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Does Pharmacy Have an Identity Crisis? | TWIRx · Pharmacy Podcast Network

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  Speaker 1: Brought to you by Paragon Pharmacy three to sixty, powered
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  Speaker 1: by the innovative Modesto Health platform. Where specialty pharmacy meets
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  Speaker 1: a clinical intelligence platform that works for both the care
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  Speaker 1: every interaction. This unified ecosystem closes critical gaps in care,
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  Speaker 1: across specialty and chronic conditions. But what truly sets Paragon
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  Speaker 1: clinical care, and patient engagement. Learn more at Paragonpharmacy dot org.
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  Speaker 2: You are listening to the global network of podcasters dedicated
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  Speaker 2: to the pharmacy profession.
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  Speaker 3: Welcome to the Pharmacy Podcast Network.
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  Speaker 2: Hey, welcome to Twerks.
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  Speaker 4: Today is May twenty second, twenty twenty six.
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  Speaker 2: Hope you had a good week Friday.
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  Speaker 4: It's a long weekend. Are you off this weekend? Are
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  Speaker 4: you taking any extra time? Are you going anywhere with
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  Speaker 4: your family? For a precursor to summer of twenty twenty six,
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  Speaker 4: we got a lot going on.
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  Speaker 2: I want to jump into twerks News right away to
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  Speaker 2: get started.
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  Speaker 4: We have two really interesting guests, Eric Abel, doctor Eric Abel,
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  Speaker 4: and he's going to be talking about provider status. He's
• 2:49
  Speaker 4: going to be talking about the pathway to unifying the
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  Speaker 4: profession and he gives strong opinions. He has an article
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  Speaker 4: out we're going to put links into. We're going to
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  Speaker 4: be talking with dar Shawn Cole Carney he's an FDA
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  Speaker 4: compliance architect. Never heard of such a title, but think
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  Speaker 4: of the most creative things you can do with your
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  Speaker 4: farm d He's also a lawyer. Brilliant man Hey out
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  Speaker 4: of Pittsburgh. Adderall shortage continues to impact Pittsburgh pharmacies. The
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  Speaker 4: reason cited for this was the scarcity to attend for
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  Speaker 4: the medication for attention disordered drugs and it's been an
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  Speaker 4: issue since twenty twenty two and it says that the
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  Speaker 4: Pittsburgh area pharmacies are facing uneven access to Adderall and
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  Speaker 4: other ADHD medications for years. The FDA first flagged the
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  Speaker 4: shortage in twenty twenty two, and some strengths may be
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  Speaker 4: available while others remain back ordered, allocated, discontinued, or hard
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  Speaker 4: to obtain. This is out of the Pittsburgh Pittsburgh Post
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  Speaker 4: Gazette and it goes on to explaining that the shortage
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  Speaker 4: reflects several overlapping issues, rising demand, telehealth, prescribing changes, controlled
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  Speaker 4: substance quota limits. I hate that part of it, which
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  Speaker 4: the Board of Pharmacy would be a little bit more
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  Speaker 4: in communications, in auditing through electronic methods to understand when
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  Speaker 4: a patient needs that and tie that back to the
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  Speaker 4: electronic health record. It's not science fiction. It could easily
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  Speaker 4: be done.
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  Speaker 2: Also, the.
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  Speaker 4: Active ingredient shortages, shipping delays, manufacture disruptions, it's a mess
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  Speaker 4: for us here in Pittsburgh. If you're suffering with ADHD
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  Speaker 4: and you rely on those medications. For community pharmacies, the
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  Speaker 4: burden is operational. It's very emotional for their relationships that
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  Speaker 4: they have with their patients throughout the the Pittsburgh area.
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  Speaker 4: The key takeaway is that access varies by pharmacy dosage
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  Speaker 4: in formulation, making pharmacists prescriber communications essential. And it's interesting
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  Speaker 4: because the pharmacist who becomes a mental health expert is
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  Speaker 4: so invaluable, so valuable to your community and and and
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  Speaker 4: demystifying psychotropics and demystifying what they could be doing. Are
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  Speaker 4: there other things that can complement if you're if you're
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  Speaker 4: short with adderalls, if you're short with some other medication,
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  Speaker 4: is there a dietary change that can be done or
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  Speaker 4: suggestions of something else to try to compensate the shortage issue.
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  Speaker 4: Next up on twerqu's news from Pharmacy Times, pharmacists are
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  Speaker 4: using MTM to catch medication safety risks and in older
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  Speaker 4: adults before they cause harm. This Pharmacy Times article highlights
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  Speaker 4: how pharmacists are using medication therapy management to identify medication
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  Speaker 4: safety risks in adults sixty five and older before they
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  Speaker 4: lead to harm. There's a major focus in the reduction
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  Speaker 4: of inappropriate medication use. Shout out to doctor Delon, known
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  Speaker 4: as the deprescribing Pharmacist and Senior Care. He knows this
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  Speaker 4: all too well. He's done some discussions blog posts. I
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  Speaker 4: want you to look up the lawn Canterbury in on
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  Speaker 4: LinkedIn and take a look at as his latest post.
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  Speaker 4: A major focus and reducing inappropriate medication use supported by
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  Speaker 4: tools such as the Ages Beers criteria, which help pharmacists
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  Speaker 4: to evaluate medications. Pharmacists start catching risky prescription over the
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  Speaker 4: countermedication use. Comprehensive medication reviews include the first generation medications
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  Speaker 4: which can increase Certain medications are increasing confusion, dizziness, constipation,
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  Speaker 4: fall risks in older adults. The MTM gives the pharmacist
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  Speaker 4: to structured opportunity to counsel patients on safer OTC choices,
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  Speaker 4: identify duplicate therapies, review drug facts, labeling and screen drug
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  Speaker 4: interventions and then also the topic of long term proton
• 7:48
  Speaker 4: pump inhibitor use flagging that as a concern for clinical
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  Speaker 4: necessity because of the increase of risks such as fractures
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  Speaker 4: and deficiencies invite them in B twelve ammonia kidney disease.
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  Speaker 4: The strongest takeaway is that pharmacists are essential medication safety
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  Speaker 4: partners for older adults. And how do we get more
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  Speaker 4: people to pay attention to what pharmacists are talking about?
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  Speaker 4: And how do you get more attention with your patients?
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  Speaker 4: How do you get more time with your patients with
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  Speaker 4: how busy everybody is and the commoditization of pharmacy. That's
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  Speaker 4: today's theme is does pharmacy have an identity crisis? Do
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  Speaker 4: we Does the public really crystal crystal clear? Do they
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  Speaker 4: understand the value of pharmacists and what pharmacists can do
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  Speaker 4: for them in their health. I don't think that they do.
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  Speaker 4: I think we do have an identity crisis. We'll get
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  Speaker 4: into that a little bit more. Up next on Twerk's News,
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  Speaker 4: CBS Health.
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  Speaker 2: No surprise, here we go again.
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  Speaker 4: CBS Health sued over alleged scheme to siphon three forty
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  Speaker 4: B drug program savings.
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  Speaker 2: You know, I learned about three forty B.
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  Speaker 4: Probably twelve years ago really to really understand it, and
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  Speaker 4: I always thought that that was insulated from fraud and
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  Speaker 4: the clutches of CVS Health and their PBM. And unfortunately
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  Speaker 4: they're facing federal lawsuits from major health systems alleging that
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  Speaker 4: the company and several subsidiaries improperly diverted approximately get this,
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  Speaker 4: two hundred and fifty million in three forty B drug
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  Speaker 4: pricing program savings between twenty twenty.
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  Speaker 2: My Barber Walters.
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  Speaker 4: Voice twenty twenty and twenty twenty five. The complaints were
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  Speaker 4: filed by entities tied to the University of Michigan University
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  Speaker 4: of Kansas Hospital Authority in Mount Sinai. So University of
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  Speaker 4: Michigan University of Kansas Hospital Authority in Mount Sinai. This
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  Speaker 4: is from the AJMC. In the lawsuit, claims that CBS
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  Speaker 4: Specialty and Well Partner were contractually required to remit third
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  Speaker 4: party payments from adjusted three point forty B specialty pharmacy
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  Speaker 4: claims back to covered entities minus agreed upon dispensing administrative fees,
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  Speaker 4: and instead, allegedly CBS used a hidden price mechanism to
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  Speaker 4: retain savings that could have supported safety netcare and for
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  Speaker 4: pharmacy stakeholders.
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  Speaker 2: For you stars, think.
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  Speaker 4: About this, Think about what's happening when you have something
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  Speaker 4: like three forty B that's so fragile as it is,
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  Speaker 4: it's designed to help people that can afford their medications.
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  Speaker 4: We need more three forty B oversite, PBM OVERSIGHTE get
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  Speaker 4: rid of pharmacies of being owned by insurance companies.
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  Speaker 2: That would be the number one.
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  Speaker 4: Part of all of this, and whether these program savings
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  Speaker 4: are reaching the intended providers. CBS is not commented on
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  Speaker 4: this active litigation, according to the related coverage, and part
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  Speaker 4: of this story also is referencing the New York Post.
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  Speaker 4: And I just don't I don't want to hear CBS
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  Speaker 4: in the news anymore. It's it's frustrating. They just keep
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  Speaker 4: getting away with I think one of their business models
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  Speaker 4: is to have enough money to be sued, and they
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  Speaker 4: know they're going to get sued because of their bad behavior,
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  Speaker 4: and they do it anyway. Hey, last up on twru's
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  Speaker 4: news be on the lookout from the Federal News Network.
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  Speaker 4: If you've never saw this, this is a great resource
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  Speaker 4: to understand what's happening at the federal level. For our
• 12:18
  Speaker 4: troops throughout the country for our veterans. The Federal News
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  Speaker 4: Network reports that lawmakers press the Department of Defense to
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  Speaker 4: commit to Trycare Pharmacy contract annual audits. Yes please, and
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  Speaker 4: here we go again with bad actors express Scripts. Express
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  Speaker 4: Scripts one of the big three pharmacy PBMs. The Defense
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  Speaker 4: Department begins planning for the next generation Trycare Pharmacy Contract,
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  Speaker 4: which would succeed the current agreement administered by express Scripts,
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  Speaker 4: and the lawmakers say that the Pentagon cannot continue to
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  Speaker 4: ignore what they describe as a major conflict of interest
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  Speaker 4: where express Scripts both acts as a pharmacy benefit manager
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  Speaker 4: and operates its own pharmacies. Duh, Like you never thought
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  Speaker 4: that was going to be a problem eight years ago.
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  Speaker 2: When you guys signed the contract. Are you kidding me?
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  Speaker 2: Are you kidding me?
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  Speaker 4: You didn't think that acting as a pharmacy and acting
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  Speaker 4: as the insurance provider, that that wasn't going to create
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  Speaker 4: a lack of auditing, a lack of double checking.
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  Speaker 3: Do you know.
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  Speaker 2: It's my tax dollar? It's your tax.
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  Speaker 4: Dollar if you're a taxpayer in the United States for
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  Speaker 4: federal covered lives, for anybody that works for the federal
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  Speaker 4: government through the Department of Defense or Congress or whoever. Policymakers,
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  Speaker 4: Why are there contracts? Why why not just say hey,
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  Speaker 4: if you are a good actor, if you're a great
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  Speaker 4: PBM and you're helping to save us money, We're going
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  Speaker 4: to do checks once a month. We're going to do
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  Speaker 4: checks once a quarter. We're going to do a deep
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  Speaker 4: dive audit once a year. And if we find fraud,
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  Speaker 4: if we find pork, if we find bullshit in there,
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  Speaker 4: we're going to sue you and then we'll just go
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  Speaker 4: get another transparent PBM, Capital RX, Transparent RX, apro our X.
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  Speaker 4: These organizations would work so hard for the federal government
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  Speaker 4: and you wouldn't have to put up with the fraud
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  Speaker 4: that the three big ones have. Just it become used
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  Speaker 4: to it, and once again they have enough money to
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  Speaker 4: pay for the fines. It says express Scripts has been
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  Speaker 4: administering trycare benefits since two thousand and three.
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  Speaker 2: How old were you in two thousand and three? Right?
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  Speaker 4: I started my pharmacy career in two thousand and five
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  Speaker 4: and knew next to nothing about the pharmacy industry. Think
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  Speaker 4: about that, tricare relying on express Scripts since two thousand
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  Speaker 4: and three, and.
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  Speaker 2: In twenty twenty.
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  Speaker 4: In twenty twenty one, it was awarded an eight year
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  Speaker 4: contract worth four point three billion and estimated charges.
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  Speaker 2: And express scripts is now.
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  Speaker 4: Senator Elizabeth Warren argued that the Department of Defense cannot
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  Speaker 4: ignore the conflict created when a PBM also operates the pharmacies.
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  Speaker 4: The push follows and ongo going scrutiny of tricare pharmacy
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  Speaker 4: access reimbursement practices in whether independent and community pharmacies are
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  Speaker 4: being disadvantaged under the current model. Do you know what
• 15:54
  Speaker 4: we did in September of twenty twenty five, we had
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  Speaker 4: a Veterans Pharmacy Summit in Washington, Pennsylvania, in Pittsburgh, Pennsylvania,
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  Speaker 4: and we brought together a bunch of administrators and a
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  Speaker 4: bunch of people and some pharmacists and you'ral Pharma shout
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  Speaker 4: out to Steve Beckman to think how do we improve
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  Speaker 4: veterans' pharmacy care. And the first suggestion that was made
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  Speaker 4: in everyone that was at the conference agreed.
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  Speaker 2: Is stop stop stop stop.
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  Speaker 4: Making it just a VA initiative, meaning open up the
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  Speaker 4: VA in your communities to servicing these veterans through independent
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  Speaker 4: community pharmacies that they're closest to and get these independents
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  Speaker 4: to sign agreements.
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  Speaker 2: With the VA.
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  Speaker 4: And if you have to have a procedure done, obviously
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  Speaker 4: go to the Veterans Administration hospital systems and care systems.
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  Speaker 4: But for follow up and for medication management, why are
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  Speaker 4: you driving the whole way to the VA. Sometimes my father,
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  Speaker 4: my own dad, he goes to the VA and he
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  Speaker 4: drives nearly an hour and a half to get to
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  Speaker 4: his certain VA. He's in eastern Florida, and he could
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  Speaker 4: go to Teresa Toll her pharmacy right there in Vero
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  Speaker 4: Beach area in Florida. Shout out to Teresa Toll, love her.
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  Speaker 4: But he could go to her pharmacy, ask questions, sit down,
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  Speaker 4: medication management. So we need to reconstruct the entire TRICARE
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  Speaker 4: understanding of how to best serve veterans and how to
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  Speaker 4: best serve people in the military and people in the
• 17:46
  Speaker 4: defense government accountability. The report previously recommended stronger Defense Health
• 17:52
  Speaker 4: Agency monitoring of TRICARE no DUH and opening it up
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  Speaker 4: to independent community pharmacy for pharmacy stakeholders. This signals growing
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  Speaker 4: congressional pressure for transparency, accountability in network adequacy in military
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  Speaker 4: pharmacy benefits. If you're listening and you have a relationship
• 18:16
  Speaker 4: or even if you don't have a relationship with your
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  Speaker 4: state representative, I want you to bring this up to them,
• 18:22
  Speaker 4: send them an email, ask to see them, help them
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  Speaker 4: understand that we need to open up the VA to
• 18:31
  Speaker 4: not only different PBMs or get rid of PBMs altogether.
• 18:36
  Speaker 4: But if we have to have a PBM, open it
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  Speaker 4: up to different instead of one PBM servicing the entire nation,
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  Speaker 4: why not have regional PBMs competing and seeing who's doing
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  Speaker 4: the best job, and definitely get rid of express Scripts,
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  Speaker 4: who's been not doing a very good job since two
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  Speaker 4: thousand and three, and open up to independent community pharmacies
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  Speaker 4: for our veterans and veterans care. Independent community pharmacies and
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  Speaker 4: our senior care consultants. These passionate people that execute on
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  Speaker 4: medication reviews and deep prescribing in the hands of our
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  Speaker 4: veteran administration and veteran services would do so well in
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  Speaker 4: servicing these people. Today's episode, does pharmacy have an identity crisis?
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  Speaker 2: What do you think? Reach out to me on LinkedIn.
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  Speaker 4: I'm going to post a blog that we published on
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  Speaker 4: the Pharmacy Podcast Network's main site, and the title of
• 19:45
  Speaker 4: that blog is does pharmacy have an identity crisis? And
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  Speaker 4: I've been around a long time listeners. I'm a passionate
• 19:59
  Speaker 4: pharmacist and pharmacy advocate, and I think that we do
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  Speaker 4: have an identity crisis, are we? You know, when you
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  Speaker 4: say I hate the term retail pharmacy, I think that
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  Speaker 4: we should stop seeing retail pharmacy. So if you, if
• 20:16
  Speaker 4: you work in community pharmacy, tell your regional directors, tell
• 20:22
  Speaker 4: your grocery store managers to stop saying retail pharmacy. The
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  Speaker 4: word retail means selling goods or services directly to the
• 20:31
  Speaker 4: end consumer for personal use, and in the Dictionary defines
• 20:35
  Speaker 4: retail as selling in small quantities directly ultimately to the
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  Speaker 4: consumer and selling goods and services to the consumer. That's
• 20:45
  Speaker 4: not what you are. You're not a retail pharmacist. You're
• 20:49
  Speaker 4: a community pharmacist. That's the environment that you're serving. This
• 20:54
  Speaker 4: has been an issue we call it chain. Are you
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  Speaker 4: an independent? Are you a grocery store? Are you mail order?
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  Speaker 4: Are you specialty? Are you digging down just into clinical
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  Speaker 4: notation and consultancy. We have an identity crisis, and there's
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  Speaker 4: tension between between the definition between reimbursement. There's a blog
• 21:22
  Speaker 4: from delon Canterbury that I posted on this our own
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  Speaker 4: blog post and he goes into this a little bit
• 21:33
  Speaker 4: where he says we need to stop lying to pharmacy students.
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  Speaker 2: He says he's been in this game since.
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  Speaker 4: Twenty ten and the narrative is broken, and he said
• 21:44
  Speaker 4: that there's seven lives that he's tired of hearing. Number one,
• 21:48
  Speaker 4: you need a residency to be successful.
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  Speaker 2: You think that's true.
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  Speaker 4: Number two, pharmacists shouldn't challenge doctors.
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  Speaker 2: We want people to die.
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  Speaker 4: I mean, our physicians and our physicians are wonderful, passionate people,
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  Speaker 4: but they cannot catch everything. That's the whole purpose of
• 22:09
  Speaker 4: a pharmacist double checking our physicians. And he does say
• 22:14
  Speaker 4: the word, by the way, pharmacists shouldn't challenge doctors. It
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  Speaker 4: should be pharmacists shouldn't challenge physicians primary care. Number three,
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  Speaker 4: the insurance company knows what's best.
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  Speaker 2: We know that's bullshit.
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  Speaker 4: Retail is a dead end. And once again number four,
• 22:34
  Speaker 4: retail is a dead end. I don't want you to
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  Speaker 4: say retail anymore. Say community. Is that what you're referencing,
• 22:39
  Speaker 4: or you're referencing big box? You know, what the huge
• 22:43
  Speaker 4: difference between an independent community pharmacy environment for a pharmacist
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  Speaker 4: or CBS or you know some of the other chains
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  Speaker 4: that pressure about stats and pressure about metrics versus an
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  Speaker 4: independent community pharmacy or even Walmart. I've heard great things
• 23:04
  Speaker 4: about Walmart. I've heard great things about Costco. So let's
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  Speaker 4: stop saying retail. Number five, you have to stay in
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  Speaker 4: your lane. I hate that. I hate it. I hate
• 23:17
  Speaker 4: the term that scope creep. I hate it. Pharmacists don't
• 23:27
  Speaker 4: want to be physicians. They want to be pharmacists, and
• 23:30
  Speaker 4: they have every right to dig into the patient's needs
• 23:33
  Speaker 4: and the patient's safety. Number six, wait until retirement to
• 23:37
  Speaker 4: live your life. Number seven, more pills equal a better health.
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  Speaker 4: Obviously that's not the case. Take a look at this blog.
• 23:47
  Speaker 4: Go to pharmacypodcast dot com. It's under our blog section
• 23:51
  Speaker 4: which is called the PPN Pulse. And if you want
• 23:55
  Speaker 4: to write a blog, if you have some writing, if
• 23:57
  Speaker 4: you're passionate about something, we will public and market that material.
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  Speaker 4: I just think that we do have an identity crisis,
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  Speaker 4: and I think that there's waves and there's certain reasons
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  Speaker 4: of commoditization of our of our profession. The public doesn't
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  Speaker 4: understand what pharmacists do. The PBMs have just raped the industry. Uh,
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  Speaker 4: it's just horrible with the three biggest PBMs have done
• 24:25
  Speaker 4: and UH, chain pharmacies are going through their own unique
• 24:32
  Speaker 4: UH situations.
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  Speaker 2: Shout out to doctor Shane Jerreminski.
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  Speaker 4: And the the efforts that he's putting out to unionize
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  Speaker 4: pharmacists throughout the country and it's working. The collapse of
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  Speaker 4: unification in our profession is an issue. The working together
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  Speaker 4: is an issue, and we're never going to We're never
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  Speaker 4: going to see big changes. Hey, there's an organization out
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  Speaker 4: of England called the NHS England.
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  Speaker 2: And they actually launched an.
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  Speaker 4: Initiative to place community pharmacy in a whole different way
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  Speaker 4: of thinking and being able to be able to see
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  Speaker 4: the value of what pharmacists are doing in community pharmacy
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  Speaker 4: and how it's not about the medication alone, it's about
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  Speaker 4: that expertise that they bring. Look this up, it's pharmacy first.
• 25:42
  Speaker 4: It's a whole campaign that they're running. And the identity
• 25:46
  Speaker 4: crisis in pharmacy is not that pharmacists lack value. The
• 25:51
  Speaker 4: crisis is that the marketplace has defined that value too narrowly.
• 25:58
  Speaker 4: PBMs have sucked out the secret sauce because they want
• 26:03
  Speaker 4: to commoditize things. PBMs define pharmacy as a reimbursement claim.
• 26:08
  Speaker 2: That's it. If you're a pharmacist right.
• 26:12
  Speaker 4: Now, If you're a technician right now, is your being
• 26:15
  Speaker 4: in healthcare? Are you boiled down to just a reimbursable claim?
• 26:22
  Speaker 2: Are you? No? Of course not.
• 26:25
  Speaker 4: Corporations define pharmacy as a traffic driving department. Manufacturers defined
• 26:30
  Speaker 4: pharmacy as a distribution endpoint. Payers define pharmacy as a
• 26:35
  Speaker 4: cost center. In even patients, they may define pharmacy as
• 26:39
  Speaker 4: a place to pick up their prescriptions. That's not pharmacy.
• 26:44
  Speaker 4: Pharmacy is so much bigger than that. Profession must define
• 26:48
  Speaker 4: pharmacy as a healthcare access point. In build around medication expertise,
• 26:54
  Speaker 4: medication expertise, medication safety, medication education, patient trust. You already
• 27:02
  Speaker 4: have that pharmacists are the most trusted providers out there,
• 27:07
  Speaker 4: your clinical intervention, your head's up for public health. Take
• 27:12
  Speaker 4: a look at this blog. Tell me what you think.
• 27:15
  Speaker 4: Does pharmacy have an identity crisis? We have a great
• 27:22
  Speaker 4: show today, two great interviews. I'm excited about this.
• 27:27
  Speaker 2: This is tworks. You are so valuable.
• 27:33
  Speaker 4: You pharmacists, you technicians, you're so so important to your
• 27:38
  Speaker 4: communities in hospitals that you work in, in your long
• 27:42
  Speaker 4: term care consultancy and specialty rare disease. This is it
• 27:47
  Speaker 4: this week in pharmacy. Let's go.
• 28:07
  Speaker 2: Hey, welcome to twerks.
• 28:10
  Speaker 4: I have a special guest today, doctor Eric Abel is
• 28:14
  Speaker 4: joining us on twerks. Eric, I've been waiting to have
• 28:18
  Speaker 4: you on my talk show for quite some time. You know,
• 28:21
  Speaker 4: I've been podcasting for seventeen years, but I've never had
• 28:26
  Speaker 4: my own show.
• 28:27
  Speaker 2: Isn't that weird?
• 28:29
  Speaker 5: I love it.
• 28:31
  Speaker 6: We've connected several times in the past and I'm quite
• 28:34
  Speaker 6: the privilege to be here, and I always have some
• 28:37
  Speaker 6: spirited discussions.
• 28:38
  Speaker 2: I know absolutely.
• 28:39
  Speaker 4: I'm excited about to day's discussion because I just wrote
• 28:44
  Speaker 4: a blog this week in Pharmacy and it was titled
• 28:47
  Speaker 4: does Pharmacy have an identity Crisis? I'm going to put
• 28:50
  Speaker 4: a link in our show notes, but it's kind of
• 28:54
  Speaker 4: on the same theme of what you're digging much deeper
• 28:59
  Speaker 4: into with a lot of backing.
• 29:02
  Speaker 2: And you have a piece.
• 29:03
  Speaker 4: That's come out, an article that's come out that's titled
• 29:06
  Speaker 4: so pharmacists want to be a provider where the profession
• 29:09
  Speaker 4: lost this way and perhaps a path to get back.
• 29:13
  Speaker 4: And I want you to open up to our listeners.
• 29:15
  Speaker 4: Start off with a short background on yourself from what
• 29:18
  Speaker 4: you do in pharmacy, a fellow Pittsburgher, and then let's
• 29:22
  Speaker 4: get into this paper.
• 29:23
  Speaker 6: Absolutely well, so a little bit of background, I would
• 29:27
  Speaker 6: say I usually describe as.
• 29:28
  Speaker 5: I've taken a number of different ninety degree terms in
• 29:31
  Speaker 5: my career.
• 29:32
  Speaker 6: I started as a you know, I've been through two
• 29:34
  Speaker 6: years of residency cardiac trained. I started out the bedside
• 29:38
  Speaker 6: in cardiac surgery, took a pivot and led bundle payments,
• 29:42
  Speaker 6: alternative payment models, and clinical transformation at Ohio State. Then
• 29:46
  Speaker 6: I took another pivot and headed over to Hi Marque
• 29:50
  Speaker 6: Health here in Pittsburgh, where I led a lot of
• 29:54
  Speaker 6: the clinical transformation, launching a lot of strategic initiatives, clinical decisions, support,
• 29:59
  Speaker 6: hospital home, all the other stuff. Then I pivoted again
• 30:02
  Speaker 6: around pandemic time and ended up landing in an AI
• 30:06
  Speaker 6: medtech company leading a software's medical device work and really
• 30:11
  Speaker 6: a big innovation change there that was ultimately acquired by
• 30:15
  Speaker 6: GE Healthcare. And since leaving GE, I actually had my
• 30:20
  Speaker 6: own startup where I advise and support pharma, medtech and
• 30:24
  Speaker 6: others really just to try and find their footing in
• 30:28
  Speaker 6: really the healthcare value chain.
• 30:29
  Speaker 5: Which is it? And uniquely I've been thinking.
• 30:33
  Speaker 6: A lot abround pharmacy and the pharmacists as a provider statement,
• 30:38
  Speaker 6: where it's not a new concept.
• 30:41
  Speaker 5: It's been a conversation that's been had at least.
• 30:43
  Speaker 6: Over the last thirty years, and a lot of advocacy.
• 30:49
  Speaker 6: But the problem is is there's a lot of different
• 30:52
  Speaker 6: organizations at the table, but we don't have conformancy, and
• 30:56
  Speaker 6: really what is our identity? What is the operating model?
• 31:01
  Speaker 6: What is the business model? What's a governance model? That
• 31:04
  Speaker 6: where we kind of have to define really vanilla ice cream?
• 31:08
  Speaker 6: What is a pharmacist? What can we do? What if
• 31:11
  Speaker 6: we're providing clinical services, who else is you know, who
• 31:16
  Speaker 6: else has done that? Because that's different than the dispensing lane.
• 31:19
  Speaker 6: So that's really the big picture. And really kind of
• 31:23
  Speaker 6: had some gut checks and like thinking, really, how can
• 31:26
  Speaker 6: I what's my lens on pharmacy when it comes to this.
• 31:32
  Speaker 4: Yeah, you know, I attend anywhere from eight to twelve
• 31:36
  Speaker 4: conferences per year.
• 31:38
  Speaker 2: I'm passionate about.
• 31:40
  Speaker 4: Being the press and getting in front of the leaders
• 31:44
  Speaker 4: that are in those sectors, whether that's one of the
• 31:48
  Speaker 4: wholesale wholesaler conferences we're going to be attending, the McKesson
• 31:51
  Speaker 4: Idea Share again.
• 31:52
  Speaker 2: I love that conference.
• 31:54
  Speaker 4: Just brings some interesting people together in independent community and
• 31:58
  Speaker 4: obviously NCPA and AP and and it's just I'm frustrated
• 32:05
  Speaker 4: when I always thought that the walls were starting to
• 32:09
  Speaker 4: come down, but then just as fast as they seem
• 32:11
  Speaker 4: to be collaborative, then all of a sudden something changes.
• 32:14
  Speaker 4: I don't know if it's a board of directors thing
• 32:17
  Speaker 4: or if it's the vision, but then all of a sudden,
• 32:19
  Speaker 4: the walls and the lack of collaboration, you know, goes,
• 32:22
  Speaker 4: it goes back to where it was. It's like you
• 32:24
  Speaker 4: take three steps forward and ten steps back in kind
• 32:29
  Speaker 4: of working together. And then I and just to be
• 32:31
  Speaker 4: selfish from my perspective, all of these big organizations are
• 32:37
  Speaker 4: they'll they'll they'll talk about provider status, they'll talk about
• 32:41
  Speaker 4: what that means, but then they go off on their
• 32:44
  Speaker 4: own pathway because they want to control a narrative or
• 32:47
  Speaker 4: they they they you know, not to not to bring
• 32:51
  Speaker 4: up this is controversial. Towers is controversial. So I don't
• 32:55
  Speaker 4: care if I'm going to make you know, listeners angry.
• 32:58
  Speaker 2: But it's like.
• 33:02
  Speaker 4: Some of the it's and the members are saying this
• 33:06
  Speaker 4: to me. So it's not just my words. It's not
• 33:08
  Speaker 4: my opinion, but they're saying, is the APHA?
• 33:12
  Speaker 2: Do they? Is the APHA in.
• 33:14
  Speaker 4: And of itself more more important than the profession?
• 33:19
  Speaker 2: Is the NCPA?
• 33:20
  Speaker 4: Is the success of the National Community Pharmacists Association?
• 33:26
  Speaker 2: Is that more important?
• 33:27
  Speaker 4: Is the association more important than the independent pharmacy as
• 33:31
  Speaker 4: a whole? Is the ASCP? The American Society Consultant Pharmacist?
• 33:37
  Speaker 4: Is that association more important than the success of the
• 33:41
  Speaker 4: consultant Pharmacist? Now, if you asked any of the CEOs,
• 33:45
  Speaker 4: Chad Wars and Doug Hoy and you know, mister Michael Hoague,
• 33:51
  Speaker 4: doctor Hoague, amazing people, wonderful people, passionate people. I've watched
• 33:55
  Speaker 4: the careers for the last fifteen years, they would all say,
• 33:59
  Speaker 4: of course, it's about the profession, but that's not the
• 34:02
  Speaker 4: actions of the actual organization. The organization seems like they
• 34:06
  Speaker 4: put themselves first because they have to control things that
• 34:10
  Speaker 4: I'm like, as an example, Eric, just to be selfish podcasting, right,
• 34:18
  Speaker 4: I've been at this for seventeen years. I try to
• 34:21
  Speaker 4: build a platform to take an eric able that you
• 34:24
  Speaker 4: have something to say and blast it out to the
• 34:27
  Speaker 4: eighty five thousand listeners that I've accumulated over the last
• 34:30
  Speaker 4: you know, seventeen plus years. And then better yet, take
• 34:34
  Speaker 4: Eric doctor Abel's knowledge and start bringing it to the consumer.
• 34:38
  Speaker 4: For goodness sakes, and stop just talking to each other.
• 34:41
  Speaker 4: Let's start talking to the public. One hundred and fifty
• 34:43
  Speaker 4: three million podcasters listeners out there in the United States.
• 34:47
  Speaker 2: One hundred and fifty three freaking million.
• 34:50
  Speaker 4: That means there's three hundred and thirty five million citizens
• 34:55
  Speaker 4: and you know, in residents in the United States, and
• 34:57
  Speaker 4: that means half of them are listening to pod right. Well,
• 35:02
  Speaker 4: the APHA, join the PPN so that we can collectively
• 35:06
  Speaker 4: come together at only eighty five thousand listeners, that that's
• 35:10
  Speaker 4: nothing compared to iHeartMedia in SiriusXM and podcasts one that
• 35:15
  Speaker 4: have millions and millions of listeners. To go to them
• 35:18
  Speaker 4: and say, listen, we are a collective. We are like
• 35:22
  Speaker 4: the AMA the American Medical Association of Podcasts, and we're
• 35:26
  Speaker 4: going to bring the expertise and the evidence based information
• 35:30
  Speaker 4: I mean, and we're going to pull this all through
• 35:32
  Speaker 4: one place so that the consumer can go one place
• 35:36
  Speaker 4: to hear pediatrics and hear geriatrics, and here what's the
• 35:40
  Speaker 4: truth about vaccines? And you know what's going on with
• 35:44
  Speaker 4: Trump or x in policy and PBM reform, and but no,
• 35:49
  Speaker 4: APHA wants to be a podcast publication. NCPA wants to
• 35:53
  Speaker 4: be a podcast publication. And I'm just like, guys, why
• 35:58
  Speaker 4: the hell did I do this? Why I bang my
• 36:00
  Speaker 4: head against the window in the wall, bleeding myself stitches,
• 36:06
  Speaker 4: not making any money for my family because I believe
• 36:09
  Speaker 4: in the profession, because I believe in the pharmacist and
• 36:13
  Speaker 4: I knew where podcast was going. Nobody listened in two
• 36:16
  Speaker 4: thousand and nine, one hundred and fifty three million listeners
• 36:18
  Speaker 4: now in the United States, And it's like, I want
• 36:21
  Speaker 4: to turn this over to the champions. I want to
• 36:23
  Speaker 4: turn it over to these big associations and your paper.
• 36:28
  Speaker 4: So pharmacists want to be a provider where the profession
• 36:31
  Speaker 4: lost this way and perhaps a path to get back
• 36:35
  Speaker 4: that plays into this whole similar theme.
• 36:38
  Speaker 6: Let me and I'm going to double click on what
• 36:41
  Speaker 6: you just said too, because I think it carries weight
• 36:45
  Speaker 6: in a lot of different ways. Let me draw another parallel,
• 36:49
  Speaker 6: and that's simple business terms. Right, when it comes to
• 36:55
  Speaker 6: membership of any organization, right, if they don't have memberships,
• 37:01
  Speaker 6: what is their value, right, what is the value like
• 37:04
  Speaker 6: somebody's paying for that? Then if they don't, if they're
• 37:09
  Speaker 6: not willing to pay, then it doesn't matter what the
• 37:12
  Speaker 6: mission is of the organization because they have no margin
• 37:14
  Speaker 6: to actually execute it. Are they listening? I would say
• 37:18
  Speaker 6: the same thing to payers. Payers, if you're going to
• 37:23
  Speaker 6: put all table stakes there and put all the prior
• 37:26
  Speaker 6: off barriers and all the other things in play, and
• 37:29
  Speaker 6: somebody no longer wants to be your member, then you
• 37:34
  Speaker 6: don't have a margin to execute your insurance products against.
• 37:38
  Speaker 5: I would say the same thing to the health systems.
• 37:42
  Speaker 5: We could argue.
• 37:42
  Speaker 6: About payer and provider and how we're doing really the
• 37:45
  Speaker 6: reimbursement pieces, but at the end of the day, if
• 37:49
  Speaker 6: there are no patients for you to serve, there is
• 37:52
  Speaker 6: no business model, right, there is no business model, And
• 37:59
  Speaker 6: so I'm zoom it out. That's the level here, And
• 38:02
  Speaker 6: I think that that's really kind of like what I
• 38:06
  Speaker 6: see you across my journey is the fact that there
• 38:09
  Speaker 6: is a way we can all help each other and
• 38:11
  Speaker 6: That's what I tried to do. That's why I named
• 38:14
  Speaker 6: my business One Another Health. It's trying to figure out
• 38:16
  Speaker 6: how can we actually help different whether it's a point solution,
• 38:20
  Speaker 6: whether it's a platform, a pop heal solution, or otherwise,
• 38:23
  Speaker 6: how can you find your spot in the value chain?
• 38:26
  Speaker 6: And I would apply that same thesis to an organization.
• 38:30
  Speaker 6: What is that your members are wanting? What is value
• 38:33
  Speaker 6: in their mind? And are you delivering? So if the
• 38:36
  Speaker 6: ecosystem is asking for pharmacists as a provider, why have
• 38:40
  Speaker 6: we sent I detail this in the article is thirty
• 38:44
  Speaker 6: years of the same narrative and it really comes into
• 38:47
  Speaker 6: a really vicious cycle of advocacy, advocacy, advocacy, but not
• 38:54
  Speaker 6: the operating model, not understanding how other providers and Allied
• 38:59
  Speaker 6: health you know, other physicians, physicians, apps, dentists, other hallot
• 39:05
  Speaker 6: health providers, how have they aligned to actually really back
• 39:11
  Speaker 6: into getting paid for cognitive services. We have pilots all
• 39:16
  Speaker 6: over the country. We have a lot of things of
• 39:18
  Speaker 6: what pharmacits are doing, but at the end of the day,
• 39:21
  Speaker 6: if it's really like how do they do that? And
• 39:24
  Speaker 6: it's more than what prompt Pharmacy Profiles has done. Is
• 39:27
  Speaker 6: giving a credentialing database, because the rest of that is
• 39:30
  Speaker 6: actually a swirly wind of I've got to get a
• 39:34
  Speaker 6: c a q H NPI profile, I've got to do
• 39:37
  Speaker 6: the Credentially, then it becomes into getting credentialed and in
• 39:40
  Speaker 6: network with a payer. All of those things are different
• 39:44
  Speaker 6: muscle than what P s AOS and other basic credentialing
• 39:48
  Speaker 6: mechanisms go.
• 39:49
  Speaker 5: It is where the rubber meets the road. That is
• 39:52
  Speaker 5: the first piece.
• 39:53
  Speaker 6: That's one of the pillars you have to tackle, and
• 39:56
  Speaker 6: then the other and so those are like, how do
• 39:59
  Speaker 6: you get in there? If the the level one E
• 40:01
  Speaker 6: and M code right now that is incident to building
• 40:04
  Speaker 6: is only twenty three dollars per encounter with a pharmacist,
• 40:08
  Speaker 6: there's no business model you can build on that to
• 40:10
  Speaker 6: actually justify the FTE of the pharmacist. And so if
• 40:14
  Speaker 6: you back that into the next layer of this, it's like, Okay,
• 40:18
  Speaker 6: if I was a business owner, my goal is to
• 40:22
  Speaker 6: one definitely deliver value to my customers and put the
• 40:26
  Speaker 6: right FTE in there that actually lets me, you know,
• 40:30
  Speaker 6: not only deliver my customer values, but also bring in
• 40:33
  Speaker 6: value to us as an organization, which means revenue and
• 40:36
  Speaker 6: so those are the pieces there, and so it's an
• 40:39
  Speaker 6: unfortunate piece where pharmacists deliver so much value, but in
• 40:44
  Speaker 6: the eyes of a practice manager or a health system,
• 40:48
  Speaker 6: they're not a revenue center unless you're dispensing the cognity
• 40:53
  Speaker 6: services are not a revenue center. They are a cost center.
• 40:57
  Speaker 6: So if I have to put I have a choice
• 40:59
  Speaker 6: of putting in app like an NP or a PA
• 41:02
  Speaker 6: and maybe extending that workforce adding another FTE, maybe I
• 41:05
  Speaker 6: add could I add a pharmacist or should add another app? Well,
• 41:09
  Speaker 6: the math is really simple. An app actually can create
• 41:14
  Speaker 6: buildable revenue. They're a revenue center. A pharmacist is not.
• 41:18
  Speaker 6: So that really begs the question, how what is the
• 41:21
  Speaker 6: operating model and business model we need to be able
• 41:24
  Speaker 6: to do and back into you know, you have dentists
• 41:28
  Speaker 6: that did this.
• 41:28
  Speaker 5: They built the whole CDT ontology that defines.
• 41:32
  Speaker 6: How their table stakes of how they engage and build
• 41:35
  Speaker 6: for services. The AMA has spent thirty to fifty years
• 41:38
  Speaker 6: on this, building out the CPT code ontology. Here's this,
• 41:43
  Speaker 6: here's our vus. This is how we're going to do it.
• 41:45
  Speaker 6: Will continue work with the payers on how on those
• 41:48
  Speaker 6: rates pharmacy has stood behind the counter for years, just
• 41:52
  Speaker 6: backed into their core business model of dispensing. They offer
• 41:55
  Speaker 6: everything else for free. We haven't thought differently. You've got
• 41:59
  Speaker 6: to step outside the box and understand do we need
• 42:02
  Speaker 6: to have own pharmacy ontology for the building that's specific
• 42:05
  Speaker 6: to ours or do we need to work with the
• 42:07
  Speaker 6: AMA Do we need to you know, how does that
• 42:09
  Speaker 6: best work to actually define vanilla ice cream? Back to
• 42:15
  Speaker 6: your definition of the pharmacist. What do we have an
• 42:17
  Speaker 6: identity crisis? What is a pharmacist? And that isn't serve that.
• 42:22
  Speaker 6: That is where the JCPP, who's supposed to be a
• 42:25
  Speaker 6: convener of all of the professional pharmacy professional organizations, has
• 42:30
  Speaker 6: a big role. And that's where they not as just
• 42:34
  Speaker 6: to hear and you know, kind of bring people together,
• 42:36
  Speaker 6: it's actually to provide different Maybe their narrative is different
• 42:41
  Speaker 6: than what it was in nineteen seventy seven when they're founded.
• 42:44
  Speaker 6: Maybe it has to be different now. Now we have
• 42:48
  Speaker 6: to define what pharmacy is, not just in infusion, not
• 42:53
  Speaker 6: just in post acute, not just in ambulatory care, not
• 42:57
  Speaker 6: just in acute care, and eed spaces or consulting. It's
• 43:02
  Speaker 6: what is a pharmacist? What's the capacity, what they can
• 43:04
  Speaker 6: do and how if they're giving cognitive services, what is
• 43:08
  Speaker 6: the Really we got to go deep and it can't
• 43:11
  Speaker 6: be about how we're different and how we're special and
• 43:14
  Speaker 6: a special snowflake.
• 43:15
  Speaker 5: It's how are.
• 43:16
  Speaker 6: We more alike and able to work in multiple forums?
• 43:20
  Speaker 6: That is really, That is what needs to happen, and
• 43:24
  Speaker 6: that is the identity crisis. And it's not just if
• 43:28
  Speaker 6: we don't do it. Now we're sitting on the same
• 43:31
  Speaker 6: vicious cycle of more advocacy, no action because nobody's going
• 43:36
  Speaker 6: to do it for you. How do you want to work?
• 43:38
  Speaker 6: What is the business model we can agree to and
• 43:41
  Speaker 6: that could be in value based care where we work
• 43:43
  Speaker 6: on services based arrangements.
• 43:45
  Speaker 5: It could be.
• 43:46
  Speaker 6: But the backstop is how do you work because the
• 43:48
  Speaker 6: incumbent business model in all of healthcare is deeper service
• 43:52
  Speaker 6: type of modeling.
• 43:54
  Speaker 5: That that is the piece. So what are those services
• 43:57
  Speaker 5: you want to do?
• 43:58
  Speaker 6: And I outlined a lot of these in the article
• 44:00
  Speaker 6: as to what are some big pieces and how do
• 44:03
  Speaker 6: we back into those and how do we aspire and
• 44:05
  Speaker 6: create a path to get there. We have to bring innovation.
• 44:08
  Speaker 6: We have to and it's not necessarily innovation in care delivery.
• 44:13
  Speaker 6: It's innovation in the business model, in the governance model,
• 44:16
  Speaker 6: operational model of how we can do this.
• 44:19
  Speaker 4: So to take us through the provider infrastructure stack it's
• 44:24
  Speaker 4: mentioned in this paper and the disent the dependency sequence
• 44:30
  Speaker 4: that cannot be shortcut.
• 44:32
  Speaker 6: Yeah, I mean I think we look at the interoperability
• 44:34
  Speaker 6: and I have to give a shout out. You know,
• 44:38
  Speaker 6: the Levitt Partners work in PIISA and what they're doing
• 44:42
  Speaker 6: is table stakes. You know that is we're in the
• 44:45
  Speaker 6: digital world now and I think we are on an island.
• 44:49
  Speaker 6: And if we don't join what the PIASA work is
• 44:52
  Speaker 6: essentially pharmacy interoperability for clinical services. Alliance and Kim Boyd
• 44:59
  Speaker 6: some friends over there are doing some great work and
• 45:02
  Speaker 6: bringing around a lot of stakeholders. This is not redefining
• 45:06
  Speaker 6: what dispensing is. This is what's different. Right when we're
• 45:09
  Speaker 6: doing services and you know what are the We've got
• 45:12
  Speaker 6: to be able to one bring in data from the EHR,
• 45:15
  Speaker 6: so we're operating against the same information providers, are we
• 45:19
  Speaker 6: and to really empower a pharmacist to work at the
• 45:22
  Speaker 6: top of their license.
• 45:24
  Speaker 5: But it's also when we do that.
• 45:25
  Speaker 6: Work, it can't live in asylum. It needs to go
• 45:28
  Speaker 6: back into the EHR. So we're part of the care team.
• 45:31
  Speaker 6: And I think the credentialing, I've already mentioned some of that,
• 45:35
  Speaker 6: but it's a different type of credentialing that we're familiar with.
• 45:38
  Speaker 6: It really comes down to payer credentially, what are the
• 45:41
  Speaker 6: pieces that a payer requires in order to be in network.
• 45:45
  Speaker 6: And there's you know c QH, Sarah Maud and the
• 45:49
  Speaker 6: crew there, there's already a playbook there, but I think
• 45:52
  Speaker 6: that those are there's a lot of work that actually
• 45:54
  Speaker 6: goes into that, and then there's so much more. But
• 45:57
  Speaker 6: I think that it's really getting the group think about
• 46:00
  Speaker 6: this is you know, if we're those are all would
• 46:03
  Speaker 6: be considered like professional services. Those are different than just
• 46:07
  Speaker 6: dispensing type things. So if those back into a medical service,
• 46:11
  Speaker 6: a medical benefit, and you're going to submit those things,
• 46:15
  Speaker 6: if that's retail or virtual and we're doing anything from
• 46:18
  Speaker 6: therapeutic drug monitoring, medrec mtm CMR, DE prescribing, point of
• 46:23
  Speaker 6: care testing, we've got to back into incumbent business models
• 46:26
  Speaker 6: and pasts. Actually, how do we join that network, how
• 46:29
  Speaker 6: are other people doing that, How can we actually actually
• 46:32
  Speaker 6: join that path and whether.
• 46:34
  Speaker 5: That goes into the clinic.
• 46:35
  Speaker 6: I think the hospital and ed, the ICUs transitions, those
• 46:38
  Speaker 6: are all pieces where pharmacists it's hard to justify them
• 46:42
  Speaker 6: just on the basis of soft dollars. It's a really
• 46:45
  Speaker 6: hard economic equation if I can't justify an FT based
• 46:49
  Speaker 6: on what revenue they can bring in, and so it
• 46:52
  Speaker 6: is a how are they delivering value? There's tons of evidence,
• 46:55
  Speaker 6: there's tons of pilots of the value they bring. There's
• 46:58
  Speaker 6: not the innovation and the business model. How can we
• 47:01
  Speaker 6: actually operate like a provider? That definition is already in
• 47:05
  Speaker 6: the market. We have to think differently in ligne to
• 47:08
  Speaker 6: those architectures.
• 47:12
  Speaker 2: So where do we go to get.
• 47:15
  Speaker 4: The the buy in from the what association do you
• 47:24
  Speaker 4: go to and say, hey, can can we double check ourselves?
• 47:29
  Speaker 4: Can we do an audit on our outreach to the
• 47:33
  Speaker 4: rest of the providers out there, the non pharmacist providers
• 47:36
  Speaker 4: out there who need to understand how to work with
• 47:39
  Speaker 4: us better. And then once we establish the vanilla ice cream,
• 47:44
  Speaker 4: then we can jump into our specialty. We can become
• 47:47
  Speaker 4: the senior care expert, or the pediatric expert or the
• 47:51
  Speaker 4: rare disease expert.
• 47:52
  Speaker 2: But where do we start.
• 47:55
  Speaker 6: I think it's trying to understand like anchor off of
• 47:58
  Speaker 6: the physicians.
• 47:58
  Speaker 5: You know, they've built this.
• 47:59
  Speaker 6: As they've actually tried to back into this understand like
• 48:05
  Speaker 6: in the community probably the most you know, pharmacies a
• 48:08
  Speaker 6: shoppable service in the in the location environment, right, it's
• 48:13
  Speaker 6: not like somebody I mean, And so that's one of
• 48:16
  Speaker 6: the things that's out there. How are those business models?
• 48:19
  Speaker 6: And then what are the professional organizations doing, What are
• 48:23
  Speaker 6: the state organization the state regulatory bodies doing, what's different
• 48:27
  Speaker 6: around their composition to be able to support those pieces
• 48:31
  Speaker 6: than what we have and what we've always done in pharmacy.
• 48:34
  Speaker 5: I mean, I think one of the big things is
• 48:37
  Speaker 5: that I think touches.
• 48:37
  Speaker 6: A lot of areas and a lot of really spicy
• 48:40
  Speaker 6: content lately is around the PBMs and the vertical integration
• 48:47
  Speaker 6: with their own pharmacies. Right, what they're doing. Well, there's
• 48:51
  Speaker 6: a path that medicine has done in thirty two plus states.
• 48:55
  Speaker 6: There's prohibitions of the corporate practice of medicine, and so
• 48:59
  Speaker 6: when you go to a health system, you know, I
• 49:01
  Speaker 6: would say, you know, whether we're in Pennsylvania, we're in Ohio,
• 49:05
  Speaker 6: et cetera. Most of those health systems operate as a
• 49:10
  Speaker 6: management services organization where they do all the back office stuff.
• 49:14
  Speaker 6: But the physician practice is a professional corporation. Anything that
• 49:19
  Speaker 6: actually goes through the corporation cannot control the doctors because
• 49:24
  Speaker 6: the corporation didn't go to medical school, and so you
• 49:27
  Speaker 6: have to have a division of those responsibilities, those decisions.
• 49:32
  Speaker 5: And so there's a.
• 49:33
  Speaker 6: Model that's out there, and almost every virtual health solution
• 49:37
  Speaker 6: out there who's offering services operates under an MSOPC model.
• 49:44
  Speaker 6: And you could actually stand up your own PC and
• 49:46
  Speaker 6: not have an MSO if you want to do all
• 49:47
  Speaker 6: of it yourself. What it's called the MSO friendly PC model,
• 49:51
  Speaker 6: and that's a place where maybe the PC the pharmacy,
• 49:55
  Speaker 6: you know, do we need to have a concept called
• 49:57
  Speaker 6: the corporate practice of pharmacy where we really define what
• 50:03
  Speaker 6: has to be done through a pharmacist and only pharmacist lands,
• 50:07
  Speaker 6: what's the oversight that has to be done, and the
• 50:10
  Speaker 6: decisions only pharmacists can make. And then the management services
• 50:15
  Speaker 6: the organization can make recommendations. They can actually you do
• 50:19
  Speaker 6: the back office things there, but they cannot intersect with
• 50:22
  Speaker 6: the practice of pharmacy. And those are really important things,
• 50:26
  Speaker 6: particularly as we start venturing into paths because we don't
• 50:30
  Speaker 6: want to build it, you know, try all these things
• 50:33
  Speaker 6: and then back into star law violations where I'm doing
• 50:36
  Speaker 6: the services here, but I'm also doing self referral to
• 50:39
  Speaker 6: my dispensing piece that becomes you know, whether you're doing
• 50:44
  Speaker 6: anti kickback or stark or any of the other things there.
• 50:47
  Speaker 6: Those are very clear pieces where nobody wants to land
• 50:50
  Speaker 6: on the OIG's list, right, So what is that architecture
• 50:54
  Speaker 6: we need to think about operationally and does that mean
• 50:57
  Speaker 6: the identity and really, you know, from an entity standpoint,
• 51:01
  Speaker 6: the regulatory standpoint, operational model, we've got to think differently
• 51:05
  Speaker 6: than how we arrive to the salute where we are
• 51:07
  Speaker 6: today and quite the conundrum. And so I think that
• 51:11
  Speaker 6: it really you've got to think around how those are
• 51:14
  Speaker 6: operating and do those make sense as a valid path
• 51:19
  Speaker 6: and guidance to our pharmacy profession because we're in a
• 51:23
  Speaker 6: really critical space where AI and a lot of these
• 51:26
  Speaker 6: things could be commoditized. But I think we bring a
• 51:29
  Speaker 6: lot to the table because it's that altruism. It's the
• 51:33
  Speaker 6: patient care, it's seeing, you know, laying the hairy eyeball
• 51:36
  Speaker 6: and getting this body senses on what's really going on
• 51:40
  Speaker 6: here and unpacking that, and I think those are really
• 51:42
  Speaker 6: important things that we've got to figure out that the
• 51:45
  Speaker 6: business model, innovation, and operational model are key pieces where
• 51:50
  Speaker 6: advocacy doesn't do that. That means we've got to figure
• 51:53
  Speaker 6: out how we're more like than.
• 51:54
  Speaker 4: Different, absolutely, And I like how you laid out the
• 52:00
  Speaker 4: key organizations, the Joint Commission of Pharmacy Practitioners and able
• 52:04
  Speaker 4: to have a baseline established that everybody already agrees on.
• 52:09
  Speaker 4: But we're not doing it together. We're not doing it
• 52:12
  Speaker 4: all together. We're not coming to the public, we're not
• 52:16
  Speaker 4: coming to cms, we're not coming you know, as one
• 52:20
  Speaker 4: as And that's why AMA is so powerful, because they
• 52:23
  Speaker 4: even though they have the fractions and they have arguments internal,
• 52:26
  Speaker 4: they've still come up with a powerful lobbying organization that
• 52:31
  Speaker 4: is one hundred times more powerful than what would the
• 52:36
  Speaker 4: single lobbying group be to represent pharmacy. Is there lobbying
• 52:41
  Speaker 4: group that represents all of pharmacy? And then inside that
• 52:45
  Speaker 4: lobbying group, have they clearly defined the value of the
• 52:49
  Speaker 4: pharmacist regardless of the flavors of the caramel sauce or
• 52:53
  Speaker 4: the chocolate or the sprinkles that you put on the
• 52:56
  Speaker 4: vanilla ice cream? Have they clearly defined hey, as the
• 53:00
  Speaker 4: medication experts. These people are the absolute If you want
• 53:04
  Speaker 4: to understand what's happening and with titration or metabolization or
• 53:09
  Speaker 4: you know this medication or this dangerous medication or whatever
• 53:12
  Speaker 4: it is, it's that pharmacist that's going to guide you.
• 53:15
  Speaker 4: So let's start there and then start breaking it into
• 53:18
  Speaker 4: our specialties.
• 53:19
  Speaker 6: Well, I think that that's the thing is Like the
• 53:21
  Speaker 6: APHA has done a lot of great advocacy work, and
• 53:24
  Speaker 6: I don't want to downplay that at all, But the
• 53:26
  Speaker 6: problem is is like most of their advocacy work is
• 53:30
  Speaker 6: largely focused on the outpatient environment, the ambulatory environment. Where
• 53:34
  Speaker 6: does the ASHP fit into that to actually say we
• 53:38
  Speaker 6: do that too, We just do it in the acute
• 53:40
  Speaker 6: care environment and our patients are sicker. Or what about
• 53:43
  Speaker 6: the home infusion where and a lot of the amatory space,
• 53:46
  Speaker 6: or the skilled nursing facilities where a lot of the
• 53:49
  Speaker 6: consultants' farmacists work there, or the chain pharmacies when you
• 53:53
  Speaker 6: have any one individual organization speaking only for themselves. I've
• 53:58
  Speaker 6: been pretty critical of of the A p h A
• 54:02
  Speaker 6: strategy because it doesn't give very directive actions of what
• 54:08
  Speaker 6: we're going to do to actually evolve this. And I
• 54:11
  Speaker 6: don't know that they represent all of the other groups.
• 54:15
  Speaker 6: And that's I think is jcpp's group and I and
• 54:18
  Speaker 6: I do not I don't want this to come across
• 54:21
  Speaker 6: as I'm being critical to profession It's really we've got
• 54:24
  Speaker 6: to figure out a path to bring us all together
• 54:28
  Speaker 6: and what is the common ground across all of those
• 54:30
  Speaker 6: organizations and how can we actually be like Simon Sinek
• 54:33
  Speaker 6: where together is better?
• 54:35
  Speaker 5: Right? Together is better?
• 54:37
  Speaker 6: And I think that and that's really the piece We've
• 54:40
  Speaker 6: got to hear the members. We also have to really
• 54:43
  Speaker 6: understand the voice of the customer, who is our customers.
• 54:45
  Speaker 6: As a pharmacist, is that part of the foremost hon
• 54:49
  Speaker 6: arguable is the patient, absolutely, but depending on where we
• 54:53
  Speaker 6: send in orbit, it's going to be always you know,
• 54:56
  Speaker 6: the physician is also our customer. The nurse who's caring
• 55:00
  Speaker 6: for the patient and as an extension, is our customer.
• 55:03
  Speaker 6: Our other pharmacists in the ecosystem are also our customer,
• 55:08
  Speaker 6: and so many other out out health professionals. We've got
• 55:11
  Speaker 6: to figure out a better way to work together. But
• 55:13
  Speaker 6: it starts with who the hell are we and what
• 55:18
  Speaker 6: is the definition of pharmacist? And then what is the
• 55:20
  Speaker 6: operating model we can bring that out to them that
• 55:23
  Speaker 6: actually is durable and scalable right now the pilots aren't
• 55:30
  Speaker 6: scalable for many reasons. And we've got that's the hard
• 55:34
  Speaker 6: work that's ahead.
• 55:37
  Speaker 4: Eric, I want the listeners to be able to reach
• 55:39
  Speaker 4: out and connect with you. You're active on LinkedIn. There's also
• 55:43
  Speaker 4: an email address that's on your screen, info at one
• 55:47
  Speaker 4: another dot health. Once again, that's info at one another
• 55:52
  Speaker 4: dot health. Is there any other way that you want
• 55:55
  Speaker 4: people to reach out to is LinkedIn?
• 55:56
  Speaker 2: The best place.
• 55:58
  Speaker 6: LinkedIn is a great place. Actually, if you click that
• 56:01
  Speaker 6: get my info, it'll it'll get You'll be able to
• 56:04
  Speaker 6: get even down to my cell phone if you wanted to.
• 56:08
  Speaker 5: I would. I would just cautions like bring them in there.
• 56:11
  Speaker 5: I would love to talk.
• 56:13
  Speaker 6: I mean, this is one of those things where I've
• 56:14
  Speaker 6: stepped outside of pharmacy and I've worked in the broader orbits.
• 56:18
  Speaker 6: Nobody's on a drug who doesn't have a disease first,
• 56:21
  Speaker 6: and we've got to figure out better path to be
• 56:24
  Speaker 6: able to bring that together. So ericabele dot org is
• 56:29
  Speaker 6: my website where I do a lot of thought leadership.
• 56:31
  Speaker 6: But Eric at one Another dot health is the email
• 56:36
  Speaker 6: you can find me. I'm on LinkedIn and happy to
• 56:40
  Speaker 6: chat and figure out how we can make it better.
• 56:43
  Speaker 4: Eric, long overdue here on this week in pharmacy. Appreciate
• 56:46
  Speaker 4: your insights. Going to have you back sooner than waiting
• 56:51
  Speaker 4: for as long as we have it connected.
• 56:53
  Speaker 2: So bringing you back to.
• 56:54
  Speaker 5: Twork soon absolutely, let's do it.
• 56:57
  Speaker 2: Thank you, Hey, just the whole on. We have more
• 57:00
  Speaker 2: to works. We'll be right back.
• 57:05
  Speaker 7: Feeling lost with the complexities of pharmacy accounting.
• 57:08
  Speaker 8: And in pharmacy today, there's so many different variables and
• 57:13
  Speaker 8: issues that impact the pharmacy, books, records, accounting, the profitabilities,
• 57:17
  Speaker 8: so or so forth. There's different components of pharmacy that
• 57:20
  Speaker 8: have its own nuances from an accounting standpoint, and so
• 57:24
  Speaker 8: it's it's tricky, there's no doubt about it.
• 57:26
  Speaker 7: Ready to take your pharmacy to the next level, but
• 57:28
  Speaker 7: don't know where to start. Psychs and Company is here
• 57:31
  Speaker 7: to help, introducing the RX Assessment. With the RX Assessment,
• 57:36
  Speaker 7: the pharmacy CPAs and advisors at PSYCHS will do a
• 57:39
  Speaker 7: deep dive into your accounting and tax situation and give
• 57:42
  Speaker 7: you the action steps you need to take to take
• 57:45
  Speaker 7: your pharmacy to the next level.
• 57:47
  Speaker 8: If you're interested in, you know, working with a team
• 57:50
  Speaker 8: who understands the industry and how the accounting and tax
• 57:54
  Speaker 8: should really be in a pharmacy, this is your chance
• 57:57
  Speaker 8: to get under the hood check of what's going on and.
• 58:00
  Speaker 5: Getting the feedback of any issues.
• 58:02
  Speaker 8: Or concerns or again things we think you're doing really
• 58:05
  Speaker 8: well with.
• 58:05
  Speaker 7: Get the financial check up your pharmacy needs and head
• 58:08
  Speaker 7: over to Seychs HYPHENCPA dot com or call two five
• 58:12
  Speaker 7: to two four eight two seven six.
• 58:15
  Speaker 3: Four to four.
• 58:26
  Speaker 4: Hey, welcome back to twerks. I want to give a
• 58:29
  Speaker 4: shout out to Eric Abel. Thanks so much for your
• 58:32
  Speaker 4: insights on this week in pharmacy. I'm very lucky to
• 58:36
  Speaker 4: have the network I have, and I want to give
• 58:39
  Speaker 4: a shout out to our younger pharmacists and also our
• 58:42
  Speaker 4: pharmacy students. I spend time at WVU School of Pharmacy
• 58:47
  Speaker 4: with doctor Mark Erra fully in his P threes, and
• 58:50
  Speaker 4: it's going to be my fourth year this fall where
• 58:53
  Speaker 4: I'm going to talk to P threes about the insights
• 58:57
  Speaker 4: from someone that's spent twenty twenty two years and the profession,
• 59:01
  Speaker 4: and I've documented the profession through podcasting obviously for seventeen
• 59:07
  Speaker 4: of those twenty two years, and I try to define
• 59:09
  Speaker 4: to them what's happening in the industry. They're concentrating on
• 59:14
  Speaker 4: getting their license and all the studying that they're doing,
• 59:17
  Speaker 4: but I always want to give them insights, and I
• 59:21
  Speaker 4: always practice what I preach, so my insights come from experts.
• 59:25
  Speaker 4: That's the reason for the Pharmacy Fifty Awards. The Pharmacy
• 59:28
  Speaker 4: fifty Most Influential People is a way for our organization
• 59:32
  Speaker 4: to find out who is in the industry that is
• 59:36
  Speaker 4: really making an impact in an innovation, in something in
• 59:40
  Speaker 4: some vertical as an expert. One of those experts that's
• 59:44
  Speaker 4: been part of my network for over twenty years makes
• 59:46
  Speaker 4: me feel old is doctor Darshan Kulkarney, pharmacist and a lawyer.
• 59:52
  Speaker 4: My favorite pharmacist lawyer out there. Darshawn, Welcome back to twerks.
• 59:58
  Speaker 3: God, it's so good to say see you. We are
• 1:00:00
  Speaker 3: both getting old at this point. I feel mentally, I
• 1:00:04
  Speaker 3: feel like we're both twenty. No, we've known each other
• 1:00:07
  Speaker 3: for twenty years, that's how long we've been doing this,
• 1:00:09
  Speaker 3: So I feel terrible but yet so excited to know
• 1:00:12
  Speaker 3: you for so long and I do have a part
• 1:00:15
  Speaker 3: of the impact you've had in the pharmacy programs and
• 1:00:19
  Speaker 3: the students as they've come up. So thank you for
• 1:00:21
  Speaker 3: having me.
• 1:00:22
  Speaker 2: It's great to have you here.
• 1:00:24
  Speaker 4: Fellow podcaster dar Shaun Talks has been around for quite
• 1:00:26
  Speaker 4: some time.
• 1:00:27
  Speaker 2: One of my favorite shows.
• 1:00:28
  Speaker 4: You're constantly putting out great content of engaging people that
• 1:00:32
  Speaker 4: you find interesting. Sometimes it's in the vertical that you're
• 1:00:35
  Speaker 4: concentrating in, sometimes it's not. Sometimes you just bring in
• 1:00:39
  Speaker 4: someone that's brand new and thinking about something that's up
• 1:00:42
  Speaker 4: and coming.
• 1:00:43
  Speaker 2: I love that about you, and you've.
• 1:00:44
  Speaker 4: Introduced me to Dan Safara and clinical Trials and so
• 1:00:48
  Speaker 4: many other people in the industry that has been extremely interesting.
• 1:00:53
  Speaker 4: I want to come back to you today and talk
• 1:00:55
  Speaker 4: about some of you know, there's things that are happening
• 1:00:59
  Speaker 4: in pharmacy that's start out as trends and then all
• 1:01:02
  Speaker 4: of a sudden they go through the growth of the
• 1:01:05
  Speaker 4: excitement kind of wears off, but then it becomes a
• 1:01:08
  Speaker 4: true way of generating more revenue and building a business.
• 1:01:12
  Speaker 4: And the trend right now that's in the it feels
• 1:01:16
  Speaker 4: like we're in that rocket ship part of it, and
• 1:01:18
  Speaker 4: I think it's going to hit a ceiling and the
• 1:01:21
  Speaker 4: legal side of it's going to get a hold of it,
• 1:01:22
  Speaker 4: and then it all of a sudden, I think it'll
• 1:01:24
  Speaker 4: become a real thing. Is the realm of the medspa?
• 1:01:27
  Speaker 4: And how are there pharmacies out there? Are there pharmacy
• 1:01:30
  Speaker 4: entities out there that are saying, hey, let's take a
• 1:01:34
  Speaker 4: time out and start delivering some higher level services to
• 1:01:38
  Speaker 4: our community. Let's define what a peptide is and demystify
• 1:01:43
  Speaker 4: it and get into it.
• 1:01:44
  Speaker 2: So talk to her.
• 1:01:45
  Speaker 4: I know that you're in that right now, and I
• 1:01:46
  Speaker 4: know that you're that a lot of people come to
• 1:01:50
  Speaker 4: you for advice and they hire you as the FDA
• 1:01:54
  Speaker 4: you know, expert or some of the things that you
• 1:01:57
  Speaker 4: keep people out of jail.
• 1:01:59
  Speaker 2: But let's let's get into that.
• 1:02:02
  Speaker 3: So before we start, I want to do a exclusive
• 1:02:07
  Speaker 3: for the Pharmacy Podcast Network. Because you and I have
• 1:02:09
  Speaker 3: known each other for so long, and because of the
• 1:02:12
  Speaker 3: value you give to these students. Because you just talked
• 1:02:14
  Speaker 3: about identifying the hot areas that are happening, I'm going
• 1:02:18
  Speaker 3: to share something. But that's okay with you, Todd.
• 1:02:20
  Speaker 2: Yeah, absolutely.
• 1:02:21
  Speaker 3: Oh so this is something I have shared with you
• 1:02:32
  Speaker 3: over time, But do you do you remember ever seeing this? I?
• 1:02:38
  Speaker 2: Oh, yeah, and it's grown, it's gotten big.
• 1:02:40
  Speaker 3: As it has. But this is something that again I
• 1:02:44
  Speaker 3: try to share every so often so that people are
• 1:02:47
  Speaker 3: pharmacy students. And this was done at when I was
• 1:02:50
  Speaker 3: working as a pharmacist and I had a pharmacy student
• 1:02:53
  Speaker 3: asked me, Darshan, I'm thinking of doing a residency because
• 1:02:56
  Speaker 3: a lot of pharmacy schools to push the residency thing.
• 1:02:59
  Speaker 3: But what else can I do you? And what Todd's
• 1:03:02
  Speaker 3: talking about as part of the pharmacy top fifty is
• 1:03:05
  Speaker 3: just what are these other areas you can get into?
• 1:03:08
  Speaker 3: And you're pointing this out right now, Todd, but this
• 1:03:11
  Speaker 3: should be bigger now because there's more stuff. But the
• 1:03:15
  Speaker 3: point being for those students who are going, what are
• 1:03:19
  Speaker 3: my options? What can I do in the future? What
• 1:03:22
  Speaker 3: drives you is the first question, and be honest with yourself.
• 1:03:26
  Speaker 3: Once you know what drives you, then you can look
• 1:03:28
  Speaker 3: at some of these other things. Just to be clear,
• 1:03:29
  Speaker 3: I make no money off of this. This is my
• 1:03:31
  Speaker 3: thing that I created, but it's Todd. I when I
• 1:03:34
  Speaker 3: try to come on I try to give value as
• 1:03:36
  Speaker 3: much as I can, because how do you not come
• 1:03:39
  Speaker 3: to PP I don't give value. So if you like
• 1:03:43
  Speaker 3: the idea of oh I want to be in the
• 1:03:45
  Speaker 3: law world, well, here are some areas you can look
• 1:03:48
  Speaker 3: at that your pharmacy degree gives you value. If you
• 1:03:52
  Speaker 3: like to be in policy, here are some areas. If
• 1:03:55
  Speaker 3: you like adventure, if you considered doctors without borders, if
• 1:03:59
  Speaker 3: you like stability. Now I say stability, but this recently
• 1:04:03
  Speaker 3: changed with a lot of people in the federal government
• 1:04:05
  Speaker 3: kind of losing their jobs. But usually the federal government
• 1:04:08
  Speaker 3: jobs or the state government jobs are permanent, and that's
• 1:04:12
  Speaker 3: great for a lot of people. And then there are
• 1:04:14
  Speaker 3: all these other areas as well. So that was going
• 1:04:16
  Speaker 3: to be my first call out to say, you know what,
• 1:04:21
  Speaker 3: if you are interested in being in the pharmacy world,
• 1:04:25
  Speaker 3: it's an exciting time. More things are happening, and yes,
• 1:04:29
  Speaker 3: AI is going to change things. The more things change,
• 1:04:32
  Speaker 3: the more they remain the same. Now talking about things
• 1:04:36
  Speaker 3: that are changing things that remain the same, I think
• 1:04:40
  Speaker 3: the fact is in the end, we are baying human
• 1:04:44
  Speaker 3: beings and we are saying, how do we take care
• 1:04:48
  Speaker 3: of ourselves in a way that we look better but
• 1:04:52
  Speaker 3: also feel better? And that's coming up. For example, Todd,
• 1:04:57
  Speaker 3: you and I are a little old for this, but
• 1:04:59
  Speaker 3: we both this time when we used to look back
• 1:05:02
  Speaker 3: and people used to go, oh, I want to be fit. Well,
• 1:05:05
  Speaker 3: now there's a whole trend called looks maxing. Have you heard, like,
• 1:05:09
  Speaker 3: have you heard that term? Because I hadn't. Looks maxine
• 1:05:11
  Speaker 3: is what the young kids. Looks maxine is what the
• 1:05:15
  Speaker 3: young kids called getting in shape and looking really good.
• 1:05:17
  Speaker 3: That's what I think it is. If I'm wrong, feel
• 1:05:19
  Speaker 3: free to let us know that I'm wrong. It's like
• 1:05:22
  Speaker 3: six seven. I don't fully understand it, but I know
• 1:05:25
  Speaker 3: it's there. But so looks maxing is that look. And
• 1:05:29
  Speaker 3: part of that is finally the peptide stack that's going
• 1:05:34
  Speaker 3: to help you get there. And you know, all those
• 1:05:39
  Speaker 3: years ago we used to talk about things like anabolic
• 1:05:42
  Speaker 3: steroids and we talked about how dangerous they were. Well,
• 1:05:47
  Speaker 3: under the Trump administration, they're saying, we want to help
• 1:05:52
  Speaker 3: enable some of these things, and they are reclassifying certain
• 1:05:56
  Speaker 3: peptides that you couldn't use previously to enable pharmacy. To
• 1:06:00
  Speaker 3: actually do that. They're gonna put the hopefully they're gonna
• 1:06:03
  Speaker 3: put the right controls in place, do the right studies,
• 1:06:05
  Speaker 3: do the right research, and enable some of those uses.
• 1:06:08
  Speaker 3: And that means that it's not going to be some
• 1:06:12
  Speaker 3: Jim bro telling you what product to use. It's not
• 1:06:16
  Speaker 3: going to be done in the corner of the gym
• 1:06:18
  Speaker 3: where someone's selling giving out these syringes and saying, YO,
• 1:06:22
  Speaker 3: use this twice a week. Why twice a week, I
• 1:06:24
  Speaker 3: don't know, because someone told him. It's not gonna be
• 1:06:28
  Speaker 3: some guy at GNC who has excuse my language, a
• 1:06:31
  Speaker 3: high school diploma telling me how to use medications. And yes,
• 1:06:35
  Speaker 3: there are supplements, but the fact is the way that
• 1:06:38
  Speaker 3: they're using it, it's like medications, and it gets to
• 1:06:41
  Speaker 3: be under the auspices of a pharmacy. And uh, there
• 1:06:47
  Speaker 3: are people like Brendan Walsh, for example, who does sports
• 1:06:51
  Speaker 3: pharmacy and this is a part of those elements. And
• 1:06:57
  Speaker 3: I think that that's awesome, that's amazing, and it gives
• 1:07:00
  Speaker 3: opportunities for pharmacists to play a meaningful role in getting
• 1:07:05
  Speaker 3: these syringes and what I do and getting getting these drugs,
• 1:07:09
  Speaker 3: and what I do is enabling that process. How how
• 1:07:14
  Speaker 3: do you is now the right moment? We're still waiting
• 1:07:18
  Speaker 3: for some of those reclassifications. They're going to happen very soon,
• 1:07:21
  Speaker 3: but you want to be ready for them. It means
• 1:07:24
  Speaker 3: that you need to have the right controls in place.
• 1:07:26
  Speaker 3: What products can you make? And then it's not just
• 1:07:30
  Speaker 3: what can you do? Do they have to be customized
• 1:07:33
  Speaker 3: ie A five oh three A or can you make
• 1:07:35
  Speaker 3: them in bulk which would be a five oh three B?
• 1:07:37
  Speaker 3: So it's manufacturing versus compounding at that point, and then
• 1:07:40
  Speaker 3: what can you say about them? Because what's been happening
• 1:07:42
  Speaker 3: over and over and over again is not just how
• 1:07:45
  Speaker 3: you make these products. The second step is how you
• 1:07:48
  Speaker 3: market those products. Do you use influencers? Do you have
• 1:07:51
  Speaker 3: rules around how you use those influencers? Are you going
• 1:07:54
  Speaker 3: to use like some kind of connection or kickback system?
• 1:07:58
  Speaker 3: And you want to avoid that. But once you have
• 1:08:01
  Speaker 3: destructure in place, talk to people like me and let
• 1:08:04
  Speaker 3: me help you stay out of trouble while you're maximizing
• 1:08:09
  Speaker 3: your profits. Now, don't go stepping into the wrong place,
• 1:08:12
  Speaker 3: because I'm seeing a lot of pharmacies do that and
• 1:08:14
  Speaker 3: we're getting they're getting into trouble. But think about the
• 1:08:16
  Speaker 3: opportunities this does give you. And I'm excited for these
• 1:08:19
  Speaker 3: opportunities because I'm working with a few different medspas, and
• 1:08:23
  Speaker 3: the funny part is these medspas are not being run
• 1:08:26
  Speaker 3: by pharmacists. I had a medspa owner reached out to
• 1:08:28
  Speaker 3: me recently and she was a MP and she didn't
• 1:08:34
  Speaker 3: know the difference. She didn't know why she couldn't take
• 1:08:38
  Speaker 3: a medication and basically just go, you know what, I'm
• 1:08:43
  Speaker 3: going to pull it out for my patient and give
• 1:08:45
  Speaker 3: out four of those to be used over the next month.
• 1:08:48
  Speaker 3: She didn't understand the difference between sterility and stability. She
• 1:08:51
  Speaker 3: didn't understand how USB seven ninety seven plays into sterility.
• 1:08:56
  Speaker 3: She's like, well, I can see this other pharmacy do that. Yes,
• 1:08:58
  Speaker 3: because they're making it in hood that gives you completely
• 1:09:02
  Speaker 3: different sterility rules. It may still be stable for sixty
• 1:09:06
  Speaker 3: days depending on what you're doing, but it's not sterile.
• 1:09:09
  Speaker 3: And that's what your role as a pharmacist is enable
• 1:09:12
  Speaker 3: that process, help educate these medspas, or it opens up
• 1:09:18
  Speaker 3: a whole new world for you at a whole new
• 1:09:20
  Speaker 3: profit center. And that's what something like TPN gives you.
• 1:09:24
  Speaker 3: The optionnity to hear from someone like me what we're
• 1:09:28
  Speaker 3: seeing and the opportunities that pharmacies are going, you know what,
• 1:09:32
  Speaker 3: maybe I need to reach out to these people. Maybe
• 1:09:34
  Speaker 3: it's the botoxes of the world. And we've seen problems
• 1:09:37
  Speaker 3: where estheticians are going, Oh, you know what, I'm going
• 1:09:41
  Speaker 3: to just start making the product on my own. I'm
• 1:09:44
  Speaker 3: going to start administering the product on my own. Well,
• 1:09:47
  Speaker 3: someone did that and she's going to jail for it.
• 1:09:50
  Speaker 3: This just happened in the last I want to say,
• 1:09:52
  Speaker 3: two weeks. There was a physician who was importing I
• 1:09:57
  Speaker 3: can't remember what product was, but they they were I
• 1:10:01
  Speaker 3: think it was one of the weight loss products, uh,
• 1:10:04
  Speaker 3: one of the GLP ones, but they were getting it
• 1:10:06
  Speaker 3: from China and they were as a Utah physician in
• 1:10:09
  Speaker 3: my recollection, they went out there and they put it out.
• 1:10:12
  Speaker 3: And the fact that they got it inappropriately and compounded
• 1:10:17
  Speaker 3: it and they were sort of just giving it out themselves,
• 1:10:20
  Speaker 3: that that put them into trouble. It's it's on the
• 1:10:22
  Speaker 3: DJ's website. There was another pharmacy, for example, who was
• 1:10:27
  Speaker 3: getting product inappropriately and they it was a violation, the
• 1:10:31
  Speaker 3: first violation from the FDA for inappropriately sourcing their GLP ones.
• 1:10:39
  Speaker 3: So you want to have sourcing, you want tracking the U.
• 1:10:43
  Speaker 3: Those rules need to be reviewed. Find out what the
• 1:10:46
  Speaker 3: FDA is looking at. Make sure that you're complying, because
• 1:10:49
  Speaker 3: you don't want to be on some website saying that
• 1:10:52
  Speaker 3: you did it wrong. And I and then looking at
• 1:10:56
  Speaker 3: federal prosecution because the fact is the Department of Justice
• 1:10:59
  Speaker 3: is looking right now to make cases to make an
• 1:11:02
  Speaker 3: example out of pharmacies. And I know I went to
• 1:11:05
  Speaker 3: school far too long as a pharmacist. I know you
• 1:11:07
  Speaker 3: went to school far too long as a pharmacist. You
• 1:11:09
  Speaker 3: don't want to be there because you want to do
• 1:11:11
  Speaker 3: right by the patients. So let's do right by the
• 1:11:13
  Speaker 3: patients together.
• 1:11:16
  Speaker 4: Let's get into compounding for a second. This is not
• 1:11:19
  Speaker 4: a trend. This is a technology platform called curify Labs.
• 1:11:24
  Speaker 4: We're going to be doing a three part series with them.
• 1:11:28
  Speaker 4: This is fascinating, dar Sean. This isn't a device that
• 1:11:32
  Speaker 4: you put ingredients into and develop compounds for the pharmacy
• 1:11:38
  Speaker 4: that doesn't want to invest in, you know, the depths
• 1:11:43
  Speaker 4: of the true compound or like the og compounders that
• 1:11:46
  Speaker 4: are like the stero and the like, the ones that
• 1:11:50
  Speaker 4: do just compounding versus the independent community pharmacy that's like, hey, listen,
• 1:11:55
  Speaker 4: there's a there's a market out there for some compounding
• 1:12:00
  Speaker 4: want a device that basically three D prints compounds.
• 1:12:04
  Speaker 2: For me, it's fascinating. I'm not sure if you've heard
• 1:12:07
  Speaker 2: of Curify Labs.
• 1:12:08
  Speaker 3: I don't know about Curify specifically. I'm not going to
• 1:12:10
  Speaker 3: make comments about them specifically, but actually reviewed a compounding
• 1:12:15
  Speaker 3: pharmacy three D printed product and the agreement that they had.
• 1:12:21
  Speaker 3: I think it's a great idea overall. I think that
• 1:12:25
  Speaker 3: there are some limitations. I don't know what these guys
• 1:12:27
  Speaker 3: do with Curify. However, what you do want to look
• 1:12:31
  Speaker 3: at are things like, huh, let me see what products
• 1:12:36
  Speaker 3: they use? Are they using? Do they disclose to you
• 1:12:39
  Speaker 3: what products they use as binding agents? What kind of
• 1:12:41
  Speaker 3: exclusivity do you have? Can someone else copy it? Those
• 1:12:44
  Speaker 3: are some of the elements you want to start out.
• 1:12:46
  Speaker 3: Who owns the product, they'll start giving you exclusivity and
• 1:12:49
  Speaker 3: the like, And I think that that could be really great.
• 1:12:51
  Speaker 3: Do you want some controls? You want some bounds around that?
• 1:12:54
  Speaker 3: And both Curify in the specific instance, but any other
• 1:12:56
  Speaker 3: three D printing company needs to have clarity on what
• 1:12:59
  Speaker 3: they can do versus pharmacists who have to have clarity
• 1:13:02
  Speaker 3: on what they're including because if there is an allergic
• 1:13:05
  Speaker 3: reaction responsible for that, you might go, oh, you know what,
• 1:13:09
  Speaker 3: we'll figure that out. Someone's gonna if someone gets hurted,
• 1:13:12
  Speaker 3: God forbid, no one does the other way around. I
• 1:13:16
  Speaker 3: hope no one gets hurt, is what I'm trying to say.
• 1:13:19
  Speaker 3: But if they do, we want to be clear whose
• 1:13:23
  Speaker 3: responsibility that is. But I think as a three D
• 1:13:25
  Speaker 3: printed drug, it gives such a great opportunity pharmacist to
• 1:13:32
  Speaker 3: sort of increase volume. And if it's a you don't
• 1:13:37
  Speaker 3: want to be doing this in for example, a GLP
• 1:13:40
  Speaker 3: one type space that is really really high risk, you
• 1:13:42
  Speaker 3: don't want to be doing that with a patented product. However,
• 1:13:45
  Speaker 3: there are other opportunities and loads of those. So for example,
• 1:13:50
  Speaker 3: in the pet space that might make sense, and I
• 1:13:54
  Speaker 3: think or you might be in like the hormone space
• 1:13:58
  Speaker 3: that you might say, this is such a simpler and
• 1:14:00
  Speaker 3: I want Or you might might be doing just kids.
• 1:14:04
  Speaker 3: And I remember we used to make that when I
• 1:14:06
  Speaker 3: used to work at write It. I say, right it now,
• 1:14:08
  Speaker 3: because I don't think they exist anymore, that's right, But
• 1:14:14
  Speaker 3: we used to make a product there easier for patients
• 1:14:17
  Speaker 3: to take, for kids to take and this is the
• 1:14:21
  Speaker 3: next version of that, and I'm excited for what this
• 1:14:23
  Speaker 3: looks like. There's also imagine taking that and putting that
• 1:14:27
  Speaker 3: into an ATM, and that's the next version of We've
• 1:14:30
  Speaker 3: been talking about ATM since I graduated in two thousand
• 1:14:33
  Speaker 3: and two. And and the fact is that I'm hoping
• 1:14:37
  Speaker 3: we're getting closer. But imagine that world. But you can't
• 1:14:42
  Speaker 3: do that necessarily with all kinds of products, and we've
• 1:14:45
  Speaker 3: got to look at the mis and bounds. But I
• 1:14:47
  Speaker 3: think it's super exciting. I think it's super such a
• 1:14:51
  Speaker 3: great opportunity for pharmacists. We're saying, you know what, I
• 1:14:53
  Speaker 3: don't want to do the heavy lift of compounding. Maybe
• 1:14:56
  Speaker 3: this becomes that tool to get you there.
• 1:14:58
  Speaker 2: Yeah.
• 1:14:59
  Speaker 4: Yes, So let's shift gears to artificial intelligence. So AI
• 1:15:03
  Speaker 4: is you know what AI at this stage of the
• 1:15:06
  Speaker 4: game reminds me of. I am old enough to have
• 1:15:12
  Speaker 4: experienced what was known as the dot com gold Rush.
• 1:15:15
  Speaker 3: Oh we were there.
• 1:15:17
  Speaker 2: You know, year old too, so you know this.
• 1:15:19
  Speaker 4: But for the younger listeners out there, dotcomgold Rush was
• 1:15:22
  Speaker 4: between nineteen ninety nine and two thousand and three, and
• 1:15:26
  Speaker 4: it was when businesses United States businesses because I'm just
• 1:15:30
  Speaker 4: going to reference the United States finally had an opportunity
• 1:15:35
  Speaker 4: to dot comt you know, to do something to build
• 1:15:39
  Speaker 4: a website, to use the Internet to build their business,
• 1:15:42
  Speaker 4: to invest in what is now known as e commerce.
• 1:15:46
  Speaker 4: And back in the between ninety nine and two thousand
• 1:15:51
  Speaker 4: and one, Door Sean, it was a run a muck
• 1:15:54
  Speaker 4: environment where people didn't know what they were doing. They
• 1:15:57
  Speaker 4: were buying big t ones, which are access to Internet.
• 1:16:01
  Speaker 4: They were buying over spending on website development, over spending,
• 1:16:06
  Speaker 4: overspending because they just thought it was their eyes all
• 1:16:10
  Speaker 4: rolled back and people were thinking that there's just going
• 1:16:13
  Speaker 4: to be all this flowing money because nobody knew how
• 1:16:15
  Speaker 4: to make definitions. I feel like the world of AI,
• 1:16:21
  Speaker 4: especially in healthcare, and then let's drill down into pharmacy.
• 1:16:25
  Speaker 4: We're going through this where there's a rush. I always
• 1:16:29
  Speaker 4: just got back from Assemia about three or four weeks ago,
• 1:16:32
  Speaker 4: and there were so many companies there that were claiming
• 1:16:36
  Speaker 4: to be we're in AI development, We're in doing this,
• 1:16:40
  Speaker 4: blah blah blah. But I only from a personal perspective,
• 1:16:45
  Speaker 4: I'm a gravitating towards the ones that have invested in pharmacy.
• 1:16:52
  Speaker 4: First in AI second, and then they're coming out and
• 1:16:57
  Speaker 4: they're developing their own policies before anybody else does, before
• 1:17:01
  Speaker 4: you know, FTC and FDA and all of the regulatory
• 1:17:04
  Speaker 4: finally gets some teeth in it where they're regulating themselves
• 1:17:08
  Speaker 4: to say, regardless of how wonderful this AI is in
• 1:17:12
  Speaker 4: this process or the or you know, insurance verification or
• 1:17:17
  Speaker 4: data entry, no matter how wonderful it seems, it still
• 1:17:22
  Speaker 4: comes back to the license of the pharmacist. It still
• 1:17:25
  Speaker 4: comes back to the technician double checking things. So talk
• 1:17:29
  Speaker 4: to me about how AI in your realm of of
• 1:17:34
  Speaker 4: being like an FDA architect for clients and making sure
• 1:17:37
  Speaker 4: people are you know, adherent to the law. Talk to
• 1:17:40
  Speaker 4: me about how hey, AI has has impacted your your
• 1:17:44
  Speaker 4: world world.
• 1:17:46
  Speaker 3: Again as always staying ahead of the curve. There, Todd,
• 1:17:49
  Speaker 3: look at you. We talked about three D printing. We
• 1:17:51
  Speaker 3: talked about DTP and sort of getting it out there
• 1:17:55
  Speaker 3: and METSPAS, but we're not talking about AI. AI for
• 1:17:59
  Speaker 3: me is and you and I talked about it like
• 1:18:02
  Speaker 3: the buzzword, if you will, and I think that's exactly
• 1:18:04
  Speaker 3: what it is. The Fact is that in two thousand
• 1:18:09
  Speaker 3: we were saying the Internet's going to change the world,
• 1:18:13
  Speaker 3: and people poo people pooh poohed that, and they said, no,
• 1:18:16
  Speaker 3: it won't and that and the people who thought that
• 1:18:20
  Speaker 3: would go like were part of the gold rush. The
• 1:18:23
  Speaker 3: fact is that the Internet did change, and it did
• 1:18:27
  Speaker 3: change everything we know about how how business operated. I
• 1:18:32
  Speaker 3: remember having a Packard bell. I don't know if you
• 1:18:34
  Speaker 3: remember packard belt, but I had a packet Bell in
• 1:18:36
  Speaker 3: like nineteen ninety four, ninety five, and that had pentium systems.
• 1:18:41
  Speaker 3: I remember all those things, and that was great. But
• 1:18:44
  Speaker 3: the fact was that even though the world may not
• 1:18:49
  Speaker 3: the world will definitely not look the same after AI.
• 1:18:52
  Speaker 3: But there is that gold rush of everyone's saying I
• 1:18:54
  Speaker 3: will be the one to change the system. But what
• 1:18:57
  Speaker 3: I'm seeing more and more of, whether we're talking about
• 1:18:59
  Speaker 3: people you using Claude or people using chat GPT, of
• 1:19:02
  Speaker 3: people using Perplexity or Gemini or something else, is that
• 1:19:08
  Speaker 3: number one, they're not building their own native system. They're
• 1:19:11
  Speaker 3: basically creating a wrapper around a pre existing system, and
• 1:19:17
  Speaker 3: then they're making what are called so you might have
• 1:19:19
  Speaker 3: it on a local system or you might have what's
• 1:19:21
  Speaker 3: a call what's called a call that imagine sort of
• 1:19:24
  Speaker 3: building something in your backyard. And then every time you
• 1:19:27
  Speaker 3: need information, you're throwing something over your fence and saying,
• 1:19:30
  Speaker 3: give me some information from here, and then someone puts
• 1:19:32
  Speaker 3: something behind it, like onto that fence and sends it
• 1:19:34
  Speaker 3: back into your backyard. But every time you do that,
• 1:19:37
  Speaker 3: it's not private anymore. There's actually a court case going
• 1:19:40
  Speaker 3: on right now in New Jersey where there was a
• 1:19:48
  Speaker 3: essentially the government is suing this person, mister Heppner, if
• 1:19:53
  Speaker 3: you will. Heppner was talking to his lawyer, and his
• 1:19:56
  Speaker 3: lawyer said, go summarize this conversation so that we can
• 1:20:00
  Speaker 3: have it. He wrote it out, went into Claude, put
• 1:20:02
  Speaker 3: it up, and Claude summarized it for him, and then
• 1:20:05
  Speaker 3: he gave it back and give it to his lawyer.
• 1:20:07
  Speaker 3: The other side, the government said, no, no, no, the
• 1:20:11
  Speaker 3: moment you went down to public facing Claude, you lost
• 1:20:13
  Speaker 3: attorney client privilege, which means you lost privacy. Now, imagine
• 1:20:19
  Speaker 3: these systems that are being created and they're now sharing
• 1:20:24
  Speaker 3: or getting access to your patient data, and that patient
• 1:20:27
  Speaker 3: data is going out and coming back in. That could
• 1:20:30
  Speaker 3: be a violation of hippo. Do you have a BA
• 1:20:33
  Speaker 3: with them? Do they know what to do with a
• 1:20:35
  Speaker 3: BA Do they have controls in place? And they may
• 1:20:37
  Speaker 3: not even know that those rules exist. So the first
• 1:20:41
  Speaker 3: thing I'd caution you on is, yes, I think AI
• 1:20:43
  Speaker 3: will change the world, but you need to look at
• 1:20:46
  Speaker 3: what rules are, what rules they're following. Do they understand
• 1:20:49
  Speaker 3: what they're looking at. Another great example, especially happens a
• 1:20:52
  Speaker 3: lot to pharmacists is this idea of, well, we want
• 1:20:58
  Speaker 3: to make sure that we are counseling patients as part
• 1:21:02
  Speaker 3: of that. There's a great system out there. Doctors use
• 1:21:04
  Speaker 3: it all the time called ambient AI. Have you heard
• 1:21:07
  Speaker 3: about this? Yes? Have you seen the lawsuits with them?
• 1:21:12
  Speaker 3: So they deal with ambient AI. And I think it's
• 1:21:15
  Speaker 3: a great concept, and I know physicians using it all
• 1:21:17
  Speaker 3: the time. We're going I don't have time to make
• 1:21:20
  Speaker 3: records of everything I'm doing, so I'm going to use
• 1:21:23
  Speaker 3: ambient AI. I'm going to record the conversation. Turns out
• 1:21:26
  Speaker 3: it hallucinates, so it knows that it needs to get
• 1:21:29
  Speaker 3: consent before recording something. There was a situation where allegedly
• 1:21:34
  Speaker 3: someone didn't get the consent, so the AI just hallucinated,
• 1:21:38
  Speaker 3: but there was consent. So and that's the kind of
• 1:21:42
  Speaker 3: stuff you have to worry about so make sure and
• 1:21:45
  Speaker 3: this is going to exactly what you were talking about, Todd,
• 1:21:48
  Speaker 3: this idea of you need to have the pharmacists, the
• 1:21:52
  Speaker 3: technicians all looking at how these tools are being used.
• 1:21:56
  Speaker 3: The report that puts out are they actually accurate? Because
• 1:22:00
  Speaker 3: the Department of Justice has already come out and said
• 1:22:03
  Speaker 3: whether or not you use AI, and we think it's
• 1:22:05
  Speaker 3: a great idea to use AI. But whether or not
• 1:22:07
  Speaker 3: you use AI, you are the one that's responsible. So
• 1:22:12
  Speaker 3: if you're going to use AI, I think that's wonderful.
• 1:22:15
  Speaker 3: But always to quote Reagan and for those for the
• 1:22:19
  Speaker 3: young kids right now, they barely know who Reagan is,
• 1:22:22
  Speaker 3: but to quote Ronald Reagan, trusts, but verify. So yes,
• 1:22:28
  Speaker 3: hopefully the AI is doing all those things you want
• 1:22:31
  Speaker 3: it to be done. To verify that every single time.
• 1:22:34
  Speaker 3: And the fact is, and we both know this, I've
• 1:22:37
  Speaker 3: worked as a pharmacist and the number of times if
• 1:22:41
  Speaker 3: you work in a EHR system, the number of time
• 1:22:44
  Speaker 3: is going to give you an interaction that is irrelevant,
• 1:22:47
  Speaker 3: You're just going to click through it and you're going
• 1:22:49
  Speaker 3: to ignore it. And the fact that makes you click
• 1:22:51
  Speaker 3: through these interactions all the time, you start ignoring those interactions. Now,
• 1:22:56
  Speaker 3: the fact is that in these scenarios, what what is
• 1:23:00
  Speaker 3: the EHR system trying to do? The EHR systems trying
• 1:23:03
  Speaker 3: to say you are responsible for clicking through it, we're
• 1:23:07
  Speaker 3: holding you responsible for it. Well, that's all well and good.
• 1:23:11
  Speaker 3: The fact is in the end you're still responsible. So
• 1:23:14
  Speaker 3: if you're using an AI, go back in check everything.
• 1:23:17
  Speaker 3: But the fact that we know we're going to click
• 1:23:19
  Speaker 3: through these things really really quickly. We're just going to
• 1:23:21
  Speaker 3: be like, I trust it's in there. And that's what
• 1:23:24
  Speaker 3: I worry about for my pharmacy, my fellow pharmacist. This
• 1:23:28
  Speaker 3: idea that we are just going to go it's done
• 1:23:32
  Speaker 3: it right the first fifteen times sixteen is probably not
• 1:23:35
  Speaker 3: a problem, not going to be a problem, but it
• 1:23:37
  Speaker 3: might be. And the other part of it is that
• 1:23:40
  Speaker 3: the summary may focus on a completely different element. And
• 1:23:44
  Speaker 3: you and I have anyone here has listened to the
• 1:23:47
  Speaker 3: Zoom summaries and the other summaries that all these systems
• 1:23:53
  Speaker 3: put out. They tend to be dry, they tend to
• 1:23:57
  Speaker 3: be sort of matter of factly, but they don't focus
• 1:24:00
  Speaker 3: on the elements that you necessarily wanted to focus on.
• 1:24:03
  Speaker 3: So if it's taking notes, make sure that those notes
• 1:24:07
  Speaker 3: are reflect the components you want reflected. And sometimes the
• 1:24:12
  Speaker 3: question is from a patient confidentiality perspective, do you need
• 1:24:16
  Speaker 3: that recording every single time? So make sure you have
• 1:24:18
  Speaker 3: controls in place, backups in place. Who owns those backups?
• 1:24:21
  Speaker 3: Because I can tell you this right now, every AI
• 1:24:24
  Speaker 3: system is trying to go, I have these conversations, how
• 1:24:26
  Speaker 3: do I monetize them? Who owns that data? And for
• 1:24:30
  Speaker 3: a lot of pharmacies, they're going, this is my patients,
• 1:24:33
  Speaker 3: these are my patients. This is my data. You can
• 1:24:35
  Speaker 3: just sell it, They're going, why not? It's on my systems.
• 1:24:39
  Speaker 3: You can clear in your contracting to make sure that
• 1:24:42
  Speaker 3: there are appropriate controls in place. But that's just some
• 1:24:45
  Speaker 3: of the stuff that's going on there.
• 1:24:46
  Speaker 2: Yeah, all right.
• 1:24:47
  Speaker 4: Last subject that is changing the game of the pharmaceutical
• 1:24:52
  Speaker 4: markets is the realm of direct to consumer. And I
• 1:24:57
  Speaker 4: want to take layers for a second, because if we
• 1:25:00
  Speaker 4: back up twenty years ago, mister Dave Marley, who's a
• 1:25:05
  Speaker 4: legend and I don't even think he's in the pharmacy
• 1:25:07
  Speaker 4: business anymore because he sold Marley direct to a manufacturer wholesaler,
• 1:25:14
  Speaker 4: But I remember the rings of the pharmaceutical ecosystem starting
• 1:25:20
  Speaker 4: to peel away, and I remember the wholesaler and then
• 1:25:25
  Speaker 4: all of a sudden.
• 1:25:26
  Speaker 2: The buying groups and then there were like.
• 1:25:31
  Speaker 4: Maybe another layer, Like the layers are becoming thinner and thinner.
• 1:25:36
  Speaker 4: And you know, I'm showing on the screen right now
• 1:25:38
  Speaker 4: Marley Drug, who is now in all fifty states, and
• 1:25:43
  Speaker 4: you know, they're one of the very first direct to
• 1:25:45
  Speaker 4: consumer from the manufacturer to the pharmacists, and they avoided
• 1:25:49
  Speaker 4: the wholesaler. And then you know, we have in an
• 1:25:53
  Speaker 4: article that came out on April fourth from Fierce Pharma,
• 1:25:57
  Speaker 4: it says a bill would for payers to apply direct
• 1:26:01
  Speaker 4: to consumer drug purchases to patient deductibles.
• 1:26:05
  Speaker 2: So the whole direct to consumer is in.
• 1:26:08
  Speaker 4: It's in kind of like a I want to know
• 1:26:12
  Speaker 4: where it's all going, goodness gracious, And then I also
• 1:26:15
  Speaker 4: want to know for the the the the smaller player,
• 1:26:20
  Speaker 4: maybe the regional chain or the independent community pharmacy owners
• 1:26:24
  Speaker 4: who have one or two or maybe five locations, like
• 1:26:28
  Speaker 4: where's all this direct to consumer stuff going? And how
• 1:26:32
  Speaker 4: do we keep people safe?
• 1:26:33
  Speaker 3: For goodness sakes, Yeah, I think direct to consumer is incredibly,
• 1:26:39
  Speaker 3: very very very busy. The most recent one for those
• 1:26:42
  Speaker 3: people who are listening, and again Todd's always bringing you
• 1:26:45
  Speaker 3: the latest information from everywhere, yesterday's news. Mark Cuban is
• 1:26:51
  Speaker 3: not part of crump arx right, and he's making sure
• 1:26:54
  Speaker 3: that these medications are being made cheaply and easily accessible
• 1:27:01
  Speaker 3: to patients through using his own platform. He's trying to
• 1:27:05
  Speaker 3: be transparent about it. But I love the fact that,
• 1:27:08
  Speaker 3: again from a direct to consumer standpoint or director patient standpoint,
• 1:27:13
  Speaker 3: they're using these tools. So I think that that or
• 1:27:18
  Speaker 3: USA today will come. We'll bring it up. But Gibs like,
• 1:27:20
  Speaker 3: I'm gonna let you pull it up. So while while
• 1:27:27
  Speaker 3: you're pulling it up, the two things you've got to
• 1:27:29
  Speaker 3: compare is the flattening off the pharmaceutical supply chain and
• 1:27:37
  Speaker 3: the flattening of the payment for the PHARMACU for the
• 1:27:41
  Speaker 3: pharmaceutical supply chain. And what I mean by that, and
• 1:27:44
  Speaker 3: this is how our world as pharmacistel has always existed.
• 1:27:48
  Speaker 3: We would work through GPOs and the like in terms
• 1:27:51
  Speaker 3: of accessing the drug itself, and the payment would be
• 1:27:53
  Speaker 3: through third party payers. And those are two different worlds
• 1:27:58
  Speaker 3: that did not necessarily interact with each other. The fact
• 1:28:04
  Speaker 3: is that COVID has helped flatten that and to be fair,
• 1:28:07
  Speaker 3: we've got to give credit where credit is due.
• 1:28:10
  Speaker 2: And you saw these pharmacies come out.
• 1:28:12
  Speaker 3: And say, you know what, whether I'm row, whether it's Hymns,
• 1:28:15
  Speaker 3: whether it's hers, they're all coming out and saying we
• 1:28:19
  Speaker 3: want access to these GLP ones. And as a result
• 1:28:24
  Speaker 3: of that access of patients got access to drugs that
• 1:28:29
  Speaker 3: they couldn't get from anywhere else. When those when when
• 1:28:35
  Speaker 3: the shortages were resolved, these pharma companies said, we don't
• 1:28:40
  Speaker 3: need to reinvent the wheel. There you go, we don't
• 1:28:44
  Speaker 3: need to reinvent the wheel. The fact is that pharmacies
• 1:28:48
  Speaker 3: already have access to these patients. They're dealing with them
• 1:28:52
  Speaker 3: every single day. How do we capitalize on that without
• 1:28:58
  Speaker 3: having to go through all these middlemen and all these
• 1:29:01
  Speaker 3: middlemen who want to have a piece of that pie.
• 1:29:05
  Speaker 3: So if I was going to charge one hundred dollars
• 1:29:08
  Speaker 3: for something, all the middlemen might take ninety of those
• 1:29:12
  Speaker 3: hundred dollars and then the pharmacy only gets ten. Well,
• 1:29:15
  Speaker 3: if I can just give the pharmacy fifty and I
• 1:29:18
  Speaker 3: still save fifty because I'm avoiding all those middle men,
• 1:29:23
  Speaker 3: the fact is that everyone's a winner except the middleman.
• 1:29:28
  Speaker 3: So I think that's what happened, which is from a
• 1:29:31
  Speaker 3: director patient standpoint, these pharmaceul companies realize that there's an
• 1:29:36
  Speaker 3: opportunity to directly deal with patients and with their caregivers
• 1:29:42
  Speaker 3: i e. The pharmacies, and I think that's where that
• 1:29:44
  Speaker 3: opportunity comes in in terms of how is that going
• 1:29:47
  Speaker 3: to get paid? The fact is that we know that
• 1:29:50
  Speaker 3: when the need is high enough and the cost is
• 1:29:53
  Speaker 3: low enough, patients will bring money out of their pockets.
• 1:29:57
  Speaker 3: But that's not fair. We paid for insurance to cover
• 1:30:00
  Speaker 3: exactly this. Insurance companies and PBMs were really really happy
• 1:30:04
  Speaker 3: because they get to say things like, well, we have
• 1:30:07
  Speaker 3: our system, you can come through our system. Will say
• 1:30:10
  Speaker 3: year nay. The fact is that we get to choose
• 1:30:13
  Speaker 3: what products you have and get paid for with the
• 1:30:16
  Speaker 3: bill like the one you showed. It forces whether using
• 1:30:20
  Speaker 3: your HSA or your FSA, to have payments made for
• 1:30:26
  Speaker 3: the money that you're putting out towards these director patient drugs.
• 1:30:29
  Speaker 3: In many ways, it goes back to that original version
• 1:30:33
  Speaker 3: of pharmacy we had all those years ago, which is
• 1:30:36
  Speaker 3: I want this drug, I'll pay you for this drug,
• 1:30:38
  Speaker 3: and then I'll figure out how to get reimbursed for it,
• 1:30:41
  Speaker 3: and that's the system we're kind of working towards. And
• 1:30:43
  Speaker 3: I think it reminds me a little bit of that
• 1:30:50
  Speaker 3: world we had. You remember this is you and I
• 1:30:53
  Speaker 3: will remember this very easily, but probably about ten years ago,
• 1:30:57
  Speaker 3: if you wanted to get a TV channel, it used
• 1:31:00
  Speaker 3: to be part of this giant bundle of like fifty
• 1:31:03
  Speaker 3: other TV channels. And I don't speak Spanish, but I
• 1:31:05
  Speaker 3: had to suddenly subscribe to Tel Mundo just to get
• 1:31:07
  Speaker 3: access to the one channel I wanted. And that was
• 1:31:10
  Speaker 3: always a pain in the butt because you're like, I'm
• 1:31:12
  Speaker 3: buying all these other channels that I don't need. So
• 1:31:15
  Speaker 3: what did they say? You then had Netflix, who came
• 1:31:17
  Speaker 3: in and said, we don't need to do that anymore.
• 1:31:19
  Speaker 3: And it reminds me of this ad going back even
• 1:31:21
  Speaker 3: furthest in the early two thousands, there was this one
• 1:31:24
  Speaker 3: ad this guy goes into this motel and he goes,
• 1:31:27
  Speaker 3: what kind of TV do you have? And the guy goes,
• 1:31:29
  Speaker 3: every channel ever made, every show ever made, whenever you
• 1:31:33
  Speaker 3: want it, And that's the world we got. So that's
• 1:31:35
  Speaker 3: someone got to say we get rid of all of
• 1:31:39
  Speaker 3: this excess and get you the product you want, and
• 1:31:42
  Speaker 3: that's where we are again. We went from you get
• 1:31:45
  Speaker 3: to get access to all these drugs, to the drugs
• 1:31:48
  Speaker 3: will be paid for by the PBM, to the PBM
• 1:31:50
  Speaker 3: saying you can't have the drugs you get paid for.
• 1:31:53
  Speaker 3: Back to the new normal, which is you can get
• 1:31:55
  Speaker 3: every drug you want as long as you as you
• 1:31:58
  Speaker 3: pay for it. And I think that's the exciting part.
• 1:32:01
  Speaker 3: Were going back to actual true healthcare. It has its
• 1:32:05
  Speaker 3: own risks, don't get me wrong, and we as pharmacists
• 1:32:07
  Speaker 3: are going to have to be part of that process
• 1:32:09
  Speaker 3: of going Are we managing those risks perfectly? Are we
• 1:32:13
  Speaker 3: making sure that patients are getting just the drugs that
• 1:32:15
  Speaker 3: they want? But if you set that up right, you're
• 1:32:18
  Speaker 3: going to be in a world where you get to
• 1:32:20
  Speaker 3: directly deal with farm sol companies. And to the question
• 1:32:23
  Speaker 3: you're asking me, Todd, the fact is that these farm
• 1:32:26
  Speaker 3: soool companies are saying, do you have access to the
• 1:32:29
  Speaker 3: patients I need to get this drug too? Yes, you
• 1:32:32
  Speaker 3: can always buy the product, But if you get to
• 1:32:34
  Speaker 3: start developing the relationships with these farmer companies and go,
• 1:32:38
  Speaker 3: you know what I have? I'm making this up. Ten
• 1:32:42
  Speaker 3: patients who are on Castleman's disease. I want to be
• 1:32:46
  Speaker 3: one of the suppliers to make sure that these drugs
• 1:32:49
  Speaker 3: are being provided for these rare disease states. I can
• 1:32:53
  Speaker 3: assure you that these farm soil companies for these rare
• 1:32:56
  Speaker 3: disease states are going to say, I want to deal
• 1:32:58
  Speaker 3: with this pharmacy because the fact is that this person
• 1:33:02
  Speaker 3: knows who his patients are or her patients are and
• 1:33:06
  Speaker 3: wants to make sure they get access. Let's make sure
• 1:33:09
  Speaker 3: that this pharmacy is ready. Let's train them. Let's you
• 1:33:12
  Speaker 3: become a specially pharmacy for your drug so you build
• 1:33:16
  Speaker 3: those relationships with those pharmacol companies you've had. I'm blanking
• 1:33:22
  Speaker 3: on the inhaled insulin. Who do you remember who's the
• 1:33:30
  Speaker 3: pharmacist who actually owns or he's the president for the company?
• 1:33:34
  Speaker 3: H Mike Castania. I think I want to say so again.
• 1:33:39
  Speaker 3: He was. He's an example of exactly those type of
• 1:33:42
  Speaker 3: people who are trying to say, how do we get
• 1:33:46
  Speaker 3: access to patients directly. I don't know if they have
• 1:33:48
  Speaker 3: a DTP program, but he as a pharmacist, and I
• 1:33:52
  Speaker 3: I imagine he's some He's got some version of that
• 1:33:55
  Speaker 3: system out there, and I think those are some of
• 1:33:57
  Speaker 3: the exciting things happening in the pharmacy world. Talk to
• 1:34:00
  Speaker 3: your supplier. Talk and suppliers may not want to tell
• 1:34:04
  Speaker 3: you because they may get cut out of this. So
• 1:34:07
  Speaker 3: talk to directly to the pharma seal company and go
• 1:34:09
  Speaker 3: I have these patients, I want to build a relationship
• 1:34:12
  Speaker 3: directly with you. How do I do that so I
• 1:34:14
  Speaker 3: can drop the cost for my patients. I think that's
• 1:34:17
  Speaker 3: going to be a game changer as you continue.
• 1:34:21
  Speaker 4: I agree, and I think that there's going to be
• 1:34:24
  Speaker 4: more manufacturers, especially in the generic field, that are going
• 1:34:30
  Speaker 4: to bypass anything to do with insurance. For example, in
• 1:34:35
  Speaker 4: the Pittsburgh area, there's three or four cash only pharmacies
• 1:34:40
  Speaker 4: popping up that started doing it five six years ago,
• 1:34:44
  Speaker 4: which it was considered so novel, But it's not going
• 1:34:47
  Speaker 4: to be novel anymore. If direct to consumer is a model,
• 1:34:50
  Speaker 4: then direct to pharmacy is going to become a model.
• 1:34:53
  Speaker 2: And it's already happening in the generic space.
• 1:34:57
  Speaker 4: So it's it's like, we're going to continue to see
• 1:35:00
  Speaker 4: the evolution of all of this.
• 1:35:01
  Speaker 3: Yeah, in the end, I work with pharmacal companies in
• 1:35:05
  Speaker 3: the director consumer space and they're often going so can
• 1:35:08
  Speaker 3: we actually dispense the drug to the patient and go no,
• 1:35:11
  Speaker 3: you're ready. You're not licensed as a pharmacist. You're not
• 1:35:14
  Speaker 3: licensed as a pharmacy. Only the pharmacy can do the dispensing. Well,
• 1:35:17
  Speaker 3: how do you do enable that to happen? Some people
• 1:35:21
  Speaker 3: may say, you know what, we're a specific kind of
• 1:35:23
  Speaker 3: product and we'll directly ship and we'll get licenses a
• 1:35:27
  Speaker 3: pharmacists as a pharmacy, but that's few and far between.
• 1:35:31
  Speaker 3: You are the last channel as a pharmacist in that
• 1:35:34
  Speaker 3: value chain, So use that. Talk to your patients, find
• 1:35:37
  Speaker 3: out what they're looking for, make sure it's available, and
• 1:35:40
  Speaker 3: you build those relationships directly. So Todd, thank you for
• 1:35:44
  Speaker 3: giving you a form to make that discussion happen.
• 1:35:47
  Speaker 2: Yeah.
• 1:35:48
  Speaker 4: I always look like having you on direktche have to
• 1:35:50
  Speaker 4: promise to come back, and we need to get you
• 1:35:52
  Speaker 4: back on more often so that we can dig into
• 1:35:54
  Speaker 4: some subjects. And I think we should do a panel
• 1:35:56
  Speaker 4: discussion with some other We should dig down into a
• 1:35:59
  Speaker 4: spacific topic, because we we went over four or five
• 1:36:03
  Speaker 4: topics today, but we'll go much deeper and bring in
• 1:36:06
  Speaker 4: some other people that have experienced this and bounce bounce
• 1:36:10
  Speaker 4: some ideas off of them, but thank you for being
• 1:36:12
  Speaker 4: on twers
• 1:36:13
  Speaker 3: Thank you for having me as always, Hey, we'll be
• 1:36:16
  Speaker 3: right back with more