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he Medicare GLP-1 Bridge: Access, Affordability & the Pharmacist’s Role | TWIRx · Pharmacy Podcast Network

• 0:01
  Speaker 1: And if your website is outdated, doesn't work, or inaccurately describes.
• 0:03
  Speaker 2: What your business currently does, you could be losing business.
• 0:26
  Speaker 2: To step up your online game, reach out to our partners,
• 0:29
  Speaker 2: Finch Marketing. They can create a customized, fully responsive website
• 0:33
  Speaker 2: to help you get found by potential clients or patients,
• 0:35
  Speaker 2: but also by search engines and AI. They offer quick
• 0:38
  Speaker 2: turnaround on new sites and updates tailored to your brand style. Plus,
• 0:43
  Speaker 2: it will look great. For a detailed website review or
• 0:46
  Speaker 2: a fresh new look, contact Finch Marketing at finchmarketingsolutions.com to
• 0:50
  Speaker 2: get started.
• 1:01
  Speaker 3: You are listening to the global network of podcasters dedicated
• 1:05
  Speaker 3: to the pharmacy profession.
• 1:06
  Speaker 4: Welcome to the Pharmacy Podcast Network. This is Twerks. We're
• 1:43
  Speaker 4: Twerks and the Works. I'm going to change mics. Got
• 1:54
  Speaker 4: the brand now. I got the brand. The brand. We
• 1:58
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• 2:03
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• 2:08
  Speaker 4: the hard way. about not protecting my brand, but big
• 2:12
  Speaker 4: announcement out on LinkedIn this week. We trademarked finally the
• 2:18
  Speaker 4: pharmacy podcast network. So that's pretty cool, right? Let's celebrate that.
• 2:31
  Speaker 4: Thank you. Thank you. Thank you. Thank you. Hey, welcome
• 2:34
  Speaker 4: to Twerks. My name's Todd, your host today. of Twerks,
• 2:37
  Speaker 4: This Week in Pharmacy, the host of other podcasts, but
• 2:43
  Speaker 4: I don't want to be hosts anymore. So shout out
• 2:45
  Speaker 4: to you, you pharmacists out there and you pharmacy technicians
• 2:49
  Speaker 4: out there. We are recruiting hosts for 2027. We're going
• 2:53
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• 2:57
  Speaker 4: want you to be a part of it. It's why
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  Speaker 4: we are the number one podcasting platform in the world
• 3:01
  Speaker 4: for the pharmacy industry. It's because of you and you're
• 3:05
  Speaker 4: driving some of the best content out there. And we
• 3:08
  Speaker 4: want you to come and be part of the network.
• 3:11
  Speaker 4: So if you've thought of podcasting, if you've thought of
• 3:16
  Speaker 4: being part of something, maybe you don't want to run
• 3:19
  Speaker 4: your own podcast. Maybe you want to be part of
• 3:23
  Speaker 4: a bigger network as we have so many people that
• 3:30
  Speaker 4: are part of this network. It's been wild. I'm inviting you.
• 3:34
  Speaker 4: Reach out to me. Send me an email. My last
• 3:37
  Speaker 4: name is Uri. It's spelled E-U-R-Y at pharmacypodcast.com. Once again,
• 3:44
  Speaker 4: that's Uri at pharmacypodcast.com. We're going to get into a
• 3:53
  Speaker 4: lot today. We have Dr. Hamilton that's coming on from BuzzHealth.com.
• 3:58
  Speaker 4: You're not going to want to miss that interview. Very
• 4:00
  Speaker 4: interesting discussion on how AI is really transforming treatment management.
• 4:07
  Speaker 4: And we're going to hear from Megan Urban from Outcomes,
• 4:14
  Speaker 4: who is one of our sponsors for today's Twerks. But first,
• 4:18
  Speaker 4: Twerks News. Twerks News is up. Medicare Part D paid nearly...
• 4:25
  Speaker 4: $ 588 million for ineligible over-the-counter drugs. And a federal audit
• 4:35
  Speaker 4: estimates that Medicare Part D plans made approximately $ 588 million
• 4:41
  Speaker 4: in improper payments between 2021 and 2023 for five medications
• 4:47
  Speaker 4: that had transitioned from prescription to over-counter status. Health and
• 4:52
  Speaker 4: Human Services Office of Inspector General attributed the problem partly
• 4:58
  Speaker 4: to outdated FDA data and the absence of a clear
• 5:03
  Speaker 4: CMS deadline for plans to stop covering affected products. CMS
• 5:09
  Speaker 4: agreed with the recommendations to establish stronger rejection procedures I
• 5:16
  Speaker 4: find this really interesting, exposing a major coordination problem in
• 5:20
  Speaker 4: the federal government. That in of itself is not a surprise.
• 5:24
  Speaker 4: The FDA labeling is an issue. Manufacturer responsibilities in communicating
• 5:29
  Speaker 4: to CMS and Part D claims processing. Read more about
• 5:35
  Speaker 4: that on Fierce Healthcare article. The link will be in
• 5:40
  Speaker 4: the show notes. Next up, On Twerks News, FDA and
• 5:45
  Speaker 4: manufacturers respond to estradiol patch supply pressure, supply issues, and
• 5:53
  Speaker 4: the FDA is working with six manufacturers to increase suppliers
• 5:57
  Speaker 4: of the transdermal patches following a sharp rise in demand.
• 6:02
  Speaker 4: Manufacturers are adding shifts, increasing batch sizes. expanding specialized production capacity,
• 6:10
  Speaker 4: although FDA has not declared a national shortage. Availability varies
• 6:16
  Speaker 4: considerably by product, pharmacy, and geographic areas. Boy, pharmacists under
• 6:21
  Speaker 4: pressure again because it's the patient at the counter that's
• 6:25
  Speaker 4: looking at you and glaring at you, and they're all
• 6:27
  Speaker 4: pissed off because they would like their patched And they're
• 6:32
  Speaker 4: serving as the conduit of information. Shout out to our
• 6:35
  Speaker 4: pharmacists and technicians as the frontline supply chain creates problems
• 6:40
  Speaker 4: for you. Helping patients to locate those products and communicate
• 6:45
  Speaker 4: with prescribers. Look to organizations like Value Drug, Key Source.
• 6:54
  Speaker 4: Reach out to them. Ask them questions about supply. You
• 6:57
  Speaker 4: might be surprised. and try to stay ahead of it.
• 7:01
  Speaker 4: But I feel bad for you guys this week in
• 7:03
  Speaker 4: pharmacy because you just have additional added pressures, and now
• 7:06
  Speaker 4: it's the estradiol patch issue. Hey, we have next up
• 7:14
  Speaker 4: on Twerks News, and oh, that last article was from Reuters.
• 7:19
  Speaker 4: I'll have that link in the show notes. Last up
• 7:23
  Speaker 4: on Twerks News, pediatric and obstetric, Obstetric, they, and I
• 7:31
  Speaker 4: don't really understand this from, it's a release of a
• 7:34
  Speaker 4: new RSV COVID guidelines. And the American Academy of Pediatrics
• 7:43
  Speaker 4: and American College of Obstetricians and Gynecologists released an update
• 7:49
  Speaker 4: on respiratory season recommendations covering RSV and COVID protection. So
• 7:57
  Speaker 4: Just a shout out to our pharmacist for clarification. A
• 8:00
  Speaker 4: difference of RSV and COVID, or is this now one vaccine?
• 8:04
  Speaker 4: Is it two vaccines, one vaccine? The professional societies are
• 8:09
  Speaker 4: providing clinical direction while federal vaccine recommendations remain unsettled. So
• 8:15
  Speaker 4: I'm confused as everybody. Once again, it comes back to
• 8:19
  Speaker 4: pharmacist oversight and pharmacist suggestion. Reach out to your local
• 8:25
  Speaker 4: state health and human services if you have suggestions, and
• 8:29
  Speaker 4: don't think that you don't have a voice. You do
• 8:31
  Speaker 4: have a voice. And also your state pharmacy associations. Please
• 8:36
  Speaker 4: reach out if you know something. Reach out to your
• 8:39
  Speaker 4: state association and try to assist. Pharmacists may encounter conflicting recommendations,
• 8:47
  Speaker 4: and that's why I'm confused around this. and it will
• 8:52
  Speaker 4: have growing patient confusion. We're going to need some clear counseling,
• 8:57
  Speaker 4: careful eligibility review and coordination with pediatricians, obstetric providers, and
• 9:04
  Speaker 4: will be essential for 2026 and 2027 respiratory season. There's
• 9:09
  Speaker 4: an article out there on Pharmacy Times that's going to
• 9:14
  Speaker 4: cover this. And like I said, I do not This
• 9:18
  Speaker 4: week in pharmacy, I do not feel like I'd want
• 9:22
  Speaker 4: to be a pharmacist necessarily a lot of the time
• 9:26
  Speaker 4: in this week. You guys go through a lot. You're
• 9:29
  Speaker 4: under so much pressure. But I feel that there has
• 9:36
  Speaker 4: to be a website that you can push patients to,
• 9:40
  Speaker 4: and therein lies an advantage for our independent community pharmacies.
• 9:45
  Speaker 4: And for our long-term care pharmacies to create an information
• 9:49
  Speaker 4: source that you know the information and you're able to
• 9:53
  Speaker 4: publish that information and you're able to assure people that
• 9:56
  Speaker 4: what they're going to has been updated. because how this
• 10:01
  Speaker 4: information gets out there and what's available. Last on Twerks News,
• 10:09
  Speaker 4: this comes from DiversifyRx and I was really impressed with
• 10:14
  Speaker 4: the layout of this information and this is the pharmacist
• 10:19
  Speaker 4: Remote Patient Monitoring Comment Playbook. CMS wants to cut contracted
• 10:26
  Speaker 4: pharmacists out of remote patient monitoring. And this document, if
• 10:32
  Speaker 4: you go to diversifyrx.com, you'll be able to find this.
• 10:36
  Speaker 4: I'll have a link in the show notes. You have
• 10:39
  Speaker 4: 10 days, 11 hours, and 29 minutes to submit your
• 10:44
  Speaker 4: comments online. On July 14th of this year, CMS released
• 10:48
  Speaker 4: its proposed rule for the 2027 Medicare physician fee schedule.
• 10:55
  Speaker 4: There's a code. It's CMS code 1848-P, as in Paul. 1848-P,
• 11:06
  Speaker 4: and buried in those 700 pages is one sentence that
• 11:10
  Speaker 4: should make every pharmacist owner sit up straight. And it
• 11:14
  Speaker 4: says that CMS proposes to pay for RPM, remote patient monitoring,
• 11:20
  Speaker 4: and RTM, remote treatment management and monitoring services only when
• 11:25
  Speaker 4: they perform by a clinical staff employed by the billing practice,
• 11:31
  Speaker 4: not when they are delivered by contractors. So the translation
• 11:36
  Speaker 4: that Diversify wrote up, if I can talk, If you
• 11:41
  Speaker 4: or your pharmacist are contracted with local physician practices to
• 11:45
  Speaker 4: run their remote physiological monitoring, RPM, or remote therapeutic monitoring, RTM, programs,
• 11:53
  Speaker 4: that entire arrangement stops being billable on January 1st of
• 11:58
  Speaker 4: 2027 unless enough of us convince CMS to change the course.
• 12:05
  Speaker 4: One piece of good news, this proposal does not touch
• 12:08
  Speaker 4: chronic care management, CCM, or Advanced Primary Care Management, APCM.
• 12:15
  Speaker 4: Contracted staffing for those services continues as is, but make
• 12:21
  Speaker 4: no mistake, if the employed only rule sticks for RPM
• 12:27
  Speaker 4: and RTM, care management could be next. We got to
• 12:30
  Speaker 4: communicate to CMS this is a bad move for public health.
• 12:35
  Speaker 4: I want you to read through this. I want to
• 12:36
  Speaker 4: give a shout out to DiversifyRx for coming up with this.
• 12:39
  Speaker 4: Thank you. for putting this together. It'll take you through
• 12:43
  Speaker 4: why your comment actually matters. There's a button here to
• 12:46
  Speaker 4: submit your comment. Everyone listening to Twerks today, I want
• 12:51
  Speaker 4: you to submit a comment. I don't care if you
• 12:52
  Speaker 4: own a pharmacy or not. This is a public health
• 12:56
  Speaker 4: issue and pharmacists need to stay part of this. For
• 13:01
  Speaker 4: your remote patient monitoring, it's a big revenue opportunity as well.
• 13:07
  Speaker 4: And like I said, I will have a link in
• 13:13
  Speaker 4: the show notes to take a look at this and
• 13:17
  Speaker 4: to understand it better. This document is well done, so
• 13:21
  Speaker 4: look it up. We have a quick message from one
• 13:27
  Speaker 4: of our new Pharmacy Podcast Network members, Outcomes. Hey, Megan,
• 13:33
  Speaker 4: take it away.
• 13:35
  Speaker 3: Hey, Todd, it's Megan Urban over here at Outcomes. I'm
• 13:38
  Speaker 3: really excited for the upcoming Labor Day holiday, but I
• 13:41
  Speaker 3: do want to be honest. I'm actually even more excited
• 13:44
  Speaker 3: for next week. Next week at Outcomes, I'm hosting a
• 13:47
  Speaker 3: special webinar on what's new in Rx30 and everything that's
• 13:52
  Speaker 3: going on at Outcomes. If you are an RX30 client
• 13:56
  Speaker 3: or are just curious about what's going on with our
• 14:00
  Speaker 3: RX30 PMS system, I encourage you to tune in and listen.
• 14:04
  Speaker 3: Until then, I hope everyone has a wonderful Labor Day weekend,
• 14:08
  Speaker 3: and we'll see you next week.
• 14:11
  Speaker 4: Hey, thanks, Megan, for that update. We have a good
• 14:15
  Speaker 4: show today. I want to give a shout-out to Dr.
• 14:19
  Speaker 4: Javi Hamilton. with BuzzHealth and what they're doing. Another example
• 14:26
  Speaker 4: of how pharmacists are in demand, BuzzHealth Bridge Program. We're
• 14:31
  Speaker 4: going to go over that. We're going to take some
• 14:34
  Speaker 4: time to listen in and to learn of what that
• 14:37
  Speaker 4: means for you. And you should know for any treatment
• 14:41
  Speaker 4: management of what this means for you. And we'll be
• 14:45
  Speaker 4: right back with more twerks.
• 14:51
  Speaker 2: Are you making the right impression with your potential patients
• 14:54
  Speaker 2: or clients? Your website is oftentimes the first and potentially
• 14:59
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• 15:02
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• 15:05
  Speaker 2: a conversation. And if your website is outdated, doesn't work,
• 15:08
  Speaker 2: or inaccurately describes what your business currently does, you could
• 15:12
  Speaker 2: be losing business. To step up your online game, reach
• 15:15
  Speaker 2: out to our partners, Finch Marketing. They can create a customized,
• 15:18
  Speaker 2: fully responsive website to help you get found by potential
• 15:22
  Speaker 2: clients or patients, but also by search engines and AI.
• 15:25
  Speaker 2: They offer quick turnaround on new sites and updates tailored.
• 15:28
  Speaker 4: To your brand style.
• 15:30
  Speaker 2: Plus, it will look great. For a detailed website review
• 15:33
  Speaker 2: or a fresh new look, contact Finch Marketing at finchmarketingsolutions.com
• 15:37
  Speaker 2: to get started.
• 15:46
  Speaker 4: Hey, we're back on This Week in Pharmacy, and I
• 15:50
  Speaker 4: have our favorite provider in the studio with me today,
• 15:54
  Speaker 4: a pharmacist, PharmD, Holly Hamilton. How are you doing? Thanks
• 16:00
  Speaker 4: so much for being here on Twerks.
• 16:02
  Speaker 5: Yeah, thank you so much for having me, Todd. I'm
• 16:04
  Speaker 5: doing well. How are you doing?
• 16:06
  Speaker 4: I'm doing great. It's the end of the week. It's Friday.
• 16:09
  Speaker 4: It's always my favorite day to get ready for the weekend.
• 16:11
  Speaker 4: Do you have any plans this weekend? What are you
• 16:14
  Speaker 4: going to be doing?
• 16:15
  Speaker 1: You know, my husband and I and our two pups
• 16:17
  Speaker 1: and a cat, we live in Portland, Maine right now.
• 16:20
  Speaker 1: So this is the first year that we decide to
• 16:22
  Speaker 1: not taking any summer vacation. So Portland, Maine and Maine
• 16:26
  Speaker 1: in general, which is very beautiful in the summer and
• 16:28
  Speaker 1: the fall.
• 16:28
  Speaker 5: So we are.
• 16:30
  Speaker 1: Just exploring farmer's market, you know, like local farm, you know,
• 16:33
  Speaker 1: like strawberry farms and things like that.
• 16:35
  Speaker 5: We're out here and exploring the beaches.
• 16:38
  Speaker 1: So yeah, that's what we try to do every weekend,
• 16:41
  Speaker 1: enjoying the summer while it lasts.
• 16:44
  Speaker 4: When you have Portland as a backdrop for your life,
• 16:46
  Speaker 4: it's almost like you can be on vacation all the
• 16:49
  Speaker 4: time if you want to be, depending on where you're
• 16:52
  Speaker 4: going and where the weather is. We're in the southwestern
• 16:56
  Speaker 4: sector of the United States, and I never knew this
• 16:59
  Speaker 4: until about two years ago. Southwestern Pennsylvania is the third
• 17:06
  Speaker 4: least sunshiny region of the United States. We get like
• 17:09
  Speaker 4: 78 days. of pure sunshine. And it's not enough for me.
• 17:14
  Speaker 4: So I'm a little bit down that summer is on
• 17:17
  Speaker 4: its eve.
• 17:19
  Speaker 1: You know, I was in Scranton, Pennsylvania for four years.
• 17:22
  Speaker 1: So I feel for you. I know exactly what you're
• 17:25
  Speaker 1: talking about.
• 17:27
  Speaker 4: More sunshine, more sunshine.
• 17:29
  Speaker 5: Yeah, exactly.
• 17:33
  Speaker 4: Hey, I want to jump into why you're here. Tell
• 17:37
  Speaker 4: our listeners, and this is important for a couple of reasons.
• 17:40
  Speaker 4: Number one, what's happening and how BuzzHealth is helping the
• 17:45
  Speaker 4: pharmaceutical delivery market, pharmacy care market with the bridge program,
• 17:50
  Speaker 4: which we'll get into. But then a sidestep and something
• 17:54
  Speaker 4: that you might not have thought more about, pharmacists are evolving,
• 18:00
  Speaker 4: major evolution. And your role is very interesting in how
• 18:06
  Speaker 4: you've evolved into becoming someone who's become an expert around
• 18:12
  Speaker 4: getting things paid for and getting the roadblocks out of
• 18:16
  Speaker 4: the way and how you've inserted yourself into BuzzHealth. So
• 18:19
  Speaker 4: this is exciting because there are pharmacist listeners right now
• 18:23
  Speaker 4: that are like, listen, I would like to make a
• 18:25
  Speaker 4: career transition. I'd like to get on a different path.
• 18:29
  Speaker 4: And you're kind of one of those pharmacists that did
• 18:31
  Speaker 4: exactly that. You're a non-traditional pharmacist per se. So talk
• 18:35
  Speaker 4: to us about a little bit about your background, where
• 18:37
  Speaker 4: you went to school, why you wanted to become a pharmacist. Yes.
• 18:42
  Speaker 1: So I went to school in.
• 18:45
  Speaker 5: Auburn University in Alabama.
• 18:47
  Speaker 1: So I went to the doctorate pharmacy program there for
• 18:51
  Speaker 1: four years.
• 18:52
  Speaker 5: And so I grew up in Vietnam.
• 18:54
  Speaker 1: I came to Alabama when I was 16, went to
• 18:58
  Speaker 1: undergrad and college.
• 19:00
  Speaker 5: Pharmacy school there. Love it there.
• 19:02
  Speaker 1: But I've just been all around the country. My background
• 19:05
  Speaker 1: mainly is in clinical pharmacy. I work mainly in hospital
• 19:08
  Speaker 1: adult internal medicine. I love hospital medicine, but I'm not
• 19:15
  Speaker 1: going to lie to you. I mean, after COVID and everything,
• 19:18
  Speaker 1: I feel like I'm speaking for all the healthcare providers
• 19:21
  Speaker 1: out there.
• 19:21
  Speaker 5: We are a.
• 19:22
  Speaker 1: Bit burned out to say the least. So, you know,
• 19:26
  Speaker 1: I think when I work in the hospital, you know,
• 19:30
  Speaker 1: I see my role as a central person between the patient,
• 19:34
  Speaker 1: the provider, the nurse, you know, like we are known
• 19:38
  Speaker 1: as a drug expert. And I don't take that term
• 19:41
  Speaker 1: lightly because I want to make sure that everything is
• 19:43
  Speaker 1: safe effective for the person who's receiving it. That could
• 19:47
  Speaker 1: be somebody's mother, somebody's sister, and sons and daughters. So
• 19:53
  Speaker 1: we take the role not so lightly. So when I
• 19:57
  Speaker 1: was working in the hospital, I realized that we can
• 20:01
  Speaker 1: talk about therapy and guidelines all day long, but if
• 20:05
  Speaker 1: the patient cannot afford the medication, what is the.
• 20:09
  Speaker 5: Point of that?
• 20:10
  Speaker 1: So I started working for Buzz, or it's now Buzz Health,
• 20:15
  Speaker 1: back in 2020, 2021, between that, during the pick up COVID.
• 20:20
  Speaker 1: So then, yeah, I was a consultant for the company
• 20:24
  Speaker 1: for a few years. And then I come out full
• 20:27
  Speaker 1: time as their senior pharmacy director. And we just focus
• 20:30
  Speaker 1: on health equity and medication assets for everyone. And now
• 20:34
  Speaker 1: we just focus on the upstream part of the prescription
• 20:38
  Speaker 1: prescription journey so like not so much at the counties
• 20:41
  Speaker 1: anymore but you know we are working every day to
• 20:45
  Speaker 1: improve uh transparency and visibility for prescription pricing where you
• 20:51
  Speaker 1: can act on it before the patient reach the pharmacy counter.
• 20:56
  Speaker 4: I love that your role has transformed into someone who
• 21:01
  Speaker 4: once again is advocating for the patient's health assuring that
• 21:04
  Speaker 4: there's less roadblocks to getting things paid for so that
• 21:07
  Speaker 4: they can stay adherent, so they can stay on medications,
• 21:10
  Speaker 4: and then you can make adjustments along the way. Talk
• 21:13
  Speaker 4: to us about BuzzHealth. There's a bridge program that really
• 21:17
  Speaker 4: has evolved and is becoming a lot more defined. Talk
• 21:22
  Speaker 4: to us about what actually qualifies for this bridge program
• 21:25
  Speaker 4: and where does the clinical fine print, where does that
• 21:29
  Speaker 4: kind of fit into this?
• 21:31
  Speaker 1: I think the bridge program is actually very interesting. And
• 21:35
  Speaker 1: when I was talking to some family member the other day,
• 21:39
  Speaker 1: you know, like there was like the bridge program, like why,
• 21:42
  Speaker 1: what is it called bridge?
• 21:44
  Speaker 5: And I say, well, I find it funny.
• 21:46
  Speaker 1: And the irony is that, you know, like the bridge
• 21:48
  Speaker 1: is not leading to anywhere, you know, like, cause they.
• 21:51
  Speaker 5: Was like, why, what is it called bridge?
• 21:53
  Speaker 1: You know, but the thing is, it was supposed to
• 21:56
  Speaker 1: be a bridge to a permanent program.
• 21:58
  Speaker 5: Called the balance model.
• 22:00
  Speaker 1: But as of April of this year, since Medicare, the
• 22:03
  Speaker 1: CMS has not had enough plan sponsor. So, you know,
• 22:09
  Speaker 1: they are put the balance model on hold for now. And, but,
• 22:14
  Speaker 1: you know, like, With that said, I don't think the
• 22:17
  Speaker 1: bridge program is a bad thing. It's run from July
• 22:21
  Speaker 1: of this year until December of 2027. So while maybe
• 22:26
  Speaker 1: as of now, as we're talking right now, we don't
• 22:28
  Speaker 1: know what is going to happen with the balanced model.
• 22:31
  Speaker 1: But for a year and a half, we can see
• 22:36
  Speaker 1: how is this model working. Because as we know, obesity is.
• 22:43
  Speaker 1: A problem is an issue that we try to, you know,
• 22:47
  Speaker 1: like we try to help a lot of people out there.
• 22:49
  Speaker 1: And I feel like the Bridge Program is a good
• 22:52
  Speaker 1: way to help to expand the coverage of these very
• 22:55
  Speaker 1: expensive GLP-1 medication that was not previously available to many
• 23:00
  Speaker 1: of our patients. So specifically, the Bridge Program covered the
• 23:06
  Speaker 1: GLP-1 for long-term weight management, right? So if you are
• 23:12
  Speaker 1: Medicare beneficiary with prescription drug coverage, either the traditional party
• 23:18
  Speaker 1: or just any prescription drug coverage with Medicare, you should
• 23:23
  Speaker 1: be able to be eligible for the bridge program. However,
• 23:28
  Speaker 1: if you have diagnosis like type 2 diabetes, then you
• 23:35
  Speaker 1: should be able to use the GLP-1 medication through your
• 23:39
  Speaker 1: traditional Part D coverage. Okay, so the interesting thing about
• 23:43
  Speaker 1: the FISH program is that it's operating completely outside of
• 23:47
  Speaker 1: your Part D coverage.
• 23:49
  Speaker 5: So they have their own.
• 23:52
  Speaker 1: System to process prior authorization, payment, all of that. So essentially,
• 23:58
  Speaker 1: you know, all these plans that sponsor property has no
• 24:02
  Speaker 1: risk in it.
• 24:02
  Speaker 5: And I think that.
• 24:03
  Speaker 1: Is definitely very interesting because, and that's why they're running
• 24:07
  Speaker 1: this as like a pilot or a bridge program per se,
• 24:10
  Speaker 1: you know, to see how would all this work. On
• 24:14
  Speaker 1: one hand, we have this program that eligible people eligible
• 24:19
  Speaker 1: patient can get these very expensive GW1 medication for weight
• 24:23
  Speaker 1: management for just $ 50 a month, right?
• 24:26
  Speaker 5: So compared to.
• 24:27
  Speaker 1: The list price of over $ 1, 000, and even when you
• 24:31
  Speaker 1: are eligible for the discount program, but the manufacturer is
• 24:35
  Speaker 1: still a couple of hundred dollars.
• 24:37
  Speaker 5: So that's not affordable for many people.
• 24:38
  Speaker 1: So $ 50 per month fixed co-payment for the bridge program.
• 24:48
  Speaker 1: I think that's a great way to see how does
• 24:51
  Speaker 1: it work, you know, to expand the assets of these
• 24:54
  Speaker 1: medication to these patients. But the things that we have
• 24:58
  Speaker 1: to keep in mind is that this $ 50 it would
• 25:02
  Speaker 1: not be counted.
• 25:02
  Speaker 5: Toward your deductible, right?
• 25:05
  Speaker 1: So, you know, like if everybody know deductible, you know,
• 25:08
  Speaker 1: you might have like, you know, like a thousand dollars
• 25:11
  Speaker 1: or $ 2, 000 deductible depends on your plans. And you're like,
• 25:14
  Speaker 1: once you meet your deductible, that's when your plan benefit
• 25:17
  Speaker 1: kicks in. So for our, um, patient who receiving GLB-1
• 25:23
  Speaker 1: through the PRISH program, you know, like this $ 50 would
• 25:26
  Speaker 1: not be counted to your out-of-pocket max or your deductible, right? So,
• 25:31
  Speaker 1: and you know, like $ 50 is when we're looking at
• 25:35
  Speaker 1: the list price of the medication was like, well, that's,
• 25:38
  Speaker 1: you know, like that's a, that's a good deal.
• 25:40
  Speaker 5: But you have to think.
• 25:40
  Speaker 1: About 50 times 12, that's $ 600 a year. And typically,
• 25:47
  Speaker 1: you will be on this medication long-term. And the population,
• 25:51
  Speaker 1: the people who are Medicare beneficiary, typically a lot of
• 25:56
  Speaker 1: these folks are on fixed income. So how does that
• 26:00
  Speaker 1: play a part in the overall long-term picture? And that's
• 26:03
  Speaker 1: the things that I'm very interested to find out and
• 26:07
  Speaker 1: to learn by December of 2027.
• 26:11
  Speaker 4: I'm so glad that you mentioned that because there are
• 26:14
  Speaker 4: listeners right now who are in the long-term care sector
• 26:17
  Speaker 4: of pharmacy. There's our community pharmacy operators who care for
• 26:23
  Speaker 4: people that are retiring. There's lots of complexities in some
• 26:26
  Speaker 4: of the changing systems. CMS confirms that retirees on employer-sponsored
• 26:33
  Speaker 4: Part D programs, which is known as the Employer Group
• 26:37
  Speaker 4: Waiver Plan or the EGWP, So yeah, more at work.
• 26:42
  Speaker 5: But yeah, that.
• 26:45
  Speaker 4: Hasn't reached most retirees. So why has that detail gone unnoticed?
• 26:52
  Speaker 1: Well, you know, the employer group waiver plan or.
• 26:56
  Speaker 5: At work, right?
• 26:57
  Speaker 1: So it can be very confusing because like those are
• 27:02
  Speaker 1: the retiree who still receive, you know, like the Medicare
• 27:06
  Speaker 1: benefit from the employers. So in a sense, it might
• 27:11
  Speaker 1: look like, you know, like commercial insurance or like employee
• 27:15
  Speaker 1: sponsored insurance. So a lot of them do not know
• 27:19
  Speaker 1: that they might be qualified for the bridge program. And
• 27:22
  Speaker 1: I think, you know, like we are, oftentimes, you know,
• 27:25
  Speaker 1: like when something like this come out, the headline would
• 27:28
  Speaker 1: be focusing on the $ 50.
• 27:30
  Speaker 5: And, you know, on one hand, you know, like I
• 27:32
  Speaker 5: think that's great.
• 27:33
  Speaker 1: You know, like everybody would be very interested in, you know,
• 27:35
  Speaker 1: like how do I assess, you know, this medication with
• 27:38
  Speaker 1: $ 50 a month. But on the other hand, I think,
• 27:41
  Speaker 1: you know, like this is where, you know, like access
• 27:43
  Speaker 1: and communication and education come in handy. And this is why,
• 27:48
  Speaker 1: you know, like benefit, you know, like managing your employee groups.
• 27:52
  Speaker 1: And even, you know, like, My people, pharmacists, this is
• 27:57
  Speaker 1: where we would shine. This is where education and talking
• 28:03
  Speaker 1: to patients would make a big difference in the big picture.
• 28:12
  Speaker 4: So you mentioned something, and I'm going to come back
• 28:13
  Speaker 4: to it. You said that this runs through December of 2027,
• 28:20
  Speaker 4: if I'm an employer, if I'm a benefits consultant, how
• 28:25
  Speaker 4: should employers think about that window?
• 28:29
  Speaker 1: Well, that's a long enough window for you to do
• 28:34
  Speaker 1: something But it's not long enough for you to look
• 28:39
  Speaker 1: at this program and see what they're doing, what's happening
• 28:43
  Speaker 1: and what are the outcomes. So you can mimic something
• 28:45
  Speaker 1: like this, right? If you are an employer who, and
• 28:49
  Speaker 1: of course, you know, like by the end, not even
• 28:51
  Speaker 1: by the end of this program, but even right now,
• 28:53
  Speaker 1: there are other people out there who are not Medicare.
• 28:57
  Speaker 1: beneficiaries looking at this program and think you know like
• 29:00
  Speaker 1: why does you know like if medicare can do this
• 29:03
  Speaker 1: you're like why can't my employer you're like looking something
• 29:05
  Speaker 1: like this for me so i think there's going to
• 29:08
  Speaker 1: be you know expectation change for that right so instead
• 29:14
  Speaker 1: of you know like even though it is not a
• 29:17
  Speaker 1: four or five years program a year and a half
• 29:21
  Speaker 1: is long enough for them to start this conversation, start
• 29:26
  Speaker 1: the education, talk to your employees, you know, see where
• 29:29
  Speaker 1: they are, like, what are their expectations, their interests, educate
• 29:33
  Speaker 1: them on, and even just start on incorporating different non-med program,
• 29:41
  Speaker 1: lifestyle modification program into your benefit package as well. as
• 29:50
  Speaker 1: a jumpstart to long-term weight management would be ideal. So
• 29:58
  Speaker 1: instead of not doing anything, I think definitely watch and
• 30:03
  Speaker 1: learn and definitely see how this program is going and
• 30:08
  Speaker 1: don't wait until December 2027.
• 30:10
  Speaker 5: See right now, how is it going? You know, like how,
• 30:12
  Speaker 5: you know, like how.
• 30:13
  Speaker 1: Many people are able to, you know, participate in the
• 30:16
  Speaker 1: bridge program, you know, like how are the $ 50, you know,
• 30:20
  Speaker 1: like fixed co-payment is playing a role.
• 30:24
  Speaker 5: In all of this. So definitely, you know, because I
• 30:27
  Speaker 5: feel like the expectation is going to change.
• 30:29
  Speaker 1: So have conversation, education, you know, like to your employee,
• 30:34
  Speaker 1: to other people that will be beneficial.
• 30:36
  Speaker 4: All right. I read, on an article through Pharmacy Times
• 30:43
  Speaker 4: about a little bit about the bridge program. Didn't really understand,
• 30:46
  Speaker 4: you know, everything that was going on. It creates this
• 30:50
  Speaker 4: new coverage pathway that's outside the traditional Part D benefit.
• 30:55
  Speaker 4: But what should pharmacists know when an eligible patient shows
• 30:58
  Speaker 4: up at the pharmacy and where the confusion or access barriers,
• 31:02
  Speaker 4: how does that play into it all?
• 31:06
  Speaker 1: I think the pharmacist would be the first person that
• 31:10
  Speaker 1: one face of the patient would see when they pick
• 31:13
  Speaker 1: up the medication. So I think with this, and I
• 31:18
  Speaker 1: mentioned that already, but the fact that the $ 50 does
• 31:21
  Speaker 1: not apply to the party deductible, I think that's huge.
• 31:26
  Speaker 1: You don't want to wait toward the end of the year.
• 31:30
  Speaker 1: Or even mid-year and somebody has been paying like $ 500
• 31:33
  Speaker 1: for this medication and they realize that, you know, why
• 31:37
  Speaker 1: my deductible is not going anywhere, right? So I think
• 31:42
  Speaker 1: it's definitely, you know, like while they are excited and
• 31:45
  Speaker 1: happy that they're able to get this medication for $ 50,
• 31:48
  Speaker 1: I think having this conversation is definitely, you know, like
• 31:52
  Speaker 1: beneficial for the patients.
• 31:54
  Speaker 5: That's for sure.
• 31:54
  Speaker 4: All right. So we have... Pharmacists listening in, technicians who
• 32:01
  Speaker 4: work on payment issues, obviously behind the scenes. What's that
• 32:06
  Speaker 4: one thing that you'd want employers and providers and pharmacists
• 32:09
  Speaker 4: to walk away knowing about the bridge program after your
• 32:13
  Speaker 4: conversation here on Twerks?
• 32:18
  Speaker 1: I think, you know, talk to your employees, you know,
• 32:21
  Speaker 1: like talk to, talk to, talk to the people in
• 32:25
  Speaker 1: the company and see what they want, right? Like instead
• 32:28
  Speaker 1: of like waiting until the end of the program, you know,
• 32:30
  Speaker 1: like stay up to date, you know, like to see
• 32:33
  Speaker 1: what is going on with the CMS bridge program, you know,
• 32:36
  Speaker 1: like how well they are doing because at the end
• 32:38
  Speaker 1: of the day, you know, like access to medication is essential,
• 32:41
  Speaker 1: but at the same time, payment model, payment pathway, and
• 32:47
  Speaker 1: how sustainable it is, is also very crucial because these
• 32:51
  Speaker 1: medications are not medication that you will be on for
• 32:55
  Speaker 1: three months. They are supposed to be for long-term treatment.
• 32:58
  Speaker 1: So how sustainable it is for your company, how sustainable
• 33:02
  Speaker 1: it is for your benefit package. So those are the
• 33:05
  Speaker 1: things that you should definitely sit down and have these
• 33:08
  Speaker 1: meaningful conversations with your folks and see what the expectations.
• 33:12
  Speaker 5: Are, what they're looking for, and what is doable.
• 33:17
  Speaker 1: And on the other hand, you can see what should
• 33:20
  Speaker 1: the plan be so that it can be sustainable forever.
• 33:23
  Speaker 1: everyone that is beneficial for your employees but also is
• 33:29
  Speaker 1: sustainable for the company.
• 33:30
  Speaker 4: Hey listeners you are not alone in any of this
• 33:35
  Speaker 4: we want to surround you with more information if you
• 33:38
  Speaker 4: do have questions about this if this still seems a
• 33:41
  Speaker 4: little shaky or confusing to you please look up buzz
• 33:45
  Speaker 4: health which is buzzhealth.com once again that's buzzhealth.com Javi, you've
• 33:51
  Speaker 4: got to promise that you're going to come back on Twerks,
• 33:54
  Speaker 4: bring another pharmacist with you, because I can always deal
• 33:57
  Speaker 4: with more pharmacists and more conversations about how we make
• 34:01
  Speaker 4: a better health care delivery model in especially our pharmacy care.
• 34:06
  Speaker 4: So thanks so much for being on Twerks.
• 34:08
  Speaker 5: Thank you so much, Todd. We need more people like you.
• 34:11
  Speaker 5: Thank you.
• 34:11
  Speaker 4: Thank you. Hey, we'll be right back with more Twerks. Hey, back, back, back.
• 34:24
  Speaker 4: What is up? Hey, we're running out to show, but
• 34:27
  Speaker 4: as we were listening to that interview, I was out
• 34:31
  Speaker 4: on the Instagram spheres. And there's an update here that
• 34:38
  Speaker 4: I want you to see from Sex Farm D, Dr.
• 34:43
  Speaker 4: Nadia Archambault. Take a listen to this.
• 34:48
  Speaker 6: We met with the FDA a couple of months ago,
• 34:49
  Speaker 6: and now they just put out this announcement. They're working
• 34:52
  Speaker 6: with all six of the manufacturers to increase supply. Guys,
• 34:56
  Speaker 6: this is the power of social media and this community.
• 34:58
  Speaker 6: We demand better healthcare, and we have to keep doing
• 35:01
  Speaker 6: that every.
• 35:02
  Speaker 5: Step of the way.
• 35:03
  Speaker 6: Of course, I'm going to keep you guys updated on
• 35:04
  Speaker 6: what happens next, but this is a huge step forward,
• 35:07
  Speaker 6: and I wanted to share it with you.
• 35:08
  Speaker 4: Is that good news? Is that good news? We just
• 35:12
  Speaker 4: did Twerks.
• 35:13
  Speaker 1: News, and.
• 35:15
  Speaker 4: The update is already out. I think that's amazing how
• 35:19
  Speaker 4: social media can impact issues in public health. Your voice matters.
• 35:25
  Speaker 4: September 4th, 2026. This was your episode of This Week
• 35:30
  Speaker 4: in Pharmacy. It's Labor Day weekend. I hope that you're
• 35:34
  Speaker 4: getting some time off, spending some time, downtime, relaxing, doing
• 35:38
  Speaker 4: something just to decompress, get ready for next week. I
• 35:43
  Speaker 4: feel like summer is coming to a close. The kids
• 35:47
  Speaker 4: are back in school. We got a lot going on
• 35:50
  Speaker 4: into the fall conference season coming up. The NCPA Inspire 2026,
• 35:56
  Speaker 4: that is the leading conference in our specialty pharmacy sector.
• 36:05
  Speaker 4: It's going to be in Washington, D.C. That's the NASP.
• 36:10
  Speaker 4: If anyone is going to the annual get together at
• 36:13
  Speaker 4: the Gaylord, please connect with me. I love talking with
• 36:18
  Speaker 4: specialty pharmacists and pharmacists in general and business people in
• 36:23
  Speaker 4: the business of pharmacy. I am excited to be returning
• 36:29
  Speaker 4: to the NASP. They're a great group. They've been an
• 36:34
  Speaker 4: amazing partner of ours. Once again, that is the National
• 36:38
  Speaker 4: Association of Specialty Pharmacy, and that is the Inspire event,
• 36:45
  Speaker 4: Inspire 2026. There's going to be a ton of people
• 36:50
  Speaker 4: there digging into specialty pharmacy. A shout-out to First Data
• 36:54
  Speaker 4: Bank and Clearway Health, who are our podcast press sponsors.
• 37:02
  Speaker 4: This is September 22nd through 25th at the Gaylord National
• 37:06
  Speaker 4: Resort I'm going to be talking about this more next
• 37:11
  Speaker 4: week on This Week in Pharmacy. And I just want
• 37:14
  Speaker 4: to thank you for what you do. Shout out to
• 37:16
  Speaker 4: our pharmacy technicians. The Impact Awards are coming up with
• 37:20
  Speaker 4: the NPTA. Shout out to Mike Johnston and his team.
• 37:25
  Speaker 4: The Impact Awards to raise up and celebrate some very,
• 37:31
  Speaker 4: very special pharmacy technicians, the right hand of pharmacists out there.
• 37:35
  Speaker 1: We are.
• 37:38
  Speaker 4: So proud to be their media and press sponsors. There's
• 37:42
  Speaker 4: a press release out there that you can read more
• 37:45
  Speaker 4: about the Impact Awards 2026. Thank you so much for
• 37:49
  Speaker 4: listening to This Week in Pharmacy. Share the show and
• 37:53
  Speaker 4: subscribe to the Pharmacy Podcast Network.
• 37:57
  Speaker 2: We're out.
• 37:57
  Speaker 4: Talk to you next week.