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PBM Reform and the AMA | PBM Reform · Pharmacy Podcast Network

• 0:05
  Speaker 1: You are listening to the global network of podcasters dedicated
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  Speaker 1: to the pharmacy profession.
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  Speaker 2: Welcome to the Pharmacy Podcast Network.
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  Speaker 3: Welcome to the PBM Reform Podcast, where we dive deep
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  Speaker 3: into the world of pharmaceutical benefit management, cutting through the
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  Speaker 3: noise to uncover the truth. Since twenty nineteen, we've been
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  Speaker 3: your go to source for the latest on how PBMs
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  Speaker 3: impact patient care, drug pricing, and the very future of pharmacy.
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  Speaker 3: Here we champion the role of pharmacists. The most knowledgeable
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  Speaker 3: advocates for medication safety and expertise. Join us as we
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  Speaker 3: expose and generate discussions that are reshaping healthcare and explore
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  Speaker 3: how we build a better payment system which focuses on
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  Speaker 3: advancing pharmacy care.
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  Speaker 1: Welcome to the PBM Reform Podcast Here on the Pharmacy
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  Speaker 1: Podcast Network.
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  Speaker 2: My name is Brek Rice. I'll be your host.
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  Speaker 4: Today.
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  Speaker 1: We have an amazing opportunity to speak with doctor Bobby
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  Speaker 1: Makamala today, who is the acting president of the American
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  Speaker 1: Medical Association the AMA.
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  Speaker 2: So doctor Bobby, so great to have you on the show.
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  Speaker 4: It's good to be here. Ck, appreciate the opportunity to
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  Speaker 4: have this conversation.
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  Speaker 1: Yeah, and I was so looking forward to this, and
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  Speaker 1: I know we have a pretty short window of time here.
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  Speaker 2: You're a very busy man doing everything that you do
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  Speaker 2: there at the AMA.
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  Speaker 1: But Number one, tell me more about your background. How
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  Speaker 1: did you get started, Where did you go to meta school?
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  Speaker 1: What made you want to become a doctor.
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  Speaker 4: Yeah, it's not a standard wow, that's amazing type answer,
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  Speaker 4: but I'm an honest guy, and I'll just tell you
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  Speaker 4: how it went. My folks moved here from India when
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  Speaker 4: they were twenty five, here in Flint, Michigan, which is
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  Speaker 4: where I grew up and where I came back to practice.
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  Speaker 4: My dad's a retired radiologist, my mom's a retired pediatrician.
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  Speaker 4: And as far as you know, why I decided to
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  Speaker 4: go to medical school, I wanted to be a journalist.
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  Speaker 4: Right There was a guy named Peter Jennings back you
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  Speaker 4: probably remember him on ABC, and I thought he was awesome,
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  Speaker 4: and I was like, I'm going to be like that guy.
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  Speaker 4: And I told my parents that, and they basically grounded
• 2:36
  Speaker 4: me until I changed my mind. And so I said, fine,
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  Speaker 4: I'll go to med school. And I got into this
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  Speaker 4: program at the University of Michigan where you get it
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  Speaker 4: in out of high school, and so, you know, I
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  Speaker 4: was just sort of doing it to keep my parents happy.
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  Speaker 4: Then I started my practice, you know, fast forward through
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  Speaker 4: med school, through residency, got married, brought my wife back
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  Speaker 4: home to Flint because it's been an amazing town. It's
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  Speaker 4: not the top of people's radar unless it's like a
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  Speaker 4: crisis or something like that or general motors moving out
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  Speaker 4: of town, but it's an amazing place to grow up.
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  Speaker 4: That's been so great to my family that I wanted
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  Speaker 4: to give back. So I started my practice and I realized,
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  Speaker 4: you know what, this is not as easy as it
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  Speaker 4: seemed in med school where you know the science, but
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  Speaker 4: then you got to deal with things like pharmacy benefit
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  Speaker 4: managers to try to do the right thing for your patients.
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  Speaker 4: And that's when I thought this isn't right, and I
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  Speaker 4: got involved in organized medicine, and fast forward another twenty
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  Speaker 4: five years. This is my twenty fifth year in practice.
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  Speaker 4: And my day job I just got back from the
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  Speaker 4: office is I'm an E ANDT so cleaning out noses,
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  Speaker 4: cleaning out of earwax, taking care of my community. But
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  Speaker 4: when I operated this morning, when I prescribe something, I
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  Speaker 4: have to go through so much more than knowing the
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  Speaker 4: right thing to do and getting it done for my
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  Speaker 4: patients with pharmacies, pharmacy benefit managers, insurance companies, prior authorization,
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  Speaker 4: you name it. And that's when I started to get
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  Speaker 4: more involved at the American Medical Association. Now here I
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  Speaker 4: am as sitting as its president, working on things like
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  Speaker 4: this with guys like you.
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  Speaker 1: Well, that's an amazing history that you've had. And and
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  Speaker 1: tell our audience what you your your actual practice is,
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  Speaker 1: what are you a specialist in?
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  Speaker 4: Yep? So I'm an odal learningologist and ear nose and
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  Speaker 4: throat duck. And I share this office with an ob
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  Speaker 4: G I N. Which sounds like a bizarre combination of specialists.
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  Speaker 4: They both begin with, oh, but that's about all they
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  Speaker 4: have in common here and selfa here yeah exactly, And
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  Speaker 4: that makes sense. Is that the person that I share
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  Speaker 4: the office with, I share this home office with. She
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  Speaker 4: sits right behind me here and she's an ob G
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  Speaker 4: I N and she's my wife.
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  Speaker 2: Ah wow, that's very convenient. That's excellent.
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  Speaker 1: So we almost didn't have a choice to be not
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  Speaker 1: to become a doctor.
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  Speaker 2: So that was you had.
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  Speaker 1: You had wise parents, and we need more good doctors
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  Speaker 1: like you so appreciate all the service that you that
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  Speaker 1: you provide.
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  Speaker 4: Thank you.
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  Speaker 1: Where where does the overlap with physicians and pbiums come in?
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  Speaker 1: Because we all know on the community pharmacy side just
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  Speaker 1: how brutalized they are by the PBMs today and how
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  Speaker 1: unfairly the especially the community pharmacies are treated. Where does
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  Speaker 1: that overlap with the medical side on physicians and the PBMs.
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  Speaker 4: Yeah, you know, it's just so frustrating because again, knowing
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  Speaker 4: the right thing to do, having the right prescription for
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  Speaker 4: the right ear infection that I see, and then having
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  Speaker 4: to go through an in between right between the pharmacy
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  Speaker 4: that is supposed to fill my prescription and me who
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  Speaker 4: writes that prescription all of a sudden, not suddenly, I
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  Speaker 4: mean it's been going on for a while, but it's
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  Speaker 4: pretty new.
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  Speaker 1: You know.
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  Speaker 4: When I started my practice twenty five years ago, we
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  Speaker 4: didn't have to deal with that. But the pharmacy benefit manager,
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  Speaker 4: the entity that's supposed to, you know, decide what it
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  Speaker 4: is that can be done based on what I wrote
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  Speaker 4: and what the pharmacy needs to fill, is an in between.
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  Speaker 4: And that's just as if healthcare wasn't complicated enough in
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  Speaker 4: our country where we have things like prior authors, which
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  Speaker 4: I am used to for twenty five years, and that
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  Speaker 4: kind of sucks too. But on top of that, now
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  Speaker 4: you see, we got PBMs to deal with, and it
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  Speaker 4: just you know, when it's not clinically oriented, right, when
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  Speaker 4: it's financially oriented, and when it's not an independent decision
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  Speaker 4: that's being made. Right, It's not like there's a third
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  Speaker 4: party that says, you know, based on what we assess,
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  Speaker 4: this is what we would say. It's not like that, right,
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  Speaker 4: When when companies that are in charge of giving the
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  Speaker 4: patient what we prescribe are also in charge of assessing
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  Speaker 4: the rightness of that prescription, that's just not right at all.
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  Speaker 1: Yeah, that is it's you know, some might say it's
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  Speaker 1: it's you know, practicing medicine without a license. Right, You've
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  Speaker 1: got an in between that's making decisions and kind of
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  Speaker 1: overstepping what the medical provider is recommending.
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  Speaker 4: Yep.
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  Speaker 1: Absolutely, absolutely something that needs to change. So let's talk
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  Speaker 1: about change because sometimes I feel like, you know, PBM reform,
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  Speaker 1: even though progress is being made, it's a very slow process.
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  Speaker 1: I use the analogy of a little guy in a
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  Speaker 1: rowboat with his hammer and chisel chipping away at that
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  Speaker 1: iceberg before the Titanic runs into it. He's making progress,
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  Speaker 1: It's just not fast enough, right, And wouldn't it be
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  Speaker 1: better to somehow skirt around that iceberg instead of running
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  Speaker 1: smack dab into it. So what is the AMA currently
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  Speaker 1: involved in to help with changing that situation with the
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  Speaker 1: middleman today?
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  Speaker 4: You know the AMA, And well, we have an action plan.
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  Speaker 4: You don't just jump into action, right. We need to
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  Speaker 4: make people aware of the circumstances. I mean, you ask
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  Speaker 4: if I if I tell my patients you know what,
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  Speaker 4: we've got a major problem with PBMs, They're gonna be like,
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  Speaker 4: what you know, peanut butter and what?
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  Speaker 2: Right?
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  Speaker 4: So it needs clarification, right, It needs people to become aware. Right.
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  Speaker 4: And it's the same thing the AMA does with everything. Right.
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  Speaker 4: We want not just physicians to be aware because we're
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  Speaker 4: knee deep in it, and for us to go to
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  Speaker 4: Congress and say, you know what, we really got to
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  Speaker 4: change this. Sometimes that's effective. But when congressmen hear from
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  Speaker 4: more than just the physician, right, when they hear from
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  Speaker 4: people that are you know, the people I grew up with, right.
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  Speaker 4: I remember my mom being a retired pediatrician. Man she
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  Speaker 4: would get all sorts of office supplies from our locally
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  Speaker 4: owned pharmacy, right, and it was amazing, right. I mean
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  Speaker 4: occasionally I would get some school clothes there because occasionally
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  Speaker 4: they had some school clothes and stuff. But it was
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  Speaker 4: that kind of relationship, right. And so when when patients
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  Speaker 4: become aware of the consequence to our community and their care,
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  Speaker 4: when all of a sudden something like this comes in
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  Speaker 4: and then the congressman hears from them in addition to us,
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  Speaker 4: that's how we become more effective at solving problems. Right,
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  Speaker 4: whether that's prior authorization, whether that's compensation for taking care
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  Speaker 4: of patients that's been stagnant for twenty five years for medicare,
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  Speaker 4: whether that's dealing with trying to take care of patients
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  Speaker 4: but having to deal with people. When congressmen here from
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  Speaker 4: we physicians and from patients, they're more likely to help
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  Speaker 4: with that problem. So that's the AMA's philosophy is let's
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  Speaker 4: get people aware of what it's going to take to
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  Speaker 4: improve their care, and that we put a lot of
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  Speaker 4: effort into that, right. I mean, we give physicians resources
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  Speaker 4: to talk to their patients. We directly sort of talk
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  Speaker 4: to patients. We have one hundred thousand patients that are
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  Speaker 4: sort of in the inner circle of the AMA where
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  Speaker 4: we know they're interested in how to improve healthcare, and
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  Speaker 4: we give them this data and the data that we
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  Speaker 4: give them, I mean, we do our own analysis, right,
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  Speaker 4: I mean, you could google and see the data about that,
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  Speaker 4: but much of it is from the American Medical Association
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  Speaker 4: and our market analysis we call that. It just sort
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  Speaker 4: of adds to the growing concern based on the data.
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  Speaker 4: And so according to that AMA analysis, the four largest
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  Speaker 4: PBMs in our country collectively have sixty seven percent of
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  Speaker 4: the national PBM market. How bad would it if a
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  Speaker 4: particular insurance company, right that people struggle to get care
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  Speaker 4: with at sixty seven percent of the market share of
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  Speaker 4: all healthcare? That's bad, yea. And healthcare a lot of
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  Speaker 4: times involves using some medicine, you know what I mean.
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  Speaker 4: I mean, when I operated this morning, every single one
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  Speaker 4: of my patients left there with the prescription for eardrops
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  Speaker 4: or antibiotic for whatever was going on that I took
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  Speaker 4: care of. And to have that decision about the rightness
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  Speaker 4: of what I prescribed controlled sixty seven percent of the
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  Speaker 4: time by four companies in this country.
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  Speaker 1: I just ain't right, Yeah, you've added at PBM. From
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  Speaker 1: the pharmacy side, it's the three big PBMs that they're
• 10:44
  Speaker 1: dealing with, you know traditionally, which is you know, optim
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  Speaker 1: Express Scripts and then CBS Care Mark, right, three big
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  Speaker 1: that the pharmacies are dealing with on a regular basis.
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  Speaker 1: Does the AMA doctor Bobby every get involved on the
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  Speaker 1: state level? You know, there's a big issue going on
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  Speaker 1: in Arkansas right now with whether or not it's legal
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  Speaker 1: for CBS to own pharmacies since they also own the PBM.
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  Speaker 4: Yep, yeah, And so we help states. I mean, this
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  Speaker 4: is what we call the Federation of Medicine right where
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  Speaker 4: some things are at the national level, right, you got
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  Speaker 4: to go to DC, We got to talk to senators,
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  Speaker 4: We've got to talk to a congressmen about an issue.
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  Speaker 4: But so much of healthcare is affected by what happens
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  Speaker 4: in your own state and somewhat even in your own community,
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  Speaker 4: but definitely in your own state, and that's not something
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  Speaker 4: I mean, we have amazing state medical society, state medical associations.
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  Speaker 4: Here in Michigan, we have the Michigan State Medical Society,
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  Speaker 4: the MSMs. I was just down in Mississippi last week
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  Speaker 4: with MSMA, Right, and so each state has that kind
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  Speaker 4: of organization that the AMA helps because that's who's on
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  Speaker 4: the front line in Arkansas, right in Michigan, in Mississippi, California,
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  Speaker 4: you name the state, it's the state Association of Physicians
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  Speaker 4: that's on the front line trying to improve patient care
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  Speaker 4: and make it easier for us to take care of
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  Speaker 4: our patients. And they don't have the resources necessarily to
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  Speaker 4: take care of this the right way, right, I mean,
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  Speaker 4: there's a lot of effort that has to get put
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  Speaker 4: in and none of that comes for free. And so
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  Speaker 4: the American Medical Association is very involved with the data,
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  Speaker 4: with the resources, with the experts that share all that
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  Speaker 4: with the state like Arkansas that's going through this. So
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  Speaker 4: it's like left and right hands working together.
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  Speaker 2: Okay, excellent.
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  Speaker 1: Well what do you think is the biggest challenge today
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  Speaker 1: that that the AMA is helping to solve with PBM reform.
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  Speaker 4: Yeah, I mean, I think it's you know, it's the
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  Speaker 4: goal is for Congress to protect American patients and sort
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  Speaker 4: of take concrete steps to comprehensive drug pricing transparency. I mean,
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  Speaker 4: when that's all done, you know, like the Wizard of Oz, right,
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  Speaker 4: I mean, no one sees him, but he's behind there
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  Speaker 4: doing something right. And that's exactly what this is like, right,
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  Speaker 4: that lack of transparency. And so what we really want
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  Speaker 4: Congress to do is sort of to zero in on
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  Speaker 4: pharmacy benefit managers and holding them accountable. I mean, it's
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  Speaker 4: not something that there should be a get out of
• 13:19
  Speaker 4: jail free card with this thing. Right when it affects
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  Speaker 4: patient care, when we want to do the right thing
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  Speaker 4: and they're getting in the way, there should be accountability
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  Speaker 4: for that. And so really Congress embracing legislative proposals, for example,
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  Speaker 4: that sort of prevent PBMs from engaging in these unfair
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  Speaker 4: and deceptive reimbursements, right when that's all in the cloud,
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  Speaker 4: when if we do it this way, we're going to
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  Speaker 4: make a little more money as opposed to doing what's
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  Speaker 4: right for the patient. Again, something that's just not right.
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  Speaker 4: And so this is very much what the AMA is
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  Speaker 4: involved in, is getting Congress involved in trying to help
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  Speaker 4: us solve this problem.
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  Speaker 1: But doctor Bobby, though so many of the dollars that
• 14:01
  Speaker 1: are helping these lawmakers get re elected are coming from
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  Speaker 1: special interests that are attached directly to those PBMs. How
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  Speaker 1: do we how do we really make new laws when
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  Speaker 1: you know, when the lawmakers are trying to stay loyal
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  Speaker 1: to the people that are helping them get elected.
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  Speaker 4: Yeah, this is a problem that applies to so much
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  Speaker 4: of what we want to do to improve the health
• 14:30
  Speaker 4: of our country, right, I mean, we the American Medical
• 14:32
  Speaker 4: Association has an office in Washington, d C. Because so
• 14:36
  Speaker 4: many of the things we need to do to promote
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  Speaker 4: the art and science of medicine and the betterment of
• 14:41
  Speaker 4: public health. Our mission relies on Congress to do things.
• 14:44
  Speaker 4: And you're absolutely right. Many times, if your contribution to
• 14:51
  Speaker 4: them doing the work that they do isn't as big
• 14:55
  Speaker 4: as somebody else, naturally there's going to be some bias
• 14:58
  Speaker 4: there and that's a problem. But how do we deal
• 15:01
  Speaker 4: with that?
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  Speaker 1: Right?
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  Speaker 4: I mean, you know, we have also being aware of
• 15:05
  Speaker 4: what it's like to get stuff done. There is the ampact,
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  Speaker 4: the Political Action Committee of American Medical Association, separate, separate group.
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  Speaker 4: But this is what they do, just like everybody else.
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  Speaker 4: But I really feel I mean, I you know, like
• 15:19
  Speaker 4: I said, my parents moved here from India. They're Hindu.
• 15:21
  Speaker 4: I went to Catholic school five days a week. I'm
• 15:23
  Speaker 4: just a confused guy, right, on both those things. But
• 15:26
  Speaker 4: I know David and Goliath, right, many people know that
• 15:30
  Speaker 4: story and having that kind of discrepancy between our influence
• 15:35
  Speaker 4: knowing the right thing to do for our patients and
• 15:38
  Speaker 4: other group's influence. I feel like David, We feel like David,
• 15:42
  Speaker 4: you know, and that's frustrating. But what's amazing is that,
• 15:45
  Speaker 4: like prior authorization, the example that I gave earlier, that's
• 15:48
  Speaker 4: something that insurance companies, the same people with the enormous
• 15:51
  Speaker 4: influence lost here in the state of Michigan, and the
• 15:56
  Speaker 4: American Medical Association does work across the country every state.
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  Speaker 4: The deal with that because when you put patient stories
• 16:04
  Speaker 4: with what it is you're asking for, then the dollars
• 16:08
  Speaker 4: don't matter so much, right, because these are constituents, right,
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  Speaker 4: These are people whose stories are critical to the congressman
• 16:15
  Speaker 4: that represents them, and so we have that behind us. Right.
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  Speaker 4: We're the ones that become the voice of our patients,
• 16:23
  Speaker 4: so that people hear, people that make decisions. And so
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  Speaker 4: it's not, luckily just the size of the check, right,
• 16:30
  Speaker 4: which is wrong. It's the stories that help to make
• 16:33
  Speaker 4: this country better that will be very influential. When those
• 16:39
  Speaker 4: stories come from constituents, our patients.
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  Speaker 1: Yeah, I've said it before on this program here on
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  Speaker 1: the PBM Reform podcast on the Pharmacy Podcast Network that
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  Speaker 1: I feel like our lawmakers should adopt the NASCAR jersey
• 16:55
  Speaker 1: where you can see who they're sponsored by. Oh that
• 16:57
  Speaker 1: congressman sponsored by Pizer, Oh that one sponsored by United Healthcare.
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  Speaker 1: It would be great to know who their allegiances are
• 17:06
  Speaker 1: aligned with.
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  Speaker 4: Yeah, I would make that. Kelvin Klein in Gucci suits
• 17:13
  Speaker 4: have all sorts of extra stuff in addition to the
• 17:15
  Speaker 4: C K and the G.
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  Speaker 2: Huh yeah, exactly. Absolutely.
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  Speaker 1: So taking you back to your medical school days, there
• 17:24
  Speaker 1: you m was doctor Marshall.
• 17:26
  Speaker 2: Rungi there when you were going through Yes, yeah.
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  Speaker 4: I know the name of first That was between nineteen
• 17:33
  Speaker 4: ninety five and the year two thousand. Actually I'm sorry, no,
• 17:36
  Speaker 4: ninety one ninety five, last century.
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  Speaker 2: So he just he just retired. So he was the
• 17:41
  Speaker 2: dean of the medical school. There you have m wonderful guy.
• 17:44
  Speaker 1: Had him on a podcast before, super super intelligent, very nice.
• 17:52
  Speaker 1: Wouldn't allow us to call him doctor Rungi. You want
• 17:55
  Speaker 1: to just call me Marshall. It's really a humble, nice guy.
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  Speaker 4: But he probably knew my name from that phase in
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  Speaker 4: my life where all I cared about was my grades
• 18:05
  Speaker 4: and keeping my parents happy, wondering why they didn't let
• 18:07
  Speaker 4: me become Peter Jennings, and I had to be in
• 18:10
  Speaker 4: this guy's medical school. Of course, I'm very thankful for
• 18:13
  Speaker 4: that now. I'm what they call sort of apathetic back then,
• 18:20
  Speaker 4: but very energized now because I want to leave this
• 18:23
  Speaker 4: country better than I found it, and dealing with things
• 18:27
  Speaker 4: like patients getting the things that we prescribed that they need,
• 18:30
  Speaker 4: having to deal with PBMs is a big part of that.
• 18:34
  Speaker 1: Yeah, so you bring up your parents again. I've got
• 18:37
  Speaker 1: to ask you, do you and your ob wife.
• 18:39
  Speaker 2: Have any children? We do? We do.
• 18:41
  Speaker 4: We have twin boys. They're twenty five, and people sort
• 18:45
  Speaker 4: of looking at me like you got twenty five year
• 18:46
  Speaker 4: old kids? Like, yeah, we started early. I mean they
• 18:49
  Speaker 4: were born when I was twenty nine, and so they're
• 18:54
  Speaker 4: good kids. Neither one is pursuing a healthcare degree.
• 18:57
  Speaker 2: Which that was going to be my next question. How
• 18:59
  Speaker 2: do they get out of that?
• 19:00
  Speaker 1: Don't grandma and grandpa have any say and their parents
• 19:03
  Speaker 1: have any say in this?
• 19:04
  Speaker 2: Well?
• 19:05
  Speaker 4: Oddly well, my folks forced me to go into medicine again,
• 19:08
  Speaker 4: very much. I'm grateful for that. They were happy with
• 19:11
  Speaker 4: my kids doing anything that they were passionate about, and
• 19:15
  Speaker 4: I see that as the critical way to measure I
• 19:18
  Speaker 4: see people. I get involved in the community here in Flint, right,
• 19:22
  Speaker 4: I owe it a lot. And when I see people
• 19:25
  Speaker 4: pursuing things that they're passionate about, whether that's their neighborhood
• 19:30
  Speaker 4: and revitalizing that, whether that's downtown, whether it's their family,
• 19:33
  Speaker 4: whether it's their school. When you do something you love,
• 19:37
  Speaker 4: nothing ever feels like work. And I can honestly say
• 19:39
  Speaker 4: that about being the president of the American Medical Association.
• 19:43
  Speaker 4: I got to travel two hundred days this year. I'm
• 19:45
  Speaker 4: flying to Washington, d C. In a few hours. But
• 19:48
  Speaker 4: it never feels like work when it's something you're passionate about. Again,
• 19:52
  Speaker 4: whether that's gardening or whether that's improving healthcare. If you're
• 19:56
  Speaker 4: doing something you love, it's great. And my kids both
• 19:59
  Speaker 4: love what they're doing. One is going to be a
• 20:01
  Speaker 4: PhD in political philosophy and the other one is a
• 20:04
  Speaker 4: biomedical engineer, and they love it. And every day they
• 20:09
  Speaker 4: just grow and they wake up, they do what they
• 20:12
  Speaker 4: need to do when they go to sleep while rested,
• 20:13
  Speaker 4: and are loving every day what more can you ask
• 20:16
  Speaker 4: for as a parent.
• 20:18
  Speaker 2: That is amazing. That is awesome.
• 20:20
  Speaker 1: So tell me, is there anything we haven't covered in
• 20:25
  Speaker 1: this episode that you think needs to be highlighted? And
• 20:29
  Speaker 1: then I have one other kind of political question. Maybe
• 20:32
  Speaker 1: I'll ask this one first and then we can go
• 20:33
  Speaker 1: back on the positive note. You've been pretty vocal about
• 20:38
  Speaker 1: what our new secretary Kennedy has said about vaccinations. Do
• 20:43
  Speaker 1: you want to cover anything or clarify anything because you
• 20:46
  Speaker 1: have been very vocal about that. Yeah, you know, I think, yes,
• 20:49
  Speaker 1: I have. The American Medical Association has, just because we're
• 20:54
  Speaker 1: driven by science, right.
• 20:55
  Speaker 4: I mean I can't even count the number of hours
• 20:57
  Speaker 4: at the University of Michigan that I spent at the deans,
• 21:00
  Speaker 4: you know, in the classes and the residency. And you
• 21:03
  Speaker 4: know still every day, you know, looking on PubMed and
• 21:06
  Speaker 4: reading about the research that improves healthcare. And that's what
• 21:10
  Speaker 4: drives us. Yeah, and all of a sudden to have
• 21:12
  Speaker 4: decisions made about something like mRNA right, and an amazing
• 21:18
  Speaker 4: way to keep people from dying the way they were
• 21:20
  Speaker 4: dying from COVID right because of mRNA vaccination. And it's
• 21:24
  Speaker 4: not perfect. I mean, it doesn't stop you from getting
• 21:27
  Speaker 4: testing positive for COVID, but it sure does prevent a
• 21:30
  Speaker 4: boatload of deaths, right, Yeah, But all of a sudden
• 21:34
  Speaker 4: to hear that from the Secretary, Rob Robert F. Kennedy Junior,
• 21:37
  Speaker 4: that we're not going to do that anymore. We're not
• 21:39
  Speaker 4: going to study mRNA vaccines. We're going back to the
• 21:42
  Speaker 4: traditional stuff that work better. That's just not right, you
• 21:45
  Speaker 4: know what I mean. I mean, when we first came
• 21:47
  Speaker 4: up with our first ant acid medication for ulcers and
• 21:51
  Speaker 4: it didn't work great, but it helped a little bit
• 21:53
  Speaker 4: to say we're not going to do that anymore. Where
• 21:56
  Speaker 4: would we be now?
• 21:57
  Speaker 2: Yeah?
• 21:58
  Speaker 4: Right? And so in the same way when the Secretary
• 22:01
  Speaker 4: of the Health and Human Services, right, a massive influential
• 22:05
  Speaker 4: the most influential thing on the future of healthcare in
• 22:08
  Speaker 4: our country isn't based on science, but it's more on
• 22:12
  Speaker 4: the social aspect of some of these things. You know,
• 22:15
  Speaker 4: there's some people when you say we're getting rid of mRNA,
• 22:18
  Speaker 4: they're going to celebrate. But that's not based on scientific knowledge.
• 22:22
  Speaker 4: That's taking something that should be in a textbook. No
• 22:25
  Speaker 4: one uses those anymore, but it should be on your
• 22:27
  Speaker 4: screen and a thousand page thing that you read to
• 22:29
  Speaker 4: learn it instead of, you know, a small Facebook post
• 22:33
  Speaker 4: saying this stuff doesn't work. Which do you rely on?
• 22:36
  Speaker 4: You should rely on this one, right, the book, not
• 22:39
  Speaker 4: the social post. But that's where we are, and that's
• 22:42
  Speaker 4: why we we always sort of make our opinion known
• 22:45
  Speaker 4: because it's an opinion that's based on science, not based
• 22:48
  Speaker 4: on social stuff.
• 22:51
  Speaker 1: I appreciate you sharing your point of view on that.
• 22:53
  Speaker 1: And back to my other question, then, is there anything
• 22:57
  Speaker 1: that the AMA is involved in with PBM reform that
• 23:01
  Speaker 1: we haven't covered that we should cover before we end?
• 23:04
  Speaker 4: I think we covered it in two very different aspects
• 23:09
  Speaker 4: that make it a wide effort from our communities in
• 23:12
  Speaker 4: our hometown letting people know what the consequences are if
• 23:16
  Speaker 4: this continues the way that it is, and the frustration
• 23:18
  Speaker 4: they'll feel as a patient to Washington d C, where
• 23:22
  Speaker 4: they have the most influence on improving the healthcare of
• 23:26
  Speaker 4: our country instead of stagnating it or even moving it backwards,
• 23:30
  Speaker 4: whether that's mRNA or whether that's access to the medicine
• 23:33
  Speaker 4: that we need for our patients, both of them. Washington
• 23:37
  Speaker 4: d C is front and center as far as influence,
• 23:39
  Speaker 4: and so I would encourage everybody that's listening to this
• 23:42
  Speaker 4: to get involved by contacting those people that need to
• 23:46
  Speaker 4: be aware of what we go through in our communities,
• 23:49
  Speaker 4: in our patients, in the health of our country so
• 23:52
  Speaker 4: they can do the right thing.
• 23:54
  Speaker 1: Yeah, I appreciate that, doctor Bobby. And now are you
• 23:56
  Speaker 1: ready for the rapid fire? This is just to get
• 23:59
  Speaker 1: to know you a little bit better, Just easy questions.
• 24:03
  Speaker 1: Just first thing that comes to mind. Are you more
• 24:05
  Speaker 1: of an early bird or a night ol? Oh?
• 24:07
  Speaker 4: Early bird? Usually, well that's because I'm fifty four now too,
• 24:10
  Speaker 4: and I wake up at four thirty, even though the
• 24:13
  Speaker 4: alarm is set for five point thirty.
• 24:15
  Speaker 2: But early bird, okay, excellent? And do you prefer the
• 24:19
  Speaker 2: mountains or the beach?
• 24:21
  Speaker 4: Mountains? All the beaches I've ever been to, they all
• 24:24
  Speaker 4: look the same to me. Sometimes it's water coming in
• 24:26
  Speaker 4: from these sometimes it's from the west, but they all
• 24:28
  Speaker 4: look the.
• 24:29
  Speaker 2: Same, okay. And do you prefer coffee, tea or something else?
• 24:34
  Speaker 4: Neither of those. I gave up caffeine about fifteen years
• 24:37
  Speaker 4: ago because a couple of days I didn't have any
• 24:39
  Speaker 4: diet coke, which is my caffeino choice, and I got
• 24:41
  Speaker 4: this massive headache, and right then I realized, oh my gosh,
• 24:44
  Speaker 4: I'm addicted to caffeine. Didn't want to be that anymore,
• 24:47
  Speaker 4: so I gave it up and so now it's more
• 24:49
  Speaker 4: juices and water.
• 24:51
  Speaker 1: Water, Yeah, plenty of water and a little bit of
• 24:55
  Speaker 1: sea salt, right to get your minerals right.
• 24:57
  Speaker 2: That's right, excellent.
• 24:59
  Speaker 1: Well, thank you, thank you so much, doctor Bobby for
• 25:01
  Speaker 1: being our guest today on the PBM Reform podcast Here
• 25:04
  Speaker 1: on the Pharmacy Podcast Network, We've been speaking with doctor
• 25:08
  Speaker 1: Bobby Makamala, who is an MD and also the acting
• 25:13
  Speaker 1: president of the AMA. And really appreciate you taking time
• 25:17
  Speaker 1: out of year so busy schedule flying around the country.
• 25:20
  Speaker 2: And running the AMA and then your.
• 25:23
  Speaker 1: Own private practice as well. It's got to keep you busy.
• 25:27
  Speaker 1: At least your twins are now self sufficient, right.
• 25:30
  Speaker 4: Absolutely, yep, yep, they're good kids. It's nice to be
• 25:34
  Speaker 4: called periodically. It keeps me happy. But no life is good.
• 25:38
  Speaker 4: And one thing I'll mention Brickett, my intersection with pharmacy
• 25:41
  Speaker 4: is not just as a physician. Eight months ago I
• 25:44
  Speaker 4: got diagnosed with brain cancer and so I had this
• 25:47
  Speaker 4: massive operation in December, and it just turns out that
• 25:50
  Speaker 4: the medicine that might keep me alive for a little
• 25:52
  Speaker 4: longer costs two hundred and fifty thousand dollars a year. Wow,
• 25:57
  Speaker 4: every day it's nine hundred bucks. It's just one of
• 26:00
  Speaker 4: those things. If I drop an aspirin, I'll just pick
• 26:03
  Speaker 4: another one out of the container. If I drop a
• 26:05
  Speaker 4: nine hundred dollars pill, I'm washing it off. I'm still
• 26:08
  Speaker 4: taking it. But it's just my intersection with with pharmaceuticals
• 26:11
  Speaker 4: and to have the possibility that a pharmacy benefit manager
• 26:18
  Speaker 4: is potentially involved. I mean, I don't think I have
• 26:20
  Speaker 4: that problem right now, but who knows it is potentially
• 26:23
  Speaker 4: involved when there's more choices saying you know what this one, No,
• 26:27
  Speaker 4: we got a better deal on this one. This is
• 26:29
  Speaker 4: one we're going to do. What am I going to
• 26:31
  Speaker 4: do as a patient? This is exactly what so many
• 26:33
  Speaker 4: patients are dealing with already, and why it's important that
• 26:35
  Speaker 4: we have this conversation. Sorry to bring in that, but
• 26:38
  Speaker 4: it's a kind of immersive intersection with what we're dealing with.
• 26:41
  Speaker 1: I absolutely appreciate you personalizing this and absolutely best of
• 26:45
  Speaker 1: luck to you, and thoughts and prayers go out to
• 26:47
  Speaker 1: you and your family that this all resolves the way
• 26:50
  Speaker 1: that it's supposed to. An amazing experience that you've had.
• 26:54
  Speaker 1: You know, similarly, you know, my day job isn't podcasting.
• 26:59
  Speaker 1: We do revenue SoC management for community pharmacies. We help
• 27:01
  Speaker 1: them process their their workers' comp claims. And when you know,
• 27:05
  Speaker 1: nurse gets a needlestick and they need HIV meds, we
• 27:09
  Speaker 1: don't need some middleman telling them when and when they
• 27:12
  Speaker 1: can't get those. We need them immediately, and so we
• 27:14
  Speaker 1: just step in and cover it whether we're going to
• 27:17
  Speaker 1: get paid or not.
• 27:18
  Speaker 4: Yeah, I mean, unfortunately, there's so many things in medicine
• 27:21
  Speaker 4: that we do, like you know, just basically, you know,
• 27:25
  Speaker 4: trying to keep track of what we do. Vaccinate people. Yeah,
• 27:28
  Speaker 4: I mean, the compensation for vaccination is pretty darn low.
• 27:33
  Speaker 4: But yet, just like you said, you do it because
• 27:35
  Speaker 4: it's the right thing to do. The better solution is
• 27:37
  Speaker 4: to have healthcare invest in those things that are good
• 27:41
  Speaker 4: for the outcomes and our patients, and that's what we
• 27:43
  Speaker 4: advocate for. But we're still going to do the right
• 27:46
  Speaker 4: thing just like you do. Just like we do.
• 27:48
  Speaker 2: Yeah. Well, thank you so much, doctor Bobby.
• 27:50
  Speaker 1: It's great to have you on the PBM Reform podcast,
• 27:54
  Speaker 1: and the best of luck to you and your family
• 27:57
  Speaker 1: and again. You've been listening to the p and Reform
• 28:00
  Speaker 1: podcast here on the Pharmacy Podcast Network until next time,
• 28:04
  Speaker 1: Stay curious everyone, and we'll see you on the next episode.