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Power, Policy, and Platforms: Inside the Forces Reshaping America’s Drug Supply Chain | TWIRx · 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. Welcome to the Pharmacy Podcast Network.
0:21
Speaker 2: Hey, welcome to Twurks.
0:22
Speaker 3: You are not going to want to miss today's This
0:26
Speaker 3: Week in Pharmacy it is Can you believe it? It
0:29
Speaker 3: is already December, December twelfth. Goodness gracious, where did twenty
0:36
Speaker 3: twenty five go? What an amazing this Week in Pharmacy
0:40
Speaker 3: it has been. I'm on cloud nine with so much
0:44
Speaker 3: of the activity that we got to be involved with,
0:47
Speaker 3: especially the Pharmacists Fight Back Act. The experience in Washington,
0:54
Speaker 3: DC was absolutely phenomenal. We cannot wait to share this
1:00
Speaker 3: with you. We're going to have a special podcast covering
1:02
Speaker 3: the Pharmacist Fight Back Act on Thursday, December eighteenth.
1:23
Speaker 4: What an experience that was.
1:40
Speaker 3: I'm grateful to APCI for sponsoring our press coverage of
1:47
Speaker 3: that event that just took place in the Capitol yesterday.
1:52
Speaker 3: We were just blown away by the participation and the
1:56
Speaker 3: excitement and the sincerit of all of the politicians that
2:02
Speaker 3: were involved, and how important it is that we have
2:06
Speaker 3: a bipartisans support for this bill. The PBM reform is
2:14
Speaker 3: happening It's taken a long time to happen. Everybody knows that.
2:18
Speaker 3: Everybody knows how frustrating it is. And I just want
2:26
Speaker 3: to just say thank you, thank you to everybody that
2:29
Speaker 3: stayed in in the fight made national news. This is
2:34
Speaker 3: coming from WKYT for Torqu's News today. This is Kentucky
2:39
Speaker 3: lawmaker introduces federal bill fight to fight pharmacy benefit Managers.
2:47
Speaker 3: This is Representative James Comey for the Fight Pharmacists Fight
2:52
Speaker 3: Back Act, and he mirrors the state law already in
2:55
Speaker 3: place for the great state of Kentucky. We got to
2:59
Speaker 3: talk with with State Representative Jake Auchenclass. We're going to
3:05
Speaker 3: have that as part of the special episode on January
3:08
Speaker 3: eighteenth of the PBM Reform Podcast. But this was exciting
3:13
Speaker 3: to be done in Washington, DC. A shout out to
3:16
Speaker 3: Pharmacists United for Truth and Transparency as well and all
3:20
Speaker 3: their work in this. Hey, let's go to the next
3:23
Speaker 3: Torquees News. This makes a lot of sense, doesn't it.
3:27
Speaker 3: If you're looking on your screen. CBS care Mark settles
3:30
Speaker 3: a PBM allegation for five million dollars. The Oklahoma Attorney
3:39
Speaker 3: General says that the PBM paid pharmacies less for drugs
3:43
Speaker 3: than what the medication cost, which is insanity. How does
3:48
Speaker 3: it even get to that point where you're doing it
3:51
Speaker 3: on purpose and you're putting pharmacies out of business and
3:57
Speaker 3: you're putting public health at risk. CBS care Mark will
4:01
Speaker 3: pay five million to Attorney General's Office. The money will
4:05
Speaker 3: repay pharmacies for sixty eight thousand plus prescriptions filled between
4:11
Speaker 3: January twenty twenty four and August twenty twenty five, for
4:15
Speaker 3: which they were paid less than what the drug costs.
4:19
Speaker 3: And this in and itself is very exciting to see
4:23
Speaker 3: that the CBS care Mark is getting this fine, that
4:27
Speaker 3: it's making the news, that it's making our public aware.
4:30
Speaker 3: But this is not even a scratch to them, because
4:34
Speaker 3: the pharmacies that are now out of business because of them,
4:37
Speaker 3: and the communities that don't have pharmacies because of them
4:40
Speaker 3: in these business practices, that's the issue, because now we
4:44
Speaker 3: don't have pharmacies in specific areas. Hey on to a
4:49
Speaker 3: little bit more brighter news. Pharmacy practice news reports, Seas
4:54
Speaker 3: of change, Preparing for payment prior authorizations, what's coming in
5:00
Speaker 3: six rolling sea of economic policy, technological and societal change.
5:06
Speaker 3: Charting a fear charging a clear financial strategy for health
5:11
Speaker 3: care systems is increasingly difficult, and how pharmacy budgets major
5:17
Speaker 3: contributors to expenses, labor, labor charges, drug and biologic revenue
5:23
Speaker 3: all across the care setting in patient outpatient. Take a read.
5:27
Speaker 3: This is going to be linked in the show notes.
5:30
Speaker 3: Once again. This came from Pharmacy Practice News reporting today
5:34
Speaker 3: December twelfth, Seeds of change preparing for payment prior authorizations
5:40
Speaker 3: coming in from specialty Pharmacy Continuum. Thank you for your work.
5:44
Speaker 3: Shout out to you guys, December twelfth. We have three
5:47
Speaker 3: forty B discount three forty B discounts at risk in
5:51
Speaker 3: twenty twenty five and beyond. This is how our three
5:56
Speaker 3: forty B drug pricing programs are facing intensive, intensifying scrutiny
6:01
Speaker 3: and legal battles at both state and federal levels in
6:05
Speaker 3: twenty twenty five, and how PBMs once again are tightening
6:09
Speaker 3: point of sale claim identification, states are enacting anti discrimination
6:16
Speaker 3: protection and covered entities are wanting waiting for the next
6:21
Speaker 3: shoe to drop, deepening on who you're speaking with, three
6:25
Speaker 3: forty B is either the greatest thing since slice spread
6:29
Speaker 3: or Lord Voldermont himself said Jesse Dresser Esquire, a partner
6:35
Speaker 3: at Fire and Lovett Life Science Department who heads the
6:39
Speaker 3: firm's Pharmacy practice group. This is once again tied back
6:44
Speaker 3: to how the PBMs have abused the system put into
6:48
Speaker 3: place to help those in need under the three forty
6:51
Speaker 3: b designed system has completely taken advantage of and the
6:56
Speaker 3: article goes on, So please do not miss out on
6:58
Speaker 3: that article in the show not Specialty Pharmacy Continuum. What
7:03
Speaker 3: a week in pharmacy it has been. We hope that
7:06
Speaker 3: you have had a good week. We hope that you're
7:10
Speaker 3: maybe getting into the Christmas spirit. I don't know, do
7:12
Speaker 3: you do you wait till the last minute to get
7:15
Speaker 3: into the into the Christmas spirit? I'm in, I'm ready
7:19
Speaker 3: to go. We will be excited to talk more about
7:25
Speaker 3: the pharmacists fight back. If you were there, we're going
7:27
Speaker 3: to be doing some follow up interviews. A shout out
7:30
Speaker 3: to Nicky Bryant, doctor Nicky Bryant, got to have you on.
7:34
Speaker 3: A shout out to Don Butterfield down in Florida. We're
7:37
Speaker 3: going to have to have you on. Excited to have
7:40
Speaker 3: seen you and spend some time with you. This is
7:44
Speaker 3: this Week in Pharmacy here we go. Hey there, welcome
8:10
Speaker 3: to this Week in Pharmacy. I'm your host, Todd Uri,
8:14
Speaker 3: founder of the Pharmacy Podcast Network. It's been a crazy week.
8:19
Speaker 3: Just got back from Washington, DC in support of the
8:21
Speaker 3: Pharmacist Fight Back Act. A shout out to Greg Ribold
8:27
Speaker 3: and the APCI team that invited us there to cover
8:31
Speaker 3: that event. There's going to be a bunch of content
8:33
Speaker 3: that's going to be coming out. We're going to be
8:35
Speaker 3: talking about what that means for the nation, what that
8:39
Speaker 3: means for our individual states, and getting updates. So we
8:45
Speaker 3: so much appreciate the updates that Greg brings us from
8:48
Speaker 3: the PBM Reform Podcast and what's going to happen in
8:53
Speaker 3: twenty twenty six. I'm hopeful there's so much happening in
8:56
Speaker 3: the usage of artificial intelligence. The later today's show, you're
9:00
Speaker 3: going to hear a discussion with Harry Travis, who is
9:04
Speaker 3: a consultant in the specially pharmacy space and he's a
9:09
Speaker 3: breath of fresh air when it comes to bringing us
9:11
Speaker 3: information about how AI is going to impact operations.
9:14
Speaker 2: And Amanda Oz going to be on.
9:16
Speaker 3: Doctor A who's going to be talking about Caratio and
9:20
Speaker 3: her role as a new consultant in the specialty pharmacy space.
9:23
Speaker 3: How does AI impact specially pharmacy specifically? Really looking forward
9:30
Speaker 3: to that interview. But today I have two special guests,
9:33
Speaker 3: both returning to twerks and no stranger to Twerks. He
9:38
Speaker 3: knows how twerks works. It's Antonio Checcha.
9:43
Speaker 5: Great to see you, my friend.
9:44
Speaker 2: It's good to see you too. You've been you've been
9:47
Speaker 2: so busy.
9:47
Speaker 3: I haven't been able to get you on, but excited
9:50
Speaker 3: that you're here today. Returning to Twerks is Alec Ginsburg.
9:58
Speaker 3: He is known as the drug store Cowboy. I absolutely
10:02
Speaker 3: love that nickname, and you are, in fact a cowboy
10:07
Speaker 3: out there. You're you're you're kicking up a lot of
10:10
Speaker 3: great information. That's why you're here today because I want
10:12
Speaker 3: to talk to you about an article that you wrote,
10:15
Speaker 3: which was titled the Hidden Lender in America's drug supply Chain.
10:20
Speaker 3: By the way, listeners, if you haven't read this, you
10:23
Speaker 3: have to read it. And I'm going to put a
10:25
Speaker 3: link in our show notes to that article. It's it's
10:29
Speaker 3: on your blog, right, Alec Or is it on linked
10:32
Speaker 3: It's at.
10:32
Speaker 6: A drugstore cowboy dot com. It'll be the first article
10:35
Speaker 6: that's on there.
10:37
Speaker 2: Excellent.
10:38
Speaker 3: I want to just open up to you, Alec, just
10:40
Speaker 3: give us the listeners, just a cliff notes of that
10:43
Speaker 3: article and why it lit some fires and how much
10:46
Speaker 3: attention it got when when you published it.
10:49
Speaker 7: Yeah, I think the inspiration for it, in the gist
10:52
Speaker 7: of it a nutshell, is that we've heard so much
10:55
Speaker 7: about the government stepping into controlling pricing of the g
10:59
Speaker 7: LP one and also with the new Inflation Reduction Act
11:03
Speaker 7: pricing it starts on January first, And my question as
11:06
Speaker 7: a pharmacy owner this whole time was, Okay, but how
11:10
Speaker 7: are we getting paid for.
11:12
Speaker 5: All of this?
11:12
Speaker 7: Because it doesn't seem like the cost is changing at all,
11:16
Speaker 7: So we're still going to be getting We're still going
11:19
Speaker 7: to be acquiring the drugs at the same price. You know,
11:21
Speaker 7: how does everything work from that point forward?
11:24
Speaker 6: And given that the.
11:26
Speaker 7: Pricing for the IRA drugs, those ten drugs they've negotiated
11:30
Speaker 7: is going to start in three weeks and I still
11:32
Speaker 7: don't know how this is going to work. I was
11:35
Speaker 7: starting to get worried, so I did a little research
11:37
Speaker 7: into it, and it turns out that they're creating this
11:40
Speaker 7: entirely new way of reimbursement for pharmacies direct with the manufacturers,
11:47
Speaker 7: and they're creating this new entity that's going to be
11:50
Speaker 7: like the transaction intermediary between pharmacies and getting reimbursements from
11:56
Speaker 7: the manufacturers.
11:57
Speaker 6: And the whole thing was so confusing.
11:59
Speaker 7: But at the end of it, when I got to
12:01
Speaker 7: the bottom of it, I realized that it's just another
12:04
Speaker 7: way for pharmacies to essentially turn into non guaranteed interest
12:10
Speaker 7: free lenders to the government, and it's just another burden
12:15
Speaker 7: that's being added to a pharmacy plate that's already operating
12:19
Speaker 7: on razor thin markets. And I just couldn't believe it,
12:22
Speaker 7: so I had to start chatting about it a little bit.
12:26
Speaker 3: I thought of Antonio as soon as I read it
12:28
Speaker 3: and wanted to hear from you. And when you said
12:31
Speaker 3: yes to the interview for to come on Twerks, I
12:34
Speaker 3: was a static because there's so much authenticity that you
12:38
Speaker 3: bring to these conversations around data through three access advisors
12:43
Speaker 3: and things that you're doing. But open us up and
12:47
Speaker 3: develop the summary for not only this article, but referencing
12:50
Speaker 3: back to what you see is the truth through data
12:53
Speaker 3: that you do in the research you do.
12:56
Speaker 5: Yeah, So it was good to hear.
13:00
Speaker 8: Alec expertly layout in layman's terms, how our system works,
13:07
Speaker 8: who funds it, and who benefits from it. You know,
13:13
Speaker 8: one of the things that I struggle with as somebody
13:16
Speaker 8: who's been trying to teach people about how the system works,
13:19
Speaker 8: is that there's for every transaction in pharmacy, it feels
13:23
Speaker 8: like there's like a dozen sub transactions, which obviously creates
13:28
Speaker 8: a lot of opportunity for those who are involved in
13:31
Speaker 8: those subtransactions to make money, but it also obviously benefits,
13:35
Speaker 8: you know, those who seek to arbitrage an increasingly complex system.
13:41
Speaker 8: The more complex it is, the easier it is to
13:44
Speaker 8: make money underneath the tent. Earlier this year, we worked
13:49
Speaker 8: with the National Community Pharmacist Association and CPA to try
13:54
Speaker 8: to predict what the impact of the IRA would be.
13:59
Speaker 8: Is excellently lays out the the IRA and the Medicare
14:09
Speaker 8: most or the maximum fare price policy creates is essentially
14:15
Speaker 8: a splitting of the transaction. To say, in the old model,
14:20
Speaker 8: whether you're paid barely or not for a Medicare claim,
14:24
Speaker 8: We're going to you're going to buy the drug at
14:26
Speaker 8: a high cost, You're going to get reimbursed at at
14:28
Speaker 8: a high price that may or may not get you
14:31
Speaker 8: to break even.
14:32
Speaker 5: But that's how it works right well.
14:33
Speaker 8: Now, under the maximum fare price under the Inflation Reduction Act,
14:39
Speaker 8: pharmacies should expect to receive about six about forty percent
14:43
Speaker 8: or less of the normal payment they would receive. So
14:47
Speaker 8: let's say you're buying a drug for about one thousand dollars.
14:50
Speaker 8: You're gonna get paid about four hundred dollars up front
14:53
Speaker 8: by your normal time schedule, but now you're gonna be
14:56
Speaker 8: waiting for about sixty percent of the overall value that
14:58
Speaker 8: transaction then come back to you weeks after that claim
15:02
Speaker 8: is processed.
15:03
Speaker 5: So we're talking about ten of the most.
15:06
Speaker 8: Popular drugs in the Medicare program for the most expensive
15:09
Speaker 8: drugs in the Medicare program, and you're asking pharmacies to
15:13
Speaker 8: float sixty percent of the value of a high cost
15:16
Speaker 8: medication without any sort of understanding whether or not you'll
15:20
Speaker 8: be made whole and essentially, again, to Alex's point, have
15:23
Speaker 8: an interest free loan back to the government. Our numbers
15:26
Speaker 8: that we put together back in January predicted that the
15:30
Speaker 8: average pharmacy would see about a ten thousand dollars week
15:35
Speaker 8: hit in terms of a budget shortfall, meaning that that's
15:39
Speaker 8: how much they'll be floating the government on average, just
15:42
Speaker 8: to prop up the negotiated payments on these ten Medicare drugs.
15:46
Speaker 7: Yeah, and not to cut you off, but just to
15:48
Speaker 7: verify that number before we hopped on, I took a look.
15:51
Speaker 7: I only had time to run it for three of
15:54
Speaker 7: the drugs, but just for eloquist, Jardians and Farciga. My
16:00
Speaker 7: pharmacy spent about one point three million dollars in twenty
16:03
Speaker 7: twenty five so far to acquire those drugs, so that
16:07
Speaker 7: you know, rough math, but it's about ten thousand dollars
16:10
Speaker 7: a week that were you know, laying out and just
16:12
Speaker 7: those three drugs alone, and that's just three of the seven.
16:15
Speaker 7: But you think about the course of the year, so
16:18
Speaker 7: let's say one point three million dollars. What this is
16:22
Speaker 7: saying is that there's there's pretty much a zero percent.
16:25
Speaker 6: Chance we're going to make any money on these medications.
16:27
Speaker 7: So let's say at the at the absolute maximum, we
16:30
Speaker 7: break even. If I just took that one point three
16:33
Speaker 7: million and let it sit in the bank and cash
16:35
Speaker 7: and made five percent, I'm making fifty thousand dollars, you know,
16:39
Speaker 7: four percent. It's just what they're asking us to do
16:43
Speaker 7: is insane. I mean, I always talk to you, Todd
16:47
Speaker 7: when I'm on here about my pharmacy has a pretty
16:49
Speaker 7: solid cash position because of the other businesses were involved in.
16:52
Speaker 7: But I don't think most pharmacies across America have that
16:55
Speaker 7: luxury where they can just say, all right, we'll take
16:58
Speaker 7: an additional chunk of change and be able to let
17:01
Speaker 7: it float for a while with no return.
17:02
Speaker 6: It's just it's.
17:03
Speaker 7: Going to You had mentioned to me before we hopped
17:06
Speaker 7: on here, like, do I have a number of how
17:08
Speaker 7: many pharmacies it might run out of business?
17:10
Speaker 4: I don't.
17:11
Speaker 6: That's more of Antonio's.
17:13
Speaker 7: Data, but I can tell you that certainly there are
17:16
Speaker 7: plenty of pharmacies that are already teetering where a couple,
17:19
Speaker 7: you know, an extra hundred thousand dollars here and there
17:21
Speaker 7: is what makes all the difference.
17:25
Speaker 3: Absolutely, we're hearing this from the buying groups that we're
17:29
Speaker 3: partnered with when we go to the pharmacy events and conferences.
17:33
Speaker 3: We're hearing directly from the slow down of growth, where
17:38
Speaker 3: a pharmacy says, hey, we wanted to position to purchase
17:41
Speaker 3: you know, two or three more pharmacies in a desert's
17:44
Speaker 3: position or somewhere where someone needs a community needs access
17:48
Speaker 3: doesn't have anymore. A rite aid closed down all over
17:51
Speaker 3: the place impacted Ohio second to Pennsylvania. How many pharmacies
17:56
Speaker 3: have been closed down throughout the state. I don't know
17:59
Speaker 3: how many in Ohio. I want to say over two
18:02
Speaker 3: hundred in Ohio right aids that are now closed down.
18:06
Speaker 3: But this has massive impacts to public health. And my
18:10
Speaker 3: question is, like policymakers media framing the new negotiated price
18:15
Speaker 3: or implementation for these types of shifts and how to
18:20
Speaker 3: get through it. But when it goes live and when
18:23
Speaker 3: this actually takes effect and when we're moving forward, what
18:27
Speaker 3: do you think what's the let's think about the patient
18:31
Speaker 3: for a second, of the people that don't have access,
18:34
Speaker 3: Like talk about that, Antonio. You have data to show
18:37
Speaker 3: maybe the tsunami that's coming.
18:41
Speaker 5: Yeah.
18:41
Speaker 8: I think one of the important things to consider is
18:44
Speaker 8: that whether we like the Biden administration's policies or not,
18:50
Speaker 8: a lot of the reforms that they injected in the
18:52
Speaker 8: Medicare program were designed to a lower the cost sharing
18:55
Speaker 8: obligations for patients and b lower the amount of money
19:00
Speaker 8: that government had to spend on medicines. So the way
19:03
Speaker 8: they got there is first and foremost, they changed ther fees.
19:07
Speaker 8: In the previous world, pharmacies were overpaid for medicines relative
19:12
Speaker 8: to their actual net prices that they were going to
19:14
Speaker 8: be paid, meaning that they were paid let's say, one
19:16
Speaker 8: hundred dollars for something that eventually could be clawed back
19:19
Speaker 8: to around fifty dollars.
19:21
Speaker 5: And pharmacies didn't like that.
19:22
Speaker 8: They didn't like the lack of predictability, they didn't like
19:24
Speaker 8: the lack of control, and they certainly didn't like what
19:26
Speaker 8: the net payments were after the clawbacks happened. But not
19:31
Speaker 8: thinking about pharmacy, what moving dir fees to the point
19:35
Speaker 8: of sale did help the patient right, because now they
19:37
Speaker 8: no longer had to overpay for their medicines at the
19:40
Speaker 8: point of sale and instead got a more reasonable cost
19:43
Speaker 8: sharing obligation. Dr fees were explicitly designed to deprive patients
19:48
Speaker 8: of the benefits of what negotiated discounts, PBMs and health
19:52
Speaker 8: plans had with pharmacies. Regardless when we liked that policy
19:55
Speaker 8: or not, it ultimately made pharmacies more cash strapped. Instead
20:00
Speaker 8: of being overpaid at the point of sale, now they
20:02
Speaker 8: went from being overpaid to underpaid at the point of sale,
20:05
Speaker 8: hoping that they can get some money later sort of
20:07
Speaker 8: enhanced bonus payment, which most.
20:09
Speaker 5: Pharmacies have not been able to get.
20:11
Speaker 8: So you have this problem where pharmacies are now essentially
20:14
Speaker 8: operating with very low cash flow. Then you compound that
20:17
Speaker 8: with the other issues with lower reimbursements across the commercial
20:20
Speaker 8: and medicaid marketplaces, although not every medicaid program has those problems,
20:24
Speaker 8: and so now you throw onto this new maximum fair
20:28
Speaker 8: price under Medicare that's now essentially telling pharmacies for some
20:31
Speaker 8: of the most popular and expensive drugs that data spense,
20:34
Speaker 8: they're going to have to float over half the value
20:36
Speaker 8: to the patient with no guarantee that they actually get
20:39
Speaker 8: made whole at the end of that reimbursement scheme, because
20:42
Speaker 8: the pharmacies relying not only upon some sort of retrospective
20:48
Speaker 8: transaction coming in from the government and the manufacturer, but
20:51
Speaker 8: they have to also rely on the PBM paying them
20:53
Speaker 8: a fair rate at the front end of that payment
20:55
Speaker 8: as well, which is not guaranteed. So an aggregate, you're
21:00
Speaker 8: asking a very cash strapped industry to prop up an
21:05
Speaker 8: entire system of the most popular medicines in the Medicare program.
21:10
Speaker 8: Whether that becomes affordable to the patient or not, is
21:13
Speaker 8: usually what the government is concerned about. What they're not
21:16
Speaker 8: thinking about, and the thing they always overlook is whether
21:19
Speaker 8: or not that pharmacy exists in the first place to
21:21
Speaker 8: give that drug to the patient.
21:25
Speaker 7: It's nuts, yeah, one hundred percent, you know, just backing
21:31
Speaker 7: up what Antonio.
21:32
Speaker 6: Said, I do want to make it clear that, like,
21:36
Speaker 6: and you'll laugh.
21:36
Speaker 7: As I say this, like this is We're already doing this.
21:40
Speaker 7: I mean, the it's not this is this is the
21:43
Speaker 7: new thing. But in terms of pharmacies chasing down money
21:46
Speaker 7: and payments from the PBMs, like, that's how we already operate.
21:49
Speaker 7: The thing that's making me angry here is that the
21:52
Speaker 7: government is stepping in and adding another complicated step to this.
21:57
Speaker 6: And just making our lives even more difficult. It's one
22:00
Speaker 6: thing for me.
22:00
Speaker 7: To swallow when I'm floating money, you know, to PBMs
22:04
Speaker 7: that I'm being forced to work with.
22:05
Speaker 6: It's another one.
22:06
Speaker 7: The government has recognized that this is a problem, as
22:09
Speaker 7: saying drug pricing is out of control and we want
22:11
Speaker 7: to help patients and everybody, and then they step in
22:14
Speaker 7: and just and make it even more complicated and make
22:18
Speaker 7: the problem a bit more exacerbated.
22:20
Speaker 6: And that's sort of what I'm screaming about.
22:23
Speaker 3: With all of this, Who and what sector, Antonio do
22:31
Speaker 3: we rush to with Hey, here's about what's to happen
22:36
Speaker 3: on a domino effect of access to medications, access to
22:41
Speaker 3: pharmacy care, access to healthcare in general.
22:44
Speaker 2: Of what of what's going to happen?
22:46
Speaker 5: What?
22:46
Speaker 3: Who do we go to with a plea?
22:51
Speaker 5: Well, you know, good luck?
22:53
Speaker 9: Right?
22:53
Speaker 8: I mean my experience, you know, watching the federal government
22:58
Speaker 8: solve drug pricing issue use is that they don't solve
23:01
Speaker 8: drug pricing issues.
23:02
Speaker 5: They often just make it more complicated.
23:05
Speaker 8: And if they accomplish anything of note, the first and
23:09
Speaker 8: foremost thing they take care of us is themselves. The
23:13
Speaker 8: government always works to insulate their own programs from drug
23:16
Speaker 8: pricing dysfunction, and that either becomes the cost of the provider,
23:20
Speaker 8: the patient, or the employer, or some.
23:22
Speaker 5: Combination of all.
23:25
Speaker 8: The biggest challenge that I see is that CMS historically, Look,
23:30
Speaker 8: don't I don't sit here and pretend like I know
23:32
Speaker 8: that everything that administrator at CMS has to juggle with
23:35
Speaker 8: is going to be easier straightforward, and the problem the
23:38
Speaker 8: issues of drug affordability for patients and plans is understandably
23:43
Speaker 8: going to be at the top of their list. But
23:45
Speaker 8: the thing that I always get bothered by is that
23:48
Speaker 8: it always feels like pharmacy or impact to providers is
23:51
Speaker 8: super far down the list, and the imblemation implementation of
23:55
Speaker 8: the inflation reduction active is very obvious that they had
23:58
Speaker 8: their eye on the prize of getting the gover the
24:00
Speaker 8: ability to negotiate drug prices without actually solving the problem
24:03
Speaker 8: of inflated drug prices in the first place.
24:05
Speaker 5: Instead to create some sort of scheme where it insulated
24:08
Speaker 5: medicare from the prop from the harms of high drug.
24:10
Speaker 8: Prices, and then as they figured out, Okay, this is
24:13
Speaker 8: how we're going to negotiate drug prices with drug companies,
24:16
Speaker 8: and here's how we're going to essentially start making the
24:18
Speaker 8: numbers work, and here's how we're going to logistically make
24:21
Speaker 8: sure providers are paid. They never, at any point really
24:24
Speaker 8: seem to consider what the financial impact would be to
24:27
Speaker 8: those providers, So the system kind of contemplated or assumed
24:31
Speaker 8: that providers would come along for the ride without actually
24:35
Speaker 8: juggling or melting that with the reality the providers don't
24:39
Speaker 8: have much more juice to.
24:40
Speaker 7: Give and just to add to that, like the stuff
24:45
Speaker 7: that we recognized here is not crazy high level, Like
24:49
Speaker 7: it doesn't take the smartest pharmacists in America or smartest
24:53
Speaker 7: pharmacy owner to have looked at this situation and recognized
24:56
Speaker 7: what the problem was going to be. Any pharmacy owner
24:58
Speaker 7: would have seen this in two minutes, like if they
25:01
Speaker 7: had asked if they had one pharmacist in the room
25:04
Speaker 7: or even not in the room, but after just we're like, hey,
25:07
Speaker 7: before we put this into practice, what do you see
25:10
Speaker 7: about this? It would have been the first thing that
25:12
Speaker 7: anybody said, and you know, even me thinking for five
25:16
Speaker 7: minutes about an alternative solution, Like you know, they could
25:19
Speaker 7: have created a new NDC for these ten drugs and said,
25:23
Speaker 7: you know, if you're want to fill for a Medicare patient,
25:27
Speaker 7: purchase this NBC at this lower price and then bill
25:31
Speaker 7: it and it's only approved for Medicare claims. Like there
25:33
Speaker 7: are so many alternate solutions to this that any pharmacist
25:37
Speaker 7: would have come up with and seen in two minutes.
25:39
Speaker 6: But they just they they don't think that far ahead.
25:43
Speaker 7: You know, they wanted the headline and they wanted to
25:46
Speaker 7: be able to tell patients they got that lower price
25:48
Speaker 7: because it looks like a political win. So they just
25:51
Speaker 7: didn't bother asking any of us. But it would have
25:54
Speaker 7: taken five minutes for if they asked any pharmacists for
25:58
Speaker 7: input to have seen this problem and anticipated exactly what
26:01
Speaker 7: Antonia was just talking about.
26:05
Speaker 2: Antonio.
26:05
Speaker 3: From a public policy and patient access perspective, I'm thinking
26:11
Speaker 3: of the independent community pharmacies they decide to drop or
26:16
Speaker 3: limit some stocking of that initial ten drugs or whatever
26:21
Speaker 3: is on the list. How do you see this affecting
26:25
Speaker 3: medicare beneficiaries.
26:29
Speaker 8: I mean, look, if in the current environment, many pharmacies
26:33
Speaker 8: are quote underpaid on some of the drugs that we're
26:35
Speaker 8: talking about under the Inflation Reduction Act, but data also
26:39
Speaker 8: suggested some pharmacies are getting overpaid for some of those drugs.
26:43
Speaker 8: So upon implementation of the Maximum Fair Price, I think
26:47
Speaker 8: it is reasonable to assume that there will be a
26:49
Speaker 8: shakeout of sorts. The NFP essentially contemplates creating a universal
26:54
Speaker 8: experience for price. The government has stepped in and said
26:57
Speaker 8: this will be the price of the drug. And then
26:59
Speaker 8: if people in the current environment are getting underpaid or
27:01
Speaker 8: overpaid relative to that line of demarcation, that it stands
27:05
Speaker 8: the reason that, once implemented, some pharmacies will be winners
27:08
Speaker 8: and some people will be losers relative to wherever they
27:11
Speaker 8: were previously. So if you're a pharmacy and you're underwater
27:15
Speaker 8: on these drugs, we Todd. We've talked a lot about
27:18
Speaker 8: issues in the marketplace where PBMs steer medicines to the
27:22
Speaker 8: pharmacies that they own. Well, one of the things pharmacies
27:25
Speaker 8: don't like talking about is the fact that they also
27:27
Speaker 8: can steer too right. Pharmacies can make decisions on which
27:31
Speaker 8: drugs to inventory and which ones not. We know that
27:34
Speaker 8: pharmacies might make decisions to not fill a particular drug
27:37
Speaker 8: when a certain payer is involved versus other payers.
27:40
Speaker 5: Whether that's right or wrong.
27:42
Speaker 8: It's the reality of incentives and why I'm a big
27:44
Speaker 8: advocate for right sizing compensation for any member of the
27:48
Speaker 8: drug supply chain to ensure that they're actually incentivized to
27:51
Speaker 8: do what we want them to do. But expect that
27:54
Speaker 8: when pharmacies start essentially having to float this type of
27:57
Speaker 8: money to the government, if they are not essentially in
28:01
Speaker 8: some sort of position to make good margin when after
28:05
Speaker 8: the ask for that no interest loan, that pharmacies will
28:08
Speaker 8: find ways to essentially start steering those medicines outside of
28:12
Speaker 8: their pharmacy, which means that they will no longer inventory
28:15
Speaker 8: those products at all, or they'll start making pragmatic decisions
28:18
Speaker 8: on when to dispense that drug versus when not to.
28:21
Speaker 8: So the challenge I see for patients is that this
28:26
Speaker 8: makes a complicated system arguably even more complicated, because the
28:30
Speaker 8: pharmacy that you rely upon to maybe get most of
28:32
Speaker 8: your medicines or all of your medicines may actually have
28:35
Speaker 8: an opposite incentive to no longer start inventorying particular medications
28:40
Speaker 8: that you might need the most.
28:44
Speaker 3: It's like the I like a pharmacy owner listening in
28:49
Speaker 3: right now, is like I can't I can't afford to
28:51
Speaker 3: carry such medications.
28:53
Speaker 2: I can't float that kind of money.
28:56
Speaker 7: Or well, well, what's ironic is you know, the whole
28:59
Speaker 7: purpose of this, at the heart of it, aside from
29:02
Speaker 7: saving the government money, the grander goal is to save
29:05
Speaker 7: the patient's money.
29:06
Speaker 9: You know.
29:07
Speaker 7: The big headline is like for patients, the costs will
29:09
Speaker 7: be significantly less. But what it's actually leading downstream to is, like,
29:15
Speaker 7: let's say you're a patient who gets a torvostatin ozempic
29:19
Speaker 7: and eloquists from a pharmacy that decides they can no
29:23
Speaker 7: longer fill eloquist for you and no longer.
29:26
Speaker 6: Feel ozempic for you because of the costs.
29:28
Speaker 7: Then you're getting your generic lipatory or torvos statin from
29:31
Speaker 7: this one pharmacy. Maybe you're getting your ozempic DTC from
29:37
Speaker 7: the drug manufacturer for cash because it's cheaper that way.
29:40
Speaker 7: And then maybe you're getting your eloquists from the PBM
29:44
Speaker 7: mail or a pharmacy. Like all of a sudden, you're
29:46
Speaker 7: just creating a polypharmacy situation, which we know as a disaster,
29:50
Speaker 7: when at the heart of it, you are just trying
29:52
Speaker 7: to help the patient from the very beginning.
29:54
Speaker 6: But this is the slippery slope that.
29:55
Speaker 5: We're going in.
30:01
Speaker 3: I'm gonna definitely hear more about it. Antonio. Wanna get
30:06
Speaker 3: you back on the PBM Reform podcast and ask you,
30:10
Speaker 3: of course, more questions and updates. The website that I
30:14
Speaker 3: want everybody to take a look at is drug store
30:18
Speaker 3: Cowboy dot com. Once again, that's drug store Cowboy dot com.
30:22
Speaker 3: The name of the article was the hidden lender in
30:27
Speaker 3: America's drug supply chain. If you haven't read this, definitely
30:30
Speaker 3: do so once again. We'll have this link posted in
30:34
Speaker 3: the in the show notes, Alec, It's so good and
30:39
Speaker 3: always so good to have you on, have your insights
30:42
Speaker 3: involved in demystifying what the heck's going on, and as
30:47
Speaker 3: a pharmacy owner, you bring a lot of great insights
30:50
Speaker 3: to this, so we always appreciate you on twerks.
30:53
Speaker 6: Thanks to really appreciate you having me.
30:56
Speaker 3: Shout out to Antonio Chacha. He is amazing the work
31:00
Speaker 3: with three access advisors. Thank you so much for everything
31:03
Speaker 3: that you do. Thank for your insights, and thank you
31:07
Speaker 3: to the twerks listeners out there. This week in pharmacy,
31:10
Speaker 3: Hey hold on, we'll be right back. Hey, some breaking
31:19
Speaker 3: news I do want to share with our listeners. There's
31:22
Speaker 3: some crazy algorithm that is knocking out pharmacist accounts off
31:28
Speaker 3: of Instagram. This is not good, especially when these pharmacists
31:33
Speaker 3: are hoping to not only entertain, but demystify pharmacists and
31:41
Speaker 3: pharmacy and speak truth about our organizations and medications. And
31:51
Speaker 3: so take a listen.
31:52
Speaker 4: Pharmacist Happy Friday.
31:54
Speaker 10: So I am Shane chairman'sy Farmdee, an actual pharmacist who
31:58
Speaker 10: works in a pharmacy, not a drug dealer. I know
32:01
Speaker 10: you guys know that, but that's an announcement for the
32:03
Speaker 10: Facebook algorithm because I don't want to get permanently deleted.
32:07
Speaker 10: I am coming to you with some terrible news that
32:09
Speaker 10: I just found out this morning. So apparently Facebook had
32:13
Speaker 10: some AI update and the algorithm has been purging pages.
32:16
Speaker 5: And Maurice, my brother from another.
32:18
Speaker 2: Mother, called me this morning.
32:20
Speaker 10: Maurice from RX Comedy and the Doctor of Comedy on Instagram.
32:23
Speaker 10: His pages on Facebook he woke up and are permanently deleted.
32:28
Speaker 10: Why so, for whatever reason, if you're running a page
32:33
Speaker 10: about medicine and comedy that's involved with drugs like we do,
32:39
Speaker 10: sometimes you put up a picture of it or you'll
32:40
Speaker 10: be talking about it, and for whatever reason, the goofy
32:43
Speaker 10: algorithm thinks you're trying to sell those things rather than
32:46
Speaker 10: just talk about them. And if you get so many
32:49
Speaker 10: like violations, you can get your page permanently deleted. It
32:53
Speaker 10: doesn't usually happen, but apparently, for whatever reason, with this
32:56
Speaker 10: new upgrade, it's happened to a bunch of people that
33:00
Speaker 10: they just woke up and there's like their pages no
33:02
Speaker 10: longer exist.
33:03
Speaker 4: And this happened to Maurice.
33:05
Speaker 10: He had nearly one hundred thousand followers and now has
33:07
Speaker 10: to start all over if he can't seem to get
33:10
Speaker 10: his page reinstated. Apparently there's a process, but it can
33:15
Speaker 10: take up to like one hundred and eighty days, So.
33:17
Speaker 5: I feel bad for him.
33:18
Speaker 10: The first thing you could do to support Maurice is
33:20
Speaker 10: go to Instagram, where his page still exists, and follow
33:23
Speaker 10: the Doctor of Comedy on Instagram. We're going to try
33:26
Speaker 10: and have Maurice do some cameo videos on my page
33:29
Speaker 10: until he gets his back up and running. But yeah,
33:33
Speaker 10: that sucks, and it's happening to a bunch of people.
33:35
Speaker 10: I guess if you search it on TikTok, you can
33:37
Speaker 10: see people like crying because they've lost one of their
33:41
Speaker 10: streams of income or some in some cases their only
33:43
Speaker 10: stream of income, or their their personal business that was
33:46
Speaker 10: generating leads and stuff. So if you're a follower who
33:51
Speaker 10: happens to be a content creator, be careful. The one
33:55
Speaker 10: thing you can do is get the pay for the
33:57
Speaker 10: blue check mark.
33:59
Speaker 2: I know you can do that.
33:59
Speaker 10: Now, I'll pay for it, because they're not going to
34:03
Speaker 10: treat those people that are paying Facebook fourteen dollars a month.
34:06
Speaker 4: Or nineteen dollars a month, whatever it costs.
34:08
Speaker 10: They wouldn't go in and randomly delete those accounts because
34:11
Speaker 10: of course they want to want to keep getting paid. Also,
34:14
Speaker 10: just be very cautious of what you put on there
34:16
Speaker 10: because you might not see it as something that would
34:18
Speaker 10: trigger the algorithm to be like a content violation, but
34:21
Speaker 10: it can be so in no way even make a
34:24
Speaker 10: joke that you're selling anything that could be a controlled substance.
34:28
Speaker 10: So I hope I didn't flag it by saying those words,
34:33
Speaker 10: but we'll see anyway, have a great day, support Maurice Free,
34:36
Speaker 10: Maurice and pharmacy on.
34:40
Speaker 4: That's nuts.
34:44
Speaker 2: That's nuts.
34:44
Speaker 3: So it's shout out to Maurice Shaw. Doctor Shaw, you
34:50
Speaker 3: will have our support. You come on twerks and share
34:54
Speaker 3: about a little bit about this nightmare. But we will
34:57
Speaker 3: be right back going to get a quick message from
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36:03
Speaker 3: Hey, welcome back to this Week in Pharmacy. If you
36:07
Speaker 3: saw in the header of this show, and if you're listening,
36:10
Speaker 3: you probably are interested in artificial intelligence? Are you tired
36:15
Speaker 3: of that word? Are you tired of that expression? Everybody? AI?
36:18
Speaker 3: What does it mean? Got back from the sure Cost event.
36:22
Speaker 3: The sure Cost we did something called the sure Cast,
36:25
Speaker 3: which was a live podcast recording that was published earlier
36:30
Speaker 3: this week on Monday. It's been a long week. It's Friday.
36:33
Speaker 3: It was in Washington, d C. On Thursday, and it
36:36
Speaker 3: was about the pharmacist fight at ACT.
36:40
Speaker 2: I can't even say it.
36:41
Speaker 3: And we will have some additional twerks probably next week
36:45
Speaker 3: with some of those recordings because What an exciting time
36:49
Speaker 3: to be part of our profession and the fight that
36:52
Speaker 3: we're in for our profession in ultimately for our patients.
36:56
Speaker 3: But let's put our nerd hats on and let's bring
36:59
Speaker 3: in two of my guests and someone that I've known
37:04
Speaker 3: for years. Harry Travis has been my friend and have
37:09
Speaker 3: referenced Harry for years in the specialty space. I met
37:12
Speaker 3: you through Armada Health, which is now called a Sembia. Harrie,
37:16
Speaker 3: it's so good to hear see you and talk with you.
37:19
Speaker 3: Appreciate you being here.
37:21
Speaker 9: Hi, Scott, great to be here.
37:23
Speaker 3: Absolutely, of all the names that I'm called, Scott is
37:27
Speaker 3: the most intertwined.
37:30
Speaker 2: Sorry but no, I don't know what it is about Scott,
37:34
Speaker 2: but definitely.
37:35
Speaker 9: Called I don't know where that came from.
37:38
Speaker 2: It's the interchange.
37:39
Speaker 3: You're not the first person to do it, many of
37:42
Speaker 3: the people to do it. Amanda, it's so good to
37:45
Speaker 3: have you back. I love talking to you at the NASP.
37:49
Speaker 3: You've been such a great reference for us over the years.
37:52
Speaker 3: Thanks for being on twerks.
37:54
Speaker 2: Thank you for having me, Amanda. We're starting out with you.
37:57
Speaker 3: I want you to give our listeners in case they're
37:59
Speaker 3: not watching us on YouTube or watching us stream live
38:02
Speaker 3: on LinkedIn. If if they don't know you, tell us
38:05
Speaker 3: who is doctor Amanda A.
38:08
Speaker 1: Yeah, wow, yes.
38:10
Speaker 12: That sounds trying not to get to existential here. Yeah,
38:16
Speaker 12: thank you so so much again for having me, Todd.
38:20
Speaker 12: My My journey into this sort of health tech intersection
38:25
Speaker 12: wasn't wasn't sort of like linear, I guess, as as
38:30
Speaker 12: most of our journeys are fairly vanilla. Start after pharmacy school,
38:35
Speaker 12: I went into retail, and immediately I realized something was
38:39
Speaker 12: different about me because I started asking lots of questions,
38:42
Speaker 12: you know, why.
38:43
Speaker 1: Do we do things this way? How can we make
38:45
Speaker 1: it better?
38:46
Speaker 6: You know?
38:47
Speaker 12: It was kind of kind of met with oh, we
38:48
Speaker 12: don't do that here, you know, so it was kind
38:50
Speaker 12: of like, okay, well where do they do that?
38:52
Speaker 1: And that that led me to specialty pharmacy.
38:54
Speaker 12: Right, specialty pharmacy is the most innovative corner of our
39:00
Speaker 12: our industry. And so when I was working in specialty,
39:05
Speaker 12: I was lucky enough to onboard all of these different
39:09
Speaker 12: technology platforms through got experience working with software vendors. A
39:14
Speaker 12: handful of them were clinicians, and so I found myself wondering, well,
39:19
Speaker 12: how do I get your job. So eventually I ended
39:22
Speaker 12: up working for a software company called VPL. Maybe some
39:26
Speaker 12: of our listeners are our VPL customers built out a
39:30
Speaker 12: pharmacy platform with them, and now I am with I'm
39:33
Speaker 12: consulting with Curious Show Advisors, and we are a strategy
39:38
Speaker 12: consulting firm. We're deeply embedded in specialty pharmacy, special the
39:43
Speaker 12: special de pharmacy, pipeline, distribution, market access. So it's really compelling,
39:50
Speaker 12: inspiring work again at the intersection of technology and all
39:55
Speaker 12: those things that I mentioned.
39:56
Speaker 1: So that's that's how I got here.
40:00
Speaker 2: Thank you for that pathway.
40:03
Speaker 3: Cheryl and John at Creatio are legends in this space
40:08
Speaker 3: and have taken punches in the face like the rest
40:10
Speaker 3: of us over the years for things that they shouted
40:13
Speaker 3: out before they become buzzwords and before they began. You're
40:18
Speaker 3: one of those prize fighters as well, Harry, And you
40:22
Speaker 3: know both of those people and have worked with them
40:25
Speaker 3: in the past. But the reason why Harry's here and
40:28
Speaker 3: the reason why you're kind of the star of the
40:30
Speaker 3: show today, Harry and the wing person is Amanda is
40:35
Speaker 3: our ai in transforming pharmacy operations and Harry was part
40:41
Speaker 3: of a podcast that was on the AJMC that they
40:46
Speaker 3: turned into a wonderful article published in October of twenty
40:49
Speaker 3: twenty five titled how AI is Transforming Pharmacy Operations. The
40:54
Speaker 3: reason why I enjoyed listening to this podcast and then
40:57
Speaker 3: having you as a follow up today on twerks Harry
41:00
Speaker 3: because you make sense of things. And the reason that
41:04
Speaker 3: I think you make sense of things is because you
41:07
Speaker 3: were thrusted and thrown into operations very early in your
41:11
Speaker 3: pharmacy career, at very high levels, with operations with CBS
41:15
Speaker 3: and operations with other specialty pharmacies, and you've worked in
41:20
Speaker 3: the trenches and then you've taken that trench insights and
41:24
Speaker 3: you've turned it into something that can become actionable. So
41:29
Speaker 3: excited to have you here today. Just wanted you to
41:31
Speaker 3: open with a little bit about that article and what
41:34
Speaker 3: you talked about and why you think it's important to
41:36
Speaker 3: understand AI in pharmacy operations.
41:40
Speaker 9: Wow, Hello Todd, Hello Amanda. That's a lot that.
41:45
Speaker 13: You've put out there, mister Yuri, to just go right
41:51
Speaker 13: to the podcast. That was a podcast that I did
41:55
Speaker 13: for aj AJMC part of relationship I have with AMCP,
42:02
Speaker 13: the Academy of Managed Care pharmacy, and we did a
42:09
Speaker 13: pre conference on AI at last year's AMCP Annual meeting
42:16
Speaker 13: in Houston, and actually we're going to do another.
42:20
Speaker 9: They're going to do another pre conference.
42:22
Speaker 13: On AI at the AMCP Annual Meeting in Nashville in
42:29
Speaker 13: April thirteen, twenty twenty six. Anybody in pharmacy, no matter
42:37
Speaker 13: where you are, community pharmacy, on the payer side, inside
42:43
Speaker 13: of managed care, just like any industry, AI is touching everything,
42:48
Speaker 13: and you really need to kind of figure out, Okay,
42:53
Speaker 13: where are the applications, who are the vendors, who's providing
42:56
Speaker 13: the technology, how does it fit, and how do you
43:00
Speaker 13: kind of deal with it in the midst of running
43:03
Speaker 13: your business or running your department flat out right now,
43:07
Speaker 13: it's not like everybody's got a whole like of a
43:09
Speaker 13: lot of time to bring on new projects and new
43:11
Speaker 13: products and new systems and things like that. So this
43:15
Speaker 13: is adding a level of stress. Hopefully in the long
43:18
Speaker 13: run it will relieve some stress and create some productivity.
43:24
Speaker 13: And that's kind of the fight that everyone's in right now.
43:30
Speaker 3: It is, and there are so many processes of this.
43:33
Speaker 3: If we were to break it down to the listener,
43:34
Speaker 3: who may not be lists who I might not be watching.
43:37
Speaker 3: We're talking about being able to analyze data quickly, make
43:41
Speaker 3: sense of that, marry that back to the patient information,
43:45
Speaker 3: connect that back with the information that's being collected at
43:48
Speaker 3: the health Electronic Health record. Talked about optimizing drug shortages
43:56
Speaker 3: and the data around that, monitoring patient adherence, inventory management,
44:01
Speaker 3: to shout back out to VPL, connecting the patient within
44:05
Speaker 3: the last mile. I mean, there's so many aspects that
44:08
Speaker 3: we've already done this. We've already worked in these spaces
44:12
Speaker 3: without anything to do with AI ten years ago, twenty
44:15
Speaker 3: years ago. But now that we have it, it must
44:17
Speaker 3: be leveraged. I wanted to go back to you, Amanda
44:21
Speaker 3: and just say, so, let's break it up into little bits.
44:25
Speaker 3: And the first of those bits, in my opinion, is
44:28
Speaker 3: the safety aspect. How are we leveraging AI to assure
44:34
Speaker 3: that pharmacists can can practice more, better, more efficiently, and
44:42
Speaker 3: keep safety at the forefront.
44:45
Speaker 1: Yeah, so, I guess through an AI lens.
44:49
Speaker 12: The honest answer is that I don't think we are
44:52
Speaker 12: scratching the surface quite yet. Just in my mind, right
44:56
Speaker 12: through my work with AI, seeing what it can do,
45:00
Speaker 12: it doesn't right. Innovation doesn't have to shout. That's what
45:03
Speaker 12: that's what John says, Right, it can be humble, quietly
45:07
Speaker 12: working in the background. And I think that from a
45:10
Speaker 12: safety standpoint, right when you think about okay, systematic approach
45:14
Speaker 12: just to safety and workflows, AI can pick up on patterns,
45:19
Speaker 12: right A, I can see things that it might take
45:24
Speaker 12: us longer to see. Right, not that we're not capable
45:27
Speaker 12: of doing the work ourselves, but using AI as a
45:32
Speaker 12: force multiplier rather than a crutch.
45:35
Speaker 1: And so safety is one of one of those.
45:37
Speaker 12: Areas that just feels feels like is ripe or prime
45:43
Speaker 12: for for you know, some sort of project or model
45:50
Speaker 12: that is you know, designed to again leverage the efficiency
45:57
Speaker 12: that that that a you know that an l l
45:59
Speaker 12: M can think faster than a human, but telling it
46:03
Speaker 12: exactly what to do. Right, This is the workflow, This
46:07
Speaker 12: is you know, how things should should be going. What
46:11
Speaker 12: patterns are we are we picking up on that you know,
46:14
Speaker 12: might might indicate an issue. And the other thing to
46:17
Speaker 12: think about there is we can use a eye to
46:20
Speaker 12: pick up on potential it's issues when it's a.
46:23
Speaker 1: Near miss rather than when it's an actual error.
46:26
Speaker 7: Right.
46:27
Speaker 3: So yeah, I think that there's challenges just to get
46:31
Speaker 3: started Harry, that's just the opening question for you is
46:36
Speaker 3: how do you see the large language models the AI
46:40
Speaker 3: in day to day operations? And by the way, how
46:42
Speaker 3: do you get started in leveraging it?
46:45
Speaker 5: Where?
46:45
Speaker 3: Where does the pharmacy operations say, let's use it here
46:49
Speaker 3: first because it's tried and true, and we can move
46:52
Speaker 3: forward from there.
46:54
Speaker 13: Let's look at it from kind of a twenty thousand
46:58
Speaker 13: foot level for a second, from the point of view
47:02
Speaker 13: of a pharmacy operator. And you could be an operator
47:07
Speaker 13: of an independent pharmacy, you could be an operator of
47:09
Speaker 13: a regional chain or one of the national chains.
47:13
Speaker 9: Just let's just.
47:14
Speaker 13: Kind of stay high level for a second there. And
47:18
Speaker 13: you know, I always say, or I cite the fact
47:21
Speaker 13: that there are seven billion prescriptions dispensed in the United
47:25
Speaker 13: States in a year, and I don't care whether it's
47:29
Speaker 13: the simplest prescription or a really complex prescription.
47:33
Speaker 9: They all kind of go through the same process.
47:36
Speaker 13: It's just whether they're going to go through the process
47:38
Speaker 13: in a nanosecond or a couple of weeks. You know,
47:41
Speaker 13: you've got to intake the prescription, got to do benefit verification,
47:45
Speaker 13: you've got to do a work up on the patient
47:47
Speaker 13: in terms of kind of medication review. You got to
47:50
Speaker 13: figure out if the patient can afford it. You got
47:52
Speaker 13: to do copay assessment, all of this on and on,
47:55
Speaker 13: figure out how you're going to ongoing in an ongoing way,
47:59
Speaker 13: keep the on their medicine medication adherents.
48:02
Speaker 9: Okay.
48:03
Speaker 13: Every one of those steps requires somebody to organize some
48:10
Speaker 13: set of data against the set of questions. What's the
48:13
Speaker 13: patient's insurance, what's their copay, what are the code numbers,
48:18
Speaker 13: et cetera, et cetera. Okay, And there are right now
48:23
Speaker 13: literally dozens of companies out there, AI powered kind of
48:28
Speaker 13: technology companies presenting single point solutions to practically every pharmacy
48:35
Speaker 13: in the country. And everyone's a little overwhelmed because all
48:40
Speaker 13: of these vendors are knocking on everybody's door. I have
48:44
Speaker 13: a solution for prior ot, I have a solution for intake,
48:48
Speaker 13: I have a solution for copay assistance. I have a
48:51
Speaker 13: solution for drug information. I have a solution for MTM.
48:55
Speaker 13: So I think as an industry, we are in what
49:00
Speaker 13: I call stage one of a three stage process, and
49:05
Speaker 13: Stage one.
49:06
Speaker 9: Is single point validation.
49:08
Speaker 13: We've got to validate how each one of these single
49:11
Speaker 13: point solutions work and validate them to a high degree
49:15
Speaker 13: of accuracy and reliability such that we're willing to kind
49:19
Speaker 13: of offload work to these AI agents that are, okay,
49:23
Speaker 13: I trust this agent to do all my benefit verification
49:28
Speaker 13: or do all my copay assistance investigation. It's going to
49:31
Speaker 13: take a while to do that, right, but over time
49:35
Speaker 13: we will validate all, you know, a certain subset of
49:39
Speaker 13: these single point solutions. And then stage two is we're
49:43
Speaker 13: going to have the and if you think of each
49:46
Speaker 13: of these solutions as a bot as an agent, stage
49:50
Speaker 13: two is you're going to have the bots talk to
49:52
Speaker 13: the bots. You know, the intake bot's going to hand
49:54
Speaker 13: it off to the benefit verification bot, who's going to
49:57
Speaker 13: hand it off to the MTB MTM bot, who's going
50:00
Speaker 13: to hand it off to the adjudication by And so
50:03
Speaker 13: stage two is kind of a sequential validation, and eventually
50:07
Speaker 13: stage three becomes all of this is going to kind
50:12
Speaker 13: of roll into, or be absorbed by, or absorb itself
50:17
Speaker 13: your pharmacy management system. So your pharmacy management systems in
50:22
Speaker 13: the future is going to be really smart and it's.
50:26
Speaker 7: Not singularity, yeah, not right, you know, and it's not
50:30
Speaker 7: going to be a whole bunch of plug ins.
50:32
Speaker 9: It's going, you know, the intelligence is going to be
50:34
Speaker 9: in the system.
50:36
Speaker 13: We're probably a long way from that years, but we're
50:41
Speaker 13: slowly working to that. Because pharmacy is a very, very
50:47
Speaker 13: data intense, kind of deterministic business. Every question in pharmacy
50:54
Speaker 13: has an answer somewhere. You just have to find it, okay,
50:59
Speaker 13: And no one making up answers in pharmacy.
51:02
Speaker 9: No one's composing the.
51:04
Speaker 13: Great American novel on some particular patient. You know, the
51:08
Speaker 13: answer is out there, it's in some file somewhere, and
51:12
Speaker 13: more and more, these large language models are able to
51:15
Speaker 13: find it. So that's kind of my quick overview of
51:20
Speaker 13: where we are right now.
51:21
Speaker 9: Now.
51:21
Speaker 13: If you're an independent operator, it's a lot harder because
51:24
Speaker 13: you don't have the resources and you're looking to your
51:27
Speaker 13: PSA oh or your GPO or somebody like help me,
51:30
Speaker 13: or your pharmacy management system. If you're a bigger player
51:34
Speaker 13: now you're reaching out and you're saying, okay, we can
51:36
Speaker 13: do a single point or we can you know, bring
51:39
Speaker 13: a coder in and we can do some of our
51:41
Speaker 13: own coding. It just really depends on the scale of
51:43
Speaker 13: the pharmacy in terms of how you're approaching this.
51:46
Speaker 2: Problem, Amanda.
51:48
Speaker 3: I don't want to get all philosophical on you, but
51:53
Speaker 3: you are here as the farm D, and I think
51:56
Speaker 3: of streamline production, automation, control, better compliance, medical adherence, drug discovery,
52:02
Speaker 3: clinical trials, all these places the farm d's playing. I
52:06
Speaker 3: like what Harry opened up with this first layer. That's terrific. However,
52:12
Speaker 3: shout out to our farm d's it's still your license.
52:15
Speaker 2: I don't.
52:16
Speaker 3: I don't care how smart or intelligent or whatever the
52:19
Speaker 3: AI system is going to get when it comes to
52:22
Speaker 3: final review, when it comes to double checking on adherence
52:26
Speaker 3: and what the patient is taking and what they're doing
52:28
Speaker 3: and how they're doing, and documentation before that drug is
52:34
Speaker 3: released and gets to the patient, it still comes back
52:37
Speaker 3: to the human that has the NABP you know, license
52:41
Speaker 3: in the state, and it comes back for responsibility. Talk
52:45
Speaker 3: to us about that balance, talk to us about using
52:47
Speaker 3: the powerful resources and being able to quickly query and
52:53
Speaker 3: quickly compare. But then it comes down to that farm
52:58
Speaker 3: D keeping us safe.
53:00
Speaker 1: Sure, yeah, I think about I think about this a lot.
53:04
Speaker 1: I lay awake at night and think about these things.
53:06
Speaker 12: No, but so you know, if for anyone listening, who's
53:12
Speaker 12: ever precepted a student.
53:13
Speaker 7: Right.
53:13
Speaker 12: It's it's sort of like that trying to pick trying
53:16
Speaker 12: to kind of say like, okay, I want I want
53:19
Speaker 12: to I want.
53:19
Speaker 1: To trust this student, but it's my license. You know.
53:22
Speaker 12: Maybe I'm I'm not going to let them dispense the
53:24
Speaker 12: most complex therapies. Maybe I'm going to let them sign
53:28
Speaker 12: it and then you know, sign a sign off and
53:30
Speaker 12: then put these over here and I'll sign off afterwards.
53:33
Speaker 7: Right.
53:33
Speaker 12: He's kind of like, think of those things that, hey,
53:37
Speaker 12: what can I trust an intern to do?
53:39
Speaker 4: Right?
53:40
Speaker 12: And that's I think a good north star as far
53:43
Speaker 12: as a cohort of sorts of different processes or pieces
53:49
Speaker 12: of that workflow that might be candidates for AI.
53:56
Speaker 1: Some something that I think about a lot, and and
53:58
Speaker 1: and it it.
54:00
Speaker 12: Never ceases to amaze me how many parallels there are
54:03
Speaker 12: with modern I say modern like agile software development sort.
54:09
Speaker 1: Of discipline and.
54:12
Speaker 12: Clinical sort of treatment modalities are that we don't have
54:17
Speaker 12: to you know, an old boss of mine used to say,
54:21
Speaker 12: we don't have to swallow the elephant hole, right, just
54:24
Speaker 12: take bite sized pieces what can you actually handle today?
54:29
Speaker 7: Right?
54:29
Speaker 12: And another good way to look at this is and Harry,
54:33
Speaker 12: you mentioned it too, right, turning to the p SAOs
54:38
Speaker 12: or the GPOs or even the pharmacy management system right
54:43
Speaker 12: as pharmacies, especially pharmacies that may not have a huge
54:46
Speaker 12: budget for these things. You may not have a capital
54:48
Speaker 12: budget for you know, another software vendor, but you know
54:51
Speaker 12: you want to use AI. You don't want to get
54:52
Speaker 12: left behind, you know, talk to your staff, what are.
54:57
Speaker 1: The most painful points of their day? What are the
55:00
Speaker 1: most painful you know.
55:05
Speaker 12: Parts of the workflow where you know that it's a bottleneck,
55:08
Speaker 12: you know, right, and in turn that that's ripe for
55:12
Speaker 12: you know, one.
55:13
Speaker 1: Day causing an error and start there.
55:16
Speaker 14: Right.
55:16
Speaker 12: In software development, we don't we don't think of the
55:19
Speaker 12: platform and build the entire thing and release it.
55:22
Speaker 1: We go incrementally, we iterate along the way, we.
55:26
Speaker 12: Ask for feedback, right, And that's you know, there's so
55:30
Speaker 12: many parallels there when you look at software and pharmacy operations,
55:36
Speaker 12: and so a lot of times I I, you know,
55:39
Speaker 12: when I'm when I'm working on projects and kind of
55:42
Speaker 12: giving giving advice that those are kind of some of
55:44
Speaker 12: the tenets that I that I go back to. You know,
55:48
Speaker 12: it doesn't have to you don't have to reinvent the
55:50
Speaker 12: wheel every time.
55:53
Speaker 1: You know, And so that's that's kind of how how
55:56
Speaker 1: I look at.
55:57
Speaker 3: AI very What point in workflow, what point in operations
56:05
Speaker 3: based on your experience seeing AI two and a half
56:10
Speaker 3: three years ago creeping into a data intensive part of
56:17
Speaker 3: the ecosystem of healthcare, what part is the safest right
56:22
Speaker 3: now to rely on AI where it's not as needed
56:27
Speaker 3: to have the farm d assuring the safety. I know
56:31
Speaker 3: as well as you do working in pharmacy technology that
56:35
Speaker 3: there is ability and there's a list of AI go
56:41
Speaker 3: to prompts that are much more operational and much less clinical.
56:47
Speaker 3: And where are you seeing pharmacy operators have the most
56:51
Speaker 3: success with AI right now?
56:53
Speaker 13: All I think, as Amanda said, and you kind of
56:57
Speaker 13: hinted at it, denaying my clinical functions are the easiest
57:02
Speaker 13: ones and the lower risk ones.
57:07
Speaker 9: But I also think.
57:08
Speaker 13: That you know, I'll kind of take this to a
57:12
Speaker 13: different level in that the leaders in the organization need
57:16
Speaker 13: to establish a level of trust with the folks on
57:20
Speaker 13: the frontline around AI that AI is not going to
57:25
Speaker 13: take your job but in order for us to make
57:29
Speaker 13: everybody's job better, everybody needs to be real transparent about
57:34
Speaker 13: how they use AI or how they could use AI
57:37
Speaker 13: and what their job is. So there are people, I
57:42
Speaker 13: am sure staff on the frontline who know what the
57:46
Speaker 13: pain points are. I'm always moving these numbers from this
57:50
Speaker 13: page over to that page. It's a real pain in
57:52
Speaker 13: the ass, and it's just, you know, mind numbing work, okay.
57:58
Speaker 13: And it's developing a level of trust with those folks
58:00
Speaker 13: for them to be able to identify that, because you
58:03
Speaker 13: don't want them to think, well, I'm not going to
58:05
Speaker 13: tell anybody about that, because if they automate that, that's
58:07
Speaker 13: two hours a day at my job that goes away.
58:10
Speaker 9: Okay.
58:11
Speaker 13: So you've got to develop the trust with folks that says, look,
58:16
Speaker 13: we're going to we're going to take away that mindless
58:19
Speaker 13: part of your job and add more upskilling, advanced skills,
58:24
Speaker 13: additional skills. You're going to be able to be a
58:26
Speaker 13: better employer, do more for our patients. You know that
58:30
Speaker 13: kind of thing. If you become part of the team
58:33
Speaker 13: that helps implement this. So you know, back to your question,
58:38
Speaker 13: I think the non clinical functions are the easiest ones
58:41
Speaker 13: to go at that. There's a lot of labor tied
58:43
Speaker 13: up there. Whether you're a solo entrepreneur, pharmacy, you know,
58:49
Speaker 13: just a one one shot pharmacy or a big chain
58:53
Speaker 13: go after the you know the friction points that are
58:56
Speaker 13: in the non low risk points right now and ask
58:59
Speaker 13: your staff about those.
59:02
Speaker 3: I want to bring in a sociological aspect to this
59:05
Speaker 3: and a reflection of the way to look at Give
59:09
Speaker 3: a shout out to gen Z just doing a podcast
59:14
Speaker 3: my thirteen year old daughter over the weekend. She has
59:16
Speaker 3: a podcast out there called Bigger, Better, Stronger, And it's
59:20
Speaker 3: just a bunch of sarcastic inside jokes among five teenagers.
59:25
Speaker 6: But do you know that.
59:28
Speaker 3: So many times as a punchline, so many times in
59:32
Speaker 3: discussion with each other. We drove from Brownsville, Pennsylvania to
59:36
Speaker 3: downtown Pittsburgh over the weekend with five bubbling teenagers in
59:41
Speaker 3: the back sharing ideas. And I can't tell you how
59:43
Speaker 3: many times I heard them say, not AI, we hate AI.
59:48
Speaker 3: We can't stand AI. I can't because they content coming
59:53
Speaker 3: out that is, of course AI, and they feel that
59:56
Speaker 3: it is not authentic. They don't think it brings any
59:59
Speaker 3: kind kind of like value. I actually took my daughters
1:00:03
Speaker 3: the lead in our school play in Brownsville, Matilda, and
1:00:08
Speaker 3: I took her picture and I.
1:00:09
Speaker 2: Said to a AI developed. I forget which one it was.
1:00:13
Speaker 2: It might have been Google.
1:00:14
Speaker 3: I said, listen, take my daughter's face and make her
1:00:17
Speaker 3: Matilda blah blah blah.
1:00:18
Speaker 5: So I did it.
1:00:18
Speaker 3: It looked exactly like her. It looked great. I showed
1:00:21
Speaker 3: her and she's like, do not use that.
1:00:23
Speaker 2: That's AI.
1:00:24
Speaker 3: And I'm just like, well, when can I use AA.
1:00:27
Speaker 3: So the reason why I'm bringing the sociological up is
1:00:30
Speaker 3: is the bias and the bias from the public, the
1:00:32
Speaker 3: bias from people that are developing hardened processes in health
1:00:39
Speaker 3: system pharmacy or specialty workflow or whatever it is. Amanda,
1:00:44
Speaker 3: talk to us about the sociological impact of this in
1:00:47
Speaker 3: the trust factor, because trust in our healthcare profession is
1:00:51
Speaker 3: at an all time low in a lot of ways
1:00:54
Speaker 3: when you read the headlines and you read the disaster
1:00:57
Speaker 3: of COVID and the way we handled it and vaccines
1:00:59
Speaker 3: and people not trusting the science, and so talk to
1:01:02
Speaker 3: us about the bias.
1:01:05
Speaker 12: Sure, yeah, the stigma is certainly real, you know, in
1:01:09
Speaker 12: in more generations, some in some some generations more than others.
1:01:14
Speaker 12: But every generation does kind of have their sentiment towards it. Right,
1:01:18
Speaker 12: there's a vibe.
1:01:20
Speaker 1: And I think that.
1:01:23
Speaker 12: You know, it's varying degrees of unknown, right and fear
1:01:27
Speaker 12: of the unknown and not understanding it. There are every day,
1:01:31
Speaker 12: there's increasingly more people right that are educating themselves on AI.
1:01:35
Speaker 12: And I don't I don't want to speak for Harry,
1:01:37
Speaker 12: but I know that, you know, maybe a year or
1:01:38
Speaker 12: two ago, when I really just didn't know anything about it,
1:01:42
Speaker 12: it was scary, and it was kind of like, oh, Ai,
1:01:46
Speaker 12: and you have this idea. You think about that movie
1:01:49
Speaker 12: you know with Haley Joel Osmond. I can't remember what
1:01:52
Speaker 12: it's called, but you know, do you know, do you
1:01:54
Speaker 12: remember which one I'm talking about where it was very
1:01:57
Speaker 12: scary at the end where the robots take over, right,
1:01:59
Speaker 12: And that's those are these dark places that you go to.
1:02:02
Speaker 12: But and this is the part where I said, I
1:02:03
Speaker 12: don't want to speak for you, Harry, but I know
1:02:05
Speaker 12: in my experience, uh, you know, just the more that
1:02:08
Speaker 12: I learned about it, just it's just it's not scary anymore.
1:02:12
Speaker 12: It's like, oh, okay, I understand how it works. I
1:02:15
Speaker 12: understand how it can fit into my you know, job
1:02:19
Speaker 12: and my industry, and I understand how it can accelerate things.
1:02:23
Speaker 12: And but it's it's not as intimidating, of course, and
1:02:27
Speaker 12: so I think across the generations, it is very interesting.
1:02:30
Speaker 12: One of my favorite content creators on LinkedIn is Cruz Corral.
1:02:34
Speaker 1: Have you seen his stuff?
1:02:36
Speaker 12: He does these, He does these, you know, different corporate
1:02:41
Speaker 12: scenarios by generation, and there's a couple of them on
1:02:45
Speaker 12: AI and they're and they're hilarious. But you know something
1:02:49
Speaker 12: kind of tying back to something Harry was saying earlier too,
1:02:53
Speaker 12: practicing at the top of our license?
1:02:55
Speaker 7: Right.
1:02:55
Speaker 12: If we think about and I know certainly in software,
1:02:58
Speaker 12: we when before we build something, we want to think, Okay,
1:03:03
Speaker 12: how am I going to know that this is successful?
1:03:05
Speaker 12: And the answer, right, a KPI a key performance indicator
1:03:09
Speaker 12: for implementing some bit of AI. It just could be
1:03:14
Speaker 12: very very small. It could be it could be bigger, right,
1:03:17
Speaker 12: depending on your resources. But a KPI could be something
1:03:21
Speaker 12: as simple as, does this result in a clinician practicing
1:03:27
Speaker 12: closer to the top of their license? Right?
1:03:30
Speaker 1: Because to me, that's success.
1:03:32
Speaker 12: If you have more time to spend on talking to patients, right,
1:03:38
Speaker 12: being empathetic with your patients, doing you know, complex clinical
1:03:45
Speaker 12: you know, thinking activities that require a human thinking, right,
1:03:50
Speaker 12: If you have more time to do that and some
1:03:53
Speaker 12: AI process or you know, menial job or duty that
1:03:57
Speaker 12: we were able to automate or simplify or just take
1:04:00
Speaker 12: from you know, it takes a minute too, it takes
1:04:02
Speaker 12: five seconds something like that. That success, you know, And
1:04:06
Speaker 12: so just thinking back to okay, it's not taking ours,
1:04:13
Speaker 12: not taking our jobs, but you will become irrelevant if
1:04:17
Speaker 12: you don't understand AI. You can't talk about AI. You
1:04:20
Speaker 12: don't you know, know which questions to ask. You don't
1:04:24
Speaker 12: know how to prompt a model, right, there's lazy prompting,
1:04:29
Speaker 12: and so you know, I guess I guess the answer.
1:04:32
Speaker 12: The TLDR of this is just educate yourself.
1:04:35
Speaker 1: You know.
1:04:36
Speaker 5: So well.
1:04:37
Speaker 3: I think it's interesting that on this podcast and this
1:04:40
Speaker 3: week in pharmacy, we're talking with three generations. We have boomer,
1:04:46
Speaker 3: we have millennial, and this is the video that a
1:04:51
Speaker 3: magical is talking about.
1:04:53
Speaker 5: Listen up.
1:04:53
Speaker 15: I just want to give the heads up that we
1:04:55
Speaker 15: will be letting go about about half the.
1:04:58
Speaker 5: Team due to AI.
1:05:00
Speaker 15: It's more efficient and we're cutting some costs. Who would
1:05:04
Speaker 15: have thought my job why stupid? You know what, go
1:05:08
Speaker 15: ahead and have my job and update the special. It's
1:05:11
Speaker 15: freaking horrible Hey, I was replacing us. Great, I just
1:05:15
Speaker 15: finished training the interns is supposed to be replacing me.
1:05:18
Speaker 15: Maybe the AI agent can finally update the CRM on time.
1:05:22
Speaker 5: I make the cut off. Yes, I made the cut off.
1:05:25
Speaker 5: Maybe I do actually like AI.
1:05:27
Speaker 15: It's happening a lot sooner than than we originally anticipated,
1:05:30
Speaker 15: and my job is good. But before there's some of
1:05:33
Speaker 15: the other executives, Uh, we don't need you anymore.
1:05:37
Speaker 9: Well, maybe I.
1:05:38
Speaker 5: Could go start that business I always wanted to start.
1:05:42
Speaker 5: It's been money.
1:05:44
Speaker 2: I just love it.
1:05:46
Speaker 3: I love I love the perception and the creativity and
1:05:49
Speaker 3: making fun of us as human being.
1:05:51
Speaker 2: But Harry, there's something to.
1:05:53
Speaker 3: That, and that's bringing you back to the question of
1:05:56
Speaker 3: authenticity and validity and trust and bias and kind of
1:06:00
Speaker 3: give us your insights and opinion on that.
1:06:02
Speaker 13: Well, I'll just say trust is probably the most important
1:06:08
Speaker 13: thing in any organization, regardless of technology or change. You've
1:06:14
Speaker 13: got to establish trust up and down the organization. And
1:06:19
Speaker 13: AI is going to kind of challenge that more than
1:06:24
Speaker 13: a lot of other technology changes because it's so pervasive
1:06:28
Speaker 13: and it can be very very disruptive, So it'll it
1:06:32
Speaker 13: will test any organization on kind of its kind of
1:06:37
Speaker 13: trust quotient from.
1:06:39
Speaker 9: Top to bottom.
1:06:42
Speaker 2: It is.
1:06:42
Speaker 3: I see it in content development, and I see being
1:06:47
Speaker 3: people being scolded in some ways for over usage and
1:06:53
Speaker 3: being able to instead of doing a doubling up on
1:06:58
Speaker 3: checking your work. It's just being cut and pace. Of course,
1:07:02
Speaker 3: we've heard about that in higher education. We've heard about
1:07:05
Speaker 3: that in medical schools and reports that are being done.
1:07:10
Speaker 3: There's actually now AI being used to check AI driven
1:07:15
Speaker 3: papers by professors and calling out people that might be
1:07:20
Speaker 3: over using it. And I think this has to do
1:07:23
Speaker 3: with anything. I remember when medi spam updated all the
1:07:28
Speaker 3: data that was accessible back when I was with Soft
1:07:31
Speaker 3: Writers Selling Framework LTC. And how a revolutionary it was
1:07:36
Speaker 3: in the infra seat sheets that were being printed.
1:07:40
Speaker 2: Out, and it was over data. There was too much data,
1:07:42
Speaker 2: so we didn't know what to use, what not to use.
1:07:45
Speaker 3: But we got through that and we had very intelligent
1:07:49
Speaker 3: pharmacy operators use it to their advantage, use it to
1:07:52
Speaker 3: be able to leap frog and pump out more information
1:07:55
Speaker 3: for the patient.
1:07:56
Speaker 2: I think that's where we're at today.
1:07:57
Speaker 3: I think we have operators who are well versed in
1:08:02
Speaker 3: running a pharmacy in an operation that has nothing to
1:08:05
Speaker 3: do with even technology for that point, but then edging
1:08:08
Speaker 3: in and using their tech and their workflow, and of
1:08:12
Speaker 3: course now AI is just a layering. However, let's talk
1:08:17
Speaker 3: about the timing of all of this. When does it
1:08:19
Speaker 3: run out? When Amanda, you're old enough to have been
1:08:23
Speaker 3: in school, you went through school, you probably didn't use
1:08:26
Speaker 3: any AI in any technology because it was all in
1:08:28
Speaker 3: the last three to five years. So when does it
1:08:31
Speaker 3: start really becoming an issue where a farm d or
1:08:35
Speaker 3: a pharmacy student becomes less and less what's the word
1:08:40
Speaker 3: inspired to push themselves to be the best farm d
1:08:43
Speaker 3: they can be because the tools that are available to
1:08:47
Speaker 3: us and the AI at our disposal is watering things down.
1:08:53
Speaker 12: You know, I have been a pharmacist long enough to
1:08:57
Speaker 12: have seen all of those changes, but not long enough
1:09:00
Speaker 12: to have thrown away my.
1:09:02
Speaker 1: Rose colored glasses yet. And I say that because, you.
1:09:07
Speaker 12: Know, when I think about the moment the epiphany when
1:09:11
Speaker 12: I realized, oh, I don't need to know everything right,
1:09:15
Speaker 12: aside from passing your boards and just making it through school,
1:09:19
Speaker 12: I just need to know how to look for it,
1:09:22
Speaker 12: where to look right, and how to like validate the
1:09:25
Speaker 12: source that I'm looking for right, don't just Google, you know,
1:09:28
Speaker 12: what's the dose of this medication? Right, just sort of
1:09:32
Speaker 12: like understanding the context of your research. And that's where
1:09:36
Speaker 12: I think AI. This is where the rose colored glasses
1:09:39
Speaker 12: come in, the silver lining.
1:09:41
Speaker 1: Right. I want to see AI in pharmacy schools. I
1:09:45
Speaker 1: want it. I want that to become a tool.
1:09:50
Speaker 7: Right.
1:09:51
Speaker 12: And I said this earlier. I think it's so powerful.
1:09:54
Speaker 12: I want it to be an accelerator, a multiplier and
1:09:57
Speaker 12: not a crutch right doing you know, looking and finding
1:10:02
Speaker 12: the most accurate and the not only accurate, but the
1:10:07
Speaker 12: most up to date. Right, because in the industry things
1:10:10
Speaker 12: are changing so fast, and so you know, without getting
1:10:14
Speaker 12: in trouble with but John and Cheryl and saying too much,
1:10:17
Speaker 12: you know, that's what I'm really excited about some of
1:10:19
Speaker 12: the projects that we're working on because.
1:10:22
Speaker 1: You know, like I was saying earlier, innovation doesn't have
1:10:25
Speaker 1: to shout, right.
1:10:26
Speaker 12: Some of the most effective tools are in the hands
1:10:29
Speaker 12: of the people who are making quiet decisions that move markets.
1:10:32
Speaker 7: Right.
1:10:33
Speaker 12: And I see AI as really being reshaping operational intelligence. Right.
1:10:43
Speaker 1: Data is not a problem.
1:10:45
Speaker 12: We have so much data we have, I would I
1:10:47
Speaker 12: would say over we've over indulged ourselves in all the
1:10:51
Speaker 12: data that we have to the point where, yeah, the
1:10:54
Speaker 12: challenge is, now, Okay, what decision do I make?
1:10:56
Speaker 6: Though?
1:10:57
Speaker 2: Right?
1:10:57
Speaker 12: How many software platforms offer dashboards? Everybody's got dashboards for everything,
1:11:01
Speaker 12: But what do I do with that?
1:11:03
Speaker 14: Right?
1:11:04
Speaker 12: And and so that's that's where the intersection is of
1:11:09
Speaker 12: where we can really use this as a springboard and
1:11:14
Speaker 12: you know, take a thousand dashboards and turn that into
1:11:16
Speaker 12: one decision that could be a pivotal decision for that
1:11:20
Speaker 12: business line, you know, and that could shape the industry.
1:11:23
Speaker 12: And so it's it's really really exciting, fulfilling, Harry.
1:11:29
Speaker 3: Three to five years, we have new roles that are
1:11:32
Speaker 3: sprouting up because of AI, the mergence of the emergence
1:11:37
Speaker 3: of pharmacists doing more digging down into specialty disease states.
1:11:41
Speaker 2: We have pharmacists who are now going to get their.
1:11:45
Speaker 3: Their board of specialty and pain management shout out to
1:11:49
Speaker 3: the pain guy Mark Gary Foley on our network. And
1:11:52
Speaker 3: but three to five years we have technicians who are
1:11:54
Speaker 3: going to step into more operational roles that dig down
1:11:58
Speaker 3: into priorization and inventory management.
1:12:02
Speaker 2: What do you see happening?
1:12:03
Speaker 3: What do you expect entirely new job categories to emerge
1:12:06
Speaker 3: to enhance our pharmacy operations.
1:12:09
Speaker 13: Well, I think everybody needs to watch what's going on
1:12:13
Speaker 13: in individual states. You know, I constantly remind everybody everybody
1:12:18
Speaker 13: in pharmacy understands this, but outside of pharmacy, and you've
1:12:20
Speaker 13: got listeners outside of the profession. You know, pharmacies regulated
1:12:25
Speaker 13: at a state level. What a pharmacist can do is
1:12:28
Speaker 13: determined by the state they live in. So watch the
1:12:35
Speaker 13: forward leaning states, the ones that are leanating into full
1:12:39
Speaker 13: practice authority Idaho, Montana, Colorado, Indiana, Iowa.
1:12:45
Speaker 9: I think indianasity there, and you know how many.
1:12:48
Speaker 13: Other states are going to move toward full practice authority
1:12:53
Speaker 13: so that, yes, pharmacists and pharmacy technicians will be and
1:12:59
Speaker 13: should be able to do a lot more in the future.
1:13:03
Speaker 13: But we've got to rewrite riggs to get them there.
1:13:06
Speaker 13: Before we even get to the point of provider status.
1:13:10
Speaker 13: Provider status assume as you're going to get paid for something,
1:13:13
Speaker 13: but first you have to legally be able to do it.
1:13:17
Speaker 13: So it starts with the regulations and then it rolls
1:13:19
Speaker 13: to provider status. And we may be living through a
1:13:23
Speaker 13: great transition where AI frees up a whole heck of
1:13:26
Speaker 13: a lot of pharmacy resources. From the kind of bureaucratic
1:13:31
Speaker 13: administrative drudgery to allow more kind of clinical outreach, more
1:13:37
Speaker 13: primary care fill the gap of the lack of primary
1:13:42
Speaker 13: care access by so many Americans with all of the
1:13:45
Speaker 13: pharmacies that are out there. So this could be real good,
1:13:49
Speaker 13: but we've got to kind of make it that it's
1:13:52
Speaker 13: not going to happen on its own.
1:13:54
Speaker 3: Absolutely, Amanda, Harry, this has been wonderful. Appreciate you sharing
1:14:00
Speaker 3: with our listeners here on this week in pharmacy. A
1:14:03
Speaker 3: shout out to Harry and the RX Roundtable dot com
1:14:07
Speaker 3: once again, the RX Roundtable dot com. It's a think tank,
1:14:12
Speaker 3: it's a mastermind. Harry takes different subjects. He throws some
1:14:15
Speaker 3: of the most intelligent operators in different sectors of healthcare,
1:14:19
Speaker 3: not just pharmacy, and mix mixes them all up. I
1:14:23
Speaker 3: really like what you've developed through the RX Roundtable.
1:14:26
Speaker 4: Harry.
1:14:26
Speaker 3: Give our listeners just a little briefing of what you're
1:14:29
Speaker 3: doing at the RX Roundtable.
1:14:31
Speaker 13: It's an expert network of solopreneurs and independent consultants in
1:14:36
Speaker 13: the kind of pharmacy and benefit management space.
1:14:39
Speaker 9: And if you want.
1:14:40
Speaker 13: To learn more about it, go scroll right to the
1:14:43
Speaker 13: top there. Todd to RXR Briefings. That's our newsletter, So
1:14:50
Speaker 13: you can go to Rxrbriefings dot com or THERX Roundtable
1:14:55
Speaker 13: dot com and sign up for one of our newsletters.
1:14:58
Speaker 13: And I'm usually writing about AI and pharmacy or interviewing
1:15:02
Speaker 13: somebody on that topic there.
1:15:05
Speaker 9: So thanks a lot for that shout out.
1:15:07
Speaker 3: Absolutely, there will be a link in the show notes
1:15:10
Speaker 3: to the rx Roundtable dot com. Amanda, we have to
1:15:14
Speaker 3: schedule some time at ACEMBIA twenty twenty six. I'm going
1:15:18
Speaker 3: to definitely be there with bells on, so you have
1:15:22
Speaker 3: reserved me some time so Curatio can give us an
1:15:26
Speaker 3: update on what's happening in specialty pharmacy.
1:15:29
Speaker 2: Awesome.
1:15:30
Speaker 1: Yes, I'll be there, Harry.
1:15:34
Speaker 2: I hope to see you there as well.
1:15:36
Speaker 3: Appreciate both of you spending time with us on this
1:15:39
Speaker 3: week in pharmacy.
1:15:41
Speaker 2: We'll talk to you soon.
1:15:42
Speaker 1: Thank you so much. Hi.
1:15:44
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Speaker 5: Back back fis