
Speaker 1: corporations are going to say, this is going to cause
21:00
Speaker 1: us to raise premiums. I mean that's their only argument, right,
21:02
Speaker 1: Like I've.
21:03
Speaker 6: Been as the sun rises, that's what they say. Yeah,
21:05
Speaker 6: as the sun rises, premiums go up.
21:07
Speaker 1: And so we're inoculating against that because we actually have
21:11
Speaker 1: been able to get some nonprofit health insurance corporations and
21:14
Speaker 1: some other examples from states that have done laws similar
21:17
Speaker 1: to this to show that that is not the case.
21:20
Speaker 1: Because politicians get very scared about potential premium inflation, and
21:24
Speaker 1: so we are going to get ahead and prebut that argument.
21:28
Speaker 5: Yeah, and I love that right so much over the years,
21:31
Speaker 5: and I think what you know, pharmacists has been raising
21:33
Speaker 5: the alarm on PPM practices for a long time and
21:37
Speaker 5: they I think they've been proven right. You know the
21:39
Speaker 5: rocks that they say to look under, Indeed, there's there's
21:42
Speaker 5: are there. But a lot of what community pharmacy has
21:45
Speaker 5: done over the years has been anecdotal, right, and I
21:49
Speaker 5: think a lot of that changed with three Axis and
21:52
Speaker 5: forty six Brooklyn doing the good sort of data driven
21:55
Speaker 5: work that they've done. I think you know, we've seen
21:57
Speaker 5: medpack and the OIG conduct duck some interesting audits. But
22:01
Speaker 5: I love the approach you're taking in terms of, you know,
22:04
Speaker 5: substantively being able to rebut some of these long held presumptions.
22:08
Speaker 5: I think it's still a yeah, obviously, it's it's it's
22:11
Speaker 5: an uphill battle on that front because some of these
22:13
Speaker 5: presumptions are entrenched in all sorts of places for sure.
22:18
Speaker 1: And you know, as you and I have discussed previously,
22:20
Speaker 1: greg federal legislation by itself is not sufficient. It's necessary,
22:24
Speaker 1: but not sufficient. We've got to move it at the
22:26
Speaker 1: federal level. We've got to move them at the state level.
22:28
Speaker 1: And in some ways, the states can even be more
22:29
Speaker 1: impactful because they also have jurisdiction over sort of scope
22:32
Speaker 1: of practice laws, and they can be probably more granular
22:35
Speaker 1: in how they bid to PBMs and how they enforce
22:39
Speaker 1: against PBMs because we run into, you know, some ARISCA
22:42
Speaker 1: issues at the federal level that makes life more complicated.
22:44
Speaker 1: So we need both federal and state legislation. We also
22:47
Speaker 1: need and I think this is something that you know,
22:50
Speaker 1: I'm really hoping to see momentum on.
22:53
Speaker 6: We need the big companies.
22:55
Speaker 1: The employers as they shop for PBMs, to start asking
23:00
Speaker 1: much harder questions against the.
23:01
Speaker 6: Big three than they currently are.
23:02
Speaker 1: Right in twenty twenty one, Congress passed the law that
23:05
Speaker 1: made the employers produciaries to their employees for the quality
23:09
Speaker 1: of that PBM contract. There was some follow on litigation
23:13
Speaker 1: against Johnson and Johnson against Wells and Fargos. That litigation
23:17
Speaker 1: has not resolved itself, or we haven't seen sort of
23:19
Speaker 1: the final class action suits that are going to point
23:22
Speaker 1: the way on how that law is going to be
23:23
Speaker 1: interpreted by.
23:24
Speaker 6: The courts, But it certainly should.
23:29
Speaker 1: Cause some HR managers and compliance desks across these big
23:32
Speaker 1: companies to think very differently about how they are negotiating
23:37
Speaker 1: these contracts and moving towards flat rate, transparent PBMs that
23:40
Speaker 1: are going to be fair to employees and fair to pharmacists.
23:44
Speaker 1: And one of the things I've pressed on is for pharma.
23:49
Speaker 1: So the pharma companies, you know, they want PBM reform too,
23:53
Speaker 1: slightly different reasons than pharmacists do. But pharmer hates PBMs almost.
23:57
Speaker 6: As much as pharmacist.
23:59
Speaker 1: And one thing I've pressed pharma on consistently is, well,
24:02
Speaker 1: what are your own internal practices for how you contract
24:05
Speaker 1: out two PBMs? Right like it's going to be hard
24:08
Speaker 1: to stand on two legs here in this argument if
24:11
Speaker 1: you if you're using SIGNA and are not operating in
24:15
Speaker 1: a way that's fiduciarily strong, and how you're setting up
24:19
Speaker 1: your employees for out of pocket costs and the way
24:21
Speaker 1: you're doing you know, rebates and dispensing fees, et cetera.
24:24
Speaker 6: So, and we are starting to see some changes there.
24:25
Speaker 6: I think you're going to.
24:26
Speaker 1: Start seeing more pharma companies try to, you know, preach
24:29
Speaker 1: what they are practice what they preach.
24:31
Speaker 5: Yeah, I think that's right, and and that's where it
24:33
Speaker 5: needs to go right for them to lead by example
24:36
Speaker 5: in that regard goes a long way. I think I
24:39
Speaker 5: think you've done a wonderful job from a bipartisan perspective right. Obviously,
24:43
Speaker 5: last year congress Woman Harshbarger was was the Republican co lead,
24:47
Speaker 5: and boy that that bill was about as bipartisan as
24:51
Speaker 5: you could get in terms of I don't know if
24:52
Speaker 5: it was like evenly, but it was.
24:54
Speaker 6: It was. I mean, it was, it was right there.
24:56
Speaker 5: And you know, I think obviously there's there's a lot
24:59
Speaker 5: of potential for bipartisan on this. Pharmacists are of course
25:03
Speaker 5: thrilled to see that transparent market based pricing. One of
25:08
Speaker 5: the things we've had conversations with is sometimes there's a
25:10
Speaker 5: head hesitancy for government pricing. This bill acts in governmental
25:14
Speaker 5: markets and it really takes away government contractors' ability to
25:19
Speaker 5: fix prices, I either PBM's ability to set and manipulate
25:23
Speaker 5: drug prices, and it moves to a market based index,
25:25
Speaker 5: which I think is great. It tackles the steering and
25:28
Speaker 5: ends the ability for PBMs to have these massive, massive
25:31
Speaker 5: overpayments to themselves their affiliated pharmacy. But something else that
25:36
Speaker 5: this bill does is it tackles rebates, and it tackles
25:39
Speaker 5: rebates in a way that returns. Essentially forces PBMs and
25:43
Speaker 5: prescription drug plans to share negotiated discounts with patients at
25:47
Speaker 5: the pharmacy counter, which is going to bring down costs.
25:51
Speaker 5: Something that doesn't get talked a lot about and something
25:54
Speaker 5: that we've been spending quite a bit of time on
25:56
Speaker 5: is there are direct correlations to higher cost of drugs
26:00
Speaker 5: and medication cost related medication not adherents, and that in facts,
26:04
Speaker 5: drives it drives outcome. So this is going to be
26:06
Speaker 5: a great bill for independent pharmacy, but it's also going
26:09
Speaker 5: to go a long way towards lowering patients out of
26:12
Speaker 5: pocket costs by curbing the steering and the markups and
26:16
Speaker 5: then also forcing discounts to be shared.
26:18
Speaker 6: I think that's.
26:19
Speaker 5: Such an interesting policy and something frankly, in his first term,
26:24
Speaker 5: President Trump worked some on with trying to reform the
26:27
Speaker 5: safe harbor you know, sort of known as the rebate rule,
26:30
Speaker 5: and that was something that was scored really unfavorably at
26:33
Speaker 5: the time by the Congressional Budget Office based on a
26:36
Speaker 5: lot of presumptions. Subsequent to that, we've seen, like West Virginia,
26:40
Speaker 5: there were actual insure actuarial findings where they had where
26:45
Speaker 5: there was similar policies adopted at the state level, and
26:48
Speaker 5: in fact, it turns out that sharing rebates with patients
26:51
Speaker 5: at the counter passing back the rest to be required
26:54
Speaker 5: to lower premiums has in fact not raised premiums as
26:58
Speaker 5: the PBMs predicted, has actually suppressed premium growth. And so
27:03
Speaker 5: I I guess I'd like that that was a lot, right,
27:06
Speaker 5: But I think it's important that we're using data to
27:09
Speaker 5: to rebut those presumptions, but also that there's just so
27:12
Speaker 5: much opportunity for by part bipartisan work.
27:15
Speaker 1: Here a question in a comment. First, the content rebates
27:22
Speaker 1: are the core original sin of the US drug pricing model.
27:28
Speaker 1: There are elements of our drug pricing model that actually
27:31
Speaker 1: work pretty well, the genericization of brand drugs that drives
27:35
Speaker 1: a lot of competition.
27:36
Speaker 6: And brings down prices.
27:37
Speaker 1: Our ability to get new medicines to market has traditionally
27:39
Speaker 1: been better than most other countries. But the rebate model
27:43
Speaker 1: has been a real achilles heel of the US drug
27:45
Speaker 1: pricing system.
27:46
Speaker 6: And listen to hard agree.
27:48
Speaker 1: The hard truth is everybody is in on it. Everybody
27:51
Speaker 1: gets a little bit of margin off the top of
27:53
Speaker 1: that medicine, right. So it's yes, it's it's the PBMs,
27:58
Speaker 1: but it's also government agencies, it's the hospitals, it's the employers,
28:03
Speaker 1: and I.
28:04
Speaker 6: Don't everybody has sort of gotten a taste for.
28:07
Speaker 1: The rebate and it has warped the incentives because fundamentally,
28:12
Speaker 1: medicines should not be a source of margin for a
28:16
Speaker 1: bunch of different middlemen. Medicines should be for the patient
28:20
Speaker 1: and pharmacists should be reimbursed based on a fair dispensing fee,
28:25
Speaker 1: and then and they should be competing based on the
28:27
Speaker 1: quality of the patient interaction they're able to deliver.
28:31
Speaker 6: Right. That is that is, we don't want a.
28:33
Speaker 1: Lot of actors in our healthcare system treating medicines as margin.
28:36
Speaker 1: We want them basically being an easy channel for the
28:40
Speaker 1: dispensal of medicines to patience, yes, and compressing all those
28:43
Speaker 1: margin opportunities. And that's the ultimate goal of my legislation
28:47
Speaker 1: and other other types of supporting legislation as well, is
28:49
Speaker 1: kind of just taking out those middlemen. And some of
28:52
Speaker 1: them are going to be, you know, some of them
28:53
Speaker 1: are government actors which are going to have very strong
28:55
Speaker 1: status quo defenders, and of course the hospitals have their
28:57
Speaker 1: own point of view on, you know, using drugs as
29:01
Speaker 1: a source of margin. My question for you is, you
29:03
Speaker 1: said the study had come back in West Virginia about
29:07
Speaker 1: how it actually lowered premiums.
29:09
Speaker 6: Did they point to a.
29:10
Speaker 1: Single to what the biggest cause of that was. What
29:13
Speaker 1: did they have sort of a point of view on
29:14
Speaker 1: the biggest driver of the lower premiums.
29:16
Speaker 5: So essentially, what the Commission of Insurance requested from the
29:20
Speaker 5: insurance companies is what was the impact of this law.
29:24
Speaker 5: And so there was not a lot of detail, but
29:26
Speaker 5: it was you know, did this law specifically drilling down
29:29
Speaker 5: to the law that requires rebates to be shared at
29:32
Speaker 5: the counter with anything beyond that to be used to
29:36
Speaker 5: reduce premiums? What was that impact on premiums? And the
29:40
Speaker 5: insurer filings themselves tell a very different story obviously than
29:44
Speaker 5: what PBM lobbyists tell, and it showed significant premium suppression
29:48
Speaker 5: from like the one don't quote me on this, but
29:50
Speaker 5: probably like one to up as high as fourteen percent
29:54
Speaker 5: in premium reduction range. It didn't break down like you know,
29:57
Speaker 5: the mechanics of exactly where and how, but it absolutely
30:03
Speaker 5: spoke volumes and it just completely different than what's predicted
30:08
Speaker 5: by the pharmacy Benefit manager and the insurer lobbyists. When
30:12
Speaker 5: these policies are advanced.
30:18
Speaker 1: Yeah, those studies really matter at the federal level, because
30:20
Speaker 1: when I'm equipped with studies from West Virginia, from Ohio,
30:24
Speaker 1: from other leading states on this, it really helps me
30:28
Speaker 1: with those prebuddles I was talking about earlier.
30:31
Speaker 6: Yeah, and makes.
30:32
Speaker 1: It easier to get particularly more senior members of the
30:35
Speaker 1: House on both sides who can really.
30:38
Speaker 6: Help this legislation move. That stuff really matters, Yeah, and
30:42
Speaker 6: I think it does.
30:43
Speaker 5: And I think in a way that's sort of what
30:44
Speaker 5: pharmacy has been missing. But what you just said as
30:48
Speaker 5: you were describing rebates, and I often use the phrase
30:51
Speaker 5: like America is addicted to rebates, right, it's America's other
30:54
Speaker 5: drug problem that frankly doesn't get talked about as much.
30:57
Speaker 5: But everybody, everybody gets gets a taste, and there's just
31:01
Speaker 5: a lot of folks who are addicted to those revenue
31:05
Speaker 5: streamings for a variety of reasons. But you know, something
31:07
Speaker 5: that you said earlier about air traffic controller struck me.
31:10
Speaker 6: Right.
31:11
Speaker 5: You didn't use the word north star, but air traffic
31:14
Speaker 5: controllers want to land the plane. And I think pharmacists
31:18
Speaker 5: want to see patients get the medications that they need
31:22
Speaker 5: to improve their health outcomes. And so the rebate issue
31:26
Speaker 5: may not speak directly to the sustainability of pharmacy, but
31:30
Speaker 5: I can't tell you, and I know you hear this,
31:32
Speaker 5: You hear from a lot of pharmacists, But how many
31:34
Speaker 5: pharmacists are frustrated and discouraged when they see patients who
31:39
Speaker 5: are making those hard choices of going without medication because
31:43
Speaker 5: they can't afford that medication. You know there's a cheaper
31:45
Speaker 5: generic that's available in the PBM because they're getting a
31:49
Speaker 5: fifty percent rebate are forcing patients to pay out of
31:52
Speaker 5: pocket for the more expensive drug, and your legislation cuts
31:56
Speaker 5: to the heart of that.
31:56
Speaker 6: One hundred percent.
31:57
Speaker 1: And there's also and those are just the trade offs
32:01
Speaker 1: that are transparent to the patient and to the pharmacist.
32:03
Speaker 1: We of course have an entire dog that didn't bark.
32:08
Speaker 6: Effect.
32:09
Speaker 1: Biosimilars is a great example of this. The PBMs have
32:12
Speaker 1: been using aggressive rebate strategies to keep biosimilars out of
32:16
Speaker 1: the marketplace in the first place, which is you know,
32:19
Speaker 1: holding up potentially as much as one hundred billion dollars
32:21
Speaker 1: an invoice spend on biologics that could have a biosimilar
32:25
Speaker 1: competitor but do not because of sort of anti competitive
32:31
Speaker 1: action ahead of a launch. And so there's a lot
32:33
Speaker 1: of those sort of unseen warping forces of rebates as well.
32:38
Speaker 5: Yes, I'm going to talk a little bit about patients
32:42
Speaker 5: before anopolies, because it's another area that you're working on
32:45
Speaker 5: a bipartisan basis and leading with. Before we do, I
32:48
Speaker 5: guess I would ask, and last year you had a
32:51
Speaker 5: powerful ask of community pharmacists what can community pharmacists do
32:55
Speaker 5: to help advance this legislation? And you know, I think
33:00
Speaker 5: if you give the marching orders, you're going to find
33:02
Speaker 5: that the message is going to resonate and they're going
33:05
Speaker 5: to do everything they can to help you in this
33:08
Speaker 5: enormous fight.
33:10
Speaker 6: Kentucky.
33:12
Speaker 1: The Chair of Energy and Commerce is from Kentucky. The
33:15
Speaker 1: Chair of House Oversight and Government Reform is from Kentucky.
33:18
Speaker 1: Bret Guthrie and James Comer. And the more pressure they
33:23
Speaker 1: feel from their constituents, the more pressure they feel from
33:28
Speaker 1: pharmacists as they are organized, I think, the more top
33:34
Speaker 1: of mind and top of docket this legislation can be.
33:38
Speaker 1: So it matters in every state to get members on
33:40
Speaker 1: and I want to get past sixty actually this time around.
33:44
Speaker 1: But in terms of like where we're trying to really
33:49
Speaker 1: focus the laser beam of different points of light, Let's
33:53
Speaker 1: make Kentucky hot.
33:55
Speaker 6: And I'll tell you, you know, Kentucky is a state that
33:58
Speaker 6: I talk about this a lot.
33:59
Speaker 5: There are places where there are cultures of winning, and
34:03
Speaker 5: Kentucky Pharmacy has a culture of winning. Right, They've had
34:06
Speaker 5: really big wins. They've got a great you know, several
34:09
Speaker 5: great leaders on the issue. At the state level. Senator
34:12
Speaker 5: Max Wise has pushed some of the nation's leading PBM
34:16
Speaker 5: reform at the state level, there's just great grassroots with
34:21
Speaker 5: this Pharmacy Association Ben Mudd and the Independent Association with
34:25
Speaker 5: Rosemary like it. It is a state where there is
34:27
Speaker 5: a culture of winning. And I think, you know, Chairman
34:30
Speaker 5: Comer has been a great champion on this and he
34:32
Speaker 5: actually was a co sponsor of Pharmacists Fight Back at
34:35
Speaker 5: Yes last year as well.
34:37
Speaker 6: Right, So that's that's to the extent.
34:41
Speaker 5: That Kentucky is a central state, and it is I'm
34:43
Speaker 5: glad that Kentucky's a central state because it's pharmacy has
34:47
Speaker 5: sort of those grass roots.
34:49
Speaker 6: They just have that culture of winning. They know how
34:51
Speaker 6: to advocate.
34:52
Speaker 5: So that's that's exciting, exciting to hear, and I think
34:56
Speaker 5: certainly Kentucky pharmacists will will rise to that occasion. And
35:00
Speaker 5: it sounds like you're still going to have a large
35:03
Speaker 5: goal of like, hey, let's let's show strong bipartisanship support,
35:06
Speaker 5: let's load up the co sponsors again, and then I
35:09
Speaker 5: think hopefully, right well, you know, we'd love to see
35:12
Speaker 5: this bill advance to a committee hearing.
35:14
Speaker 1: That's the goal, right we So the basic PBM reform
35:17
Speaker 1: package that was supposed to pass in December of twenty
35:19
Speaker 1: four but Elon must tweeted about it and this peaker
35:22
Speaker 1: pulled it down. That still needs to pass and then
35:24
Speaker 1: my bill is next up. Now, the longer that it
35:26
Speaker 1: waits to do the basic PBM reform package, the more
35:29
Speaker 1: I'm thinking, if I can get a markup and you know,
35:31
Speaker 1: a ledge hearing and then a markup on this bill,
35:33
Speaker 1: we can add it to that basic reform package. Right.
35:35
Speaker 1: That's that's a very aspirational goal just because that PBM
35:38
Speaker 1: reform package has been.
35:39
Speaker 6: Cooked for a long time. But that is happening, and
35:43
Speaker 6: there's synergies, there's synergies, totally, totally.
35:45
Speaker 1: This is where the puck is headed. I mean, we
35:47
Speaker 1: follow Wayne Gretzky. We want to skate to where the
35:49
Speaker 1: puck is going. This is the clear next step. And yeah,
35:53
Speaker 1: we got to get it marked up.
35:54
Speaker 6: Yeah, very good. You know it's easy.
35:57
Speaker 5: It's hard to pass the bill anywhere, right Anyway, I
36:00
Speaker 5: always say, like you can drop a bill in a
36:02
Speaker 5: state that says puppies are cute, completely non controversial, It's
36:06
Speaker 5: going to be hard to pass it. But states have
36:08
Speaker 5: had a good track record of passing some significant legislation
36:11
Speaker 5: and in certain ways leading on the issue.
36:13
Speaker 6: One of the.
36:14
Speaker 5: Things that I loved about last year at the federal
36:16
Speaker 5: level is a couple of bills you were involved with,
36:19
Speaker 5: Pharmacists Fight Back Act. All of a sudden, states are
36:21
Speaker 5: following federal legislative leads and states, are you know, your
36:26
Speaker 5: work inspired state reform, you know, in sort of in
36:30
Speaker 5: spirit and from a technical perspective in many ways. From
36:33
Speaker 5: Pharmacists Fight Back Act, also Patients Before Monopoly, which which
36:37
Speaker 5: you had had a big hand in obviously with Representative Harshburger,
36:41
Speaker 5: Senators Holly and Senators Warren. And I think there's some
36:46
Speaker 5: talk of, hey, this is a messaging bill, right, but
36:49
Speaker 5: lo and behold, last year it got a ton of attention.
36:52
Speaker 5: And again I think, talk about skating where the puck
36:55
Speaker 5: is headed, right, vertical integration is so integral to so
36:58
Speaker 5: many of the sort of egregious unfit or practice as
37:00
Speaker 5: we see. But states followed suit, right, A similar legislation
37:05
Speaker 5: was introduced in several states, and Arkansas introduced it, and boy,
37:10
Speaker 5: it wasn't a messaging bill in Arkansas, was it so?
37:13
Speaker 1: And it got litigated in Arkansas as well, and that
37:15
Speaker 1: is that going to be appealed to that outcome.
37:17
Speaker 5: Yeah, yeah, I mean that was that was a very
37:20
Speaker 5: sort of temporary and you know, injunctive action, right, and
37:24
Speaker 5: obviously there's a lot of litigation to go. That was
37:27
Speaker 5: maybe the first round and you know, I'm not going
37:30
Speaker 5: to apply on it, but.
37:31
Speaker 6: I but it's helpful.
37:33
Speaker 1: And this is why the federal state volleying is so helpful,
37:36
Speaker 1: is you know, it gets litigated out of Arkansas, we
37:39
Speaker 1: can maybe update the federal bill depending on how the
37:41
Speaker 1: courts are weighing in on that. See how judges you know,
37:45
Speaker 1: poke holes, et cetera.
37:46
Speaker 6: Construction policy.
37:47
Speaker 1: This is this is how we want things done. We
37:49
Speaker 1: want different states acting. We want federal policy makers hearing
37:53
Speaker 1: and listening to both how state policymakers and judges are
37:56
Speaker 1: responding to it.
37:57
Speaker 6: And this bill, you know, it's by partisan.
38:00
Speaker 1: It's bicameral at the federal level, bringing together some people
38:03
Speaker 1: who don't agree on a whole.
38:04
Speaker 6: Lot of other things.
38:05
Speaker 1: Right, And it has a really simple thesis. It just says,
38:11
Speaker 1: you know, listen, it can be the money or it
38:13
Speaker 1: can be the medicine, but it can't be both.
38:15
Speaker 6: Okay, if you're.
38:16
Speaker 1: In the business of managing the money around this, fine,
38:20
Speaker 1: you can be a PBM. Now we're going to have
38:22
Speaker 1: rules for that, but you can do it if you're
38:25
Speaker 1: in the business of actually moving the medicines.
38:27
Speaker 6: That's a separate business.
38:29
Speaker 1: And when we bring together the two, the medicines and
38:31
Speaker 1: the money, what happens is is the patients and the
38:32
Speaker 1: pharmacists come last.
38:34
Speaker 6: And we're not going to let that happen.
38:36
Speaker 1: And I think this thing has a lot of resonance
38:39
Speaker 1: on both sides of the aisle, in fact, because on
38:42
Speaker 1: both sides of the aisle there is a real growing
38:44
Speaker 1: awareness that the vertical integration of the last twenty five
38:47
Speaker 1: years has been bad for United States healthcare.
38:49
Speaker 6: Yeah.
38:50
Speaker 5: Absolutely, And look that's in certain ways, that's a major
38:53
Speaker 5: shift that eyes are open on that, right because for
38:56
Speaker 5: years and years and years, anytime somebody said vertical integration
38:59
Speaker 5: and increase efficiencies, doors swung open and they'd let these
39:04
Speaker 5: just megamergers go through from an agency level as well
39:08
Speaker 5: as a lot of like the State Commission of Insurance level.
39:11
Speaker 6: But I think more and more we're seeing and you did,
39:15
Speaker 6: you know, you've done.
39:16
Speaker 5: Several just wonderful jobs in pointing out sort of the
39:20
Speaker 5: exploitation of PBM prices at their affiliated pharmacies for some
39:25
Speaker 5: of these quote specialty medications versus the national aver drug
39:29
Speaker 5: acquisition costs for example. And so I think this bit,
39:32
Speaker 5: you know, this legislation certainly builds on that. And can
39:35
Speaker 5: we expect to see that legislation reintroduced soon as well. Yes,
39:41
Speaker 5: So there's going to be obviously, you know, Buddy Carter's
39:44
Speaker 5: got to build that's got a lot of support out there.
39:46
Speaker 5: With Pharmacists Fight Back Act introduced and then pages Pop
39:49
Speaker 5: was coming, there's going to be a lot of really
39:52
Speaker 5: I think exciting good work to do at the federal
39:55
Speaker 5: level that pharmacists can can really rally around and we'll
39:59
Speaker 5: need their help very good. Well, well I believe they will.
40:04
Speaker 5: They will answer that call. I say that with confidence.
40:07
Speaker 5: So appreciate you coming on anything else that you wanted
40:12
Speaker 5: to address or point out to listeners, if not, just
40:15
Speaker 5: grateful for your time. Know you're busy, No, you probably
40:18
Speaker 5: have thirty places to go from here on out.
40:20
Speaker 1: I will.
40:21
Speaker 6: I do want to give one shout out.
40:22
Speaker 5: You had a pretty neat sort of a documentary of
40:25
Speaker 5: types where you were trailed for a couple.
40:27
Speaker 6: Of days just so folks could see just.
40:29
Speaker 5: Sort of how busy, how busy, your life is sort
40:34
Speaker 5: of partying. Do you want to tell our listeners a
40:36
Speaker 5: little about that and where they can find it? I
40:38
Speaker 5: think it was shared on so LinkedIn and if that's
40:41
Speaker 5: is that right?
40:42
Speaker 6: Yeah?
40:43
Speaker 1: Tangle sort of a non partisan newsletter that did a
40:46
Speaker 1: three days behind the scenes with me.
40:47
Speaker 6: It racked up a ton of interest.
40:51
Speaker 1: People I think found it refreshing to get to kind
40:53
Speaker 1: of peek behind the curtain, and we really gave them
40:55
Speaker 1: a lot of access.
40:56
Speaker 6: I mean it was not it was there was there
40:58
Speaker 6: was weas the solid days of them with me on
41:01
Speaker 6: the hill.
41:02
Speaker 1: I think part of it actually was me talking to
41:03
Speaker 1: pharmacists if I remember correctly, us as part of it.
41:07
Speaker 1: And people are interested, they can go to tangle dot com,
41:10
Speaker 1: I believe is where it is and search for it
41:12
Speaker 1: under my name.
41:12
Speaker 4: If you go to the show notes, you're gonna find
41:15
Speaker 4: access to that that connection and video. And this is
41:19
Speaker 4: so thankful that you could come back on Jake.
41:23
Speaker 6: This has been awesome. Take care everybody. Thank you so much.