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Don't Get Paid Below Your Cost Anymore! | PBM Reform · Pharmacy Podcast Network

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Speaker 1: You are listening to the global network of podcasters dedicated
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Speaker 1: to the pharmacy profession.
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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 ex orse. Join us as
1:02
Speaker 3: we expose and generate discussions that are reshaping healthcare and
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Speaker 3: explore how we build a better payment system which focuses
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Speaker 3: on advancing pharmacy care.
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Speaker 1: Well, welcome everybody to the PBM Reform Podcast here on
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Speaker 1: the Pharmacy Podcast Network.
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Speaker 4: My name is Bret Rice.
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Speaker 1: I'll be your host today and I've had the privilege
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Speaker 1: of working with community pharmacies now for more than twenty years.
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Speaker 1: I absolutely love the industry. We'll do everything I can
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Speaker 1: to help community pharmacies be more profitable, and one of
1:36
Speaker 1: those missions is this PBM Reform podcast, which today I
1:42
Speaker 1: have a longtime industry friend that is joining the podcast today.
1:49
Speaker 1: And Chris, you've been around pharmacy for how many years now?
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Speaker 2: Yeah? So Berke, I'd say working in the industry for
1:56
Speaker 2: about fifteen years.
1:57
Speaker 4: You know.
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Speaker 5: I started out.
2:00
Speaker 2: The primary wholesaler and just worked with stores and day
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Speaker 2: to day operations and helping them be better, kind of
2:07
Speaker 2: tracked best practices and tried to share it with each
2:10
Speaker 2: with each of them, and you know, that turned into
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Speaker 2: roles with you know, by Light and consumer packaged good
2:16
Speaker 2: product and now with a software company that me and
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Speaker 2: some friends came up with just seeing some of the
2:23
Speaker 2: core issues that pharmacies face from a buying and reimbursement perspective.
2:29
Speaker 2: So it's been a labor of love, like you, just
2:34
Speaker 2: going into these drug stores and seeing how they can
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Speaker 2: impact communities and how they work with their customers. I
2:39
Speaker 2: fell in love with them from day one, and you know,
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Speaker 2: I've always been very relationship oriented and really want to
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Speaker 2: make sure that we have a sustainable model moving forward.
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Speaker 1: Okay, And Chris, are you a pharmacist yourself or just
2:52
Speaker 1: always been on the business side.
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Speaker 5: No, I'm.
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Speaker 2: Basically in marketing and business graduated with the NBA from
3:00
Speaker 2: you versus Tennessee essentially my first job. You know, most
3:04
Speaker 2: kids they worked, you know, delivering pizzas or McDonald's. I
3:08
Speaker 2: worked in the nursing home. So I started with healthcare
3:11
Speaker 2: in high school and the nursing home as a CNA
3:13
Speaker 2: and just really fell in love with just the interaction
3:16
Speaker 2: of patients and that led into just a career and
3:23
Speaker 2: nursing home administration, d MB sales, and then independent pharmacy.
3:27
Speaker 2: But really independent pharmacy is where I just feel the
3:31
Speaker 2: pure relationship of that customer with that you know, that
3:35
Speaker 2: drug store.
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Speaker 4: Yeah, that's excellent.
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Speaker 1: I think you and I first met about four or
3:41
Speaker 1: five years ago. I think you were introducing the bio
3:45
Speaker 1: light product to community pharmacies and we really loved that
3:50
Speaker 1: that product and.
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Speaker 4: Use it in our own home.
3:54
Speaker 1: And and you had a good run with that company
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Speaker 1: and helping that launch that through Uni Pharmacies and get
4:01
Speaker 1: it into the big hole sellers so they can just
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Speaker 1: buy it now directly from the big hole sellers. And
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Speaker 1: then you spread your wings into this software development of
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Speaker 1: the pharmacy marketplace. So tell me how that all came about?
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Speaker 4: Was that?
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Speaker 1: Were you a founder there or did you get brought
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Speaker 1: in to bring in your marketing expertise.
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Speaker 2: Yeah, So when I was at mckisson, I met Wade
4:30
Speaker 2: Hinkle and Tanner Hinkel. They founded a company called inventory Iq,
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Speaker 2: which helped drugstore set up perpetual inventory and manage cash
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Speaker 2: flow a little bit better. When my pharmacies that were
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Speaker 2: shopping and working with me at McKesson would say, hey, Chris,
4:44
Speaker 2: I'm really struggling.
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Speaker 5: To pay my bill.
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Speaker 2: You know, we look at the p and L the
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Speaker 2: balance sheet and say, hey, like there's probably some variances
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Speaker 2: on the amount of inventory you're carrying on your shelves.
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Speaker 5: You might need to talk to these guys.
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Speaker 2: These guys did a great job of really being a
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Speaker 2: customer driven and supporting the stores and helping them, and
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Speaker 2: we just developed a relationship and they approached me and said, Chris,
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Speaker 2: we would like to use our technology to develop a
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Speaker 2: ordering software because we're hearing so many complaints from drug
5:17
Speaker 2: stores about that is their value there?
5:19
Speaker 5: And I said, there would only be.
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Speaker 2: Value there if you guys address the full picture. Other
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Speaker 2: platforms don't look at how it all blends together and
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Speaker 2: how rebates come into play, and you know, compliance, and
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Speaker 2: it's just a very convoluted mess. And for years, wait
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Speaker 2: and Tanner sat back and designed our platform, and about
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Speaker 2: the time that you know, we had by Light launched
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Speaker 2: and this platform is ready to go full bore. You know,
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Speaker 2: I came back into the fold and now we're working
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Speaker 2: with you know, about a thousand drug stores on that
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Speaker 2: side of the software. But now we're even more excited
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Speaker 2: about our PBM appeal, your enhancement that we want to
6:01
Speaker 2: talk about with Sorees today.
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Speaker 1: Yeah, and I'm glad you brought that up because obviously
6:06
Speaker 1: this is the PBM Reform podcast, so we do want
6:09
Speaker 1: to talk about that. You know, your experience with the
6:12
Speaker 1: impact that PBMs have had on community pharmacies. What have
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Speaker 1: you seen out there and what does this new application
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Speaker 1: do for community pharmacies?
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Speaker 2: Well, Rick, you know, PBMs unfortunately have so much control
6:29
Speaker 2: over the industry and the core of the business. Even
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Speaker 2: at Bylight, you know, I would be talking to drug
6:34
Speaker 2: stores about a very fun product, but they were so
6:37
Speaker 2: anxious and just burn out addressing just the buying and
6:40
Speaker 2: selling of drugs. It's hard to focus, you know, you
6:43
Speaker 2: just have so much bandwidth and energy and you see
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Speaker 2: owners and staff just really just at their wits end
6:49
Speaker 2: about limited control. So what we've tried to do is
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Speaker 2: address the core issue of the business, which is the
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Speaker 2: buying and selling of drugs, and what we're doing with
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Speaker 2: this new feature. Fortunately, there are states that are passing
7:04
Speaker 2: laws that pretty much say, hey, a PBM cannot reimburse
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Speaker 2: you under your cost, and it's amazing that states are
7:12
Speaker 2: able to get that passed. Everybody is focused on federal legislation,
7:16
Speaker 2: federal reform, and I'm telling you it's the states that
7:21
Speaker 2: are going to make the movement to create, you know,
7:23
Speaker 2: the future of pharmacy. So what we have done is
7:26
Speaker 2: we've looked into the success of some of these laws
7:29
Speaker 2: and stores that are getting the process down to how
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Speaker 2: to do mac appeals and recoup money and substantial money back,
7:37
Speaker 2: and we've designed a software capability to help them organize
7:43
Speaker 2: that process, streamline.
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Speaker 5: It, and automate pieces of it.
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Speaker 2: Because there's just a couple of assumptions that were happening
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Speaker 2: happening where stores were saying, hey, my p SAO is
7:53
Speaker 2: doing that on my behalf. Well yes and no, they
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Speaker 2: have limitations and what they can do because of the
8:01
Speaker 2: FTC issues with the wholesaler owned PSAOS.
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Speaker 5: So really, you know, stores think.
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Speaker 2: That people are doing these appeals on their behalf, but no,
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Speaker 2: it's up to them to do it, and we.
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Speaker 5: Want to help them with that.
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Speaker 1: Now, you mentioned that the states are passing some laws. Now,
8:19
Speaker 1: how many states do you know? How many have adopted
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Speaker 1: this new rule?
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Speaker 2: Yeah, I'd say about fifteen have really strong enforceable laws.
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Speaker 2: Other states have the laws, but they don't have any
8:30
Speaker 2: teeth where the Insurance Commission has enforceability. So what we're
8:34
Speaker 2: trying to do is we're trying to meet with each
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Speaker 2: insurance commissioner and discover what the law entails, what the
8:41
Speaker 2: process is, who are the contacts, what are the forms
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Speaker 2: that are needed to fill out, and how we can
8:47
Speaker 2: automate that process for the drug store. So we are
8:50
Speaker 2: meeting with the National Association and Insurance Commission to do
8:53
Speaker 2: a presentation next month, and we are trying to develop
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Speaker 2: some standardization with this process with each state and help
9:00
Speaker 2: them manage the law and the regulations around it where
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Speaker 2: they don't have to reinvent the wheel, so Alabama doesn't
9:07
Speaker 2: have to suffer the same challenges that Tennessee suffered. Really,
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Speaker 2: the goal of the PBMs is to fragment and fatigue
9:15
Speaker 2: our pharmacies, and that's how they win, they find loopholes,
9:18
Speaker 2: they create chaos, and our owners and their staff give
9:22
Speaker 2: up because they just don't have the time and energy
9:24
Speaker 2: and resources to execute. And that's what we're finding is
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Speaker 2: laws are going in place, but you know there's minimal
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Speaker 2: stores that are executing because they are just so confused
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Speaker 2: and drained from the process.
9:40
Speaker 4: Yeah, okay, that's understandable.
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Speaker 1: So with the fifteen states that have enforceable rule that
9:47
Speaker 1: a drug can't be reimbursed below the acquisition cost, still
9:52
Speaker 1: the pharmacy's responsibility was to appeal that and there's you know,
9:59
Speaker 1: some paperwork that have to be submitted. So your process
10:02
Speaker 1: is automating all of that for the pharmacy. And do
10:08
Speaker 1: you also like, how would a pharmacy know if they're
10:11
Speaker 1: in a state that would even have this available to them.
10:15
Speaker 5: Yeah, so that's a great question.
10:17
Speaker 2: You know, we at Pharmacy Marketplace have a document that
10:20
Speaker 2: shows every state with the law and then the process
10:24
Speaker 2: and the benchmarking for that. I'd be glad to send
10:26
Speaker 2: that to you, Brick or you know, if anybody wants
10:29
Speaker 2: to reach out to my organization, me or anybody at
10:31
Speaker 2: Pharmacy Marketplace, we'd be glad to go through that and
10:35
Speaker 2: customize our conversation based on their state. And then what
10:39
Speaker 2: I'm doing is getting with the states that don't have
10:41
Speaker 2: those laws to really show them the pathway forward. So
10:45
Speaker 2: anybody that has a passion and interest for state perform
10:48
Speaker 2: or recouping what's rightfully owed to them, you know, I
10:52
Speaker 2: would encourage them to reach out to us and we
10:54
Speaker 2: will have that conversation.
10:56
Speaker 4: Yeah.
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Speaker 1: Well, I tell our listeners how they reach you.
10:59
Speaker 4: What's a good email for you?
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Speaker 2: Yeah, it's Chris k r I s at Pharmacy Marketplace
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Speaker 2: dot com and be glad to meet with them and
11:09
Speaker 2: go through their specific situation and really show them like, hey,
11:14
Speaker 2: here is the pathway for you know a sizeable amount
11:18
Speaker 2: of money that you're owed. You know, a typical drug
11:22
Speaker 2: store brick that's doing this process correctly. It's it's fifty
11:26
Speaker 2: to one hundred thousand dollars back in that store's pocket,
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Speaker 2: you know, just from.
11:31
Speaker 5: Hey, you have paid me.
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Speaker 2: Under underwater on this and now I from this law,
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Speaker 2: I am owed back to at least my cost. And
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Speaker 2: the stores are doing both generics and brand they're able
11:46
Speaker 2: to really identify where the most bang for the buck is.
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Speaker 2: And it's when you're using a software technology like ours,
11:53
Speaker 2: you're able to decrease the amount of time that you're
11:55
Speaker 2: having to you know, have somebody spend on this. It's
11:59
Speaker 2: it's similar to metsun think. You know, they started with
12:02
Speaker 2: a very manual process and then it got hard to
12:04
Speaker 2: scale it to a certain extent, so they had to
12:07
Speaker 2: incorporate software. And we're seeing the same kind of adoption
12:11
Speaker 2: with these macapeals.
12:13
Speaker 1: Wow, that is tremendous numbers that you that you quoted,
12:17
Speaker 1: what you know, give give me an example of what
12:20
Speaker 1: the highest amount that you saw that was able to
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Speaker 1: claw back and then what the lowest amount has been.
12:26
Speaker 1: That way, pharmacies can kind of say, well, I fall
12:29
Speaker 1: somewhere in between.
12:30
Speaker 2: Well, yeah, you know, we've talked to stores in our
12:33
Speaker 2: discovery calls where it's one hundred and fifty to two
12:35
Speaker 2: hundred thousand dollars depending on their volume and their drug mix. Right,
12:40
Speaker 2: So think of your high and specialty items that you're dispensing,
12:43
Speaker 2: Think of your GLP ones that you're dispensing. You know,
12:46
Speaker 2: a lot of these drug stores are saying, hey, I'm
12:48
Speaker 2: not going to dispense that, right, They're sending patients away
12:52
Speaker 2: and they might be losing valuable generics with those decisions.
12:56
Speaker 2: But now you know, with these recoupment rights of these laws,
13:00
Speaker 2: they know, well I'm going to feel this, but I
13:03
Speaker 2: have an opportunity to recoup it on the back end.
13:07
Speaker 2: So yeah, think of all the Manjarros and the Zimpics
13:10
Speaker 2: that you've been having to dispense at a loss. You know,
13:13
Speaker 2: think about those hard decisions of well, I have a
13:16
Speaker 2: long term patience that's on a room toward arthritis drug
13:20
Speaker 2: now or oncology drug God forbid. Even if the PBMs
13:24
Speaker 2: let you dispense that, a lot of times with these
13:27
Speaker 2: brand contracts, it ends up being at a loss. So
13:30
Speaker 2: what we're trying to do is stabilize some of these
13:33
Speaker 2: purchasing and dispensing habits where there's not so much chaos.
13:38
Speaker 4: Yeah, and on the low end, what can a pharmacy expect.
13:42
Speaker 2: Yeah, I'd say a small drug store twenty five thirty
13:45
Speaker 2: thousand dollars, right, you know, if they're one hundred a day,
13:48
Speaker 2: they're barely making you know, making it as is, so
13:52
Speaker 2: every penny counts. And you know we have stores that say, well,
13:56
Speaker 2: I only prioritize losses above twenty bucks, and we have
13:59
Speaker 2: store to say no, that's my money. I'm going to
14:03
Speaker 2: submit everyone that is a penny loss. You know, it's
14:06
Speaker 2: just the principle of the matter, and I'm going to
14:09
Speaker 2: go after every cent that's.
14:11
Speaker 5: Owed to me.
14:12
Speaker 1: Yeah, so take take our listeners through the timeline on
14:17
Speaker 1: when that recruitment happens. Is it something that is you know,
14:20
Speaker 1: a year down the road, When can they see those
14:24
Speaker 1: those funds come back?
14:26
Speaker 5: Yeah?
14:26
Speaker 2: So essentially every state has a process where the pharmacy
14:30
Speaker 2: has a time frame to do an appeal based on
14:33
Speaker 2: this dispensement of that drug. Right, so you dispense it
14:36
Speaker 2: to miss Jones, You're able to run a report say
14:40
Speaker 2: hey that you know, I lost ten dollars on that,
14:44
Speaker 2: and that state says, well, you have seven days to
14:46
Speaker 2: appeal this drug, or that state might say thirty days.
14:50
Speaker 2: You know, there are different time frames and our software
14:52
Speaker 2: takes that into account based on where you're at. From there,
14:56
Speaker 2: the PBM has a certain timeline to respond to that
15:00
Speaker 2: peel typically, whether that be seven or thirty days whatever.
15:04
Speaker 2: If the PBM hasn't responded appropriately within that timeframe, then
15:08
Speaker 2: they are out of compliance with the law and the
15:11
Speaker 2: state has given the pharmacy the option to file an
15:14
Speaker 2: external complaint and you know say, hey, this PBM's not
15:18
Speaker 2: in compliance. That creates hey, we're going to review this.
15:22
Speaker 2: See if you're owed money, get them to pay you,
15:25
Speaker 2: and then find them. In Tennessee, there's finds happening millions
15:29
Speaker 2: of dollars of fines that have occurred due to out
15:32
Speaker 2: of being PBMs being out of compliance. But they might
15:37
Speaker 2: approve you at the front end and you are able
15:40
Speaker 2: to reverse and rebuild it almost immediately. So any anywhere
15:44
Speaker 2: from hey, seven days to thirty to forty five days,
15:48
Speaker 2: you just have to follow up the process and guidelines
15:50
Speaker 2: within your state. That's what kind of our software is
15:53
Speaker 2: helping with is taking the manual air or the human
15:56
Speaker 2: element out of those guidelines for you to be able
15:59
Speaker 2: to track and everything appropriately.
16:01
Speaker 1: Okay, and you're you're realizing that underpayment right at the
16:07
Speaker 1: dispensing right because you're getting the paid label, you see
16:11
Speaker 1: that it's below your acquisition cost. So that's when you
16:14
Speaker 1: would start the appeal processes immediately.
16:17
Speaker 2: Well, yes, definitely you can brick. Our software will be
16:21
Speaker 2: able to develop that list of eligible appeals because what
16:24
Speaker 2: we do is we identify the ben PC in group
16:27
Speaker 2: numbers that are eligible per that state law. So say
16:31
Speaker 2: it's just commercial plans and we have to scrub out
16:35
Speaker 2: ARISA plans or federal plans like. That's part of what
16:38
Speaker 2: we're doing for the stores, making a report within workflow
16:41
Speaker 2: that they can go in and see, hey, these are
16:44
Speaker 2: the opportunities that are eligible per the state's actual law.
16:48
Speaker 1: Okay, so you've identified the upside? Is there any Downside's
16:54
Speaker 1: the what's the cost to the pharmacy to use this application?
17:00
Speaker 5: Yeah? Great point, Breck.
17:01
Speaker 2: So essentially what we're doing is we are technology company.
17:05
Speaker 2: We charge a subscription fee, and with that you get
17:08
Speaker 2: both our sourcing application, sub buying appropriately from your primary
17:14
Speaker 2: and secondary hole of salers, really seeing where that sweet
17:18
Speaker 2: spot of blending those options are where you're going to
17:21
Speaker 2: maximize your rebates but also get some opportunity from the
17:24
Speaker 2: secondary market.
17:25
Speaker 5: And then you get this piece.
17:27
Speaker 2: So a subscription could run anywhere from Some basic versions
17:32
Speaker 2: of our platform are free, but to have you know,
17:35
Speaker 2: the Catillac version right now, it's three hundred dollars, but
17:38
Speaker 2: with the ROI on both sides, you know it's substantial.
17:42
Speaker 2: You know, I'm really throwing out conservative numbers when you say, hey, sourcing,
17:47
Speaker 2: you can you know, save thirty forty thousand dollars and
17:50
Speaker 2: then on the PBM reform you know you can do
17:53
Speaker 2: the same, if not more so it could be six
17:56
Speaker 2: figure in terms of bottom line back to your pocket.
18:00
Speaker 2: I've seen the core issue that you complain about every day, right,
18:03
Speaker 2: you know, there's a lot of vendors and new opportunities
18:07
Speaker 2: and they're asking you to really do adopt new practices.
18:11
Speaker 2: You're buying and selling drugs. You need to be able
18:13
Speaker 2: to do it fairly and appropriately, and we are trying
18:17
Speaker 2: to do that in a way that is already in
18:19
Speaker 2: your workflow and you can do it efficiently, save time
18:22
Speaker 2: and save money.
18:23
Speaker 1: Yeah, I want to remind our listeners you're listening to
18:26
Speaker 1: the PBM Reform podcast here on the Pharmacy Podcast Network
18:29
Speaker 1: and our guest today, Chris Ray, has been in the
18:32
Speaker 1: industry for about fifteen sixteen years now helping community pharmacies
18:37
Speaker 1: and now is new project which I really love, helps
18:43
Speaker 1: hold the PBMs accountable for the you know, the drastic
18:48
Speaker 1: underpayments that we've seen for years. There was a recent
18:52
Speaker 1: statistic Chris that showed that about one fourth of the
18:56
Speaker 1: medications dispensed from a community pharmacy walked out the or
19:00
Speaker 1: below the acquisition cost of that medication. Your platform fixes
19:06
Speaker 1: that bleed, if you will, and help holds the PBM accountable,
19:13
Speaker 1: but through a mechanism that automates it right to make
19:17
Speaker 1: it easier to apply for those appeals. We've discussed that
19:21
Speaker 1: there's about fifteen states that really do.
19:25
Speaker 4: I guess.
19:27
Speaker 1: Enforce that rule, but more states that have the rule
19:30
Speaker 1: in place that they just need to step up their
19:33
Speaker 1: enforcement game. You're meeting with with what group is at
19:38
Speaker 1: the insurance National Insurance.
19:41
Speaker 2: Board, National Association of Insurance Commissioners. So it's the enforcement
19:45
Speaker 2: and mechanism for these laws. It's the group that will
19:48
Speaker 2: be finding the PBMs and addressing the I guess the
19:54
Speaker 2: end complaint that the pharmacies have where hey, I was
19:58
Speaker 2: paid to under my cost I can prove to you
20:01
Speaker 2: with a valid invoice or whatever benchmarks established through that law.
20:06
Speaker 2: Like here here, it is black and white. And what
20:08
Speaker 2: we're doing is we're gonna help those insurance commissioners see
20:11
Speaker 2: the patterns in the loopholes that the PBMs are establishing
20:17
Speaker 2: and really help them address that proactively.
20:20
Speaker 1: Okay, excellent, And you know, I think what I like
20:25
Speaker 1: about what you're doing is actually bringing those enforcement dollars
20:31
Speaker 1: back to the pharmacy. Because a lot of states do
20:33
Speaker 1: have insurance commissions rules in place that if a payer,
20:38
Speaker 1: you know, has done something incorrect that they find can
20:45
Speaker 1: be applied, but it comes back to the state and
20:48
Speaker 1: the and the poor pharmacy who was you know, offended
20:52
Speaker 1: by that payer is like, all right, we're still we're
20:57
Speaker 1: still out of loss. But the state was able to
20:59
Speaker 1: apply fine and and and get that paid by the
21:03
Speaker 1: by the payer or the PBM. But your system is
21:06
Speaker 1: actually applying those those funds to come back whatever was
21:12
Speaker 1: was underpaid. We'll come back to the community pharmacy. Now,
21:17
Speaker 1: do they just have to come at the at the
21:20
Speaker 1: acquisition cost so that there's just a break even or
21:24
Speaker 1: how do you get those extra dollars that you're talking
21:26
Speaker 1: about that could equate to one hundred two hundred thousand
21:30
Speaker 1: per year?
21:31
Speaker 2: Yeah, yeah, that's unfortunately break A lot of the times
21:34
Speaker 2: the law states say hey, we're going to bring you
21:36
Speaker 2: to be whole with the acquisition cost, and so in
21:41
Speaker 2: the PBM portals they say, hey, what is your desired
21:43
Speaker 2: reimbursement and you might put, you know, one thousand dollars
21:47
Speaker 2: over acquisition costs, but they're going to pay you up
21:50
Speaker 2: to the penny, right, They're they're not going to give
21:53
Speaker 2: you anything that is not stated in the law. So
21:56
Speaker 2: really it is them paying the pharmacies back their money
21:59
Speaker 2: that you know. But yeah, we're hoping to get this
22:03
Speaker 2: information back to the states to say, here's how the
22:06
Speaker 2: law impact is happening, here's how many pharmacies have used
22:10
Speaker 2: the platform, and here's you know, essentially crowdsourced information for
22:15
Speaker 2: you to develop a better mouse trap for the PBMs.
22:19
Speaker 5: And that's one of the.
22:19
Speaker 2: Things that we're going to be able to provide is
22:21
Speaker 2: just agnostic, neutral party data to show in the states,
22:26
Speaker 2: you know, if their law is being impactful. And you know, ultimately,
22:30
Speaker 2: I think that will be valuable because when we spoke
22:33
Speaker 2: with some of the insurance commissioners, they're saying, look, we
22:37
Speaker 2: passed this law and only fifty pharmacies in this state
22:40
Speaker 2: have actually you know, taken advantage of it. So we've
22:44
Speaker 2: hired support and we're here to enforce it, but unfortunately
22:47
Speaker 2: they're not using it. And that's men talk about a
22:51
Speaker 2: kicking the teeth, you know, working hard to advocate for
22:55
Speaker 2: legislation and then the PBMs could say, look, you know
22:58
Speaker 2: what came of it, but we know that if we
23:03
Speaker 2: can develop a better or more seamless workflow with this,
23:07
Speaker 2: then more stores will enact and there will be momentum,
23:10
Speaker 2: and then those states can say yes, like all the
23:13
Speaker 2: support staff that we've hired, now we can support them
23:16
Speaker 2: and they can assist the pharmacies, and now we have
23:19
Speaker 2: information flowing back to show the positive impact to our
23:22
Speaker 2: communities and community pharmacy deserts aren't happening. You know, I'm
23:26
Speaker 2: an idealist, but I'm hoping that you know, everybody is
23:30
Speaker 2: going to get behind this, the wholesalers, the buying groups,
23:32
Speaker 2: the p seos, obviously the pharmacies. We need everybody's support
23:37
Speaker 2: so we can really allocate our resources, time and effort
23:41
Speaker 2: into going and talking to these states and making sure
23:45
Speaker 2: that everybody's on the same page.
23:48
Speaker 1: Okay, and so the two part question for you, Chris,
23:51
Speaker 1: what are the key states that you are helping today?
23:56
Speaker 4: And then what is your expansion states? What are those
23:59
Speaker 4: that you're looking at?
24:00
Speaker 2: Yeah, so really what we're saying is there's three different
24:03
Speaker 2: patterns of these laws, one being you have to show
24:07
Speaker 2: us approved fiscal invoice where you were aggrieved. So that
24:13
Speaker 2: is a state like Tennessee. Tennessee is the pioneer in
24:16
Speaker 2: my opinion of this law.
24:18
Speaker 5: They've been.
24:20
Speaker 2: Enforcingate for about a year and a half two years.
24:23
Speaker 2: That's where we've piloted this program. Then other states like
24:27
Speaker 2: Alabama where there's an AAC benchmark component to it, or
24:34
Speaker 2: a state like Kentucky or Iowa where there's more of
24:38
Speaker 2: a Nateeck file benchmark to it. So we're really trying
24:43
Speaker 2: to focus on those three patterns to get very competent
24:48
Speaker 2: on whatever way those other states go. So a lot
24:52
Speaker 2: of the Southeast states have enforceability also, Oklahoma, Iowa, I
24:57
Speaker 2: think Illinois just passed one Colorado. You know, so there's
25:02
Speaker 2: there's quite a bit of momentum, and I really encourage
25:07
Speaker 2: the stores to reach out to US or their state
25:09
Speaker 2: association to get more detail.
25:12
Speaker 1: So there's a lot of population and pharmacy concentration, and
25:17
Speaker 1: two key states that always seem to be the problem
25:20
Speaker 1: states for payers, and that would be California and New York. Right,
25:25
Speaker 1: you have any solutions or or what what's the time
25:28
Speaker 1: frame for getting you know, support in those two main states.
25:34
Speaker 2: Yeah, So I believe that there is some enforceability with
25:36
Speaker 2: California and medicaid. We just haven't had a lot of
25:40
Speaker 2: store show interest from California. Everything we're doing is based
25:43
Speaker 2: on I guess curiosity and demand from a customer of
25:47
Speaker 2: California stores. One is to research and develop, you know,
25:51
Speaker 2: the tools specific to them, and you know, we need
25:54
Speaker 2: to hear from them. I think California has a component
25:59
Speaker 2: and to address it. New York I know that they're
26:02
Speaker 2: still you know, doing some legislative advocacy folks up there
26:07
Speaker 2: in the Northeast. You know, we've actually gave us part
26:10
Speaker 2: of this idea. So I'm hoping to hear back from
26:13
Speaker 2: them as as we continue progress out outside of the Southeast.
26:18
Speaker 2: I think we're growing our UH our relationships are kind
26:22
Speaker 2: of growing out of the Southeast market.
26:24
Speaker 4: Okay, excellent.
26:25
Speaker 1: Well, anything that that you hoped we would would touch
26:28
Speaker 1: on that we haven't yet for this this podcast.
26:32
Speaker 2: Really Brick, I think that the drug stores need to
26:36
Speaker 2: know there's light at the end of the tunnel. You know,
26:38
Speaker 2: federal reform UH might be discouraging at times, but your
26:43
Speaker 2: states have a huge impact on what could be a
26:48
Speaker 2: tipping point for federal legislation, So I would encourage them
26:52
Speaker 2: to get more involved in their state, you know affairs,
26:55
Speaker 2: whether it be through their association or that the different
26:58
Speaker 2: advocacy groups that really represent community pharmacy. And you know,
27:02
Speaker 2: just know that there are stories that are having success
27:08
Speaker 2: and stabilizing with with you know, opportunities like this, and
27:13
Speaker 2: just keep up the fight. I know that people continue
27:16
Speaker 2: to tell them, you know, keep up the fight, don't
27:19
Speaker 2: be the victim. But you know, reality is that they're
27:22
Speaker 2: super stressed, and we understand that.
27:25
Speaker 5: But really know.
27:26
Speaker 2: That we're here to advocate for them, and if they
27:28
Speaker 2: support us, we're going to support them through, through and
27:31
Speaker 2: through because they've meant so much to me in my
27:34
Speaker 2: career and I know what they do to the communities
27:36
Speaker 2: and how they positively impact them.
27:38
Speaker 1: Yeah, and I'm so glad that you made that point
27:41
Speaker 1: and reiterated that point that it really you need to
27:44
Speaker 1: get involved at the state level. You know, I had
27:46
Speaker 1: to sit down with you know, Doug croy n CPA
27:51
Speaker 1: about reform specifically for unbundling these networks so that a
27:56
Speaker 1: pharmacy could actually you know, choose the net work they
28:00
Speaker 1: want to participate in, and and and and get rid
28:03
Speaker 1: of the ones that didn't make any sense to them.
28:05
Speaker 1: But you know, the big three are really savvy and
28:08
Speaker 1: they know how to bundle all their networks and kind
28:11
Speaker 1: of take a take it all or or you're kicked
28:14
Speaker 1: out of the network approach. You know. So if you
28:16
Speaker 1: want the all the Medicare lives or all of the
28:18
Speaker 1: commercial health plan lives, you've got to take all of
28:22
Speaker 1: our crummy other managed care networks as well. And that
28:27
Speaker 1: was the point that that Doug made, is it really
28:29
Speaker 1: starts at the state level. You've got to you've got
28:31
Speaker 1: to get those changes made for any real reform started
28:38
Speaker 1: at the state level, and then eventually it starts to
28:40
Speaker 1: to to grow and get more momentum, and then other
28:45
Speaker 1: states adopted as well.
28:46
Speaker 4: So love what you're doing.
28:49
Speaker 1: Amazing opportunity for community pharmacies to to have somebody help
28:54
Speaker 1: them figure out what you know, that process for.
28:59
Speaker 4: For recruiting recouping.
29:00
Speaker 1: Some of those those that bleed that money that is
29:03
Speaker 1: that is slipping out of their pharmacy today. And and
29:07
Speaker 1: uh so give our listeners one more time your email
29:11
Speaker 1: so they know how to contact you.
29:13
Speaker 2: Yeah, so it's Chris with a K k R I
29:16
Speaker 2: S at pharmacy Marketplace dot com and I would love
29:20
Speaker 2: to talk to you guys and show you a demo
29:23
Speaker 2: of the software and answer any questions you have about
29:26
Speaker 2: your state specifics. And if I don't have the answers,
29:29
Speaker 2: we'll we will do the research together.
29:31
Speaker 5: So that's uh, that's my commitment to you.
29:34
Speaker 1: That's awesome, Chris, and thank you for being our guest
29:37
Speaker 1: today on the PBM Reform Podcast. Now I have some
29:41
Speaker 1: fun facts so we can get to know you a
29:43
Speaker 1: little better before we close. This is your kind of
29:46
Speaker 1: rapid fire. So are you more of an early birder?
29:49
Speaker 1: Night ol?
29:50
Speaker 5: I'd say night ol.
29:51
Speaker 2: Unfortunately, my wife is an early birder and that is
29:54
Speaker 2: always a fun, you know, a fun point of contention
29:57
Speaker 2: when I'm still on that bed at you know, six
29:59
Speaker 2: and six starting and she's raring to good.
30:04
Speaker 4: And do you prefer the mountains or the beach?
30:07
Speaker 2: So I'm a Appalachian boy here in Nuxing, Tennessee, so
30:11
Speaker 2: mountains are my comfort level. And I'm an avid hiker
30:14
Speaker 2: in the Appalachian Trail, so I would say the mountains.
30:17
Speaker 1: Yeah, that's beautiful country. Absolutely, And then what's your drink
30:22
Speaker 1: of preference? Are you a coffee, tea or something else.
30:26
Speaker 2: Well, I'm gonna say coffee until I get dehydrated them
30:29
Speaker 2: by a light so shameless plug there.
30:33
Speaker 4: That was a good, good answer, good answer. All right.
30:36
Speaker 1: Well, I appreciate you Chris for being our guest today
30:40
Speaker 1: here on the PBM Reform podcast on the Pharmacy Podcast Network.
30:44
Speaker 4: My name is Bret Rice.
30:45
Speaker 1: And until next time, stay curious, folks, and keep learning.
30:50
Speaker 1: Doing everything you can at the state level to make
30:53
Speaker 1: positive changes in PBM reform. I absolutely love community pharmacies.
30:58
Speaker 4: Will do everything I can to help you be are
31:00
Speaker 4: profitable