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Manufacturer Direct D2C and the Future of Independent Pharmacy | TWIRx Special Series · Pharmacy Podcast Network

0:05
Speaker 1: You are listening to the global network of podcasters dedicated
0:09
Speaker 1: to the pharmacy profession.
0:10
Speaker 2: Welcome to the Pharmacy Podcast Network.
0:39
Speaker 3: Hey, the landscape of pharmacy, I don't have to tell you,
0:43
Speaker 3: goodness gracious, is undergoing a massive plate tectonics structural shift.
0:48
Speaker 3: Our manufacturers are now direct sourcing and direct to consumer,
0:54
Speaker 3: which is known as D2C pharmacy models.
0:58
Speaker 4: They're rapidly accelerating.
1:00
Speaker 3: And it's been pioneered by organizations like Lilly Direct and
1:04
Speaker 3: Pfizer Direct and these portals and Trump Rx. And it's
1:08
Speaker 3: very confusing. It needs demystified. We need to know where
1:11
Speaker 3: it's showing up, how it's being leveraged, how it's going
1:14
Speaker 3: to impact our independent community pharmacies. And therefore, we have
1:19
Speaker 3: to reach out to people that know what's going on.
1:22
Speaker 3: I want to introduce a friend of mine who's been
1:25
Speaker 3: in my network for, I'm going to sound old saying this,
1:28
Speaker 3: but it's been over 15 years, maybe 20 years. I
1:30
Speaker 3: don't want to say 20 years, but it could be.
1:33
Speaker 3: Shelly Bailey, welcome to the show.
1:35
Speaker 4: How are you?
1:36
Speaker 5: Oh, hello, Todd.
1:37
Speaker 1: Thanks for having me. Yeah, you just aged both of us,
1:39
Speaker 1: so thanks for that. But no, thank you for having
1:43
Speaker 1: me here today. You know, I work on different strategic
1:47
Speaker 1: initiatives here at IPC, and some of those initiatives include
1:50
Speaker 1: partnerships with manufacturers, which is why we're having the conversation
1:55
Speaker 1: here today. But I do want to welcome Sammy Salem
1:58
Speaker 1: to this conversation. Sammy?
2:00
Speaker 5: Hey, Shelly. How are you?
2:02
Speaker 6: Thank you for having me on the on this podcast today, Todd.
2:06
Speaker 6: I am a retail pharmacy owner. I'm also the owner
2:10
Speaker 6: and CEO of Virus Compounding Pharmacy, as well as the
2:13
Speaker 6: executive board member with AAPA, an affiliate under IPC. So
2:18
Speaker 6: pleasure to be on this podcast today, and let's get
2:21
Speaker 6: to it.
2:24
Speaker 2: All right.
2:24
Speaker 3: So I want to set some groundwork, and I'm going
2:27
Speaker 3: to turn this over to Shelly, because that's why we
2:29
Speaker 3: have you here today, is that authority and understanding. And
2:33
Speaker 3: like you said, the relationships that you're building with the
2:35
Speaker 3: manufacturer are so key and things are changing. PBMs are changing.
2:39
Speaker 3: Payment models are changing. How things are being paid for
2:42
Speaker 3: access is changing. Supply chain. So when I think of
2:46
Speaker 3: the threat to manufacture, to consumer, of what that means
2:49
Speaker 3: for education and safety, when I think of the opportunity
2:53
Speaker 3: that manufacturers have to the end all source, which is
2:58
Speaker 3: of course our our outputs, our pharmacies out there. There's
3:02
Speaker 3: a lot that goes into this. So kind of open
3:05
Speaker 3: up from the beginning, let's set the stage direct to
3:09
Speaker 3: consumer in the future of independent pharmacy.
3:12
Speaker 4: Shelly, give us the groundwork here.
3:16
Speaker 2: Yeah, absolutely.
3:17
Speaker 1: You know, I like to kind of start things usually
3:19
Speaker 1: by talking to people about where things have been up
3:23
Speaker 1: until very recently, kind of with the explosion of direct
3:26
Speaker 1: to consumer or direct to employer. Yeah, I would say
3:30
Speaker 1: over the last three years, I mean, especially heightened when
3:32
Speaker 1: Pfizer launched their direct program for vaccines, we started this
3:38
Speaker 1: new world where pharmacies were traditionally used to, we have
3:43
Speaker 1: a PSAO, we sign up, we get all of.
3:46
Speaker 2: Our PBM contracts through that channel. We don't have too.
3:49
Speaker 1: Much discretion related to that. And we just kind of
3:51
Speaker 1: move forward with claims adjudication. And as all these novel
3:54
Speaker 1: programs came out, there wasn't necessarily a role in a
3:59
Speaker 1: more strategic way for retail pharmacy to benefit. So retail
4:03
Speaker 1: pharmacy kept really helping the nation during a really critical
4:08
Speaker 1: time where we needed all hands on deck to pull
4:11
Speaker 1: through healthcare access for people. But as this explosion of
4:16
Speaker 1: D2C really started to happen, retail wasn't at the table.
4:21
Speaker 2: And so for the last few years, what.
4:24
Speaker 1: We find from pharmacy owners, I was a pharmacy owner myself,
4:27
Speaker 1: which is how I met Todd probably in 2010 or something.
4:31
Speaker 1: But while retail pharmacy was out there saving lives, these
4:37
Speaker 1: innovative models started to pop up. And until recently, retail
4:41
Speaker 1: pharmacies just haven't been really strategically included.
4:45
Speaker 2: In the D2C or D2E space.
4:48
Speaker 1: And so we'll talk more about it throughout our discussion,
4:51
Speaker 1: but I think it's really exciting now that to be
4:54
Speaker 1: at a position where, through partnerships like what we've built
4:57
Speaker 1: here with IPC, that we can really bring retail pharmacy
5:01
Speaker 1: to the table related to D2C that clearly benefits patients,
5:07
Speaker 1: it benefits the pharmacy, it benefits local payers in a
5:11
Speaker 1: more strategic way in the past. And you know, I
5:14
Speaker 1: guess from my perspective, Sammy, as you have, you know,
5:18
Speaker 1: still your pulse on working the bench to seeing all
5:22
Speaker 1: this kind of play out in real time, you know,
5:25
Speaker 1: have you seen any shift from what commercial payers are doing,
5:29
Speaker 1: what cash pay is doing, and then also kind of
5:32
Speaker 1: where things are headed to DTC and, and, You know,
5:35
Speaker 1: are you finding that you've been historically carved out? Are
5:38
Speaker 1: you finding that you've had to refer people out because
5:41
Speaker 1: you couldn't match the DTC price? What are you really
5:44
Speaker 1: seeing kind of in real time, you know, up until
5:47
Speaker 1: some of these new programs that you've been participating in?
5:50
Speaker 6: Yeah, Shelly, really, there isn't a true access to these
5:54
Speaker 6: opportunities or to these programs for the likes of our
5:58
Speaker 6: standard retail independent pharmacies. our pharmacies are reporting back where
6:03
Speaker 6: these scripts are leaving, right? They're seeing it leave and
6:06
Speaker 6: our pharmacists are not saying, identifying it as a channel shift,
6:10
Speaker 6: they're calling it just a loss in a prescription, right?
6:13
Speaker 6: You know, their patients are coming to the counter and saying,
6:16
Speaker 6: you know, my doctor told me to go to this
6:18
Speaker 6: website or my insurance on the cover, they asked me
6:21
Speaker 6: to go to this manufacturer for support. That's how they're
6:24
Speaker 6: identifying these type of opportunities or these manufacturer programs as
6:28
Speaker 6: it pertains to, you know, what's happening at the retail side.
6:35
Speaker 6: Has there been a true opportunity or access to these
6:37
Speaker 6: type of programs for retail pharmacies? There hasn't been until
6:40
Speaker 6: this point in time with the programs that you're creating
6:43
Speaker 6: through IPC.
6:45
Speaker 5: And it is a very good program.
6:47
Speaker 6: I mean, some of the patients that I've worked with
6:49
Speaker 6: recently through this program have appreciated the opportunity to gain
6:53
Speaker 6: access to certain medications that they just didn't have access
6:57
Speaker 6: to before in a more affordable fashion. And frankly speaking,
7:01
Speaker 6: the economics and the pharmacy level have been favorable. And
7:04
Speaker 6: in many cases, more favorable than the traditional model.
7:06
Speaker 5: So it's been a welcoming program to be a part of.
7:09
Speaker 2: Well, thank you for sharing that perspective, Sammy.
7:12
Speaker 1: I guess so one of the things I think of
7:14
Speaker 1: when I've been listening to you speak right now is
7:17
Speaker 1: kind of how in some ways everything ended up a
7:20
Speaker 1: little bit fragmented, even more fragmented than before.
7:23
Speaker 2: Let's say kind of post-COVID.
7:25
Speaker 1: With the explosion more of digital pharmacies and things. So
7:29
Speaker 1: maybe some of these new programs are kind of bringing
7:32
Speaker 1: it back so it's more manageable for a pharmacy to
7:35
Speaker 1: be able to.
7:36
Speaker 2: Deploy these programs.
7:38
Speaker 1: When you think of how cash used to work, where
7:41
Speaker 1: the patient would pay an out-of-pocket, there was an expense associated,
7:45
Speaker 1: the pharmacy would adjudicate. When I think of how manufacturers
7:50
Speaker 1: can be more strategic in a closer relationship, whether that's
7:56
Speaker 1: D to C or D to E, from my perspective,
8:00
Speaker 1: I think a lot about, I always think about policy
8:03
Speaker 1: because I'm a pharmacy nerd and I like to think
8:06
Speaker 1: about nerdy pharmacy things like policy.
8:08
Speaker 2: I think of some of the.
8:09
Speaker 1: Laws like what West Virginia did related to point of
8:12
Speaker 1: sale rebates.
8:13
Speaker 2: That was a law that West Virginia passed.
8:15
Speaker 1: But as you try to figure out what the heck
8:18
Speaker 1: a point of sale rebate looks like, how does it
8:20
Speaker 1: ultimately benefit the end consumer? I think a lot of,
8:24
Speaker 1: it's easy to talk about, but hard to do, right?
8:27
Speaker 1: So when I think of these types of manufacturer supported
8:32
Speaker 1: and manufacturer sponsored.
8:33
Speaker 2: Programs, I think of these really as.
8:35
Speaker 1: No better world to create an opportunity for a real
8:40
Speaker 1: point of sale rebate than these types of programs.
8:45
Speaker 2: I get asked, I don't know if.
8:46
Speaker 1: You do, Sammy, when you're hearing from consumers or local
8:51
Speaker 1: companies and organizations you work with, a lot of people
8:54
Speaker 1: have told me lately with some of these manufacturer-sponsored programs, Shelly,
8:58
Speaker 1: this sounds too good to be true. Like, who's losing
9:02
Speaker 1: in these types of arrangements where the pharmacy.
9:05
Speaker 2: Makes more, the patient pays the same.
9:08
Speaker 5: Out of pocket.
9:08
Speaker 1: I mean, I have my perspective on who might be
9:11
Speaker 1: losing and maybe some will share, some won't, but like,
9:15
Speaker 1: do you see this as a lose-lose or, you know,
9:17
Speaker 1: I mean, just does every, does one person win and
9:19
Speaker 1: one person lose, or can everyone kind of be better
9:23
Speaker 1: together when you look at the supply chain, how rebate
9:26
Speaker 1: structures work? Is there a loser in this or is
9:30
Speaker 1: there kind.
9:31
Speaker 2: Of a mutual win-win?
9:32
Speaker 6: My honest opinion is that when you gain access or
9:35
Speaker 6: when you provide access to these type of services or programs,
9:39
Speaker 6: you're actually putting more product onto the market.
9:41
Speaker 5: These are individuals.
9:42
Speaker 6: These are patients that have not been able to gain
9:45
Speaker 6: access at an affordable price point previously, right? So if
9:50
Speaker 6: you're able to put more product into the marketplace, I
9:52
Speaker 6: don't think anybody within the supply chain or within the
9:55
Speaker 6: vertical is going to have any issues with that directly,
9:59
Speaker 6: especially in a situation that it's almost in a very
10:01
Speaker 6: transparent model, right? We're seeing a situation where right at
10:06
Speaker 6: the point of sale, we're seeing what the front end,
10:09
Speaker 6: what the cost is to the patient, what the reimbursement is,
10:12
Speaker 6: or what the quote-unquote rebate would be for us.
10:15
Speaker 5: At the pharmacy level. And it's really straightforward.
10:18
Speaker 6: I mean, there's no hidden, you know, costs associated with
10:21
Speaker 6: it or DIR, you would call it, you know, any
10:24
Speaker 6: type of, you know, backend callback. It's really a model
10:30
Speaker 6: that makes sense across the board. And going back to
10:32
Speaker 6: your question, who's losing in this? I mean, ultimately we're
10:35
Speaker 6: here for the patient. We're a patient-centered approach no matter
10:38
Speaker 6: what we do. Every one of our pharmacies operate in
10:40
Speaker 6: that manner. We would not be around here if we
10:42
Speaker 6: didn't have that patient relationship, which always, you know, which
10:45
Speaker 6: is what we value at the independent pharmacy level is,
10:48
Speaker 6: you know, maintaining that relationship with our patients and making
10:50
Speaker 6: sure that we're there for them. And ultimately, if they're
10:53
Speaker 6: their ultimate benefactor in this relationship or in this transaction,
10:56
Speaker 6: then guess what?
10:58
Speaker 5: There is no loser.
10:59
Speaker 1: Well, Sammy, I'm glad that you shared that perspective because
11:02
Speaker 1: clearly community pharmacy certainly is patient-centric because if they weren't,
11:07
Speaker 1: they wouldn't be selling a lot of these branded medications
11:10
Speaker 1: because so many of the commercial payer arrangements have pharmacies
11:15
Speaker 1: very significantly below just cost of drug, not cost to dispense,
11:19
Speaker 1: but cost to drug. So I appreciate that you reinforced
11:22
Speaker 1: the concept that no matter what programs are on the market,
11:25
Speaker 1: no matter what you can access, what you can't access,
11:27
Speaker 1: it's what drives retail pharmacies, community.
11:30
Speaker 2: Pharmacies is always patient first, right?
11:33
Speaker 1: Related to, from my perspective, who might win, who might lose,
11:37
Speaker 1: you know, a lot of stores since we've went live,
11:40
Speaker 1: you know, with our new network have said, wow, Shelly,
11:43
Speaker 1: isn't this somehow bad for manufacturers? I have a much
11:47
Speaker 1: better reimbursed rate, the patient's paying the lower out of pocket.
11:51
Speaker 1: Isn't this bad for manufacturers? And why would a manufacturer
11:56
Speaker 1: do this? And from my perspective, We all know how,
12:00
Speaker 1: you know, and this program isn't, you know, a rebate-based model,
12:03
Speaker 1: but really just a true-up of the patient out-of-pocket and
12:06
Speaker 1: the reimbursed adjudicated amount.
12:08
Speaker 2: But in the rebate world, in the funded space, right,
12:12
Speaker 2: we all know how that works. A claim adjudicates 180
12:15
Speaker 2: days later.
12:16
Speaker 1: There's a bundled rebate from the PBM or from the manufacturer.
12:21
Speaker 2: To the PBM.
12:23
Speaker 1: Whoever's carrying that cost, which is often the plan and
12:27
Speaker 1: the employer, there's a huge days to cash related to that.
12:31
Speaker 2: And then the pharmacy loses because of the aggressive network rate.
12:35
Speaker 1: From my perspective, doing these things, manufacturer rebates are so
12:40
Speaker 1: aggressive in the funded space and they have to be
12:42
Speaker 1: for formulary management and all those sorts of things to
12:45
Speaker 1: be able to have key product placement. I look at
12:48
Speaker 1: this as like, there's one big middleman in this discussion
12:52
Speaker 1: and that is eliminated from, from doing this. And so
12:57
Speaker 1: when you do that, there's a lot more.
12:59
Speaker 2: Money to be shared, right?
13:01
Speaker 1: So pharma is not given more than they otherwise are
13:04
Speaker 1: giving to one of the big five pharmacies benefiting the
13:08
Speaker 1: patients benefiting. But I also think there's an empowerment piece
13:11
Speaker 1: of this, both for the pharmacy, for the, and also
13:16
Speaker 1: for the.
13:16
Speaker 2: Manufacturer, right?
13:18
Speaker 1: Because The manufacturer now has a world where they can
13:21
Speaker 1: work with community-based pharmacies in an economic model that works
13:26
Speaker 1: for the pharmacy and also works for the manufacturer, which
13:29
Speaker 1: also improves affordability and access to the consumer. And so
13:33
Speaker 1: I think it's funny the number of calls I get
13:35
Speaker 1: that people are like, oh, Shelly, these programs are fantastic.
13:40
Speaker 1: From a strategic perspective, why the heck would you ever
13:42
Speaker 1: do anything like this? You're never going to be friends
13:43
Speaker 1: with a manufacturer ever again. But the reality is, you know,
13:47
Speaker 1: the manufacturers are really leaning in. They're leaning into this
13:52
Speaker 1: direct-to-consumer channel. They're leaning into direct-to-employer. They're leaning a little
13:58
Speaker 1: bit out of the traditional PBM model, right? And while
14:03
Speaker 1: we're all pharmacy owners serving patients, a lot of our
14:07
Speaker 1: patients own companies. They're employers, right? We can be the
14:13
Speaker 1: ambassador and market access team for, I mean, we can
14:18
Speaker 1: do so many things at the pharmacy point of sale
14:22
Speaker 1: that really help pull.
14:24
Speaker 2: Through new innovation.
14:25
Speaker 1: When I explain what IPC is or what we do
14:29
Speaker 1: to stakeholders outside of independent pharmacies, I always explain this
14:33
Speaker 1: as how many voters are through our wingspan of ecosystem, right?
14:38
Speaker 2: Because when you're talking.
14:39
Speaker 1: Externally and you're really trying to gain support for PBM
14:43
Speaker 1: reform or other strategic initiatives we have, you know, pharmacists,
14:48
Speaker 1: you know, as medical providers and all these types of things,
14:51
Speaker 1: I like to explain that if we want to be
14:53
Speaker 1: successful in being able to improve affordability for more patients, right,
14:59
Speaker 1: we're empowering all of our strategic partners when we lean
15:02
Speaker 1: into these types.
15:03
Speaker 2: Of innovative programs.
15:05
Speaker 1: And so I know that was a super long-winded question
15:08
Speaker 1: to you, Sammy, and response back, but I just get
15:12
Speaker 1: pretty excited.
15:13
Speaker 2: About how these, you know, types of types of programs were.
15:18
Speaker 3: I mean, I want to ask a dumb question. Um,
15:22
Speaker 3: how the heck does a pharmacy get paid? I mean,
15:24
Speaker 3: how are they that that's the, I've, I've watched the
15:30
Speaker 3: economics of all of this and I'm wondering like, how
15:34
Speaker 3: do they actually make money?
15:36
Speaker 5: Well, in this program or.
15:41
Speaker 6: In the traditional model, because I'm still trying to figure
15:43
Speaker 6: out the answer to that question when it comes down
15:45
Speaker 6: to the traditional model, Todd.
15:46
Speaker 5: So that's another podcast in itself.
15:48
Speaker 2: Well, and on this program, I'm happy to lean into
15:51
Speaker 2: the how, right. You know, I kind of, you know,
15:55
Speaker 2: when we think of the how, you know.
15:57
Speaker 1: There's, there's different mechanisms for how in some of these
16:01
Speaker 1: new programs it's working.
16:02
Speaker 2: We know how it works with IRA, right.
16:04
Speaker 1: There's the, the, MFT that kind of lives in the
16:07
Speaker 1: middle and trues up a pharmacy.
16:09
Speaker 2: That's very complex.
16:11
Speaker 1: There's all sorts of challenges when you're trying to do
16:13
Speaker 1: things like that. Different states are trying to do things
16:17
Speaker 1: like that with their drug affordability boards and things. And
16:20
Speaker 1: that's why with this program, I think it's the cleanest
16:24
Speaker 1: way that I've seen an opportunity to build margin, lower
16:27
Speaker 1: out-of-pocket expense, is because it's built in the same workflow
16:32
Speaker 1: as other adjudicated transactions. So- you know, to answer that
16:37
Speaker 1: question in these types of models, the pharmacy doesn't have
16:41
Speaker 1: to work with manufacturer by manufacturer, right? So they're not
16:44
Speaker 1: calling the drug company and trying to work something out.
16:46
Speaker 1: So all the opportunities are kind of bundled under one solution, right?
16:51
Speaker 1: Once a pharmacy joins into one of these solutions, claims
16:56
Speaker 1: adjudicate within standard workflows. So, you know, you have it
17:01
Speaker 1: in product dispense, you adjudicate the transaction just like you
17:04
Speaker 1: would a funded claim, the patient pays whatever is the
17:08
Speaker 1: identified patient out of pocket, the remaining delta from the
17:12
Speaker 1: contract rate and the patient out of pocket is paid
17:17
Speaker 1: just in the same type of workflow as a covered
17:21
Speaker 1: benefit claim would be.
17:22
Speaker 2: So a third.
17:22
Speaker 1: Party administrator pays the delta just like in.
17:26
Speaker 2: A commercial claim or a Medicaid claim or something.
17:29
Speaker 1: And so I think that's really interesting because We've always
17:33
Speaker 1: had pharmacies for the last 10 to 20 years trying
17:36
Speaker 1: to do unique things with local payers or.
17:40
Speaker 2: With other strategic partners.
17:41
Speaker 1: But it's always been, how much do you ask a
17:44
Speaker 1: pharmacy to go outside of workflow to be successful?
17:47
Speaker 2: And I think we could.
17:49
Speaker 1: Have another podcast about that and all the other types
17:51
Speaker 1: of things that we ask pharmacies to do outside of workflow.
17:54
Speaker 2: But what we know is if we want to be able.
17:57
Speaker 1: To empower the pharmacy to help themselves, we have to
18:00
Speaker 1: work within.
18:01
Speaker 2: A standard workflow.
18:02
Speaker 1: So what's exciting to me about making sure that a
18:06
Speaker 1: pharmacy is paid the right rate, they're paid timely, they're
18:09
Speaker 1: paid all these things, is to make sure that things
18:11
Speaker 1: adjudicate no differently than any other standard transaction that a
18:16
Speaker 1: pharmacy might participate in.
18:17
Speaker 6: Yeah, and I'll follow up on my personal experience within
18:20
Speaker 6: the program that I'm currently enrolled with, with the IPC.
18:24
Speaker 5: Usually within 21 to 25 days, I've seen reimbursement in.
18:27
Speaker 6: And frankly speaking, that's in a very, very reasonable timeline.
18:33
Speaker 6: So to answer your question, Todd, normal workflow, like Shelly
18:38
Speaker 6: just answered, the pharmacist doesn't experience any type of additional
18:42
Speaker 6: type of strain or another channel they have to go
18:47
Speaker 6: through is submitting a claim and getting reimbursed.
18:51
Speaker 5: And actually a more aggressive timeline than some other payers do.
18:55
Speaker 1: And I think for seamless like reconciliation and things like that,
18:59
Speaker 1: the payment actually still is facilitated through a traditional PSAO agreement.
19:04
Speaker 1: So the pharmacy still gets the 835. They can track,
19:08
Speaker 1: you know, the timing of payment and things. And so
19:11
Speaker 1: it just it works within traditional workflow. I know if
19:14
Speaker 1: I was a listener, because as you know, Todd, I've
19:16
Speaker 1: been a listener for a very long time when I was,
19:20
Speaker 1: you know, building my own retail NSP business.
19:23
Speaker 2: If I was listening right now, obviously something I would
19:25
Speaker 2: think about is rates, right?
19:27
Speaker 1: Like, I'm just going to address the elephant in the
19:28
Speaker 1: room here. I'm a straight shooter, as you know. And
19:31
Speaker 1: I can say that, you know, while rates, we can't
19:34
Speaker 1: get to the exact specifics of in this type of format,
19:37
Speaker 1: what I can say is I haven't seen these types
19:40
Speaker 1: of reimbursement rates to a pharmacy available at scale in
19:45
Speaker 1: over a decade, So I remember when the market really
19:50
Speaker 1: shifted over 10 years ago now. But I haven't seen
19:56
Speaker 1: rates this favorable for 10 to 13 years. And again,
20:01
Speaker 1: someone's going to say, well, that sounds too good to
20:03
Speaker 1: be true. Where's all this magic pot of gold that
20:06
Speaker 1: wasn't otherwise available?
20:07
Speaker 2: There is no magic pot of gold. It's just more of.
20:11
Speaker 1: That money is coming from the manufacturer direct to the pharmacy.
20:16
Speaker 2: And that is what excites me is to be able
20:19
Speaker 2: to build that margin back to the pharmacy.
20:24
Speaker 4: I like that. I like the sound of that. It
20:26
Speaker 4: sounds good.
20:27
Speaker 3: If I, let's play make-believe. If I melted the system
20:31
Speaker 3: down and started all over again, there's a trend happening.
20:37
Speaker 3: And actually I'm very proud to say in the Pittsburgh area,
20:40
Speaker 3: there's two of them. So it's not even like it's
20:43
Speaker 3: condensed because these two pharmacy pharmacists and pharmacy owners went
20:47
Speaker 3: to school together. Kyle McCormick and Brandon Antonopoulos have a
20:52
Speaker 3: cost plus, um, pharmacies in their community and they dictate everything. They,
20:59
Speaker 3: they get to do whatever they want and they're not, um,
21:03
Speaker 3: They're not subject or hostage to any payment system. So
21:06
Speaker 3: if I went back in time and I melted it
21:08
Speaker 3: all down and we started all over again, is that
21:11
Speaker 3: that you think this is the future? Do you think
21:12
Speaker 3: cost plus and direct to consumer and, you know, getting
21:17
Speaker 3: the pharmacist as the only gatekeeper between a medication and
21:22
Speaker 3: the patient once the physician prescribes?
21:25
Speaker 4: Like, is that where we want this to go?
21:29
Speaker 1: I mean, Sammy or Todd, you're asking me the kind
21:32
Speaker 1: of nerdy stuff that I love to talk about.
21:34
Speaker 2: All day, every day. So, I mean, I would say, yes.
21:37
Speaker 1: I mean, I think there's already a trend in this
21:39
Speaker 1: and I, you know, would be really interested to see
21:40
Speaker 1: what Sammy sees at the counter as well. But I
21:43
Speaker 1: think there's a huge trend on all these sorts of,
21:46
Speaker 1: you know, off-benefit models, right? I think 2026 is gonna
21:51
Speaker 1: probably be the biggest year of commercial coverage for programs
21:55
Speaker 1: like GLP-1s under the traditional funded benefit.
21:58
Speaker 2: Because now there's all sorts of.
22:01
Speaker 1: Innovative programs like what we're working on, what other partners
22:04
Speaker 1: in the industry are doing, where employers are getting smarter.
22:09
Speaker 1: And they're like, look, we're going to have maybe a
22:12
Speaker 1: watered down drug benefit, like an ICRA plan or something.
22:16
Speaker 1: And I know this isn't directly your question, but I'll
22:19
Speaker 1: get to the more direct answer. But I think drug
22:21
Speaker 1: benefits are going to be narrowed considerably. Everyone's going to
22:25
Speaker 1: know where the top 20 high impact drugs live from
22:29
Speaker 1: a gross to net access ability for payers. And if
22:34
Speaker 1: I'm the total rewards manager at a large employer or
22:37
Speaker 1: self-insured employer or something, I'm going to say, these 10 NDCs,
22:42
Speaker 1: you go to this partner because they're already getting the
22:45
Speaker 1: point of sale rebate.
22:46
Speaker 2: I don't have to wait to get my money. These
22:48
Speaker 2: other 15 NDCs, You go that.
22:51
Speaker 1: Way and I cover it on an HSA or a
22:53
Speaker 1: debit card. So in many ways, we're going backwards. So
22:57
Speaker 1: I remember in the late 90s where my grandparents' medicine
23:01
Speaker 1: shop pharmacy, every drug we did was cash. And once
23:04
Speaker 1: in a while, someone would come in with a covered
23:05
Speaker 1: benefit and we didn't even barely know how to bill
23:08
Speaker 1: a third party. And you just prayed no one came
23:10
Speaker 1: in because you had no idea how. I mean, you
23:13
Speaker 1: prayed that no one with a funded benefit came in
23:15
Speaker 1: because you had no idea how to even bill that transaction.
23:18
Speaker 2: And so I think that what's covered on benefit will shrink.
23:25
Speaker 1: The PPMs that are charged to employers will shrink, right?
23:31
Speaker 5: You hope.
23:32
Speaker 2: That's probably a bad assumption, but it might work.
23:35
Speaker 1: And then all these pharmacies that want to do cost plus,
23:39
Speaker 1: I think there's limitations on cost plus. You can control
23:45
Speaker 1: a piece of that. I think in the generic space,
23:47
Speaker 1: it works real well. You can factor in your cost
23:49
Speaker 1: to dispense. It's like a NADAC plus. It's like an
23:53
Speaker 1: average actual acquisition cost. I'm from Oregon, so we do
23:55
Speaker 1: all that kind of stuff. But you're going to be
23:58
Speaker 1: limited on the high-impact branded drugs because you'll never be
24:03
Speaker 1: able to do cost plus in a way that works
24:06
Speaker 1: for the patient or for the consumer.
24:08
Speaker 2: And that's where when more of these types of programs,
24:11
Speaker 2: you know, come.
24:12
Speaker 1: To life, you could open a pharmacy, you could grab
24:14
Speaker 1: the programs from the partners you want and kind of
24:18
Speaker 1: make sure if you're those two Pittsburgh pharmacies that you've
24:20
Speaker 1: leaned into your own.
24:22
Speaker 2: Cost plus for lower whack items.
24:26
Speaker 1: And then you plug the holes on the high impact
24:29
Speaker 1: drugs with programs like this. So I think that we're
24:32
Speaker 1: going backwards in a good way. I guess is how
24:36
Speaker 1: I would frame it. But Sammy, what are you seeing
24:38
Speaker 1: related to, are more patients just paying out of pocket
24:41
Speaker 1: because they can't access like a high deductible?
24:47
Speaker 6: From my perspective, Shelly, I mean, honestly, if you look
24:51
Speaker 6: at it at a macro level, the amount of people
24:54
Speaker 6: that are uninsured nationally and the amount of people that
24:57
Speaker 6: are underinsured nationally.
24:58
Speaker 5: Is at an all-time high.
25:00
Speaker 6: And that's why Todd, the two individuals that you mentioned
25:03
Speaker 6: in Pittsburgh went into this area and opened up these
25:08
Speaker 6: cost-plus pharmacies because fact of the matter is there is
25:11
Speaker 6: a good market out there for people to gain access
25:14
Speaker 6: to medications or therapies that are available in a cost-plus fashion.
25:19
Speaker 6: that's fully transparent to them, that they're not being overcharged on,
25:24
Speaker 6: and they're getting access to these medications. I mean, that
25:27
Speaker 6: fact of the matter, that's exactly what's happening, you know, nationally,
25:31
Speaker 6: no matter where you look or turn. And it's because
25:34
Speaker 6: of the simple fact that we have a ton of
25:35
Speaker 6: people that are underinsured and uninsured. Even at the, you know,
25:40
Speaker 6: government level, right, when you look at, you know, Medicaid
25:43
Speaker 6: and Medicare and And a lot of states, the majority
25:45
Speaker 6: of the states out there have adopted the cost plus
25:47
Speaker 6: model with their Medicaid reimbursement.
25:49
Speaker 5: I mean, I know in Michigan, I have a lot
25:50
Speaker 5: of experience.
25:51
Speaker 6: You know, AAPA as a GPO pushed for legislation and
25:54
Speaker 6: passed it, you know, in the state of Michigan.
25:57
Speaker 5: Has helped NCPA advocate for it at the federal level.
26:01
Speaker 6: But what I will tell you that that cost plus
26:03
Speaker 6: model has saved, for example, the state of Michigan, nearly
26:07
Speaker 6: 40 to $ 60 million, depending.
26:09
Speaker 5: On the year, in.
26:11
Speaker 6: Revenue to the bottom line in the Medicaid program. And
26:14
Speaker 6: that number, if you look at it in an indirect fashion,
26:16
Speaker 6: could be much more higher, right? If you look at
26:19
Speaker 6: what they were able to do with respect to their
26:20
Speaker 6: rebate model within their preferred drug list, But with that
26:24
Speaker 6: being said, this is kind of what this whole program
26:27
Speaker 6: is all about. This direct-to-consumer manufacturer program that IPC and
26:32
Speaker 6: Shelley has created is being able to feed into that system, right?
26:39
Speaker 6: or that carve out that some of these, you know,
26:41
Speaker 6: payers or commercial plans are, you know, putting their members
26:44
Speaker 6: into because they just can't afford to be able to
26:47
Speaker 6: serve an entire, to manage an entire drug benefit.
26:50
Speaker 5: You know, program. It's hard.
26:54
Speaker 6: Will that be a program that's sustainable long term? I
26:58
Speaker 6: do believe that managing drug benefits are going to be
27:02
Speaker 6: front and center for any type of health plan moving
27:04
Speaker 6: forward because it's always the anchor.
27:06
Speaker 5: Of the premium, the cost associated with it.
27:10
Speaker 6: Do I think that we're going to be in a
27:11
Speaker 6: world or in a situation where we could be creative
27:14
Speaker 6: like these type of programs or a cost plus cash
27:16
Speaker 6: pay model that could help drive down premium costs, kind.
27:22
Speaker 5: Of carving out some of the drug benefit?
27:24
Speaker 6: I do think that's going to happen in the near future,
27:26
Speaker 6: and it will be beneficial to for the pharmacist because
27:30
Speaker 6: they will be able to control that conversation like we're
27:33
Speaker 6: doing right now with this program with IPC.
27:34
Speaker 1: So, Sammy, you mentioned quite a few things that I
27:39
Speaker 1: wanted to make sure to lean into. Now, I forgot
27:42
Speaker 1: a couple of them, but one thing that came top
27:44
Speaker 1: of mind when you were discussing this made me think of,
27:48
Speaker 1: you know, was also 340B, right?
27:50
Speaker 2: So, I think something that comes up.
27:53
Speaker 1: You know, for me a lot is, you know, when
27:55
Speaker 1: you talk about kind of cost plus, that's kind of
27:57
Speaker 1: what sliding scale was 20 years ago, 15 years ago
28:01
Speaker 1: and things. But with the new 340B rebate model, and
28:05
Speaker 1: we know that, you know, a lot of independent pharmacies
28:08
Speaker 1: and just retailers in general or contract pharmacies, as.
28:12
Speaker 2: We know, that model is shifting, right?
28:16
Speaker 1: There's going to be, in my 25 years, people have
28:19
Speaker 1: been telling me 340B is going to change and You know,
28:23
Speaker 1: I continue to move forward as I did, but.
28:25
Speaker 2: I do believe now there will be changes, you.
28:27
Speaker 1: Know, in the next 24 to 36 months, even quicker
28:31
Speaker 1: with the rebate. But I think this is also another
28:35
Speaker 1: way that kind of gets to the cost plus for
28:40
Speaker 1: some of the individuals, you know, that need to benefit
28:42
Speaker 1: from it and gets to the kind of the net
28:46
Speaker 1: that a lot of, you know, pharmacies are trying to
28:49
Speaker 1: support for their local patients. employers and things, keeping in
28:53
Speaker 1: mind that 340B is changing. And so, but as 340B changes,
29:00
Speaker 1: manufacturer direct to consumer, manufacturer direct to employer is going
29:05
Speaker 1: to increase. So you're a pharmacy now doing contract pharmacy.
29:09
Speaker 1: You're going to see, I mean, just speaking frank, you're
29:13
Speaker 1: going to see a reduction in 340B claims ultimately at
29:16
Speaker 1: some point in time.
29:17
Speaker 2: But can you lean into these types.
29:19
Speaker 1: Of programs to give you a lift that gets you
29:23
Speaker 1: the patient? It still keeps affordability at the forefront for
29:26
Speaker 1: the consumer, but also helps keep margin, you know, to
29:30
Speaker 1: the pharmacy so that the pharmacy can, you know, keep
29:32
Speaker 1: their doors open. We always said when we owned our pharmacy,
29:35
Speaker 1: like there's, we have to make money to help people, right?
29:39
Speaker 2: If we don't make money, we cannot help anyone, right?
29:43
Speaker 1: Right?
29:43
Speaker 2: And so as 340B, that's something that we're all talking
29:46
Speaker 2: about right now.
29:47
Speaker 1: We're all very much closely watching these types of, you know,
29:50
Speaker 1: manufacturer-supported programs, I think, are a way to bridge the
29:55
Speaker 1: gap for both consumers and for, you know, and for
29:59
Speaker 1: the pharmacies.
30:00
Speaker 4: Sammy, I have this glass half full mentality. I can't
30:05
Speaker 4: help it.
30:06
Speaker 3: It's my, I wake up in the morning, I, you know,
30:08
Speaker 3: say some prayers, try to get some breakfast, try to
30:11
Speaker 3: get some exercise in, and I want to light the
30:14
Speaker 3: day on fire. So I want good things to happen.
30:16
Speaker 3: And I hear about how the future of pharmacy isn't
30:21
Speaker 3: just the prescription. It's not just the dispensing fee. It's immunizations.
30:28
Speaker 3: It's treatment management. It's getting paid for remote patient monitoring.
30:32
Speaker 3: It's digging into supplement business and managing that. It's preemptive
30:40
Speaker 3: services that can help people live longer, healthier lives. Is
30:45
Speaker 3: that a realistic way of thinking? Is that the future
30:48
Speaker 3: of our independent community pharmacies?
30:51
Speaker 6: Well, Todd, I think it's a part of it. I
30:53
Speaker 6: don't think it's, when you say is it the future,
30:55
Speaker 6: I do think the core of who we are as pharmacists,
30:58
Speaker 6: independent pharmacists, and providing a service or a level of
31:02
Speaker 6: care to our patients is always going to be the
31:04
Speaker 6: dispensing piece, right? But what accompanies that, what comes with
31:09
Speaker 6: the type of service that our patients are going to
31:11
Speaker 6: expect out of us is providing those type of services, right?
31:15
Speaker 6: And the ability for our pharmacists to be able to
31:17
Speaker 6: adapt to those type of, the ability to.
31:20
Speaker 5: Provide those services.
31:21
Speaker 6: And I know we spent a lot of, like a
31:23
Speaker 6: lot of states and nationally, the ability to provide some
31:26
Speaker 6: of those services, whether it be immunization or the types
31:29
Speaker 6: of monitoring that you're referring to, whether it be remote
31:32
Speaker 6: therapy monitoring or RPM monitoring.
31:36
Speaker 5: Or chronic care.
31:37
Speaker 6: Management to a degree, to work with our providers that
31:41
Speaker 6: we work with on a day-to-day basis, primary care providers,
31:44
Speaker 6: that is. I think that's all gonna be a part
31:47
Speaker 6: of who we are as pharmacists in the future, 100%.
31:51
Speaker 6: Simply because the ability for the patient to access us
31:54
Speaker 6: on a daily basis. You know, they touch us, they
31:56
Speaker 6: feel us, they're able to see us, they're able to
31:58
Speaker 6: communicate with us freely. And we have to be a
32:01
Speaker 6: part of that conversation. We will be a part of
32:03
Speaker 6: that conversation But is it solely the future? When people
32:08
Speaker 6: talk about that, I think some people envision the dispensing
32:12
Speaker 6: side going away, and I don't think that'll ever go away, right?
32:14
Speaker 6: I mean, every patient's going to come in and need
32:18
Speaker 6: that type of service, whether it's an urgent care medication
32:21
Speaker 6: or whether it's a maintenance medication or whatever it may be.
32:25
Speaker 6: Pharmacists are going to always be there for that, for
32:28
Speaker 6: all levels of service.
32:29
Speaker 5: And one thing that our pharmacists need to be a
32:31
Speaker 5: part of is being able to adapt. to that ability
32:35
Speaker 5: to be, you know, to offer those other types of
32:37
Speaker 5: ancillary services.
32:38
Speaker 3: I want the listeners to, to listen in and maybe
32:42
Speaker 3: listen to this podcast again, but reaching out to people
32:46
Speaker 3: like Shelly and reaching out to IPC and reaching out
32:49
Speaker 3: to AAPA and Sammy and people that know what's going
32:52
Speaker 3: on to demystify, to understand and where to go. Shelly,
32:57
Speaker 3: help our listeners understand how to get the pharmacies involved,
33:01
Speaker 3: how to get the pharmacists involved, how to, how to
33:04
Speaker 3: kind of corral this so that they can feel in
33:07
Speaker 3: control and getting involved with direct-to-consumer and tighter relationships with
33:12
Speaker 3: our manufacturers.
33:14
Speaker 2: Yeah, absolutely. Thank you for asking, Todd.
33:16
Speaker 1: I mean, I would say just a very low-level way
33:18
Speaker 1: to get started would be for those that want to
33:21
Speaker 1: access programs like this would be to reach out to
33:24
Speaker 1: the IPC digital health team, Sure, Todd, for the notes
33:28
Speaker 1: for the podcast, you'd be able to put that contact
33:30
Speaker 1: information there. I think that's just a really dip your
33:33
Speaker 1: toe in the water kind of way that gets started.
33:37
Speaker 1: You see how it works. You know, you then can
33:39
Speaker 1: see in real time if those economics change. or in
33:42
Speaker 1: alignment with what works for your pharmacy, right? I believe
33:47
Speaker 1: I'm a trustworthy person, but, you know, every pharmacy has
33:49
Speaker 1: a different model of, you know.
33:51
Speaker 2: What reimbursement works for them and things.
33:53
Speaker 1: I believe strongly a model like this will work. But again,
33:57
Speaker 1: I would just encourage people to try. And then once
33:59
Speaker 1: you've dipped your foot in the water, you've tried a
34:02
Speaker 1: little bit, again, I would.
34:03
Speaker 2: Continue to, I mean, just.
34:06
Speaker 1: being the pharmacy person I am, it's listening to podcasts,
34:10
Speaker 1: more of the different podcasts that you.
34:12
Speaker 2: Do, Todd.
34:13
Speaker 1: My favorite time to listen to you, Todd, was always
34:16
Speaker 1: like 10 p.m. to midnight when I was working on
34:18
Speaker 1: prior auths, right? But like- listen and learn from others
34:23
Speaker 1: that are already doing these types of things. Listen to
34:26
Speaker 1: more webinars that, you know, IPC has a myriad of
34:29
Speaker 1: things that we're doing in this space and just learning,
34:32
Speaker 1: you know, from others, attending conferences, attending all the independent
34:37
Speaker 1: pharmacy conferences that are coming up, the wholesaler conferences that
34:41
Speaker 1: are coming up. But it's really, I think, trying to
34:44
Speaker 1: not have the visceral reaction.
34:47
Speaker 2: Of these new things are happening. I don't like it.
34:50
Speaker 2: It isn't good for me, so I'm not going to participate.
34:54
Speaker 1: You know, someone told me way back in my 20s,
34:57
Speaker 1: if you're not, you know, sitting at the table, you're
34:59
Speaker 1: on the menu.
35:00
Speaker 2: And I think we all know that.
35:02
Speaker 1: That's been something that for going a couple decades back, right?
35:07
Speaker 2: I think pharmacy struggled.
35:08
Speaker 1: With a little bit and now we've been racing to
35:11
Speaker 1: catch up over the last 20 years and things that
35:13
Speaker 1: we're all doing together, but we're.
35:16
Speaker 2: All better together.
35:17
Speaker 1: So the more of us that can lean in to
35:21
Speaker 1: empowering the partners that we wanna work with, right? empowers
35:25
Speaker 1: ourselves and empowers our patients. And so I would just
35:28
Speaker 1: really ask stores to be open and curious and.
35:33
Speaker 2: Use these types of tools.
35:35
Speaker 1: This is one tool in the toolbox, clinical services, billing
35:39
Speaker 1: for clinical services.
35:40
Speaker 2: That's another tool, right, Todd?
35:42
Speaker 1: Whatever shape, weight, and form 340B is another tool in
35:46
Speaker 1: the toolbox.
35:46
Speaker 2: Remote monitoring is another tool.
35:49
Speaker 1: And so I see them all working together, but it's
35:52
Speaker 1: keeping an open mind because, you know, we're traditionally pretty
35:55
Speaker 1: cautious of any sort of payer relationship.
35:59
Speaker 2: And so it's listening to others.
36:01
Speaker 1: It's listening to other podcasts on similar topics and just
36:04
Speaker 1: giving it a try.
36:06
Speaker 5: Yeah, I'd like to add something to that, Todd, if
36:07
Speaker 5: I may.
36:09
Speaker 6: The first thing is this doesn't cost anything to any
36:11
Speaker 6: pharmacy to be a part of, you know, and that's
36:14
Speaker 6: the first thing that everyone says, what's a catch, right?
36:16
Speaker 6: I mean, Shelly said it a couple of times, you know,
36:19
Speaker 6: you know, who's losing, you know, what's going on here.
36:21
Speaker 6: And as far as the pharmacist is concerned, you're not losing,
36:24
Speaker 6: you're actually winning. So don't worry about anything else. Second
36:27
Speaker 6: thing from an AAPA perspective, like, you know, our account
36:30
Speaker 6: management team led by Kelly Sneed and Shem Shibley. So
36:34
Speaker 6: you've had the pleasure of meeting Todd before. They spend
36:37
Speaker 6: a lot of time talking to our members about these
36:39
Speaker 6: type of programs exactly. Day-to-day is when these opportunities come up,
36:43
Speaker 6: you know, a lot of my members, you know, will
36:45
Speaker 6: send me messages off, you know, off topic. Sometimes they say, hey,
36:47
Speaker 6: Kelly and Shem's, took a lot of time to talk
36:50
Speaker 6: to me about this MTM program or this, you know,
36:53
Speaker 6: whatever it may be. And I know a lot of
36:54
Speaker 6: these pharmacy GPOs, including IPC, spend a lot of time,
36:58
Speaker 6: you know, with their, you know, training their account management
37:00
Speaker 6: representatives and calling their members and getting them aligned on
37:04
Speaker 6: these type of programs and getting them on board with them.
37:07
Speaker 6: So I think that, you know, from the AAPA's perspective,
37:10
Speaker 6: from my view, a lot of our members are very
37:12
Speaker 6: receptive to this type of engagement, are usually very highly
37:17
Speaker 6: engaged on these type of programs. because of our account
37:19
Speaker 6: management team and the ability to reach out to them
37:22
Speaker 6: and their level of trust with us. So the way
37:24
Speaker 6: I see it moving forward is how do we get
37:26
Speaker 6: these pharmacies on board with these type of programs is
37:30
Speaker 6: leveraging all the great things Shelly and IPC are doing
37:33
Speaker 6: and making available to their affiliate pharmacies and encouraging and
37:38
Speaker 6: training and getting our account management team to be able
37:41
Speaker 6: to properly push this information out and get these pharmacies
37:46
Speaker 6: on board is critical moving forward. I mean, that's going
37:49
Speaker 6: to break the ceiling, the glass ceiling that's above us
37:52
Speaker 6: when it comes down to offering these.
37:53
Speaker 5: Types of services.
37:54
Speaker 3: Listeners, as Shelly said in the show notes, if you're driving,
37:58
Speaker 3: you're doing something, jogging, chopping vegetables, chopping broccoli. Remember that, Shelly,
38:03
Speaker 3: from Saturday Night Live. If you're doing something, you can't
38:07
Speaker 3: look at your screen. Don't worry about it. Wait till
38:09
Speaker 3: you get back somewhere safe. Go to the show notes.
38:12
Speaker 3: There's going to be links there. to get you access
38:15
Speaker 3: to these people and these experts and be able to
38:18
Speaker 3: ask questions and be able to understand how to get going.
38:22
Speaker 3: And that's just it. It's prep right now. You have
38:26
Speaker 3: to start thinking, what are we doing differently? What are
38:29
Speaker 3: we doing to build a new infrastructure to enter 2027,
38:34
Speaker 3: not starting, but moving into a new program and moving
38:39
Speaker 3: into new marketing?
38:40
Speaker 4: And this is another thing.
38:42
Speaker 3: IPC has always been good, and shout out to AAPA, too.
38:47
Speaker 3: I've worked with them at the IPC conferences, an amazing group.
38:50
Speaker 3: They're good at marketing. They're good at communications. They're going
38:53
Speaker 3: to teach you and help you push programs out to
38:57
Speaker 3: your community to make it understandable and to get your
39:01
Speaker 3: community involved, get them asking questions back to the independent
39:04
Speaker 3: community pharmacies and become the source of information, become the
39:08
Speaker 3: healthcare hub that you are in your communities. I am
39:12
Speaker 3: so honored to have had both of you on the
39:16
Speaker 3: show today. Thank you so much, Shelley, for bringing such
39:19
Speaker 3: a great guest to us, somebody that's in the trenches
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Speaker 3: that cares about his community and cares about what's happening
39:26
Speaker 3: in healthcare today.
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Speaker 4: Sammy, this has been great. I want to thank you both.
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Speaker 5: Pleasure's mine, Todd. Thank you so much.
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Speaker 6: And Shelly, as always, we'd love to work with you
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Speaker 6: guys and hopefully we can continue all the good work.
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Speaker 2: Absolutely. Thank you both for having me today.
39:40
Speaker 3: Hey, you were listening to the Pharmacy Podcast Network, one
39:44
Speaker 3: of our programs sponsored by Independent Pharmacy Cooperative, IPCRX.com. Take
39:51
Speaker 3: a look, ask lots of questions. Let's get ready for
39:53
Speaker 3: a new year coming up this fall. And If you're
39:56
Speaker 3: going to NCPA, make sure we connect. We will be
40:00
Speaker 3: there as press covering the event. Make sure you connect
40:04
Speaker 3: with Shelly and the IPC team. And just take time
40:10
Speaker 3: to meet each other. It's so important that we get together.
40:12
Speaker 3: I say together, Rx. Hey, we'll talk to you next time.