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WAC Price Decreases Are Happening Now | Pharmacy Crossroads · 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.
• 0:22
  Speaker 2: This is Pharmacy Crossroads with your host, community pharmacy business
• 0:27
  Speaker 2: veteran the road trip goth Bruce naland Community pharmacy is
• 0:33
  Speaker 2: at a crossroads. Pharmacy owners across the country are evolving
• 0:37
  Speaker 2: their pharmacy businesses and making a bigger impact on their communities.
• 0:41
  Speaker 2: Bruce talks with the most innovative community pharmacy owners, pharmacy
• 0:45
  Speaker 2: industry experts, and people who are passionate about the business
• 0:49
  Speaker 2: of pharmacy and its impact on community healthcare. Pharmacy Crossroads
• 0:54
  Speaker 2: is a member of the Pharmacy Podcast Network. And now
• 0:57
  Speaker 2: here's our host, Bruce Neland.
• 1:03
  Speaker 3: Well, hello again everybody.
• 1:04
  Speaker 4: This is Bruce Neland bringing you another episode of Pharmacy Crossroads.
• 1:10
  Speaker 4: Those of you who listened late last December, you heard
• 1:14
  Speaker 4: me talking about whack decreases with one of the industry's
• 1:19
  Speaker 4: most prominent figures, Jay Blackburn, who's the CEO of the
• 1:25
  Speaker 4: Compliant Pharmacy Alliance frequently referred to as CPA. And we're
• 1:33
  Speaker 4: talking again about whack decreases and some of the things
• 1:38
  Speaker 4: that have happened and some of the things that are
• 1:40
  Speaker 4: still happening, and more importantly, things you can do to
• 1:46
  Speaker 4: insulate yourself from this cash flow tsunami. And I just
• 1:52
  Speaker 4: invented that on the fly there, cash flow tsunami. I'm
• 1:56
  Speaker 4: gonna I'm gonna patent that. Hey, say hello to my
• 2:02
  Speaker 4: listeners and just remind us a little bit about who
• 2:06
  Speaker 4: CPA is and how long you've been there.
• 2:09
  Speaker 5: Sure a good chatting again with you.
• 2:11
  Speaker 6: It's hard to believe five weeks has gone by already,
• 2:14
  Speaker 6: right since we last chatted. Jay Blackburn, CEO at the
• 2:18
  Speaker 6: Compliance Pharmacy Alliance. We're an independent pharmacy buying group. We
• 2:23
  Speaker 6: have around twenty two hundred members around the country.
• 2:27
  Speaker 5: We purchased primarily.
• 2:28
  Speaker 6: Through sen Kora, so if I drop their name, it's
• 2:31
  Speaker 6: inadvertent later, but we do.
• 2:33
  Speaker 5: Purchase all of our drugs through sen Kora.
• 2:36
  Speaker 6: And I've been with the company for this is my
• 2:39
  Speaker 6: twentieth year with CPA.
• 2:42
  Speaker 5: Hard to believe, and you know, we've seen growth over
• 2:46
  Speaker 5: time and we're at a size now and you know,
• 2:50
  Speaker 5: I'm sure.
• 2:51
  Speaker 6: We talked last time about you know, what kind of
• 2:54
  Speaker 6: impact these little what seemed to be industry changes maybe
• 2:58
  Speaker 6: not so meaningful, but when you have twenty two hundred
• 3:02
  Speaker 6: independents serving you know, millions of patients each year, these
• 3:07
  Speaker 6: things have a big swing and can't impact us, impact
• 3:12
  Speaker 6: us quickly, so.
• 3:14
  Speaker 4: Well again, by now, most of the people who are
• 3:19
  Speaker 4: listening to this are going to have heard about whack
• 3:22
  Speaker 4: decreases in MFP more than they want to. More importantly,
• 3:28
  Speaker 4: they've some of them have been clubbered and lost a little.
• 3:31
  Speaker 3: Bit of money.
• 3:32
  Speaker 4: And our goal here is to figure out how to
• 3:35
  Speaker 4: moving forward some of the things you can do. And
• 3:39
  Speaker 4: you know, the thing that dawned on me is I'm
• 3:42
  Speaker 4: doing a little bit of research for this is Yeah,
• 3:44
  Speaker 4: this is happening this year, but it's going to happen
• 3:47
  Speaker 4: again next year too and after that as well.
• 3:50
  Speaker 3: Is that right, Jay?
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  Speaker 6: Yeah, So you know, I'm sure we'll get into it
• 3:55
  Speaker 6: a little bit about you know, all the things that
• 3:57
  Speaker 6: happened in twenty twenty six. We had ten drugs initially
• 4:02
  Speaker 6: on the MFP lists, and each manufacturer reacted a little
• 4:06
  Speaker 6: bit differently in some cases. But yeah, as we move
• 4:09
  Speaker 6: into twenty twenty seven, twenty twenty eight, the government has
• 4:14
  Speaker 6: fifteen drugs on the list for each of those years,
• 4:18
  Speaker 6: and I would say the activities that took place at
• 4:24
  Speaker 6: the manufacture level will be roughly the same. You know,
• 4:29
  Speaker 6: so you're probably going to have half of those drugs
• 4:31
  Speaker 6: take whack decreases in advance. And who knows what else
• 4:36
  Speaker 6: may happen with the government and regulation and IRA and
• 4:40
  Speaker 6: so on between now and then, but I will tell
• 4:43
  Speaker 6: you that expect more of the unexpected between now and then,
• 4:48
  Speaker 6: for sure.
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  Speaker 3: Yeah.
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  Speaker 4: So I'm just going to backpet a little bit. MFP
• 4:51
  Speaker 4: is Manufacture Fair Pricing and then you.
• 4:55
  Speaker 3: Just threw out the IRA there. That's that.
• 5:01
  Speaker 4: Acronym for the law that they passed called the Inflation
• 5:05
  Speaker 4: Reduction Act. Okay, we did this five weeks ago. It's
• 5:09
  Speaker 4: now three weeks into the year. What has happened? What
• 5:13
  Speaker 4: have the manufacturers done?
• 5:16
  Speaker 5: Yeah?
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  Speaker 6: So, you know, I think what took place is mostly
• 5:19
  Speaker 6: what we expected. You know, they announced that they're, you know,
• 5:23
  Speaker 6: the different manufacturers are going to have whack decreases. You know,
• 5:28
  Speaker 6: it varied a little bit because some of the manufacturers
• 5:31
  Speaker 6: that announced whack decreases those drugs were on that Inflation
• 5:36
  Speaker 6: Reduction Act MFP list. One of those manufacturers synced up
• 5:42
  Speaker 6: their whack reductions to MFP.
• 5:45
  Speaker 5: So so their new whack was going to eat MFP.
• 5:48
  Speaker 6: The other four we weren't sure, right, So throughout the
• 5:53
  Speaker 6: you know, I think last time you brought up the
• 5:54
  Speaker 6: drug eloquist when you think about what happened with eloquists.
• 5:58
  Speaker 5: They they're on the m FP list.
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  Speaker 6: They announced they're going to have a whack decrease, but
• 6:04
  Speaker 6: they aren't didn't indicate that it was going to sync
• 6:07
  Speaker 6: the two up. So what we experience, well, maybe I'll
• 6:11
  Speaker 6: give the listeners a little bit more on eloquence than
• 6:14
  Speaker 6: what they're looking for, but we dug Indeed, the old
• 6:17
  Speaker 6: whack was six hundred and six dollars, the new whack
• 6:20
  Speaker 6: was three forty five, So there was a forty three
• 6:24
  Speaker 6: percent drop from old whack.
• 6:26
  Speaker 5: To new whack. Now old whack down the MFP.
• 6:31
  Speaker 6: MFP is two forty eight, right, so that's another eighteen
• 6:35
  Speaker 6: percent off of whack. But I joked around with one
• 6:38
  Speaker 6: of my team members the other day, my ex wife.
• 6:41
  Speaker 6: You know, back when Macy's I think was a thing.
• 6:43
  Speaker 6: I know they're still in business, but you'd get the
• 6:46
  Speaker 6: Sunday paper they have a flyer in there and there
• 6:49
  Speaker 6: would be a bunch of things on sale, and it
• 6:51
  Speaker 6: would say forty percent off jewelry, another thirty percent off
• 6:55
  Speaker 6: at the calendar, and another thirty off of you blah
• 6:57
  Speaker 6: blah blah. Right, So forty thirty thirty means it's free. Well, no,
• 7:02
  Speaker 6: it's not right. So in this case, you had forty
• 7:06
  Speaker 6: three percent off the original whack, you get down to
• 7:10
  Speaker 6: the new whack, then that's twenty eight percent off of
• 7:13
  Speaker 6: the new whack down to MFP forty three twenty eight
• 7:16
  Speaker 6: seventy one. Now the actual old down to MFP is
• 7:21
  Speaker 6: fifty nine percent. So when you think about the complexity
• 7:25
  Speaker 6: in our business, how we get reimbursed, how we pay
• 7:28
  Speaker 6: for drugs, how we're supposed to get reimbursed the rebate Trev,
• 7:32
  Speaker 6: this is you need a PhD, I think, and to
• 7:36
  Speaker 6: have the data right in front of you for most
• 7:38
  Speaker 6: every plane to determine whether you're actually making money. So
• 7:42
  Speaker 6: again back to your question, I think we got everything
• 7:46
  Speaker 6: that we were anticipating.
• 7:47
  Speaker 5: It just took a little bit of time to play out.
• 7:50
  Speaker 3: If you will, well, that's an opportunity for me.
• 7:53
  Speaker 4: Remind our listeners that if you go to the compliantarx
• 7:58
  Speaker 4: dot com website, they've got spreadsheets and detailed listings of
• 8:03
  Speaker 4: all of this information. I didn't expect anybody who have
• 8:06
  Speaker 4: taken notes as Jay went through that mathematical calculation. So
• 8:10
  Speaker 4: it's all on their website, and I clearly want to
• 8:14
  Speaker 4: emphasize CPA compliant, Pharmacy Alliance compliant our x is. The
• 8:21
  Speaker 4: website is making this information available to any pharmacy, regardless
• 8:27
  Speaker 4: of who their wholesaler or GPO is. So with that
• 8:31
  Speaker 4: as a background, it's three weeks in. What have you
• 8:34
  Speaker 4: heard from your members?
• 8:37
  Speaker 5: Yeah, so, you know, I think we're seeing what we expected.
• 8:41
  Speaker 6: I think, you know, we had a couple of challenges
• 8:44
  Speaker 6: along the way. You know, you know, it was posted
• 8:48
  Speaker 6: and published from the manufacturers in the wholesalers with regards
• 8:52
  Speaker 6: to return goods. Right, so immediately once this information came out,
• 8:59
  Speaker 6: the whole sailors, you know, put a block on returns.
• 9:03
  Speaker 6: So that was back on for the January one changes.
• 9:06
  Speaker 6: That was back on December first. And you know a
• 9:10
  Speaker 6: lot about how Pharmaci's Independence specifically managed their inventory. Right.
• 9:16
  Speaker 4: We always think you've got twenty two hundred members, they
• 9:19
  Speaker 4: do it twenty three hundred ways.
• 9:21
  Speaker 3: Right, that's a.
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  Speaker 6: That's a great comment, Bruce. But yeah, so it's about
• 9:27
  Speaker 6: sixty percent used perpetual inventory in the pharmacy management system.
• 9:32
  Speaker 6: Forty percent use some other method. It's typically I use
• 9:37
  Speaker 6: the last bottle, I buy two more in and when
• 9:39
  Speaker 6: you have a relief pharmacists from the hospital, he doesn't
• 9:42
  Speaker 6: care about cash flow. He always orders three and so
• 9:45
  Speaker 6: next Saturday when he's working, he's never.
• 9:47
  Speaker 5: Out right, that's how that works.
• 9:50
  Speaker 6: But what you have is we typically when missus Smith
• 9:53
  Speaker 6: walks in the door, we never want to be out.
• 9:56
  Speaker 5: Of the drug, right.
• 9:58
  Speaker 6: So what ends up happening is in the perpetual inventory world,
• 10:02
  Speaker 6: we always set it up to reorder a full bottle,
• 10:06
  Speaker 6: whether you're grade thirty or sixty, right, so we always
• 10:09
  Speaker 6: want to have product on the shelf. Maybe unlike some
• 10:12
  Speaker 6: of the chains. You know, the chains today they have
• 10:15
  Speaker 6: no problem telling you come back tomorrow or come back
• 10:18
  Speaker 6: two days later when they get it in.
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  Speaker 5: But that's not how we roll.
• 10:22
  Speaker 6: So what happened is, you know, you have all these
• 10:25
  Speaker 6: situations where the wholesaler says, on December first, we're no
• 10:30
  Speaker 6: longer taking returns at least through the end of the year.
• 10:33
  Speaker 6: So in most cases, these are high velocity drugs that
• 10:37
  Speaker 6: were on this initial IRA list, and most of them
• 10:42
  Speaker 6: we were going to sell through, but not every product
• 10:45
  Speaker 6: we had on the shelf could get sold through, if
• 10:50
  Speaker 6: you will. But long and short, you know, we end
• 10:54
  Speaker 6: up having pharmacies. I'll use the term eat some drug
• 10:59
  Speaker 6: no matter how many times we email texts, all that
• 11:03
  Speaker 6: communications tough around the holidays, right that month of December's
• 11:06
  Speaker 6: you know, pretty busy, and so we've had pharmacies lose
• 11:10
  Speaker 6: thousands of dollars due to the fact that they couldn't
• 11:14
  Speaker 6: return the product. And it's no blame to the wholesalers
• 11:17
  Speaker 6: because when you think about the other side, if everybody
• 11:20
  Speaker 6: after the first of the year can return the newly
• 11:23
  Speaker 6: priced product and use an old invoice from three months ago,
• 11:28
  Speaker 6: the wholesaler can't eat that cost sealer either. So we
• 11:31
  Speaker 6: understand how the system works. It's challenging, but in the end,
• 11:37
  Speaker 6: you know, we communicate fairly consistently and we've eliminated most
• 11:43
  Speaker 6: of those challenges. But yeah, it's definitely a bit of
• 11:46
  Speaker 6: a headache on.
• 11:47
  Speaker 5: The front end.
• 11:48
  Speaker 4: Well, and you know, that's water over the bridge. So
• 11:53
  Speaker 4: where do we go from here? What's gonna come over
• 11:55
  Speaker 4: happen in the next three to six months, Yeah, so.
• 11:58
  Speaker 6: We're gonna you know, we have a couple of areas
• 12:00
  Speaker 6: to focus on, not to forget that on February first,
• 12:06
  Speaker 6: there are two drugs left on Lily's list Human Logue,
• 12:10
  Speaker 6: QuickPen and Lounjev. So we still have a couple more
• 12:14
  Speaker 6: price decreases coming. But overall, when you think dollar volume wise,
• 12:19
  Speaker 6: it's about one fiftieth from a dollar perspective compared to
• 12:23
  Speaker 6: what happened in January.
• 12:24
  Speaker 5: So definitely not the end of the world.
• 12:26
  Speaker 6: But we you know, price decreases anywhere from thirty seven
• 12:30
  Speaker 6: to seventy five percent, you know, pretty impactful from a
• 12:36
  Speaker 6: compliant Pharmacy Alliance perspective. To give you some thought around that,
• 12:42
  Speaker 6: is it six percent of what we bought drug volume
• 12:47
  Speaker 6: wise in twenty twenty five was the Eloquist And so
• 12:52
  Speaker 6: when you have six six percent of your volume is Eloquist,
• 12:56
  Speaker 6: and it draw old whack to new whack, forty three
• 12:59
  Speaker 6: percent from a little or earlier I mentioned you know,
• 13:02
  Speaker 6: about three percent, give or take of our overall volume.
• 13:06
  Speaker 5: Dropped on that one drug.
• 13:08
  Speaker 6: Right, So when you look at it holistically, a little
• 13:12
  Speaker 6: shy nine and a half percent of what we purchased
• 13:15
  Speaker 6: dollar wise in twenty twenty five decrease on January one,
• 13:21
  Speaker 6: so roughly ten percent of our purchase volume and sales
• 13:25
  Speaker 6: dropped overnight.
• 13:27
  Speaker 4: Now there is a mechanism for people to recoup some
• 13:32
  Speaker 4: of this money, not that's lost already, but going forward
• 13:36
  Speaker 4: in order to get those rebates. I've read a little
• 13:39
  Speaker 4: bit about this Medicare Transition Facilitator. So we've got MFP,
• 13:46
  Speaker 4: manufacture fair price, and now we've got the MTF.
• 13:51
  Speaker 3: What's that?
• 13:53
  Speaker 6: So the MTF is the transaction Facilitator is we'll just
• 13:58
  Speaker 6: say that the government put the together and most of
• 14:01
  Speaker 6: the pharmacy owners are familiar. NCPA has been publishing it,
• 14:05
  Speaker 6: we've published stuff. But what it is is it's a
• 14:09
  Speaker 6: uh the system built and design that would allow you
• 14:14
  Speaker 6: to you know, process your Medicare claims and then they
• 14:19
  Speaker 6: get if you will spun up into the facilitator. And
• 14:23
  Speaker 6: what that does is that you know, the PBM reimburses
• 14:27
  Speaker 6: you MFP and then you bought the drug at whack,
• 14:31
  Speaker 6: let's say, and then the MTF will take the rebate
• 14:36
  Speaker 6: from the manufacture and process it down through your p SAO.
• 14:42
  Speaker 6: So i'll speak to you know, our members use five
• 14:45
  Speaker 6: or six different p SAOs, but Bruce. You may be
• 14:49
  Speaker 6: familiar with sen Chorus p SAO called elevate, and so
• 14:54
  Speaker 6: what happens is that you know, you enrolled through the
• 14:59
  Speaker 6: MTF process, and then that differential between whack down the
• 15:04
  Speaker 6: MSP gets processed through your p s AO. In this case,
• 15:08
  Speaker 6: Elevated would then deposit those monies into the pharmacy's account. Right,
• 15:15
  Speaker 6: So it's just was a it's another step in the
• 15:18
  Speaker 6: process whereby we're buying product at black from the wholesaler,
• 15:25
  Speaker 6: get reimburse MFP, and then the manufacturer is in essence
• 15:31
  Speaker 6: truing us up by sending that through our p s AO.
• 15:34
  Speaker 4: But I guess the key point that I think might
• 15:38
  Speaker 4: be misunderstood is if you have a p s AO there,
• 15:43
  Speaker 4: they don't do this automatically for you. Stores have to
• 15:46
  Speaker 4: individually register with this Medicare Transaction Facilitator.
• 15:52
  Speaker 3: Is that correct?
• 15:53
  Speaker 5: That's a great call out. I should have hit on that.
• 15:56
  Speaker 6: Yeah, So every pharmacy the processing medicare claims at, wants
• 16:02
  Speaker 6: to get trewed up from whack.
• 16:04
  Speaker 5: Down the MFP they need needed or need if you.
• 16:08
  Speaker 6: Haven't done it, need to sign up through the MTF.
• 16:13
  Speaker 6: I'll give you some statistics on CPA because you know,
• 16:17
  Speaker 6: with a lot of members and there's other groups out
• 16:19
  Speaker 6: there that are our size, it's hard to hurt all
• 16:22
  Speaker 6: the cats. But as of December first, we had roughly
• 16:29
  Speaker 6: four hundred pharmacies that had yet to enroll through the
• 16:34
  Speaker 6: MTF process. So we're on the phone talking about email
• 16:38
  Speaker 6: texteing dollan you know, almost like dollan for dollars, right,
• 16:41
  Speaker 6: trying to get them to enroll. Please to say that
• 16:44
  Speaker 6: we were down to less than fifty after the first
• 16:48
  Speaker 6: of the year. But even though pharmacies didn't sign up
• 16:53
  Speaker 6: through the MTF process, they still can.
• 16:56
  Speaker 5: And I think that's where you were leading me to.
• 16:59
  Speaker 6: If they can, you'll go out there today and enroll,
• 17:03
  Speaker 6: because until they enroll and the Transaction Facilitator HUG knows
• 17:09
  Speaker 6: where to send their rebate credits right from whack down
• 17:13
  Speaker 6: to MFP, the system doesn't know that they're using Elevator,
• 17:19
  Speaker 6: they're using health maart at lists.
• 17:22
  Speaker 5: Or Leader, you know what I mean. So you need
• 17:24
  Speaker 5: to go.
• 17:24
  Speaker 6: In if you haven't done it. It's a great question,
• 17:27
  Speaker 6: great call out. We're going to save people thousands of
• 17:30
  Speaker 6: dollars today on this just one question.
• 17:33
  Speaker 5: They need to go out there and make sure they've
• 17:35
  Speaker 5: checked all the boxes. So otherwise I know what's going
• 17:39
  Speaker 5: to happen.
• 17:40
  Speaker 6: You know what's going to happen at some point later
• 17:43
  Speaker 6: this month or early February. I think you called it
• 17:46
  Speaker 6: the as I wrote it down, their cash flow tsunami.
• 17:50
  Speaker 5: We're going to have some.
• 17:52
  Speaker 6: Members of ours and other independents have that aha moment
• 17:58
  Speaker 6: that what happened my checking account? Right, where's the money? Well,
• 18:02
  Speaker 6: the problem is they're filling planes and they're not going
• 18:05
  Speaker 6: to see them. But good news. I've been told from
• 18:09
  Speaker 6: a couple of industry sources that if they go back
• 18:13
  Speaker 6: and enrolled today, it may take a week or two,
• 18:17
  Speaker 6: but they will then get these credits from the manufacturer
• 18:21
  Speaker 6: that are sitting chewed up back to January first, Right.
• 18:26
  Speaker 6: But the longer they wait, the you know, more painful it's.
• 18:30
  Speaker 5: Going to be.
• 18:31
  Speaker 4: So this kind of an off the wall question. But
• 18:35
  Speaker 4: for the pharmacies that aren't CPA members, I mean, can
• 18:40
  Speaker 4: you share a little bit about where they might be
• 18:43
  Speaker 4: going or to get the help here? I mean, who
• 18:45
  Speaker 4: else out there is trying to help with this?
• 18:48
  Speaker 6: So I'm assuming you know our peers who run similar
• 18:52
  Speaker 6: groups are doing the same thing. Speaking to you know,
• 18:56
  Speaker 6: our partner at sen Kora for their p SAO members,
• 19:03
  Speaker 6: our members, joint members using elevate. They're tracking, we're tracking.
• 19:08
  Speaker 6: They're able to pull some stuff off the MTP site
• 19:11
  Speaker 6: and keeping us in the loop, and then we you know,
• 19:15
  Speaker 6: badger our members to make sure they're doing it. I'm
• 19:18
  Speaker 6: sure that the other p SAOs are doing it. But
• 19:21
  Speaker 6: there are you know, a bunch of i'll call them
• 19:24
  Speaker 6: non affiliated independence out there.
• 19:26
  Speaker 5: That aren't with a buying group or GPO.
• 19:30
  Speaker 6: And unless they have a tight relationship with their maybe
• 19:33
  Speaker 6: sales executive or something someone else, they may be sitting
• 19:38
  Speaker 6: out there, you know, in no man's land.
• 19:40
  Speaker 5: So I'm sure there are a number of folks out there.
• 19:43
  Speaker 6: But if you're unaffiliated and you're not hearing from your
• 19:47
  Speaker 6: buying group, let's say i'd reach out to NCPA. At
• 19:51
  Speaker 6: a minimum, they have a bunch of information published out there,
• 19:55
  Speaker 6: maybe even a recorded webinar or to make sure that
• 19:58
  Speaker 6: you get enrolled and.
• 19:59
  Speaker 7: Get but and how they can always call us that.
• 20:04
  Speaker 7: I'm not suggesting they do that, but you know, again,
• 20:07
  Speaker 7: trying to keep independent pharmacies alive and serving their community,
• 20:12
  Speaker 7: getting paid and reimburse and filling the checking account is
• 20:15
  Speaker 7: super important, right, So.
• 20:17
  Speaker 4: Well, and I know, again this is one of those
• 20:20
  Speaker 4: generous things you've done. But you've got field reps out
• 20:24
  Speaker 4: there who obviously know most of the pharmacies and their territory,
• 20:29
  Speaker 4: whether they're CPA members or not, and they might not
• 20:33
  Speaker 4: be able to do do but they can at least
• 20:36
  Speaker 4: help point these pharmacies to places to go, can't they.
• 20:40
  Speaker 6: Yeah, so we have a real small field team and
• 20:43
  Speaker 6: they do about fifty percent of their work is servicing
• 20:45
  Speaker 6: our members and making sure they're doing what we need.
• 20:47
  Speaker 5: Them to do.
• 20:48
  Speaker 6: But yeah, they do go call on other independents and
• 20:52
  Speaker 6: they're armed with you know, I don't want to say flyers,
• 20:55
  Speaker 6: but they have you know, materials and weblinks and all
• 20:59
  Speaker 6: that be able to provide some sort of we'll call
• 21:03
  Speaker 6: it on site coaching.
• 21:05
  Speaker 5: But yeah, again, this is these types of situations and
• 21:09
  Speaker 5: I think.
• 21:10
  Speaker 6: You know how we've tried to go about it and
• 21:12
  Speaker 6: you know, kind of providing all the information we can
• 21:15
  Speaker 6: and making it available. And we don't have everything, so
• 21:17
  Speaker 6: we're always open to more. But this is an independent
• 21:21
  Speaker 6: pharmacy thing. This isn't a CPA thing. So to your point,
• 21:26
  Speaker 6: the more educated, the independent pharmacy community is from wherever
• 21:31
  Speaker 6: the source is, it's good for all of us.
• 21:34
  Speaker 3: So let's move on.
• 21:35
  Speaker 4: What's going to happen in twenty seven twenty eight, and
• 21:39
  Speaker 4: what do you suggest people do to get ready or
• 21:42
  Speaker 4: how they going to get ready, how they're going to
• 21:44
  Speaker 4: handle this going on?
• 21:46
  Speaker 5: Yeah, so you know a couple of things.
• 21:48
  Speaker 6: As I mentioned, fifteen more drugs in twenty seven, fifteen
• 21:52
  Speaker 6: more in twenty eight, definitely some big names in twenty
• 21:56
  Speaker 6: twenty seven.
• 21:57
  Speaker 5: If you haven't seen the list, you know.
• 22:00
  Speaker 6: Our initial review of the drug list, we anticipate very
• 22:04
  Speaker 6: much the same basic extrapolation sets based on dollar volume, based.
• 22:09
  Speaker 5: On the drugs, a few more drugs compared to the.
• 22:12
  Speaker 6: Ten we're expecting Whack decreases about one hundred and twenty
• 22:17
  Speaker 6: to one hundred and thirty percent of what we saw,
• 22:20
  Speaker 6: which means if I saw roughly ten percent, you know,
• 22:24
  Speaker 6: overall deflation in our portfolio dollar wise in twenty six,
• 22:28
  Speaker 6: I'm looking at twelve to thirteen fourteen percent deflation on
• 22:32
  Speaker 6: top of that, you know, so and again, uh, you know,
• 22:37
  Speaker 6: the years have been flying by, But who knows what
• 22:40
  Speaker 6: other events in twenty six that may trigger some differential
• 22:45
  Speaker 6: or other thought process in the CFO minds at these manufacturers, right,
• 22:50
  Speaker 6: because they all have a different methodology, right, just like
• 22:54
  Speaker 6: we explained on Bristle with eloquists, right, dropping whack by
• 22:59
  Speaker 6: forty three percent, but still having another eighteen percent.
• 23:03
  Speaker 5: Off a whack down the MFP. Why did they do that?
• 23:07
  Speaker 6: I don't know, but I guarantee you there's some financial
• 23:10
  Speaker 6: reason to do so, you know what I mean.
• 23:13
  Speaker 4: They have smart people playing with as best they know how. So, Jay,
• 23:19
  Speaker 4: you've made stuff available to people to get prepared for
• 23:22
  Speaker 4: this it's happened. Are you quitting now or what can
• 23:25
  Speaker 4: people take advantage of from you and your website?
• 23:29
  Speaker 6: Yeah? So I'd say a couple of things. I would First,
• 23:32
  Speaker 6: I would plead to each owner to identify one key
• 23:36
  Speaker 6: employee at each of their pharmacies, right, especially for multisore
• 23:40
  Speaker 6: absentee owners. Make sure you have somebody at the pharmacy
• 23:44
  Speaker 6: who's staying on top of these manufacturer changes. I'd say
• 23:48
  Speaker 6: on a monthly basis, right, you know, for my team,
• 23:51
  Speaker 6: you know they're going to say on top of it.
• 23:54
  Speaker 6: We've you know, kind of received some positive feedback from
• 23:58
  Speaker 6: non CPA per participants are non affiliated pharmacies that appreciated
• 24:03
  Speaker 6: the information we put out there out on.
• 24:06
  Speaker 5: That and you mentioned a couple of times at complying
• 24:08
  Speaker 5: our x dot com.
• 24:10
  Speaker 6: But one of my team members the other day suggested
• 24:12
  Speaker 6: that we put one of those opt in email type
• 24:16
  Speaker 6: things out there where we could push updated information once
• 24:21
  Speaker 6: a month if there are any changes for those that
• 24:24
  Speaker 6: are interested in receiving it. Right, So I'm not pushing it,
• 24:28
  Speaker 6: but you know, you know, an email update twelve times
• 24:33
  Speaker 6: in the next year could be helpful, but I'm not
• 24:36
  Speaker 6: selling it. So we're thinking about doing something like that.
• 24:39
  Speaker 6: We're going to continue to update that, you know, we'll
• 24:42
  Speaker 6: call it industry facing website as information. As I just
• 24:45
  Speaker 6: mentioned earlier, Lily's going to be changing well, update the
• 24:48
  Speaker 6: site and so on. So we're going to continue to
• 24:52
  Speaker 6: do that, and I think you were alluding to it
• 24:54
  Speaker 6: to beginning out on the site. We've made multiple slices
• 24:59
  Speaker 6: of this data available out there. First one is just
• 25:03
  Speaker 6: that four whack decrease. What's the percentage? You know, you
• 25:07
  Speaker 6: want to hand that out at the next pharmacy staff.
• 25:11
  Speaker 5: Meeting, bring awareness to it. We've made a.
• 25:14
  Speaker 6: Short list of just the top twenty. NBC's one at
• 25:18
  Speaker 6: least one per drug, so that the pharmacy staff as
• 25:23
  Speaker 6: they're filling prescriptions, they can see that data set, like
• 25:26
  Speaker 6: I gave you the numbers for eloquists, so it gives
• 25:29
  Speaker 6: them a feeling of hey, am I filling this prescription underwater?
• 25:35
  Speaker 6: Because you know, over time, this Medicare reimbursement methodology through
• 25:41
  Speaker 6: IRA is going to work its way.
• 25:44
  Speaker 5: Into the commercial marketplace.
• 25:45
  Speaker 6: And we know how PBMs, you know, want to consolidate
• 25:51
  Speaker 6: or simplify things.
• 25:52
  Speaker 5: On their end, so you need to be aware. So
• 25:54
  Speaker 5: I think just having that list available. And then one
• 25:57
  Speaker 5: of the things that we did.
• 25:58
  Speaker 6: We have a good number of members that I like
• 26:02
  Speaker 6: to call them data jockeys, but they want everything in Excel.
• 26:08
  Speaker 6: So our team, my COO, Amanda Rieger, she went out
• 26:12
  Speaker 6: there and we've done two things. We have a full
• 26:14
  Speaker 6: list of all sixty seven NDCs that were impacted in Excel.
• 26:20
  Speaker 6: You know, you can go in there, punch in, hey
• 26:22
  Speaker 6: I bought three of these and create your own estimated
• 26:26
  Speaker 6: you know, credits that you're going to receive. She also
• 26:31
  Speaker 6: built it in a fillable PDF with the calculations in there.
• 26:35
  Speaker 6: So we've probably gone a little crazy, but we have
• 26:40
  Speaker 6: enough members that somebody's going to ask for the raw data,
• 26:44
  Speaker 6: so that's why you get the excel file. So they're
• 26:46
  Speaker 6: sort of the you know, the crawling, which is the
• 26:49
  Speaker 6: one pager you're walking with the top twenty and you're
• 26:53
  Speaker 6: running with scissors with all sixty seven in an excel file.
• 26:58
  Speaker 5: But that's all.
• 26:58
  Speaker 6: Out on the CP site and we'll continue to update it,
• 27:02
  Speaker 6: definitely in February when we see what the final Lilly numbers.
• 27:06
  Speaker 5: Are for those couple drugs that I mentioned earlier.
• 27:09
  Speaker 6: So and then as we progress throughout the year, there
• 27:14
  Speaker 6: may be some things that we're hearing.
• 27:16
  Speaker 5: We'll post that out there.
• 27:18
  Speaker 6: And then definitely, this has been an interesting ride in
• 27:22
  Speaker 6: twenty six, twenty five one into twenty six, and as
• 27:26
  Speaker 6: I mentioned earlier, we expect twenty seven to be none
• 27:31
  Speaker 6: the less exciting as what we just encountered.
• 27:34
  Speaker 4: So yeah, well, I mean we've done a good job
• 27:39
  Speaker 4: of covering most of what's on your suggested conversation list.
• 27:44
  Speaker 4: I get a little free wheeling or whatever, so I
• 27:46
  Speaker 4: might have missed something. Is there something on your list
• 27:49
  Speaker 4: that you wanted to make sure you said before we
• 27:52
  Speaker 4: end this thing.
• 27:53
  Speaker 5: No, I think we.
• 27:54
  Speaker 6: Covered a lot of ground. I think that between the
• 27:57
  Speaker 6: two episodes of the podcast, you've put the well the
• 28:01
  Speaker 6: other one in this one.
• 28:02
  Speaker 5: I think we've covered a.
• 28:03
  Speaker 6: Lot of ground, you know, I think that, you know,
• 28:08
  Speaker 6: last couple of comments may be that independent pharmacists are
• 28:11
  Speaker 6: challenged every day, right.
• 28:13
  Speaker 5: We're used to that, We're used.
• 28:15
  Speaker 6: Of focusing our attention on what's coming next as an industry.
• 28:21
  Speaker 5: We need to say on top of these things.
• 28:23
  Speaker 6: Because we're not talking you know, oh, I got you know,
• 28:26
  Speaker 6: three dollars for a lie Center pro script or, as
• 28:29
  Speaker 6: Doug Hoy says, bubble gum drug price. I got a
• 28:31
  Speaker 6: dollar twenty nine. We're talking significant dollars, hundreds of dollars
• 28:36
  Speaker 6: in whack changes. So there's inventory you got to worry about.
• 28:40
  Speaker 5: Did you buy? Right?
• 28:41
  Speaker 6: Are you this sensing?
• 28:42
  Speaker 5: You know what I mean?
• 28:43
  Speaker 6: Like it's a little bit of everything, and it's only.
• 28:45
  Speaker 5: Going to continue.
• 28:46
  Speaker 6: So again, we have the information for this subset from
• 28:52
  Speaker 6: twenty five to twenty six on our website.
• 28:54
  Speaker 5: Feel free to get that.
• 28:56
  Speaker 6: And you know, maybe you know again, I'm not looking
• 28:59
  Speaker 6: to come on here again, but you.
• 29:01
  Speaker 5: Know, maybe in April or May when this you know,
• 29:04
  Speaker 5: when the real dust settles, because.
• 29:06
  Speaker 6: Yes, now we know We're assuming we're going to get
• 29:09
  Speaker 6: all these credits through the wholesaler from the manufacture and
• 29:13
  Speaker 6: they have every pharmacy categorized. Prop there'll be some craziness
• 29:18
  Speaker 6: that we encounter sometime by the end of this first quarter.
• 29:21
  Speaker 6: So hey, maybe we come back next time and spend
• 29:25
  Speaker 6: just a few minutes given a quick recap of what
• 29:28
  Speaker 6: we encountered, and then for those pharmacies that are on
• 29:34
  Speaker 6: it that's alcohol, go it alone a little bit and
• 29:36
  Speaker 6: be unaffiliated. You know, we just kind of give you
• 29:38
  Speaker 6: some more guidance on what we saw so that they
• 29:41
  Speaker 6: can go back to their wholesaler partner and make sure
• 29:44
  Speaker 6: that they got the proper credits right, because again, you know,
• 29:48
  Speaker 6: we estimate. We looked at the data, and there are
• 29:51
  Speaker 6: some pharmacies that are expecting from the credit process five
• 29:55
  Speaker 6: hundred or one thousand, and there are some that are
• 29:57
  Speaker 6: expecting thirty or forty thousand, so and real money and
• 30:01
  Speaker 6: real impact for many pharmacies out there.
• 30:05
  Speaker 3: So well, that's the case, and you know, I.
• 30:07
  Speaker 4: I happen to be a Monzierno customer and benefited at
• 30:14
  Speaker 4: the end of the year for having met the donut hole,
• 30:17
  Speaker 4: which isn't the donut hole anymore. So I had a
• 30:19
  Speaker 4: couple couple months of free and now I've got You know,
• 30:25
  Speaker 4: it was seven hundred and eighty dollars to get my
• 30:27
  Speaker 4: first supply, and you know, I wasn't the only one.
• 30:31
  Speaker 3: Fortunately. I know what's going on.
• 30:32
  Speaker 4: But there's people standing at the pharmacy counter getting to
• 30:36
  Speaker 4: hit with you know, the deductibles kicking in again. And
• 30:40
  Speaker 4: my heart goes out to the technicians and the people
• 30:43
  Speaker 4: who are standing at the counter and have to explain
• 30:46
  Speaker 4: that stuff again and again and again. But then doing
• 30:49
  Speaker 4: that is what makes us independent pharmacies and professional caregivers.
• 30:54
  Speaker 4: So hey, everybody, Jay, let me thank you profusely for
• 30:59
  Speaker 4: doing this. It's an honor to have got acquainted with
• 31:02
  Speaker 4: you a little bit via this process. I can run
• 31:06
  Speaker 4: this on for another minute or so, but I feel
• 31:09
  Speaker 4: to go ahead and call it over and say, hey,
• 31:12
  Speaker 4: thanks to everybody.
• 31:13
  Speaker 3: Oh here's the last thing I knew.
• 31:14
  Speaker 4: I wanted to remind Jays mentioned the podcast he did
• 31:18
  Speaker 4: five weeks ago that can be found as all of
• 31:21
  Speaker 4: mine can, at pharmacycrossroads dot com. There's a just a
• 31:27
  Speaker 4: library there of all my past podcasts. That's Pharmacycrossroads dot
• 31:32
  Speaker 4: com And with that, I'm gonna say, hey, everybody, thanks
• 31:37
  Speaker 4: for listening, and we hope that something we say on
• 31:41
  Speaker 4: this program will help you do more and be better.
• 31:46
  Speaker 4: That's it for Pharmacy Crossroads, Good.
• 31:49
  Speaker 2: Day, Thanks for listening to Pharmacycrossroads. If you're interested in
• 31:53
  Speaker 2: talking with Bruce, please contact the show visit Pharmacycrossroads dot com.
• 31:58
  Speaker 5: We look forward to hearing from you. Memories and Manori