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Patients Rising Rx with Terry Wilcox | PBM Reform with APCI · Pharmacy Podcast Network

• 0:05
  Speaker 1: You are listening to the global network of podcasters dedicated
• 0:09
  Speaker 1: to the pharmacy profession.
• 0:10
  Speaker 2: Welcome to the Pharmacy Podcast Network.
• 0:34
  Speaker 3: Welcome to the PBM Reform Podcast, where we dive deep
• 0:38
  Speaker 3: into the world of pharmaceutical benefit management, cutting through the
• 0:41
  Speaker 3: noise to uncover the truth. Since 2019, we've been your
• 0:46
  Speaker 3: go-to source for the latest on how PBMs impact patient care,
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  Speaker 3: drug pricing, and the very future of pharmacy. Here, we
• 0:55
  Speaker 3: champion the role of pharmacists, the most knowledgeable advocates for
• 0:59
  Speaker 3: medication safety and expertise. Join us as we expose and
• 1:04
  Speaker 3: generate discussions that are reshaping healthcare and explore how we
• 1:08
  Speaker 3: build a better payment system, which focuses on advancing pharmacy care.
• 1:19
  Speaker 4: Hey, welcome back to another episode of the PBM Reform Podcast.
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  Speaker 4: When I think of where PBMs have come and gone
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  Speaker 4: and shout out to Don Meff of Greensburg, Pennsylvania, the
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  Speaker 4: late Dom Meff. He taught me about PBMs back.
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  Speaker 5: In 2012-ish, 2013.
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  Speaker 4: Dom helped to set up one of the very first
• 1:48
  Speaker 4: PBMs around the steel industry for U.S.
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  Speaker 5: Steel.
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  Speaker 4: And even back then with the flat administrative fee at
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  Speaker 4: 10 cents, 20 cents, 25 cents a claim, He admitted
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  Speaker 4: of how much money, hand over fist, even after fees
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  Speaker 4: and after expenses, the PBM model was making. And now
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  Speaker 4: we jettison into the future. This would have been like
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  Speaker 4: the 70s, 80s. Now we come into, it's 2026. We
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  Speaker 4: don't have to describe necessarily as much as we used to,
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  Speaker 4: to a senator, to a state representative, what a pharmacy
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  Speaker 4: benefit manager is and or what it does. But we
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  Speaker 4: still know that they're getting in the way of patient care.
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  Speaker 4: They're getting in the way of physician decisions. They're getting
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  Speaker 4: in the way of pharmacists delivering care, delivering expertise and intelligence.
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  Speaker 4: They're definitely getting in the way of keeping pharmacies open
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  Speaker 4: because of the collapse of hundreds and thousands of pharmacies
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  Speaker 4: that have closed over the last five years because of
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  Speaker 4: PBM practices. My guest today, CEO of the Patients Rising organization.
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  Speaker 4: You can find them at patientsrising.org is Terry Wilcox. I'm
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  Speaker 4: so glad you're here with.
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  Speaker 5: Me, Terry. Welcome to the PBM Reform Podcast.
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  Speaker 2: Thank you, Todd. It's nice to be here.
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  Speaker 4: You are a podcaster, so I love getting podcasters on
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  Speaker 4: the show. Talk to our listeners about your background and
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  Speaker 4: your mission at Patients Rising and what you do, and
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  Speaker 4: then also share your podcast.
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  Speaker 1: Well, Patients Rising is an organization where we're really focused
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  Speaker 1: on getting advocates and patients and caregivers in the room
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  Speaker 1: where policy decisions are made. That's one of our biggest
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  Speaker 1: missions because patient voices and patient stories are the things
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  Speaker 1: that move the needle the most. We founded Patients Rising
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  Speaker 1: 11 years ago, and you can find it at patientsrising.org.
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  Speaker 2: We've been around.
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  Speaker 1: We work on Like I said, you can see right
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  Speaker 1: up there, we have our policy center and we have
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  Speaker 1: our learning center. And both of those things, the policy
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  Speaker 1: center is where all of the policy issues and things
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  Speaker 1: that we're working on live. And the learning center is
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  Speaker 1: where we educate advocates. We also, like I said, we
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  Speaker 1: have a podcast. It's called State of the Patient Podcast.
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  Speaker 1: It's hosted by me. And we also have a very
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  Speaker 1: active blog and we have a private community. So there's
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  Speaker 1: many ways to get engaged with Patients Rising, and you
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  Speaker 1: can find all of that, like I said, on the
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  Speaker 1: website at patientsrising.org.
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  Speaker 5: Thank you for that.
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  Speaker 4: I'm going to have a link in our show notes
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  Speaker 4: to patientsrising.org. The reason why I'm excited that you're here today, you're,
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  Speaker 4: you know, when I'm out there advocating for, as much
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  Speaker 4: as I'm for the patient, it's through the intermediary. It's
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  Speaker 4: It's the pharmacist. It's the pharmacy. And that's what I'm
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  Speaker 4: advocating for. That's what I'm positioning. That's what I'm talking about.
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  Speaker 4: But when you boil that down, it does come back
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  Speaker 4: to the patient. It comes back to the patient's family.
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  Speaker 4: It comes back to the social determinants of health and
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  Speaker 4: the impact on living, eating, rent, being able to stay
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  Speaker 4: in just what we take advantage of because of the
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  Speaker 4: expense of medication, because of the expense of health care.
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  Speaker 4: So patients rising is much bigger than just what we
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  Speaker 4: focus on.
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  Speaker 5: We're kind of like a piece of healthcare.
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  Speaker 4: You guys are the whole enchilada where it's like, hey,
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  Speaker 4: the patient's going through this, this, and this, and we
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  Speaker 4: need the patient's voice to rise more so that it
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  Speaker 4: becomes about them again rather than the administration, rather than
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  Speaker 4: about the insurance carrier.
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  Speaker 5: And this is flip-flopped. I don't know how old you are.
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  Speaker 5: Don't tell me. Don't tell our listeners. I always say
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  Speaker 5: how old I am.
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  Speaker 4: But the reason why I always mention that is to
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  Speaker 4: framework the listeners that might be the millennial, that might
• 6:00
  Speaker 4: be the Gen Z, that don't really remember back in
• 6:03
  Speaker 4: the day. But I remember when the physician was really
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  Speaker 4: at the center of health care and they were able
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  Speaker 4: to say things that would get done. And now it's.
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  Speaker 5: Been jacked up. And now it's whack.
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  Speaker 4: Where it's the insurance provider, they own the hospitals, they
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  Speaker 4: own the pharmacies, they own the physicians, they own too much,
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  Speaker 4: and it's perverted healthcare. I have a book actually here
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  Speaker 4: called Healing the Healthcare System by Gil Bash, one of
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  Speaker 4: my dear friends. He's the Global Health and Purpose Chair.
• 6:50
  Speaker 4: at Finn Partners, which is a huge PR agency. And
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  Speaker 4: this book talks about exactly what we're going to talk
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  Speaker 4: about today.
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  Speaker 5: And that is.
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  Speaker 4: Why, why is our healthcare system constantly, constantly putting the
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  Speaker 4: systems first and the patient gets to be last.
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  Speaker 5: And it's, it's an upside down pyramid, but.
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  Speaker 4: From your perspective and your experience, Terry, when did that
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  Speaker 4: start taking place? When did you see the shift starting
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  Speaker 4: to happen where the pyramid started flipping?
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  Speaker 1: Well, I would say, look, to your point, I do
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  Speaker 1: remember the time when healthcare was about your physician, when
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  Speaker 1: healthcare was.
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  Speaker 2: Predictable.
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  Speaker 1: And I think one of the things that you can
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  Speaker 1: see now is how things are unpredictable, right? That various,
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  Speaker 1: you know, the patients don't know what things are going
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  Speaker 1: to cost. Patients don't know what their out-of-pocket's gonna be.
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  Speaker 1: There's so many variables. And I really feel that shift
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  Speaker 1: started actually around the time Patients Rising started, right? About
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  Speaker 1: 11 years ago and a little bit before that probably. But,
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  Speaker 1: you know, when I was, you know, younger, it was
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  Speaker 1: just easy.
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  Speaker 5: You knew.
• 8:16
  Speaker 2: Generics.
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  Speaker 1: Were $ 5, you know, name brand was 25 or whatever
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  Speaker 1: it was, but you knew what it was. And there
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  Speaker 1: was autonomy for the patient to make that decision. It
• 8:27
  Speaker 1: didn't seem as big a deal for you to say, no,
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  Speaker 1: I still want Advair. I don't want whatever the generic is.
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  Speaker 1: I still want Advair. And you could make that choice
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  Speaker 1: to pay that more money to do that. It was just,
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  Speaker 1: it was predictable and the patient's got to say, and
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  Speaker 1: now I feel like, even.
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  Speaker 2: If the patients are like, you know what?
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  Speaker 1: I don't want fill-in-blank generic, or I don't want the biosimilar.
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  Speaker 1: I don't want this because I'm stable. And you know
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  Speaker 1: how long it took me to get stable? Like, I
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  Speaker 1: don't want to screw up anything. That they don't have
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  Speaker 1: that same kind of autonomy. And the doctors don't either.
• 9:01
  Speaker 1: And so it's, you know, hours of paperwork for doctors
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  Speaker 1: to get through that. And so now we're like, we're
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  Speaker 1: at this crossroad.
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  Speaker 2: It's not even a crossroad. We've been here for so long.
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  Speaker 1: It's just like, How do we navigate it so that
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  Speaker 1: patients can get at least some of that autonomy back
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  Speaker 1: where they feel like, They can predict things. I think
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  Speaker 1: that's the biggest thing. It's not that people necessarily don't
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  Speaker 1: want to pay any money for their health care or
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  Speaker 1: they don't want to pay.
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  Speaker 2: It's like, but tell me, can you give me any
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  Speaker 2: heads up? Do I have a copay accumulator? Do I
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  Speaker 2: have this thing? Do I have that thing?
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  Speaker 1: Am I going to, you know, am I going to
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  Speaker 1: have to always pay $ 3, 000 in February? It's just that
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  Speaker 1: is the part. that I think is scary and infuriating
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  Speaker 1: for many Americans, especially those living with chronic illnesses and
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  Speaker 1: rare disease.
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  Speaker 4: So I'm seeing more and more of the panels where
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  Speaker 4: they'll bring on the c-level um executives from health care
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  Speaker 4: companies they'll be sitting before congress they'll they'll get drilled
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  Speaker 4: um I love the facial expressions. I love the discomfort
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  Speaker 4: that these executives look like they're going through. It brings
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  Speaker 4: joy to me.
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  Speaker 5: Maybe it shouldn't.
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  Speaker 4: Maybe I need to pray that away. However, I'm still
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  Speaker 4: frustrated because in the back of my mind as I'm
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  Speaker 4: watching some very good questions, whereas when I first started
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  Speaker 4: seeing these things happen infrequently, let's say three years ago,
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  Speaker 4: some of the questions that the state representative or the
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  Speaker 4: senator was asking weren't even good questions.
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  Speaker 5: It's almost as if the.
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  Speaker 4: Lobbyists got in between and got them to do these
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  Speaker 4: softball questions, whereas now it's some hard-hitting questions.
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  Speaker 5: I love it.
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  Speaker 4: However, let's pretend ABC Insurance Company gets caught doing something
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  Speaker 4: That number one isn't in the best interest of the
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  Speaker 4: patient or the care. Number two is a conflict of interest.
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  Speaker 4: And number three is just downright dishonest or whatever.
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  Speaker 5: And let's slap.
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  Speaker 4: A $ 500 million fine on a half billion dollar fine, whatever.
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  Speaker 4: What's sickening to me is the health care insurance companies,
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  Speaker 4: the PBMs, have already prepared for these fines. And it's
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  Speaker 4: just the cost of doing business. Nobody's going to jail.
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  Speaker 4: So part of the reform of healthcare, not just PBM reform,
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  Speaker 4: in my opinion, is to get certain states, because you're
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  Speaker 4: going to have to do it at the state level
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  Speaker 4: first before federal catches on, Arkansas, Tennessee, Ohio, Idaho. These
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  Speaker 4: are some real champion states. PBM reform states that have
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  Speaker 4: done some freaking amazing things, that now we're going to
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  Speaker 4: see the federal side start to pay a lot more
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  Speaker 4: attention to about what the outcomes of some of the
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  Speaker 4: decisions that took place two years ago. I want people
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  Speaker 4: to go to jail for cheating the healthcare system, not
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  Speaker 4: so much in the commercial space, because commercial is commercial,
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  Speaker 4: but when you're spending my freaking tax dollar on on
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  Speaker 4: what's supposed to be medications and what's supposed to be
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  Speaker 4: care for people, especially like in Medicaid or 340B, where
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  Speaker 4: we know the people that are getting cared for are
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  Speaker 4: the most needy of needy. They're the ones that can't
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  Speaker 4: afford food and they, you know, their families and they're
• 12:50
  Speaker 4: cutting pills in half. And those are the instances where
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  Speaker 4: we see organizations taking that money and not delivering care,
• 12:59
  Speaker 4: but it's in the form, it's like just being sucked
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  Speaker 4: up in profit Terry, that's where I want to, I
• 13:04
  Speaker 4: want to see jail time.
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  Speaker 5: And I don't know if that's ever going to happen.
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  Speaker 4: It probably won't happen, but I would love to see
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  Speaker 4: executives go to jail for that.
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  Speaker 5: Yeah.
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  Speaker 1: I mean, it's a really, the, the Medicaid space and
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  Speaker 1: the 340B space, when you're talking about 340B hospitals.
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  Speaker 2: Is, is a minefield. Yeah.
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  Speaker 1: Of complete, a lot of unknown. You just sort of
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  Speaker 1: walk through and you don't really know what's going to
• 13:34
  Speaker 1: be covered, what's getting covered. I mean, Patients Rising, we
• 13:36
  Speaker 1: actually did a series in six states where we analyzed
• 13:41
  Speaker 1: the medical bankruptcy file or the bankruptcy files. And we
• 13:45
  Speaker 1: specifically focused on medical bankruptcy and we focused on 340B
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  Speaker 1: hospitals in those states. And if those people who were
• 13:54
  Speaker 1: filing bankruptcy had a significant bill that was driving their bankruptcy.
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  Speaker 1: We were actually really conservative and gracious in our assumptions.
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  Speaker 1: And there is no universe for most of these bankruptcies.
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  Speaker 1: If you looked at the file of what people put
• 14:12
  Speaker 1: under penalty of perjury on the paper of what their
• 14:15
  Speaker 1: income was, there is no universe where these people would
• 14:19
  Speaker 1: have passed a means test to get a $ 200, 000 medical bill.
• 14:23
  Speaker 2: It wouldn't have happened.
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  Speaker 1: And so that means, guess what? There was no means test.
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  Speaker 1: These people were just thrown through the system, given a
• 14:32
  Speaker 1: bill they could never pay. They were beat down by
• 14:36
  Speaker 1: collections agencies and their life was financially ruined for seven
• 14:41
  Speaker 1: years when they had to declare bankruptcy.
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  Speaker 2: And then, you.
• 14:47
  Speaker 1: Know, and then the hospital gets a write-off for the 340.
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  Speaker 1: So It's things like this that happen that are infuriating.
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  Speaker 1: It's like, how do these things happen, especially in programs
• 15:00
  Speaker 1: that are government supported?
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  Speaker 2: Now, granted, 340B.
• 15:04
  Speaker 1: Is pharmaceutical industry supported. Let's be clear about that. But
• 15:08
  Speaker 1: it is mandated by the government and how it operates
• 15:11
  Speaker 1: is controlled by regulatory measures in Congress. And so there's
• 15:18
  Speaker 1: a lot of levers that can be pulled there for
• 15:20
  Speaker 1: it not to work like And so that, you know,
• 15:23
  Speaker 1: we really sit in that space of like, there is
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  Speaker 1: a lot going on. And I think the unknown pieces
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  Speaker 1: that just sort of slipped through the cracks, people who
• 15:33
  Speaker 1: are waiting for Medicaid waivers in states, people who are
• 15:37
  Speaker 1: waiting for all, for care all.
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  Speaker 2: Over the place.
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  Speaker 1: It's like, what is happening and where is it going?
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  Speaker 1: And the vertical integration and a lot of those pieces
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  Speaker 1: are are part of it. But to your point, and
• 15:50
  Speaker 1: to many people's point, you can't just take a, you know,
• 15:54
  Speaker 1: what would it do if you were just like, I
• 15:55
  Speaker 1: say now today, all of you are no longer vertically integrated. Okay,
• 16:01
  Speaker 1: what happens then? Like, what happens to all of that immediately? Like,
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  Speaker 1: when you create a behemoth like this, the unraveling of
• 16:11
  Speaker 1: it is not just a deputization of unravel. You know,
• 16:16
  Speaker 1: you don't just wave a wand and go unravel that.
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  Speaker 5: It's here.
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  Speaker 1: And so how do we make it behave better? And
• 16:22
  Speaker 1: how do we, you know, and what can be unraveled?
• 16:26
  Speaker 1: What can be fixed? I think that's the question I
• 16:28
  Speaker 1: go to sleep at night. I used to just be like,
• 16:30
  Speaker 1: let's beat up on this one and let's beat up
• 16:31
  Speaker 1: on that one and let's beat, beat, beat, beat, beat.
• 16:33
  Speaker 2: And now I've sort.
• 16:34
  Speaker 1: Of moved to a place of like, I don't know
• 16:36
  Speaker 1: how constructive the beating is, as fun as it is
• 16:38
  Speaker 1: to your point, people go.
• 16:40
  Speaker 2: To jail or whatever.
• 16:41
  Speaker 1: But is it, you know, what's going to actually get
• 16:44
  Speaker 1: us to the place where we can have a better system.
• 16:48
  Speaker 1: And that's where we struggle. And all these things that
• 16:52
  Speaker 1: we're talking about, community pharmacists, primary care doctors, all of
• 16:56
  Speaker 1: these things, they're a huge part of that. And I
• 16:59
  Speaker 1: think they've been sidelined in some instances.
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  Speaker 5: They've been sidelined. They've been pushed off to the side
• 17:06
  Speaker 5: because it's the... I'm a capitalist. I love....
• 17:13
  Speaker 4: The opportunities that America has, um, delivered to the free
• 17:20
  Speaker 4: market system and what it's created.
• 17:23
  Speaker 5: It's created millionaires and billionaires and.
• 17:25
  Speaker 4: It's created opportunity, but it's been perverted in the realm
• 17:30
  Speaker 4: of healthcare. And I, I would like to see change
• 17:37
  Speaker 4: being made. It's going to have to happen at the
• 17:39
  Speaker 4: state level first, where it's like, Hey, should we look
• 17:44
  Speaker 4: at how companies move and how they grow, where they're
• 17:51
  Speaker 4: getting their money, and being a lot more, you know,
• 17:56
  Speaker 4: scrutinizing everything much more, and then go to the public sector,
• 18:01
  Speaker 4: going to Wall Street and saying, should there be a
• 18:07
  Speaker 4: different animal of investment that it acts different than the
• 18:12
  Speaker 4: tech companies or it acts different than fundraising or it
• 18:17
  Speaker 4: acts different. I just got back from the bio plus
• 18:20
  Speaker 4: health gathering in Pittsburgh and it was put on by, um,
• 18:25
  Speaker 4: university of Pittsburgh hosted it. And there was Carnegie Mellon
• 18:29
  Speaker 4: and MIT and all these funding organizations were there.
• 18:34
  Speaker 5: The room was filled.
• 18:36
  Speaker 4: Everybody wanted to know what's the next big thing. how
• 18:40
  Speaker 4: do I give you my, my name, my, my number,
• 18:44
  Speaker 4: what I'm doing, preparing for the next investment in the,
• 18:48
  Speaker 4: you know, the first round of funding and second and
• 18:50
  Speaker 4: third and everything. However, if you are in healthcare, you
• 18:56
  Speaker 4: almost have to take a higher level of, of like
• 19:02
  Speaker 4: of an oath, like the, the way that the pharmacist
• 19:04
  Speaker 4: makes and takes the oath and the physician takes the
• 19:07
  Speaker 4: oath and they, They're promising the public that they'll do
• 19:09
  Speaker 4: no harm. Everybody in healthcare should sign an oath. I
• 19:14
  Speaker 4: don't care if you're an administrator or me. I'm a podcaster.
• 19:17
  Speaker 4: I'm in public relations. We should all sign some kind
• 19:21
  Speaker 4: of oath that if we find out that what we've
• 19:24
  Speaker 4: done to make money has negatively impacted, and this could
• 19:30
  Speaker 4: become a litigious thing too that could get out of control,
• 19:34
  Speaker 4: but there's got to be a system that you put
• 19:37
  Speaker 4: Accountability and responsibility in the hands of these C-level class
• 19:41
  Speaker 4: people that are making them responsible for the decisions that
• 19:45
  Speaker 4: they're making and their boards of directors are making that
• 19:48
  Speaker 4: mean that... mean the patient is not getting the care
• 19:53
  Speaker 4: that they say that they're getting. Like these beautiful advertisements
• 19:56
  Speaker 4: and these campuses that look like, you know, the Taj
• 20:00
  Speaker 4: Mahals and there's everything so fancy and the multi millions
• 20:05
  Speaker 4: of dollars of salary that these individuals are getting. It's
• 20:08
  Speaker 4: just not making sense the way that it's set up
• 20:12
  Speaker 4: right now. And I used to be so anti one-payer system.
• 20:17
  Speaker 4: I didn't like the thought of that. And socialized medicine,
• 20:19
  Speaker 4: I couldn't stand the thought of that and how it
• 20:22
  Speaker 4: was going to make care less or not as good.
• 20:26
  Speaker 4: And then I'm thinking, well, if you, like you said, Terry,
• 20:29
  Speaker 4: if you and I woke up tomorrow morning, we had
• 20:32
  Speaker 4: the magic switch and we said, that's it. Like we
• 20:37
  Speaker 4: could make it what we wanted it. You still have
• 20:40
  Speaker 4: to have physicians. You have to have nurses. You have
• 20:42
  Speaker 4: to have pharmacists. So we could definitely protect them and
• 20:46
  Speaker 4: their income. The income's there, by the way. The revenue
• 20:50
  Speaker 4: is here, right? It's floating around in the atmosphere of healthcare.
• 20:56
  Speaker 4: But it's the profit side of it that's going to
• 20:59
  Speaker 4: the companies and the corporations and the stockholders. And people
• 21:03
  Speaker 4: are getting wealthy off of people's demise and, and poor
• 21:10
  Speaker 4: people and general people and the mid, you know, the
• 21:13
  Speaker 4: middle level income earners, these people are getting beat up
• 21:17
  Speaker 4: and not getting healthcare.
• 21:19
  Speaker 5: They're not able to afford healthcare.
• 21:21
  Speaker 4: So I, the, the system needs to be gutted and
• 21:25
  Speaker 4: it needs to be rebuilt on standards of being like,
• 21:28
  Speaker 4: you're not, you cannot be We can't do it this
• 21:31
  Speaker 4: way anymore because it's not sustainable. That's the only reason
• 21:34
  Speaker 4: it's so expensive. Like the United States, for example, that's
• 21:37
  Speaker 4: why the United States is so jacked up right now
• 21:40
  Speaker 4: is because it's a run amok profit engine for the few.
• 21:45
  Speaker 5: Well, absolutely.
• 21:46
  Speaker 1: I maintain always that there is already enough money in
• 21:48
  Speaker 1: the system. There should be no one not being taken
• 21:53
  Speaker 1: care of.
• 21:54
  Speaker 5: There just shouldn't.
• 21:54
  Speaker 1: There shouldn't be anyone who's like splitting pills in half
• 21:59
  Speaker 1: or doing things like that. There just absolutely, there just
• 22:02
  Speaker 1: shouldn't be. And part of it is, even if you
• 22:05
  Speaker 1: look at charts and various other things, is the administrative
• 22:08
  Speaker 1: bloat everywhere. The administrative bloat is pretty intense. And one
• 22:15
  Speaker 1: of the things I always say is, you know, these,
• 22:17
  Speaker 1: a lot of these hospitals and these systems are nonprofit, right?
• 22:22
  Speaker 1: And as a nonprofit organization, you work really hard to
• 22:27
  Speaker 1: keep your, you know, administrative overhead piece to 20% or less.
• 22:35
  Speaker 1: Some go a little bit over, it depends, you know,
• 22:37
  Speaker 1: on the, how many people they have on staff and
• 22:38
  Speaker 1: things like that. But we don't hold that standard to
• 22:42
  Speaker 1: nonprofit hospitals. We don't hold that standard. That whole standard
• 22:47
  Speaker 1: is held to patients rising and American Cancer Society or whatever,
• 22:50
  Speaker 1: all these other, you know, nonprofit organizations. It's not held
• 22:54
  Speaker 1: with a gun to your head or anything, but if
• 22:56
  Speaker 1: they look at your 990 and they see that's out
• 22:58
  Speaker 1: of whack, it's a bad sign, right? You're not being
• 23:03
  Speaker 1: responsible or whatever. And so I do think that there
• 23:07
  Speaker 1: are levers. There are things that we can do. To
• 23:10
  Speaker 1: your point, I'm a capitalist too.
• 23:12
  Speaker 2: I get it. I want everyone to make money. I understand.
• 23:16
  Speaker 2: I support.
• 23:17
  Speaker 1: However, If you're taking money from the government, if you're
• 23:21
  Speaker 1: taking tax dollars that's creating that, then there should be
• 23:26
  Speaker 1: a lot of accountability measures in place for you to
• 23:29
  Speaker 1: get that. And I also think that creating, you know,
• 23:34
  Speaker 1: one of the reasons why we were very supportive of
• 23:37
  Speaker 1: funding patients and not the system and things like that
• 23:41
  Speaker 1: is giving patients more autonomy and giving doctors more autonomy.
• 23:45
  Speaker 1: It has been a negative impact on patients that all
• 23:48
  Speaker 1: these doctors have been bought up and all these, it's
• 23:51
  Speaker 1: had a negative impact on patients. It's impossible to get
• 23:54
  Speaker 1: into a primary care. My husband has to go to
• 23:56
  Speaker 1: his cardiologist for his primary care doctor because we can't
• 24:00
  Speaker 1: get one. You know, it's insane. And so where is the,
• 24:04
  Speaker 1: you know, what are we, what.
• 24:05
  Speaker 2: Are we, what are we doing?
• 24:06
  Speaker 1: How are we, how are we going to fix those
• 24:09
  Speaker 1: pieces of the system? Because we have the capability to
• 24:13
  Speaker 1: do that. We have the technology. We have the innovation,
• 24:16
  Speaker 1: but what we don't have is the will. And also
• 24:22
  Speaker 1: what we also have is a bunch of differing lobbying
• 24:25
  Speaker 1: fights going on at the state and federal level that
• 24:28
  Speaker 1: also keep us kind of stuck or getting sort of
• 24:31
  Speaker 1: marginally there every year or every other year, depending. But
• 24:37
  Speaker 1: I do agree, a lot needs to happen in the states.
• 24:40
  Speaker 1: but you know, how did the, how do things happen
• 24:42
  Speaker 1: in the States? You've got to pick things that will
• 24:44
  Speaker 1: happen in the States that aren't going to be tied
• 24:45
  Speaker 1: up in courts. You know, um, I think that the
• 24:49
  Speaker 1: stuff being tied up in courts is not beneficial to
• 24:52
  Speaker 1: the patient. It's, and it does create a sort of,
• 24:56
  Speaker 1: you know, back and forth. Well, but to your point,
• 24:59
  Speaker 1: we have to see how some of these, these cases
• 25:02
  Speaker 1: pan out in these States and sort of what happens. Um,
• 25:06
  Speaker 1: on the other side of them in all the states
• 25:08
  Speaker 1: you mentioned, Tennessee, Arkansas, Ohio, Iowa, et cetera. So, but yeah,
• 25:15
  Speaker 1: I mean, solving healthcare is a, you know, I think
• 25:19
  Speaker 1: a lot of people sit and ponder it over, you know,
• 25:21
  Speaker 1: on all sorts of podcasts and with all sorts of
• 25:24
  Speaker 1: glasses of wine and beer across the country, you know,
• 25:29
  Speaker 1: all the time.
• 25:30
  Speaker 2: And so.
• 25:32
  Speaker 1: Patients Rising thinks about it a lot because it's one
• 25:35
  Speaker 1: of the things that we you know, work tour is
• 25:37
  Speaker 1: building a better healthcare system overall, because our system that
• 25:43
  Speaker 1: has perverse incentives and it is out of whack for
• 25:46
  Speaker 1: many people, especially the sickest among us that are the
• 25:49
  Speaker 1: most expensive.
• 25:51
  Speaker 4: Yeah, it's so true. It's so true. Listeners, patientsrising.org. Reach
• 26:01
  Speaker 4: out to Terry Wilcox, connect with her on LinkedIn. take
• 26:06
  Speaker 4: a look at patientsrising.org. And this is the first time
• 26:11
  Speaker 4: publicly that we're talking about this, but Patients Rising and
• 26:16
  Speaker 4: the Pharmacy Podcast Network are going to continue to collaborate together.
• 26:21
  Speaker 4: We're going to be releasing a new show called Patients
• 26:24
  Speaker 4: Rising RX, and we're going to be reaching out to
• 26:28
  Speaker 4: administrative companies, PBM companies, pharmaceutical manufacturers, 340B covered entities. We're
• 26:36
  Speaker 4: going to do a lot in supporting patients rising around
• 26:41
  Speaker 4: pharmacy care and around pharmaceutical care and around fundraising. And
• 26:46
  Speaker 4: I was thinking of Accessia Health. I was thinking of
• 26:49
  Speaker 4: the NASP in specialty pharmacy and just ways to get
• 26:55
  Speaker 4: you in touch with more pharmacy care ecosystem members that
• 27:01
  Speaker 4: could pull levers that could really help The people that
• 27:04
  Speaker 4: you're helping, Terry, the most important people in health care
• 27:07
  Speaker 4: are our patients. And when I say patients, by the way,
• 27:10
  Speaker 4: I'm starting to shift things the way I think.
• 27:13
  Speaker 5: You know, let's talk about capitalism. Let's go back to
• 27:17
  Speaker 5: that for a second.
• 27:18
  Speaker 4: If an independent community pharmacy, we're seeing a lot of
• 27:24
  Speaker 4: changes in long-term care where long-term care pharmacy is now
• 27:27
  Speaker 4: being delivered at the home level. It's not an assisted
• 27:30
  Speaker 4: living center. It's not a skilled nursing center. So the
• 27:33
  Speaker 4: community pharmacy is starting to do different things to ensure
• 27:37
  Speaker 4: care can be delivered to the home, blood pressure cuffs, monitoring, telehealth,
• 27:44
  Speaker 4: things that they can engage the patient in their home.
• 27:48
  Speaker 4: Another evolution of it is what can we deliver more,
• 27:54
  Speaker 4: such as home care, such as cleaning or bathing. So
• 27:58
  Speaker 4: one of the things that I'm talking to our pharmacists
• 28:00
  Speaker 4: more about is patients for life, and that is people
• 28:05
  Speaker 4: that are perfectly healthy that need to understand, hey, I
• 28:12
  Speaker 4: like running, I play soccer, or I'm going to be
• 28:16
  Speaker 4: in a triathlon, or something's happening. How can I go
• 28:20
  Speaker 4: to my pharmacy or my pharmacist and say, hey, I'm
• 28:23
  Speaker 4: not on any medications, I'm perfectly healthy, but I want
• 28:26
  Speaker 4: to do this, this, or this, so that it's almost
• 28:29
  Speaker 4: preventative I'm in my thirties and when I'm in my seventies,
• 28:33
  Speaker 4: I don't want to be on 16 medications. So what
• 28:36
  Speaker 4: do I do now to meet up with my pharmacist
• 28:41
  Speaker 4: once a quarter or once a year at minimum, just
• 28:44
  Speaker 4: like you meet with your doctor and saying, tell me
• 28:47
  Speaker 4: what I can be doing now. And then guess what
• 28:50
  Speaker 4: that does, Terry, that creates revenue for the pharmacy or
• 28:54
  Speaker 4: the pharmacist or the system where it's like, instead of spending,
• 28:59
  Speaker 4: you know, $ 250, 000 because of my emergency room visit and
• 29:05
  Speaker 4: the crisis that I was in with a triple bypass, blah, blah, blah.
• 29:09
  Speaker 4: And my heart was ready to blow up. Now I
• 29:11
  Speaker 4: back up 30 years earlier and I start spending $ 25
• 29:16
  Speaker 4: a month or $ 50 a month for some club membership
• 29:20
  Speaker 4: that I get tied into to ensure that I'm on
• 29:22
  Speaker 4: the right track. People are interested in their health today
• 29:27
  Speaker 4: because Unlike they were when you and I were young
• 29:30
  Speaker 4: kids and growing up, it was always a reactionary system.
• 29:33
  Speaker 5: Now, patients want to be taken care of.
• 29:37
  Speaker 1: No, I mean, you can see it in the technology.
• 29:40
  Speaker 1: sources that have come up. I mean, Hume and functional
• 29:45
  Speaker 1: health medicine and MIDI and talkiatry. I mean, there's already
• 29:51
  Speaker 1: been all kinds of things that have been started online.
• 29:54
  Speaker 1: And people are using them because it's like, hey, I
• 29:57
  Speaker 1: can just have this doctor online and they'll at least
• 29:59
  Speaker 1: talk to me for 15 or 20 minutes, whatever it is.
• 30:02
  Speaker 1: It's still not a super long appointment, but it is virtual.
• 30:05
  Speaker 1: And you do get their full attention for the entire time.
• 30:08
  Speaker 1: They're in there for the full opportunity to talk to you.
• 30:12
  Speaker 1: And right now also, because of things like 340B and
• 30:16
  Speaker 1: all the vertical integration and the hospitals buying everything up,
• 30:21
  Speaker 1: the hospital should exist. with state-of-the-art facilities everywhere within a
• 30:26
  Speaker 1: certain mile radius of every American for the sole purpose
• 30:30
  Speaker 1: of handling emergencies. That is what they were designed for.
• 30:35
  Speaker 1: And that is what they should do. They are not
• 30:37
  Speaker 1: a primary care facility. They are not, hey, you've been
• 30:41
  Speaker 1: diagnosed with cancer and you have to go through 13
• 30:43
  Speaker 1: weeks of chemo in a doctor's office. That's for a
• 30:47
  Speaker 1: doctor's office. Doesn't need to be in a hospital. And so,
• 30:51
  Speaker 1: and that has driven up.
• 30:53
  Speaker 2: The cost of healthcare.
• 30:55
  Speaker 1: If the hospitals just existed and, you know, research centers
• 30:59
  Speaker 1: and Cleveland Clinic and all these places do a ton
• 31:01
  Speaker 1: of research, I get it. That, you know, you have
• 31:03
  Speaker 1: to think about how it's laid out. But what it
• 31:05
  Speaker 1: isn't is a place that needs to buy up all
• 31:09
  Speaker 1: of these things, independent practices and things that are working fine.
• 31:13
  Speaker 2: Pharmacy, you know, it just, you don't need it. You
• 31:16
  Speaker 2: don't need it.
• 31:17
  Speaker 1: The hospital needs to be what a hospital was meant
• 31:19
  Speaker 1: to be. And it's become something else entirely. It's become
• 31:24
  Speaker 1: a whole, you know, your whole, it's like here in
• 31:26
  Speaker 1: Northern Virginia where I live, everything is Nova. You know,
• 31:29
  Speaker 1: everything's owned by Nova, Northern Virginia, hospital this or that,
• 31:33
  Speaker 1: everything is Nova. And that's how it is everywhere. Everything
• 31:36
  Speaker 1: has been bought up and it's one system. And does
• 31:41
  Speaker 1: it need to be that way? Same thing with pharmacies,
• 31:44
  Speaker 1: like You know, there's very few mom and pop pharmacies.
• 31:48
  Speaker 1: I mean, I do use CVS. It's right outside my
• 31:50
  Speaker 1: door and I'm Aetna. So, you know, it's like, that's
• 31:54
  Speaker 1: just where I'm at. But, you know, we've lost the
• 32:00
  Speaker 1: ability to have the choice. And it's time for, you know,
• 32:07
  Speaker 1: adjustments and new ideas. And that's why I love the
• 32:10
  Speaker 1: idea of doing the podcast with you guys to be
• 32:12
  Speaker 1: able to.
• 32:12
  Speaker 2: Talk about some of these bigger things.
• 32:14
  Speaker 1: And engage with some people that, you know, may or
• 32:18
  Speaker 1: may not be considered the enemy or the other side
• 32:21
  Speaker 1: of things. I think you have to have conversations with
• 32:24
  Speaker 1: the other side of things in order to get anything accomplished.
• 32:28
  Speaker 1: And that's one thing I have learned in 11 years
• 32:31
  Speaker 1: of advocacy is you can't just yell at people.
• 32:34
  Speaker 3: It's fun.
• 32:35
  Speaker 1: It's great fun. No, I am all in on how
• 32:39
  Speaker 1: fun that is. But it is not productive for the
• 32:42
  Speaker 1: patient in the long run. True. So I, I, I,
• 32:46
  Speaker 1: you know, I am a person who likes to, you know,
• 32:48
  Speaker 1: try to build bridges, even if we don't agree, even
• 32:51
  Speaker 1: if we don't agree. I, I, I, I have, that
• 32:54
  Speaker 1: has been a shift of Terry Wilcox because I wasn't always,
• 32:57
  Speaker 1: I didn't start out in advocacy that way.
• 32:59
  Speaker 2: Definitely.
• 33:00
  Speaker 1: But I have moved there because I, I get more
• 33:03
  Speaker 1: done the other way.
• 33:05
  Speaker 2: So.
• 33:06
  Speaker 4: Hey, listeners, once again, take a look, patientsrising.org, uh, reach
• 33:12
  Speaker 4: out to Terry. Um, out there on the link sphere, LinkedIn.
• 33:18
  Speaker 5: We're excited.
• 33:19
  Speaker 4: Hey, this is part one of a special interview with
• 33:23
  Speaker 4: Terry Wilcox, Patients Rising. Part two is coming with Greg Reibold,
• 33:30
  Speaker 4: part of the APCI team. He is our host of
• 33:34
  Speaker 4: the PBM Reform podcast. He's going to dig into legislation.
• 33:39
  Speaker 4: He's going to talk with Terry about H.R. 6610. That's
• 33:44
  Speaker 4: HR Bill 6610. So stay tuned. Come back to the
• 33:49
  Speaker 4: PBM Reform podcast and listen in to that excellent discussion.
• 33:53
  Speaker 4: I can't wait to hear it. Terry, thank you so
• 33:56
  Speaker 4: much for coming on the show. Thank you for being
• 33:59
  Speaker 4: willing to work with the Pharmacy Podcast Network on other things.
• 34:03
  Speaker 4: And we don't have enough attention around the patient. Like
• 34:07
  Speaker 4: I said, I'm all about the pharmacist and the pharmacy,
• 34:10
  Speaker 4: but we need to be more about the patient. And
• 34:13
  Speaker 4: we're hoping that this is going to build bridges to
• 34:15
  Speaker 4: other sectors of healthcare and deeper sections of the ecosystem
• 34:21
  Speaker 4: of pharmacy care.
• 34:22
  Speaker 5: So thanks for doing this.
• 34:24
  Speaker 2: Thank you, Todd. I really appreciate it.
• 34:27
  Speaker 1: All right.
• 34:28
  Speaker 4: You were listening to the Pharmacy Podcast Network, the PBM
• 34:30
  Speaker 4: Reform Podcast, Terry Wilcox, Patients Rising. You'll hear more on
• 34:36
  Speaker 4: the next PBM Reform Podcast.