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The Devil Wore a Lab Coat & PBM Reform in Illinois | TWIRx · Pharmacy Podcast Network

0:07
Speaker 1: Thanks for listening to the Pharmacy Podcast Network.
0:19
Speaker 2: Welcome to This Week in Pharmacy. I'm your host Todd.
0:22
Speaker 2: You're a founder of the Pharmacy Podcast Network. I am
0:25
Speaker 2: in New Jersey right now at the Explore Events, the
0:30
Speaker 2: first user conference put on by Primarx, and we will
0:34
Speaker 2: be there today Friday, October tenth through Saturday. And if
0:40
Speaker 2: you are here in New Jersey, make sure that you
0:42
Speaker 2: connect with us here.
0:44
Speaker 3: And we are so excited.
0:46
Speaker 2: Today we have two amazing interviews and features, one with
0:50
Speaker 2: the IPC group John Covello and Illinois Pharmacist Association's executive director,
0:58
Speaker 2: and can't wait for you to hear this, and then
1:01
Speaker 2: a special guest. I am not giving it away. Actually
1:04
Speaker 2: it's already in the title. What am I saying?
1:05
Speaker 3: Mary Cutter is here.
1:06
Speaker 2: I cannot wait for you to hear her and her
1:09
Speaker 2: passion and her work and her art. It's all today
1:13
Speaker 2: on this Week in Pharmacy. How things are changing so
1:36
Speaker 2: rapidly with PBM reform and the impact is coming from
1:39
Speaker 2: the grassroots efforts of organizations like the NCPA and put
1:45
Speaker 2: in the state organizations that are just so key. We
1:49
Speaker 2: are so lucky to have a state organization on tourks
1:52
Speaker 2: Today Illinois Pharmacist Association CEO Executive Director Garth Reynolds. I'm
1:58
Speaker 2: so excited to see you, Garth.
2:00
Speaker 3: How are you.
2:01
Speaker 4: I'm great, Todd, thank you very much for having me.
2:03
Speaker 2: Absolutely and John Cavello no stranger to the pods through
2:08
Speaker 2: IPC's relationship with the Pharmacy Podcast Network.
2:11
Speaker 5: It's great.
2:12
Speaker 3: Thank you John.
2:13
Speaker 1: Great. Yeah, I'm glad to be here. You know, I'm
2:15
Speaker 1: senior director of Government Relations for IPC, working under our
2:20
Speaker 1: executive vice President Mark Kenney, with our whole team around
2:22
Speaker 1: the country and our partners, great partners in the states
2:26
Speaker 1: like the Illinois Farms Association. So I'm really excited that
2:29
Speaker 1: we can talk about a really very positive development for
2:32
Speaker 1: community pharmacy in Illinois.
2:35
Speaker 3: It was big news.
2:36
Speaker 2: And this week in Pharmacy we are featuring HB one
2:41
Speaker 2: six nine seven. I feel like that main movie back
2:48
Speaker 2: in the day where he was like HB one nine
2:50
Speaker 2: er niner and then he's like, I hear at niner
2:53
Speaker 2: in there. So this is HB one six nine seven.
2:57
Speaker 3: Garth.
2:58
Speaker 2: I'm kicking this right over to you. Are give our
3:00
Speaker 2: listeners a summary of what this is.
3:03
Speaker 4: So house built sixteen ninety seven, or also known as
3:07
Speaker 4: the Prescription Drug Affordability Act, was the premier healthcare initiative
3:13
Speaker 4: this session from Governor Pritzker and looking at trying to
3:17
Speaker 4: address PBM reform from multiple different levels, mainly looking at
3:21
Speaker 4: access issues like trying to get rid of spread pricing
3:24
Speaker 4: patients steering, moving rebates back to the employers and health plans,
3:30
Speaker 4: but also looking at just trying to really rip open,
3:35
Speaker 4: throw the curtains back, and getting more transparency into this
3:38
Speaker 4: process and a lot of different determinations of getting more
3:43
Speaker 4: data back to the state to really look into these
3:46
Speaker 4: issues both on a commercial and in a public sphere.
3:49
Speaker 4: And that's the other thing too. It also helps align
3:53
Speaker 4: because we have our managed Medicaid program which has kind
3:55
Speaker 4: of been running, you know, out on its own in
3:58
Speaker 4: a lot of ways regulatory wise, and this finally puts
4:01
Speaker 4: them back under the umbrella of the Department of Insurance, saying, yes,
4:04
Speaker 4: you are still responsible to medicate, but you're also responsible
4:07
Speaker 4: to the Department of Insurance. But the last piece, and
4:11
Speaker 4: probably the biggest piece when it comes to what we're
4:13
Speaker 4: talking about today, is there's about seventy million dollars that's
4:17
Speaker 4: being focused on shoring up pharmacy sustainability and patient access
4:22
Speaker 4: through throughout the states. Because in Illinois, just like a
4:26
Speaker 4: lot of states, we have pharmacy deserts, both in urban
4:28
Speaker 4: and rural areas. And we've got seventy four of our
4:31
Speaker 4: one hundred and two counties are considered pharmacy deserts. Four
4:34
Speaker 4: of our counties don't have a pharmacy at all right now,
4:37
Speaker 4: and so this is a major access epidemic issue in Illinois.
4:42
Speaker 4: And this isn't just a rural Illinois issue. Seven part
4:45
Speaker 4: of that seventy four is Cook County, Due Page, will Caine,
4:50
Speaker 4: Lake County, the Coller counties around suburban Chicago are all
4:54
Speaker 4: in the city itself, are all part of the pharmacy
4:57
Speaker 4: desert issue in Illinois. And so you know what, what
5:00
Speaker 4: some of the sustainability part of this program is doing
5:03
Speaker 4: is really trying to expand our current existing critical access
5:07
Speaker 4: care pharmacy, which you had a slide briefly that showed,
5:10
Speaker 4: you know, we started that program back in twenty eighteen,
5:14
Speaker 4: working with IPC and our pharmacy stakeholders in establishing that process.
5:19
Speaker 4: But you see there's been a lot of building a
5:21
Speaker 4: momentum with getting you know pharmacy regulation of PBMs and
5:26
Speaker 4: getting DOI more involved back in twenty nineteen and getting
5:29
Speaker 4: the state to look at their own data and to
5:31
Speaker 4: realize that almost two hundred million dollars was found in
5:34
Speaker 4: spread in the managed Medicaid program in just two years,
5:37
Speaker 4: so it's a billion dollars extrapolated since that time. And
5:41
Speaker 4: then just continuing more transparency and anti retaliation audit protections
5:45
Speaker 4: for pharmacy. So this has been building and for the
5:48
Speaker 4: governor to finally say enough's enough, we need to make
5:53
Speaker 4: a massive change in this area was a huge momentum
5:56
Speaker 4: push for us and a huge morale boost or pharmacy
6:01
Speaker 4: to know that the state is finally has listened to
6:04
Speaker 4: all of our advocacy and is wanting to push this
6:08
Speaker 4: forward and really take a serious approach to PBMs and
6:12
Speaker 4: say the line is drawn here, we're going to start
6:16
Speaker 4: looking at you a lot closer and getting things more
6:19
Speaker 4: sustainable for pharmacies. But it doesn't solve everything. As we
6:22
Speaker 4: all know, We've got more momentum to continue our advocacy,
6:27
Speaker 4: but I'll pull back, so jumpkin head in a little
6:29
Speaker 4: bit here.
6:30
Speaker 1: Yeah, I mean, you know, Todd, this is really an
6:33
Speaker 1: interesting development where Garth and I have been working on
6:35
Speaker 1: this probably for about six years, and the building blocks
6:40
Speaker 1: of previous laws getting We actually call it the Illinois
6:44
Speaker 1: model where we're helping other states because we've been involved
6:47
Speaker 1: in the managed care reforms in California, New York, Ohio,
6:53
Speaker 1: a bit in Kentucky. You know, we learned a lesson
6:55
Speaker 1: early on from the reforms in West Virginia. Huge advances
6:59
Speaker 1: for a short term reform and then a permanent one
7:04
Speaker 1: in Michigan. And we're working with other states, but you know,
7:08
Speaker 1: getting this kind of study we passed. Garth and I
7:11
Speaker 1: worked together to pass a law to mandate what the
7:14
Speaker 1: state orderer had to do and what information had to
7:17
Speaker 1: be provided to them. That that setup of a study
7:22
Speaker 1: requirement and the results is really the template we're trying
7:26
Speaker 1: to use everywhere of getting governments to look at their
7:29
Speaker 1: own data to understand how they're getting overbuilt. You know, basically,
7:34
Speaker 1: they charge the state one amount of money and they're
7:37
Speaker 1: paying the pharmacies less or in many instances they pay
7:42
Speaker 1: themselves more than they pay local bricks and mortar, community
7:46
Speaker 1: based pharmacies. It's all spread by a different name, but
7:50
Speaker 1: I think it's easy for understand in the policy world,
7:53
Speaker 1: they're getting overbuilt. And you know in all these states
7:56
Speaker 1: we've been doing this around the country. It's close to
8:00
Speaker 1: billion dollars that state governments have identified, like Illinois to
8:05
Speaker 1: the amount of the overbuilding. I mean, it kind of
8:07
Speaker 1: fills in very appropriately to our federal bill that Congressman
8:14
Speaker 1: Buddy Carter has pushed to do the Medicaid reforms to
8:17
Speaker 1: mandate this. So this is a really important first step.
8:20
Speaker 1: But you know, Garth, I know, you know, this year
8:23
Speaker 1: was a big move.
8:23
Speaker 6: We got a lot of.
8:25
Speaker 1: The commercial reforms of spread that they can't do and
8:29
Speaker 1: not paying themselves better and rebate passed through that also
8:32
Speaker 1: benefits not just the commercial marketplace, but also the public
8:36
Speaker 1: employee state plan in Illinois as well as this critical
8:40
Speaker 1: lifeline program for Medicaid managed care exactly.
8:45
Speaker 4: And it'll be great to see as other states have shown,
8:49
Speaker 4: you know, what the state will see in savings as
8:51
Speaker 4: these is going to effect, and they can kind of
8:53
Speaker 4: see that there's a lot more here that can be
8:56
Speaker 4: done if they if they really start holding the pbums accountable.
9:02
Speaker 1: And you know, the evidence, Todd is that the six
9:06
Speaker 1: or eight states that have done these reforms already again
9:09
Speaker 1: their numbers, not the industries. The governments have identified that
9:13
Speaker 1: it has saved them incumulably a billion dollars. So take
9:20
Speaker 1: they were getting ripped off by a billion dollars. Since
9:23
Speaker 1: the states that do the reforms, they've now saved a
9:26
Speaker 1: billion dollars. That's two billion dollars on it. And then
9:29
Speaker 1: there's another group where the states have sued in Illinois
9:32
Speaker 1: was one of them, the biggest MCO senteen for this
9:36
Speaker 1: over building. They're going to collect over a billion dollars.
9:39
Speaker 1: That's three billion dollars. That shows you that what we're
9:42
Speaker 1: talking about in the federal bill is real, the amount
9:45
Speaker 1: of money this will save of both federal and state
9:48
Speaker 1: tax payers, and more importantly, still pay pharmacies at the
9:53
Speaker 1: full cost to preserve access. You know, I know Garth
9:56
Speaker 1: and his colleagues we always talk about the deserts, which
9:59
Speaker 1: is crucial problem. But we also have a lot of members,
10:03
Speaker 1: whether it's IPC or Illinois Farm's Association or any state associations,
10:08
Speaker 1: we have a lot of members that are cutting back
10:10
Speaker 1: on which medicaid drugs they can afford to fill. And
10:14
Speaker 1: I've read some literature where even the insurance industry is
10:18
Speaker 1: now identifying those pharmacies that remain, or what they're calling
10:23
Speaker 1: keystone pharmacies. They can a keystone in a building. They're
10:26
Speaker 1: kind of holding up the system of being the last
10:29
Speaker 1: ones left standing. And Todd, I know, you go around
10:31
Speaker 1: the country, all of right EID stores are now closed.
10:34
Speaker 1: There are certain states where Pennsylvania being a good example,
10:38
Speaker 1: there's a real access issue now. So we're very hopeful
10:42
Speaker 1: that working together with the Only Farmers Association and everybody
10:45
Speaker 1: in the coalition that Garth put together, which was everybody
10:49
Speaker 1: in the industry working together, this will be an important
10:53
Speaker 1: part of preserving their ability to take in every Medicaid
10:57
Speaker 1: prescription presented to them.
11:00
Speaker 2: This is a great update, would you, for the listener's
11:02
Speaker 2: sake just go through the benefits of HB one six seven.
11:08
Speaker 2: The cool people say HB sixteen ninety seven.
11:13
Speaker 4: Yeah, So with the bill, you know, like I said,
11:16
Speaker 4: it broke up in the three categories. But really we
11:17
Speaker 4: get into these these last components of this that we're
11:21
Speaker 4: going to be lowering prescription costs by improving access and
11:26
Speaker 4: lowering costs by you know, removing the blurred business practices
11:31
Speaker 4: that PBMs deploy. And one of the things that we
11:33
Speaker 4: didn't talk about here, is that it also removes the
11:37
Speaker 4: probably one of the more most manipulated sector and that
11:40
Speaker 4: specialty pharmacy. The specialty designation does not exist in Illinois
11:44
Speaker 4: after January one, and so this is in addition to that,
11:48
Speaker 4: we're you know, that's trying to change a lot of
11:50
Speaker 4: patient access. If you've got a pharmacy, you can meet
11:52
Speaker 4: those qualifications to dispense that medication, then the patient can
11:56
Speaker 4: go to their pharmacist. This is about bringing the pharmacists
11:59
Speaker 4: pay relationship back to the forefront and this is the
12:02
Speaker 4: first step of a major step forward and making that
12:06
Speaker 4: a reality. And so, you know, in addition to all
12:11
Speaker 4: the transparency measures, one of the things we didn't talk
12:13
Speaker 4: about in the pharmacy sustainability, this also requires an annual
12:16
Speaker 4: dispensing fee survey to be done as well, and the
12:20
Speaker 4: goal is to have that being performed by one of
12:22
Speaker 4: the colleges of pharmacy to be able to provide the
12:25
Speaker 4: expertise review in that calculation of knowing the factors that
12:30
Speaker 4: need to be utilized in that because we do have
12:32
Speaker 4: some national studies, but they don't come around enough to
12:35
Speaker 4: keep moving with the economy as it. Ebbs and flows.
12:39
Speaker 4: On part of that transparency, which is very important. The
12:42
Speaker 4: three top PBMs every five years are going to have
12:46
Speaker 4: full market conduct of analysis done. And what's great about it,
12:50
Speaker 4: it starts in twenty twenty six, so we come out
12:53
Speaker 4: the door the top three are going to have are
12:56
Speaker 4: going to be put another microscope. So I'm hoping that
13:01
Speaker 4: that will incentivize more compliance to the rules into the
13:06
Speaker 4: new legislation from the PBMs, because we've not seen them
13:11
Speaker 4: be compliant, fully compliant in other states.
13:14
Speaker 1: Yeah, and you know garthe Bray's really important points. There's
13:17
Speaker 1: about eight states now todd that do periodic costs to
13:22
Speaker 1: dispense surveys of pharmacies to find out what their true
13:27
Speaker 1: costs are. But to put Guard's point in context, there
13:30
Speaker 1: hasn't been a national studies since before COVID, So think
13:34
Speaker 1: about what's changed in the last six years since that
13:38
Speaker 1: last national study has been done. A lot more states
13:42
Speaker 1: are starting to look at the cost of filling a
13:45
Speaker 1: specialty drug of what you know, that's got to have
13:48
Speaker 1: a differentiation, and you know, great examples. You know there
13:51
Speaker 1: have been forefront states like West Virginia and Tennessee that
13:55
Speaker 1: and I know New York is in the process of
13:57
Speaker 1: doing it, doing these conduct studies, and you know, they're
14:00
Speaker 1: finding beyond simply scofflaws where they're not complying with what
14:06
Speaker 1: the law requires, and you know, providing real penalties and
14:11
Speaker 1: real enforcement actions to show the PBMs they're serious about this.
14:17
Speaker 1: I mean, we all know this or are in this industry.
14:20
Speaker 1: You really have We always talk about the Big three,
14:23
Speaker 1: but you really have five big ones that control ninety
14:25
Speaker 1: percent of every prescription in this country. And while it
14:29
Speaker 1: may not technically meet a monopoly definition, it's certainly mon
14:33
Speaker 1: optimistic where they're controlling everything and it's a dysfunctional and
14:39
Speaker 1: an economically perverse system that's operating. So these reforms just
14:47
Speaker 1: on that alone, beyond the Medicaid provisions, are giving real teeth.
14:51
Speaker 1: And you know, Garth, I'm real optimistic. You know, you
14:54
Speaker 1: have an insurance commissioner who worked in the in the
14:59
Speaker 1: healthcare industr. So hopefully Director Gillespie, you know, is going
15:04
Speaker 1: to use everything she learned from her years of being
15:07
Speaker 1: on on the other side to know what to go
15:08
Speaker 1: look for.
15:09
Speaker 4: I've been very encouraged with her, with her drive and
15:14
Speaker 4: not only her testimony but her actions with the Department
15:16
Speaker 4: of Leyton and very glad to have her leadership right now.
15:20
Speaker 4: And I, as I've said on many other avenues, I
15:24
Speaker 4: don't want to ever leave this position forever because we're
15:28
Speaker 4: glad to have someone who knows and understands and knows
15:30
Speaker 4: where to hold these entities accountable. And so we're glad
15:34
Speaker 4: for her leadership and her dedication and being a partner
15:39
Speaker 4: and listening to everyone about their experiences which we don't
15:44
Speaker 4: We didn't have it, and.
15:46
Speaker 1: It's important, you know, we see this IPC around the country.
15:50
Speaker 1: This isn't a red or blueish or purple or any
15:53
Speaker 1: other color. It's really about green. Republican states, Democratic states
15:59
Speaker 1: splits things. Everybody is doing the same thing. All the
16:03
Speaker 1: state governors and state legislators are woken up to a
16:07
Speaker 1: basic fact. The PBMs aren't saving them money. And some
16:13
Speaker 1: plan sponsors are finally waking up to this too. You know,
16:17
Speaker 1: we know the damage it's done to patients and to pharmers,
16:20
Speaker 1: community farmies as they're providers. But the plan sponsors are
16:24
Speaker 1: finally seeing the way they conduct themselves and their lack
16:29
Speaker 1: of accountability even to them who are paying their bills,
16:32
Speaker 1: is woking them up to the fact that that reform
16:35
Speaker 1: needs to be done in Washington. But the good news
16:38
Speaker 1: is for anybody listening, reforms are happening in state after state,
16:43
Speaker 1: and you know, we now have a number of states
16:46
Speaker 1: that are really trying to get to cost base pass
16:49
Speaker 1: through reimburse for pharmacies. You know, we doubled the number
16:52
Speaker 1: of states that have done this year. But put it
16:54
Speaker 1: into context Todd and the Medicaid managed care states, we
16:58
Speaker 1: now have thirty three steats of either still pay it
17:00
Speaker 1: themselves at a cost based system directly from Medicaid called
17:04
Speaker 1: the FEF for service car about or they mandated it
17:08
Speaker 1: within their managed care programs that they have to follow
17:11
Speaker 1: that same steps. I mean, that's that's significant reforms we've
17:16
Speaker 1: had well, i'd say certainly in the last eight years.
17:21
Speaker 2: Yep, Hey, Garth, you have to promise to come back
17:25
Speaker 2: and us an update on this weekend pharmacy because this
17:28
Speaker 2: has been wonderful news opportunity to get you on and John,
17:33
Speaker 2: you guys are amazing always giving us the insights that
17:36
Speaker 2: we really need to share because what's happening in Illinois
17:39
Speaker 2: is going to impact the rest of the nation. People
17:41
Speaker 2: are going to be able to follow up with it.
17:42
Speaker 2: So I want to thank you both for being on
17:44
Speaker 2: the pharmacy.
17:46
Speaker 4: Well, I appreciate it. And just one quick thing, you
17:49
Speaker 4: know we talked about. You know, we've got a program
17:51
Speaker 4: out here for critical access pharmacies that right now the
17:55
Speaker 4: Department you have to attest for the new We're doing
17:58
Speaker 4: an annual one time attes state for them to be eligible,
18:01
Speaker 4: and you know, sign up, get let the state tell
18:05
Speaker 4: you whether you qualify or not. Don't wait because if
18:08
Speaker 4: you wait, you're going to be left at the end
18:10
Speaker 4: of the line waiting for twenty twenty seven. So act
18:13
Speaker 4: on that. You'll see links to it from US and
18:16
Speaker 4: you'll see links to it from the department. So please
18:18
Speaker 4: make sure to act on that before October thirty.
18:21
Speaker 1: First, yes, you have to get those applications by October thirty. First,
18:25
Speaker 1: what really means to the bottom line top for managed care,
18:29
Speaker 1: You're going to go from getting fees that you probably
18:31
Speaker 1: get right now from a managed care entity anywhere from
18:34
Speaker 1: fifty seventy five cents, you will be getting fifteen dollars
18:39
Speaker 1: and fifty five cents for each qualified Medicaid managed care
18:42
Speaker 1: prescription or if you're in these rural counties, you got
18:46
Speaker 1: to reup at people, so get those applications in. You'll
18:50
Speaker 1: be getting that directly from the state too. So this
18:53
Speaker 1: is real money. It's in line what's been done in
18:56
Speaker 1: other states, and it's what we're doing to deliver policy
19:00
Speaker 1: results that really are tangible of what you'll see at
19:02
Speaker 1: the counter to keep serving those patients and not if
19:04
Speaker 1: to turning away any Medicaid prescription because you cannot afford
19:08
Speaker 1: to fill those patient needs and leaving them in alert
19:12
Speaker 1: as to where they can get their prescriptions filled anywhere.
19:15
Speaker 4: And there's going to be an additional twenty five million
19:18
Speaker 4: dollars support program. We're going to know a lot more
19:20
Speaker 4: about that by the end of fourth quarter this year.
19:22
Speaker 4: They're still working on the application eligibility process and so
19:26
Speaker 4: that'll be we'll have a lot more information about that soon.
19:29
Speaker 4: But Todd, I really appreciate you letting this talk about
19:31
Speaker 4: the success here and you enforcement and implementation is how
19:36
Speaker 4: we make sure that this is a win for everyone,
19:38
Speaker 4: including our patients. So we appreciate everyone's support and thank
19:42
Speaker 4: you very much for having today, Tod.
19:44
Speaker 1: As we get to know more of those details, will
19:46
Speaker 1: be another opportunity for us to join you again on
19:48
Speaker 1: Pharmacy podcasts.
19:50
Speaker 2: Don come on back to This Week in Pharmacy and
19:53
Speaker 2: tell us we'll be looking forward to this update in
19:56
Speaker 2: the fourth quarter. Hey, hold on, we have more to
19:59
Speaker 2: come on this Week in Pharmacy.
20:09
Speaker 7: This episode is sponsored by Independent Pharmacy Cooperative, widely known
20:13
Speaker 7: as IPC. Established in nineteen eighty three, IPC is the
20:16
Speaker 7: nation's largest group purchasing organization owned by independent pharmacy with
20:21
Speaker 7: a mission of maximizing the success of community pharmacists. IPC
20:25
Speaker 7: works to provide members with access to effective programs and
20:29
Speaker 7: services designed to enhance profitability for independent pharmacy. Read more
20:33
Speaker 7: about our mission by checking out our website at ipcarx
20:37
Speaker 7: dot com. That's ipcarx dot com.
20:51
Speaker 8: Hey all, Rob Chress here the godfather of functional pharmacy,
20:54
Speaker 8: and thank you for allowing me in for a This
20:56
Speaker 8: Week in Pharmacy episode here, and I want to talk
21:00
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Speaker 8: the news lately, and I think it's going to gain
21:04
Speaker 8: more attraction, so it's a good thing to know. And
21:06
Speaker 8: it's about folic acid and how it differs from folinic
21:11
Speaker 8: acid lukovorin as well as the active form of folate
21:15
Speaker 8: which can be received through supplements, which is five methyl
21:18
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21:20
Speaker 6: Now we're also going to connect the.
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21:32
Speaker 6: Well as diets. So I really want this.
21:34
Speaker 8: To be a pharmacist forward, clinically useful, but also patient friendly,
21:39
Speaker 8: little little training or video for you spot in the news.
21:44
Speaker 8: So first and foremost by folic acid. So back in
21:48
Speaker 8: the nineties. So first of all, what is folic acid.
21:51
Speaker 8: So folic acid is basically a stable, low cost form
21:57
Speaker 8: that's used in grain fortification and it's also used and
22:00
Speaker 8: obviously prescriptions like follic acid one milligram, the little yellowpill
22:04
Speaker 8: they start using the late nineties and they noticed that
22:06
Speaker 8: it did help reduce snoraltude deffects. It worked, which is great,
22:11
Speaker 8: But the form actually matters because the folic acid itself,
22:15
Speaker 8: if we're only relying on that, might have some negative
22:18
Speaker 8: downstream effects in other areas that we're going to talk about.
22:22
Speaker 8: This follic acid is synthesized and it's oxidized. It must
22:28
Speaker 8: be reduced before your body can actually use it. So
22:32
Speaker 8: if your body can't use it. That's the problem. And
22:36
Speaker 8: think about it this way. It's used to remain stable
22:40
Speaker 8: in greens on a grocery store shelf, so that means
22:43
Speaker 8: it's tough to break down basically, so it could be
22:46
Speaker 8: difficult for our bodies to break down and people do
22:48
Speaker 8: have challenges with it. Now, lad data also suggests that
22:53
Speaker 8: it can actually compete with natural foliate, like the foliate
22:56
Speaker 8: that comes from our foods, so it might actually push
22:59
Speaker 8: the natural folate off of their receptors, so we don't
23:02
Speaker 8: gain those true benefits.
23:04
Speaker 6: Now, folinic acid.
23:05
Speaker 8: Or leukovoron look of orin is a reduced active folate
23:09
Speaker 8: used clinically to bypass certain ensmatic transport bottlenecks where folic
23:16
Speaker 8: acid can get stuck up in.
23:17
Speaker 6: So we're going to cover that.
23:19
Speaker 8: Please understand the food folate is efficiently converted to the
23:23
Speaker 8: five methotetrahydrofolate. It takes little work to do that, so
23:27
Speaker 8: it's important that we start there on the foundations. Now,
23:30
Speaker 8: you also might hear about unmetabolized folic acid. So this
23:34
Speaker 8: is fullic acid that shows up in higher levels of
23:37
Speaker 8: the blood with higher intakes. Now, the clinical data or
23:41
Speaker 8: meaning is still being debated. It looks like there could
23:44
Speaker 8: be some negative downstream effects, but that's not what I
23:46
Speaker 8: want to focus on today. What I want to talk
23:50
Speaker 8: about here, really, and first and foremost is for you
23:52
Speaker 8: to understand that our genes don't change in.
23:55
Speaker 6: A short period of time.
23:56
Speaker 8: So we're sitting with the same genetic fluprint that we
23:58
Speaker 8: had thousands of years ago.
24:00
Speaker 6: What has changed is our.
24:01
Speaker 8: Ability to identify certain mutations.
24:04
Speaker 6: That are going on in our body.
24:06
Speaker 8: We might have a mutation that might show we have
24:09
Speaker 8: challenge with uptake of full eight. Now it doesn't mean
24:12
Speaker 8: we have the problem, right, understand this. The mutations only
24:15
Speaker 8: mean potential. Now, when we talk about potential, we need
24:19
Speaker 8: to bring the conversation in of epigenetics, because epigenetics is
24:24
Speaker 8: the input that we put into our body.
24:26
Speaker 6: This input can be from supplements, it can be.
24:29
Speaker 8: Stress, it can be diet, a whole host of things,
24:31
Speaker 8: and these are the things that literally can flip the
24:34
Speaker 8: switches whether a good gene is turned on or off,
24:37
Speaker 8: or a bad gene is turned on or off.
24:39
Speaker 6: So within the realm of epigenetics.
24:42
Speaker 8: We also talk about in addition to the FOLL eight
24:45
Speaker 8: B twelve, these are central inputs as well as methyl
24:48
Speaker 8: downers like samy. So when we're talking about the brain
24:54
Speaker 8: and the full eight metabolism, there's certain receptors in an
24:58
Speaker 8: autism group that could have are known as alpha antibodies
25:01
Speaker 8: towards them. So they have these antibodies. And here here's
25:04
Speaker 8: an analogy I like to use.
25:06
Speaker 6: So let's use football, right and we're in the fall
25:09
Speaker 6: right now.
25:09
Speaker 8: So if you can imagine a running back is looking
25:13
Speaker 8: to score in the end zone, right, the end zone
25:15
Speaker 8: is the brain. It's where the full eight receptors reside.
25:19
Speaker 8: The running back is the active foll eate the defensive
25:22
Speaker 8: line or these auto alpha or these alpha alpha auto antibodies,
25:27
Speaker 8: So the natural folate has trouble getting through them. So
25:30
Speaker 8: I hope that makes sense. But what we want to
25:33
Speaker 8: do is help the fol eight get to the brain.
25:36
Speaker 8: So quick reminder, food fol eight arise mostly in its
25:41
Speaker 8: reduced form, only has to go through a few steps
25:45
Speaker 8: before it is then ability to be active, activated and
25:49
Speaker 8: worked upon.
25:51
Speaker 6: So let's get into the brain a little bit.
25:54
Speaker 8: Within the autistic community, there's something called cerebral folate deficiency.
26:00
Speaker 8: Now with this connection, there's a subgroup of autistic children
26:07
Speaker 8: that have fullate receptor. Alpha autoantibodies I just talked about
26:13
Speaker 8: that can interfere with it. They block the folate from
26:16
Speaker 8: getting in there. So now we've got a couple things here. One,
26:19
Speaker 8: if we're taking food grade or even the prescription folic
26:24
Speaker 8: acid that might compete on these receptors. Now we got
26:28
Speaker 8: a second layer to this. Some people have these alpha
26:33
Speaker 8: autoantibodies right, and they block the path of fullate getting
26:37
Speaker 8: in there. So then this can lead to an issue
26:39
Speaker 8: of cerebral grain folate deficiency even when serum folate or
26:45
Speaker 8: follic acid looks fine all right, And that's one of
26:49
Speaker 8: the areas where leucovorren or fullinic acid or even five
26:52
Speaker 8: methyl tetrahybrid folate, the supplement form of natural folate can help.
26:57
Speaker 8: It can get through those certain bottlenecks. And there's also
27:01
Speaker 8: some data that has shown I want to talk about
27:03
Speaker 8: this because they've done the studies with dairy and with
27:08
Speaker 8: children that have had these alpha auto antibodies. What has
27:13
Speaker 8: happened is they've noted they've removed the dairy and they've
27:16
Speaker 8: seen the antibodies go down. They put the dairy back in,
27:21
Speaker 8: and then they saw the antibodies come back. So I
27:24
Speaker 8: really want you to look at this foundational element where
27:26
Speaker 8: food first matters and the foods that basically will contain
27:31
Speaker 8: natural folid or the leafy greens, citrus fruits, eggs, liver
27:39
Speaker 8: can do it as well. So you know, we really
27:41
Speaker 8: want to lean into a healthy diet first and not
27:44
Speaker 8: rely on fortified foods, fortified supplements and things like that.
27:48
Speaker 8: So it's a great place to start. All right, Now,
27:52
Speaker 8: let's transition. Let's talk about full or methylation and the
27:57
Speaker 8: rise of attention that we've seen and heard about fully
28:01
Speaker 8: methyl methylation. So once again, I kind of want to
28:06
Speaker 8: go back to remember, our genes don't change, so it's
28:08
Speaker 8: not like we suddenly became head methylation issues.
28:12
Speaker 6: Yes, there's over forty percent of our.
28:14
Speaker 8: Population that might have or that had these mutations, but
28:17
Speaker 8: it doesn't mean they're active. So we want to look
28:20
Speaker 8: at the functional active component to this. So you might
28:24
Speaker 8: hear that methylation problems are everywhere, right, and then give
28:28
Speaker 8: full a go, fill give fully, give fully, but the
28:32
Speaker 8: clear story is that our genes are stable, right, but
28:37
Speaker 8: inputs diet quality full eight form B twelve B six.
28:42
Speaker 8: These cofactors ribo flave and even lifestyle things like sleep, stress, medications, alcohol, pollution,
28:49
Speaker 8: and even natural agent can.
28:51
Speaker 6: All shift our methylation capacity.
28:54
Speaker 8: Right, So the mutations show potential, right, potential to be
28:58
Speaker 8: an issue, but they don't show active. So I want
29:01
Speaker 8: you to get that. So I want to bring us
29:03
Speaker 8: back to the foundation and what we can do here.
29:05
Speaker 8: So in that case, we want to start with a
29:08
Speaker 8: healthy diet. Right when I say plant slant, we want
29:12
Speaker 8: to rotat our natural greens. Consume foods like eggs, citrus, fruits, meats, liver, right,
29:20
Speaker 8: all that.
29:20
Speaker 6: Stuff, So we want to make sure we're getting enough
29:22
Speaker 6: that light.
29:23
Speaker 8: We also can consider fulinic acid or leucovorin or five
29:27
Speaker 8: m THHF the supplement form of foliate that can be
29:30
Speaker 8: received from high quality practitioner great supplement companies, maybe in
29:36
Speaker 8: addition or instead of alternative to folic acid. Because of
29:40
Speaker 8: these things, the competitive inhibition at the receptor cells, the
29:44
Speaker 8: unmetabolized folic acid that floats through the body. Now have
29:50
Speaker 8: you ever heard of hypermethylation, So hypermethylation could be a
29:53
Speaker 8: real thing, and in.
29:54
Speaker 6: This case, how the patients feel well.
29:56
Speaker 8: They might feel wired, but tired, jittery, headachy, issues with
30:02
Speaker 8: sleeping after they start a high dose or stacked methyl donors,
30:07
Speaker 8: things like natural fol eight five methyl tetrahydrofol eate, a
30:11
Speaker 8: methyl B twelve or even sami. Yes, that's supplement over
30:15
Speaker 8: the counter that can be used for depression.
30:18
Speaker 6: Now, especially if B twelve is low.
30:23
Speaker 8: Now I want you to think about what medications can
30:25
Speaker 8: lower a B twelve. Two big ones I want to
30:28
Speaker 8: share with met Foreman can lower B twelve levels by
30:31
Speaker 8: about a third.
30:32
Speaker 6: So it's an important thing to look at.
30:34
Speaker 8: And the other thing is acid blockers, whether it's a
30:36
Speaker 8: proton pump inhibitor or even an H two blocker. These
30:41
Speaker 8: things basically can deplete the body's absorption of B twelve.
30:45
Speaker 6: So these are some core factors we need to look at.
30:49
Speaker 8: So often it's about dose the pace of how we
30:52
Speaker 8: rise it and balance out.
30:55
Speaker 6: It's not broken biology.
30:57
Speaker 8: So if someone starts on a natural fold and if
31:01
Speaker 8: they start on a methyl be twelve and they start
31:04
Speaker 8: noting these feelings, what we want to do is we
31:06
Speaker 8: want to step back, and we want to go low
31:08
Speaker 8: and slow. Maybe start with that one milligram natural foll
31:12
Speaker 8: eight maybe then add a little bit of that methyll
31:15
Speaker 8: be twelve and then the cofactors with it. Because the
31:18
Speaker 8: cofactors like the B twelve, the rib of flight, and
31:20
Speaker 8: the B six are all important here. So we want
31:22
Speaker 8: to balanced approach to our B vitamins, especially with methylation.
31:27
Speaker 8: Now here's one thing i want to talk about in
31:29
Speaker 8: natural medicine. What I've seen over the years at nauseum
31:33
Speaker 8: is that if something seems like a good idea, well
31:35
Speaker 8: more must be a better idea.
31:37
Speaker 6: Well that's not the case.
31:38
Speaker 8: As you all probably know, too much of a good
31:40
Speaker 8: thing can literally be a bad thing. And I've seen
31:43
Speaker 8: people come to us on doses of five, ten, fifteen
31:46
Speaker 8: milligrams of fold eight and they've had side effects with it.
31:49
Speaker 6: I've seen people come to us either on normal.
31:51
Speaker 8: Doses or even high doses of methyl BE twelve and
31:55
Speaker 8: have issues with it.
31:56
Speaker 6: So what we want to do is we want to
31:57
Speaker 6: rell it back. We want to make sure the diet foundational,
32:01
Speaker 6: we want to.
32:01
Speaker 8: Modify all that other stuff, and we want to build
32:03
Speaker 8: lower slow. We don't need to go high, and we
32:06
Speaker 8: don't need to stack all the time, if that makes sense.
32:11
Speaker 6: So I want to talk.
32:14
Speaker 8: About B twelve now, because B twelve can be methyl
32:17
Speaker 8: B twelve can be very.
32:18
Speaker 6: Sensitive for some patients.
32:20
Speaker 8: So you might be familiar with the cyanocobalamin, which is
32:23
Speaker 8: the common kind of cheaper form that you see in
32:27
Speaker 8: lower grade vitamins and stuff like that. That does not
32:30
Speaker 8: help the methylation cycle, that does not support healthy methylation.
32:34
Speaker 6: So then we often lean to what's called methyl B twelve.
32:38
Speaker 6: But what happens is sometimes.
32:39
Speaker 8: People take in methyl B twelve get that same jitteriness,
32:42
Speaker 8: the headaches, that difficulty sleep in, the hyperactivity, agitation.
32:46
Speaker 6: But we do have options for that. If a lower
32:48
Speaker 6: does doesn't support them.
32:50
Speaker 8: We can use something that's known as hydroxycabolamine, which is
32:54
Speaker 8: essentially a gentler non methyl B twelve that your cells
32:58
Speaker 8: actually convert as need. It's often better tolerated and actually
33:03
Speaker 8: longer act, and even.
33:04
Speaker 6: If it was chosen to give them through injection. Adnisol.
33:08
Speaker 6: Caboaloman is another one.
33:10
Speaker 8: It's the mitochondrial BE twelve useful with methyl methylmolonic.
33:14
Speaker 6: Acid, And I want to talk about that.
33:16
Speaker 8: So methymolonic acid, Like, we can test a serum BE
33:19
Speaker 8: twelve and it might seem normal, it might seem low,
33:22
Speaker 8: but if we test methyl molonic acid and it's high,
33:27
Speaker 8: that's going to tell us we have a low functionality
33:29
Speaker 8: within the cell for B twelve.
33:31
Speaker 6: So in these cases we want to search for something else.
33:34
Speaker 6: It might be the.
33:34
Speaker 8: Methyl, it might be the adentosyl, it might be the hydroxyl.
33:38
Speaker 8: But if they notice the hyperactivity with the methyl, then
33:41
Speaker 8: we want to lean towards the a dentosol or the
33:46
Speaker 8: hydroxyl form in that if that makes sense. So, and
33:51
Speaker 8: there's actually combination products. I know one particular, one company
33:54
Speaker 8: in particular, they have a product out there.
33:56
Speaker 6: To solve that problem and they put the two of
33:59
Speaker 6: them to which is helpful.
34:01
Speaker 8: So now to kind of get a little bit into
34:04
Speaker 8: the lab markers that I think it's important to look at.
34:09
Speaker 8: I talked about the MMA methamolonic acid that will tell
34:13
Speaker 8: us the active activity of B twelve within our cells.
34:16
Speaker 8: So that can be instead of, or in addition to
34:19
Speaker 8: a B twelve test.
34:20
Speaker 6: I like it.
34:21
Speaker 8: In addition, we test both in our practice. You can't
34:25
Speaker 8: optimize folate or methylation if you miss the B twelve.
34:29
Speaker 8: So it's really important not just serum BE twelve, but
34:32
Speaker 8: what's going.
34:32
Speaker 6: On in the cell when we go with this a
34:36
Speaker 6: little further.
34:37
Speaker 8: For instance, if you have a patient that might have
34:39
Speaker 8: serum be twelve loads that are low, or a patient
34:43
Speaker 8: that's on things like metformin or an acid blocker, and
34:46
Speaker 8: they could be symptomatic or has risk factors such as
34:50
Speaker 8: being vegan, low intake of B twelve, older adults, or
34:55
Speaker 8: people with gastric illness. If we've got digestive issues, the
35:00
Speaker 8: body relies on intrinsic factor, which is like a chaperone
35:03
Speaker 8: that takes B twelve and takes it through. But intrinsic
35:07
Speaker 8: factor can be neutered basically with digestive issues, so that's
35:11
Speaker 8: why oftentimes an injectable.
35:12
Speaker 6: Would be a better.
35:14
Speaker 8: Option, or even a sublingual, so we can kind of
35:16
Speaker 8: bypass that route. Lastly, homocystein will add some context as well.
35:23
Speaker 8: I love homocysteine as my first look at methylation issues.
35:27
Speaker 8: If homocysteine is high, it's showing a conversion isn't happening,
35:31
Speaker 8: and the conversion is usually happened from a B six
35:34
Speaker 8: at B twelve or full eight efficiency, So that's going
35:37
Speaker 8: to give us direction into that a.
35:39
Speaker 6: Couple other factors.
35:41
Speaker 8: Low kidney function in itself can elevate methyl molonic acid,
35:44
Speaker 8: so we want to check EGFR A recent BAT twelve
35:49
Speaker 8: dose of methyl molonic acid. So if they took it
35:52
Speaker 8: right before the labs, that can quickly elevate or normalize it.
35:57
Speaker 8: I should say keep it out of the high level,
35:58
Speaker 8: which suggests efficiency. Pregnancy can also lower B twelve physiologically,
36:05
Speaker 8: so we want to use it in the context of
36:07
Speaker 8: the individual. In regards back to full eight and the
36:12
Speaker 8: cerebral folate deficiency standard. Fol Late labs are limited for
36:17
Speaker 8: brain transport issues. If the history is compelling, if it
36:22
Speaker 8: suggests a regression of language issues or delays in language,
36:27
Speaker 8: or even a compatible phenotype, if we're going to test
36:29
Speaker 8: that route, then we want to discuss testing on those
36:33
Speaker 8: auto alpha antibiodies because we can test and we can
36:35
Speaker 8: find out. Oftentimes that might be a referral to a
36:39
Speaker 8: specialist or something like that. So now let's talk about diet.
36:44
Speaker 8: Let's end it with this, because as I was kind of.
36:45
Speaker 6: Alluding to, I think a lot of things are foundation first.
36:48
Speaker 8: Food first, So food first, folate and label literacy is
36:53
Speaker 8: really really important. So first of all, smart eating, no
36:57
Speaker 8: added folic acid, Right, we want to get our high
37:01
Speaker 8: natural folate from foods, which are greens, spinach, romaine, kale, legumes, lentils,
37:08
Speaker 8: chippeas black beans. Asparagus is another one. I didn't mention.
37:13
Speaker 8: An avocado, citrus, liver, and eggs. Grains you can get
37:18
Speaker 8: it from. Just make sure they're non fullic acid fortified cane,
37:22
Speaker 8: while buckwheat, wild and brown rice, sweet potatoes, and even
37:27
Speaker 8: potatoes themselves. Now to limit added folic acid, you want
37:32
Speaker 8: to either look for full of acid added or enriched
37:35
Speaker 8: wheat flour. That's what that is. So that is something
37:39
Speaker 8: absolutely to avoid. So that's another big thing. As far
37:43
Speaker 8: as B twelve mindfulness, where do we get it? Well,
37:47
Speaker 8: kind of talked about those issues we can. We want
37:50
Speaker 8: to recognize the role that dairy plays in this whole thing,
37:54
Speaker 8: and then choose supplementation if we needed digestive health health
37:57
Speaker 8: and also keep an eye if your patients are on
38:00
Speaker 8: that form n PPIs H two blockers.
38:04
Speaker 6: So I hope this helped.
38:05
Speaker 8: I kind of wanted to give you a breakdown of
38:08
Speaker 8: this leukoform leucovorin folinic acid story, the relationship and the
38:14
Speaker 8: autistic population, the competitive nature of folic acid to natural
38:20
Speaker 8: folate kicking it off, the receptors, the auto alpha antibodies
38:25
Speaker 8: that can come up, and the relationship to dairy, how
38:27
Speaker 8: that can stimulate it, and how we can assess this
38:31
Speaker 8: through lab values and gain a little more knowledge that
38:34
Speaker 8: will help the patient. And then the options right, so
38:37
Speaker 8: natural supplements five methyl tetra hydrofolate and when we supplement
38:42
Speaker 8: with those or folate, stacking with other methyl donors like
38:45
Speaker 8: sammy and B twelve, go low and slow, and then
38:49
Speaker 8: the options for B twelve, especially if people are noticing
38:52
Speaker 8: that jittery effect. The overmethylation stories, we can normalize in
38:57
Speaker 8: more cases than not for sure by going low and
39:01
Speaker 8: slow and not stacking all one, not doing all at.
39:03
Speaker 6: Once, but add one at a time.
39:05
Speaker 8: So thanks a lot for your time, have a great
39:08
Speaker 8: this week in pharmacy, and I'll talk to y'all later.
39:11
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39:42
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41:26
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Speaker 9: of what has went down in Kentucky, there was a college,
42:30
Speaker 9: so the very respected college that they ended up shutting
42:33
Speaker 9: its doors a couple of years ago and turning it
42:35
Speaker 9: into a recovery center, rehab center because there's more of
42:39
Speaker 9: a demand for that than folks going to college. And
42:41
Speaker 9: you just think about that, Oh my gosh, you know.
42:44
Speaker 9: And I live in Nashville now, and for the last
42:49
Speaker 9: couple of years, I've been making my bread and butter
42:51
Speaker 9: writing songs for other folks to sing, folks like Bailey Zimmerman,
42:55
Speaker 9: Nate Smith, Elexandra k But I found myself very naturally, know,
43:00
Speaker 9: leading into writing songs about something that you know, you know,
43:05
Speaker 9: songs that tell a story. And that being said, it's
43:10
Speaker 9: just been on my heart to tell the truth about
43:14
Speaker 9: what happened where I was from. And so I wrote
43:16
Speaker 9: this song called the Devil war Live Coat, and the
43:20
Speaker 9: song just fell out. It was a really fast song
43:22
Speaker 9: that we wrote a lot of times, randy folks that
43:24
Speaker 9: don't know much about the songwriting world. Five days a week,
43:28
Speaker 9: you know, all throughout Nashville, folks walk into a writing room.
43:32
Speaker 9: There's normally three or four writers in the room. They'll
43:34
Speaker 9: have their guitar, their keyboard, and they'll bounce around different
43:37
Speaker 9: song ideas, titles, and then they'll write a song together.
43:41
Speaker 9: And that's how most of the songs are written that
43:42
Speaker 9: are on the radio. And usually our writing sessions three.
43:46
Speaker 6: To four hours.
43:47
Speaker 9: Well, i'll tell you what lack Coat for better or.
43:51
Speaker 6: For worse worse.
43:52
Speaker 9: My co writers and I we start talking about it
43:56
Speaker 9: and it just fell out in like forty five minutes,
43:59
Speaker 9: and that's really fast for a song to be written.
44:02
Speaker 9: But I think it's just because Rida's running from our hearts.
44:05
Speaker 9: And I didn't know how it was going to be
44:09
Speaker 9: received whenever I posted a little snippet of it online.
44:12
Speaker 9: But what blew me away was the comment section. How
44:17
Speaker 9: I knew what had happened in Kentucky, and that's what
44:20
Speaker 9: I wrote about, you know, just a devastation that's still
44:24
Speaker 9: folks are trying to come back from. But I was
44:27
Speaker 9: looking at the comment section and folks are like, I'm
44:29
Speaker 9: from Massachusetts, it happened here too, People down in Georgia.
44:32
Speaker 6: People out west.
44:34
Speaker 9: I mean, it was all over the place, and it's
44:36
Speaker 9: really been crazy now playing it live in all different places.
44:41
Speaker 9: I was out in Oklahoma a couple of weeks ago,
44:44
Speaker 9: opened up for Hank Junior. It was my first arena show,
44:47
Speaker 9: which was very exciting. But even after thank you, thank you,
44:50
Speaker 9: thank you, But I played that song in the arena
44:54
Speaker 9: and after the show, I had a little meet and greet,
44:56
Speaker 9: you know, and when I tell you, how many folks
44:59
Speaker 9: came up and talked about how that's on touch them
45:02
Speaker 9: and they started telling me. I mean I had two
45:05
Speaker 9: different people, you know, tell me about loved ones that
45:08
Speaker 9: they had lost. Then you know one person that told
45:11
Speaker 9: me that how they've been cleaned for ten years, and
45:13
Speaker 9: you know, how they have been roped in as well,
45:16
Speaker 9: how they have been a victim of it. It's really
45:18
Speaker 9: mind blowing. And this was our in Oklahoma.
45:20
Speaker 6: You all say it was a nation lot.
45:24
Speaker 2: It's something that I intimately understand. I was honored to
45:30
Speaker 2: be the director of business development for a Opioid use
45:34
Speaker 2: disorder medicationist as a treatment center that really put the
45:40
Speaker 2: value of the patient first instead of the dose and go.
45:44
Speaker 2: Sometimes these method and centers are more about taking advantage
45:48
Speaker 2: of someone's addiction and because and now it's a life
45:52
Speaker 2: thing that they're just it's a fast food market, pay
45:57
Speaker 2: goes through the same thing, whereas now we were dialing
45:59
Speaker 2: into the individual and really starting to look at their
46:03
Speaker 2: lives as whole and families and people. And then we
46:07
Speaker 2: started bringing in pharmacy services where we're like, hey, listen,
46:10
Speaker 2: not only are you addicted to an opioid and you're
46:15
Speaker 2: we're weaning you and we're getting you better and a
46:17
Speaker 2: little bit more freedom, but now you have diabetes or
46:20
Speaker 2: you have hypertension or something.
46:22
Speaker 3: And it was the whole patient. It was.
46:25
Speaker 2: It wasn't just driving because these I remember these many
46:29
Speaker 2: of these people that we got a chance to talk
46:31
Speaker 2: with and that we're open to talking with me because
46:34
Speaker 2: I wanted to know what's valuable to you from the
46:37
Speaker 2: service that you're getting. And they were like, I'm treated
46:40
Speaker 2: with respect here, Like I'm not. I don't feel like
46:42
Speaker 2: I'm I don't feel like I'm a junkie per se,
46:47
Speaker 2: or I don't feel like I'm being treated differently because
46:50
Speaker 2: I have this disease.
46:51
Speaker 3: And that's that's what this starts.
46:55
Speaker 2: With, is you're calling it out and you're doing it
46:58
Speaker 2: with respect to the people that you have this song
47:02
Speaker 2: from their perception and from your perception, and it's true.
47:06
Speaker 3: And it's up to people that are listening.
47:08
Speaker 2: It's it's up to our pharmacists and our technicians and
47:10
Speaker 2: our nurses, our positions to protect the patient.
47:14
Speaker 9: One hundred percent man. And I'll tell you what. It's
47:17
Speaker 9: hearts like yours that make the change. And there's a
47:20
Speaker 9: lot of This is the thing that's so crazy. I mean,
47:23
Speaker 9: I don't know what the percentage would be, but I'd
47:25
Speaker 9: say ninety eight ninety nine percent of folks in the
47:27
Speaker 9: medical world come in with a great heart and great perspective,
47:32
Speaker 9: great brains obviously, and they really are there to help people,
47:36
Speaker 9: you know. But it's like the old expression when bad
47:37
Speaker 9: apple can run the whole.
47:39
Speaker 6: Bushel, you know.
47:39
Speaker 9: And that being said, you're right, you know, it kind
47:45
Speaker 9: of made me feel a little something whenever you said
47:48
Speaker 9: how treating folks with respect, because you're right. People can feel,
47:53
Speaker 9: you know, all kinds of ways, and not a good
47:57
Speaker 9: way when they find themselves addicted to something. And the
48:01
Speaker 9: truth of the matter is, you know, whenever I wrote
48:04
Speaker 9: The Devil World lab Coat, my hope was that just
48:07
Speaker 9: folks felt seen and if one person you know that's
48:10
Speaker 9: gone through this, you know, feels not alone. You know,
48:15
Speaker 9: in the aftermath of it all. My job here is done.
48:19
Speaker 9: I hand the keys to you, you know, because y'all
48:21
Speaker 9: really are in that industry. But it's a wild thing,
48:25
Speaker 9: but it kindness does go a long way.
48:28
Speaker 3: I tell you what.
48:29
Speaker 2: There are pharmacy conferences, national pharmacy conferences that we go to,
48:34
Speaker 2: and I'm going to tell you Mary, I'm reaching out
48:37
Speaker 2: to these conference creators because I would like nothing more
48:41
Speaker 2: to go to one of our national conferences and have
48:44
Speaker 2: you as the headliner entertainment for us, because not only
48:47
Speaker 2: are you speaking, because I've been to conferences where we've
48:50
Speaker 2: had some amazing bands that are extremely famous and well
48:54
Speaker 2: to do, and that's great. I just think that there's
48:56
Speaker 2: something to an entertainer that not only is talented from
49:01
Speaker 2: that music position that we all just wanted to just
49:02
Speaker 2: party and listen to some good music. But the but
49:06
Speaker 2: the digging down into the substance of much of your
49:09
Speaker 2: songs are are just part of it all. And you know,
49:13
Speaker 2: when I was young, and I would listen to a
49:15
Speaker 2: lot of I'm a lot older than you gen x
49:17
Speaker 2: are here, and I'd listen to like the cure or something.
49:20
Speaker 2: And my mom would come in and listen to my
49:22
Speaker 2: music for a little bit and she'd be like, I'm
49:24
Speaker 2: worried about you because you're like listening to this depressing
49:28
Speaker 2: dark music. And I'm like, but I it actually makes
49:31
Speaker 2: me feel better, even though it seems like down and
49:34
Speaker 2: depressing whatever, and your music is anything but depressing. But
49:38
Speaker 2: what you are doing is you're addressing something in this
49:42
Speaker 2: amazing tune and the beat and just the style, but
49:46
Speaker 2: you're you're calling it out. And that's why people keep
49:49
Speaker 2: coming up to because it's like, wait, I went through
49:52
Speaker 2: this and now there's this song about it that I
49:54
Speaker 2: can relate to.
49:56
Speaker 9: Thank you sugar. That really means a lot to me.
49:59
Speaker 9: And you know, God, I honestly, and there's been lots
50:02
Speaker 9: of artists before me, you know that have you know,
50:05
Speaker 9: used their voice for you know, written songs for change,
50:09
Speaker 9: you know, and not every song has to be you know,
50:12
Speaker 9: this call to action activism situation. But I'm just written
50:15
Speaker 9: from my heart. But you're right, though, isn't it crazy?
50:18
Speaker 9: How I guess it's like anything else, how you know,
50:20
Speaker 9: sometimes people have used parables to you know, spread their message,
50:24
Speaker 9: and it's the same kind of thing with a song,
50:26
Speaker 9: you know, but I do like music that rocks, and so,
50:29
Speaker 9: you know, even with lab code, I was like, how
50:31
Speaker 9: do we make this where we could run on a
50:33
Speaker 9: treadmill well listening, So.
50:34
Speaker 6: That was the goal.
50:37
Speaker 3: I love it. I love it.
50:38
Speaker 1: Mary.
50:39
Speaker 3: Where are you coming next?
50:40
Speaker 2: So you can give a shout out to the pharmacist
50:42
Speaker 2: and our technicians and people throughout that are in the
50:45
Speaker 2: hospital systems and the community pharmacies and taking care of
50:48
Speaker 2: our seniors.
50:49
Speaker 3: Where can they.
50:50
Speaker 9: I'm going on my first headline and tour in just
50:53
Speaker 9: about a month. I'm so excited. So I'm gonna be
50:57
Speaker 9: in Georgia, I'm going to be on you know, Hio,
51:01
Speaker 9: gonna be in a bunch of towns in Tennessee and Kentucky,
51:04
Speaker 9: gonna be up in Illinois as well, and everything can
51:07
Speaker 9: be found on my website. It's very cutter and cutter
51:11
Speaker 9: with the K, like like you cut paper, but with
51:13
Speaker 9: the K. And we have all the show dates on
51:15
Speaker 9: there and folks and grab tickets. But I'm so excited.
51:18
Speaker 9: It's going to be really fun.
51:20
Speaker 3: This is terrific. I don't see you in Pittsburgh, but
51:23
Speaker 3: I'm not.
51:23
Speaker 9: Yet, baby, you know, I can't wait to get up
51:26
Speaker 9: there though.
51:27
Speaker 2: It's gorgeous this time of year. You're missing You're missing
51:29
Speaker 2: Whens are the are right their greatest on fire level
51:33
Speaker 2: of changing. But you guys get some good foliage too there.
51:37
Speaker 2: So it's a beautiful time to be in Tennessee.
51:40
Speaker 9: I've a lot of really good people that are down
51:42
Speaker 9: here that are born and raised, you know, Pittsburgh folks,
51:46
Speaker 9: and you know I can't wait to make my way
51:48
Speaker 9: up there too soon.
51:49
Speaker 3: Go stealers right, Oh yeah, baby, well, I love it.
51:54
Speaker 3: Thank you so much, Mary, this has been such a treat.
51:57
Speaker 3: I appreciate you being here on twerks.
51:59
Speaker 9: Thank you. I appreciate you.
52:01
Speaker 5: Buy a decent alibi. You could say what you want,
52:04
Speaker 5: but tombstones don't lie, strongounds, tore down about it appeals,
52:10
Speaker 5: so with a smile, don't care when it kills, no colds,
52:13
Speaker 5: it no conspiracy.
52:15
Speaker 4: It just is what it is.
52:17
Speaker 3: It's air haster.
52:19
Speaker 6: One May's great.
52:24
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52:28
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52:33
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