Latest / Gladden Longevity Podcast / The Cost-Effectiveness of Compounding Pharmacies - Episode 348

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The Cost-Effectiveness of Compounding Pharmacies - Episode 348 · Gladden Longevity Podcast

• 0:00
  The data that's being pulled from thousands of samples being submitted from hundreds
• 0:05
  of these companies. I mean, it is insane.
• 0:07
  Over 80% of the drugs you buy on the black market,
• 0:11
  which is what's pretty much what it is a black market,
• 0:13
  80% of them do not meet specification.
• 0:15
  Can you imagine a supply chain where 80% of the drugs coming out of
• 0:20
  it weren't under spec? That is what has happened because the FDA
• 0:25
  has not allowed compound pharmacies to make these.
• 0:28
  Hey everyone, I just finished a podcast with Sean Nurian from Empower Pharmacy down
• 0:33
  in Houston, Texas. This is a really interesting conversation we have talking about
• 0:37
  peptides, talking about the state of the FDA,
• 0:40
  talking about how compounding pharmacy can actually get you medications cheaper than
• 0:44
  you can get at your local pharmacy.
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  There are many interesting things here to chat through,
• 0:48
  and I think you're gonna find this a very interesting podcast.
• 0:50
  He went from saving hearts as a cardiologist to rewriting the entire aging playbook.
• 0:56
  Dr. Jeffrey Gladden believes 100 is the new 30,
• 0:59
  and he's got the science to back it up.
• 1:01
  This is the Gladden Longevity Podcast.
• 1:05
  John, welcome to the Glad Longevity Podcast.
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  It's good to see you. Yeah, good.
• 1:08
  Doc, great to see you as well.
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  I appreciate you taking the time.
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  So tell us what's been going on at Empower.
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  I know you guys are a pharmacy that started,
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  you know, it's not like twenty years ago.
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  I think if I'm not mistaken, it was a lot more recent than that.
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  And yet you've really been on a a growth spurt,
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  an expansion spurt. And I'm curious to understand what's what's kind of going
• 1:28
  on for you guys.
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  Yeah, so you're close. We're we've been around for 17 years this July.
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  We celebrated our happy birthday on the first.
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  Okay, great. Since the past seventeen years,
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  you know, how we ended up becoming one of the premier competent farmers
• 1:41
  in the country is by one, working with providers like yourself
• 1:46
  to inform us on what is the best type of therapy for their patients.
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  And working with our medical affairs teams and our R and D department
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  to create these very
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  unique stable formulations that work for for many of these patients better than
• 2:05
  a commercial option could have helped that patient.
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  So we see more and more doctors learning about personalization
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  and customization and utilizing compounding pharmacies to be able to create
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  as what you would say the best possible ecosystem in s within our bodies.
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  And
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  You all our ecosystem is just is a number of chemicals and certain amounts.
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  And if some of those chemicals are off,
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  we're off. You know, the disease states are due to many of them
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  due to chemical imbalances. So by working with providers all that
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  are learning about functional medicine,
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  preventative medicine, longevity medicine,
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  and creating personal protocols,
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  we're seeing patients like never before getting access to these drugs at
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  a lower and lower cost point, which is
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  One of the greater one. Another reason why doctors are
• 2:57
  now utilizing compounding pharmacies,
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  their patients can't afford the commercial option.
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  And if the patient can't afford the medicine,
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  what's the point of seeing the doctor?
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  That doctor just lost a patient.
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  That's an interesting point that compounding pharmacies will sell,
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  and we found this to be true, that you'll sell something to a client.
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  We don't sell, you know, we don't sell medications through the practice,
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  right? And in Texas, there's a separation of church and state between pharmacies
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  and physician offices. So we don't sell anything,
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  but we we notice, and of course,
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  we advocate for our clients to be able to get things at a reasonable price.
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  And it's and for ourselves for that matter.
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  So it's impressive to see that it's actually.
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  more cost effective to go through a compounding pharmacy than it is to
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  go through a retail pharmacy. And that's interesting.
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  There's several reasons behind that.
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  Yeah. One is company pharmacies,
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  we don't have to go through a new drug application process.
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  So which could take 10 plus years and billions of dollars.
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  You know, we're allowed to use medications that have already been FD approved.
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  We're allowed to use those active ingredients to create another medicine,
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  but in a different dosage form,
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  strength, or combination. So that's that's a huge R and D cost that we don't have
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  to recoup. Right. Also, our supply chain is
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  Much more integrated than the traditional healthcare system where
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  you have a manufacturer selling to a wholesaler,
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  selling to a pharmacy, then going through a PBM and a carrier.
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  Like we're just going directly to you.
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  And so you're cutting out all the unnecessary middlemen as well.
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  Yeah, that's right.
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  And number three, there are seven thousand compounding pharmacies I have
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  to compete with.
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  Mm-hmm. Yeah, there you go.
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  Karma doesn't have seven thousand other
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  Companies. Yeah, that's right.
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  They typically have one or two or zero in many cases.
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  That's and so for all these reasons,
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  that's the situation. That's why we have this situation we have here
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  in the United States, where drug prices just continue to climb ten percent a year,
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  year over year, with no end in sight,
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  but not in the compounding industry.
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  Our prices go down. We track below inflation.
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  And so that way a provider can be ensured that their patient can get access.
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  Not just today, but for the rest of their lives.
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  No, I think that's a wonderful thing.
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  I think, you know, everybody's cost sensitive and and will always be cost sensitive.
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  And everybody's quality sensitive at the same time.
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  So I think, you know, when people think about compounding pharmacies,
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  we know that there's also not only a spectrum in pricing,
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  but there's also a spectrum in quality.
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  So maybe you can talk a little bit about the things that you do that ensure that
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  people are getting what they think they're getting,
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  you know, particularly with things like compounded thyroid and,
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  you know, some other things that are a little more sensitive to compounding.
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  Maybe you can talk us through that a little bit.
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  Yeah.
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  You know, the the quality standards within compounding are well established.
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  They've been around for millennia.
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  All c all medicine was compounded before pharmaceutical companies existed.
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  So there is ~ and and the United States Pharmacopoe,
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  the private agency that oversees the standards and pretty much makes
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  up the rules for compounding, they've been around for a very long time
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  and they're constantly updating their chapters to always improve quality over time.
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  And so by if company pharmacies following the rules.
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  Then this the medicine can be considered safe and is dispensable to patients.
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  Now there's there's a there's a level above USP called GMP,
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  also known as good manufacturing practices.
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  And these are the standards that pharmaceutical companies have to meet.
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  And they aren't registered with the FDA.
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  Well, compounders have a version of manufacture ourselves.
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  It's called an outsourcing facility,
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  a 503B. And a 503B has to match.
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  those high stands, the same standards that farmer has to meet.
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  And so what differentiates us is that we're both a compounding pharmacy,
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  a 503A, and an outsourcing facility,
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  a 503B. And so we use many practices that we've learned at
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  our 503B and apply them to our 503A.
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  And so for example, you you mentioned about your thyroid medication.
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  It's probably a a mix of T three,
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  T four, you know, dosed in the micrograms of each.
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  And
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  I mean, having you know, if a patient takes too much thyroid,
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  just just by ten the the therapeutic index,
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  it's so narrow that it could harm cause a patient to feel very uncomfortable
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  or have the medication not work at all.
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  And so what we do, not a requirement,
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  but we every single capsule we make,
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  we send it through an automated check weigh that weighs that capsule one at a time.
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  And that capsule is off by a specific percentage.
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  We reject it. No.
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  That's not a requirement, but that's that but that's the that's the level
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  of quality that we go to. And so by being a manufacturer that's
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  in registered the FDA for the past 10 years,
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  we've learned how to apply the highest quality system in compounding at our 503A.
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  It's very nice to see it's it's like a combination between traditional pharma,
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  but used at the pharmacy level where you can make millions of prescriptions a year,
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  customized at the highest quality possible.
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  So
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  Quality is a is a very important point as well.
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  So with pharmacies like yours,
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  are you routinely inspected by the FPDA or or that kind of thing?
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  Or what what's what's the quality control here so people understand what actually
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  happens?
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  Sure.
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  we're licensed in all 50 states.
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  So that technically means anybody from any of those states can show
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  up unannounced anytime they want.
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  Them's the rules. And so we have people from FDA,
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  DEA, state boards flying in all the time to make sure that
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  the medications that we're making are indeed ~ follow the the requirements
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  of each individual one of those state or federal law books.
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  And
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  We have an entire compliance and regulatory and quality team that go
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  in and ensure that our electronic quality management system is readily accessible
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  so we can give them all the documents that they want,
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  practically immediately. We don't use paper anymore.
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  Yeah, they're they're coming in and verifying every every month.
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  Kinda like living under the the weight of an,
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  you know, unexpected audit at any time,
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  probably several times a year kind of thing,
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  with people should
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  It
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  should you you should always be under the weight of an audit.
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  You should they you should you should run your organization fully audit ready.
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  You should run audits on yourself.
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  That's right. That's that's how you tr create a true quality system where you're
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  always trying to penetrate, find something wrong,
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  use outside consultants, inside departments,
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  and that's right, you know, eventually create create a system that is just like
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  i let's say exceeds the standards.
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  Yeah. Beautiful. No, that's beautiful.
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  So, you know, I think one of the things that's on everybody's mind these days
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  is the whole peptide story, right?
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  In terms of what compounding pharmacies can do and can't do it.
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  I know I think it was RFK came out with something,
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  I don't know, a couple of months ago talking about releasing peptides back
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  and then the FTA is in the middle of it.
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  Where does all that stand with regards to you being able to,
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  you know, dispense peptides again?
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  There's a meeting of FDA's compounding advisory committee on July twenty third
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  and ~ twenty-fourth. And they're looking at seven peptides that people have asked
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  to be allowed for pharmaceutical compounding.
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  Of course, five others came off a safety list back ~ in April and ~ we'll
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  get their own neck next hearing ~ in February of next year.
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  And so I I want to be clear up front on two things.
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  One, coming off the list isn't the same as FDA approving anything,
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  and going into the meeting.
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  FDA's own staff are recommending against adding all seven.
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  So the honest headline isn't peptides approved.
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  It's FDA is finally putting these under a real microscope.
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  I think that's good. We've always thought the science and the safety
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  and the data that should decide this,
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  not the marketing. And so we'll see the FDA make a recommendation of no,
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  the 12 PCAC members, pharmacy compounding advisory committee members,
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  the ones that decide and vote.
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  on whether these will get accepted,
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  we'll listen to the FDA's argument and to industry's argument
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  and patients' arguments and academics arguments and see based on the data,
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  the studies, and the evidence provided,
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  whether or not these chemicals are considered ~ safe to be used
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  in the human population through the 503 mark.
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  Interesting. So seven now, five later,
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  and you think that not all seven are gonna get through.
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  So that'll be interesting to see what comes through.
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  I predict, I mean, if you look at the roster was recently updated.
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  Okay. PCAC roster, the the twelve members.
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  And I mean, previously, trying to get a drug nominated through the PCAC
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  was an onerous process.
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  Why do you think that is? Why do you think it's so onerous?
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  Is this big pharma kind of squashing stuff or what do you think's happening?
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  Well, I think
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  I
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  th I think it's a it's a regulatory agency creating its own rules
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  and which is pretty much how the PCAC worked.
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  It was it was agreed it was created by the FDA and it was populated
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  by the FDA primarily. I think there are only two people on that ~ have ever
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  had actual real world compounding experience.
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  The other tenors has so you know,
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  people with experience growing up in the FDA.
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  So they understand the FDA process of getting a new a drug approved.
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  Right. And now they're going to be asked to assess whether a drug should
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  get approved.
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  with no double blind placebo controlled studies,
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  no, you know, phase one, two, phase three,
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  none of that. And they all said,
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  look, well we don't this is not the evidence I'm used to seeing.
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  So I can't say this is safe. And so they would always reject.
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  Most of the votes, the two compounding members would be like,
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  yes, add that. And the other ten would like,
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  no. So many many substances did not get approved.
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  And you know, we what's changed since then?
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  I believe eight members have been replaced in the past week,
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  appointed in the past. Many of these members have real-world
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  Interesting. And
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  compounding experience. They understand what actually happens inside
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  of a compounding pharmacy, what actually gets discussed amongst their providers.
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  And they can actually talk about the evidence that they are seeing
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  on the ground level with these biomarker improvements.
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  on these patients. I mean, man many of these peptides,
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  the you know, the the claims are are remarkable.
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  And so it can't j it can't just be placebo for for from any of these.
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  And so that I mean, and if it works and millions of patients have tried
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  it and we don't see any serious adverse events,
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  any ~ any significant ones that we do see with other drugs.
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  I I think that is the bar for safe and efficacious.
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  So I I I'm I'm I'm optimistic.
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  That all all of them will get approved.
• 13:56
  Yeah, well that's great. I didn't realize they just replaced eight people
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  on the on the twelve person committee.
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  You know, I think from the clinician side,
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  of course, we feel like there's a bureaucracy that has a locked in mindset
• 14:08
  as to what kind of evidence constitutes evidence that's worthy of approval.
• 14:12
  And, you know, what's interesting to us is that we look at the things that
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  do get approved and we shake our heads because,
• 14:18
  you know,
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  Different Alzheimer's drugs and you know cancer drugs.
• 14:22
  I mean, yeah, somebody lives six weeks longer,
• 14:24
  right? And it costs, you know,
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  $300,000. I mean, it's it seems so completely counterintuitively ridiculous that
• 14:31
  you feel like people are actually lost inside their own system of thought that they
• 14:37
  would approve something like that and disallow something that,
• 14:41
  you know, there was so much experience with of,
• 14:43
  you know, improved outcomes for for patients,
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  ~ clients.
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  And and reject it because it isn't coming through a particular,
• 14:50
  you know, data stream, right? Is is really what it boils down to.
• 14:54
  It's really to me, it's a case in point of people getting trapped inside their
• 14:57
  own thought process. And it's not to say that integrity isn't important.
• 15:01
  It's not to say that safety isn't important because those are those are,
• 15:04
  you know, first and foremost in everybody's mind.
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  But there are alternative ways to go about,
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  you know, assessing the data, assessing
• 15:12
  you know, outcomes and things like that where you can get very comfortable with
• 15:16
  the fact that, you know, I mean,
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  in our experience, we've only had like two adverse reactions to a peptide.
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  And it was both related to the carrier that the peptide was in at the time.
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  So it's pretty interesting. People had some allergic reactions,
• 15:29
  local little little allergic reactions.
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  But you compare that to, you know,
• 15:33
  a client we have right now that came to us out of Kaiser Permanente
• 15:37
  who was treated for psoriasis with non steroidal anti inflammatories and,
• 15:40
  you know, just about
• 15:42
  put on dialysis with it, right?
• 15:43
  He showed up with a GFR of 14,
• 15:46
  you know, normal would be over 60,
• 15:48
  closer to 90 would be ideal. And,
• 15:50
  you know, a hemoglobin of seven,
• 15:51
  right? Because he couldn't wake red blood cells anymore.
• 15:55
  And, you know, you see these kinds of things from the quote unquote over-the-counter
• 15:59
  safe drugs. And it's we never see that with these ever.
• 16:04
  We we never see anything close to that.
• 16:06
  Right. So it's really
• 16:08
  An interesting case. I hope that the FTA can make a wise decision.
• 16:11
  You know, the the country needs a wise decision and it needs to be kept safe.
• 16:15
  But I hope that they can see just how safe these things are.
• 16:18
  So that would be a a a boon for everybody,
• 16:21
  I think. Yeah.
• 16:21
  Absolutely. I think, you any other decision is only gonna but put patients
• 16:26
  in harm's way. Yeah as they will only be able to source them from research
• 16:31
  use only websites. And the data that's being that that's being pulled from thousands
• 16:32
  That's right.
• 16:37
  of samples being submitted from hundreds of these companies.
• 16:41
  I mean, it is insane. Over eighty percent of the drugs you buy on the black market,
• 16:48
  which is what's it's pretty much what it is a black market.
• 16:49
  It's not a great market, it's a black market.
• 16:51
  And eighty percent of them do not meet specification.
• 16:54
  Can you imagine a supply chain where eighty percent of the drugs coming
• 16:59
  out of it weren't under spec? I mean happened.
• 17:02
  That is
• 17:04
  That is what has happened. Yeah.
• 17:06
  Because the FDA has not allowed compounding pharmacies to make these.
• 17:10
  And so if if the FDA votes that these should not be made,
• 17:14
  all that will happen is the black market will grow larger,
• 17:17
  the Chinese cartels will grow richer.
• 17:19
  And these drugs will be made in China instead of America.
• 17:22
  Yeah. So I'm hopeful. I'm hopeful that the FDA will make the right
• 17:26
  I do like the idea of the compounding pharmacies making these because then
• 17:30
  you do know that there's integrity,
• 17:32
  you know, in the process of of making them and verifying that they're made properly,
• 17:36
  verifying what's in
• 17:38
  The chemicals that come in, they have to be a certain pharmaceutical spec.
• 17:41
  Yeah. They have to show that they're not dangerous,
• 17:44
  they don't have heavy metal toxicity,
• 17:46
  they don't have endotoxins. You know the the the the certificate analysis tests
• 17:51
  for all of these, like they would for any pharmaceutical product.
• 17:53
  We come in, we validate it, comes through validated supply chain.
• 17:56
  Yeah. Then the vendor gets qualified,
• 17:58
  the material gets qualified, the drugs are made in an actual clean room,
• 18:02
  not some guy's bathtub. Yeah. And they're and they're you know,
• 18:07
  they're tested.
• 18:08
  for sterility and endotoxins and you have stability studies done showing that
• 18:12
  the medication is stable over its shelf life.
• 18:14
  Would you rather have patients in that system?
• 18:16
  Or or s or some like some guy it's making you out of his house.
• 18:18
  Of course.
• 18:22
  That's what's happening.
• 18:24
  No, I know. I know. It's it's kind of crazy.
• 18:26
  Quite honestly. So let's let's hope that the FDA comes along with that.
• 18:30
  So in terms of, you know, personalized medicines,
• 18:33
  what are some of the areas that you're seeing that you're making more
• 18:36
  and more prescriptions for what what's kind of top front and center?
• 18:40
  I mean, hormones have always been a piece of it,
• 18:41
  of course, hormone replacement therapy.
• 18:43
  But there are some other things you're working with probably.
• 18:46
  What are those?
• 18:47
  we manufacture and compound medications under nine primary areas of treatment.
• 18:51
  You have men's health, which consists of and men related products that
• 18:56
  are somewhat related to ED, topical solutions,
• 18:59
  testosterone. So you have a little bit of that.
• 19:00
  But then you have some ~ branch off into hormone replacement therapy,
• 19:04
  which also covers a lot of what's in women's health.
• 19:07
  And then you have weight management medications,
• 19:10
  GLP ones included, ~ dermatology formulations,
• 19:13
  mental health.
• 19:15
  sexual health and IV nutrition and and and now peptides.
• 19:19
  And so with those with those 10 different areas,
• 19:22
  we can kind of kind of cover the entire longevity,
• 19:25
  health and wellness, functional medicine landscape,
• 19:27
  and be that one stop shop for the providers that want to utilize us
• 19:31
  for patients in any state in the country.
• 19:34
  What about Red or True Tide? Are you guys compounding that currently
• 19:38
  or what's what's your status with
• 19:39
  That
• 19:39
  it hasn't been FT approved yet,
• 19:41
  so compounders cannot legally compound it.
• 19:42
  Yeah. I have heard reports that there are some compounders that
• 19:46
  are compounding it and with all the pressure from Lily trying to protect their drug,
• 19:52
  as soon as Lily finds out that a compounder is making it,
• 19:55
  they sick the boards on them. And then and the boards do what they do.
• 19:59
  They revoke their licenses immediately.
• 20:00
  So we've seen a couple of compound pharmacies with get that were making retruditide
• 20:04
  have their licenses revoked in an emergency session.
• 20:07
  Interesting.
• 20:08
  While it can be a a compound can make anything,
• 20:12
  doesn't mean we should. Like there are there are some drugs that are just like
• 20:16
  a right now, in my opinion, a little more off limits than others.
• 20:20
  Yeah. And retrutite is definitely at the top of that list.
• 20:23
  And what where is Redatru Tide in the regulatory approval process?
• 20:28
  Yeah, it sa supposedly it'll get approved sometime in twenty twenty-seven.
• 20:32
  Given with how much Lily is going to make off of this drug,
• 20:37
  they have been dumping as much as possible into accelerating its approval.
• 20:42
  And so I've heard some reports saying it may get approved as early as this year,
• 20:46
  the end of this year. And then others say maybe not till the end ~ or
• 20:51
  or of of twenty twenty-seven. But yeah,
• 20:53
  yeah, once one thing is for sure,
• 20:55
  once it does get approved.
• 20:57
  I mean, it is going to be a wonder it's it's gonna make some megalytide
• 21:00
  and jerzebetide look like, you know,
• 21:03
  drugs that ~ should not be used in medicine.
• 21:05
  It's just like it's just retrudite is so much better across every other every
• 21:09
  category you can imagine. So, you know,
• 21:11
  I think we're gonna see a large market shift to retruditide and you know,
• 21:14
  ensuring that patients and pro providers determine that a patient could benefit from
• 21:20
  a customized version of a a GLP one,
• 21:22
  that yeah, they will be able to make them.
• 21:25
  So that's a good I think it'll be an exciting ~ addition to our market.
• 21:28
  No, we think so too. We think it'll be helpful.
• 21:30
  It's interesting. It does seem to lower heart rate variability
• 21:34
  and increase resting heart rate.
• 21:35
  We've seen that. We've seen it that that's p been reported as well.
• 21:39
  So that's an interesting feature because typically we're trying to lower heart rate
• 21:43
  and increase heart rate variability,
• 21:44
  right? more parasympathetic nervous system tone.
• 21:47
  So we'll see how that plays out.
• 21:48
  I think there's a GLP four in the offing as well,
• 21:52
  I've heard.
• 21:52
  That may be coming, you know, you have GLP one,
• 21:54
  GLP two, GLP three, which would be redotrutite,
• 21:57
  and then GLP four, which basically has four components to it.
• 22:00
  So we'll see how this plays out.
• 22:01
  But it's a really interesting area because it does,
• 22:03
  to your point, play into longevity in terms of not only cardiovascular health
• 22:08
  and brain health and kidney health,
• 22:09
  but there does seem to be some benefits,
• 22:12
  you know, cognitive function, other things,
• 22:14
  right? So pretty interesting. The S GLT twos are also interesting in that regard,
• 22:18
  I think. So
• 22:19
  Absolutely, I they there's there's so many great indications that they should
• 22:23
  do practically everything is that GLP one can help with.
• 22:26
  And we're finding out more and more reasons that they can be used.
• 22:29
  We sponsored a study at Baylor showing that GLP one's a particular trisepatide does
• 22:35
  improve sperm parameter. So especially in obese patients.
• 22:37
  Okay, interesting.
• 22:40
  wow. So sperm motility or sperm viability or
• 22:44
  Regression, motility, count, everything.
• 22:48
  It's it's a it's a it's a great and just shows you how obesity causes
• 22:53
  so many downstream effects. Yeah.
• 22:55
  Downstream comorbidities. And you know,
• 22:58
  so GLP1s are being used to help just about everything.
• 23:00
  Now there is a downside to GLP1s.
• 23:02
  Forty percent of the weight you're losing is muscle.
• 23:02
  Mm-hmm. yeah.
• 23:06
  Muscle is the organ of longevity.
• 23:06
  That's right.
• 23:09
  Well, it's one of them. It's not the long I people get that wrong.
• 23:13
  It's not the organ of longevity.
• 23:15
  It's one metric of longevity, but yeah,
• 23:17
  it's important.
• 23:17
  Exactly.
• 23:18
  I mean to have to to lose muscle mass while you're on a therapy that's supposed
• 23:23
  to be making you healthy is kind of backwards.
• 23:25
  And so what we're seeing is a lot of patients,
• 23:27
  they're losing the weight, and then now that they've lost muscle,
• 23:32
  the tissue that burns more calories than than than fat does,
• 23:34
  That's right.
• 23:36
  now they're gaining the weight back even faster.
• 23:39
  Well, that's be yeah, that's because it actually suppresses garolin,
• 23:42
  right? Garolin is the the brain peptide that basically stimulates appetite.
• 23:47
  So if you suppress that and then you're not hungry.
• 23:49
  But if it rebounds when you stop the medicine,
• 23:51
  you've got more of it. Now you're gonna now you got you're hungrier than
• 23:54
  you ever were, right? And now you're gonna be putting on fat in place
• 23:57
  of the muscle that you lost. It's it can be tricky to get people off these.
• 24:00
  We have a whole strategy on actually how to transfer them off
• 24:03
  and maintain muscle mass while they're if they are taking it.
• 24:06
  So
• 24:07
  There's an interesting molecule out there called Calocurb,
• 24:09
  a meristate that was discovered in New Zealand that comes from a hops plant that
• 24:14
  they did double blind placebo control trials and showed that the weight loss
• 24:18
  was equivalent to GLP one, but it was fat and not muscle that was lost.
• 24:23
  And it stimulates endogenous GLP one,
• 24:25
  but also C C Y and C C K rather and PYY were also stimulated that also have
• 24:32
  an impact on appetite. And it's it's taken orally as a as a
• 24:35
  As a supplement, quite honestly.
• 24:37
  So if somebody's afraid of a GLP one is something they can look into,
• 24:40
  calicurb and you have to be a little careful with any of these drugs
• 24:43
  or medications or supplements and that you can end up with some diarrhea
• 24:47
  if you load in too much too quickly.
• 24:49
  But yeah, we've had good success with that as well.
• 24:51
  So yeah, interesting stuff.
• 24:53
  Yeah, and the great thing about retruditite is it's more muscle sparing than
• 24:57
  megatite or trazepatite. So if we're talking just on just on the basis
• 25:01
  of losing muscle mass, I mean that's that's going to be the go-to.
• 25:04
  There's no reason not to use it except price.
• 25:06
  And this is why compounding pharmacies are going to play a a huge role
• 25:12
  in expanding access to these therapies to so many more patients.
• 25:16
  I can imagine when Redder True gets approved it's gonna be very expensive,
• 25:19
  right? Although he's gonna obviously recoup and try to make
• 25:22
  They're
• 25:22
  gonna try to make as much money as they can for as long as they can off your back.
• 25:28
  That's right. Will they be able to get it cheaper through you than they could
• 25:32
  through Lily?
• 25:33
  Absolutely. Yeah. There's no reason for a common.
• 25:35
  We we don't need to charge. We don't need ninety nine point five percent margin
• 25:39
  on our products. That's what you always getting.
• 25:41
  They're they're made ninety-nine point five percent margin.
• 25:44
  That is do you think that's right?
• 25:46
  If you're if you're a provider trying to put your patient on a on what
• 25:47
  Yeah, that's incredible.
• 25:51
  may be a lifelong therapy and their insurance doesn't cover it or they don't qualify
• 25:55
  because their BMI is not above twenty seven or th yeah,
• 25:59
  what are you to do? Pay.
• 26:01
  Pay $1,000 cash? I mean, come on.
• 26:04
  Patients, that the majority, the vast majority of the population cannot afford
• 26:07
  ~ $1,000 a month in cash. So thank God for compounding pharmacies.
• 26:11
  Because without them, there one,
• 26:14
  patients wouldn't be able to access,
• 26:16
  and two, there would be no incentive for pharmaceutical companies
• 26:19
  to lower their prices. I mean,
• 26:20
  just look at what Novo and Lily have done over the past couple of years.
• 26:23
  They've cut their prices by one half to two thirds in order to compete,
• 26:28
  as they should. Great. And what's happening?
• 26:31
  Patients got more access to medications because so compounders,
• 26:35
  we play a vital role. We are the last stop when it comes to patients getting access
• 26:40
  in our system. And without us,
• 26:42
  I mean, I don't our system does not become better.
• 26:44
  It becomes a lot worse. So we spend a lot of our time fighting pharma.
• 26:48
  You know, Lil Lily is suing us.
• 26:50
  You know, we're having to meet Lily and all the boards,
• 26:53
  and they're trying to misinform your pharmacy board members in every single state
• 26:58
  to try to convince them.
• 26:59
  To clamp down on compounding and not allow GLP ones to be made.
• 27:03
  I mean, the amount of rules like the memos that get sent out from the board staff.
• 27:07
  Like it there's a there's a battle in every single state all the time.
• 27:11
  And you know, and pharma is doing their best to be able
• 27:15
  to prevent any potential competitors coming into the most lucrative market
• 27:22
  that's ever existed.
• 27:24
  Yeah, well God bless compounding pharmacies at this point because,
• 27:27
  you know, you're really kind of fighting against a monopoly.
• 27:29
  Once there's a monopoly, you would think there would be an antitrust,
• 27:32
  you know, situation with pharma,
• 27:34
  but nobody's ever brought seems to bring that up.
• 27:36
  So
• 27:37
  Well,
• 27:37
  you know, there there are there are a lot of instances of price fixing that that
• 27:41
  that's been rampant in the industry.
• 27:42
  But you know, our industry is unique in that you can have a patent,
• 27:46
  you can make something for ever up for twelve years for as much as you want.
• 27:51
  And sometimes, I mean, that doesn't that is not in the best interest
• 27:55
  of patient access as it really ever is.
• 27:57
  And so the incentives for the system are are not aligned.
• 28:02
  You know, and you know, then compounding is just a system,
• 28:02
  That's right.
• 28:05
  then thank God for compounding because
• 28:07
  You know, at the end of the day,
• 28:08
  no body, no government entity can get in the way of the doctor-patient relationship.
• 28:14
  You know, it is completely up to you to prescribe whatever you think is
• 28:18
  in the best interest of your patients and every other prescriber
• 28:22
  in this country that holds true as well.
• 28:24
  And so if you believe that some other medication that is
• 28:28
  not commercially available would benefit your patients,
• 28:30
  you can send that to a compounding pharmacy and you can be assured that patient
• 28:34
  is going to
• 28:35
  be taken care of very ~ in many cases much better than
• 28:39
  the traditional pharmaceutical and healthcare system will treat that patient.
• 28:42
  Yeah. No, that's really good for the audience to realize.
• 28:45
  What's nice is that you're licensed in all fifty states.
• 28:48
  We run into situations where different we have people from many different states
• 28:52
  that come to see us and then it can be problematic to ~ you know,
• 28:55
  get things to them, but you can ship to all fifty states.
• 28:58
  So that's that's pretty nice.
• 29:00
  Yes.
• 29:00
  Yeah, I mean, to get licensed in all fifty states and keep those licenses over
• 29:05
  ten plus years, I mean, that is a feat of compliance.
• 29:09
  That is what, you know, the systems that must be built,
• 29:10
  Yeah.
• 29:14
  the the the quality management systems,
• 29:16
  the healthcare track the the the patient tracking record systems,
• 29:20
  the the you know, the compounding system,
• 29:22
  they all have to combine together and make sure that they are all you abide
• 29:26
  by every single rule, not just for the United States foreign Wikipedia.
• 29:29
  But for every individual state as well.
• 29:31
  And they all have different rules.
• 29:32
  And the rules are always changing.
• 29:34
  And so it literally takes an army,
• 29:37
  a regulatory affairs team, a government affairs team,
• 29:39
  to be able to ensure that the landscape is one,
• 29:44
  always being assessed, and that we our processes internally meet those
• 29:49
  qualifications. And then two, finding where there may be some rules that don't make
• 29:55
  sense, that don't help patient access.
• 29:57
  That gives formula its monopoly.
• 29:59
  And then we go in and we lobby and we educate and we make sure people understand
• 30:05
  the value of compound. Because not many people know what compounding is.
• 30:07
  They're completely unaware. Compounding only makes up three percent
• 30:11
  of all prescriptions dispensed in this country.
• 30:13
  That's it. But I think this country is becoming much more educated,
• 30:16
  especially because of the company's role in the GLP one shortage and now that's
• 30:20
  As well. Yeah. I think so. I mean,
• 30:22
  when I was practicing cardiology,
• 30:23
  I never thought about a compounding pharmacy because,
• 30:26
  you know, everything just went through a pharmacy.
• 30:28
  I remember when a compounding pharmacy opened up in a town that
• 30:31
  we were servicing and they sent me their information,
• 30:34
  I was like, I'm not even sure what I would use them for,
• 30:36
  quite honestly. Like maybe they make compounded stuff for pain management
• 30:40
  or something like that. But, you know,
• 30:42
  it's interesting when you move into the functional space and all of
• 30:44
  a sudden you start trying to customize things for individuals,
• 30:47
  you know, based on test results and who they are and
• 30:49
  understanding them more deeply.
• 30:51
  The only place you can really get that is with a you know,
• 30:53
  collaborating with a compounding pharmacy.
• 30:55
  So
• 30:56
  Absolutely. That's what we're here for.
• 30:57
  We're here to make sure that your patients get exactly what the doctor ordered.
• 31:02
  Yeah, exactly. Well, cool. Anything else you'd like to cover?
• 31:06
  Anything else you'd like to share with us?
• 31:08
  You know, it's just you know, compounding,
• 31:09
  we're we're going through a renaissance.
• 31:11
  It's such an exciting time to be in healthcare where patients can get access
• 31:16
  to all kinds of healthcare that we wouldn't be able to do the true
• 31:21
  our traditional PCP. And channels being created,
• 31:25
  telemedicine or specialty concierge clinics and everything in between that'll
• 31:31
  be able to solve whatever type of health issue that wouldn't be covered under your
• 31:36
  traditional policy.
• 31:38
  under insurance. And the costs are going are getting lower and lower every single
• 31:43
  year, which means patients, more patients are getting access to these therapies,
• 31:47
  which means we're living better,
• 31:49
  healthier, happier, and more productive lives.
• 31:51
  And so you know it's it's it's such a great time.
• 31:53
  We're we're very lucky to be in this space supporting the many providers like
• 31:57
  yourself that are doing God's work.
• 31:59
  So thank you.
• 32:00
  Yeah. It's a very exciting time because there's so many breakthroughs.
• 32:03
  I think we're really gonna crack the code on aging this year,
• 32:06
  actually. There's so many things that I won't talk about in this particular podcast,
• 32:09
  but we've actually gotten to a point where there's some amazing things going
• 32:13
  on that we're super excited about.
• 32:15
  So anyway, I appreciate you coming on and sharing with us,
• 32:18
  you know, your perspective on compounding pharmacy and opening people's eyes
• 32:21
  to the the good work that you guys do.
• 32:23
  So thanks for that.
• 32:24
  Pleasure is all mine. Thanks for having How do we live young for a lifetime?
• 32:27
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• 32:29
  The answers are out there, and we're bringing them to you every episode.
• 32:34
  Make sure you're subscribed. Check out more episodes right here.
• 32:38
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• 32:42
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