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Inside M3P: What Medicare Providers and Patients Need to Know | NASP Specialty Pharmacy Podcast · Pharmacy Podcast Network

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Speaker 1: You are listening to the global network of podcasters dedicated
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Speaker 1: to the pharmacy profession. Welcome to the Pharmacy Podcast Network.
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Speaker 2: You're listening to the NASP Specialty Pharmacy Podcast, a collaboration
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Speaker 2: between the National Association of Specialty Pharmacy and the Pharmacy
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Speaker 2: Podcast Network. Each episode dives deep into trends, challenges, innovations,
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Speaker 2: and patient centric practices shaping the future of this dynamic
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Speaker 2: and rapidly evolving industry. Whether you're a pharmacist or healthcare provider,
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Speaker 2: patient advocate, or industry leader, you'll hear expert insights, real
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Speaker 2: world evidence, and thought provoking discussion that highlights all that
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Speaker 2: makes specialty pharmacy special.
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Speaker 3: In support of NASP's mission to empower specialty pharmacy stakeholders
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Speaker 3: to advance the standard of patient care, NASP supports a
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Speaker 3: free market healthcare system in which all specialty pharmacies compete
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Speaker 3: on the same fare and level playing field, because that
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Speaker 3: is in the best interest of the patients we collectively serve.
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Speaker 3: NASP is committed to working with all stakeholders and policymakers
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Speaker 3: to ensure that all patients have access to the life
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Speaker 3: saving medications they need and the high touch patient care
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Speaker 3: and support services they deserve from the pharmacy of their choosing.
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Speaker 4: Hello.
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Speaker 5: My name Michila Arqatt and I'm the President and CEO
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Speaker 5: of the National Association of Specialty Pharmacy. I am delighted
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Speaker 5: to welcome my special guests, Diane Amdhal and Sherry Wallace
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Speaker 5: to this episode of the NASP Podcast. For more than
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Speaker 5: forty years, Diane Amdal RNMS has kept her finger on
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Speaker 5: the pulse of ever changing Medicare regulations. She's a registered
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Speaker 5: nurse who launched her first company in the basement of
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Speaker 5: her home and grew it into a multi million dollar
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Speaker 5: business providing Medicare related training for long term care businesses.
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Speaker 5: Over the years, Diane has delivered more than five hundred
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Speaker 5: Medicare related presentations and webinars to consumers, professional organizations, and
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Speaker 5: companies including Edward Jones, Allstate, FPA, and more, making her
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Speaker 5: a very experienced and highly rated speaker. Today. Through her
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Speaker 5: company sixty five Incorporated, Diane uses her extensive experience to
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Speaker 5: provide seniors, their families, and the professionals that serve them
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Speaker 5: with unbiased, individualized Medicare enrollment guidance through fee for service consultations.
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Speaker 5: And the I sixty five Medicare guidance software. Diane also
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Speaker 5: works with the nation's foremost corporations like PBS and McMillan Publishing,
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Speaker 5: providing their human resources staff, employees, and retirees with expert,
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Speaker 5: unbiased Medicare consultation and speaking services. Diane has been featured
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Speaker 5: in publications such as USA Today, The Washington Post, The
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Speaker 5: Wall Street Journal, CBS, Money Watch, Kiplinger, and many more.
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Speaker 5: She is also a technical expert for this for Medicare
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Speaker 5: and Medicaid Services, the organization that runs the Medicare program. Additionally,
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Speaker 5: Diane's book, Medicare and You is available at human x Books.
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Speaker 5: Cherry Wallace is a dedicated sales executive with over twenty
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Speaker 5: years of experience in patient access and health care solutions.
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Speaker 5: Currently an account representative at a Carrea Health Specialty Pharmacy,
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Speaker 5: she has spent the past two and a half years
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Speaker 5: delivering results that directly enhance the patient experience. Cherry's passion
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Speaker 5: lies in advancing sustainable, best in class patient care, ensuring
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Speaker 5: that every initiative she leads, empowers, educates, and supports all
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Speaker 5: stakeholders in the healthcare journey. Her consistent topchair performance is
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Speaker 5: driven by a deep rooted belief that every success must
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Speaker 5: ultimately benefit the patient. Cherry is a true advocate committed
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Speaker 5: to making health care more accessible, compassionate, and effective for
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Speaker 5: those who need it most. Diana Cherry, thanks so much
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Speaker 5: for joining me today.
3:57
Speaker 4: Thanks for having me.
3:59
Speaker 5: Yes, thank you too, so Diane. For those unfamiliar, what
4:04
Speaker 5: exactly is the Medicare Prescription Payment Plan or M three
4:08
Speaker 5: P and why is it often referred to as smoothing.
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Speaker 6: The Medicare Prescription Payment Plan is a new program that
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Speaker 6: started January first of this year. The introduction coincided with
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Speaker 6: the two thousand dollars cap on party drug costs. That
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Speaker 6: two thousand dollars cap is the most anybody would pay
4:27
Speaker 6: for medications out of pocket that are covered, meaning listed
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Speaker 6: in the plan's formulary and obtained from an in network pharmacy.
4:37
Speaker 6: If a person is going to hit that two thousand
4:40
Speaker 6: dollars cap in January, that can be a real big
4:43
Speaker 6: hit in their budget. So the centers for Medicare Medicaid
4:47
Speaker 6: Services came up with.
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Speaker 5: This MPPP or M three P.
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Speaker 6: It is like the old department store installment payment plans.
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Speaker 6: You have a two thousand dollars bill and they split
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Speaker 6: the payment into equal amounts that will carry from January
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Speaker 6: through December, and so therefore the smoothing comes into play,
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Speaker 6: which means instead of a big hit of two thousand,
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Speaker 6: you have a nice smooth ride. The ride isn't always
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Speaker 6: that smooth, as you will hear, and there can be hiccups.
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Speaker 6: And I guess that's why we are here today talking
5:17
Speaker 6: about the program.
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Speaker 5: Share any insights.
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Speaker 4: It can be really helpful for patients who don't have
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Speaker 4: on a fixed income the amount of money necessary to
5:30
Speaker 4: pay for their biologic or some sort of the high
5:33
Speaker 4: cost drugs, so it can be really helpful to them.
5:37
Speaker 4: But I think there are pitfalls which we can discuss.
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Speaker 4: Is to just making sure that they understand how that's
5:42
Speaker 4: going to be build to them and what that impact
5:45
Speaker 4: is to their coverage overall.
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Speaker 5: So, Dan, can you tell us what inspired you to
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Speaker 5: focus on m THREEP for this podcast. Ah.
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Speaker 6: I think what inspired me to focus on it is
5:55
Speaker 6: because it is it is confusing. It is not a
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Speaker 6: program that has the kind of numbers that the government
6:02
Speaker 6: would think that it would have for the number of
6:04
Speaker 6: people with high drug costs, and I think part of
6:07
Speaker 6: that comes into the reason being they don't understand the program.
6:13
Speaker 6: You know, some of the things about the program I
6:15
Speaker 6: think we should lay out is that participation is entirely voluntary.
6:20
Speaker 6: Well that is until next year, and that will come.
6:24
Speaker 6: But anyway, it is up to you to decide whether
6:26
Speaker 6: you should enroll. If you have the high drug costs
6:30
Speaker 6: at the beginning of the year, you'll get notified by
6:32
Speaker 6: your plan. Now, let's say you don't have high drug
6:34
Speaker 6: costs in January and you go to the pharmacy in
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Speaker 6: May and suddenly you have one of these high cost
6:39
Speaker 6: drugs that's going to be two thousand dollars. The pharmacy
6:44
Speaker 6: will give you a notice called the Likely to Benefit
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Speaker 6: that explains what the program is, and then you can
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Speaker 6: decide if you want to enroll, and then your cost
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Speaker 6: will be smoothed. I already mentioned it only for covered medications.
7:01
Speaker 6: The once you're in the program, there is no co
7:04
Speaker 6: payment that or cost sharing that you will pay the pharmacy,
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Speaker 6: And I think that might be one of the reasons
7:09
Speaker 6: people are reluctant. They are going to get bills from
7:12
Speaker 6: their farm from their drug plan. Now the bills are
7:17
Speaker 6: not the amount that they would think. Sometimes you know,
7:19
Speaker 6: you take an amount divide by twelve, but there are
7:22
Speaker 6: involved calculations that drug plans use and they will send
7:27
Speaker 6: you the bill. Then you have to arrange to pay
7:29
Speaker 6: it to them, not to the pharmacy. Then you pay
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Speaker 6: these bills on a monthly basis, and the amount of
7:35
Speaker 6: the bill can change. Why it is not more, Why
7:40
Speaker 6: there are not more people involved? I really have no
7:43
Speaker 6: answer except CMS has not done much to promote it.
7:47
Speaker 6: We have done some education here, but many of our
7:50
Speaker 6: clients decide I don't want to I don't want to
7:53
Speaker 6: change the way that I pay for the medications. I
7:56
Speaker 6: want to know what I'm paying now. I don't want
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Speaker 6: to deal with monthly bills from my drug plan because
8:01
Speaker 6: if I try to call them, I run into problems.
8:04
Speaker 6: So there's many of those reasons, and we decided we're
8:09
Speaker 6: going to focus on it to kind of let the
8:11
Speaker 6: pharmacists know that it's out there, because they play an
8:14
Speaker 6: important role in notifying people.
8:17
Speaker 5: And Sherry can speak more to that.
8:20
Speaker 3: Right.
8:21
Speaker 5: So, as you were talking, it just got me thinking, Cherry,
8:23
Speaker 5: who pays the pharmacy? How do they get paid?
8:26
Speaker 4: CMS pays the pharmacy, and so the patient really is
8:32
Speaker 4: in a different position because they're not walk there way,
8:35
Speaker 4: they can walk out of the pharmacy and not pay anything,
8:38
Speaker 4: but then they are going to get a bill from
8:39
Speaker 4: their plan. I think as to why people are not enrolling,
8:44
Speaker 4: and the last numbers I had showed it was less
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Speaker 4: than two hundred thousand people that had enrolled so far
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Speaker 4: this year. Those are a couple of months old, but
8:51
Speaker 4: I don't think they've significantly jumped by any large amount.
8:55
Speaker 4: We at the pharmacy, when we talk to patients on
8:59
Speaker 4: the phone about their coverage, we'll say to them, you know,
9:03
Speaker 4: your doctor got prescribed this this medication to you, and
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Speaker 4: this is what the out of pocket cost is for
9:09
Speaker 4: you at this time, and then we have this option
9:12
Speaker 4: for you to talk about, you know, the M three
9:14
Speaker 4: P plan. Patients hear that big number with one thousand
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Speaker 4: plus dollars after it, and they don't understand about paying
9:23
Speaker 4: for They don't have the money to pay for that.
9:25
Speaker 4: They're also remember that people are getting a lot of
9:28
Speaker 4: medications at the pharmacy that aren't triggering the knowledge of
9:32
Speaker 4: this plan. To say, they get Aliquis, which is I
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Speaker 4: think the most commonly covered you know, high cost sort
9:39
Speaker 4: of regular prescription drug for CMS. So if they're picking
9:42
Speaker 4: up their quest prescription, they can be spending one hundred
9:45
Speaker 4: and fifty to three hundred dollars a month commonly, so
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Speaker 4: they are already facing that monthly cost and they don't
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Speaker 4: understand how that would integrate into the M three P
9:54
Speaker 4: out of pocket. So unless we get patients started right
9:57
Speaker 4: away at the beginning of January, if they've already paid forloquists,
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Speaker 4: they may not have the money for that next bill
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Speaker 4: to be coming. Remember, these are all people on a
10:04
Speaker 4: pretty solidly fixed income monthly, and so I think where
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Speaker 4: we see people drop off largely is right in the
10:11
Speaker 4: very beginning, where they hear that the what they consider
10:14
Speaker 4: the COPEID, but what's the out of pocket cost for
10:16
Speaker 4: them on their plan for this medication? And it just
10:19
Speaker 4: seems insurmountable. And so when someone's trying to explain to
10:23
Speaker 4: them what this is, they're not They don't even stay
10:28
Speaker 4: on the phone. Look you listen to them or read
10:29
Speaker 4: the notes. A lot of patients aren't even staying on
10:32
Speaker 4: the phone to hear about the options for paying it.
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Speaker 4: They're just like, I can't afford this. I'm going to
10:36
Speaker 4: go talk to my doctor. And whether they even show
10:38
Speaker 4: up and talk to their doctor. After that, it varies,
10:42
Speaker 4: like we start to just see people drop off there rapidly,
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Speaker 4: to the point of, you know, very few people actually
10:48
Speaker 4: getting that medication, which already is a problem with some
10:51
Speaker 4: of these high cost drugs. The number of prescriptions written
10:54
Speaker 4: compared to the patients who actually can receive them is
10:57
Speaker 4: quite different.
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Speaker 5: Is there require for the pharmacists to describe or explain
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Speaker 5: this program to the beneficiaries.
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Speaker 4: Unfortunately, there is no educational requirement. To my knowledge, pharmacies
11:09
Speaker 4: do not have to provide education to the patient about this.
11:12
Speaker 4: We do at a carrier health. We provide that as
11:15
Speaker 4: part of educating the patient and will answer questions, refer
11:19
Speaker 4: them to their plan. We can even be on the
11:22
Speaker 4: phone with them while they talk to their plan. We
11:25
Speaker 4: can talk to the doctor who can talk to the
11:27
Speaker 4: patient and have the patient come in, and often the
11:30
Speaker 4: doctor is a more trusted source because remember we're on
11:33
Speaker 4: the phone at the pharmacy level with them. But they
11:36
Speaker 4: you know, a lot of times if they're at their
11:37
Speaker 4: retail pharmacy, the person there isn't educated to help them
11:40
Speaker 4: even if they wanted to, and because there's no requirement,
11:43
Speaker 4: they just aren't getting, you know, counter education at their
11:47
Speaker 4: typical part of point of getting one of these medications.
11:50
Speaker 4: And if it's your first time getting a specialty drug,
11:52
Speaker 4: remember that this is a big educational jump for patients anyway,
11:57
Speaker 4: because there's a lot that comes with these these medications.
12:00
Speaker 4: There's a lot of training for the medication. There's a
12:02
Speaker 4: lot of details, there's a lot of things that patients
12:05
Speaker 4: are already worried about because of why they're getting the medication,
12:08
Speaker 4: what may be going along with that. There's a lot
12:10
Speaker 4: to take in and so I think that we're just
12:12
Speaker 4: not overall, we're failing all of us in the community,
12:18
Speaker 4: in the village of getting people their medication. We're all
12:21
Speaker 4: getting all the information to the patients as best we can,
12:25
Speaker 4: and there's just loopholes everywhere.
12:27
Speaker 6: CMS does not require the pharmacy to provide education, so
12:32
Speaker 6: Sherry was correct. It is up to the plan to
12:34
Speaker 6: do that, and anybody who has ever tried to contact
12:38
Speaker 6: a representative from their part the plan knows the problems
12:41
Speaker 6: that are involved. Now. Twenty twenty six, one of the
12:45
Speaker 6: regulations that was finalized has to do with informing the
12:49
Speaker 6: Drug Plan members about the cost of a drug. CMS
12:53
Speaker 6: had put forth that at the time a prescription is delivered,
12:57
Speaker 6: the pharmacy is supposed to give the price the out
13:01
Speaker 6: of pocket cost to the patient, but what ended up
13:05
Speaker 6: being finalized was that they do not have to inform
13:08
Speaker 6: them of the actual cost of the drug at the
13:10
Speaker 6: point of sale, but CMS encourages them to leverage standard
13:14
Speaker 6: industry data to provide cost verbally upon request, so if
13:19
Speaker 6: the patient requests an idea of the cost, they will
13:23
Speaker 6: get kind of a ballpark number. And as Shary and
13:27
Speaker 6: I were discussing, if I don't exactly know how much
13:30
Speaker 6: I'm going to pay for this drug, I'm just going
13:31
Speaker 6: to leave it sit there with the pharmacist and then
13:34
Speaker 6: we could figure this out later. And then as a result,
13:38
Speaker 6: we do not get the medications that we need.
13:40
Speaker 5: So this is a lot of change for these beneficiaries.
13:42
Speaker 5: How do you see this impacting patients directly, especially those
13:45
Speaker 5: who are already struggling with access or affordability, Diane.
13:49
Speaker 6: Oh, definitely, the confusion, the confusion, and I would just
13:54
Speaker 6: if I was in that situation and on a fixed income,
13:57
Speaker 6: I would definitely decide to run away and go to
13:59
Speaker 6: talk to my doctor. As Sherry has said, so many
14:02
Speaker 6: do we deal with so many people, and these people,
14:07
Speaker 6: many of our clients, are not unfixed incomes, and even
14:10
Speaker 6: they have opted not to because I think they do
14:12
Speaker 6: not trust the drug plans to have the bills be correct.
14:16
Speaker 6: They know that if there's a question about the bill,
14:18
Speaker 6: they're going to have trouble getting it clarified. So they
14:21
Speaker 6: just would rather continue to pay the way that they pay.
14:24
Speaker 6: And as I said, some of them, good chunk of them,
14:28
Speaker 6: can afford the cost. But you know people who are
14:32
Speaker 6: on mail order they pay once every three months. You
14:35
Speaker 6: go into the plan, you're paying monthly. And is it
14:37
Speaker 6: any wonder trying to figure out the numbers exactly how
14:41
Speaker 6: much I pay a month? Is that match when I'm
14:43
Speaker 6: supposed to pay? That's where the confusion comes in. And
14:47
Speaker 6: I agree with the numbers that Sherry had put forth,
14:51
Speaker 6: because people aren't signing up, and I don't know if
14:53
Speaker 6: it's going to become much better with some of the
14:55
Speaker 6: changes that they put forth. Scherry mentioned there's no requirement
15:01
Speaker 6: for them to enroll. But those people in the plan
15:05
Speaker 6: as we talk right now, if they're in the MPPP
15:09
Speaker 6: and they continue with the same plan, which not a
15:12
Speaker 6: real good chance of that, but if they continue with
15:14
Speaker 6: the same plan they're in, they will be automatically enrolled
15:17
Speaker 6: in the program unless they opt out.
15:19
Speaker 5: And we know people rarely opt out.
15:22
Speaker 6: When given the opportunity to because they may not be
15:24
Speaker 6: paying attention or whatever. So they would program next year again.
15:28
Speaker 6: And as I said to Sherry, and neither of us
15:31
Speaker 6: know what if the expensive drug that I took at
15:34
Speaker 6: the start of the year that put me in the
15:36
Speaker 6: program has been discontinued in I no longer would have
15:39
Speaker 6: those costs. Will I get automatically enrolled in a program
15:42
Speaker 6: where the costs are going to be crazy? Just so
15:46
Speaker 6: much unknown? And I often say I think the people
15:49
Speaker 6: at CMS who develop these programs have not been down
15:52
Speaker 6: here where Sherry and I live to see how the
15:55
Speaker 6: rubber meets the road, and you can't get there from here.
15:59
Speaker 6: Sometimes has always been my approach with Medicare and some
16:02
Speaker 6: of the rules.
16:04
Speaker 5: Right, I guess it probably it makes sense from the
16:06
Speaker 5: perspective of, oh, geez, we don't think a lot of
16:08
Speaker 5: people know about this, so it looks like these people
16:10
Speaker 5: would have benefited from it, and we're going to auto
16:12
Speaker 5: enroll them. But to your point, not thinking oh, something
16:15
Speaker 5: may have changed, right, and maybe they no longer need this,
16:18
Speaker 5: maybe they're on something else maybe right, So then how
16:20
Speaker 5: do you capture that? So I think sometimes I think
16:24
Speaker 5: they have the best intentions, it's just not fully vetted correct. Yeah,
16:30
Speaker 5: what we.
16:31
Speaker 4: See on the specialty pharmacy side is that like most
16:35
Speaker 4: things with high cost drugs, it falls on the prescriber's
16:40
Speaker 4: office to do the bulk of the education. Here if
16:43
Speaker 4: patients are to receive those meds, they're they're coming in
16:47
Speaker 4: because there is a follow up criteria determined the provider,
16:52
Speaker 4: if they're prescribing a drug like this, has requirements to
16:55
Speaker 4: see the patient every so often, determined efficacy, et cetera.
16:59
Speaker 4: So the patient is going into a trusted source and
17:02
Speaker 4: a safe space where they're already comfortable discussing things. And
17:07
Speaker 4: so the patients really depend on their providers to be
17:10
Speaker 4: able to explain how this program works and also explain
17:14
Speaker 4: to them and remind them. I mean, I forget things
17:19
Speaker 4: all the time, and I don't have to worry about
17:21
Speaker 4: this medication thing being one of them. But if you
17:24
Speaker 4: start on a medication and then you want to change
17:27
Speaker 4: or opt out of the M three P as it goes,
17:29
Speaker 4: you know into next year. The prescriber's offices are the
17:32
Speaker 4: wonderful source that patients do have, but access to their
17:36
Speaker 4: office that's also there's a hurdle there. That many hurdles,
17:39
Speaker 4: But when you do have a prescriber office, they're really
17:42
Speaker 4: the centrals clearing house functionally that works to get patients
17:46
Speaker 4: the info, like we'll call them and say, hey, your
17:48
Speaker 4: doctor prescribed this for you and here's the pathway. But
17:51
Speaker 4: often the patients depend on the doctor's office or the
17:54
Speaker 4: prescriber's office to really help them through all the steps
17:57
Speaker 4: and help them, you know, unenroll at the end of
17:59
Speaker 4: the year or explain what their notices me. So as
18:02
Speaker 4: part of educating the offices, I'm going it's like full
18:06
Speaker 4: speed ahead this time of year anyway. The medication coordinators
18:11
Speaker 4: call it blizzard season, and that's when you know, everybody's
18:14
Speaker 4: plans are changing and things are changing, formulas are changing everything.
18:18
Speaker 4: And so I'm educating the offices so that they can
18:21
Speaker 4: better help the patients navigate all these little intricacies to say, hey,
18:25
Speaker 4: if you don't want to sign up for next year,
18:27
Speaker 4: or if your Medicare plan is not being offered next year,
18:31
Speaker 4: which many of them aren't you're going to have to
18:32
Speaker 4: sign up again for this. And so the prescriber's office
18:36
Speaker 4: is going to also be able to help the patients
18:38
Speaker 4: if they're educated and willing, which in my experience they
18:43
Speaker 4: really are. But they can stage the medication prescriptions, they
18:46
Speaker 4: can sample a little bit at the end of the year.
18:49
Speaker 4: They can really work with the patients to get them
18:51
Speaker 4: started on the right schedule that meets their needs, so
18:54
Speaker 4: the bills will come, you know, when they need the
18:56
Speaker 4: bills to come. They're really the prescribers office really has
19:00
Speaker 4: just gotten this basket dropped in their lap. And so
19:04
Speaker 4: on top of the other costs and efforts it takes
19:06
Speaker 4: to get access to these medications, this is really falling
19:10
Speaker 4: on the prescribers' offices, which is why they're leaning on
19:13
Speaker 4: specially pharmacy for help with this.
19:16
Speaker 6: And I think I need to add another change for
19:19
Speaker 6: twenty twenty six. Let's say that the prescriber's office does
19:23
Speaker 6: convince the patient that this program would be beneficial. In
19:28
Speaker 6: twenty twenty six, these patients cannot sign up at the
19:33
Speaker 6: pharmacy counter. They would have to enroll through their plan.
19:36
Speaker 6: So we circle back to all of the problems that
19:39
Speaker 6: people have trying to figure out how do I enroll
19:41
Speaker 6: through my plan. I actually spent an hour trying with
19:46
Speaker 6: the different drug plans trying to see where I would
19:49
Speaker 6: enroll on the website, nothing is consistent, nothing is standardized.
19:53
Speaker 6: In one plan. I couldn't find a place where I
19:57
Speaker 6: can sign up for this program.
19:58
Speaker 5: So taking away.
20:00
Speaker 6: Signing up the pharmacy counter, I think, is only going
20:02
Speaker 6: to add more hurdles to getting the necessary medications.
20:06
Speaker 5: It's a lot. They're put on anyone's stakeholder, right, Like
20:09
Speaker 5: we're talking about, you know, putting it on a provider,
20:12
Speaker 5: and Medicare is not the only payer that they deal with, right,
20:15
Speaker 5: So patients are expecting them to be experts on all
20:18
Speaker 5: of these plans, right for beneficiaries, but then for like
20:22
Speaker 5: you know, the commercial market and the exchange and you
20:24
Speaker 5: know self funded and it's a lot.
20:27
Speaker 4: It's a lot. And the medication coordinators in these offices,
20:30
Speaker 4: I can't say enough as to what they do to
20:34
Speaker 4: provide this key access point for patients because they know
20:39
Speaker 4: so many things about so many plans. They know the
20:42
Speaker 4: intricacies of what's on the formula in which stage. You remember,
20:45
Speaker 4: drugs come out all the time, so I'm speaking like
20:48
Speaker 4: from a specialty perspective, but you know, I was just
20:51
Speaker 4: in office yesterday and saw that something. I saw that
20:54
Speaker 4: it had cleared the FDA a couple of weeks ago,
20:56
Speaker 4: and now it's being sampled and available in the office.
20:59
Speaker 4: So we were discussing does this fall before or after
21:02
Speaker 4: in these formularies for access? So would you have to
21:07
Speaker 4: prescribe this before this drug or would you be able
21:10
Speaker 4: to prescribe this drug first? So they not only have
21:12
Speaker 4: to get the patient that's in front of them, like
21:14
Speaker 4: we're just talking one discrete example of working with this
21:17
Speaker 4: particular medicure patient for this, but they have to by
21:20
Speaker 4: the time the patient's gotten here, that coordination has already
21:25
Speaker 4: gotten the prescriber the information that says, okay, this is
21:29
Speaker 4: where we're headed. But this is the steps that the
21:31
Speaker 4: patients are going to have to go through. This is
21:33
Speaker 4: what's on formulay with their plan, this is what's excluded.
21:36
Speaker 4: They're going to really be understanding and helping the prescriber
21:41
Speaker 4: all in all steps of this, which is why I
21:44
Speaker 4: think we see so many challenges that the provider office
21:47
Speaker 4: level currently as they're struggling to fund all of this
21:50
Speaker 4: man power in their office in addition to being healthcare providers. Yeah,
21:57
Speaker 4: m hm, And I think you know, the farmer companies
22:00
Speaker 4: are also really struggling to be helpful and help this,
22:07
Speaker 4: but they only have their piece of the puzzle. Like
22:09
Speaker 4: so many people enter this system siloed that it's very
22:14
Speaker 4: difficult to get all pieces of the puzzle to make
22:16
Speaker 4: the puzzle. You know, it'd be like trying to put
22:18
Speaker 4: a thousand piece Jake Saw puzzle together and you're missing
22:21
Speaker 4: like two hundred and fifty pieces or many more pieces
22:24
Speaker 4: depending on which silo you're coming from, trying to get somebody,
22:27
Speaker 4: you know through their shoots and ladders game.
22:30
Speaker 6: And I've always said, you don't have a picture on
22:32
Speaker 6: the box to help you.
22:33
Speaker 4: No.
22:35
Speaker 5: I wonder, Diane, how long it'll be before Medicare Party,
22:38
Speaker 5: you know, stipulates where it has to be on the
22:40
Speaker 5: website right to standardize that, because I think they do
22:42
Speaker 5: a pretty good job of trying to make sure that,
22:45
Speaker 5: you know, the benefit is applied consistently right to all beneficiary.
22:49
Speaker 5: So I wonder if that's coming right now.
22:52
Speaker 6: I think CMS has their hands full with trying to
22:54
Speaker 6: standardize the websites for the Medicare advantage plans, the network directories,
22:59
Speaker 6: and the supplement benefits, which is another entire can of worms.
23:04
Speaker 4: Another important piece of information for providers, offices and patients
23:11
Speaker 4: alike is that since this program came into play this year,
23:15
Speaker 4: which will be last year next year, in twenty twenty five,
23:19
Speaker 4: we have seen one pharmaceutical manufacturer require enrollment a proof
23:25
Speaker 4: of active enrollment in the M three P program prior
23:29
Speaker 4: to them offering PAP or patient assistance two patients for
23:33
Speaker 4: medication cost assistance. And so that is only one manufacturer
23:39
Speaker 4: that does it for all of their lines or all
23:41
Speaker 4: of their products. But I believe this will be we'll
23:44
Speaker 4: see this more and more in twenty twenty six in pharma.
23:48
Speaker 4: Our pharma partners have confirmed this when we've been talking,
23:51
Speaker 4: you know, kind of just informally. Currently we have quite
23:55
Speaker 4: a few of the manufacturer manufacturers asking patients to certify
24:02
Speaker 4: that they have signed up for the M three P.
24:04
Speaker 4: But it's just an ascertation that they can fill out,
24:07
Speaker 4: send in and then the PAP applications are processed after that.
24:12
Speaker 4: Some are requiring them to do some sort of proof,
24:17
Speaker 4: like a piece of paper showing that they've signed up
24:19
Speaker 4: for the M three P and I think that's going
24:22
Speaker 4: to be the standard that we're going to get to
24:25
Speaker 4: by the end of twenty twenty six. Because the pharma
24:28
Speaker 4: companies are, you know, in the office when you're really
24:31
Speaker 4: really busy as a provider, it's tempting to be like, Okay,
24:34
Speaker 4: the patient can't afford their out of pocket, it's troublesome
24:38
Speaker 4: to get the PA's it's you know, And so the
24:40
Speaker 4: offices and the patients, like everyone's really leaned on the
24:43
Speaker 4: pharma partners to come up and provide this no cost
24:47
Speaker 4: medication through their pack programs. But barma can't be expected
24:51
Speaker 4: to do that, especially with everything else that's going on.
24:54
Speaker 4: And when we think about how these especially in the
24:58
Speaker 4: medicare with them three p this is really limiting the
25:01
Speaker 4: amount of money that's being paid to the plans for
25:04
Speaker 4: these drugs. Something's got to be able to give here,
25:07
Speaker 4: and so I think that we're just going to see
25:09
Speaker 4: these patients having to actively enroll and show proof of it.
25:13
Speaker 4: So the knowledge of how to get this done in
25:16
Speaker 4: the office, where to go for each plan, what the
25:18
Speaker 4: link is for each plan, the education on how to
25:21
Speaker 4: do it, and then for the patient who says, okay,
25:24
Speaker 4: I'm an actively enroll, but then and I'm going to
25:27
Speaker 4: do that, but then there's a time limit there where
25:30
Speaker 4: you actively enroll, medication is dispensed, you get a bill.
25:34
Speaker 4: When does PAP come in? How is that being handshaked
25:37
Speaker 4: between everyone involved? Because there's several partners there and maybe
25:42
Speaker 4: you know a couple different types of pharmacies. If you're
25:44
Speaker 4: talking if the barma partner is you know, self dispensing
25:48
Speaker 4: some of the free drug this can get really complicated.
25:51
Speaker 4: And offices are facing this more and more. And it's
25:54
Speaker 4: the most popular drugs or the most commonly written drugs
25:58
Speaker 4: that we're seeing coming up first. And it's not a
26:01
Speaker 4: roll out where it's like, oh, this name brand drug
26:04
Speaker 4: is doing this. They're doing it one thing for one diagnosis,
26:08
Speaker 4: one thing for another diagnosis, and one thing for another.
26:11
Speaker 4: And I've talked to pharma partners who are mightily struggling
26:15
Speaker 4: to get people enrolled in the M three P because
26:17
Speaker 4: they don't even understand all the finer points of enrollment
26:21
Speaker 4: and getting through. So their frms and partners are really
26:25
Speaker 4: struggling as well. So this is where I think with
26:27
Speaker 4: pharma and specialty pharmacy sides, we're going to have to
26:31
Speaker 4: all really work together here with our provider offices to
26:34
Speaker 4: get these patients enrolled and gone and getting through the
26:37
Speaker 4: system in a more timely manner, because this is going
26:39
Speaker 4: to cause major holdups.
26:42
Speaker 5: So all of this really highlights the importance of education
26:44
Speaker 5: and clarity. What resources or tools do you recommend for
26:48
Speaker 5: providers and patients to better understand the new process. JERRYL.
26:53
Speaker 6: Mass has done an absolutely lousy job of education. The
26:57
Speaker 6: stuff that's on their website. It took me some time
27:01
Speaker 6: to figure it out, and they address it to consumers,
27:06
Speaker 6: But forget it. If this consumer here, sitting here cannot
27:09
Speaker 6: figure it out from I've written things, but that doesn't
27:13
Speaker 6: do much good. So maybe Sherry has a better answer
27:16
Speaker 6: from her perspective, or maybe from the Pharmacy Association's perspective.
27:23
Speaker 4: What I'm seeing coming this year that are just dropping,
27:27
Speaker 4: like I'm just seeing him in my inbox. Even this
27:29
Speaker 4: morning I saw another one come is that some of
27:32
Speaker 4: the Medicare plans and Medicare Advantage plans are adding new
27:36
Speaker 4: tools for the twenty twenty six plan year, knowing that
27:39
Speaker 4: this is open enrollment, so they are adding additional resources
27:43
Speaker 4: and things where patients and family members can go and
27:47
Speaker 4: get more information. I think how those are going to be,
27:51
Speaker 4: you know, I don't know, because it's just going to
27:53
Speaker 4: depend on the plan and what was already there for patients.
27:57
Speaker 4: But I would say that there's also some your specialty
28:03
Speaker 4: pharmacy in provider's office, and patients that have access to
28:07
Speaker 4: their provider can always get information from the specialty pharmacy,
28:11
Speaker 4: even if they're not receiving it, they can they can
28:13
Speaker 4: always try to find so I think that's a pretty
28:16
Speaker 4: good if you're on a high cost drug, the part,
28:18
Speaker 4: there will be a pharmacy that will provide education, and
28:21
Speaker 4: your provider can put you in touch with someone there,
28:24
Speaker 4: and you have to find the one that works with
28:25
Speaker 4: your PBM and your plan and all that. But there
28:28
Speaker 4: will be education available. You just may have to pick
28:30
Speaker 4: and choose and not go maybe to some of the
28:33
Speaker 4: ones you've used in the past, kind of branch out
28:35
Speaker 4: and use different things. But I do see the plans
28:38
Speaker 4: starting to add additional information. And I think all of
28:41
Speaker 4: the specialty pharmacies have guides to the M three P.
28:44
Speaker 4: They vary widely how useful and eat readable and you know,
28:48
Speaker 4: wonderful they are, but they all have provided those so
28:51
Speaker 4: because specialty pharmacy is so entrenched in this world, they're
28:54
Speaker 4: really one of the few places where you do have
28:57
Speaker 4: a non siloed for the most art viewpoint of the system.
29:01
Speaker 4: Because we deal with our pharma partners, we deal with
29:04
Speaker 4: the payers, we deal with the patients, the providers. There's
29:07
Speaker 4: really nobody in that loop that we're not commonly dealing
29:10
Speaker 4: with as an entity, so that if you can get
29:13
Speaker 4: access to someone there, I think that's really your best bet.
29:16
Speaker 4: But I am hopeful that you know, maybe by twenty
29:18
Speaker 4: twenty seven a lot of these plan additional education things
29:23
Speaker 4: will be helpful. And then Diane hasn't mentioned yet, but
29:27
Speaker 4: she has a fantastic tool that I've been recommending to people.
29:30
Speaker 4: It's called heymo dot com, where you can research for
29:34
Speaker 4: Medicare specifically, you can research what plans would be best
29:38
Speaker 4: for you. You can type in the particulars of your
29:40
Speaker 4: exact situation and look at what the landscape will be
29:43
Speaker 4: for your twenty twenty six years. And I think that's
29:46
Speaker 4: a fantastic tool. H e y moe dot com.
29:51
Speaker 5: Oh okay, awesome.
29:53
Speaker 6: AM always stands for Medicare Open Enrollment, and I think
29:58
Speaker 6: what sets us apart Medicare dot gov is looking at
30:03
Speaker 6: way more pharmacies fifteen of them, I think, and also
30:07
Speaker 6: the expertise of my partner and I in guiding it.
30:12
Speaker 6: Like I told Sherry, so many people with levo thyrox
30:16
Speaker 6: and will enter a capsule which the drug plans do
30:19
Speaker 6: not cover, and we will tell them change that to
30:22
Speaker 6: a tablet and those kinds of things we do. The
30:26
Speaker 6: interpretation Medicare dot Dove plan finder does not, So thank
30:29
Speaker 6: you Sherry for mentioning it. It's been a lot of work,
30:32
Speaker 6: but it is a nifty little It's.
30:36
Speaker 4: Really a much needed tool, and I've been sharing it
30:39
Speaker 4: with provider offices as well because I think it's helping
30:43
Speaker 4: them kind of navigate with their patients and the patient's
30:46
Speaker 4: families because a lot of times there are several levels
30:48
Speaker 4: to dealing with just the levels of patients and paying
30:52
Speaker 4: their bills and hip a compliance and who's ordering for
30:56
Speaker 4: the patient. Remember that we have multiple people in that
30:58
Speaker 4: chain as well to single person receiving the medication.
31:05
Speaker 5: So this is really interesting, right with all of this
31:07
Speaker 5: like direct to consumer type pricing models right and deliberate
31:11
Speaker 5: models that we're hearing about, it's just very very important
31:14
Speaker 5: that somebody have a complete patient profile right with all
31:17
Speaker 5: of these claims on there, so that these programs do
31:20
Speaker 5: what they're supposed to do.
31:21
Speaker 4: That would be ideal. And what's interesting is that patients
31:26
Speaker 4: often don't even have their own complete profile because their
31:29
Speaker 4: profile is spread between they're my chart programs that are
31:35
Speaker 4: spread across health plans, I mean health organizations, and so
31:43
Speaker 4: if you're looking for the records of this doctor, you're
31:45
Speaker 4: going to log into one my chart, another one over here,
31:48
Speaker 4: another one over here. And then if your insurance plan
31:51
Speaker 4: does not work with that health system anymore, that's not
31:54
Speaker 4: where your provider is. Your provider moves. You suddenly have
31:57
Speaker 4: to try to pull stuff out and move things around.
32:00
Speaker 4: And often technology isn't fully accessible to patients who are receiving,
32:06
Speaker 4: you know, these high cost drugs for one reason or
32:08
Speaker 4: the other. I mean, like I just I just hung
32:11
Speaker 4: up the phone with a coordination person at an office
32:15
Speaker 4: and she was calling to tell me she started chemo,
32:18
Speaker 4: and she was telling me the challenges of getting chemo
32:21
Speaker 4: as especially as a person ironically who coordinates meds as
32:24
Speaker 4: a living and we were talking about it just personally.
32:27
Speaker 4: She was like, it's just to be on the other side.
32:29
Speaker 4: I've always known what it's like to be on my
32:31
Speaker 4: side of the desk and had sympathy. But she's like,
32:34
Speaker 4: as you go through it, it's so incredibly frustrating, And
32:36
Speaker 4: she said, I don't have all my faculties. You know,
32:39
Speaker 4: I'm sick as I'm doing this, And she's like, I
32:41
Speaker 4: think we forget how sick people are when we're talking
32:44
Speaker 4: to them on the phone, because it just becomes your
32:46
Speaker 4: normal and when you work in the field that people
32:48
Speaker 4: are sick and they're having issues. But she's like, I
32:50
Speaker 4: can't stay awake some days to make phone calls, and
32:53
Speaker 4: I think we forget that in the patient care access
32:56
Speaker 4: arenas sometimes that we are our patients who are getting
32:59
Speaker 4: these MEDA medications are the most at risk that we
33:02
Speaker 4: can probably deal within the healthcare system. So they need
33:05
Speaker 4: more and more resources and education to make this easier
33:08
Speaker 4: for them. And this is an incredibly difficult program just
33:11
Speaker 4: in general.
33:13
Speaker 6: If I could back up on what she said at
33:15
Speaker 6: the beginning about the question that she asked about a
33:18
Speaker 6: complete patient profile. As an old home care nurse, there
33:22
Speaker 6: is a condition of participation for home care that we
33:25
Speaker 6: have to do a complete medication regimen review. And reconciliation
33:29
Speaker 6: and talking to the physician, right and as our old
33:33
Speaker 6: home care nurse, when I would see medications prescribed by
33:36
Speaker 6: six different doctors and all kind of in the same class,
33:40
Speaker 6: It's like, okay, okay, now what I find interesting, CMS again,
33:45
Speaker 6: in its great wisdom, has proposed a supplemental benefit for
33:49
Speaker 6: Medicare advantage plans. Not supplemented benefits are not covered by Medicare.
33:55
Speaker 6: Medication reconciliation post hospital discharge. Okay, that is a supplemental
34:00
Speaker 6: benefit that the advantage plans can choose to provide, which
34:04
Speaker 6: might get to the core of the problem that Sheila
34:06
Speaker 6: asked about. However, I have now reviewed seventy Medicare advantage
34:12
Speaker 6: plans and I have not found one plan that offers
34:15
Speaker 6: that as a supplemental benefit, because I do not. I
34:19
Speaker 6: think it is such a major undertaking. They have no
34:22
Speaker 6: idea of the cost that would be involved, the time
34:25
Speaker 6: that you would spend verifying these drugs with different physicians,
34:28
Speaker 6: all the things that Sherry said, And that just shows
34:32
Speaker 6: you that there's a big issue with if the government's
34:34
Speaker 6: looking at medication reconciliation as a not something that Medicare
34:38
Speaker 6: would not cover, and therefore we're just going to throw
34:40
Speaker 6: it along with dental and gym membership and transportation.
34:44
Speaker 5: It just it bothers me greatly as a nurse, sure,
34:49
Speaker 5: and so I think that's why it's so important. At
34:51
Speaker 5: least if it was being adjudicated through their prescription benefit
34:54
Speaker 5: right least all of the drugs are somewhere. Right. I
34:58
Speaker 5: don't know about you know, people, you know, providers being
35:00
Speaker 5: able to access them, but the PBM or the party sponsor,
35:02
Speaker 5: whoever's doing that, has that access at least in the pharmacies,
35:06
Speaker 5: right then that would be returned to them saying hey,
35:08
Speaker 5: they're on these duplicate meds now, whether or not people
35:10
Speaker 5: you know intervene or not. But I just keep thinking
35:15
Speaker 5: about as I hear more and more of these programs
35:16
Speaker 5: that we're going to kind of go around the insurance
35:19
Speaker 5: and we're going to go directly to the patient. But
35:21
Speaker 5: I don't think, like we were talking about it in
35:23
Speaker 5: the beginning, I don't think people are thinking totally through
35:25
Speaker 5: that what that means, right, people are on more than
35:29
Speaker 5: one medication, more than.
35:32
Speaker 6: One medication to treat the same problem, and that's where
35:36
Speaker 6: you get into the side effects, and I know, just
35:39
Speaker 6: personal experience I'm sure we all have it. My daughter's
35:42
Speaker 6: father in law's confusion was increasing greatly and I took
35:45
Speaker 6: one look at his drug regimen and I thought, oh my,
35:48
Speaker 6: And thankfully he had a primary care physician that paid
35:52
Speaker 6: attention based upon what I suggested, cut his twelve meds
35:56
Speaker 6: down to three. And it's amazing the difference that that's
35:58
Speaker 6: made in this gentlemen.
36:00
Speaker 5: Oh, I'm sure, sure, I'm sure. So what are some
36:03
Speaker 5: of the risks or pitfiles of patients aren't properly enrolled
36:06
Speaker 5: and informed about M three P.
36:09
Speaker 6: I think the risks come more with the drug plan.
36:13
Speaker 6: There are if the patient isn't properly informed, they're going
36:16
Speaker 6: to get hit with the higher cost, which is the
36:17
Speaker 6: risk of them not getting a medication, which Sherry has
36:21
Speaker 6: explained beautifully the bigger problem. I think if people don't
36:26
Speaker 6: understand the risks, I fear we're going to be coming
36:30
Speaker 6: to a problem with drug plans being stiffed. You know,
36:34
Speaker 6: I get two thousand dollars worth of medications in January. Well,
36:37
Speaker 6: if I don't pay those monthly bills, the drug plan
36:41
Speaker 6: can kick me out of the M three P. But
36:44
Speaker 6: I still have my drug coverage, which I think is
36:48
Speaker 6: there's a disconnect there. If I'm not paying the bills
36:51
Speaker 6: that the drug plan has already paid the pharmacy for,
36:54
Speaker 6: you can see where the risk is for the drug plan.
36:56
Speaker 6: And maybe, as I think about it now, speaking out loud,
36:59
Speaker 6: maybe that's part of the reason the education is lagging behind,
37:02
Speaker 6: because they face so much risk, particular.
37:07
Speaker 5: At the end of the year.
37:08
Speaker 6: As I understand it, the drug plan is paying the
37:11
Speaker 6: pharmacies for medications in advance as the patients pick them up,
37:16
Speaker 6: like in November. Right, Well, if the patient switches plans
37:19
Speaker 6: to a different company, there since that first company with
37:23
Speaker 6: a bill.
37:25
Speaker 5: But are they paying them proactively or retroactively? I can't
37:28
Speaker 5: imagine they're paying proactively.
37:29
Speaker 6: No, They're two thousand dollars is divided into twelve segments.
37:33
Speaker 6: I hit them up for two thousand dollars at the
37:35
Speaker 6: beginning of the year, and I pay one hundred what
37:38
Speaker 6: did I say?
37:38
Speaker 5: One hundred and sixty.
37:39
Speaker 6: Seven dollars a month? So if I quit paying that
37:42
Speaker 6: plan in June, they're sitting on one thousand.
37:45
Speaker 5: Dollars that I owe them, right, But as the pharmacy,
37:48
Speaker 5: you still owe it to me because I gave it out.
37:50
Speaker 6: Well, the pharmacies are being paid by the drug plan.
37:53
Speaker 6: The MPP does not affect the way that the pharmacies
37:56
Speaker 6: are being paid. CMS did confirm that, and it's twenty
37:59
Speaker 6: twenty six final of the rules.
38:02
Speaker 5: Okay, but you're right, like the plans are carrying all
38:05
Speaker 5: the liability and now they become like debt collectors. Yes,
38:11
Speaker 5: So looking ahead, how can we as an industry better
38:14
Speaker 5: support continuity of care and adherence for those eligible for
38:17
Speaker 5: M three.
38:17
Speaker 4: P And I'll start I think I think that what
38:24
Speaker 4: all of us can start to do from this stay
38:27
Speaker 4: forward is think how can we better educate patients. From
38:34
Speaker 4: my standpoint as someone who goes into physician offices multiple
38:37
Speaker 4: times a day, I try always to come up with
38:41
Speaker 4: some sort of holistic concept of start to finish, how
38:45
Speaker 4: this is going to better help a patient and what
38:48
Speaker 4: we need to do to smooth out, you know, unintended
38:52
Speaker 4: the problems for the patients and looking at as a
38:55
Speaker 4: holistic situation, so understanding that the patient, especially as we
38:59
Speaker 4: look into twenty twenty six and patients changing plans and
39:03
Speaker 4: a lot of CMS and different healthcare things will be
39:09
Speaker 4: changing in the next twelve to eighteen months, and you
39:12
Speaker 4: have to keep up on that. So I think we all,
39:15
Speaker 4: if we're in a healthcare facing company, providing healthcare, working
39:19
Speaker 4: with healthcare providers, we have to really double down on
39:22
Speaker 4: our oath to better educate everyone who's providing services and
39:27
Speaker 4: make information as easy to find as possible. That means,
39:32
Speaker 4: you know, languages other than English, helping people who have
39:35
Speaker 4: you know, need a bigger bond size, or can't access
39:38
Speaker 4: things on a smartphone, or whatever their challenges may be.
39:42
Speaker 4: We need to try to help with this information gap
39:45
Speaker 4: so that everybody has an easy place to go where
39:48
Speaker 4: it's easy to look at a menu and find the information.
39:50
Speaker 4: Because the coordinators in an office don't have hours to
39:53
Speaker 4: search through plan sites for enrollment links, right, that's just
39:57
Speaker 4: not feasible. And there's things besides this prescription smoothing program
40:04
Speaker 4: that they need to access. So we just really need
40:06
Speaker 4: to double down and work on education and we're all
40:09
Speaker 4: better access to quality, up to date information for people
40:14
Speaker 4: and just better education. So if it means making a
40:16
Speaker 4: better flyer that incorporates all the parts of something for
40:20
Speaker 4: a patient, if we can help provide that to a
40:23
Speaker 4: provider's office and encourage them, like some of these drugs
40:26
Speaker 4: are incredibly complex to take store, maintain, how the shipments work,
40:31
Speaker 4: rams black boxes like it just adds up. So if
40:34
Speaker 4: we can just take our piece and really double down
40:37
Speaker 4: on committing to give better education throughout the year, I
40:40
Speaker 4: think it will go a long way.
40:45
Speaker 5: And Dane.
40:47
Speaker 6: From my perspective, I don't have direct contact with patients,
40:53
Speaker 6: but we have included it in our educational information when
40:57
Speaker 6: patients are eligible for it. When we do their drug reviews,
41:02
Speaker 6: not hay Mole, but our other drug reviews that we do,
41:06
Speaker 6: we do include information on that. I do write about
41:09
Speaker 6: it through my Forbes column. I did the twenty twenty
41:13
Speaker 6: six update right away in September when it came out.
41:17
Speaker 6: So from our perspective, I have a long list of
41:22
Speaker 6: coming up with once we turn the corner into next year,
41:26
Speaker 6: it's my plan to be able to develop some of
41:28
Speaker 6: these short webinar types of things that we can post online.
41:32
Speaker 6: And this is on the list along with probably three
41:36
Speaker 6: dozen other things. But anyway, it's there because people need
41:40
Speaker 6: education because Medicare has become so complex at a time
41:44
Speaker 6: in their life when they're slowing down, when they don't
41:46
Speaker 6: want to deal with computers anymore, what do we make them.
41:48
Speaker 5: Do right, right, And it's very very complicated.
41:53
Speaker 4: Right.
41:53
Speaker 5: I've seen some of the calculations and it's very hard
41:55
Speaker 5: to follow.
41:57
Speaker 6: That is true.
42:00
Speaker 4: And remember the patients aren't seeing that, and they're only
42:03
Speaker 4: getting the information that their pharmacy is telling them. And
42:06
Speaker 4: and and also remember that patients when they when when
42:10
Speaker 4: you talk about in network pharmacy, not all in network
42:13
Speaker 4: pharmacies end up with the same copay for patients. And
42:18
Speaker 4: so there's the patient only knows what that one pharmacy
42:22
Speaker 4: is telling them in that one moment, and what they're
42:25
Speaker 4: understanding of that copay is whether it's monthly, bi monthly
42:28
Speaker 4: mail order, ninety days, what you know, whatever you're talking
42:31
Speaker 4: about with them. There's complexities to just that one discreete
42:35
Speaker 4: price that we're that we're communicating with that patient in
42:38
Speaker 4: that particular time, but it varies over time, so it's
42:43
Speaker 4: not it's not simple.
42:45
Speaker 5: No, not at all. Well, thank you both so much
42:48
Speaker 5: for chatting with me and sharing this valuable information.
42:51
Speaker 4: Well thank you for putting it out.
42:55
Speaker 6: A double thank you.
42:58
Speaker 5: All. At the same time, as a reminder, n e
43:01
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43:12
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43:20
Speaker 5: Until next time, have a great day,