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PBM Reform Update from CPhA | PBM Reform Podcast · Pharmacy Podcast Network

• 0:07
  Speaker 1: Thanks for listening to the Pharmacy Podcast Network.
• 0:31
  Speaker 2: Welcome to the PBM Reform Podcast, where we dive deep
• 0:35
  Speaker 2: into the world of pharmaceutical benefit management, cutting through the
• 0:39
  Speaker 2: noise to uncover the truth. Since twenty nineteen, we've been
• 0:43
  Speaker 2: your go to source for the latest on how PBMs
• 0:46
  Speaker 2: impact patient care, drug pricing, and the very future of pharmacy.
• 0:52
  Speaker 2: Here we champion the role of pharmacists, the most knowledgeable
• 0:56
  Speaker 2: advocates for medication safety and expertise. Join us as we
• 1:01
  Speaker 2: expose and generate discussions that are reshaping healthcare and explore
• 1:05
  Speaker 2: how we build a better payment system which focuses on
• 1:08
  Speaker 2: advancing pharmacy care.
• 1:17
  Speaker 3: Well, welcome everybody to another episode of the PBM Reform
• 1:20
  Speaker 3: Podcast here on the Pharmacy Podcast Network.
• 1:23
  Speaker 4: My name is Brett Rice. I'll be your host today
• 1:26
  Speaker 4: and I have.
• 1:26
  Speaker 3: The privilege of working with community pharmacies now for twenty
• 1:31
  Speaker 3: two years. It's been an amazing career and I absolutely
• 1:34
  Speaker 3: love the industry. And today we have the pleasure of
• 1:39
  Speaker 3: speaking with CPhA, the California Pharmacist Association. We have their CEO,
• 1:46
  Speaker 3: Susan Bania, and also doctor Sean Kim with us as
• 1:51
  Speaker 3: our guest today.
• 1:52
  Speaker 4: So welcome to the program.
• 1:54
  Speaker 1: Well, thank you so much for having us. We're thrilled
• 1:56
  Speaker 1: to be here today.
• 1:57
  Speaker 3: Yeah, looking forward to learning more about both of you
• 2:01
  Speaker 3: and then jumping into some of the PBM reform that's
• 2:05
  Speaker 3: affecting your state and what you're working on for twenty
• 2:09
  Speaker 3: twenty six. So before we get into all that, Susan,
• 2:12
  Speaker 3: you've now been the CEO there for what six years?
• 2:16
  Speaker 4: Is that correct?
• 2:16
  Speaker 1: Yep, that's right.
• 2:18
  Speaker 3: Well, before we get into those details, we want to
• 2:21
  Speaker 3: learn more about you, Susan.
• 2:23
  Speaker 4: So where did you grow up?
• 2:25
  Speaker 1: Well, I actually grew up in Taiwan, so I do
• 2:28
  Speaker 1: have a kind of an unusual background.
• 2:33
  Speaker 3: Yeah, i'd say that's a little further away from California
• 2:35
  Speaker 3: than I thought.
• 2:36
  Speaker 1: Yeah, my father was a Presbyterian minister, and so I
• 2:40
  Speaker 1: was born there and went through high school in Taiwan
• 2:44
  Speaker 1: and then came back to southern California for college. And
• 2:47
  Speaker 1: my training is as a high school English teacher.
• 2:50
  Speaker 3: Okay, so I thought you would go the teacher route.
• 2:54
  Speaker 3: I'm a product of two school teachers. Both my parents
• 2:58
  Speaker 3: were educators. Have a fondness my mother in the California system.
• 3:04
  Speaker 3: I remember back in the days this might date me.
• 3:07
  Speaker 4: I think the.
• 3:07
  Speaker 3: Governor was brown at the time, and they didn't have
• 3:13
  Speaker 3: a state approved budget, and so she got IOUs as
• 3:17
  Speaker 3: her paycheck for a while.
• 3:19
  Speaker 4: So I remember that as a kid happened so well?
• 3:24
  Speaker 4: Any siblings? Were you an only child?
• 3:27
  Speaker 5: Oh?
• 3:27
  Speaker 1: No, I'm the youngest of four, and I really did
• 3:31
  Speaker 1: love my childhood. I think it was a wonderful kind
• 3:34
  Speaker 1: of global experience and wouldn't trade it for anything. Went
• 3:38
  Speaker 1: to American schools my whole time there, but certainly gives
• 3:43
  Speaker 1: one an appreciation for how all of the world has
• 3:48
  Speaker 1: to cooperate together to really, you know, be successful, from
• 3:54
  Speaker 1: country to country, nation to nation.
• 3:56
  Speaker 3: Yeah, so, Susan, that educational experience has got to be
• 3:59
  Speaker 3: incredibly though it was American americanized. Did you have the
• 4:03
  Speaker 3: same opportunities for extracurriculum where there where their sports, where
• 4:08
  Speaker 3: their music was their theater?
• 4:10
  Speaker 4: What what were you involved in?
• 4:12
  Speaker 2: Oh?
• 4:13
  Speaker 1: Played high school basketball, ran track, and yeah, we had
• 4:18
  Speaker 1: all the same opportunities.
• 4:21
  Speaker 3: That's excellent. That's excellent. So well, let's jump to you,
• 4:25
  Speaker 3: doctor Sean. Where did you grow up? Are you a
• 4:28
  Speaker 3: native California?
• 4:30
  Speaker 5: No, I'm actually I'm an immigrant from South Korea.
• 4:34
  Speaker 6: I moved to the States.
• 4:37
  Speaker 5: In high school, I had to have host family down
• 4:40
  Speaker 5: in Georgia and Alabama. So I grew up down there
• 4:44
  Speaker 5: and then went to college in Virginia, Maryland for a
• 4:48
  Speaker 5: pharmacy school and did the residency in d C with
• 4:52
  Speaker 5: American Pharmacy Disassociation.
• 4:55
  Speaker 3: What's the what's the pronunciation of of Southern Korean? That's
• 5:00
  Speaker 3: got to be interesting, right.
• 5:03
  Speaker 5: I believe I don't really have accent, but my wife
• 5:06
  Speaker 5: definitely picks up on men, so I do have accent.
• 5:10
  Speaker 6: But yeah, it evolved over time.
• 5:13
  Speaker 4: Yeah, now that's awesome. That's awesome.
• 5:15
  Speaker 3: Yeah, the you know, the you said yet your family
• 5:19
  Speaker 3: in the South. I started my career in community pharmacy
• 5:23
  Speaker 3: in Tennessee, oh and uh and so got to love
• 5:27
  Speaker 3: the Southern food and everything in that part of the country.
• 5:31
  Speaker 3: I think I gained ten pounds just the first, you know,
• 5:35
  Speaker 3: a couple of months that I was in the in
• 5:37
  Speaker 3: the Tennessee area, just because everything's deep fried out there.
• 5:40
  Speaker 4: Was it was wonderful.
• 5:43
  Speaker 3: It was a joke about, you know, when they finally
• 5:45
  Speaker 3: legalize marijuana in the South, it would be deep fried,
• 5:49
  Speaker 3: it would be battered and deep So yeah, and what
• 5:56
  Speaker 3: about extracurricular for you, Sean, were you in sports in music?
• 6:01
  Speaker 4: What was your your extracurricular Yeah, I.
• 6:04
  Speaker 6: Love try and build.
• 6:06
  Speaker 5: As Susan also mentioned, I did long distance, did full
• 6:12
  Speaker 5: distance marathon before and did coming to the Santiago. So
• 6:16
  Speaker 5: I'm like, I like to do things a lot, I guess,
• 6:22
  Speaker 5: but then you know, so I can focus on myself.
• 6:26
  Speaker 6: But yeah, running is my favorite thing to do.
• 6:29
  Speaker 4: Yeah, where have you done more than one marathon?
• 6:32
  Speaker 6: I did two, one, one half and one full. So
• 6:35
  Speaker 6: if it is only calling for a full than just one, yeah.
• 6:38
  Speaker 4: Yeah, where where was that marathon.
• 6:40
  Speaker 6: At Richmond, Virginia?
• 6:41
  Speaker 3: Okay, not one that I've I've run. I've done a
• 6:45
  Speaker 3: lot in the West. Saint George was probably our favorite.
• 6:49
  Speaker 3: Every October. My wife and I would run that together.
• 6:53
  Speaker 3: We would start together, she would always finish ahead of me.
• 6:57
  Speaker 3: She finished one time, slowed down for me one time
• 7:00
  Speaker 3: because it fell right on our anniversary and so we
• 7:03
  Speaker 3: actually finished the race together and on newspapers there to
• 7:08
  Speaker 3: take a picture and everything of us doing that on
• 7:10
  Speaker 3: our anniversary. But yeah, she's much faster runner than me,
• 7:14
  Speaker 3: but still a lot of fun we've done. I don't know,
• 7:18
  Speaker 3: she's probably done twenty five or so I've probably only
• 7:21
  Speaker 3: done I've probably only done about ten or twelve.
• 7:24
  Speaker 6: Wow.
• 7:25
  Speaker 4: Yeah, but yeah, I love that run.
• 7:26
  Speaker 3: People say that it was a good time for you,
• 7:28
  Speaker 3: you to you know, do your training together where you
• 7:31
  Speaker 3: can catch up because we had four children. Was busy
• 7:34
  Speaker 3: life back when we were running marathons. I said, no,
• 7:37
  Speaker 3: I would listen. My wife would do all the talking
• 7:41
  Speaker 3: and I was breathing, you know, I was just trying
• 7:43
  Speaker 3: to breathe. But it was a good time to get
• 7:46
  Speaker 3: downloaded on what was going on with the family.
• 7:49
  Speaker 4: So excellent. Well what let's start with you, Susan.
• 7:53
  Speaker 3: What brought you over to pharmacy from education and getting
• 7:58
  Speaker 3: into pharmacy.
• 8:00
  Speaker 1: Well, I ran for public office, and so at the
• 8:04
  Speaker 1: local level city council mayor, then county office, and then
• 8:10
  Speaker 1: actually ended up in our state Assembly. So that's where
• 8:12
  Speaker 1: I learned about pharmacy. I chaired the Business and Professions
• 8:15
  Speaker 1: Committee when the big health provider bill came through. And
• 8:20
  Speaker 1: then when I turned out in the end of twenty sixteen,
• 8:24
  Speaker 1: I worked in a nonprofit and then this job popped
• 8:27
  Speaker 1: up and I was like, you know what, it would
• 8:29
  Speaker 1: be wonderful to see the work I was able to
• 8:31
  Speaker 1: do while in the legislature actually implemented in real life.
• 8:35
  Speaker 1: And so I've thoroughly enjoyed that opportunity I've had post
• 8:39
  Speaker 1: public service to realize some of those changes and laws
• 8:46
  Speaker 1: in real time. And that's how I ended up at
• 8:48
  Speaker 1: the California Pharmacist Association.
• 8:51
  Speaker 3: Wow, okay, And it was somebody pulling you in saying
• 8:56
  Speaker 3: we really could use you, or how did that introduction
• 9:00
  Speaker 3: come about?
• 9:01
  Speaker 1: Someone else in another association encouraged me to actually apply
• 9:05
  Speaker 1: for the job because on there they had said, you know,
• 9:07
  Speaker 1: farm D preferable, and I'm like, I'm a long way
• 9:10
  Speaker 1: from a farm D. And so they said, no, you really,
• 9:14
  Speaker 1: you know, you have a perspective they should they should appreciate.
• 9:17
  Speaker 1: And so one of the questions in the interview, because
• 9:20
  Speaker 1: there was a segment that was thought they should hire
• 9:23
  Speaker 1: a pharmacist as their CEO, and they said, so, what
• 9:27
  Speaker 1: are we going to tell people who think we should
• 9:30
  Speaker 1: have hired a pharmacist if we hire you? And I said, well,
• 9:33
  Speaker 1: you've got plenty of those already. What you don't have
• 9:36
  Speaker 1: is a former legislator who has colleagues in the building,
• 9:40
  Speaker 1: who has built a decade of relationships with and that's
• 9:44
  Speaker 1: really what we need. And quite frankly, I think some
• 9:47
  Speaker 1: of our more recent success legislatively has been because of
• 9:51
  Speaker 1: those relationships, that that long term trust that nothing else
• 9:56
  Speaker 1: can substitute for.
• 9:59
  Speaker 3: Yeah, I that's that's amazing. Now, doctor Kim, did you
• 10:03
  Speaker 3: always know you wanted to be a farm d.
• 10:06
  Speaker 5: No, I'll be honest with you. I think it evolved
• 10:09
  Speaker 5: over time. Once I graduated from my undergrad with the
• 10:14
  Speaker 5: science degree, I worked in a compounding facility, and then
• 10:20
  Speaker 5: you got some sense of Okay, these are the different
• 10:24
  Speaker 5: things that you can do with the pharmacy degree. Met
• 10:28
  Speaker 5: what they called untraditional like unconventional folks like msls and whatnot,
• 10:34
  Speaker 5: and decided to explore and went to some conferences, met
• 10:38
  Speaker 5: some friends and yeah, and listened to a lot of
• 10:43
  Speaker 5: podcasts too, actually, like what it called ARX Radio by
• 10:47
  Speaker 5: Shameless plug by doctor Richard Waite, who is one of
• 10:51
  Speaker 5: my biggest mentor from Florida. I tuned into his podcast
• 10:55
  Speaker 5: and then decided to take it out on univers Maryland.
• 11:00
  Speaker 4: And where did you go to pharmacy school Maryland? Okay?
• 11:04
  Speaker 3: That was both there, both okay, excellent. I wondered if
• 11:08
  Speaker 3: you were a usc person, because you know, I knew
• 11:13
  Speaker 3: one of the compounding professors. In fact, I'm wearing his
• 11:17
  Speaker 3: his hat right now, Sports Farm. That's one of your members,
• 11:21
  Speaker 3: Robert Nickel so been a big influence in compounding, especially
• 11:26
  Speaker 3: there in the state of California, but now all over
• 11:29
  Speaker 3: he's he's expanded. So a good friend and colleague in
• 11:33
  Speaker 3: the industry. Yeah, so let's get into the state level
• 11:40
  Speaker 3: with PBM reform. It was explained to me, you know
• 11:44
  Speaker 3: one time when I thought that, you know, n CPA
• 11:47
  Speaker 3: is a national association of pharmacists, could you know, move
• 11:52
  Speaker 3: the needle for me on on something that I thought
• 11:56
  Speaker 3: was really important with reform. And I was talking to
• 11:59
  Speaker 3: to Doug hoy about that, and and he mentioned that
• 12:02
  Speaker 3: it really needs to start at the state level, and
• 12:07
  Speaker 3: and so that's what I wanted to get into. You know,
• 12:09
  Speaker 3: why do you think it's so important that the individual
• 12:12
  Speaker 3: states start to move things in the right direction and
• 12:16
  Speaker 3: not have it pushed down from a federal standpoint.
• 12:20
  Speaker 1: I think, you know, there's a few few issues there.
• 12:24
  Speaker 1: You know, if you're talking some of the federal money,
• 12:27
  Speaker 1: you know, and how it's allocated, you know, then the
• 12:30
  Speaker 1: states really, you know, need to be connected at those points.
• 12:33
  Speaker 1: Of intersection. But traditionally, state legislators are more nimble. They're
• 12:40
  Speaker 1: able to pass legislation within a year or two, unlike
• 12:43
  Speaker 1: the federal government, which is just a massive bureaucracy. So
• 12:47
  Speaker 1: I would say that the most practical reason for it
• 12:50
  Speaker 1: happening at the state level is just the time it takes.
• 12:53
  Speaker 1: And now, in California, you know, we are so large
• 12:56
  Speaker 1: that our session goes on forever. Our legislature is very
• 13:02
  Speaker 1: complex compared to some of the states that you know,
• 13:05
  Speaker 1: get done in a few weeks. But also the states
• 13:07
  Speaker 1: are so different. You know, right now, we don't have
• 13:11
  Speaker 1: uniform regulations, we don't have uniform laws. Maybe someday we'll
• 13:15
  Speaker 1: get there, but knowing the United States of America's mentality,
• 13:20
  Speaker 1: we're probably always going to have differences state to state.
• 13:23
  Speaker 4: Yeah, very well said.
• 13:25
  Speaker 3: And you know, speaking specifically for the challenges that pharmacists
• 13:30
  Speaker 3: have in the state of California facing PBMs, are they
• 13:36
  Speaker 3: really different than what other states would have to deal
• 13:39
  Speaker 3: with or is it a lot of the same issues?
• 13:42
  Speaker 1: They are the same issues. I think that you know,
• 13:46
  Speaker 1: our fight was super hard on the reform because we
• 13:49
  Speaker 1: represent such a huge segment of their business. Right there's
• 13:54
  Speaker 1: so many lives in California that when you look at hey,
• 13:57
  Speaker 1: are they going to regulate us and not let us
• 13:59
  Speaker 1: make as much money. That's a bigger fight in California
• 14:02
  Speaker 1: than it's going to be in a state that has
• 14:04
  Speaker 1: less lives that are being covered. So we really had
• 14:09
  Speaker 1: a battle on our hands. The PBMs did not want
• 14:13
  Speaker 1: to lose. They didn't want to be regulated, they did
• 14:15
  Speaker 1: not want transparency in California. And the fact that we
• 14:18
  Speaker 1: accomplished this was sent up Bill forty one that has
• 14:21
  Speaker 1: just gone into effect January first of this year. Has
• 14:24
  Speaker 1: been a multi year fight and a real battle, you know,
• 14:29
  Speaker 1: David and Goliath. Here we are relatively small nonprofit up
• 14:34
  Speaker 1: against huge national and business you know, interests that poured
• 14:39
  Speaker 1: a lot.
• 14:40
  Speaker 4: Of money, multi billion dollar interests.
• 14:44
  Speaker 1: Yeah, so you know, we we'd run a bill nine
• 14:47
  Speaker 1: sixty six the year before that the governor vetoed, which
• 14:50
  Speaker 1: was really a heartbreak.
• 14:51
  Speaker 4: Cout.
• 14:51
  Speaker 1: One of the rewarding things about SB forty one passing
• 14:55
  Speaker 1: and now being law is that when we're working with
• 14:58
  Speaker 1: the governor and we came back, this bill's actually more
• 15:03
  Speaker 1: has is stronger, has a less forgiving timeline than nine
• 15:07
  Speaker 1: sixty six, So you know that the dragging on the
• 15:10
  Speaker 1: fight did not play out into the best interests of
• 15:12
  Speaker 1: the PBMs. It played out into the best interests of
• 15:16
  Speaker 1: the citizens of you know, California and and hopefully the
• 15:19
  Speaker 1: nation if this, you know, is able to move across
• 15:22
  Speaker 1: to other states.
• 15:24
  Speaker 3: Yeah, well, congratulations on SB forty one. That's a true
• 15:28
  Speaker 3: huge accomplishment. What initiatives are you currently working on now
• 15:33
  Speaker 3: for twenty twenty.
• 15:33
  Speaker 1: Six implementation and enforcement? You know, it's all fine to
• 15:40
  Speaker 1: get a bill and work it really hard, and you know,
• 15:44
  Speaker 1: you pop the champagne because you got a signature, and
• 15:47
  Speaker 1: then the really really hard work begins. And you know,
• 15:52
  Speaker 1: that's where Sean comes in to work through the maze
• 15:56
  Speaker 1: of bureaucracy within the administration's departments where you know, they're
• 16:02
  Speaker 1: going to be licensed in one department, Department of Managed Healthcare,
• 16:05
  Speaker 1: the data is going to be in a different department,
• 16:08
  Speaker 1: you know, healthcare affordability. You've got the Department of Justice
• 16:12
  Speaker 1: who said, hey, we want to enforce as well. So
• 16:16
  Speaker 1: it's how is all of this going to get stood
• 16:19
  Speaker 1: up in the next year? Is going to take a
• 16:22
  Speaker 1: lot of time, coordination, and effort, and we really see
• 16:25
  Speaker 1: that as our role, and Sean has been building these
• 16:28
  Speaker 1: relationships into the administration's departments so that you know, it
• 16:33
  Speaker 1: doesn't just fall flat and never amount to anything.
• 16:37
  Speaker 3: Yeah, So try to take some of the complexity out
• 16:41
  Speaker 3: because I know forty one has a lot to it.
• 16:43
  Speaker 3: But walk us through what is that actually accomplishing for
• 16:49
  Speaker 3: patients and pharmacists alike in California.
• 16:53
  Speaker 1: And I'm going to let Sean get into some of
• 16:54
  Speaker 1: the weeds, but you know, big picture, one of the
• 16:57
  Speaker 1: most important things was saying, there's affiliated pharmacy which the
• 17:01
  Speaker 1: PBMs own, and then there's the non affiliated pharmacies which
• 17:04
  Speaker 1: are our independents and Walgreens and Safe Way other non
• 17:09
  Speaker 1: PBM owned you've got to treat them the same.
• 17:13
  Speaker 4: Yeah, don't don't get me.
• 17:14
  Speaker 3: Yeah, don't get me started on the affiliate pharmacies that
• 17:19
  Speaker 3: that have ten thousand locations, but yet you know, seventy
• 17:23
  Speaker 3: five percent of their profit comes from the PBM. So
• 17:26
  Speaker 3: it's like PBMs are making a little more money than
• 17:29
  Speaker 3: they need to.
• 17:30
  Speaker 1: Well, and if it's you know, good for the goose,
• 17:31
  Speaker 1: it's good for the ander. And so this is where
• 17:34
  Speaker 1: it's really playing out. Like this week, last week, we
• 17:38
  Speaker 1: are hearing from our independence. Hey, all of a sudden,
• 17:41
  Speaker 1: we're getting audited multiple times, and so we're going right
• 17:46
  Speaker 1: back into forty one. We're saying, send us all of
• 17:48
  Speaker 1: the data, because guess what what forty one was supposed
• 17:52
  Speaker 1: to do was level that playing field and saying you
• 17:55
  Speaker 1: cannot audit you're your own pharmacies in a different way
• 17:59
  Speaker 1: than you audit everyone else. So already here we are
• 18:02
  Speaker 1: beginning of February. I'm very aware of the fact that
• 18:06
  Speaker 1: they it isn't going to be magical fairness, right, We're
• 18:09
  Speaker 1: going to have to fight this every step of the way.
• 18:12
  Speaker 3: Yeah, So Sean, simplify it. What's in it for the pharmacist.
• 18:18
  Speaker 5: There are multiple things in the provisions, such as like
• 18:21
  Speaker 5: prohibition of spread pricing or mandatory passed through or cost sharing,
• 18:27
  Speaker 5: limits to the point of sale, and most importantly non
• 18:32
  Speaker 5: discriminating nation against the network or affiliated pharmacy. What we
• 18:38
  Speaker 5: have learned over time is that as we enacted the provision,
• 18:44
  Speaker 5: you have to build the infrastructure properly. So that's what
• 18:48
  Speaker 5: Susan has alluded Allier and where she brings much of
• 18:53
  Speaker 5: the asset was the previously built on relationship with the
• 18:57
  Speaker 5: state agencies. If we can go deeper into the details
• 19:04
  Speaker 5: that how the PPM will be licensed will be through
• 19:08
  Speaker 5: the Departmental Managed Healthcare which does the licensing for health
• 19:14
  Speaker 5: plans as well. So regarding the Knock Skin Act, there
• 19:19
  Speaker 5: are the entity that who license the health plans, so
• 19:22
  Speaker 5: it'll be the similar mechanism for the PBMs. And with
• 19:27
  Speaker 5: that say that the timeline is having to have everyone
• 19:32
  Speaker 5: licensed by the end of twenty twenty seven, So we
• 19:36
  Speaker 5: have to continuously educate our members and the public entities
• 19:40
  Speaker 5: to understand what the timeline is and the expectation is.
• 19:44
  Speaker 5: At the same time, we also have to keep them
• 19:49
  Speaker 5: accountable for if this is actually happening and if we
• 19:55
  Speaker 5: see some unfair practices, just like what Susan mentioned about
• 20:00
  Speaker 5: increased amount of the audits, and those audits have been
• 20:04
  Speaker 5: much more strict compared to what has been done previously,
• 20:10
  Speaker 5: so we have to make sure it is all documented
• 20:13
  Speaker 5: and categorized to be able to provide it to our
• 20:19
  Speaker 5: state agency such as DMHC, and then not to mention
• 20:23
  Speaker 5: there's another NTTHKI that we have to work with well.
• 20:27
  Speaker 1: It's also important to note that the prohibitions are effective now,
• 20:33
  Speaker 1: so the licensing they're giving time for because the Department
• 20:36
  Speaker 1: needs the time, and there's these contracts already in place
• 20:40
  Speaker 1: that aren't going to run out. But the prohibitions became
• 20:45
  Speaker 1: prohibited as of January first, twenty twenty six, and so
• 20:48
  Speaker 1: within the bill also is an enforcement mechanism of fines
• 20:52
  Speaker 1: that the Department of Justice can levy up to I
• 20:55
  Speaker 1: think it's seven thousand dollars for every single violation. So
• 21:01
  Speaker 1: that's where you know, we're already now thinking, okay, how
• 21:04
  Speaker 1: are you know? We've got to get in these complaints,
• 21:06
  Speaker 1: get in the information, and test out the enforcement mechanism
• 21:12
  Speaker 1: because we've we've done work in the past, and as
• 21:15
  Speaker 1: you well know, if there's no teeth, then there's no change.
• 21:20
  Speaker 1: So we're really twenty six is going to be I
• 21:25
  Speaker 1: think that opportunity to not only test out what are
• 21:29
  Speaker 1: the you know, what are the guidelines for enforcement, where
• 21:34
  Speaker 1: is DOOJ going to react and engage with us on enforcement,
• 21:39
  Speaker 1: but then also regulation. We're really hoping Department and Managed
• 21:42
  Speaker 1: Healthcare will take a stakeholder approach because, as you know,
• 21:46
  Speaker 1: with pharmacy, what we find the very first thing we
• 21:50
  Speaker 1: find is no one understands it. So one of our
• 21:54
  Speaker 1: first jobs is always education because this is fairly new
• 21:59
  Speaker 1: and so there's going to be a steep learning curve
• 22:03
  Speaker 1: even within the regulating arm of Department and Managed Healthcare.
• 22:08
  Speaker 3: Yeah, I'm glad you brought that up, Susan, because a
• 22:10
  Speaker 3: lot of states have laws on the books that are
• 22:16
  Speaker 3: just not enforced, right. You know, I think about just
• 22:20
  Speaker 3: the unfair reimbursements, reimbursing below acquisition cost You would think
• 22:25
  Speaker 3: that's a no brainer, right, But if no one's holding
• 22:29
  Speaker 3: you know, the PBM responsible, they just continue to reimburse
• 22:33
  Speaker 3: below the acquisition costs. So how do you make sure
• 22:37
  Speaker 3: now with this new forty one bill that that you
• 22:41
  Speaker 3: do get the backing from you know, DJ and from
• 22:45
  Speaker 3: the other enforcement you know systems to really hold people accountable.
• 22:52
  Speaker 1: Well, I think the first thing you want to do
• 22:53
  Speaker 1: is make sure the regulations are written right. We don't
• 22:56
  Speaker 1: want to have to go in and then say this
• 22:58
  Speaker 1: isn't working. You know, you didn't understand what you were doing.
• 23:01
  Speaker 1: So that's a lot of our work this year is
• 23:04
  Speaker 1: to help the Department of Managed Healthcare, you know, at
• 23:08
  Speaker 1: least hit the bullseye right for regulations. Department of Justice
• 23:12
  Speaker 1: in our state had our Attorney General has shown a
• 23:14
  Speaker 1: great interest in regulating PBMs. He has had many amicust
• 23:19
  Speaker 1: briefs across the nation that he's signed onto. He doesn't
• 23:23
  Speaker 1: shy away from confrontation, and you know, with PBMs being
• 23:28
  Speaker 1: a very visible target right now, we're really hopeful and
• 23:32
  Speaker 1: we know they've done a lot of work because they
• 23:34
  Speaker 1: were very active in the crafting of the bill, so
• 23:37
  Speaker 1: they're not They weren't sitting back and just saying, well,
• 23:40
  Speaker 1: we'll see what happens. They actually made sure that their
• 23:45
  Speaker 1: ability to enforce was fully protected. So we take that
• 23:49
  Speaker 1: as a signal that this is an issue they've already
• 23:53
  Speaker 1: shown they're interested in and that I think they're going
• 23:56
  Speaker 1: to have an appetite to actually get involved in the enforcement.
• 24:00
  Speaker 3: Do you get the insurance commissions involved as well?
• 24:04
  Speaker 1: No, California is really unique in that sense. We bifurcated
• 24:08
  Speaker 1: our insurance and you know, the Insurance Commission only has
• 24:12
  Speaker 1: our private plans and all managed healthcare is under Department
• 24:17
  Speaker 1: and managed healthcare, so they split them out, and that anyway,
• 24:23
  Speaker 1: we keep our insurance commissioner busy with fire recovery, so
• 24:28
  Speaker 1: he's not as active in healthcare in California as in
• 24:31
  Speaker 1: other states.
• 24:32
  Speaker 3: Yeah, we're a year out and we're still dealing with
• 24:35
  Speaker 3: that big fire, aren't we.
• 24:36
  Speaker 1: Oh, every couple of years is a big fire.
• 24:39
  Speaker 4: But yeah, yeah, that one was.
• 24:41
  Speaker 1: Particularly devastating in southern California because it was in neighborhoods.
• 24:44
  Speaker 4: Yeah, yeah, exactly.
• 24:47
  Speaker 3: Well, Sean, what's in it for the patient now, specifically
• 24:51
  Speaker 3: in terms of access? Does that change accessibility? Does it
• 24:55
  Speaker 3: change transparency? This sp forty one.
• 24:59
  Speaker 5: Yeah, they should get the pass through for every rebase
• 25:05
  Speaker 5: what they're saying. So what we are trying to catch
• 25:10
  Speaker 5: as a transparency is there will be further discussion at
• 25:15
  Speaker 5: the Healthcare of Access and Information Department that we mentioned
• 25:20
  Speaker 5: earlier h KAI and then from the committee meetings that
• 25:25
  Speaker 5: will discuss what kind of data or what kind of
• 25:29
  Speaker 5: price is fair to catch.
• 25:32
  Speaker 6: So as what we just saw with the federal.
• 25:37
  Speaker 5: Bill, h R seven one four eight, if I'm not
• 25:41
  Speaker 5: mistaken with the numbers, talks about the relevance and the
• 25:45
  Speaker 5: transparency price. But we also see that in California at
• 25:49
  Speaker 5: state level as well, there is much more discussions even
• 25:53
  Speaker 5: including the stakeholders from a PBM side too, And that's
• 25:57
  Speaker 5: why we're the State association is much needed to represent
• 26:02
  Speaker 5: the profession to make sure the fair price is capture
• 26:06
  Speaker 5: rather than just the sticker price that we've been seeing
• 26:10
  Speaker 5: such as whack or mac.
• 26:12
  Speaker 3: Yeah. Good, good explanation. Well, you know, wanted to focus
• 26:16
  Speaker 3: on the winds first as congratulations you have a win,
• 26:20
  Speaker 3: but you know what's still broken? What what do you
• 26:24
  Speaker 3: still want to work on for California.
• 26:26
  Speaker 1: Dispensing fees are really not a huge problem. They're so
• 26:32
  Speaker 1: low right now in our medical program, which is Medicaid,
• 26:36
  Speaker 1: we do have a floor. The state does reimburse fairly.
• 26:41
  Speaker 1: So this year we are going to be co sponsoring
• 26:43
  Speaker 1: an effort around UH at least holding everyone accountable for
• 26:49
  Speaker 1: the for the same dispensing fee that the state pays
• 26:52
  Speaker 1: for medical So we are we know that will be difficult.
• 26:57
  Speaker 1: There will be a fight over the fact that you know,
• 27:00
  Speaker 1: the PBMs don't seem to have any problem not telling
• 27:03
  Speaker 1: the truth when they're in the state House, and UH,
• 27:07
  Speaker 1: you know that that it's going to drive prices up
• 27:09
  Speaker 1: and all of that. I think that you know, what
• 27:12
  Speaker 1: we're fairly confident in now is that we've built a
• 27:16
  Speaker 1: tremendous amount of trust within decision makers with legislators UH,
• 27:21
  Speaker 1: and that we're really hopeful that they will see the
• 27:24
  Speaker 1: need for the you know, long term viability of this profession.
• 27:29
  Speaker 1: For dispensing fees, no one understands and you know, a
• 27:32
  Speaker 1: lot of what we do is education. That's why being
• 27:34
  Speaker 1: a teacher is perfect when you're either lobbying or working,
• 27:38
  Speaker 1: uh in this environment. You know, but who's going to
• 27:41
  Speaker 1: keep the lights on, who's paying for the tech, who's
• 27:44
  Speaker 1: covering the cost of the bottle? You know, all of
• 27:48
  Speaker 1: this that a small business has to have as huge expenses,
• 27:52
  Speaker 1: the rent, who's covering that. Once you explain it to them,
• 27:57
  Speaker 1: they're shocked. They don't you know, they're like, what that.
• 28:00
  Speaker 1: You know, someone's being reimbursed seventeen cents, not reimbursed, but
• 28:03
  Speaker 1: the dispensing fee is seventeen cents. That's crazy. And we're like, yes,
• 28:07
  Speaker 1: it's going to drive them out of business. In fact,
• 28:09
  Speaker 1: that's the point. We had three hundred and forty right
• 28:13
  Speaker 1: eates closed in California last summer, which is just you know,
• 28:17
  Speaker 1: devastating on the access issue. So you know, you're talking
• 28:20
  Speaker 1: about patient access, and we lead with you know the
• 28:24
  Speaker 1: fact that there has to be a sustainable business model
• 28:29
  Speaker 1: for access to be maintained for patients, and so I
• 28:34
  Speaker 1: think that you know, we are as with all of
• 28:38
  Speaker 1: our efforts, it's going to probably take more than one year.
• 28:40
  Speaker 1: But that's one big problem, is just the increasing cost
• 28:44
  Speaker 1: of running a business not being covered. And then the
• 28:48
  Speaker 1: other big effort we're working on is around standard of care.
• 28:52
  Speaker 1: And standard of care is incredibly important because what we've
• 28:56
  Speaker 1: learned is we have passed bills. Let's say, you know
• 28:58
  Speaker 1: you've got to pay you know, pay equity if you're
• 29:01
  Speaker 1: going to pay a physician's assistant, you've got to pay
• 29:04
  Speaker 1: a pharmacist. But you know, the plans don't want to
• 29:07
  Speaker 1: credential the pharmacists. The plans don't want to set up
• 29:09
  Speaker 1: a payment system. And when we've really dug into it
• 29:12
  Speaker 1: over the last couple of years, one of the problems
• 29:14
  Speaker 1: is the prescriptive way that pharmacy has been regulated, where
• 29:19
  Speaker 1: you're allowed to do these three things, but you can't
• 29:21
  Speaker 1: do these two. But then maybe you can do that one,
• 29:23
  Speaker 1: but maybe we'll change our minds and you can't. And
• 29:26
  Speaker 1: the plans are like, we're not going to start doing
• 29:28
  Speaker 1: this huge overhaul to start paying you if we don't
• 29:31
  Speaker 1: have certainty. So we know that standard of care really
• 29:36
  Speaker 1: is deeply connected to being successful long term with payers
• 29:42
  Speaker 1: and elevating the profession into that position where and the
• 29:47
  Speaker 1: sustainability is. This is the link that needs to happen
• 29:51
  Speaker 1: for the whole profession, is that there has to be
• 29:54
  Speaker 1: a flow of funds into pharmacy. And if we we
• 30:00
  Speaker 1: believe that Sarah cares is and very very important objective
• 30:04
  Speaker 1: and as a bill we are going to be running
• 30:07
  Speaker 1: this year.
• 30:08
  Speaker 3: Yeah, I want to dive into that more with you.
• 30:10
  Speaker 3: We'll have to have a follow up episode for sure,
• 30:13
  Speaker 3: because I've got some ideas on that myself of what
• 30:17
  Speaker 3: needs to happen, and it is it is truly unfortunate that,
• 30:22
  Speaker 3: you know, a pharm d a doctor of pharmacy is
• 30:26
  Speaker 3: treated less than even a nurse practitioner in most billing scenarios,
• 30:32
  Speaker 3: right and the one you know practitioner that is helping
• 30:37
  Speaker 3: patients all day long and not getting compensated for it.
• 30:40
  Speaker 3: You know, I couldn't walk into my primary care provider
• 30:43
  Speaker 3: with a skin rash and say, hey, what do.
• 30:45
  Speaker 4: You think this is?
• 30:46
  Speaker 3: But I can share walk into my pharmacy and ask,
• 30:48
  Speaker 3: hey do you think this is poison oak?
• 30:49
  Speaker 4: Is it a bug bite?
• 30:50
  Speaker 3: And they're going to help me right there on the spot,
• 30:53
  Speaker 3: and pharmacists need to be compensated for that. So in
• 30:56
  Speaker 3: a future episode we'll.
• 30:59
  Speaker 4: Talk about that. But i'd love to, you know, when
• 31:02
  Speaker 4: when you're talking about.
• 31:03
  Speaker 3: Other, you know, key things that you want to work on.
• 31:08
  Speaker 3: Has has it ever come up about the unbundling of
• 31:11
  Speaker 3: all these networks, because sometimes pharmacies are kind of held hostage.
• 31:16
  Speaker 3: If they want one payer, one PBM, that PBM then
• 31:20
  Speaker 3: bundles all these other networks together and forces it upon
• 31:24
  Speaker 3: the pharmacy.
• 31:25
  Speaker 4: Has that ever been a discussion.
• 31:28
  Speaker 5: If I may chime in, I don't think it's actually
• 31:32
  Speaker 5: just pharmacy issue. If you look at it, you know,
• 31:35
  Speaker 5: the small clinics and the small physician. It applies to
• 31:41
  Speaker 5: all like the payers and the providers as the dynamic
• 31:46
  Speaker 5: that we're seeing. But I think the pharmacy profession as
• 31:49
  Speaker 5: a whole starting to notice more and more as we
• 31:52
  Speaker 5: are evolving the our professional identity evolves over time from
• 31:58
  Speaker 5: the pharmacy benefit dispensing.
• 32:00
  Speaker 6: Model only to what we do with the clinical care models.
• 32:05
  Speaker 4: Yeah.
• 32:06
  Speaker 3: Yeah, And you know I've talked to all the the
• 32:10
  Speaker 3: you know, executives of p SAOs pharmacy service organizations and
• 32:14
  Speaker 3: I'll ask them, why are you in that network that
• 32:17
  Speaker 3: is not beneficial to your you know, to your pharmacy membership,
• 32:22
  Speaker 3: And the p SAOs tell tell me all the time, well,
• 32:25
  Speaker 3: we're kind of held hostage. If if we want our
• 32:28
  Speaker 3: pharmacies to have access to the sixty five million lives
• 32:32
  Speaker 3: on the commercial side, we have to sign this agreement
• 32:36
  Speaker 3: which then puts them in network well on the workers
• 32:38
  Speaker 3: comp side and other other networks that the pharmacy doesn't
• 32:41
  Speaker 3: really need. So it would, you know, be a much
• 32:45
  Speaker 3: more fair system if the p SAOs, if the pharmacies
• 32:49
  Speaker 3: could actually pick the networks they want to participate in
• 32:52
  Speaker 3: and exclude the ones that just.
• 32:54
  Speaker 4: Don't make sense.
• 32:56
  Speaker 6: Yep, that makes sense to me.
• 33:00
  Speaker 3: So I don't know if you're comfortable in doing this
• 33:03
  Speaker 3: or not, but if you want to give a shout
• 33:06
  Speaker 3: out to who are the champions there in Sacramento that
• 33:09
  Speaker 3: are really helping with PBM reform for the state of.
• 33:12
  Speaker 1: California, Well, you know, certainly Senator Scott Wiener, who was
• 33:18
  Speaker 1: the author of SB forty one and the author of
• 33:21
  Speaker 1: the one that got vetoed the year before nine to
• 33:23
  Speaker 1: sixty six, he's willing to take the fight right and
• 33:28
  Speaker 1: and take it on and fight for what is right.
• 33:31
  Speaker 1: And because you know, there's there's there was so much opposition,
• 33:37
  Speaker 1: such incredible pressure against the bill. So he definitely gets
• 33:42
  Speaker 1: a shout out for sure, and then we have many
• 33:45
  Speaker 1: other champions as well. But you know, we we've had
• 33:49
  Speaker 1: built really good relationships with the Assemblyman Mark Berman, who's
• 33:55
  Speaker 1: at the San Mateo area and he is the chair
• 33:58
  Speaker 1: of Business and Professions and has really come to understand
• 34:02
  Speaker 1: the entire profession. And I think, you know, let me
• 34:06
  Speaker 1: shout out the consultants and the committee consultants and the
• 34:10
  Speaker 1: staff members. You know, sometimes we focus on the electeds
• 34:14
  Speaker 1: because their names on the bill, and I'll tell you
• 34:17
  Speaker 1: it's the hours and hours and hours of work with
• 34:19
  Speaker 1: the staff members and committee consultants that really builds the bill.
• 34:24
  Speaker 1: And they we just really are appreciative of all the
• 34:28
  Speaker 1: understanding and work. And you know, we're trying to take
• 34:32
  Speaker 1: something that's really a financial crisis when you think of
• 34:35
  Speaker 1: the Medicaid cuts, the fragility of our health system around
• 34:40
  Speaker 1: price right now, and say pharmacy is a solution. If
• 34:45
  Speaker 1: you'll do this, if you'll allow pharmacy to thrive, and
• 34:48
  Speaker 1: if the money can flow into pharmacy. We can save
• 34:51
  Speaker 1: you money, we can help be part of the solution
• 34:55
  Speaker 1: to what has become a really you know, crisis level
• 34:59
  Speaker 1: of who's going to get covered and is there enough
• 35:01
  Speaker 1: to go around? So in that sense, you know, in
• 35:04
  Speaker 1: that argument, we I think are going to expand our
• 35:07
  Speaker 1: base of champions just through necessity and the fact that
• 35:11
  Speaker 1: we have an incredible solution to offer them.
• 35:14
  Speaker 4: Wow. Excellent.
• 35:16
  Speaker 3: So, now that you've got a little momentum not only
• 35:18
  Speaker 3: at the state level with forty one, but also now
• 35:21
  Speaker 3: nationally right with what's being headlines are reading the most
• 35:27
  Speaker 3: significant PBM reform in the past twenty years being passed
• 35:31
  Speaker 3: and signed into law by our president.
• 35:35
  Speaker 4: What you know, let's keep the momentum going.
• 35:37
  Speaker 3: So what can your members, your pharmacy members, and also
• 35:42
  Speaker 3: the patients of your state do to help get involved?
• 35:46
  Speaker 1: And I should say one of our co sponsors was
• 35:48
  Speaker 1: a chronic care coalition. It was patients because they do
• 35:53
  Speaker 1: understand the direct benefits to having that access. So I think,
• 35:58
  Speaker 1: you know, building these strong coalitions across different groups is
• 36:03
  Speaker 1: incredibly important and keeping those going is absolutely vital to
• 36:09
  Speaker 1: keeping the momentum going. I think also you know what
• 36:14
  Speaker 1: I mentioned earlier. You know, the crisis in healthcare isn't
• 36:18
  Speaker 1: going to end this year or next year around funding
• 36:22
  Speaker 1: and healthcare and the high cost of healthcare. So we
• 36:26
  Speaker 1: really do have an opportunity to make good use of
• 36:28
  Speaker 1: a crisis, right and say, hey, we've got to change.
• 36:32
  Speaker 1: We understand that, you know, the Medical Association you know,
• 36:36
  Speaker 1: wants to hold the line and keep pharmacists you know,
• 36:40
  Speaker 1: back where they were twenty years ago. But you know,
• 36:43
  Speaker 1: I believe there's just going to be pressure on them
• 36:45
  Speaker 1: to say no, now we're in twenty twenty six and
• 36:49
  Speaker 1: that old model isn't sustainable and we're going to have
• 36:53
  Speaker 1: to use pharmacy and get into clinical care within their scope.
• 36:57
  Speaker 1: No one's talking about them doing surgery in the pharmacy,
• 37:01
  Speaker 1: you know, they're not going to be doing what a
• 37:04
  Speaker 1: physician does. They're doing the medication side that they're really
• 37:07
  Speaker 1: good at. So I think that that momentum is going
• 37:11
  Speaker 1: to continue out of sheer crisis and the situation that
• 37:15
  Speaker 1: we find ourselves in the nation.
• 37:17
  Speaker 3: Yeah, well, I've had doctor and Macamala on this program,
• 37:21
  Speaker 3: you know, from the AMA, and they are under pressure too.
• 37:25
  Speaker 3: There is PBM pressure at all levels so it's it's
• 37:29
  Speaker 3: all in our best interest to figure it out. And
• 37:31
  Speaker 3: I'm not saying get rid of them.
• 37:32
  Speaker 4: They're there.
• 37:33
  Speaker 3: There's a very amazing purpose if we can just take
• 37:37
  Speaker 3: the greed out of it and properly compensate pharmacies for
• 37:43
  Speaker 3: doing the job that pharmacy has been trained to do.
• 37:46
  Speaker 1: And we're really careful to say too that we're talking
• 37:48
  Speaker 1: about the bad practices of PBMs because there are smaller PBMs.
• 37:52
  Speaker 1: There are many PBMs that are very transparent and function
• 37:56
  Speaker 1: well and are not taking advantage to just you know,
• 38:01
  Speaker 1: make money hand over fists. So thanks for pointing that out,
• 38:04
  Speaker 1: because that's an important distinction. We have a lot of
• 38:07
  Speaker 1: pharmacists who work for PBMs, you know, and we've had
• 38:11
  Speaker 1: to spend a lot of time saying, hey, we're not
• 38:12
  Speaker 1: talking about your job here, we're talking about these exploitive
• 38:17
  Speaker 1: business practices that are destroying an entire profession. Yeah, PBMs
• 38:22
  Speaker 1: have a function to fill for sure.
• 38:24
  Speaker 3: Yeah, I'm glad we recovered that and don't have to
• 38:29
  Speaker 3: put the disclaimer in the show notes. So absolutely a
• 38:34
  Speaker 3: lot of a lot of eyes on what California does,
• 38:37
  Speaker 3: and you know, whether it works there or not, whether
• 38:39
  Speaker 3: it rolls out to other parts of the country. Susan
• 38:43
  Speaker 3: and doctor Kim, do you have your eyes on any
• 38:46
  Speaker 3: other states and what they're working on?
• 38:50
  Speaker 5: Just as Susan talked about the standard of care, you know,
• 38:54
  Speaker 5: there are some prominent states there are pursuing and I
• 39:00
  Speaker 5: see there are much more trends throughout the country as well.
• 39:04
  Speaker 5: But yeah, we learn from the odders as much as
• 39:08
  Speaker 5: they also.
• 39:09
  Speaker 6: Learn from us.
• 39:10
  Speaker 1: Absolutely we do. And you know, the executives of the
• 39:15
  Speaker 1: pharmacy associations, pharmacists associations across the country all get together.
• 39:20
  Speaker 1: We're in meetings. I'm on the board of NASPA. We
• 39:24
  Speaker 1: talk to each other all the time and we share information,
• 39:27
  Speaker 1: you know, all of our bills. We can access what's
• 39:30
  Speaker 1: happening all around and you know, take the good and
• 39:34
  Speaker 1: then work around it. So there is a lot of
• 39:37
  Speaker 1: collaboration between the states as well to try to find
• 39:42
  Speaker 1: the way through. Because I'll tell you some of these
• 39:45
  Speaker 1: PBMs involved in the bad practices, I describe them as
• 39:48
  Speaker 1: shape shifters because the minute you get them, you know,
• 39:52
  Speaker 1: nailed down on something they can't do, they've come up
• 39:54
  Speaker 1: with some new way to be exploited of independent pharmacy
• 39:59
  Speaker 1: so you know that in that sense, you know, the
• 40:02
  Speaker 1: battle probably never ends.
• 40:04
  Speaker 4: Yeah.
• 40:04
  Speaker 3: Now, you you know billion dollar organizations that have shareholders
• 40:09
  Speaker 3: that they need to return a you know, return on
• 40:12
  Speaker 3: their investment, and they're looking for every angle to squeeze another,
• 40:17
  Speaker 3: you know, nickel out of that blood to death turn
• 40:22
  Speaker 3: up right. Yes, yeah, I understand, I understand. But so Susan,
• 40:27
  Speaker 3: take out your magic wand and wave it around. What
• 40:30
  Speaker 3: do you want to have happen in the next three
• 40:34
  Speaker 3: to five years for California.
• 40:37
  Speaker 1: I really want medication management to be able to happen
• 40:40
  Speaker 1: in the pharmacy, you know. I think these chronic disease
• 40:43
  Speaker 1: states that we see not going away. And one reason
• 40:48
  Speaker 1: they're not going away is we aren't allowing pharmacists to
• 40:51
  Speaker 1: get in there with the patients at the front end.
• 40:54
  Speaker 1: And if we would allow our pharmacists and and and
• 40:58
  Speaker 1: remove the barriers from them being able to practice what
• 41:02
  Speaker 1: they know, if we would do that, we would have
• 41:05
  Speaker 1: a healthier population and we would have a more sustainable
• 41:08
  Speaker 1: health system for everyone else. The number of people who
• 41:11
  Speaker 1: are having to go to the er where they could
• 41:14
  Speaker 1: be seen in the pharmacy, it's such a waste of money, resources,
• 41:18
  Speaker 1: and good health. Really with a uti with a strep throat,
• 41:22
  Speaker 1: you know, you want a mom dragging four kids into
• 41:24
  Speaker 1: the er so that she could get some you know,
• 41:27
  Speaker 1: an ox sicillin or do you want to And you
• 41:29
  Speaker 1: could probably correct me on the drug Sean, I probably
• 41:32
  Speaker 1: said the wrong one.
• 41:33
  Speaker 4: Or are you for.
• 41:35
  Speaker 1: Or and I'm a mother of four myself, right, or
• 41:37
  Speaker 1: you could take them to your pharmacy and before it
• 41:40
  Speaker 1: spreads through the entire neighborhood. So you know, what I
• 41:44
  Speaker 1: want to see is the move into clinical care within
• 41:48
  Speaker 1: the scope of the pharmacist, for them to have full
• 41:50
  Speaker 1: practice authority to do what they're so so skilled at doing,
• 41:55
  Speaker 1: which is preventing disease from going crazy throughizations and other
• 42:01
  Speaker 1: public health measures, and then their early intervention. If we
• 42:05
  Speaker 1: can nip something in the bud, we've just saved money
• 42:08
  Speaker 1: and we've saved your health. And then medication management. That's
• 42:11
  Speaker 1: the long range. That's the person who's on five or
• 42:14
  Speaker 1: ten medications with a chronic disease condition.
• 42:17
  Speaker 4: Poly pharmacy, Yes, let's keep them out of the er.
• 42:21
  Speaker 1: So that's my magic wand and I actually think it
• 42:25
  Speaker 1: doesn't have to be magic. I think it's common sense.
• 42:28
  Speaker 3: Yeah, I truly believe the future of community pharmacy is
• 42:31
  Speaker 3: more of a health hub and not just a dispensary
• 42:35
  Speaker 3: any longer. Doctor Kim, do you have a magic wand
• 42:38
  Speaker 3: do you have any wishes for the next three.
• 42:40
  Speaker 4: To five years.
• 42:42
  Speaker 5: I believe in our national pharmacy associations to take care
• 42:47
  Speaker 5: of the national provider status. Meanwhile, we'll do our best
• 42:54
  Speaker 5: to take care of the state business.
• 42:57
  Speaker 6: What we are doing the best. If I had to
• 43:00
  Speaker 6: one magic wand.
• 43:02
  Speaker 5: And rooting for the pharmacy internal parability to allow the
• 43:08
  Speaker 5: pharmacy to have health records, else records operate data.
• 43:14
  Speaker 4: Yeah, yeah, very good.
• 43:17
  Speaker 1: This could do with more data. They're like data wizards already,
• 43:22
  Speaker 1: so if we allowed them to really get that medical
• 43:25
  Speaker 1: you know, profile on data, it would help patients tremendously.
• 43:30
  Speaker 4: Yeah.
• 43:30
  Speaker 3: That's excellent, excellent point. So well, ready for rapid fire.
• 43:35
  Speaker 3: We're gonna have Susan you answer first, and then Sean
• 43:39
  Speaker 3: you answer second.
• 43:40
  Speaker 4: Same question. You're ready, here we go. Are you more
• 43:43
  Speaker 4: of an early bird or a night owl? Night? Okay?
• 43:48
  Speaker 4: And do you prefer the mountains.
• 43:49
  Speaker 1: Or the beach beach?
• 43:51
  Speaker 3: Oh, mountains okay, we have a difference there. And do
• 43:55
  Speaker 3: you prefer coffee, tea or something else coffee, coffee, coffee.
• 44:03
  Speaker 3: I had somebody on that said stronger the better exactly,
• 44:08
  Speaker 3: so well, thank you both for being our guests today
• 44:11
  Speaker 3: on the PBM Reform Podcast here on the Pharmacy Podcast Network.
• 44:15
  Speaker 3: It's been a pleasure to get to know you better
• 44:18
  Speaker 3: look forward to the next few years of your accomplishments
• 44:21
  Speaker 3: there in the state of California, my home state where
• 44:25
  Speaker 3: I grew up, so we have you know, have a
• 44:29
  Speaker 3: love for your state, So thank you so much for
• 44:31
  Speaker 3: being here today.
• 44:32
  Speaker 4: I want to thank all of our listeners that you
• 44:34
  Speaker 4: have been listening to the.
• 44:35
  Speaker 3: PBM Reform Podcast here on the Pharmacy Podcast Network. Until
• 44:39
  Speaker 3: next time, everyone, stay curious and keep plowing away.
• 44:44
  Speaker 4: Thank you.