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Bagging Better Benefits: The Grocery PBM Disruptor | PBM Reform · Pharmacy Podcast Network

• 0:07
  Speaker 1: Thanks for listening to the Pharmacy Podcast Network.
• 0:31
  Speaker 2: Welcome to the PBM Reform Podcast, where we dive deep
• 0:35
  Speaker 2: into the world of pharmaceutical benefit management, cutting through the
• 0:39
  Speaker 2: noise to uncover the truth. Since twenty nineteen, we've been
• 0:43
  Speaker 2: your go to source for the latest on how PBMs
• 0:46
  Speaker 2: impact patient care, drug pricing, and the very future of pharmacy.
• 0:52
  Speaker 2: Here we champion the role of pharmacists, the most knowledgeable
• 0:56
  Speaker 2: advocates for medication safety and expertise. Join us as we
• 1:01
  Speaker 2: expose and generate discussions that are reshaping healthcare and explore
• 1:05
  Speaker 2: how we build a better payment system which focuses on
• 1:08
  Speaker 2: advancing pharmacy care.
• 1:17
  Speaker 3: Well, welcome everybody to the PBM Reform Podcast here on
• 1:20
  Speaker 3: the Pharmacy Podcast Network. My name is Brett Rice. I'll
• 1:23
  Speaker 3: be your host today and it's been my privilege to
• 1:26
  Speaker 3: work with community pharmacies now for over twenty years. I
• 1:29
  Speaker 3: love the industry and it's been a great time to
• 1:34
  Speaker 3: work with fantastic pharmacists and community pharmacies across the country.
• 1:41
  Speaker 3: And today I have the honor and privilege to speak
• 1:44
  Speaker 3: with one of those farm d's and someone that I've
• 1:49
  Speaker 3: been following a lot of their posts and seeing what
• 1:54
  Speaker 3: differences they're making in the industry. So welcome to the program,
• 1:58
  Speaker 3: doctor Jim Kirby.
• 2:01
  Speaker 4: Hi, thanks Brec for having me.
• 2:03
  Speaker 3: Yeah, so if you, I think most people know who
• 2:06
  Speaker 3: doctor Kirby is, but you're the chief commercial officer for
• 2:09
  Speaker 3: Kroger Health and wanted to jump into a little bit
• 2:13
  Speaker 3: of your you as as a person first before we
• 2:17
  Speaker 3: get into what you do and the work that you
• 2:19
  Speaker 3: do at Kroger Health. So, Jim, where did you grow up?
• 2:22
  Speaker 4: We're going way back back to the beginning.
• 2:25
  Speaker 1: So I grew up in northeast Ohio, North Canton specifically
• 2:29
  Speaker 1: so pro Football Hall of Fame is that claimed the
• 2:34
  Speaker 1: fame I guess and what put Canton, Ohio on the
• 2:36
  Speaker 1: on the map. And went to school at Ohio State
• 2:41
  Speaker 1: to get my pharmacy degree back then, I think it
• 2:44
  Speaker 1: was only Ohio State. They added the sometime later after
• 2:48
  Speaker 1: I graduated, and then eventually I made it down here
• 2:53
  Speaker 1: to Cincinnati and it was the last post BS farm
• 2:57
  Speaker 1: d class in the in the state that the resistance. Nay,
• 3:01
  Speaker 1: and met my wife in that program and we settled
• 3:05
  Speaker 1: here and rest is history.
• 3:07
  Speaker 3: Yeah, Now, is your wife also a pharmacist?
• 3:10
  Speaker 4: She is?
• 3:11
  Speaker 1: She is the director of inulatory Care at Mercy West Hospital.
• 3:15
  Speaker 3: Okay, excellent, excellent, Keep keeping it in the family. And
• 3:19
  Speaker 3: so when you when you were growing up, did you
• 3:21
  Speaker 3: know you always wanted to be a pharmacist? How did
• 3:23
  Speaker 3: that come about? Uh?
• 3:26
  Speaker 4: Man had?
• 3:28
  Speaker 1: I had no idea what I wanted to do when
• 3:30
  Speaker 1: I grew up, And thankfully I had a father that
• 3:33
  Speaker 1: he helped guide me into things that I shouldn't do
• 3:36
  Speaker 1: when I when I grow up. And so I was like,
• 3:39
  Speaker 1: I want to maybe be a psychologist. And he's like, well,
• 3:42
  Speaker 1: how long do you have to go to school for that?
• 3:44
  Speaker 1: And what are you going to do with that degree?
• 3:46
  Speaker 1: And you know, I've got people that have psychology degrees
• 3:49
  Speaker 1: that work on the in the paper plant with me
• 3:52
  Speaker 1: or they drive truck, and so you don't need to
• 3:54
  Speaker 1: go to college and go.
• 3:55
  Speaker 4: Into all this death to do that.
• 3:57
  Speaker 1: And I said, well, what about you know, being in
• 4:03
  Speaker 1: sociology And he's kind of like the same sort of argument.
• 4:06
  Speaker 1: So he was really pushing me to think about the
• 4:10
  Speaker 1: I guess the financial health of my future and get
• 4:14
  Speaker 1: into a career that would allow me to be out
• 4:18
  Speaker 1: of debt from student loans but also be able to
• 4:20
  Speaker 1: contribute back to society. So I ended up still pursuing
• 4:25
  Speaker 1: psychology classes for a time at Ohio State, and I
• 4:28
  Speaker 1: had a biopsych class that I loved, learning about the
• 4:32
  Speaker 1: action of neurotransmitters in the brain and that influenced depression
• 4:35
  Speaker 1: and anxiety and all those sorts of things.
• 4:38
  Speaker 4: And I ended up landing in pharmacy school.
• 4:41
  Speaker 1: But the kind of interesting part was is, even though
• 4:46
  Speaker 1: I was very interested in pharmacy, I went to pharmacy school,
• 4:50
  Speaker 1: and I never had my heart set on practicing pharmacy,
• 4:53
  Speaker 1: that I would practice law. And I was just going
• 4:57
  Speaker 1: to graduate with pharmacy degree just to get me into
• 4:59
  Speaker 1: law school, but that.
• 5:02
  Speaker 4: Didn't end up happening either.
• 5:03
  Speaker 1: And again I think I can attribute that back to
• 5:05
  Speaker 1: my dad as well. He said, well, what are you
• 5:06
  Speaker 1: going to do with the law degree? And how much
• 5:08
  Speaker 1: more is years of school is that? And how much more.
• 5:10
  Speaker 4: Debt you going to the end, And so that kind
• 5:13
  Speaker 4: of aided me.
• 5:13
  Speaker 1: And I had taken the alsat got into a couple
• 5:16
  Speaker 1: of schools, but it was really during the time I graduated,
• 5:20
  Speaker 1: I still had to finish some grad intern hours and
• 5:22
  Speaker 1: I worked at CBS, and I had never worked in
• 5:25
  Speaker 1: a community pharmacy before all my intern hours were at
• 5:28
  Speaker 1: a hospital, and that's really where I fell in love
• 5:33
  Speaker 1: with pharmacy again, just dealing with all the craziness of
• 5:36
  Speaker 1: the public. I thrived on it, thrived on interacting with
• 5:39
  Speaker 1: people and getting to know them a bit more. So
• 5:42
  Speaker 1: that combined with my dad's advice not to pursue law,
• 5:44
  Speaker 1: I was like, you know, if I go down that path,
• 5:46
  Speaker 1: law I was going to supersede anything with pharmacy. So
• 5:49
  Speaker 1: they're going to stick with pharmacy. And then ended up
• 5:52
  Speaker 1: pursuing a farm d done at UC Yeah.
• 5:56
  Speaker 3: So did you have grew up with siblings? Were you
• 6:00
  Speaker 3: only child?
• 6:01
  Speaker 4: I have a younger brother. He's in the food business.
• 6:05
  Speaker 3: Okay, did your dad give him as much counsel as
• 6:08
  Speaker 3: he gave you? And I don't know.
• 6:10
  Speaker 4: I think he got off got off a lot easier. Yeah.
• 6:13
  Speaker 3: Those younger kids, I'm the youngest in my family. You know,
• 6:16
  Speaker 3: they get away with everything, right. Yeah. So, well, do
• 6:22
  Speaker 3: you think it was your father who influenced you mout
• 6:25
  Speaker 3: growing up or what was your major influence growing up?
• 6:30
  Speaker 4: Well?
• 6:30
  Speaker 1: I was the first person in my family to go
• 6:32
  Speaker 1: to college, so I would say I had probably he
• 6:37
  Speaker 1: was probably one of the major influences in my life.
• 6:40
  Speaker 1: And also had a very tight group of friends that
• 6:44
  Speaker 1: we all went to Ohio State together and then we
• 6:46
  Speaker 1: all stay close. And one of them is also a pharmacist.
• 6:50
  Speaker 1: He graduated the year after me, and the other two
• 6:53
  Speaker 1: guys do very different things and live in different parts
• 6:57
  Speaker 1: of the country, but we were pretty tight and so
• 6:59
  Speaker 1: that was I would say, very formative in my early
• 7:03
  Speaker 1: days as well, having those relationships.
• 7:06
  Speaker 3: Okay, yeah, did you grow up playing sports? Were you
• 7:09
  Speaker 3: in music, acting, what were your extracurriculas.
• 7:13
  Speaker 1: No. I did a little bit of acting, but singing
• 7:18
  Speaker 1: definitely was not for me or for anyone else that
• 7:20
  Speaker 1: would listen to me. I was more interested in technology
• 7:26
  Speaker 1: and computers, and I remember, you know now I'm really
• 7:29
  Speaker 1: dating myself of like the first Atari computer, not the
• 7:33
  Speaker 1: Atari eight hundred that you played Space Invaders on, but
• 7:36
  Speaker 1: like the Atari computer.
• 7:37
  Speaker 4: And then I built my first computer at home, and
• 7:41
  Speaker 4: so I was really into programming and those sorts of things.
• 7:44
  Speaker 4: So really a nerd at heart.
• 7:46
  Speaker 1: I loved Latin too, excelled and then participated in some
• 7:51
  Speaker 1: different competitions for Latin scholarship, So that was not really
• 7:59
  Speaker 1: making myself out like a nerd, but that was kind
• 8:01
  Speaker 1: of the fun things I enjoyed, as well as playing
• 8:03
  Speaker 1: backyard football and stuff with my friends, but did never
• 8:07
  Speaker 1: do any high school structured sports.
• 8:09
  Speaker 3: Okay, all right, so got your farm d you started you,
• 8:16
  Speaker 3: I guess you interned out a chain, so you saw
• 8:19
  Speaker 3: the retail side. And then where'd you go from there
• 8:21
  Speaker 3: in your career? And how did you end up landing
• 8:24
  Speaker 3: at Kroger.
• 8:25
  Speaker 1: So one of my buddies that was in pharmacy school
• 8:29
  Speaker 1: with me, he was from Columbus and so he had
• 8:32
  Speaker 1: kind of had it with being in Columbus and wanted
• 8:35
  Speaker 1: to do something different.
• 8:35
  Speaker 4: But he wanted to.
• 8:36
  Speaker 1: Stay in Ohio, within driving distance of his aging parents.
• 8:41
  Speaker 1: So he said, Hey, I'm going to move either to
• 8:43
  Speaker 1: Cleveland or Cincinnati. You want to come? And I was
• 8:47
  Speaker 1: like sure, I'd be open to either one. I mean,
• 8:50
  Speaker 1: Cleveland was only an hour for my parents, in Cincinnati
• 8:53
  Speaker 1: be three and a half.
• 8:54
  Speaker 4: So I was like, either one.
• 8:55
  Speaker 1: And so he's like, great, I've got an interview with
• 8:58
  Speaker 1: drug and porium down and SI, which you like to come? So,
• 9:01
  Speaker 1: I mean this was like predated the Step Brothers movie
• 9:05
  Speaker 1: where they dual interviews, and I feel like that's exactly
• 9:08
  Speaker 1: what we did interviewed together for jobs, and because I
• 9:13
  Speaker 1: had worked at a CBS with the drive through, and
• 9:17
  Speaker 1: drug emporium was opening up a brand new store format
• 9:20
  Speaker 1: that was focused on holistic care supplements and vitamins that
• 9:27
  Speaker 1: they much bigger expanded set that they normally had, and
• 9:30
  Speaker 1: they had a drive through that they wanted somebody with
• 9:32
  Speaker 1: some level of experience. And so my short time as
• 9:35
  Speaker 1: CBS qualified me to manage that store. And then my
• 9:38
  Speaker 1: buddy got a job as a staff pharmacist at a
• 9:40
  Speaker 1: different drug and fororium. So that's what initially brought me
• 9:44
  Speaker 1: to Cincinnati and really built that business from the ground up.
• 9:50
  Speaker 1: I had to do doctor detailing and do healthfares across
• 9:55
  Speaker 1: the city of Mason here north of Cincinnati, and really
• 9:59
  Speaker 1: learned they all alternative complimentary medicine side of the business too,
• 10:03
  Speaker 1: and interactions with pharmaceuticals and whatnot.
• 10:06
  Speaker 4: So it was it.
• 10:07
  Speaker 1: Was a great, great learning experience all around. And then
• 10:11
  Speaker 1: I ended up going back, as I said, got my
• 10:14
  Speaker 1: farm d from there. So I was very fortunate to
• 10:19
  Speaker 1: be given those kind of amazing opportunities that one thing
• 10:22
  Speaker 1: led to another.
• 10:24
  Speaker 3: Yeah, so drug importum are they still around today? Are
• 10:28
  Speaker 3: they being acquired, what's the status.
• 10:32
  Speaker 4: They are gone? They evolved, closed down shop.
• 10:35
  Speaker 1: And when I was in farm D School, they were
• 10:39
  Speaker 1: really pushing me.
• 10:40
  Speaker 4: You see. Was great because it was a very small program.
• 10:44
  Speaker 1: Only fourteen were in my class, and then we had
• 10:46
  Speaker 1: the track in farm D's that were coming in.
• 10:49
  Speaker 4: It's just the advent of the all farm D curriculum.
• 10:52
  Speaker 4: But the.
• 10:55
  Speaker 1: Dean and the assistant dean and the chair, we're all
• 10:58
  Speaker 1: very invested in MYEW and all of our futures and
• 11:01
  Speaker 1: what we were going to do. And the thing that
• 11:03
  Speaker 1: they kept talking to me about was is clinical pharmacy
• 11:06
  Speaker 1: in the community. They said, there needs to be a
• 11:10
  Speaker 1: focus on delivering clinical services in a community pharmacy set.
• 11:15
  Speaker 4: It can't just be about putting pills in a bottle.
• 11:18
  Speaker 1: And they said that I would be perfect to lead
• 11:22
  Speaker 1: that effort, and that there was a connection at Kroger
• 11:25
  Speaker 1: and that they wanted to have kind of a shared
• 11:28
  Speaker 1: faculty position, but they wanted to be a full time
• 11:30
  Speaker 1: employee of Kroger, and so it was a new position
• 11:33
  Speaker 1: that they were developing and that's what they wanted me
• 11:37
  Speaker 1: to pursue.
• 11:38
  Speaker 4: I wasn't exactly sold.
• 11:40
  Speaker 1: I was going to do a residency and had applied
• 11:45
  Speaker 1: to some different programs, but at the end of the day,
• 11:47
  Speaker 1: I ended up choosing the Kroger out.
• 11:50
  Speaker 3: Yeah, so, now, how many years have you been with Kroger.
• 11:54
  Speaker 4: Let's see, this will be about twenty four years.
• 11:58
  Speaker 1: And years over a twenty four year period, I actually
• 12:02
  Speaker 1: left Kroger in the middle there and helped start Anthem
• 12:06
  Speaker 1: specialty pharmacy that was called Precision our XT Specialty Solution
• 12:10
  Speaker 1: and it was a subsidiary of their PBM next our
• 12:14
  Speaker 1: X And did that for a couple of years, and
• 12:17
  Speaker 1: the business grew as we were bringing all the well
• 12:19
  Speaker 1: point plans into the specialty pharmacy world. And we relocated
• 12:23
  Speaker 1: to Indianapolis, and I was commuting back and forth for
• 12:26
  Speaker 1: a while, and I had an offer to move and
• 12:28
  Speaker 1: determined that my wife and I were starting a family
• 12:31
  Speaker 1: here and we didn't want to relocate to Indianapolis.
• 12:34
  Speaker 4: So I did that for a while and then eventually.
• 12:38
  Speaker 1: Came crawling back on my hands and knees to Kroger
• 12:40
  Speaker 1: for a job and started back in the division office
• 12:44
  Speaker 1: again and seeing patients in some of the programs I
• 12:49
  Speaker 1: had started the first time around, and then ended up
• 12:52
  Speaker 1: then managing those programs, going into the division office as
• 12:55
  Speaker 1: the clinical manager, and then I came here to general
• 12:59
  Speaker 1: office in twenty thirteen.
• 13:01
  Speaker 3: Okay, yeah, great, great career and a long time with
• 13:05
  Speaker 3: a great company and worked your way up the food chain.
• 13:10
  Speaker 3: Now to you know, chief commercial officer there, and so
• 13:16
  Speaker 3: tell me exactly what is your stewardship then, as you know,
• 13:19
  Speaker 3: that's pretty a broad title, right, chief commercial officer. So
• 13:23
  Speaker 3: what are your actual stewardships?
• 13:27
  Speaker 4: Yeah, and it's it's evolved over the course of time.
• 13:30
  Speaker 1: I would say that, you know, kind of like what
• 13:32
  Speaker 1: I had described in my history. My overall broad charge
• 13:36
  Speaker 1: is how do we advance community pharmacy practice and have
• 13:40
  Speaker 1: our pharmacists and our technicians delivering care at the top
• 13:44
  Speaker 1: of their licenses and putting the patient at the center
• 13:48
  Speaker 1: while we improve outcomes at a lower cost. Now what
• 13:52
  Speaker 1: does that mean for me specifically? In my REMIT on
• 13:54
  Speaker 1: a day to day basis, I'm in charge of the
• 13:57
  Speaker 1: innovation and research, so the things that we need to
• 14:01
  Speaker 1: be developing and thinking about for the next three years
• 14:04
  Speaker 1: that are.
• 14:04
  Speaker 4: Coming down the pike.
• 14:06
  Speaker 1: I am in charge of professional affairs, so our relationships
• 14:10
  Speaker 1: with universities in particular, as well as nonprofits and trade associations,
• 14:16
  Speaker 1: professional associations. I have responsibility for our PBM. I have
• 14:21
  Speaker 1: responsibility for our Food for Health initiative, and then our
• 14:24
  Speaker 1: business development and strategic partnership team.
• 14:27
  Speaker 3: Okay, well, we want to jump into the PBM side
• 14:32
  Speaker 3: here because you are listening to the PBM Reform podcast
• 14:35
  Speaker 3: series here on the Pharmacy Podcast Network, and so we
• 14:40
  Speaker 3: wanted to learn more about Kroger's your own solution to
• 14:44
  Speaker 3: pharmacy benefit management. So tell us about your PBM.
• 14:50
  Speaker 4: Sure, so it was started, I have to go back.
• 14:54
  Speaker 1: I think it was started in nineteen ninety seven, and
• 14:59
  Speaker 1: it may even.
• 14:59
  Speaker 4: Be your earlier than that.
• 15:00
  Speaker 1: I may have that year wrong, but it's been around
• 15:02
  Speaker 1: for a long time and it was created primarily for
• 15:06
  Speaker 1: the purpose of serving our own associates.
• 15:09
  Speaker 4: To start, and Kroger is organized.
• 15:11
  Speaker 1: We have about give or take four hundred and fifty
• 15:14
  Speaker 1: thousand or so employees, and some of those are managed
• 15:17
  Speaker 1: underneath the consolidated benefit Then some of them are called
• 15:20
  Speaker 1: not consolidated, which are like the tap Hartley Union plans.
• 15:24
  Speaker 1: And we've got about one hundred and we'll say one
• 15:30
  Speaker 1: hundred and fifty thousand lives or so that are underneath
• 15:33
  Speaker 1: that consolidated benefit plan. So this is your management group,
• 15:37
  Speaker 1: your store managers, your general office and corporate folks follow
• 15:42
  Speaker 1: underneath of that. So the PBM started with managing benefits
• 15:47
  Speaker 1: for that consolidated group, and then, just like with any
• 15:50
  Speaker 1: other employer, you have to win lives with the tap
• 15:53
  Speaker 1: partley groups. Even though they're supporting Kroger, they may also
• 15:56
  Speaker 1: be supporting other companies as well, like the eat cutters
• 16:00
  Speaker 1: may have different retailers that are in that union group.
• 16:04
  Speaker 4: So you have to go and bid and win those groups.
• 16:06
  Speaker 1: So we were successful in winning some of those groups.
• 16:09
  Speaker 4: We don't have all of them, but we have a
• 16:11
  Speaker 4: portion of them.
• 16:12
  Speaker 1: And that's really where Kroger prescription Plans stabilize itself for
• 16:18
  Speaker 1: a number of years, and then eventually it started to
• 16:21
  Speaker 1: kind of spread its wings a little bit and serve
• 16:24
  Speaker 1: as a solution for other self insured employers, particularly smaller ones.
• 16:29
  Speaker 1: I would say, our clients range anywhere from you know,
• 16:32
  Speaker 1: small as maybe fifty to you know, the size of
• 16:35
  Speaker 1: the Kroger company is our largest client. But those small
• 16:42
  Speaker 1: companies that really needed to have or wanted to have
• 16:45
  Speaker 1: importable benefits for their employees but not have to go
• 16:49
  Speaker 1: fully insured. This was a really nice option for them.
• 16:54
  Speaker 1: And so we've grown now you know, about ninety different clients,
• 16:58
  Speaker 1: i'd say, in addition to our own.
• 17:02
  Speaker 4: Kroger employees, and that's who we service.
• 17:05
  Speaker 3: Yeah, okay, excellent. And what do you think differentiate your
• 17:11
  Speaker 3: pharmacy benefits versus a big one of the big three
• 17:16
  Speaker 3: that everyone hears about, you know, the optims, express scripts
• 17:20
  Speaker 3: and caremart.
• 17:22
  Speaker 4: Yeah.
• 17:23
  Speaker 1: I think that there's you know, there's a lot of
• 17:26
  Speaker 1: anti PBM rhetoric that's going on in the industry, and
• 17:30
  Speaker 1: there's a lot of movement towards reform. And I am
• 17:33
  Speaker 1: certainly for reform. I mean, given my history as a
• 17:36
  Speaker 1: community pharmacy leader and innovator, I would be a hypocrite
• 17:43
  Speaker 1: if I didn't think that there needed to be some
• 17:46
  Speaker 1: reform in the PBM world.
• 17:47
  Speaker 4: But I'm also not to the.
• 17:49
  Speaker 1: Camp where I have my torch out my pitchfork and
• 17:52
  Speaker 1: say PBMs are the devil and they need all go away.
• 17:56
  Speaker 1: They perform a necessary service in allowing pharmacies to electronically
• 18:02
  Speaker 1: adjudicate and receive real time payment for prescriptions they've just gotten,
• 18:07
  Speaker 1: you know, maybe a little bit out over their skis.
• 18:10
  Speaker 1: And the way that they try to make money and
• 18:14
  Speaker 1: create value to their upstream plans and and take value
• 18:20
  Speaker 1: from their their lower stream providers aka the pharmacies. And
• 18:24
  Speaker 1: obviously there's issues with transparency and payments and and and
• 18:29
  Speaker 1: the games that the PBMs play with getting you on
• 18:32
  Speaker 1: definitions and rotating maclists and so on and so forth.
• 18:36
  Speaker 1: And so I would say that PBMs aren't evil breck
• 18:41
  Speaker 1: and of themselves.
• 18:43
  Speaker 4: I think some of the practices that they.
• 18:45
  Speaker 1: Typically use to create profitability for themselves or value for
• 18:50
  Speaker 1: their clients is where the issue really lies.
• 18:52
  Speaker 4: So we want to be above all of that.
• 18:57
  Speaker 1: You know, we we have to operate as a as
• 19:00
  Speaker 1: a PBM, but we're not going to play the games.
• 19:05
  Speaker 1: We're not going to try to screw pharmacies out of
• 19:08
  Speaker 1: their out of fair and reasonable reimbursement. So I think
• 19:13
  Speaker 1: that's probably the biggest, you know, foundational point that I
• 19:18
  Speaker 1: that I want to make, is that transparency and fairness
• 19:23
  Speaker 1: is absolutely key. But now I think we've come to
• 19:27
  Speaker 1: a place where many PBMs are, you know, using those
• 19:30
  Speaker 1: same terms, and they've also they've almost become euphemisms, and
• 19:34
  Speaker 1: you know, everyone claims that they're fair and transparent, and
• 19:37
  Speaker 1: what does that really mean, they're fair and transparent to
• 19:39
  Speaker 1: the extent that they're willing to share with you.
• 19:41
  Speaker 4: Those fees are those those ways in which.
• 19:46
  Speaker 1: They calculate reimbursements and those sorts of things. But are
• 19:50
  Speaker 1: they really That's really the question. So what we're trying
• 19:54
  Speaker 1: to do is is really change the game, and not
• 19:58
  Speaker 1: just by pain pharmacies fairly, but also getting pharmacies to
• 20:04
  Speaker 1: do clinical interventions for our clients and selling our clients
• 20:08
  Speaker 1: for the ability of what pharmacies can do for them
• 20:12
  Speaker 1: to reduce drug costs but also to better manage outcomes.
• 20:19
  Speaker 1: So like for our you know, for Kroger pharmacies in general,
• 20:23
  Speaker 1: just speak to this versus the pharmacies that we don't own.
• 20:28
  Speaker 1: Our Kroger pharmacies do more than five being clinical interventions
• 20:31
  Speaker 1: a year.
• 20:32
  Speaker 4: And that's not drug utilization review. That's just and that's
• 20:35
  Speaker 4: just not for KPP either.
• 20:36
  Speaker 1: That's for all of our book of business that Kroger
• 20:39
  Speaker 1: Pharmacy has.
• 20:41
  Speaker 4: But KPP.
• 20:43
  Speaker 1: Pays Kroger Pharmacies to do those services to manage adherence,
• 20:49
  Speaker 1: extended day supplies CMRS, suboptimal drug use.
• 20:55
  Speaker 4: Even the Lockzam prescribing.
• 20:57
  Speaker 1: For high risk opioid prescriptions, so really the gamut of
• 21:03
  Speaker 1: clinical services by a pharmacy, and we pay for diabetes
• 21:07
  Speaker 1: management and hypertension management to those programs. We've had a
• 21:10
  Speaker 1: couple of different iterations of those programs over the course
• 21:13
  Speaker 1: of time. So that's one thing that we want to
• 21:15
  Speaker 1: stand by is the power of community pharmacy. And if
• 21:18
  Speaker 1: I look ahead of where we want to go, is
• 21:22
  Speaker 1: we want to look at how do we now take
• 21:25
  Speaker 1: the access of our membership at KPP to Kroger pharmacies
• 21:30
  Speaker 1: and other pharmacies that can provide a similar or standard
• 21:34
  Speaker 1: service set and bring food into the picture as well,
• 21:39
  Speaker 1: and really look at the holistic and social determinants of
• 21:43
  Speaker 1: health needs for our membership and bringing that opportunity to
• 21:49
  Speaker 1: our employer.
• 21:49
  Speaker 4: Base to say, like, let's forget about PBM profits. We
• 21:54
  Speaker 4: don't even need to be thinking about that.
• 21:57
  Speaker 1: Let's just talk about the membership and how do we
• 22:01
  Speaker 1: use these pharmacies that are in a we'll call it
• 22:05
  Speaker 1: a pseudo clinically integrated network to deliver the right interventions
• 22:11
  Speaker 1: at the right time to be thinking about food, transportation
• 22:15
  Speaker 1: and these other benefits to deliver for you a healthier
• 22:19
  Speaker 1: member population that's contributing to your bottom line. What if
• 22:24
  Speaker 1: PBM profits weren't even on the table when you think
• 22:26
  Speaker 1: about fees and cost plus, Like, what if we just
• 22:28
  Speaker 1: took those all off the table and you took those
• 22:30
  Speaker 1: savors and invested in your associates in that way? Would
• 22:34
  Speaker 1: that be of interest to you? And I think that's
• 22:36
  Speaker 1: the game changer. I think that PBMs go back to
• 22:40
  Speaker 1: what the PBMs are supposed to do, just you know,
• 22:43
  Speaker 1: provide a service, but you instead focus on the interactions
• 22:47
  Speaker 1: that you have with the patients to improve outcomes and costs.
• 22:52
  Speaker 1: That's the power of the PBM with the community pharmacy.
• 22:56
  Speaker 3: Yeah, and doctor Kirby, that's what caught my attention about
• 22:59
  Speaker 3: you when you started talking about that, when that very
• 23:02
  Speaker 3: thing that you just covered and how food could be
• 23:05
  Speaker 3: medicine and how you know we should change the focus
• 23:10
  Speaker 3: on preventative instead of reactive. That really caught my attention.
• 23:14
  Speaker 3: I thought, Man, you're onto something. That's what I think
• 23:17
  Speaker 3: all community pharmacies should be focused on, is what do
• 23:20
  Speaker 3: we do for prevention wise versus just being a dispensary.
• 23:26
  Speaker 3: And that's very reactive.
• 23:27
  Speaker 1: Right.
• 23:28
  Speaker 3: We could do a whole nother podcast series just on that.
• 23:31
  Speaker 3: But you know, keeping in the theme here of PBM,
• 23:36
  Speaker 3: it does make sense personally to me to take care
• 23:40
  Speaker 3: of your own employees, right, you have your own pharmacies,
• 23:44
  Speaker 3: you have your own employees. My company, even though we
• 23:46
  Speaker 3: only do workers comp, right, we don't do any of
• 23:49
  Speaker 3: the commercial plans, and workers comp is only like one
• 23:52
  Speaker 3: percent of all those claims. But still it's so much
• 23:55
  Speaker 3: easier to do that for our own clients who have
• 23:58
  Speaker 3: their own pharmacies.
• 23:59
  Speaker 4: Right.
• 24:00
  Speaker 3: In fact, we help a large hospital system out west
• 24:05
  Speaker 3: just straight past through. If a nurse accidentally gets a needlestick,
• 24:09
  Speaker 3: that's a pretty costly drug therapy that they have to
• 24:12
  Speaker 3: go on to protect them from you know, all the
• 24:15
  Speaker 3: blood diseases, HIV, hepatitis, et cetera. And it's a pretty
• 24:19
  Speaker 3: expensive therapy. Well, we do a straight pass through. It's
• 24:22
  Speaker 3: that you know, employer or that hospital patient at that
• 24:27
  Speaker 3: hospital's pharmacy. It's straight cost of the medication. You know,
• 24:33
  Speaker 3: it's got to save them millions of dollars a year. Right,
• 24:36
  Speaker 3: So I could see that benefit doing the program that
• 24:39
  Speaker 3: you started out to do for your own employees Kroger's employees,
• 24:44
  Speaker 3: but now for these self ensured companies that don't own
• 24:47
  Speaker 3: their own pharmacies. You hope they use your pharmacy, but
• 24:50
  Speaker 3: they could go to any pharmacy. Right, how do you
• 24:53
  Speaker 3: price that and still make it a workout for a
• 24:58
  Speaker 3: cost containment for the employer. It's still a fair reimbursement
• 25:01
  Speaker 3: to the pharmacy.
• 25:03
  Speaker 1: Yeah, I mean in today's world, in the traditional PBM
• 25:08
  Speaker 1: employer relationship, that that has to your cost to your
• 25:12
  Speaker 1: rap network is built in to the overall pricing that
• 25:17
  Speaker 1: you're you're giving. We don't favor Kroger pharmacies over and
• 25:21
  Speaker 1: pay them differently than what we would pay other pharmacies.
• 25:24
  Speaker 1: I think that that has to be rule number one.
• 25:28
  Speaker 1: But if an employer is choosing a preferred or an
• 25:32
  Speaker 1: exclusive network, obviously there's different benefits that are conferred based
• 25:37
  Speaker 1: upon that. And that's where you know, I'm trying to
• 25:40
  Speaker 1: drive towards to say, like what if, like here in Cincinnati,
• 25:43
  Speaker 1: we're based uh and you know we have high market
• 25:48
  Speaker 1: share within Kroger here in Cincinnati, Why wouldn't any other
• 25:53
  Speaker 1: local employer here in Cincinnati not want to use.
• 25:57
  Speaker 4: Kroger pharmacy in the Kroger store?
• 26:00
  Speaker 1: You know, they were getting these additional benefits like food
• 26:03
  Speaker 1: stipends and clinical services at the pharmacy, it makes all
• 26:07
  Speaker 1: the sense of the world.
• 26:08
  Speaker 4: And if basically functions like.
• 26:10
  Speaker 1: They are an owned entity, like they are treating their
• 26:13
  Speaker 1: own associates just like we treat our own associates. So
• 26:17
  Speaker 1: I think that's really where we have the right to
• 26:22
  Speaker 1: win is in the place where we have market share
• 26:24
  Speaker 1: within the stores. But I think this goes and I
• 26:28
  Speaker 1: have a vision that it's not just about Kroger, and
• 26:31
  Speaker 1: it's not just about where we have market share. That
• 26:33
  Speaker 1: if you pick any other competitor, I'm not going to
• 26:36
  Speaker 1: say them by name, but if they agree to a
• 26:39
  Speaker 1: standard service set and agree to deliver certain outcomes and
• 26:44
  Speaker 1: that we're measuring it in the same way as Kroger
• 26:46
  Speaker 1: pharmacies are whether they have food or whether they don't. Now,
• 26:51
  Speaker 1: if they have food, then I kind of have to
• 26:53
  Speaker 1: apply the same thing, like are they measuring the nutrition
• 26:55
  Speaker 1: of the purchases in the same way that we are,
• 26:57
  Speaker 1: So we can aggregate the data. But you can create
• 27:00
  Speaker 1: this cross organizational, clinically integrated network across different competitors, and
• 27:07
  Speaker 1: you could do the same thing then nationally than you
• 27:10
  Speaker 1: could in a highly concentrated grower market.
• 27:14
  Speaker 3: Yeah, yeah, absolutely, How do you handle reporting. Is there
• 27:20
  Speaker 3: a pretty robust communication channel between you and your and
• 27:25
  Speaker 3: your clients on reporting those very measures that you're tracking.
• 27:30
  Speaker 1: Yes, I mean there's there's detailed reports on the clinical
• 27:35
  Speaker 1: programs from utilization and success rate to the outcome measures.
• 27:41
  Speaker 4: But then also on the more.
• 27:43
  Speaker 1: Traditional PBM side, I would say that we have in
• 27:47
  Speaker 1: other PBMs that are small or boutique. I think this
• 27:49
  Speaker 1: is where they kind of stand apart too, is that
• 27:51
  Speaker 1: they have very specific drug level reporting, which they typically
• 27:57
  Speaker 1: don't get that kind of information from the the Big three.
• 28:01
  Speaker 3: Right, how does your PBM handle rebates?
• 28:08
  Speaker 1: I mean really that's up to the employer. You still
• 28:12
  Speaker 1: have employers that like to focus on rebates because that's
• 28:18
  Speaker 1: part of the way that they've built their.
• 28:20
  Speaker 4: P and L is built on that.
• 28:25
  Speaker 1: Then you have others that want the lowest absolute net cost.
• 28:31
  Speaker 1: We try to again in the spirit of transparency and education,
• 28:36
  Speaker 1: we try to take.
• 28:39
  Speaker 4: A higher road approach.
• 28:40
  Speaker 1: I guess with our employers and let them know, like,
• 28:42
  Speaker 1: here are the different scenarios that you might be considering,
• 28:45
  Speaker 1: and here's the pros and cons of this.
• 28:47
  Speaker 4: We like to recommend the lowest net cost.
• 28:50
  Speaker 1: Now that doesn't mean necessarily you know, in the case
• 28:53
  Speaker 1: of especially pharmacy only biosimilars. I think what it does
• 28:57
  Speaker 1: is it takes into account, like lowes net costs would be,
• 29:00
  Speaker 1: consideration of what the expected rebates would be, what the
• 29:05
  Speaker 1: expected conversion rates and adoption rate of a particular formula
• 29:09
  Speaker 1: a choice would be. And we try to you know,
• 29:11
  Speaker 1: walk hand in hand with the employer to educate them
• 29:13
  Speaker 1: on what's realistic, what are their goals and how do
• 29:18
  Speaker 1: we achieve the lowest net costs for the most clinically integrate,
• 29:22
  Speaker 1: most clinically afflicacious product.
• 29:25
  Speaker 4: I think that's that's really the key.
• 29:27
  Speaker 1: But you've got I mean, we've we've tested the market
• 29:31
  Speaker 1: and the games that are being shared with employers are
• 29:35
  Speaker 1: really heartbreaking that they'll put in all sorts of guarantees
• 29:39
  Speaker 1: and assumptions that you know, the GLP one growth will
• 29:42
  Speaker 1: go by one hundred percent, and it's you know, these
• 29:45
  Speaker 1: different things that assumptions that maybe an HR leader doesn't
• 29:50
  Speaker 1: welly have the awareness or understanding whether that prediction or
• 29:53
  Speaker 1: those guarantees are going to be real or not.
• 29:55
  Speaker 4: But when we look at them, we're like, this is
• 29:58
  Speaker 4: this is the same.
• 29:59
  Speaker 1: We're not going to We're not going to play these games,
• 30:01
  Speaker 1: and we try to look and price where it's going
• 30:06
  Speaker 1: to be in real time when we would have the
• 30:08
  Speaker 1: business versus you know, looking at claims files that are
• 30:11
  Speaker 1: two years old and making assumptions that are outdated or
• 30:15
  Speaker 1: just altogether wrong, and trying to win the business based
• 30:18
  Speaker 1: on that.
• 30:18
  Speaker 4: We're trying to win the business based on reality.
• 30:22
  Speaker 3: Yeah, So with that in mind, then how do you
• 30:25
  Speaker 3: handle formularies. You know, it sounds like there's a lot
• 30:28
  Speaker 3: of consultation to try to get to the to the
• 30:32
  Speaker 3: lowest cost, but you know, formularies can come into effect
• 30:36
  Speaker 3: where you're also trying to provide the best clinical solution
• 30:41
  Speaker 3: as well.
• 30:42
  Speaker 4: Yep.
• 30:43
  Speaker 1: Well, clinical is always first, and so we have a
• 30:46
  Speaker 1: P and T committee that's made up of physicians across
• 30:51
  Speaker 1: the region and different health systems and different specialties, so
• 30:54
  Speaker 1: that we have a good representation within each therapeutic category
• 30:59
  Speaker 1: and they'll review the our formula. Pharmacy team will present
• 31:06
  Speaker 1: information in them on a quarterly basis, and they'll review
• 31:08
  Speaker 1: all the clinical data and make recommendations UH. And then
• 31:12
  Speaker 1: then we apply the economic assessment of how this will
• 31:15
  Speaker 1: affect rebates and and UH and overall net costs of
• 31:21
  Speaker 1: the of the formulary within that particular condition.
• 31:24
  Speaker 4: So it's it's definitely a balance clinical as always.
• 31:27
  Speaker 1: First, but it operates very much like a hospital P
• 31:31
  Speaker 1: and T where you have the the clinical and then
• 31:33
  Speaker 1: the value assessment.
• 31:35
  Speaker 3: Okay, and can your clients see a complete list of
• 31:39
  Speaker 3: the formulary.
• 31:42
  Speaker 4: Yep, and there's different formulas that they can choose from.
• 31:45
  Speaker 3: Okay, excellent, and then that So I'm glad that you
• 31:50
  Speaker 3: mentioned that that they you know, first, clinical is first,
• 31:54
  Speaker 3: and then you look at at the cost and so
• 31:58
  Speaker 3: we see you know, I think that's one of the
• 32:02
  Speaker 3: bad raps of PBMs today is that you know, you
• 32:06
  Speaker 3: and it's always the outliers. Right, one patient couldn't get
• 32:10
  Speaker 3: one medication, but you know, two hundred thousand patients are
• 32:15
  Speaker 3: getting a formulaary medication that's working just fine. But you
• 32:18
  Speaker 3: hear that squeaky will not being able to get there
• 32:20
  Speaker 3: one medication because it was on not on formulary. So
• 32:25
  Speaker 3: glad that you take that approach. What additional you know,
• 32:30
  Speaker 3: data or reporting you think sets you apart from you know,
• 32:34
  Speaker 3: from the big three PBMs.
• 32:39
  Speaker 1: Well I mentioned about the certainly the rebate reporting and
• 32:42
  Speaker 1: getting level down to a level of specificity that that
• 32:46
  Speaker 1: they Big three typically dult and there's also a level
• 32:51
  Speaker 1: of data and reporting that's provided in order for us
• 32:53
  Speaker 1: to be consultated in helping them think about a particular
• 32:59
  Speaker 1: formula or think about formulae changes that we would maybe
• 33:03
  Speaker 1: ask them or recommend that they make, or clinical.
• 33:06
  Speaker 4: Programs that we would ask them to be involved with.
• 33:10
  Speaker 1: But I think the other thing that gets really interesting
• 33:13
  Speaker 1: is when you have employers that will give us access
• 33:17
  Speaker 1: to the medical data and combine that then with our
• 33:20
  Speaker 1: prescription claims data, and then that becomes a very rich
• 33:25
  Speaker 1: opportunity for us to make more intelligent recommendations and new
• 33:32
  Speaker 1: recommendations that we maybe otherwise wouldn't have perfu into. So
• 33:37
  Speaker 1: that's a key thing now from your question with more
• 33:40
  Speaker 1: output directive, but even from an input direction, I think
• 33:44
  Speaker 1: that's maybe a differentiator too as we start to think
• 33:47
  Speaker 1: about the food and purchase data and the medical claims
• 33:51
  Speaker 1: data and the pharmacy data. The more data sets that
• 33:54
  Speaker 1: we have available to us, the better and differentiated service
• 33:57
  Speaker 1: we can provide.
• 33:59
  Speaker 3: Yeah, I was a good lead into My next question
• 34:02
  Speaker 3: was how fluid is you know, the opportunity for a
• 34:07
  Speaker 3: client to go in midyear and make adjustments and changes
• 34:13
  Speaker 3: based on maybe more evidence that's now being gathered.
• 34:17
  Speaker 1: Sure, quarterly, quarterly is generally because you have to have
• 34:21
  Speaker 1: some sort of structured cadence so that you're not just
• 34:26
  Speaker 1: going at will and things are just changing midstream and
• 34:29
  Speaker 1: people don't know what end is up.
• 34:31
  Speaker 4: But clients have the opportunity.
• 34:33
  Speaker 1: To make change, and we we regularly make changes on
• 34:35
  Speaker 1: a quarterly basis.
• 34:37
  Speaker 3: Do you have some kind of a pill process for
• 34:39
  Speaker 3: that one off when a patient really is feeling like
• 34:42
  Speaker 3: they need a name brand but the but you know,
• 34:46
  Speaker 3: the generic is on formulay?
• 34:49
  Speaker 4: Yeah, we are.
• 34:50
  Speaker 1: Our clinical team reviews all level all appeals, all level
• 34:54
  Speaker 1: two reviews, and all appeals. So there is the opportunity
• 34:57
  Speaker 1: to look at, you know, what is this patient's unique case.
• 35:02
  Speaker 1: Why did they need this non formulary drug. Do they
• 35:05
  Speaker 1: have allergies to the other the other drugs in the class.
• 35:10
  Speaker 4: Have they tried it and they failed? What's going on here?
• 35:12
  Speaker 1: So there is that, Uh, there is that process put
• 35:17
  Speaker 1: in place. And in fact, when I came to General Office,
• 35:20
  Speaker 1: I was that formulary review the PA review pharmacist for KPP.
• 35:27
  Speaker 4: So I got it was.
• 35:28
  Speaker 1: Hard because you know, I had a bleeding heart. I'm like, well,
• 35:31
  Speaker 1: of course we're going to prove it is they need access.
• 35:33
  Speaker 1: It's you know, that's it's a community provider. That's you're
• 35:37
  Speaker 1: always kind of your your your first point of view
• 35:39
  Speaker 1: is how do you get this patient they're drug versus
• 35:43
  Speaker 1: On the plan side, you're looking at you know, what's
• 35:46
  Speaker 1: the cost, what's the other ramifications here? So I think
• 35:48
  Speaker 1: that balance that we have with Kroager prescription plans, like
• 35:52
  Speaker 1: with myself.
• 35:53
  Speaker 4: Now leading it.
• 35:55
  Speaker 1: Of pharmacists thinking like community pharmacy providers, but doing it
• 36:00
  Speaker 1: with the plan fiduciary interest in mind.
• 36:04
  Speaker 3: Wow, that's excellent. Well, is there anything doctor Kirby that
• 36:07
  Speaker 3: we haven't discussed that you think is important that we
• 36:10
  Speaker 3: should let our listeners know about.
• 36:15
  Speaker 4: I think we touched on most of the things.
• 36:18
  Speaker 1: I would say that, you know, for the listeners and
• 36:22
  Speaker 1: my fellow pharmacists out there, is that I would say
• 36:26
  Speaker 1: a couple of things. One is I would find ways
• 36:28
  Speaker 1: to work with PBMs and challenge them on what you
• 36:32
  Speaker 1: can do to improve the care of their membership. They're
• 36:35
  Speaker 1: open and looking and oftentimes they're looking to digital or
• 36:40
  Speaker 1: virtual solutions for diabetes management and hypertension management. But our
• 36:45
  Speaker 1: staffs are more than equipped to be able to do
• 36:48
  Speaker 1: those sorts of things and deliver I would say, better
• 36:50
  Speaker 1: outcomes because of the longitudinal relationships that we have and
• 36:54
  Speaker 1: exist more than just in a digital virtual ecosystem.
• 37:00
  Speaker 4: So that's that's one thing.
• 37:03
  Speaker 1: And the second thing I would say is standard ground
• 37:07
  Speaker 1: on things that should be managed by the pharmacist as
• 37:12
  Speaker 1: providers and.
• 37:12
  Speaker 4: Not taken by the PBM.
• 37:14
  Speaker 1: So for instance, medical billing for test to treat services
• 37:22
  Speaker 1: and chronic disease management services. You know, I just use
• 37:25
  Speaker 1: that as an example that you could work with the
• 37:27
  Speaker 1: PBM on and bill as a B to B service provider,
• 37:31
  Speaker 1: but you could also, you know, particularly as we move
• 37:34
  Speaker 1: forward with provider status in certain states or just you know,
• 37:40
  Speaker 1: being considered as such by the pair billing those encounters
• 37:44
  Speaker 1: on the medical benefit and getting into the medical networks
• 37:47
  Speaker 1: and dealing directly with the upstream plan is absolutely key.
• 37:50
  Speaker 1: And you've got several PBMs that are trying to insert
• 37:54
  Speaker 1: themselves in that space and build those medical clinical encounters
• 38:01
  Speaker 1: as a NCPDP transaction, and I think that that's completely inappropriate.
• 38:08
  Speaker 1: We are providers, we are clinicians, and we need to
• 38:13
  Speaker 1: act like the rest of the provider community and become
• 38:18
  Speaker 1: providers in the Medical Networks Bill as such and not
• 38:22
  Speaker 1: allow the PBMs to negotiate on our behalf.
• 38:26
  Speaker 3: Very well said, and I'm glad that you brought that up.
• 38:28
  Speaker 3: That's a key point. A lot of community pharmacies and
• 38:34
  Speaker 3: grocery store chains and others are looking at how to
• 38:37
  Speaker 3: expand their scope of services into more clinical and for me, it's,
• 38:42
  Speaker 3: you know, another way to bypass the poor reimbursements of
• 38:47
  Speaker 3: just dispensing the medication and offering more services to your patients.
• 38:51
  Speaker 3: And it's going to make those patients more sticky to
• 38:54
  Speaker 3: you if you're providing those additional services as a community pharmacist.
• 39:01
  Speaker 3: Some rapid fire questions for you, real quick, Jim. Just
• 39:04
  Speaker 3: the first thing comes to mind. You're ready? Are you early?
• 39:08
  Speaker 3: Birder night?
• 39:08
  Speaker 1: Ol?
• 39:10
  Speaker 3: Uh?
• 39:11
  Speaker 4: Neither? How about that.
• 39:15
  Speaker 3: Depends on the circumstance.
• 39:17
  Speaker 4: That's right.
• 39:18
  Speaker 1: If it's if there's bourbon involved, then maybe late night.
• 39:21
  Speaker 1: But on a given work work day, I like to
• 39:25
  Speaker 1: rise early and have.
• 39:27
  Speaker 4: My loon time.
• 39:28
  Speaker 3: Yeah, okay, excellent. And then are you do you prefer
• 39:31
  Speaker 3: the mountains or the beach mountains? Okay? And are you
• 39:37
  Speaker 3: do you prefer coffee, tea or something else.
• 39:40
  Speaker 4: Coffee stronger the better.
• 39:42
  Speaker 1: Okay, if you can kill a small rodent, that's the
• 39:45
  Speaker 1: type of coffee I like.
• 39:48
  Speaker 3: Your spoon stands up in it right, exactly excellent. So well,
• 39:54
  Speaker 3: thank you doctor Kirby for being our guest today on
• 39:57
  Speaker 3: the pbum Reform Podcast. It's great to get know you
• 40:00
  Speaker 3: a little better and I hope that this has been
• 40:03
  Speaker 3: educational to a lot of our listeners today, So thanks
• 40:07
  Speaker 3: again for being here, and you have been listening to
• 40:10
  Speaker 3: the Pbium Reform Podcast here on the Pharmacy Podcast Network.
• 40:14
  Speaker 3: Thanks everyone,