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The Drugstore Cowboy Rides Again: PBM Reform in Arkansas & PGx Safeguards for Xeloda Patients | TWIRx · Pharmacy Podcast Network

• 0:02
  Speaker 1: A fourth generation pharmacy owner known as the drug Cowboy.
• 0:07
  Speaker 1: Arkansas Health Bill one one five zero in a conversation
• 0:12
  Speaker 1: with APCI from our PBM Reform podcast and Pharmacode, you
• 0:18
  Speaker 1: know makes in the impact of testing as well as
• 0:22
  Speaker 1: the complexity of specific medications that could prove to be
• 0:27
  Speaker 1: a major issue for people's health. All of that coming
• 0:31
  Speaker 1: up on This Week in Pharmacy. Welcome to This Week
• 0:55
  Speaker 1: in Pharmacy. I am your host, Todd Uri, founder of
• 0:57
  Speaker 1: the Pharmacy Podcast Network. I hope you've had a good week.
• 1:02
  Speaker 1: Just got done with our Crazy Helloween special. Hopefully you
• 1:06
  Speaker 1: were scared. If you weren't, whatever, you don't have to be.
• 1:10
  Speaker 1: Appreciate you listening. Appreciate you being part of today's Twerks.
• 1:16
  Speaker 1: November seventh, twenty twenty five. Hey, it's my mom's birthday today.
• 1:21
  Speaker 1: Shout out to Joyce Joyce Dallaire down in Vero Beach.
• 1:27
  Speaker 1: Happy birthday, Mom. I hope you have a great day.
• 1:31
  Speaker 1: I have to call my mom on her birthday. Hey,
• 1:34
  Speaker 1: we have a lot going on. First up is going
• 1:37
  Speaker 1: to be Twerks News, and the first article that I
• 1:43
  Speaker 1: am excited to talk about is the Bingingham Bingingham Binghamton.
• 1:49
  Speaker 2: I can't say it. This is why I wasn't a.
• 1:51
  Speaker 1: Pharmacist Bangington, Bangingham, Bingham ten University. Goodness gracious. The School
• 2:00
  Speaker 1: of Pharmacy holds emergency management management simulations and this goes through, hey,
• 2:06
  Speaker 1: what if there's a major situation in your community and
• 2:11
  Speaker 1: how are you preparing for a major disaster or a pandemic.
• 2:16
  Speaker 1: Being able to dig down into how emergency management would
• 2:20
  Speaker 1: work with pharmacy owners, pharmacists, health systems, hospital systems, this
• 2:26
  Speaker 1: is amazing. Shout out to the School of Pharmacy and
• 2:30
  Speaker 1: really digging down into how to leverage pharmacy in an
• 2:34
  Speaker 1: emergency time. Next up, I want to just make a
• 2:40
  Speaker 1: shout out to VCEU Health. VCU Health School has actually
• 2:48
  Speaker 1: they have a School of Pharmacy as well, but VCU
• 2:51
  Speaker 1: Health is pharmacies are expanding access through a new home
• 2:55
  Speaker 1: delivery option. We know that the increase of pharmacy home
• 3:00
  Speaker 1: long term care at home, this is major for the
• 3:05
  Speaker 1: entire nation. But starting on November eleventh, home delivery will
• 3:08
  Speaker 1: be available from all VCU Health pharmacy locations in the
• 3:13
  Speaker 1: Richmond area. This is a This is not just a trend.
• 3:17
  Speaker 1: This is going to become standard of care where we'll
• 3:20
  Speaker 1: have people that aren't able to get out of their home,
• 3:23
  Speaker 1: they don't have they don't have transportation, or there's a
• 3:26
  Speaker 1: pharmacy that's too far away from them. I see an
• 3:29
  Speaker 1: expansion of long term care at home and this is
• 3:32
  Speaker 1: wonderful to see. From a VCU health shout out to
• 3:36
  Speaker 1: you guys. Big news Lily and the US government agree
• 3:41
  Speaker 1: to expand access to A B city medications into millions
• 3:45
  Speaker 1: of Americans. This was just posted by Eli Lilly and
• 3:49
  Speaker 1: Company in November sixth of this week, and it goes
• 3:52
  Speaker 1: into announcing agreement between the US government to expand access
• 3:57
  Speaker 1: to obesity medications and really marking a pivotal moment in
• 4:02
  Speaker 1: the US health care policy and defining milestones for people
• 4:06
  Speaker 1: in need of OBCD medications. This is good for the
• 4:12
  Speaker 1: evolution of PBM reform, but good news from Lily. It's
• 4:17
  Speaker 1: good to hear that access is getting more attention from
• 4:23
  Speaker 1: the United States government in what's happening and pharmacists no
• 4:28
  Speaker 1: firsthand when we have medication shortages and how compounders can
• 4:33
  Speaker 1: step in and how that's a big controversy in and
• 4:36
  Speaker 1: of itself with the manufacturers saying that they don't want
• 4:42
  Speaker 1: compounding to rise when need be, and I think you
• 4:46
  Speaker 1: need to be a player in it, and Lily obviously
• 4:48
  Speaker 1: is an immense and powerful player. However, when patients need
• 4:55
  Speaker 1: customize things and additional medication is that may not be available,
• 5:01
  Speaker 1: we have the compounders stepping in and we're so proud
• 5:09
  Speaker 1: that the APC, the Alliance for Pharmacy Compounders, is a
• 5:13
  Speaker 1: member of the Pharmacy Podcast Network. And it's really a
• 5:16
  Speaker 1: nice balance to have information from sources, trusted sources that
• 5:21
  Speaker 1: are concentrating ultimately on services for the patient, in the
• 5:27
  Speaker 1: needs of the patient, instead of it being just about
• 5:31
  Speaker 1: the business and just about the formulary and in the
• 5:34
  Speaker 1: customization of where that can take all pharmacy services, not
• 5:39
  Speaker 1: just not just big box or community or health system,
• 5:44
  Speaker 1: but all of them. And I just think there's something
• 5:48
  Speaker 1: we need to pay attention to as a pharmacy care organization,
• 5:53
  Speaker 1: and here at TWERQUES, we want to pay more attention
• 5:56
  Speaker 1: to what's happening. Hey, if you have success in obesity specifically,
• 6:01
  Speaker 1: and you're a pharmacist, you're a independent community pharmacy, you're
• 6:06
  Speaker 1: a clinic. We want to talk more about obesity. We
• 6:09
  Speaker 1: did a multi part series on the Obesity Chronicles that's
• 6:14
  Speaker 1: out there. If you google Obesity Chronicles Pharmacy podcast, the
• 6:20
  Speaker 1: ten part series will come up and it's an important,
• 6:24
  Speaker 1: very scientific ten part podcast series that you could update
• 6:29
  Speaker 1: and listen to. We have a lot going on. We
• 6:32
  Speaker 1: have several interviews today and several guests on the show,
• 6:37
  Speaker 1: and we're going to start out with Amantha Bagden from
• 6:42
  Speaker 1: our ex Post And I can't wait for you guys
• 6:46
  Speaker 1: to hear this on this Week in Pharmacy, Hey, and
• 6:53
  Speaker 1: on this Week in Pharmacy, you know, we talk about data,
• 6:58
  Speaker 1: We talk about many things happening in the markets. We
• 7:02
  Speaker 1: just got done with twerks news, good news, bad news,
• 7:06
  Speaker 1: what's happening in our profession. I really am drawn to
• 7:12
  Speaker 1: people in our profession who are passionate about this industry
• 7:17
  Speaker 1: and what's happening in the transformation, but they take time
• 7:20
  Speaker 1: to keep up with what's going on and apply their
• 7:24
  Speaker 1: passions and their outlets, their talents, their experiences to improve
• 7:30
  Speaker 1: in something. And an entrepreneur who rose, I don't know
• 7:34
  Speaker 1: if it's been twelve fifteen years. I became a friend
• 7:38
  Speaker 1: of hers and have looked up to her and her
• 7:40
  Speaker 1: aspirations to keep pushing. Amantha bagged and I want to
• 7:44
  Speaker 1: welcome you back to this week in Pharmacy. Although I
• 7:47
  Speaker 1: don't know if it's your first time or second time
• 7:49
  Speaker 1: on twerks, but we got to get you here more often.
• 7:52
  Speaker 3: Amantha, Hey Todd, it's good to be back. I know
• 7:58
  Speaker 3: we've had several encounters. There's really hard to keep track.
• 8:01
  Speaker 3: Thank you so much for having me back on the.
• 8:03
  Speaker 4: Show, though.
• 8:04
  Speaker 1: Absolutely you need to tell the listeners because you're very
• 8:08
  Speaker 1: inspiring as a woman leader in business, as a healthcare
• 8:13
  Speaker 1: leader in general, where you've done things at a whole
• 8:18
  Speaker 1: other level with your background and you started in pharmacy.
• 8:21
  Speaker 1: You have to tell people quick little story so we
• 8:24
  Speaker 1: can bring them up to date to our ex post.
• 8:28
  Speaker 3: Yeah, I am a pharmacy technician.
• 8:32
  Speaker 4: I've been a pharmacy technician.
• 8:33
  Speaker 3: Since I was sixteen years old, so more than half
• 8:36
  Speaker 3: my life now, and I spent a majority of my
• 8:39
  Speaker 3: career working at independent pharmacy and absolutely fell in love
• 8:44
  Speaker 3: with the level of patient care that you get to
• 8:47
  Speaker 3: experience every day with your customers there. And you know,
• 8:51
  Speaker 3: throughout my journey, I noticed how difficult it it really
• 8:55
  Speaker 3: had become for pharmacy owners to stay profitable. And you know,
• 8:59
  Speaker 3: I worked under a very smart, entrepreneurial pharmacist myself, Greta Goldshane.
• 9:08
  Speaker 3: She's now a pharmacy in Calabasas doing a lot of
• 9:12
  Speaker 3: really cool stuff on the point of care.
• 9:13
  Speaker 4: Testing side of things.
• 9:15
  Speaker 3: And you know, when I was working with her, we
• 9:19
  Speaker 3: struggled with excess inventory and it was my job as
• 9:22
  Speaker 3: the technician to call around to other stores. And you
• 9:25
  Speaker 3: know sometimes that might getting into my car or my
• 9:27
  Speaker 3: lunch break and driving to another pharmacy and taking notes
• 9:30
  Speaker 3: manually and just kind of putting, you know, post its everywhere.
• 9:33
  Speaker 3: And you know, that really led me to launch our
• 9:37
  Speaker 3: ex posts as an easier way to connect more pharmacies
• 9:41
  Speaker 3: for inventory sharing. And it's been a long journey, but
• 9:44
  Speaker 3: we've seen a lot of success, particularly in the last
• 9:48
  Speaker 3: year or two, and now that you know.
• 9:50
  Speaker 4: We've gotten to.
• 9:53
  Speaker 3: Sixteen states in total, we're looking forward to some of
• 9:57
  Speaker 3: the next things that we can do beyond just helping
• 10:00
  Speaker 3: pharmacy save money, but also helping them generate revenue. But
• 10:04
  Speaker 3: with the real focus on what's near and dear to
• 10:07
  Speaker 3: my heart, which is the pharmacy technician and how to
• 10:10
  Speaker 3: get them appropriately paid, which is a frustration I think
• 10:13
  Speaker 3: that many of us share in the industry.
• 10:16
  Speaker 1: Yeah, there's a couple parts there. First of all, I
• 10:18
  Speaker 1: want to back up, and there are pharmacists listening. There
• 10:23
  Speaker 1: are technicians listening who have aspirations to do something that
• 10:28
  Speaker 1: they've been doing at least I hope you've been doing it.
• 10:31
  Speaker 1: And the reason why I say that is always have
• 10:33
  Speaker 1: a side kind of hustle, whether that's your blog or
• 10:37
  Speaker 1: your podcast, or your passion, or it's something driven in
• 10:41
  Speaker 1: technology or the use of AI and making it make
• 10:44
  Speaker 1: sense within the business of pharmacy, whatever that is. Continue
• 10:48
  Speaker 1: to pursue that you did that alongside of your primary
• 10:52
  Speaker 1: work as a pharmacy technician. And now you're running ourx
• 10:57
  Speaker 1: post and growing our ex post and your meeting with investors,
• 11:01
  Speaker 1: and you're delivering complex proposals, and you're working with banks,
• 11:07
  Speaker 1: and you're working with insurance organizations and you have a
• 11:10
  Speaker 1: lawyer now. So it's what people are listening to at
• 11:14
  Speaker 1: this moment and having you on Twerqus is someone who
• 11:17
  Speaker 1: transformed from being a pharmacy technician at you know, or
• 11:22
  Speaker 1: in the pharmacy business at sixteen, became a pharmacy technician
• 11:25
  Speaker 1: and now you saw a void. It was impacting your profession.
• 11:28
  Speaker 1: It was also impacting independent community pharmacy, which is a
• 11:31
  Speaker 1: soft spot in both of our hearts. So as what
• 11:35
  Speaker 1: do you say to these people that are listening right
• 11:37
  Speaker 1: now that are like, I want to build something, you know,
• 11:40
  Speaker 1: I see a void. I see something that I'm passionate about.
• 11:44
  Speaker 4: Yeah.
• 11:45
  Speaker 3: I think it starts with micro adjustments, being very open
• 11:50
  Speaker 3: minded to coachability and learning from everyone around you.
• 11:55
  Speaker 4: I think one of the key things is networking.
• 11:57
  Speaker 3: I always tell early founders network with as many other
• 12:00
  Speaker 3: founders as much as possible and find out, you know,
• 12:04
  Speaker 3: what the challenges they experience are, so hopefully you don't
• 12:08
  Speaker 3: repeat the same mistakes. But it's never going to be
• 12:12
  Speaker 3: an easy journey. But if it was easy, it wouldn't
• 12:15
  Speaker 3: be worth it. And I think one of the things
• 12:17
  Speaker 3: that keeps me going is a lot of the stuff
• 12:19
  Speaker 3: I do on the advocacy side. So I'm on the
• 12:22
  Speaker 3: board of two local pharmacy chapters here in Los Angeles.
• 12:26
  Speaker 3: I've served on the Reference Nominating and Policy Committee for
• 12:31
  Speaker 3: the California Pharmacist Association.
• 12:35
  Speaker 4: One California or Pharmaist Association.
• 12:37
  Speaker 3: Technician of the year last year and was elected delegate
• 12:40
  Speaker 3: for this upcoming years American Pharmacists Association House of Delegates
• 12:45
  Speaker 3: and also going out there to the non pharmacy sauce
• 12:48
  Speaker 3: and bringing a lot of awareness to the space. I
• 12:50
  Speaker 3: think it's always shocking when I talk to non pharmacy
• 12:53
  Speaker 3: people and you know, their first question or you know
• 12:57
  Speaker 3: comments is always, oh, I didn't know kindant pharmacies still exists.
• 13:01
  Speaker 3: And I love coming back and saying like, they make
• 13:04
  Speaker 3: up thirty six percent of all retail pharmacies, but they're
• 13:08
  Speaker 3: nothing to sneeds up.
• 13:11
  Speaker 1: If you started to include some of the independent pharmacies
• 13:15
  Speaker 1: that are embedded into grocery stores or other entities, I
• 13:20
  Speaker 1: guarantee you that that percentage would be higher it is.
• 13:23
  Speaker 3: It's about two thirds, which are are just not.
• 13:30
  Speaker 4: CBS and not Walgreens. And yeah that you soon.
• 13:34
  Speaker 3: Include writing rip right ad writ It was my first
• 13:37
  Speaker 3: job when I was sixteen, so it does hold a
• 13:41
  Speaker 3: special place in my heart, and especially because thrifty ice
• 13:44
  Speaker 3: Creams started here in so cal I can't wait for
• 13:47
  Speaker 3: whoever bought that fifty ice cream brand to bring their
• 13:49
  Speaker 3: pop ups here.
• 13:51
  Speaker 1: That's awesome, all right, So I have something to ask
• 13:54
  Speaker 1: you we both know what's happening in pharmacy. You and
• 13:57
  Speaker 1: I have discussed this at other confert instance. I'm not
• 14:00
  Speaker 1: sure if it was a Sembia or I met you.
• 14:03
  Speaker 1: It was in Vegas when we sat down and talked
• 14:06
  Speaker 1: for about an hour and we I mean, this might
• 14:10
  Speaker 1: have actually been two years ago. Time goes by too fast,
• 14:14
  Speaker 1: but we were talking about the void that's going to
• 14:18
  Speaker 1: take place based on pharmacists being drawn into digital health
• 14:24
  Speaker 1: mapping disease states, being stewards of the entire therapy that
• 14:30
  Speaker 1: the physician launched, specialty medications, specialty disease states. I could
• 14:36
  Speaker 1: just keep going on and on pediatrics, you know. So
• 14:40
  Speaker 1: when that starts to happen, you have systems like eye
• 14:43
  Speaker 1: Care Plus, which is part of the IPC system. You
• 14:47
  Speaker 1: have Docstation, you have all these systems that you have PRISM,
• 14:51
  Speaker 1: which is a brand new system for pharmacists. They're actually
• 14:54
  Speaker 1: specific to birth control to start out, which is just
• 14:57
  Speaker 1: amazing because of their speciesivity and expertise. All Right, so
• 15:02
  Speaker 1: that void takes place, it's going to happen, it's already happening.
• 15:06
  Speaker 1: We have the business that's sitting there, the pharmacy business,
• 15:09
  Speaker 1: sometimes the single business. Sometimes tends stores, whatever. Just like you,
• 15:14
  Speaker 1: we have our technicians that have been sucked up into
• 15:17
  Speaker 1: the business of running that pharmacy keeping it profitable. There's
• 15:22
  Speaker 1: all this data talk to me because I just want
• 15:26
  Speaker 1: the listeners to hear your passion. This is exciting. This
• 15:29
  Speaker 1: is an exciting time to be an aggressive pharmacy technician
• 15:34
  Speaker 1: that is ready to do things that techs haven't normally
• 15:37
  Speaker 1: done in the past and level up and make more money.
• 15:42
  Speaker 4: Yeah.
• 15:43
  Speaker 3: And I do want to say I appreciate companies like
• 15:46
  Speaker 3: doock Station started by a pharmacist Sam and Unscripted started
• 15:51
  Speaker 3: by a farmacist James. And I do think a lot
• 15:54
  Speaker 3: of these solutions should be sold by insiders and it's
• 15:57
  Speaker 3: a very tight knit community. Yeah, Pharmacy technicians are kind
• 16:01
  Speaker 3: of you know, as pharmacists move up in their roles
• 16:06
  Speaker 3: at the pharmacy doing more clinical services. What we see
• 16:09
  Speaker 3: in states particularly like Iowa and Idaho that have expanded,
• 16:14
  Speaker 3: you know, standard of care models. Here in California, Governor
• 16:18
  Speaker 3: Newsom just signed our Standard of Care Bill eighty fifteen
• 16:22
  Speaker 3: oh three that.
• 16:26
  Speaker 4: Very soon after.
• 16:27
  Speaker 3: Pharmacy technicians also kind of move up in that standard
• 16:33
  Speaker 3: of care model. And I think there is this expectation
• 16:37
  Speaker 3: that they need to learn and adopt some of these
• 16:41
  Speaker 3: new workflows. And what I think is really fundamental right
• 16:45
  Speaker 3: now is that pharmacy technicians take this opportunity to own
• 16:48
  Speaker 3: that and be very proactive in the skills that they
• 16:52
  Speaker 3: can implement in these settings and learning how to go
• 16:57
  Speaker 3: into the pharmacy systems, identify opportun tunities, present that report
• 17:02
  Speaker 3: to the pharmacists and pharmacy owner and say hey, like,
• 17:05
  Speaker 3: you know, these are the patients that are on ASKMA medications.
• 17:09
  Speaker 4: Like we can do education.
• 17:11
  Speaker 3: I mean we're already doing health education, motivational interviewing on
• 17:15
  Speaker 3: you know, are they taking the meds appropriately?
• 17:17
  Speaker 4: What are some lifestyle changers that.
• 17:19
  Speaker 3: Are preventing them from being adherent to the medications?
• 17:24
  Speaker 4: What can what coaching can we really do.
• 17:28
  Speaker 3: That these technicians can really be proactive about identifying those opportunities,
• 17:32
  Speaker 3: bringing them to their business owner and saying, hey, if
• 17:35
  Speaker 3: you give me some time to work on this project
• 17:39
  Speaker 3: and we can clearly demonstrate that these clinical opportunities are
• 17:44
  Speaker 3: bringing in revenue from clinical billing, I would really like
• 17:48
  Speaker 3: to participate on that additional revenue that's coming in. Like
• 17:51
  Speaker 3: I under I was at a pharmacy where I knew
• 17:54
  Speaker 3: that I could get paid more working at a CBS,
• 17:58
  Speaker 3: but I loved my kind of you know, my independent
• 18:02
  Speaker 3: pharmacy family.
• 18:03
  Speaker 4: But that was, you know, ten years ago.
• 18:05
  Speaker 3: Nowadays you need to have a much better living wage
• 18:11
  Speaker 3: and a career style wage. And you know, I am
• 18:14
  Speaker 3: also you know, acutely tuned to the fact that pharmacies
• 18:18
  Speaker 3: don't have more money. So this is really a way
• 18:21
  Speaker 3: to be entrepreneurial within your existing environments, to help to
• 18:27
  Speaker 3: help your your employer bring in more money and then
• 18:32
  Speaker 3: lay clean to some of that success.
• 18:34
  Speaker 5: Yeah.
• 18:36
  Speaker 1: Absolutely, absolutely. I love what you're saying. I love what
• 18:39
  Speaker 1: you're saying. And the reason is is this is encouragement
• 18:43
  Speaker 1: to the pharmacy owners and operators right now, who when
• 18:46
  Speaker 1: they hear you first say pharmacy technicians that are are
• 18:50
  Speaker 1: good pharmacy technicians. They've been there, they put in the work,
• 18:54
  Speaker 1: they're helping to build the business. They need a pay raise.
• 18:57
  Speaker 1: There's always the shriek in the room because you're like,
• 19:00
  Speaker 1: but that means that our profit margins and are it's
• 19:05
  Speaker 1: going to all go down if you but you're saying,
• 19:08
  Speaker 1: uh uh, you could leverage the technician, empower the technician,
• 19:12
  Speaker 1: send them to conferences like the one I'm going to
• 19:16
  Speaker 1: next weekend. Sure cost and sure cost all about analyzing
• 19:21
  Speaker 1: to the grandular level, super duper grandular level where you
• 19:24
  Speaker 1: have an opportunity to make money. Canvassing physicians reaching out
• 19:29
  Speaker 1: to your patients with ancillary therapies and services and dme
• 19:35
  Speaker 1: and just dig into the business and show that these
• 19:40
  Speaker 1: individuals who are taking initiative putting in more hours, maybe
• 19:44
  Speaker 1: you need to switch them to the salary, stop paying
• 19:47
  Speaker 1: them hourly and let them know. We're going to put
• 19:49
  Speaker 1: a bonus structure onto this engine that if you raise
• 19:53
  Speaker 1: revenue in any way, and you could build categories that
• 19:56
  Speaker 1: you could track and KPIs and the whole thing. This
• 19:58
  Speaker 1: isn't just fagazi. If you started tracking each of those departments,
• 20:02
  Speaker 1: each of those verticals, at the end of a quarter
• 20:05
  Speaker 1: or the end of a year, you could write out
• 20:07
  Speaker 1: a bonus check because they were directly involved in impacting
• 20:12
  Speaker 1: the growth with your physicians, the growth with your community,
• 20:16
  Speaker 1: community events, diabetic education seminars. I could go on and on.
• 20:21
  Speaker 1: We could set and podcasts for six hours of how
• 20:25
  Speaker 1: you could have technicians literally bringing in more money to
• 20:30
  Speaker 1: your pharmacy and in turn providing a lot more healthcare
• 20:34
  Speaker 1: services to communities, especially those communities that don't have a
• 20:38
  Speaker 1: pharmacy for five, ten, twenty miles away or healthcare.
• 20:42
  Speaker 4: Provider you know, in that same way radius.
• 20:44
  Speaker 3: And because there continues and prosis to be a shortage
• 20:48
  Speaker 3: of physicians across the US, you're like, I know here
• 20:51
  Speaker 3: in California when we have our Pharmacy Advocacy Day in
• 20:55
  Speaker 3: Sacramento talking to legislators, their constituents are concerned learn about
• 21:01
  Speaker 3: accessing healthcare. I mean that's a different conversation from affordability.
• 21:06
  Speaker 3: It's we just don't know where to go when we're
• 21:10
  Speaker 3: feeling sick. We don't know how we're going to access
• 21:14
  Speaker 3: our endocrinologists for our annual appointment. And so there is
• 21:18
  Speaker 3: this appetite to leverage you know, doctorates of pharmacy, four
• 21:23
  Speaker 3: years undergrad four years of graduate school.
• 21:27
  Speaker 4: A lot of them have done residencies.
• 21:29
  Speaker 3: And you know there is always post education CE training
• 21:34
  Speaker 3: that they continue on that they should be leveraged more
• 21:38
  Speaker 3: and that they should be paid for the work.
• 21:40
  Speaker 4: That they're doing.
• 21:42
  Speaker 1: Absolutely, Amantha, I so enjoyed talking to you. You always
• 21:47
  Speaker 1: bring extra ideas to me and appreciate you sharing this
• 21:52
  Speaker 1: with listeners. If you're listening, you're curious, you want to
• 21:56
  Speaker 1: work with Amantha. She's active on LinkedIn, so look her up.
• 21:59
  Speaker 1: Then also go to our ex dash post dot com.
• 22:05
  Speaker 1: Once again, that's our ex dash post dot com. I'm
• 22:08
  Speaker 1: gonna put that in the show notes. So if you're
• 22:11
  Speaker 1: somewhere you're driving, you can't pick up a pen or
• 22:14
  Speaker 1: do something, don't worry about it. We'll have it in
• 22:15
  Speaker 1: the show notes. Promise me you'll be back on twerks
• 22:19
  Speaker 1: sometime sooner than later.
• 22:22
  Speaker 3: Yeah, and I definitely hope to catch you Apha in
• 22:26
  Speaker 3: Los Angeles next year my hometown.
• 22:28
  Speaker 4: It's three blocks away from where I live.
• 22:30
  Speaker 3: And we can plan some special self for the pharmacy
• 22:33
  Speaker 3: technicians together.
• 22:34
  Speaker 4: I know that myself and I'm Kristen's there another.
• 22:37
  Speaker 3: Pharmacy technician who's very active and in the advocacy work,
• 22:42
  Speaker 3: are hatching some special plans.
• 22:44
  Speaker 1: That's awesome. Thank you for what you do, Amantha, and
• 22:48
  Speaker 1: for hanging out with me and always being a source
• 22:51
  Speaker 1: of good information to us. I appreciate you.
• 22:54
  Speaker 6: Thank you too, Todd, keep up the great work.
• 23:06
  Speaker 7: This episode is sponsored by Independent Pharmacy Cooperative widely known
• 23:09
  Speaker 7: as IPC, established in nineteen eighty three. IPC is the
• 23:13
  Speaker 7: nation's largest group purchasing organization owned by independent pharmacy with
• 23:18
  Speaker 7: a mission of maximizing the success of community pharmacists. IPC
• 23:22
  Speaker 7: works to provide members with access to effective programs and
• 23:25
  Speaker 7: services designed to enhance profitability for independent pharmacy.
• 23:29
  Speaker 2: Read more about our mission.
• 23:31
  Speaker 7: By checking out our website at ipcrx dot com. That's
• 23:35
  Speaker 7: ipcarx dot com.
• 23:47
  Speaker 1: Hey, welcome back to this Week in Pharmacy. I'm your host,
• 23:50
  Speaker 1: Todd Uray. It's been great. This has been an exciting show.
• 23:54
  Speaker 1: I'm excited about what's happening in pharmacogenomics. Been one of
• 23:59
  Speaker 1: the topics and the subjects that I've just been fascinated with.
• 24:02
  Speaker 1: Since twenty sixteen, twenty nineteen, we launched the first podcast
• 24:08
  Speaker 1: dedicated to our pharmaciste and physicians about PGX, and as
• 24:12
  Speaker 1: you know, doctor Melissa Smith has taken over the show
• 24:17
  Speaker 1: and revolutionized it, taking it to a whole other level.
• 24:20
  Speaker 1: And it's been a hot week in PGX. Melissa, How
• 24:23
  Speaker 1: are you?
• 24:24
  Speaker 4: I'm good? How are you this morning?
• 24:25
  Speaker 1: Todd doing great? So I want to just jump right in.
• 24:30
  Speaker 1: You brought something to our attention. You brought on Karen Merritt,
• 24:34
  Speaker 1: who was a fabulous guest on your show, going through
• 24:39
  Speaker 1: the preventable toxicity the pharmacogenomics case for testing in oncology.
• 24:45
  Speaker 1: That interview listeners, if you have not heard this is
• 24:48
  Speaker 1: just tremendous. It's on all of your platforms, Spotify, Apple,
• 24:53
  Speaker 1: anywhere that you're looking for podcasts, just look up Pharmacy
• 24:55
  Speaker 1: Podcast Network and you'll find it. What a great subjec
• 25:00
  Speaker 1: to just flag that that's a prime example of how
• 25:04
  Speaker 1: testing can save lives. And Meritt's story with her mother
• 25:09
  Speaker 1: was just super impactful. Yeah, when she.
• 25:14
  Speaker 8: Actually when we first connected, that was the first thing
• 25:16
  Speaker 8: we talked about that and she is very passionate about
• 25:19
  Speaker 8: that and that is her driving force to do what
• 25:21
  Speaker 8: she does for advocating for this type of testing and
• 25:24
  Speaker 8: for the FDA to update these labels for these medications
• 25:29
  Speaker 8: like Zolota and five fluor yoursil currently. That's what is
• 25:34
  Speaker 8: kind of the next initiative along with that is to
• 25:37
  Speaker 8: get not only Zolota, Capesita beam that's just been updated
• 25:41
  Speaker 8: that testing is required prior to taking and now getting
• 25:45
  Speaker 8: five floor you're sill to fall suit. And it was
• 25:49
  Speaker 8: just amazing to me that it took so many people
• 25:52
  Speaker 8: being harmed by these therapies for it to come to
• 25:57
  Speaker 8: fruition like this.
• 25:58
  Speaker 4: Yes, this right here.
• 25:59
  Speaker 8: So as far as the toxicities go, they're fast and
• 26:04
  Speaker 8: what she explained in her mother's experience, it was literally
• 26:07
  Speaker 8: weeks and then she was taken out through this medication.
• 26:11
  Speaker 8: And it had they had this testing prior, this may
• 26:14
  Speaker 8: not have been the case for her mom. So this
• 26:16
  Speaker 8: is why it's so important to bring awareness around this,
• 26:19
  Speaker 8: making sure providers are knowledgeable of the testing laboratories that
• 26:24
  Speaker 8: can offer this for them, or even if you have
• 26:26
  Speaker 8: questions in general and just need support, I'm a great
• 26:29
  Speaker 8: resource for that, so you can reach out to me.
• 26:32
  Speaker 8: I can get you connected with the right types of
• 26:34
  Speaker 8: labs that are reputable that are testing for DPYD and
• 26:39
  Speaker 8: making sure that you're well taken care of as far
• 26:42
  Speaker 8: as being knowledgeable and feeling supported in that.
• 26:46
  Speaker 1: Space, Melissa, when I started researching, and my research is
• 26:52
  Speaker 1: more about building show notes or blogs that will accentuate
• 26:57
  Speaker 1: what topics that our pharmacists start talking about. And I
• 27:02
  Speaker 1: would always go to this table of pharmacogenomic biomarkers and
• 27:06
  Speaker 1: drug labeling, and it's been updated as of September of
• 27:10
  Speaker 1: twenty twenty four, and I would expected them to do
• 27:14
  Speaker 1: some new updates with some of the news that's come out.
• 27:17
  Speaker 1: But when I first started the show in twenty nineteen,
• 27:23
  Speaker 1: there were less than two hundred medications that were listed
• 27:26
  Speaker 1: on this and now there's like twice as many. So
• 27:30
  Speaker 1: once again, this drives the need for a pharmacist to
• 27:37
  Speaker 1: be accessible, be available, and be knowledgeable about when to test,
• 27:44
  Speaker 1: helping the physician understand the results, consulting with them, then
• 27:49
  Speaker 1: of course counseling the patient. Can you can you give
• 27:52
  Speaker 1: us some other examples of some other medications out there
• 27:55
  Speaker 1: that have kind of thrown you a reason to pause
• 28:02
  Speaker 1: based on some of the data and studies.
• 28:05
  Speaker 8: Absolutely, this is a number one that I always go
• 28:09
  Speaker 8: to with regards to plavix clipidogrel. That's a type of
• 28:13
  Speaker 8: medication that if we do not have testing prior to it,
• 28:17
  Speaker 8: and it's usually a first line treatment when we're trying
• 28:19
  Speaker 8: to prevent further strokes and heart attacks and patients right
• 28:22
  Speaker 8: antiplatelet medication, it requires activation through two C nineteen, and
• 28:27
  Speaker 8: the pharmacogenomic testing is important to understand whether or not
• 28:31
  Speaker 8: it's being activated, and then essentially we're getting potential treatment
• 28:36
  Speaker 8: failures for these patients the more and more compromise their
• 28:39
  Speaker 8: sip t C nineteen activity is coming back genetically. That
• 28:42
  Speaker 8: doesn't even take into consideration the combinations of therapies that
• 28:46
  Speaker 8: patients take with this commonly prescribed medication, because like I said,
• 28:50
  Speaker 8: it's a cost effective medication. First line treatment generally prescribe
• 28:54
  Speaker 8: post stroke and heart attack for patients, and without having
• 28:58
  Speaker 8: this knowledge based patient unbeknownst to their knowledge, without being tested,
• 29:03
  Speaker 8: could be at risk for just being on a medication
• 29:06
  Speaker 8: that's just worthless to them. So that's that's a big
• 29:08
  Speaker 8: one right there. And many of the mental health medications
• 29:11
  Speaker 8: have high levels of testing as well, because it can
• 29:16
  Speaker 8: prevent side effects and toxicities. Things like lexapro, Selexa, Zoloft
• 29:21
  Speaker 8: very common antidepressants that patients take, and in the antipsychotic
• 29:25
  Speaker 8: space too as well, we have quite a bit of
• 29:27
  Speaker 8: information there too. A lot of that guidance is around
• 29:30
  Speaker 8: dosing recommendations and also potential toxicities from the therapies as well.
• 29:36
  Speaker 8: I mean it and pay management. Pain management is another area.
• 29:41
  Speaker 8: So many people are unaware of the fact that they
• 29:44
  Speaker 8: could be taking something like vic it in something that
• 29:46
  Speaker 8: is hydrocode on based for its opioid, and the activation
• 29:50
  Speaker 8: of that drug is necessary to give you proper pain control.
• 29:52
  Speaker 8: Tramadol encodeine also included within that literature. If many patients
• 29:58
  Speaker 8: that have counseled and I speak with regularly, their prior
• 30:00
  Speaker 8: experience is typically when I find that there are two
• 30:03
  Speaker 8: D six is intermediate or poor, it needs to activate
• 30:06
  Speaker 8: those drugs in order for them to give you proper
• 30:08
  Speaker 8: pain control.
• 30:09
  Speaker 4: That their experience was.
• 30:11
  Speaker 8: I had a ton of side effects, not ge vomiting, dizziness,
• 30:14
  Speaker 8: but no pain control. And many times providers, let's say
• 30:20
  Speaker 8: that it's more subtle on the side effects, they may
• 30:22
  Speaker 8: even increase the dose for those for patients and encourage
• 30:25
  Speaker 8: them to maybe take one more tablet because it's one
• 30:27
  Speaker 8: to two every four to six hours on some of
• 30:28
  Speaker 8: those indications, and it's really just putting them more at
• 30:32
  Speaker 8: risk for increased side effects in just less effective treatment.
• 30:37
  Speaker 8: So the idea is really just to make it available
• 30:40
  Speaker 8: to all and really promote the idea of testing foundationally,
• 30:47
  Speaker 8: even at a primary care level, because it extends in
• 30:51
  Speaker 8: so many areas of a patient's care, especially when it
• 30:54
  Speaker 8: comes to their medications and what I also want to
• 30:56
  Speaker 8: say is is that many providers are wanting the EBBA
• 31:00
  Speaker 8: and the FDA table for these pharmacogenomic findings is a
• 31:03
  Speaker 8: perfect place to send them because it's all consolidated as
• 31:05
  Speaker 8: far as the level of evidence and what's being recommended.
• 31:09
  Speaker 8: The specific phenotype, whether intermediate or poor metabolism is there.
• 31:15
  Speaker 8: But the thing that still irks me a little bit
• 31:19
  Speaker 8: with the FDA is that it's not testing recommended for everything.
• 31:22
  Speaker 8: So it's the way that they label things is that
• 31:26
  Speaker 8: it's either testing recommended, testing considered, or actionable evidence. And
• 31:33
  Speaker 8: then for me, it just makes more sense for it
• 31:37
  Speaker 8: to be available to all. I mean, it really does
• 31:41
  Speaker 8: help with lessening the rispective for adverse side effects or
• 31:45
  Speaker 8: verse drug reactions here. So for me, it still begs
• 31:50
  Speaker 8: the question why it's still something that kind of is
• 31:53
  Speaker 8: blocking a barrier here for it being able to be
• 31:56
  Speaker 8: more accessible to our patients.
• 31:58
  Speaker 9: Right.
• 31:59
  Speaker 1: Yes, And I'd like to have an opportunity to dig
• 32:04
  Speaker 1: down into the lobbying side of this because I know
• 32:07
  Speaker 1: how that impacts healthcare.
• 32:10
  Speaker 8: Karen really opened my eyes to that as far as
• 32:13
  Speaker 8: her work and advocacy there and what they actually have
• 32:16
  Speaker 8: to do to get things. It's a lot of just
• 32:20
  Speaker 8: calling and emailing and getting patient cases presented before the
• 32:25
  Speaker 8: FDA for them to really make movement right. And it's
• 32:30
  Speaker 8: sad that it takes like adverse drug reactions and even
• 32:33
  Speaker 8: potential to ask for patients for this to occur.
• 32:37
  Speaker 4: This is a prime example with Saloda.
• 32:40
  Speaker 1: I want to shift a gear for listeners because we
• 32:42
  Speaker 1: are in an age where the dispensing fee is no
• 32:46
  Speaker 1: longer going to sustain our pharmacists. Our pharmacies are privately
• 32:52
  Speaker 1: owned pharmacies, our specialty. It's going to be more about
• 32:55
  Speaker 1: the services and the knowledge that the pharmacist has that
• 32:59
  Speaker 1: digs down and to the specialty that they're that they're championing.
• 33:03
  Speaker 1: Shout out to Jenna Quinn and perfecting pedes and her
• 33:06
  Speaker 1: setting the world on fire of pediatric care and digging
• 33:10
  Speaker 1: down into very complex situations where the pediatrician is is
• 33:16
  Speaker 1: stumped and they're like, we're not sure what to do. Well,
• 33:19
  Speaker 1: you kick it over to the medication specialists and move forward.
• 33:23
  Speaker 1: But in building your business and building Florida PGX Consulting,
• 33:28
  Speaker 1: what do you say to other pharmacists like you who
• 33:31
  Speaker 1: are who have been drawn to the science and the
• 33:34
  Speaker 1: testing of pharmacogenomics. How do you build your business? I
• 33:39
  Speaker 1: mean that's like the that's the million dollar question. But
• 33:42
  Speaker 1: you've been doing it long enough to kind of give
• 33:44
  Speaker 1: us some insight to that.
• 33:46
  Speaker 8: Well, it's relationships, is relationship building and trust. So let's
• 33:51
  Speaker 8: say you're a pharmacist who's in a retail setting and
• 33:55
  Speaker 8: like I was, and you're you're interested in trying to
• 33:58
  Speaker 8: basically break into this. A lot of that is entrepreneurial spirit, right,
• 34:03
  Speaker 8: you have to start digging into what your state laws
• 34:06
  Speaker 8: and regulations are with building out an LLC for yourself
• 34:10
  Speaker 8: or incorporating yourself. Yes, all those things on the back end,
• 34:13
  Speaker 8: but the most important thing is building the relationship with
• 34:15
  Speaker 8: practitioners around you. So that way, that's a resource for you,
• 34:19
  Speaker 8: a referral when it comes to needing testing for these patients,
• 34:24
  Speaker 8: more complex patients. So in the independent pharmacies, this is
• 34:28
  Speaker 8: a perfect space to introduce this because not only are
• 34:32
  Speaker 8: you in better communication with a lot of the medical
• 34:37
  Speaker 8: groups around you who are sending prescriptions directly to you,
• 34:40
  Speaker 8: you have more of an opportunity to have that personalized
• 34:43
  Speaker 8: conversation with practitioners and being able to open the door
• 34:47
  Speaker 8: to helping to manage this type of medication information and
• 34:52
  Speaker 8: testing for them. So that's where I see it being
• 34:56
  Speaker 8: hugely impactful for independent pharmacists because one you're already can order.
• 35:00
  Speaker 8: This is a place that people come to. You can
• 35:02
  Speaker 8: easily test these things. It's an oral swab, it's very
• 35:05
  Speaker 8: simplified instead of having to do blood draws and things
• 35:08
  Speaker 8: of that nature. And you can incorporate that into the
• 35:12
  Speaker 8: verification process because let's think about it. I mean, we
• 35:16
  Speaker 8: we have drudge drug interaction review of information when we're
• 35:20
  Speaker 8: at the pharmacy retail level, whether it be independent or
• 35:22
  Speaker 8: large chains.
• 35:24
  Speaker 9: But what we don't have is.
• 35:26
  Speaker 8: A window into the genetics, the compounded risk factors that
• 35:29
  Speaker 8: are not always considered or talked about. The concept is
• 35:33
  Speaker 8: always there for us as pharmacists. Pharmacokinetics and pharmacodynamics is built.
• 35:37
  Speaker 4: Into our DNA, so to speak.
• 35:41
  Speaker 8: We get the concept of incorporating it. It's just a
• 35:44
  Speaker 8: little bit of practice of identifying, understanding, and then combining
• 35:47
  Speaker 8: the knowledge into the compounded risk between the drudge gene
• 35:50
  Speaker 8: interaction and the drudge drug interactions. And that's the point
• 35:54
  Speaker 8: of verification. I mean truly, that's the last point of
• 35:58
  Speaker 8: all oversight of the medica reaching to the patient generally,
• 36:02
  Speaker 8: and not only does a partitioner need to be aware
• 36:05
  Speaker 8: of this at prescribing, but it's the pharmacist at that
• 36:08
  Speaker 8: end stage that needs to also be incorporating this into.
• 36:12
  Speaker 4: Their verification process too.
• 36:14
  Speaker 8: So for me, that's where I see it going in
• 36:17
  Speaker 8: the future, truly for pharmacists to kind of leverage that.
• 36:21
  Speaker 8: But I also there's relationships to be had with the
• 36:24
  Speaker 8: laboratory spaces as well with consulting with them because they
• 36:27
  Speaker 8: need pharmacists like ourselves to be able to communicate this
• 36:30
  Speaker 8: information to the providers and many times that's where a
• 36:35
  Speaker 8: barrier for ordering comes is there. I don't want to
• 36:39
  Speaker 8: say lack of knowledge base, but it's it has to
• 36:43
  Speaker 8: do with being able to understand the report they're receiving,
• 36:46
  Speaker 8: utilize it to their advantage, and being able to implement
• 36:49
  Speaker 8: it when actually prescribing for the patients too. But they
• 36:52
  Speaker 8: need to have advocacy as well, and that's where the
• 36:54
  Speaker 8: pharmacists need to come in and play that role.
• 36:57
  Speaker 1: So being a non pharmacist, but I have hung out
• 37:03
  Speaker 1: in technology to support pharmacies for so long, I'm very
• 37:08
  Speaker 1: frustrated The NDC list is there. You come up with
• 37:13
  Speaker 1: a medication, one of those medications that we just showed
• 37:16
  Speaker 1: on the screen that was, you know, being flagged by
• 37:19
  Speaker 1: FDA that I guess they that's probably the bucket of
• 37:22
  Speaker 1: black box warnings or whatever. But regardless, an NDC could
• 37:26
  Speaker 1: easily be identified in a pharmacy management software system like
• 37:30
  Speaker 1: primar X or Pioneer or whatever. Time that medication is
• 37:34
  Speaker 1: subscribed and it's brought up for processing, the pharmacists during
• 37:39
  Speaker 1: final review would get a message to say, you know,
• 37:43
  Speaker 1: here's the statistics. Now we have AI for god's sakes,
• 37:46
  Speaker 1: here's the statistics on this medication. Here are the latest
• 37:50
  Speaker 1: articles on this you know medication. You know, here's what
• 37:53
  Speaker 1: to look out for. At that point, in my opinion,
• 37:57
  Speaker 1: because of the stewards of safety that you are, the
• 38:00
  Speaker 1: pharmacists are reaching out to that physician either electronically or
• 38:05
  Speaker 1: picking up the phone or doing something. I would hope
• 38:07
  Speaker 1: it would be electronic, just from the eat from the
• 38:10
  Speaker 1: pharmacy management system to the EHR and flagging it back
• 38:13
  Speaker 1: to the physician and saying, hey, listen, I highly recommend
• 38:17
  Speaker 1: that we run a pharmacogenomics test. And by the way,
• 38:20
  Speaker 1: I'm ready to do it here at the pharmacy, or
• 38:22
  Speaker 1: I'm ready to do it here at my consultant space
• 38:24
  Speaker 1: or wherever you guys are. Can we move forward and
• 38:28
  Speaker 1: then But what I'm talking about, of course this would
• 38:32
  Speaker 1: be fluid, it would it would work nicely, But it's like.
• 38:35
  Speaker 5: When you send somebody over to have a vaccination done right,
• 38:40
  Speaker 5: And the other point of that is making it accessible
• 38:44
  Speaker 5: and cost effective for the patient.
• 38:46
  Speaker 8: That's where we have a true barrier in care as well,
• 38:49
  Speaker 8: because a lot of insurance companies commercial insurance companies are
• 38:53
  Speaker 8: not readily covering the cost of this test yet FSA
• 38:56
  Speaker 8: and HUSA, we'll cover the cost of it, and the
• 39:00
  Speaker 8: insurance process comes into play. It makes it extremely difficult
• 39:04
  Speaker 8: for it just to be covered like a vaccine is
• 39:07
  Speaker 8: and it be free for them. This is what we
• 39:09
  Speaker 8: really truly want to get patient care at when it
• 39:12
  Speaker 8: comes to this level of testing, making it that much
• 39:14
  Speaker 8: more accessible, and that's where I feel it's kind of
• 39:18
  Speaker 8: like a break in the chain right for patients being
• 39:22
  Speaker 8: more apt and wanting to participate. I think they all
• 39:25
  Speaker 8: I don't think it's a patient level issue at all.
• 39:28
  Speaker 8: They all want this information, but it is a barrier
• 39:31
  Speaker 8: when it comes to the cost end of it.
• 39:34
  Speaker 1: So I just talked with Michael Banville yesterday who's probably
• 39:39
  Speaker 1: going to be on TWERUS in the future. He's working
• 39:43
  Speaker 1: with a company called All's Path and they're doing testing
• 39:47
  Speaker 1: that is tied right into DNA and the effects of
• 39:50
  Speaker 1: medications on you know, on people that are on certain treatments.
• 39:57
  Speaker 1: And I've talked to him about our you know, deep
• 40:00
  Speaker 1: resources that we have throughout the network, and starting with
• 40:03
  Speaker 1: you lead pharmacogenomics, I'm going to put you guys together
• 40:08
  Speaker 1: for a future conversation. But the reason why I'm bringing
• 40:10
  Speaker 1: that up is, once again, I just feel that from
• 40:14
  Speaker 1: the FDA's point of view, and however that trickles down,
• 40:17
  Speaker 1: including payment through CMS and payment through private insurance, that
• 40:22
  Speaker 1: we have to come to a point where it's not
• 40:27
  Speaker 1: waiting on the physician to run the test. It's going
• 40:31
  Speaker 1: back to a certified you know as well as I do.
• 40:33
  Speaker 1: There's board certifications. If you had a certification of some
• 40:37
  Speaker 1: sort in pharmacogenomics and you use it's not.
• 40:40
  Speaker 8: There yet, but I know that people are advocating and
• 40:43
  Speaker 8: pushing for the board certification for this.
• 40:46
  Speaker 1: Yeah, but if that were the case, why doesn't want
• 40:50
  Speaker 1: to unclog the bottleneck, which is going to become the
• 40:54
  Speaker 1: physician because they're so busy. And why in the world
• 40:58
  Speaker 1: we have a setup that it's the pharmacist that makes
• 41:01
  Speaker 1: the determination, that says, hey, this CPT code and this
• 41:05
  Speaker 1: ICD ten code and this over here gives me the
• 41:08
  Speaker 1: right to run a test for my patient because this
• 41:12
  Speaker 1: medication has been flagged and it could be harmful. So therefore,
• 41:16
  Speaker 1: let's run a four hundred dollars PGX test or however
• 41:21
  Speaker 1: much that they are. Now.
• 41:22
  Speaker 2: When I started to do it.
• 41:23
  Speaker 1: In two thousand and fifteen sixteen, it was like a
• 41:26
  Speaker 1: twenty two hundred dollars test, And now I know that
• 41:29
  Speaker 1: it's it's certainly not well, it's.
• 41:32
  Speaker 8: Much more reasonable for a cost perspective, And when you
• 41:35
  Speaker 8: think about the actual cost of adverse drug reactions, which
• 41:38
  Speaker 8: can be into the hundreds of thousands, and even more
• 41:40
  Speaker 8: advanced cases where they're staying hospitalized for a longer period
• 41:45
  Speaker 8: of time because of these things, towards the five hundred thousands,
• 41:48
  Speaker 8: even the millions, I mean, a four hundred dollars test
• 41:50
  Speaker 8: is nominal in the sheer comparison of cost. So it's
• 41:58
  Speaker 8: something that's utilized over and over again. You're not having
• 42:01
  Speaker 8: to be retested like a metabolic panel. This is something
• 42:03
  Speaker 8: that you test once and then until there's more evidence
• 42:06
  Speaker 8: or additional genes to be brought into the picture, which
• 42:09
  Speaker 8: takes a long time to do. That's when maybe additional
• 42:13
  Speaker 8: testing would be necessary. But when you have more comprehensive
• 42:17
  Speaker 8: gene panels, like having anywhere from like thirty nine genes
• 42:21
  Speaker 8: being tested as opposed to limiting to maybe twenty genes,
• 42:26
  Speaker 8: that also opens the doors for a more comprehensive review
• 42:29
  Speaker 8: and extension into more you know, rare type medication testing
• 42:36
  Speaker 8: already done upfront, not delaying care and any kind of
• 42:39
  Speaker 8: chemotherapies for example like Whizzelota.
• 42:44
  Speaker 4: That's a great example because the way it's phrased.
• 42:50
  Speaker 8: Is within the FDA update is that testing we are
• 42:55
  Speaker 8: we are recommending testing, but if it means delaying care,
• 43:00
  Speaker 8: can still begin therapy prior, and who would want to
• 43:03
  Speaker 8: do that knowing the intensity of onset of these toxicities
• 43:08
  Speaker 8: potentially for patients with these deficiencies already. So I feel
• 43:11
  Speaker 8: like that's a liability even for the FDA to put
• 43:13
  Speaker 8: that language in with even that update, you know what
• 43:16
  Speaker 8: I mean, I think it should be testing required prior
• 43:19
  Speaker 8: to starting, and if we already have patients within the system,
• 43:22
  Speaker 8: within the healthcare system that are just being tested automatically
• 43:24
  Speaker 8: for these things, is not going to delay care at all.
• 43:26
  Speaker 8: They're just going to have it accessible already and just
• 43:29
  Speaker 8: know right away instead of and then getting alternative therapy
• 43:34
  Speaker 8: is being recommended as opposed to waiting on this information
• 43:37
  Speaker 8: which can take upward to seven to fourteen days with
• 43:39
  Speaker 8: some laboratories, right, so that really can delay care.
• 43:44
  Speaker 1: Well, So this is awesome. Really appreciate your insights and
• 43:48
  Speaker 1: intelligence for the Pharmacy podcast network and the work that
• 43:51
  Speaker 1: you're doing for your patients, but also the education that
• 43:54
  Speaker 1: you're bringing, the partnerships that you're bringing to our physicians,
• 43:58
  Speaker 1: and the support that you're you're extending. And excited to
• 44:02
  Speaker 1: see the business growing. It's Florida PGX Consulting. Yes, just
• 44:07
  Speaker 1: take a look. Link up with Melissa on LinkedIn. I
• 44:11
  Speaker 1: cannot wait to have you back on Torqus.
• 44:14
  Speaker 4: Yes, thank you so much for having me again. I
• 44:15
  Speaker 4: always love doing these.
• 44:17
  Speaker 1: All right, thanks for listening to torks today. We'll talk
• 44:21
  Speaker 1: to you soon. Have a great week.
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• 45:23
  Speaker 1: Hey, welcome back to this week in pharmacy. It is
• 45:27
  Speaker 1: a good day, November seventh, twenty twenty five. Can you
• 45:31
  Speaker 1: believe it is almost the end of twenty twenty five?
• 45:35
  Speaker 1: I remember when it started, and I'm like, I'm gonna
• 45:38
  Speaker 1: be twenty pounds later and I'm only at the ten spot.
• 45:43
  Speaker 1: I'm going to be more fit, be more healthy. So
• 45:46
  Speaker 1: far that's going good. But what's your end of year
• 45:48
  Speaker 1: look like, and what are you planning for? You have
• 45:51
  Speaker 1: to start planning now for twenty twenty six. And part
• 45:55
  Speaker 1: of planning is how we work with government officials, how
• 46:00
  Speaker 1: you educate your state representatives, how you're embracing your state
• 46:05
  Speaker 1: pharmacy organizations and planning with them that if you do
• 46:10
  Speaker 1: a tour with a state representative or a senator to
• 46:13
  Speaker 1: teach them about how you're impacting your community and community health,
• 46:19
  Speaker 1: get your state pharmacy association involved and make it a thing.
• 46:25
  Speaker 1: Get press involved, and get the educations out there. More
• 46:29
  Speaker 1: has happened in PBM reform and writing the ship than
• 46:34
  Speaker 1: ever before in my twenty plus years in pharmacy. And
• 46:38
  Speaker 1: if I'm looking at things from just a pharmacy perspective,
• 46:44
  Speaker 1: what better governor to have than Governor Huckabee of Arkansas
• 46:51
  Speaker 1: Because she is a fighter, and she's fighting for independent
• 46:56
  Speaker 1: community pharmacies, and she's fighting for better access, and she's
• 46:59
  Speaker 1: fighting for fairness for her constituents. And I think it's
• 47:04
  Speaker 1: going to bleed over. I know it's going to bleed
• 47:06
  Speaker 1: over into other other states. But today on Twerks, we
• 47:10
  Speaker 1: are welcoming a good friend of ours here at the
• 47:14
  Speaker 1: pharmacy Podcast Network. Greg Ribaled of APCI. Greg, Welcome to twerks.
• 47:22
  Speaker 10: Thank you so much for having me. Always a pleasure.
• 47:24
  Speaker 10: I'm particularly excited to be here today with your other.
• 47:26
  Speaker 1: Guest, absolutely, and we're talking about pharmacy associations. This is
• 47:32
  Speaker 1: the guy of the Arkansas Pharmacist Association, and I'm kind
• 47:37
  Speaker 1: of jealous because he probably knows Governor how could be
• 47:41
  Speaker 1: and probably has met her. So we want to welcome
• 47:44
  Speaker 1: John Vincent. John.
• 47:49
  Speaker 9: Yeah, it's great to be here. Todd, good to see you.
• 47:51
  Speaker 9: Good to see you. Greg.
• 47:53
  Speaker 4: Hey, John.
• 47:54
  Speaker 1: Hey, So, Governor Huckabee, have you had a chance to
• 47:58
  Speaker 1: meet her?
• 47:59
  Speaker 9: Yeah, Yes, Actually I have. Governor Sarah Huckabee Sanders Is
• 48:04
  Speaker 9: she's actually the youngest governor in the country. She's in
• 48:07
  Speaker 9: her early forties, and she is finishing up a first
• 48:11
  Speaker 9: term and working on I think following Day started this
• 48:15
  Speaker 9: week in Arkansas and she filed for a second run
• 48:18
  Speaker 9: at governor here in the great state of Arkansas. And
• 48:21
  Speaker 9: we have had a lot of great interactions with not
• 48:24
  Speaker 9: only her, but some of her key leadership and team
• 48:28
  Speaker 9: and staff are very accessible, interested in our issues, and
• 48:34
  Speaker 9: it's been good work with her.
• 48:36
  Speaker 1: Yeah, Governor Huckabee Sanders was also at the NCPA twenty
• 48:41
  Speaker 1: twenty five. I didn't get to meet her. Too much
• 48:45
  Speaker 1: was going on, but it was it was great to
• 48:47
  Speaker 1: see that she took time to talk with pharmacy owners
• 48:53
  Speaker 1: and you know in the NCP, I thought that was wonderful. Hey,
• 48:56
  Speaker 1: this week in pharmacy. The reason why I'm so excited
• 48:58
  Speaker 1: to have you here, John and Greg is to talk
• 49:02
  Speaker 1: about things that are are pretty hot on the press,
• 49:05
  Speaker 1: and that is Sanders. Governor Huckabee Sanders announced Arkansas's application
• 49:12
  Speaker 1: for rural health funding and John, you brought it to
• 49:16
  Speaker 1: my attention how many times pharmacy and pharmacists were mentioned
• 49:21
  Speaker 1: in this press release from the Governor's office. And can
• 49:25
  Speaker 1: you take us through this and what this means for
• 49:28
  Speaker 1: Arkansas and what this means for pharmacy and pharmacists in Arkansas.
• 49:33
  Speaker 9: Yeah. Sure, we're still digesting it ourselves because it's hot
• 49:37
  Speaker 9: off the press this week. But there's about one hundred
• 49:40
  Speaker 9: and twenty five page application that went to CMS and
• 49:44
  Speaker 9: most states, if not all, fifty or in the process
• 49:47
  Speaker 9: of doing this. This is the time of year where
• 49:50
  Speaker 9: the administration will be reviewing proposals to provide fifty billion
• 49:56
  Speaker 9: dollars in funding across the country. So Arkansas application it
• 50:00
  Speaker 9: was announced this week they're asking for one billion dollars.
• 50:05
  Speaker 9: And we did submit ideas from the Arkansas Pharmacists Association,
• 50:10
  Speaker 9: from Arkansas CPEESN which is a clinical integrative network, as
• 50:15
  Speaker 9: did other organizations. I know Walmart submitted ideas and c
• 50:19
  Speaker 9: of our national partners to our governor and we were
• 50:22
  Speaker 9: able to meet with Secretary Jim Hudson, who was the
• 50:26
  Speaker 9: chairman of the committee that reviewed these ideas and their
• 50:29
  Speaker 9: team that put the proposal together. So in the not
• 50:32
  Speaker 9: necessarily in the press release, but in the full one
• 50:35
  Speaker 9: hundred and twenty five page actual application, which is included
• 50:39
  Speaker 9: in the press release the link pharmacists are mentioned a
• 50:42
  Speaker 9: lot and a big part of what rural transformation should be.
• 50:46
  Speaker 9: Our pharmacy owners, our pharmacists that work in Arkansas have
• 50:52
  Speaker 9: business practices in all seventy five counties, and of course
• 50:56
  Speaker 9: they work in hospitals, nursing homes and community practice is
• 51:00
  Speaker 9: primarily seeing patients. And we do have community pharmacy practices
• 51:05
  Speaker 9: in all seventy five counties in our state. About half
• 51:08
  Speaker 9: of those are independent pharmacy owned still and it's a
• 51:11
  Speaker 9: good mix with really strong a network of pharmacies and
• 51:16
  Speaker 9: then within that clinical integrade network. Within our state, one
• 51:19
  Speaker 9: hundred and eighty of those are part of that clinical
• 51:22
  Speaker 9: Integrade network. So we're well positioned on practice transformation, on
• 51:28
  Speaker 9: delivery of care and new ways, whether that's telehealth, whether
• 51:32
  Speaker 9: that's being paid for our time, for our expertise, and
• 51:36
  Speaker 9: other innovation ideas that are going to come out of this.
• 51:39
  Speaker 9: Pharmacists are going to play a big role, and we
• 51:41
  Speaker 9: appreciate the partnership with the administration.
• 51:44
  Speaker 1: That's incredible, Greg, that's some good news. How does this
• 51:48
  Speaker 1: tie back to your concerns where you oversee all fifty states?
• 51:55
  Speaker 1: You have members in all fifty states, But this could
• 51:57
  Speaker 1: become a domino effect where we take other successes and
• 52:03
  Speaker 1: other ends in other states and try to spread this
• 52:07
  Speaker 1: throughout the entire country because we know that pharmacy deserts
• 52:11
  Speaker 1: are ravaging health care access to so many people throughout
• 52:15
  Speaker 1: the country.
• 52:17
  Speaker 6: Yeah.
• 52:17
  Speaker 10: Absolutely, And look, you know, I think you know, just
• 52:21
  Speaker 10: to reinforce your point right in terms of serving as
• 52:23
  Speaker 10: a model and to give John an Arkansas compliment here
• 52:26
  Speaker 10: because what we see really over and over again is
• 52:30
  Speaker 10: Arkansas serving as a model and sort of shaping pharmacy
• 52:34
  Speaker 10: in a variety of different ways for years and years
• 52:37
  Speaker 10: and years, right, John, I think twenty eighteen there was
• 52:39
  Speaker 10: you know, big legislation that helped shape shape things, sort
• 52:44
  Speaker 10: of shape national policy and the direction of other states took.
• 52:48
  Speaker 10: And this, you know, to me is fascinating because obviously
• 52:50
  Speaker 10: you're working really hard on this rural health angle and
• 52:54
  Speaker 10: leading on this. But that's you know, that's not the
• 52:56
  Speaker 10: only thing you've done this year. That's not the only
• 52:58
  Speaker 10: thing you've done this week, is it?
• 53:00
  Speaker 6: Right?
• 53:00
  Speaker 10: Like you're you're you're in the thick of it on
• 53:03
  Speaker 10: on the legal front as well.
• 53:04
  Speaker 9: Correct, Right, We had a Meekus brief released today or
• 53:09
  Speaker 9: not today, but this week, uh and did a media
• 53:12
  Speaker 9: interview today about that with the Supreme Court, not the
• 53:16
  Speaker 9: Supreme Court case, but the Eighth Circuit Court of Appeals
• 53:19
  Speaker 9: with relation to a piece of legislation. We're probably going
• 53:21
  Speaker 9: to get into a minute in a few minutes, but
• 53:23
  Speaker 9: that was released today. The Community Oncology Alliance, which represents
• 53:29
  Speaker 9: oncology practices and pharmacies in Arkansas and across the country,
• 53:34
  Speaker 9: also released an amikas brief or a friend of the
• 53:36
  Speaker 9: court brief. This week. So it's crazy. There's a lot
• 53:39
  Speaker 9: going on.
• 53:40
  Speaker 10: Yeah, by the way, right, like we're talking about you
• 53:44
  Speaker 10: a pharmacy law being in the Eighth Circuit. Arkansas is
• 53:46
  Speaker 10: the state that effectively, you know, took a pharmacy issue,
• 53:51
  Speaker 10: the ARISA issue, all the way up to the US
• 53:53
  Speaker 10: Supreme Court, got you know, got certain granted, and then
• 53:56
  Speaker 10: one before the US Supreme Court. So you guys, you
• 54:00
  Speaker 10: know the state of Arkansas is no stranger to fighting
• 54:05
  Speaker 10: to enforce state pharmacy laws. Land on that front too.
• 54:10
  Speaker 9: And I always like when we're talking about some of
• 54:13
  Speaker 9: the cool things Arkansas's doing, Todd clearly it wouldn't be
• 54:17
  Speaker 9: possible without our national partners, without APCI, NCPA, APHA, as
• 54:25
  Speaker 9: well as NASPA and lots of other states. There have
• 54:29
  Speaker 9: been many leaders. It's not just an Arkansas thing, but
• 54:32
  Speaker 9: we learn a lot from each other in North Dakota,
• 54:35
  Speaker 9: West Virginia, Iowa, Alabama, Montana, Oklahoma, Georgia. I'm going to
• 54:40
  Speaker 9: leave somebody out Tennessee, the point a Louisiana. I mean,
• 54:43
  Speaker 9: there's a lot of making Kentucky big time. Ben mud
• 54:47
  Speaker 9: Over in Kentucky and their group, there's been a lot
• 54:50
  Speaker 9: of success and movement. But Arkansas has certainly over the
• 54:55
  Speaker 9: last twenty years and certainly in the last ten, been
• 54:59
  Speaker 9: very aggressive at protecting patients and fighting for our profession.
• 55:04
  Speaker 1: I love it. Yeah, shout out to the pharmacy associations
• 55:08
  Speaker 1: out there if you want to get on this week
• 55:12
  Speaker 1: in pharmacy and give us an update. We know what happens.
• 55:16
  Speaker 1: These other states are listening, they're watching the news. If
• 55:20
  Speaker 1: we can spread some good news, we can spread some
• 55:22
  Speaker 1: progress in PBM or form. You have our microphone at
• 55:27
  Speaker 1: your disposal just to let you know. Hey, John, you
• 55:31
  Speaker 1: you started letting the cat out of the bag. Why
• 55:33
  Speaker 1: we actually brought you here. So let's jump in before
• 55:36
  Speaker 1: before it jumps out itself. And that is that is
• 55:41
  Speaker 1: HB one one five zero ar state, Arkansas state legislator
• 55:47
  Speaker 1: to prohibit a pharmacy benefits manager from obtaining certain pharmacy permits.
• 55:54
  Speaker 1: I absolutely love this because, in my uneducated opinion of
• 56:00
  Speaker 1: not having an MBA or not even having a farm D,
• 56:04
  Speaker 1: I don't think any insurance organization should be allowed to
• 56:08
  Speaker 1: own or operate pharmacies. I think that's a complete conflict
• 56:12
  Speaker 1: of interest. This is getting us much closer to such
• 56:17
  Speaker 1: a setting.
• 56:20
  Speaker 9: I agree. Thanks thought. It is a very simple bill
• 56:23
  Speaker 9: in terms of it is a conflict of interest to
• 56:27
  Speaker 9: be both the fox and guarding the Henhouse. And this
• 56:31
  Speaker 9: bill simply eliminates that conflict of interest and says you
• 56:35
  Speaker 9: can be a licensed PBM or you can be a
• 56:38
  Speaker 9: licensed pharmacy, but you cannot be both. And there are yeah,
• 56:43
  Speaker 9: pick one or the other in our state. And there
• 56:46
  Speaker 9: are too many instances both in examples from patients from
• 56:52
  Speaker 9: data collected within Arkansas as well as Wall Street Journal,
• 56:57
  Speaker 9: New York Times, Federal Trade Commission on two different occasions
• 57:02
  Speaker 9: in the last year US House oversight led by Chairman
• 57:07
  Speaker 9: Comer of Kentucky, where we are seeing patients forced to
• 57:12
  Speaker 9: pharmacies with one star or two star reviews that get
• 57:16
  Speaker 9: bad service, poor healthcare outcomes, and they're paying billions of dollars.
• 57:21
  Speaker 9: More so, they're capturing up to the latest Federal Trade
• 57:26
  Speaker 9: Commission report showed that three pharmacies are filling seventy percent
• 57:32
  Speaker 9: of all specialty and brand drugs in the United States
• 57:35
  Speaker 9: owned by three PBMs and in doing so, Yeah, and
• 57:39
  Speaker 9: the markups are billions and billions of dollars massive.
• 57:42
  Speaker 10: So Todd, we were looking at some data and federal
• 57:46
  Speaker 10: employee health benefit plan last year. And this was a
• 57:48
  Speaker 10: plan where the PBM required their mail order specialty pharmacy
• 57:53
  Speaker 10: to fill the prescriptions. Patients couldn't go anywhere else the
• 57:56
  Speaker 10: beneficiaries in this federal plan. And we found markups will
• 58:00
  Speaker 10: be the highest markup we found, but we found markups
• 58:02
  Speaker 10: for MS drugs that were as high as forty seven
• 58:05
  Speaker 10: thousand percent over the national drug acquisition costs. Forty seven
• 58:09
  Speaker 10: thousand percent markup to treat patients with a really really
• 58:14
  Speaker 10: serious condition. And oh, by the way, their choice was restricted.
• 58:19
  Speaker 1: That's horrible.
• 58:20
  Speaker 9: And it's normal in other industries to have these conflicts
• 58:24
  Speaker 9: of interest ban For example, if I'm Anheuser Busch and
• 58:29
  Speaker 9: I make beer, I cannot also be the distributor and
• 58:33
  Speaker 9: the retail sales. Yep, they're required to be separate. And
• 58:37
  Speaker 9: it's because when you are all one, you can abuse
• 58:40
  Speaker 9: the system to benefit yourself. And there was a report
• 58:43
  Speaker 9: this just this week nationally in stat News that one
• 58:47
  Speaker 9: of the three big PBMs also owns physician health practices
• 58:52
  Speaker 9: and they're finding that they overpay the practices they owned
• 58:56
  Speaker 9: by seventeen percent on average, and in areas where they
• 58:59
  Speaker 9: have a market concentration of greater than twenty five percent.
• 59:03
  Speaker 9: They're overpaying themselves compared to other physician bres is about
• 59:07
  Speaker 9: sixty one percent. Yeah, and so pharmacy is the tip
• 59:09
  Speaker 9: of the Osburg.
• 59:10
  Speaker 10: It is the tip of the iceberg and a point.
• 59:13
  Speaker 10: I'm glad you brought that up, John, And something that
• 59:15
  Speaker 10: I think is important not to get lost in that
• 59:18
  Speaker 10: is this isn't like aberrational or statistically insignificant, right, This
• 59:22
  Speaker 10: isn't an insurer that owns a couple of physician practices.
• 59:26
  Speaker 10: They're the largest employer of physicians in the country, or
• 59:29
  Speaker 10: one of the largest employer. I think they're the largest
• 59:32
  Speaker 10: employer of physicians of the country at this point through
• 59:34
  Speaker 10: you know, aggressive acquisition. So we're not talking about, hey,
• 59:37
  Speaker 10: they're paying themselves more. And it's a lip on the radar, right.
• 59:41
  Speaker 10: You know, these insurers, these PBMs, they're so big that
• 59:46
  Speaker 10: their practices the minute they start them become entrenched on
• 59:50
  Speaker 10: a massive scale. Right, And it might feel normal, it
• 59:53
  Speaker 10: might feel normalized.
• 59:54
  Speaker 7: But it's not.
• 59:55
  Speaker 10: They're just doing it on as big of a scale
• 59:57
  Speaker 10: as it could be done.
• 1:00:01
  Speaker 4: Nuts.
• 1:00:02
  Speaker 10: But John, really glad you brought that up, because that frankly,
• 1:00:04
  Speaker 10: that that's a big story that came out this week,
• 1:00:07
  Speaker 10: and it should be bigger. Todd, I'd like to add,
• 1:00:11
  Speaker 10: you know, look like obviously the work that Arkansas did
• 1:00:13
  Speaker 10: this year and passing this getting the side into law
• 1:00:16
  Speaker 10: is nation leading and it's going to shape again a
• 1:00:19
  Speaker 10: lot of policy, a lot of states are looking at this.
• 1:00:22
  Speaker 10: I think it also helps build momentum at the federal level.
• 1:00:24
  Speaker 10: We're probably I mean, I expect to see patients before
• 1:00:27
  Speaker 10: monopolies reintroduced at the federal level as well. That was
• 1:00:32
  Speaker 10: introduced by Senator Holly and Warren and Congress and Auchincloss
• 1:00:36
  Speaker 10: and Harshbarger, and so I would anticipate seeing that again.
• 1:00:41
  Speaker 10: And the success that Arkansas had in that I think
• 1:00:43
  Speaker 10: will will help build momentum for that. But as big
• 1:00:47
  Speaker 10: of a story is Arkansas and the pharmacists there, you know,
• 1:00:51
  Speaker 10: helping to support the passage of that law. To me,
• 1:00:54
  Speaker 10: you know, one of the maybe a bigger story or
• 1:00:56
  Speaker 10: as big is that in the face of like massive
• 1:01:00
  Speaker 10: pushback in adversity, Governor Sarah harkerby Sanders has just become
• 1:01:07
  Speaker 10: just an amazing champion for a you know, standing up
• 1:01:11
  Speaker 10: to PBMs and not being intimidated, but also just a
• 1:01:14
  Speaker 10: champion for pharmacy and she's she's leaned into that, and
• 1:01:17
  Speaker 10: boy is it amazing to see.
• 1:01:21
  Speaker 1: It really is, And it's refreshing to see how a
• 1:01:25
  Speaker 1: governor standing up for her her residence and her constituents
• 1:01:30
  Speaker 1: and people she knows the dollars that are flowing through
• 1:01:35
  Speaker 1: the state systems and medicaid, for example, and what how
• 1:01:39
  Speaker 1: dollars are being given to big organizations to raise their
• 1:01:45
  Speaker 1: stock price instead of for covering meds of people who
• 1:01:48
  Speaker 1: are not buying groceries because they don't have medication. And
• 1:01:52
  Speaker 1: it's it's just silly. It didn't make any sense to
• 1:01:56
  Speaker 1: me when I first learned about PBMs and understanding what
• 1:02:00
  Speaker 1: we've done, and when we started the PBM Reform podcast
• 1:02:03
  Speaker 1: that you now host, Greg. It's an education for us all.
• 1:02:08
  Speaker 1: But it's also tracking. We've been tracking this since twenty nineteen,
• 1:02:12
  Speaker 1: and it's it's people like you know, Sarah, Sarah Huckabee Sanders,
• 1:02:19
  Speaker 1: that's it's making huge abilities for us to finally make
• 1:02:24
  Speaker 1: way and to get attention. And then you sprinkle Mark
• 1:02:28
  Speaker 1: Cuban into that, and you sprinkle sprinkled Representative Jake Auchenkloss
• 1:02:33
  Speaker 1: that keeps showing up everywhere. He's on TikTok, he's on Instagram,
• 1:02:37
  Speaker 1: he's on the NUDS. Absolutely, it's like we're chip chip
• 1:02:40
  Speaker 1: chipping away, and it's I'm finally seeing huge cracks in
• 1:02:44
  Speaker 1: these behemoth, three big players that I think we're going
• 1:02:49
  Speaker 1: to finally get to the Do you guys remember the
• 1:02:51
  Speaker 1: in the nineteen eighties, the divestiture of AT and T
• 1:02:54
  Speaker 1: and how they broke it apart, Like that has to happen.
• 1:02:58
  Speaker 1: We have to the consume U We's sick. And by
• 1:03:01
  Speaker 1: the way, they're not even as sixteenth as evil as
• 1:03:06
  Speaker 1: the pharmas ass Todd.
• 1:03:09
  Speaker 9: I'm glad you brought that up because that case was
• 1:03:12
  Speaker 9: part of what inspired the law. And then the Patients
• 1:03:15
  Speaker 9: Before Monopolies Act at the federal level gave us the idea.
• 1:03:20
  Speaker 9: And you go back to the Federal Trade Commission breaking
• 1:03:24
  Speaker 9: apart the bells back in the late seventies early eighties,
• 1:03:27
  Speaker 9: that was a ten year process. It took ten years.
• 1:03:30
  Speaker 9: So it was the bright thing to do, but it
• 1:03:32
  Speaker 9: took a decade. So at the heart and core of
• 1:03:36
  Speaker 9: Acts sixty four HB eleven fifty at the state level
• 1:03:40
  Speaker 9: is our governor, our Attorney General and our elected state
• 1:03:44
  Speaker 9: legislators and the Senate in the House felt like there
• 1:03:48
  Speaker 9: are patient lives at stake and they will die if
• 1:03:51
  Speaker 9: we wait ten years. John, we can treat. Yeah, we
• 1:03:54
  Speaker 9: can take action now and particular seasons.
• 1:03:57
  Speaker 10: John's paid me to ask this question, John, But how
• 1:04:00
  Speaker 10: it took took them a decade? How many days did
• 1:04:03
  Speaker 10: it total?
• 1:04:03
  Speaker 5: Days?
• 1:04:03
  Speaker 10: How many days did it take you to get the
• 1:04:05
  Speaker 10: sucker into you know, your support, to get still across
• 1:04:08
  Speaker 10: the fish.
• 1:04:09
  Speaker 9: Yeah, well it was a I mean, it was definitely
• 1:04:11
  Speaker 9: a year of conversations. It was filed in early January
• 1:04:15
  Speaker 9: and then had to have a fiscal node and be
• 1:04:18
  Speaker 9: evaluating all the things that usually happened. But when it
• 1:04:20
  Speaker 9: actually got introduced in committee and ran in committee and
• 1:04:24
  Speaker 9: then to the floor on both chambers starting the House,
• 1:04:27
  Speaker 9: it took a week. It was fast amazing because we
• 1:04:30
  Speaker 9: had because we had spent months and months and months educating,
• 1:04:35
  Speaker 9: working with leadership, and getting to a position where leadership
• 1:04:40
  Speaker 9: in both the House and Senate, Governor's office and Attorney
• 1:04:44
  Speaker 9: General were all behind it and supportive.
• 1:04:47
  Speaker 4: Yeah.
• 1:04:47
  Speaker 10: And I think for context, you know, I say this often, right,
• 1:04:51
  Speaker 10: so so often, independent pharmacy community pharmacy could be the
• 1:04:54
  Speaker 10: canary and the coal mine. They're seeing the steering, they're
• 1:04:57
  Speaker 10: seeing the exploitation, they're seeing them. But you know, this
• 1:05:01
  Speaker 10: is a bill that targets This is a law now
• 1:05:03
  Speaker 10: that targets vertical integration.
• 1:05:04
  Speaker 4: Right.
• 1:05:04
  Speaker 10: This isn't a pharmacy bill, right, that's there's nothing directly
• 1:05:10
  Speaker 10: impacting non vertical integrated pharmacies.
• 1:05:13
  Speaker 6: Right.
• 1:05:13
  Speaker 10: This is this is a pro competition bill. This is
• 1:05:17
  Speaker 10: an anti monopoly bill, and this is something that really
• 1:05:19
  Speaker 10: at its core targets vertical integration. Todd, if you'll indulge
• 1:05:24
  Speaker 10: me on this, if you took that bill away this year, right,
• 1:05:28
  Speaker 10: if that bill didn't pass, if that bill wasn't introduced,
• 1:05:32
  Speaker 10: and you look at the other bills that were advocated
• 1:05:34
  Speaker 10: for in Arkansas, Arkansas still would have had one of
• 1:05:39
  Speaker 10: the strongest legislative years in the country for community pharmacy. John,
• 1:05:43
  Speaker 10: Would you mind talking just a little bit about some
• 1:05:45
  Speaker 10: of the other other work that you did the session.
• 1:05:48
  Speaker 9: Yeah, sure, So several things leading up to the session.
• 1:05:52
  Speaker 9: There was a rule that supports an existing law that
• 1:05:55
  Speaker 9: requires PBMs to show their homework on their payment methodology
• 1:06:00
  Speaker 9: to cover not only the drug but cost the dispense.
• 1:06:03
  Speaker 9: That's Rule one twenty eight. And then there's a prompt
• 1:06:07
  Speaker 9: Payment bill that requires and there is there was legislation
• 1:06:19
  Speaker 9: to clarify it and strengthen any willing provider laws in
• 1:06:23
  Speaker 9: Arkansas and access and to ensure that specialty drugs and
• 1:06:28
  Speaker 9: certain drugs that are covered by our PBM laws are
• 1:06:31
  Speaker 9: not forced arbitrarily and block an adequate network for patients.
• 1:06:38
  Speaker 9: And the Private Right of Action bill that Greg mentioned
• 1:06:41
  Speaker 9: a minute ago that provides a pathway in the courts
• 1:06:46
  Speaker 9: litigation more clearly for pharmacies that are negatively impacted from
• 1:06:52
  Speaker 9: law breakers.
• 1:06:54
  Speaker 10: Yeah, I mean you know that that obviously, it's like
• 1:06:57
  Speaker 10: a just a shorter expoard of policy. Goody see that
• 1:07:01
  Speaker 10: you worked on in PUSH which is amazing.
• 1:07:03
  Speaker 9: But yeah, new marks. Yeah, a network clarity and transparency
• 1:07:08
  Speaker 9: like North Dakota has where they have to disclose to
• 1:07:11
  Speaker 9: the p SAOs and the pharmacy on contracts which Ben
• 1:07:15
  Speaker 9: and groups are included. What type of plans are they?
• 1:07:18
  Speaker 9: Are they self funded? Are they federal or are they
• 1:07:20
  Speaker 9: medicare d make that more clear on the front end
• 1:07:24
  Speaker 9: prohibitions against opt out contracts without sixty days notice and
• 1:07:29
  Speaker 9: certified mail, I mean just a lot of little things
• 1:07:32
  Speaker 9: that will make practice from the business side easier. Did
• 1:07:38
  Speaker 9: not have as many this particular session scope related issues,
• 1:07:43
  Speaker 9: but we've had some advancements in that in recent years
• 1:07:46
  Speaker 9: as well, consistent with rest in the nation and also
• 1:07:50
  Speaker 9: payment for services. So you've got to got two baskets
• 1:07:52
  Speaker 9: here of business and then professional that we work on,
• 1:07:56
  Speaker 9: and this particular session was more business focused.
• 1:08:00
  Speaker 10: But yeah, here you are a post session. You're working
• 1:08:02
  Speaker 10: on you know, rural health and working with the state
• 1:08:05
  Speaker 10: and the federal government on that too.
• 1:08:06
  Speaker 9: So right for clinical practice and payment for their services.
• 1:08:09
  Speaker 1: Yes, excellent work, John, you know, bravo to you and
• 1:08:17
  Speaker 1: your team at the Arkansas Pharmacists Association and also how
• 1:08:20
  Speaker 1: you're tying into the national organizations and there's a lot
• 1:08:24
  Speaker 1: of nonpartisan support of what's happening. The only part, the
• 1:08:31
  Speaker 1: only organization that seems to be upset about this is
• 1:08:34
  Speaker 1: CBS Health And I read there January or June tenth
• 1:08:40
  Speaker 1: rebuttal about what Governor Sarah Huckabee Sanders had wrong. I
• 1:08:47
  Speaker 1: read through it, and it had nothing to do with
• 1:08:50
  Speaker 1: with what's best for patients. That had to do with
• 1:08:52
  Speaker 1: what's best for their business and the ability not associate
• 1:08:58
  Speaker 1: or do something with their pharmacies to bring them out
• 1:09:01
  Speaker 1: from under the umbrella. There's nothing. It's like reverse merge.
• 1:09:06
  Speaker 1: I mean they they they're gobbling up insurance companies and
• 1:09:10
  Speaker 1: practices and pharmacies. And so just turn it off for
• 1:09:14
  Speaker 1: the state of Arkansas and try and stop trying to
• 1:09:16
  Speaker 1: make it like it's it's detrimental to nothing more than
• 1:09:20
  Speaker 1: your business. It's not. It's not impact to healthcare. It's
• 1:09:24
  Speaker 1: it's giving people a choice, and it's in it's evening
• 1:09:28
  Speaker 1: the playing field. And and obviously they're the rebuttal was
• 1:09:34
  Speaker 1: was a was laughable.
• 1:09:38
  Speaker 9: And and what he's taught. What's Todd's talking about is
• 1:09:41
  Speaker 9: the governor's op ed to the New York Times, which
• 1:09:43
  Speaker 9: is pretty cool to see her. Yeah, it was awesome.
• 1:09:47
  Speaker 9: It was very well written and told story about a constituent,
• 1:09:51
  Speaker 9: a patient who was unable to fill her access her
• 1:09:54
  Speaker 9: breathing treatments, which resulted in delays and care harm, emergency
• 1:10:01
  Speaker 9: room visit and hospitalization because of the harm that this
• 1:10:05
  Speaker 9: vertical integration does. And the bill is really it is
• 1:10:09
  Speaker 9: not or the law. Now it was a bill, it
• 1:10:11
  Speaker 9: isn't law now it's yes, it will improve the market
• 1:10:15
  Speaker 9: and improve the ability because an independent or a small
• 1:10:19
  Speaker 9: pharmacy or Walmart or Lalgreens is never going to get
• 1:10:22
  Speaker 9: a fair contract if the person they're trying to sign
• 1:10:25
  Speaker 9: a contract with also owns pharmacies, never going to happen.
• 1:10:29
  Speaker 9: But more importantly than what it does for the market,
• 1:10:32
  Speaker 9: is about protecting public and patient health and safety, and
• 1:10:37
  Speaker 9: that for many many years, Gregg's the attorney here, that
• 1:10:42
  Speaker 9: is a state's rights to decide who is licensed and
• 1:10:46
  Speaker 9: how do we best protect health and safety. That is
• 1:10:49
  Speaker 9: not a federal government responsibility, or it has not been historically.
• 1:10:54
  Speaker 9: That has been left to the states to decide that.
• 1:10:56
  Speaker 9: So that's why part of the idea of why we
• 1:10:59
  Speaker 9: could in the state, and just from a nuanced thing,
• 1:11:03
  Speaker 9: it is not enforced at the insurance department. It is
• 1:11:06
  Speaker 9: about licensure of the pharmacy and through the state Board
• 1:11:10
  Speaker 9: of Pharmacy. And to John or you don't.
• 1:11:12
  Speaker 10: Yeah, And to John's point, licensing is squarely an area
• 1:11:17
  Speaker 10: within states, within states rights right. Historically, yes, there's a
• 1:11:21
  Speaker 10: massive precedent for.
• 1:11:22
  Speaker 9: That, and there is no carve out for Walmart. I
• 1:11:25
  Speaker 9: don't care what you read in the national news. That
• 1:11:27
  Speaker 9: is a lie that does not exist. There is no
• 1:11:30
  Speaker 9: carve out. Walmart does not own a PBM. They hire one,
• 1:11:35
  Speaker 9: like the rest of the employers do that are not
• 1:11:38
  Speaker 9: affiliated with PBMs. The case is not dead. The case
• 1:11:43
  Speaker 9: is simply in a phase right now where they're deciding
• 1:11:46
  Speaker 9: is the enforcement delayed and we see and listen and
• 1:11:51
  Speaker 9: hear the merits of the case. That's kind of where
• 1:11:54
  Speaker 9: it is right now at the AH Circuit and try
• 1:11:56
  Speaker 9: to decide does it go into effect January first, twenty
• 1:12:00
  Speaker 9: six or is the enforcement delayed until the courts can
• 1:12:03
  Speaker 9: hear the merits of the case? Yep, Greg, once you
• 1:12:06
  Speaker 9: add from the attorney.
• 1:12:07
  Speaker 10: So no, yeah, I think that's right.
• 1:12:09
  Speaker 2: Right.
• 1:12:09
  Speaker 10: There's nothing that's you know, nothing that's happened in this
• 1:12:12
  Speaker 10: case at this point that would that would give me
• 1:12:14
  Speaker 10: pause or make me, you know, feel uncomfortable.
• 1:12:17
  Speaker 6: Right.
• 1:12:17
  Speaker 10: I think it's gone the way one would largely expect
• 1:12:19
  Speaker 10: it to go. Don't want to get too much into
• 1:12:22
  Speaker 10: the legalities, right, but you know they're leaning One of
• 1:12:24
  Speaker 10: their core arguments is sort of this obscure dormant commerce
• 1:12:28
  Speaker 10: clause argument, essentially trying to argue that, hey, this this
• 1:12:32
  Speaker 10: favors in state versus out of state this is a
• 1:12:35
  Speaker 10: law that targets vertical integration and the anti competitive harms
• 1:12:39
  Speaker 10: that come from vertical integration.
• 1:12:40
  Speaker 9: So I think regardless regardless of where you're located.
• 1:12:43
  Speaker 10: Regardless of location, and it was.
• 1:12:46
  Speaker 9: Purposefully drafted not to do that.
• 1:12:49
  Speaker 10: It was yeah, yeah again. And I think that one
• 1:12:52
  Speaker 10: of the things we see is Arkansas has not blinked, right,
• 1:12:54
  Speaker 10: They have leaned into defending this just enthusiastically. And that's that's,
• 1:13:00
  Speaker 10: you know, a testament to them and their fortitude, because
• 1:13:02
  Speaker 10: a lot of states do blink, and they haven't. And
• 1:13:05
  Speaker 10: I think it's a testament to the you know, the
• 1:13:06
  Speaker 10: work of the association and John and the pharmacists in
• 1:13:10
  Speaker 10: that state. This is a little bit less technical. I
• 1:13:11
  Speaker 10: don't know if this is illegal analysis or not. But
• 1:13:14
  Speaker 10: when you hear John list off everything they've done this session,
• 1:13:18
  Speaker 10: you know, for the folks who are watching, you can
• 1:13:20
  Speaker 10: see this. For the folks who are listening, you can't.
• 1:13:21
  Speaker 10: You have to take my word for it. John doesn't
• 1:13:23
  Speaker 10: even look tired, does he Todd? He looks like like unbelievable,
• 1:13:29
  Speaker 10: all this right, prolific year, doesn't even doesn't even look
• 1:13:33
  Speaker 10: like he's lost lost any sleep. I don't know how
• 1:13:35
  Speaker 10: he doesn't.
• 1:13:36
  Speaker 9: I do think you have to go. I know, I'm
• 1:13:38
  Speaker 9: shouting out to the association again, but you do have
• 1:13:42
  Speaker 9: to be organized. We went up against the most money
• 1:13:46
  Speaker 9: ever spent in the history of our state trying to
• 1:13:49
  Speaker 9: kill a bill. I'm talking billboards, unlimited television commercials, digital
• 1:13:56
  Speaker 9: media strategy, emails the patient. It's automated emails and phone calls.
• 1:14:02
  Speaker 9: A call bank center where human beings are calling patients
• 1:14:07
  Speaker 9: and calling legislators. A truck with a billboard electronic billboard
• 1:14:12
  Speaker 9: driving around the capitol vote no on. I mean, this
• 1:14:16
  Speaker 9: is Washington, d c. Type of money spent in Arkansas,
• 1:14:19
  Speaker 9: little o Arkansas, one percent of the population to try
• 1:14:22
  Speaker 9: to kill this legislation. And in the federal court hearing
• 1:14:26
  Speaker 9: they admitted on record that this bill impacts and disrupts
• 1:14:32
  Speaker 9: billions and billions of dollars in revenue going to those
• 1:14:35
  Speaker 9: three PBM owned pharmacies on space. They didn't say specialty
• 1:14:39
  Speaker 9: and brand, but that's where a lot of the revenue
• 1:14:41
  Speaker 9: is coming from.
• 1:14:44
  Speaker 1: Incredible, incredible work. Well once again, congratulations on all the
• 1:14:52
  Speaker 1: work that you've done, John, and congratulations to the Arkansas
• 1:14:58
  Speaker 1: Pharmacists Association. And a shout out to Governor Sanders, Governor Huckabee,
• 1:15:05
  Speaker 1: Sarah Huckabee Sanders just for standing up once again for
• 1:15:10
  Speaker 1: people and for hardworking people that just want they just
• 1:15:16
  Speaker 1: want to be able to get their medications affordable and
• 1:15:19
  Speaker 1: act to it. And I hope that this spills over
• 1:15:23
  Speaker 1: to more state governors to really take a look at
• 1:15:25
  Speaker 1: this and really to dial in because it'll impact the
• 1:15:29
  Speaker 1: state's budget as well of where the money is going,
• 1:15:32
  Speaker 1: how it's being allocated, and how it's being used for,
• 1:15:35
  Speaker 1: especially rural health where you don't have access. You have
• 1:15:38
  Speaker 1: to drive ten twenty miles to get to a pharmacy
• 1:15:42
  Speaker 1: in some places because of the shutdown. They did it
• 1:15:45
  Speaker 1: to themselves. They closed down all of right A. They
• 1:15:49
  Speaker 1: started closing down Walgreens, They're closing down parts of CVS Health,
• 1:15:54
  Speaker 1: and it was like they ate their young. They did
• 1:15:57
  Speaker 1: it in the way that their model was.
• 1:16:00
  Speaker 9: And the law does impact both brick and mortar and
• 1:16:03
  Speaker 9: mail order to be clear, So there are six hundred
• 1:16:07
  Speaker 9: and fifty mail order licensed pharmacies in Arkansas. One hundred
• 1:16:11
  Speaker 9: of those roughly are PBM affiliated, So that means even
• 1:16:15
  Speaker 9: if all of them chose to be a middleman and
• 1:16:18
  Speaker 9: make more profit than delivering healthcare. If that's what they choose,
• 1:16:22
  Speaker 9: there would still be five hundred and fifty left and
• 1:16:27
  Speaker 9: it would strengthen and grow as more opportunity was there.
• 1:16:30
  Speaker 9: And then at the brick and mortar level, there are
• 1:16:32
  Speaker 9: about thirty six of seven hundred and forty brick and
• 1:16:36
  Speaker 9: mortar pharmacies that would be affected, none of them in
• 1:16:39
  Speaker 9: rural areas that are more than a mile or two
• 1:16:42
  Speaker 9: away from an independent or another chain. So all the
• 1:16:46
  Speaker 9: ads of two point seven million ar Kansas are going
• 1:16:49
  Speaker 9: to lose access of rural Arkansas is not true.
• 1:16:53
  Speaker 1: Yeah, yeah, the CVS all if that's what they're losing
• 1:16:57
  Speaker 1: access to unless they, like I said, just drop the
• 1:17:02
  Speaker 1: PBM part of it in the state of Arkansas and
• 1:17:05
  Speaker 1: move on with the pharmacy business. But they can't stand
• 1:17:08
  Speaker 1: toe to toe to independent pharmacy. So it's probably the
• 1:17:12
  Speaker 1: reason that they're upset about that portion of it because
• 1:17:16
  Speaker 1: once again, it's it's hard to compete with a organization,
• 1:17:20
  Speaker 1: a small business that's part of the community, that's grown
• 1:17:23
  Speaker 1: up in that community, that knows people you know in
• 1:17:27
  Speaker 1: person and has vested in the health of their community,
• 1:17:31
  Speaker 1: and that therein lies you know, how this combination became
• 1:17:36
  Speaker 1: more about once again about those profits had nothing to
• 1:17:38
  Speaker 1: do with healthcare.
• 1:17:40
  Speaker 9: And there are dozens of losses PBMs.
• 1:17:42
  Speaker 1: That don't own pharmacies exactly.
• 1:17:44
  Speaker 9: So there are you know, if they were if they
• 1:17:46
  Speaker 9: were to lose their PBM lossons or give it up
• 1:17:49
  Speaker 9: in Arkansas to be a pharmacy instead, they could certainly
• 1:17:53
  Speaker 9: do that, and businesses could choose to select one of
• 1:17:57
  Speaker 9: the other dozens of transparent on vertically integrated PBM. I
• 1:18:01
  Speaker 9: mean it's possible to do that. The market would improve
• 1:18:04
  Speaker 9: and patient care would improve if that happened.
• 1:18:07
  Speaker 1: Absolutely, John promised, you're going to come back and spend
• 1:18:12
  Speaker 1: some time with us, give us some updates later in
• 1:18:15
  Speaker 1: the year.
• 1:18:16
  Speaker 9: Yeah, this has been fun. Thanks for having me, Todd appreciate.
• 1:18:18
  Speaker 9: It's good to see you. Greg.
• 1:18:20
  Speaker 4: Yep.
• 1:18:20
  Speaker 10: Always a pleasure.
• 1:18:22
  Speaker 1: Greg, thank you so much for all your work. Thanks
• 1:18:25
  Speaker 1: for hosting the PBM Reform podcast, which you can hear
• 1:18:30
  Speaker 1: on the Pharmacy Podcast Network. And what's up next? You
• 1:18:34
  Speaker 1: want to drop us any any hints to who your who?
• 1:18:37
  Speaker 1: Your next special guest is going to be?
• 1:18:39
  Speaker 10: Yes, sir, Well, we've got we've got some big ones
• 1:18:41
  Speaker 10: coming up, so I'll just leave it at that and
• 1:18:43
  Speaker 10: I'm hopeful that we're gonna hopeful that we're gonna to
• 1:18:46
  Speaker 10: be able to get one of them. Are waiting on
• 1:18:48
  Speaker 10: some federal action, and I believe we're going to see
• 1:18:51
  Speaker 10: some federal action soon and that'll be one worth listening
• 1:18:53
  Speaker 10: to for sure.
• 1:18:55
  Speaker 1: All Right, gentlemen, thank you so much for being on
• 1:18:58
  Speaker 1: this Week in Pharmacy Listener. We will be right back
• 1:19:02
  Speaker 1: with more works. Hey everyone, it's Todd Uri with the
• 1:19:11
  Speaker 1: Pharmacy Podcast Network. I could not be more excited to
• 1:19:14
  Speaker 1: talk to you that we're going to be doing the
• 1:19:16
  Speaker 1: Surecast with sure Cost at the Insights User Conference on
• 1:19:21
  Speaker 1: November thirteenth and fourteenth. I'm going to be part of
• 1:19:24
  Speaker 1: this event. I cannot wait to meet with you, talk
• 1:19:27
  Speaker 1: with you, leverage data together, learn how to use data better.
• 1:19:32
  Speaker 1: And it's going to be an incredible opportunity to connect
• 1:19:35
  Speaker 1: with other pharmacy owners and innovators, colleagues who are all
• 1:19:38
  Speaker 1: working together for the same goal helping pharmacies thrive. And
• 1:19:42
  Speaker 1: what better way to capture those conversations than a live
• 1:19:46
  Speaker 1: event that's sure Cast And I can't wait to bring
• 1:19:49
  Speaker 1: this to you, sit down with so many of you.
• 1:19:51
  Speaker 1: This is going to be in Nashville. Don't forget on
• 1:19:54
  Speaker 1: November thirteenth through fourteenth, and there will be a lenk
• 1:19:58
  Speaker 1: to go to the registration and we'll see you there. Hey,
• 1:20:10
  Speaker 1: special feature on this week in Pharmacy. You know, if
• 1:20:14
  Speaker 1: you listen to the show, if you listen to anything
• 1:20:17
  Speaker 1: that I participate in, you know, audience, how excited I
• 1:20:22
  Speaker 1: get when I get to meet people in pharmacy, pharmacists
• 1:20:26
  Speaker 1: that are making a difference. When I think of history,
• 1:20:30
  Speaker 1: when I think of where pharmacy started, and we just
• 1:20:34
  Speaker 1: got done with through Pharmacy Month. This month it's about
• 1:20:38
  Speaker 1: different disease state management. I think it's diabetes month. But
• 1:20:41
  Speaker 1: when I get a chance to connect with people who
• 1:20:43
  Speaker 1: are generational pharmacists and people who are passionate about our profession.
• 1:20:50
  Speaker 1: And this individual is part of CEO big Alow, the
• 1:20:54
  Speaker 1: oldest apothecary in the entire United States. I want to
• 1:20:57
  Speaker 1: introduce Alec Ginsburg to twerks. Come on in too, twerks.
• 1:21:03
  Speaker 1: You don't have to twrks if you don't want to.
• 1:21:04
  Speaker 2: But thanks so much for having me Tom.
• 1:21:07
  Speaker 1: I'm really excited to be here, excited to have you all. Right,
• 1:21:11
  Speaker 1: what as a that's a big thing to say in
• 1:21:14
  Speaker 1: the country, the oldest apothecary. Tell me about your generational
• 1:21:20
  Speaker 1: You've been soaking in it since you can remember. You
• 1:21:22
  Speaker 1: probably don't remember.
• 1:21:22
  Speaker 2: Yeah, yeah, exactly, So you know, Seal Biglow. We say
• 1:21:27
  Speaker 2: we're the oldest apothecary in the United States, And I'll
• 1:21:29
  Speaker 2: clarify it doesn't mean we were the first one ever founded,
• 1:21:33
  Speaker 2: but we are, as far as we know, the oldest
• 1:21:35
  Speaker 2: that is still continuously operating. So we were founded in
• 1:21:39
  Speaker 2: eighteen thirty eight in downtown New York City. We're located
• 1:21:43
  Speaker 2: in the West Village for those locals on sixth Avenue
• 1:21:46
  Speaker 2: and eighth Street. Founded in eighteen thirty eight. Actually we
• 1:21:50
  Speaker 2: were called the Village Apothecary Shop by a doctor named
• 1:21:53
  Speaker 2: Galen Hunter, and through the years the pharmacy was passed
• 1:21:57
  Speaker 2: down to kind of different employees. Late eighteen hundred's, a
• 1:22:02
  Speaker 2: pharmacist named Clarence Otis Bigelow took it over. He built
• 1:22:06
  Speaker 2: a new building for the pharmacy literally right next door,
• 1:22:09
  Speaker 2: so same block and everything, but just a brand new building.
• 1:22:12
  Speaker 2: In nineteen oh two, renamed the store after himself, COEO. Bigelow,
• 1:22:17
  Speaker 2: And he was kind of like a master Marketer. So
• 1:22:21
  Speaker 2: if you think back to what medicine was, like, you know,
• 1:22:25
  Speaker 2: one hundred years ago, even it was there wasn't the
• 1:22:28
  Speaker 2: modern commercial medications. Like you couldn't go to a doctor
• 1:22:31
  Speaker 2: and have him write you a prescription for lipatour and
• 1:22:34
  Speaker 2: go to the pharmacy. You know, that's where the term
• 1:22:36
  Speaker 2: apothecary comes from. You would go to the pharmacy or
• 1:22:39
  Speaker 2: the apothecary and that they would have you know, everybody
• 1:22:42
  Speaker 2: who worked there would have their individual recipes like you
• 1:22:45
  Speaker 2: can see on the screen there, and they would mix
• 1:22:47
  Speaker 2: them up for you and you'd go home and you'd
• 1:22:49
  Speaker 2: kind of hope that you picked the right guy to
• 1:22:52
  Speaker 2: make the thing that he thought was going to work
• 1:22:54
  Speaker 2: for you. So what Clarence Bigelow was really brilliant at
• 1:22:58
  Speaker 2: is instead of like other pharmacy apothecary kind of just
• 1:23:02
  Speaker 2: giving it to you in like a plane jar, he said,
• 1:23:05
  Speaker 2: we're gonna wrap everything up like a gift. We're gonna
• 1:23:08
  Speaker 2: make it beautiful. And that's where his kind of marketing
• 1:23:11
  Speaker 2: mind came for. And if you imagine somewhere like you know,
• 1:23:14
  Speaker 2: New York City, you take you know, takes you three
• 1:23:17
  Speaker 2: hours to get from uptown to downtown and like a
• 1:23:20
  Speaker 2: horse and buggy, you wait in the pharmacy for four
• 1:23:22
  Speaker 2: hours after showing like your itchy skin and hoping that
• 1:23:25
  Speaker 2: the guy is gonna mix something up for you. And
• 1:23:28
  Speaker 2: then you get home and of course it's not gonna
• 1:23:30
  Speaker 2: work immediately, but like you could spend your whole day
• 1:23:34
  Speaker 2: waiting to get this thing that you thought was gonna
• 1:23:37
  Speaker 2: cure you. So he realized if you wrapped it up
• 1:23:39
  Speaker 2: like a gift and made it beautiful, like that placebo
• 1:23:43
  Speaker 2: effect almost you know, I hate to use that term
• 1:23:45
  Speaker 2: as a pharmacist, because of course we were making things
• 1:23:47
  Speaker 2: that were real, but you know, you kind of tricked
• 1:23:49
  Speaker 2: the patient into believing that this was gonna work much
• 1:23:52
  Speaker 2: better than anywhere around you. So that's kind of where
• 1:23:55
  Speaker 2: CEO Bigelow got its its name and its reputation from.
• 1:23:59
  Speaker 2: And of course we, you know, were famous for treating
• 1:24:01
  Speaker 2: like Thomas Edison lived around the corner and he ran
• 1:24:04
  Speaker 2: here to get a sad when he burned his finger
• 1:24:07
  Speaker 2: in you know, venting the light bulb. Eleanor Roosevelt, Lou Reed,
• 1:24:12
  Speaker 2: David Bowie, tons of you know, major names. But in
• 1:24:16
  Speaker 2: the nineteen thirties, during the Great Depression, the store kind
• 1:24:19
  Speaker 2: of became run down, and my great grandfather came over
• 1:24:23
  Speaker 2: from Poland to escape the war. He studied His name
• 1:24:26
  Speaker 2: was William Ginsburg. He studied by candlelight to go to
• 1:24:28
  Speaker 2: Columbia University pharmacy school, and he wound up buying the
• 1:24:32
  Speaker 2: store in nineteen thirty nine and just sort of kept
• 1:24:36
  Speaker 2: it going as he was a you know, a very
• 1:24:39
  Speaker 2: ethical Eastern European pharmacist who wanted to make prescriptions and
• 1:24:43
  Speaker 2: do good in the community, and he just kind of
• 1:24:44
  Speaker 2: kept the name going until my grandfather came into the business,
• 1:24:48
  Speaker 2: and then my father eventually in the eighties, and I
• 1:24:51
  Speaker 2: joined full time in twenty sixteen. But of course we
• 1:24:55
  Speaker 2: all grown up working in the store, as you know.
• 1:24:59
  Speaker 2: When I I was seven years old, I was wrapping
• 1:25:01
  Speaker 2: gifts at Christmas time. I've been the delivery guy. I've
• 1:25:04
  Speaker 2: worked as a cashier. I had been a staff pharmacist
• 1:25:08
  Speaker 2: for a couple of years right when I graduated. And
• 1:25:10
  Speaker 2: now I'm sort of running the store and the operations
• 1:25:14
  Speaker 2: of the store, the pharmacy and I don't know if
• 1:25:16
  Speaker 2: we'll get into this today, but we do have a
• 1:25:18
  Speaker 2: large cosmetic business based on all those formulas that I
• 1:25:22
  Speaker 2: had just mentioned. You know, we have, as you saw
• 1:25:24
  Speaker 2: on the website, the archives, the history books, those those
• 1:25:27
  Speaker 2: formulas that doctors used to make, and our product line
• 1:25:30
  Speaker 2: we've created is based on all those original formulas that
• 1:25:34
  Speaker 2: are just as good today as they were two hundred
• 1:25:37
  Speaker 2: years ago. You know, just because we have all these
• 1:25:40
  Speaker 2: modern products in modern medicine, it doesn't mean that rose
• 1:25:43
  Speaker 2: sav is not as good as it was in you know,
• 1:25:45
  Speaker 2: eighteen fifty.
• 1:25:47
  Speaker 1: Yeah, well, I didn't know this was going to turn
• 1:25:50
  Speaker 1: into a marketing and business development episode, but it's kind
• 1:25:54
  Speaker 1: of a gem. And I want to say this, so
• 1:25:57
  Speaker 1: there's been a massive, massive face It's been percolating for
• 1:26:01
  Speaker 1: about ten years, but more so in the last two years,
• 1:26:06
  Speaker 1: and that is to get away from your primary source
• 1:26:10
  Speaker 1: of revenue having to be captured by a PBM or
• 1:26:14
  Speaker 1: captured by an insurance that if you could do something
• 1:26:17
  Speaker 1: else in pharmacy that you know is beneficial to the public,
• 1:26:22
  Speaker 1: but doing it in a way that attracts the public
• 1:26:25
  Speaker 1: to feeling like this is a better quality product because
• 1:26:29
  Speaker 1: it's backed by a clinical pharmacist. And you start to
• 1:26:33
  Speaker 1: dial into that this website, everybody just listening if you're listening,
• 1:26:37
  Speaker 1: if you're driving in a car, jogging, you know us
• 1:26:40
  Speaker 1: we're going to have it in the show notes. But
• 1:26:42
  Speaker 1: it's bigelowchemist dot com. Even the name ALEC gives me
• 1:26:48
  Speaker 1: a sense of quality as a consumer. I'm not a clinician,
• 1:26:51
  Speaker 1: I'm not a pharmacist. I'm not even a pharmacy technician.
• 1:26:54
  Speaker 1: But I've been documenting our profession for twenty years and
• 1:26:58
  Speaker 1: dialing into what works, what brings in the client, what
• 1:27:02
  Speaker 1: brings in the customer the patient to start trusting. And
• 1:27:06
  Speaker 1: the pharmacist is the number one trusted provider in healthcare,
• 1:27:11
  Speaker 1: seeing their patients nine times, if not twelve times more
• 1:27:15
  Speaker 1: than primary care. It gets them. It gives you so
• 1:27:17
  Speaker 1: much access to people, and people are emotional, people are
• 1:27:23
  Speaker 1: could be taken advantage of. So I'm if I'm dialing
• 1:27:26
  Speaker 1: into a woman's skin and she has ezema or she
• 1:27:30
  Speaker 1: has a sensitive skin because the winter. I know, during
• 1:27:33
  Speaker 1: the winter months we use heat in our house that's electric,
• 1:27:37
  Speaker 1: it drives our skin out. If I went to the
• 1:27:39
  Speaker 1: pharmacy and I saw this gorgeous setting of products, you know,
• 1:27:44
  Speaker 1: against the end cap, and I got to walk in
• 1:27:46
  Speaker 1: and all of a sudden, someone approaches me and they're like, hey,
• 1:27:49
  Speaker 1: do you have any questions on you know, our skincare line.
• 1:27:52
  Speaker 1: Oh my gosh, Like that's a boutique. It's it's taking
• 1:27:56
  Speaker 1: pharmacy and it's bringing it back to what it was,
• 1:27:58
  Speaker 1: but then it's wrapping it in professionalism.
• 1:28:01
  Speaker 2: And that's sort of one of the questions that I
• 1:28:04
  Speaker 2: get more than anything, is what actually is an apothecary
• 1:28:08
  Speaker 2: because I think, you know what I just described to you,
• 1:28:12
  Speaker 2: going to a pharmacy one hundred years ago and sort
• 1:28:14
  Speaker 2: of like having a bespoke product made for you. That's
• 1:28:17
  Speaker 2: what an apothecary was in the truest sense before modern
• 1:28:20
  Speaker 2: medicine was created about you know, sixty years ago with
• 1:28:23
  Speaker 2: the invention of penicillin. But I think today what I
• 1:28:27
  Speaker 2: tell people is an apothecary means you're getting bespoke treatment,
• 1:28:32
  Speaker 2: and that could mean that we're making a specific product
• 1:28:34
  Speaker 2: for you, but it also could mean that the pharmacist
• 1:28:36
  Speaker 2: comes out from behind the counter and really teaches you about,
• 1:28:41
  Speaker 2: you know, the medicinal properties of the certain products that
• 1:28:44
  Speaker 2: you have. It's that's the difference between the chain pharmacies,
• 1:28:48
  Speaker 2: you know, the CVS is and a place like Bigelow
• 1:28:50
  Speaker 2: or any neighborhood pharmacy across the country. I think that's
• 1:28:53
  Speaker 2: what the spirit of an apothecary is. And again I
• 1:28:57
  Speaker 2: try not to like knock the chain pharmacies, but I
• 1:29:00
  Speaker 2: think the easiest, the nicest way that I can put
• 1:29:02
  Speaker 2: it is, if you go to a CVS, it's no
• 1:29:04
  Speaker 2: secret that there's probably going to be one pharmacist who
• 1:29:07
  Speaker 2: feels extremely overwork just checking their prescriptions. Bigelows we do
• 1:29:12
  Speaker 2: about five hundred prescriptions a day, and we do that
• 1:29:15
  Speaker 2: with three full time staff pharmacists, not including myself, my father,
• 1:29:21
  Speaker 2: and Bruce Shreiber, who's the manager of our pharmacy and
• 1:29:24
  Speaker 2: on the floor every day. So our philosophy is every
• 1:29:27
  Speaker 2: single person who comes into the store with a question
• 1:29:30
  Speaker 2: for a pharmacist should be able to have as much
• 1:29:33
  Speaker 2: undivided attention time with that person as possible. And I
• 1:29:37
  Speaker 2: think that's the spirit, that's the true spirit of the
• 1:29:39
  Speaker 2: apothecarry Our pharmacists don't run out to answer a question
• 1:29:44
  Speaker 2: and be like I have to get back and answer
• 1:29:45
  Speaker 2: the phone and check a script. If there's somebody there
• 1:29:48
  Speaker 2: who needs to spend an hour talking about their gut,
• 1:29:51
  Speaker 2: health or their skin. Our pharmacists have time to do
• 1:29:54
  Speaker 2: that as well as our technicians. It goes on to
• 1:29:57
  Speaker 2: them as well. Where we have most pharmacies have technicians
• 1:30:01
  Speaker 2: who also serve as like the cashiers and the customer
• 1:30:03
  Speaker 2: service people, we separate those roles completely. I have five
• 1:30:07
  Speaker 2: full time technicians who are strictly technicians. They are the
• 1:30:11
  Speaker 2: experts in insurance and just like with the pharmacists and
• 1:30:14
  Speaker 2: the apothecary idea of bespoke treatment, those technicians are specifically
• 1:30:20
  Speaker 2: like if you have insurance questions, you know they can
• 1:30:23
  Speaker 2: spend as much time as you need explaining things. I
• 1:30:26
  Speaker 2: always say to them, teach we're as pharmacists we know
• 1:30:30
  Speaker 2: at this point unfortunately because of the nature of the business,
• 1:30:33
  Speaker 2: we're never going to be able to solve every problem.
• 1:30:35
  Speaker 2: We're not going to magically be able to make your
• 1:30:37
  Speaker 2: copaid disappear, your deductible lower. But if we can teach
• 1:30:41
  Speaker 2: you something, explain to you why things are the way
• 1:30:46
  Speaker 2: they are, then you at least feel trust. It builds
• 1:30:50
  Speaker 2: that trust that you were talking about in that personal connection,
• 1:30:52
  Speaker 2: which is incredibly, incredibly important in a store that is
• 1:30:56
  Speaker 2: supposed to anchor the neighborhood, which is what a pharmacy
• 1:30:58
  Speaker 2: should be doing. And yeah, that's the philosophy of Bigelow.
• 1:31:04
  Speaker 2: You also you touched on something before that I wanted
• 1:31:07
  Speaker 2: to follow up on, which is, unfortunately I know a
• 1:31:11
  Speaker 2: lot of most of the people who listen to this,
• 1:31:12
  Speaker 2: I assume are pharmacy owners or pharmacists who are trying
• 1:31:15
  Speaker 2: to get to the business of pharmacy. It's no secret
• 1:31:18
  Speaker 2: to any of us at this point that you cannot
• 1:31:20
  Speaker 2: survive just filling prescriptions. It's just not possible. Now, maybe
• 1:31:25
  Speaker 2: there are some pharmacies now we are trying to do
• 1:31:27
  Speaker 2: that without playing with the PBMs, you know, the cost
• 1:31:31
  Speaker 2: plus route and the cash only pharmacies, which certainly is promising,
• 1:31:34
  Speaker 2: and I've spoken to some of the owners doing that,
• 1:31:36
  Speaker 2: but in general, if you want to fill prescriptions with
• 1:31:38
  Speaker 2: people using insurance, you cannot survive as a pharmacy doing
• 1:31:43
  Speaker 2: only that. You have to come up with some source
• 1:31:45
  Speaker 2: of revenue, whether it's services, whether it's a membership or
• 1:31:49
  Speaker 2: like I'm doing here, products our own or other products.
• 1:31:53
  Speaker 2: And I think we're a great representation of a pharmacy
• 1:31:59
  Speaker 2: who's dipping their toes into a million different ways to
• 1:32:02
  Speaker 2: figure it out. And I just as you're fascinated by
• 1:32:05
  Speaker 2: talking to multiple pharms as I love talking to other
• 1:32:07
  Speaker 2: pharmacy owners as well and figuring out what they have
• 1:32:10
  Speaker 2: done to squeeze that little bit of revenue out that
• 1:32:14
  Speaker 2: they're not getting anymore from just code base.
• 1:32:17
  Speaker 1: Yeah, I love it, Alec. So we're going to shift
• 1:32:20
  Speaker 1: gears and get into something called the drug store Cowboy,
• 1:32:25
  Speaker 1: which is fascinating to me and it's a whole advocacy
• 1:32:28
  Speaker 1: and mission. It's part of your life. But before I
• 1:32:31
  Speaker 1: shift that gear, I want to go back to the
• 1:32:34
  Speaker 1: clinical side and the ability to make money rather than
• 1:32:38
  Speaker 1: it having to be a dispensing fee. We have a
• 1:32:42
  Speaker 1: partner and a client called IPC Independent Pharmacy Cooperative that
• 1:32:46
  Speaker 1: has a platform called i care Plus. It's a digital
• 1:32:49
  Speaker 1: platform that acts as an EHR, communicates with multiple other
• 1:32:53
  Speaker 1: providers and really collects the information and then gets the
• 1:32:56
  Speaker 1: pharmacy paid for. In your opinion, where do you see
• 1:33:01
  Speaker 1: the value the role of the pharmacist going, Because it's
• 1:33:05
  Speaker 1: not about dispensing anymore. We're getting so close to a
• 1:33:08
  Speaker 1: point in the time and history. I'm going to see it,
• 1:33:10
  Speaker 1: You're going to see it. I know it's going to
• 1:33:12
  Speaker 1: be in our lifetime that dispensing is going to be
• 1:33:16
  Speaker 1: not even really probably part of the intricacy and the
• 1:33:20
  Speaker 1: intelligence of what a pharmacist starts to dial into pediatrics
• 1:33:24
  Speaker 1: or a rare disease or blood disorder or something. So
• 1:33:28
  Speaker 1: talk to us a little bit about that.
• 1:33:29
  Speaker 2: Yeah, I think pharmacists, of course, you know I'm biased
• 1:33:33
  Speaker 2: because I am one, but I think we're the most
• 1:33:36
  Speaker 2: underutilized licensed profession in America. I think, you know, we
• 1:33:42
  Speaker 2: people are always shocked to find out that I have
• 1:33:44
  Speaker 2: a doctorate degree and I spent four years to become
• 1:33:47
  Speaker 2: a pharmacist because to ninety percent of Americans, like when
• 1:33:50
  Speaker 2: they think pharmacists, they think the guy in the white
• 1:33:53
  Speaker 2: cope at CBS, you know, who unfortunately has to count
• 1:33:56
  Speaker 2: pills himself a lot because he doesn't have the help
• 1:33:59
  Speaker 2: that he needs. And I think you see in times
• 1:34:04
  Speaker 2: of need when we're activated as a profession. So like
• 1:34:08
  Speaker 2: the easiest example is during COVID when we need it
• 1:34:11
  Speaker 2: to all of a sudden vaccinate you know, millions of people,
• 1:34:15
  Speaker 2: and you knew that doctors weren't going to be able
• 1:34:16
  Speaker 2: to do it immediately. They were just like pharmacists are
• 1:34:19
  Speaker 2: trained to do that, and we were activated and that's
• 1:34:22
  Speaker 2: how the country got vaccinated. There are plenty of other
• 1:34:26
  Speaker 2: situations like that that for whatever reason, whether it's politics
• 1:34:30
  Speaker 2: or you know, pride, they just won't allow pharmacists nationwide
• 1:34:35
  Speaker 2: to do I mean, I still find it ridiculous that,
• 1:34:38
  Speaker 2: like every day I have patients in my pharmacy who
• 1:34:42
  Speaker 2: are out of refills on medications that they've been taking
• 1:34:45
  Speaker 2: the same dose of for ten years, and I cannot
• 1:34:48
  Speaker 2: just with my authority as a pharmacist, be like, yes,
• 1:34:51
  Speaker 2: I can refill this, rather than playing phone tag with
• 1:34:54
  Speaker 2: the doctor's office. I think that's a big part of it.
• 1:34:57
  Speaker 2: And then there are you know, certain states allow pharmacists
• 1:35:01
  Speaker 2: to have clinical judgment and manage to these states. So
• 1:35:05
  Speaker 2: like there's I know in North Carolina where I went
• 1:35:07
  Speaker 2: to school, like if you do a certain number of
• 1:35:09
  Speaker 2: hours of diabetes training, then you can, you know, help
• 1:35:13
  Speaker 2: patients manage those things. Birth Control is another one where
• 1:35:17
  Speaker 2: like there's no reason a pharmacists shouldn't be able to
• 1:35:20
  Speaker 2: use some regular testing to be able to help patients
• 1:35:23
  Speaker 2: pick which is the correct contraceptive for them. There's plenty
• 1:35:28
  Speaker 2: of ways for pharmacists to fill in gaps in the
• 1:35:32
  Speaker 2: healthcare system, and I think, little by little, we're getting
• 1:35:36
  Speaker 2: to this breaking point where the costs are becoming so
• 1:35:39
  Speaker 2: high that eventually we're going to have no choice but
• 1:35:42
  Speaker 2: to allow pharmacists to do these things. And the real
• 1:35:45
  Speaker 2: question for the pharmacy owners is when that happens, are
• 1:35:48
  Speaker 2: you all of a sudden going to be scrambling to
• 1:35:50
  Speaker 2: figure out how to capitalize on it? Or are you
• 1:35:53
  Speaker 2: going to be are you already thinking about it now
• 1:35:56
  Speaker 2: and figuring out how to set yourself up. You know,
• 1:35:59
  Speaker 2: with the compounding boom that just happened, you saw how
• 1:36:03
  Speaker 2: quickly the winners were sort of determined the second there
• 1:36:08
  Speaker 2: was this space allowed for it. All of a sudden,
• 1:36:11
  Speaker 2: you know, there were five or six winners, and everybody
• 1:36:14
  Speaker 2: else's kind of left trying to figure out what the
• 1:36:17
  Speaker 2: next thing is going to be. I always try to
• 1:36:18
  Speaker 2: advise these other pharmacy owners I talked to, like, when
• 1:36:21
  Speaker 2: the clinical service things happened happens, we're not going to
• 1:36:24
  Speaker 2: get three years of warning for you to prepare for it.
• 1:36:27
  Speaker 2: All of a sudden, that switch is going to be
• 1:36:29
  Speaker 2: turned on and either you're going to be the winner
• 1:36:30
  Speaker 2: or somebody else's make sure that you're thinking about this.
• 1:36:34
  Speaker 1: In advance absolutely. Just we just welcomed the Alliance for
• 1:36:39
  Speaker 1: Pharmacy Compounding, which is our leading association the United States
• 1:36:43
  Speaker 1: to assure the validity, the accuracy and the excellence of
• 1:36:48
  Speaker 1: pharmacy compounders. Very proud to have them on the network.
• 1:36:52
  Speaker 1: And I'm proud to hear that you guys are into compounding.
• 1:36:55
  Speaker 1: Are you doing stero or non sterile or a combination.
• 1:36:58
  Speaker 2: So we it's complicated for us because where a landmarked
• 1:37:04
  Speaker 2: business and a landmark building in New York City, which
• 1:37:06
  Speaker 2: means that the New York City government has deemed us
• 1:37:09
  Speaker 2: historically significant and the building itself historically significant. We are
• 1:37:13
  Speaker 2: not allowed to adjust anything. If you come to Bigelow
• 1:37:16
  Speaker 2: and I think you probably saw on the website like
• 1:37:18
  Speaker 2: it looks like it did one hundred years ago, which
• 1:37:20
  Speaker 2: is something that's super cool about it. But unfortunately a
• 1:37:24
  Speaker 2: couple of years ago when USP standards changed and in
• 1:37:27
  Speaker 2: order to do certain compounding you had to meet USP
• 1:37:30
  Speaker 2: eight hundred and have like a sterile compounding hood. Because
• 1:37:34
  Speaker 2: we can't adjust our building, we can't do that anymore.
• 1:37:37
  Speaker 2: So we used to do a lot of hormones and
• 1:37:38
  Speaker 2: things like that, but now we basically do a lot
• 1:37:42
  Speaker 2: of the hemorrhoid creams you know, niphetopine del tizem, and
• 1:37:45
  Speaker 2: we do a lot of low dose neltres owne capsules,
• 1:37:49
  Speaker 2: but we cannot do any sterile compounding anymore. Unfortunately, I
• 1:37:54
  Speaker 2: have you know, we can transition through this comment to
• 1:37:58
  Speaker 2: Drugstore Cowboy. I've been pretty local about the whole compounding world,
• 1:38:04
  Speaker 2: and I see lots of I don't know if you
• 1:38:06
  Speaker 2: had Scott run or the CEO of the compounding organization
• 1:38:09
  Speaker 2: on here, but I see him posting on LinkedIn all
• 1:38:12
  Speaker 2: the time about it. And I have mixed feelings about
• 1:38:14
  Speaker 2: compounding because, on the one hand, I think, just like
• 1:38:18
  Speaker 2: I said, pharmacists are capable of way more than we're doing.
• 1:38:21
  Speaker 2: Like I fully believe that myself and all the people
• 1:38:24
  Speaker 2: who have trained as pharmacists are capable of making safe medications,
• 1:38:28
  Speaker 2: and that's another example of filling in the gaps when
• 1:38:31
  Speaker 2: there's a shortage who do reactivate reactivate the pharmacists. On
• 1:38:34
  Speaker 2: the other hand, and I've talked about this in Drugstore Cowboy,
• 1:38:39
  Speaker 2: I am all about the advancement of medicine as a whole,
• 1:38:42
  Speaker 2: and unfortunately, the way that our healthcare system is set
• 1:38:46
  Speaker 2: up pharm milk. Companies need to make money with the
• 1:38:51
  Speaker 2: drug patents and the drugs they invent in order to
• 1:38:55
  Speaker 2: invest more into research and development. And part of me
• 1:38:58
  Speaker 2: worries that were about to eradicate the entire drug patent system,
• 1:39:03
  Speaker 2: and I don't know where the advancement of medicine is
• 1:39:08
  Speaker 2: going to come from at that point. And not that
• 1:39:10
  Speaker 2: i'd be answer sending these questions, but these are just
• 1:39:12
  Speaker 2: things that I think about out loud on my newsletter
• 1:39:15
  Speaker 2: Drugstore Cowboy, that we can discuss a little bit about.
• 1:39:19
  Speaker 1: Well, let's get to that. I was really fascinated by
• 1:39:22
  Speaker 1: the newsletter. I'd like to encourage all of our listeners
• 1:39:26
  Speaker 1: to take a look. Just go to Drugstorecowboy dot com.
• 1:39:30
  Speaker 1: Once again, that's drug Store Cowboy dot com. It'll be
• 1:39:34
  Speaker 1: there'll be a link in the show notes to take
• 1:39:35
  Speaker 1: you here. Talk to us about this newsletter and your
• 1:39:39
  Speaker 1: dedication to this, because this can become I mean, you're
• 1:39:42
  Speaker 1: talking to a guy that had a full time job
• 1:39:45
  Speaker 1: for the first ten years of running a podcast network,
• 1:39:48
  Speaker 1: and then I had to come home and put a
• 1:39:50
  Speaker 1: bunch of podcasts together by myself before we went before.
• 1:39:54
  Speaker 1: I guess we're at the one in the big leagues now.
• 1:39:56
  Speaker 2: But yeah, so you know what it's like to have
• 1:39:59
  Speaker 2: a weekly and more than weekly homework assignment for yourself
• 1:40:03
  Speaker 2: that you created out of thin air. So drugstore cowboy. Yeah,
• 1:40:07
  Speaker 2: So for the past, I would say, let's start with
• 1:40:12
  Speaker 2: about a year ago. I, just like many of the
• 1:40:15
  Speaker 2: pharmacyst I'm sure you speak to, had felt about as
• 1:40:18
  Speaker 2: beaten down as I ever had by the PBM life
• 1:40:23
  Speaker 2: and fighting with them on audits and reimbursements. And this
• 1:40:27
  Speaker 2: was during the rise of GLP ones, you know, the
• 1:40:32
  Speaker 2: real takeoff of them. And I'm in the West Village
• 1:40:35
  Speaker 2: of New York City. This is you know, where Sex
• 1:40:37
  Speaker 2: and the City was based. My customers are a less
• 1:40:40
  Speaker 2: celebrities and wealthy people, so I probably feel more GLPS
• 1:40:45
  Speaker 2: than ninety percent of the pharmacies in America. And we
• 1:40:48
  Speaker 2: were just hemorrhaging money. And I was really feeling beaten down.
• 1:40:52
  Speaker 2: And then I listened to a podcast with Mark Cuban
• 1:40:57
  Speaker 2: and he he just he said exdrealmly, extremely confidently that
• 1:41:02
  Speaker 2: he fully believes that we will rebuild the system in
• 1:41:05
  Speaker 2: our lifetime in a way that's favorable to patients and pharmacies.
• 1:41:09
  Speaker 2: And it just got me. It like reignited something in me,
• 1:41:13
  Speaker 2: and I sort of was like, I need to figure
• 1:41:15
  Speaker 2: out a way to make a difference here. I'm not
• 1:41:18
  Speaker 2: going to start my own drug company like he did.
• 1:41:21
  Speaker 2: But I said to myself, I do have a platform.
• 1:41:24
  Speaker 2: You know, I have this qualifier that I run the
• 1:41:26
  Speaker 2: oldest pharmacy in America and the biggest city in America,
• 1:41:31
  Speaker 2: and that I had a great pharmacy education. So I
• 1:41:34
  Speaker 2: spent the next few months kind of figuring out what
• 1:41:38
  Speaker 2: I wanted to do with that. And one of the
• 1:41:39
  Speaker 2: things that stood out to me is that I believe
• 1:41:42
  Speaker 2: Bigelows has one of the brightest and most successful customer
• 1:41:47
  Speaker 2: bases of any pharmacy in America, just based on where
• 1:41:52
  Speaker 2: we are. We take care of all, you know, the
• 1:41:53
  Speaker 2: Wall Street people, all the writers for the New York
• 1:41:57
  Speaker 2: Times and the magazine editors, and a common theme to
• 1:42:00
  Speaker 2: me is that as smart and successful as these people are,
• 1:42:03
  Speaker 2: none of them understand anything about their health care whatsoever,
• 1:42:06
  Speaker 2: Like I would have to explain things as basic as
• 1:42:08
  Speaker 2: what a cope and a prior authorization is and why
• 1:42:11
  Speaker 2: I don't come up with the price that you have
• 1:42:13
  Speaker 2: to pay. And I was just like, if these people
• 1:42:17
  Speaker 2: don't understand what their healthcare is, then how does anybody
• 1:42:21
  Speaker 2: in America? And we live in the most politically active
• 1:42:26
  Speaker 2: time that I can remember in my life. Right now,
• 1:42:29
  Speaker 2: we're in history and people care are angrier at healthcare
• 1:42:33
  Speaker 2: than they ever have been. They care a ton about it.
• 1:42:36
  Speaker 2: Look how many shows there were about the opioid epidemic,
• 1:42:39
  Speaker 2: and you know, people protesting about Medicare and Obamacare and everything.
• 1:42:45
  Speaker 2: And I was like, so the interest is there, But
• 1:42:50
  Speaker 2: if we want anything to change, then people really need
• 1:42:54
  Speaker 2: to understand how everything works and what actually is going
• 1:42:58
  Speaker 2: on behind the scenes. And I didn't think that anybody
• 1:43:01
  Speaker 2: was explaining that to the common man. I think there's
• 1:43:04
  Speaker 2: fantastic journalism made for people like you and me who
• 1:43:08
  Speaker 2: live and breathe this stuff every day in pharmacy owners.
• 1:43:11
  Speaker 2: But we're just a small group of people. If you
• 1:43:12
  Speaker 2: want anything to really change politically in this country with policy,
• 1:43:16
  Speaker 2: you need the masses involved and you need them to
• 1:43:18
  Speaker 2: get what's going on. So I said, I want to
• 1:43:20
  Speaker 2: fill in that gap, almost like pharma for dummies. You know,
• 1:43:25
  Speaker 2: I hate saying that because I don't want to make
• 1:43:28
  Speaker 2: it seem like it's not for smart people. But like
• 1:43:30
  Speaker 2: I was like, if in five minutes a week, I
• 1:43:33
  Speaker 2: could teach all these people little bits and pieces of
• 1:43:38
  Speaker 2: what even a PBM is. I mean, how many people
• 1:43:40
  Speaker 2: in your life have no idea what a PBM is.
• 1:43:43
  Speaker 2: Arguably they're the companies that are affecting Americans more than
• 1:43:46
  Speaker 2: anyone else in the world. And I just said to myself,
• 1:43:50
  Speaker 2: all right, every day I'm already doing this. I'm explaining
• 1:43:54
  Speaker 2: to smart people in simpler terms, what you know a
• 1:43:58
  Speaker 2: coope is how it was determined what a PBM is.
• 1:44:01
  Speaker 2: And I just said, why don't I try to take
• 1:44:03
  Speaker 2: that and put it into a newsletter format and expand
• 1:44:08
  Speaker 2: my reach and you know, you'll see, my newsletter is free.
• 1:44:11
  Speaker 2: I asked for your email address just because I wanted
• 1:44:13
  Speaker 2: to go to your inbox. But I don't charge for it.
• 1:44:16
  Speaker 2: I don't plan on charging for it. I don't plan
• 1:44:18
  Speaker 2: on monetizing it. It's just about I actually think, like
• 1:44:22
  Speaker 2: Mark Cuban said, we have a chance to change these
• 1:44:25
  Speaker 2: things that I'm very passionate about in our lifetimes here.
• 1:44:30
  Speaker 2: But the only way to do that is to make
• 1:44:31
  Speaker 2: sure that people really get what's going on. And I'm
• 1:44:35
  Speaker 2: trying to do my part. So I tried to make
• 1:44:39
  Speaker 2: it fun, and you know you could tell from the
• 1:44:41
  Speaker 2: branding and the imagery Drugstore Cowboys a callback to a
• 1:44:44
  Speaker 2: very popular movie from the nineties. And I just said,
• 1:44:49
  Speaker 2: once a week, I'm going to try to pick one topic,
• 1:44:51
  Speaker 2: whether it's news, whether it's an explainer, whether it's my
• 1:44:55
  Speaker 2: thoughts on compounding, and just teach people about the things
• 1:44:59
  Speaker 2: that they I don't know. And I think it's really
• 1:45:01
  Speaker 2: started to connect with people to the point where even
• 1:45:05
  Speaker 2: Mark Cuban himself a week ago Coming full Circle, tweeted
• 1:45:09
  Speaker 2: a link to my article, my PBM explainer and said,
• 1:45:12
  Speaker 2: this is a great explainer of PBMs. Everybody should read this.
• 1:45:15
  Speaker 2: So it's been a really exciting homework assignment. As I
• 1:45:19
  Speaker 2: put it.
• 1:45:19
  Speaker 1: Before, incredible, incredible. You heard it here, You heard it
• 1:45:24
  Speaker 1: here on Torqu's Drugstore, Cowboy Drugstore, Cowboy dot com. I
• 1:45:30
  Speaker 1: will once again once again have a link in the
• 1:45:32
  Speaker 1: show notes. We have to have you back. If I
• 1:45:35
  Speaker 1: get up to New York, I come up to meet
• 1:45:39
  Speaker 1: the arcs inside our team there on Rhode Island, not
• 1:45:41
  Speaker 1: that far away. Got to schedule some time and come
• 1:45:45
  Speaker 1: see the store, take some photos and get some good
• 1:45:48
  Speaker 1: sushi or something. With you sometimes.
• 1:45:50
  Speaker 9: Yeah.
• 1:45:50
  Speaker 1: Yeah.
• 1:45:50
  Speaker 2: We've been here for one hundred and eighty seven years
• 1:45:53
  Speaker 2: in the same spot, so no matter when you come back,
• 1:45:56
  Speaker 2: I promise you we'll still be around and you'll know
• 1:45:58
  Speaker 2: where to find us.
• 1:46:00
  Speaker 1: I like this has been tremendous. Thank you so much
• 1:46:03
  Speaker 1: for being on twerks and spending time with me.
• 1:46:07
  Speaker 2: Thanks for having me appreciate it all right,