Latest / Pharmacy Podcast Network / Margins, Models, & The Future of Pharmacy | Supply, Trust, & The Business of Pharmacy

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Margins, Models, & The Future of Pharmacy | Supply, Trust, & The Business of Pharmacy · Pharmacy Podcast Network

0:00
Speaker 1: Hey, this is Brian Crook with Carris Pharmacy check us
0:03
Speaker 1: out in Venida and Junction City, Oregon.
0:13
Speaker 2: Thanks for listening to the Pharmacy Podcast Network.
0:31
Speaker 3: Welcome to Supply Trust and the Business of Pharmacy, the
0:34
Speaker 3: podcast where we dive into the forces shaping pharmacy today,
0:37
Speaker 3: from the supply chain to strategy and everything in between.
0:41
Speaker 3: Hosted by Andy Crawford, a twenty five year pharmacy industry
0:44
Speaker 3: professional and vice president of Sales and Marketing at key Source.
0:49
Speaker 3: For the past nineteen years, he has worked directly with
0:51
Speaker 3: pharmacies and manufacturers, navigating disruption, driving growth, and building partnerships
0:57
Speaker 3: rooted in trust. This series is about real conversation with
1:00
Speaker 3: industry insiders, pharmacy owners and leaders who understand what's at
1:04
Speaker 3: stake and where we go from here.
1:06
Speaker 2: Hey, welcome back to the key Source three part podcast series.
1:11
Speaker 2: My name is Todd Urie, founder of the Pharmacy Podcast Network,
1:14
Speaker 2: and I'm excited about our third part of this series
1:18
Speaker 2: because this series has been an education for me. In
1:21
Speaker 2: updating me, I mean way back in the day, I
1:24
Speaker 2: tried to help start a pharmacy buying group and I
1:27
Speaker 2: did learn a lot about the back end and the
1:30
Speaker 2: administration and generics versus brands and contracts, and certainly wasn't
1:35
Speaker 2: my sweet spot at all. I needed to be out
1:38
Speaker 2: there generating the business, not running the business. And people
1:41
Speaker 2: like Andy Crawford who are leaders in our industry, who
1:44
Speaker 2: have worked with us over a period of time now
1:48
Speaker 2: with this three part series, but more so, I've been
1:51
Speaker 2: able to spend some time with Andy at the ANACDS
1:54
Speaker 2: Total Store Expo. I've talked with him and his team
1:58
Speaker 2: at the NASP actually pharmacy. And there's an aspect of
2:02
Speaker 2: today's episode that's pretty important. We're going to be talking
2:05
Speaker 2: about supply, trust and business, the impact on business. I
2:10
Speaker 2: want to make a reference. This is a book that
2:12
Speaker 2: I just started reading called Trust Matters, and this is
2:16
Speaker 2: by David Horsager. And how I got this book was
2:22
Speaker 2: from Framework LTC's innovation conference. They had him as a
2:25
Speaker 2: speaker and he is amazing. He blew my mind of
2:29
Speaker 2: how important trust is and think about that. People think
2:33
Speaker 2: about that, my listeners, my favorite providers out there. We
2:38
Speaker 2: are in a situation right now, just in the temperament
2:41
Speaker 2: of our world that trust is more important than ever
2:45
Speaker 2: and the partners that we develop and the people that
2:48
Speaker 2: we rely on and the information that we trust. That's
2:52
Speaker 2: a big deal. I want to welcome back my co
2:55
Speaker 2: host and my new friend. Over the months I've I've
3:00
Speaker 2: met and spent some time with you, Andy, and you're
3:02
Speaker 2: not only hilarious, but you're, like Zuelanders said, you're incredibly
3:09
Speaker 2: incredibly good looking.
3:11
Speaker 4: Well, you know, I only can do so much, only
3:14
Speaker 4: can do so much, Todd, thank you for having me.
3:17
Speaker 4: You're a great buddy to hang out with. It's been
3:20
Speaker 4: a lot of travel these few months, so it's great
3:22
Speaker 4: to be at any CDs be with Shila ANYSP and
3:28
Speaker 4: always a pleasure so love to love to shed some
3:30
Speaker 4: light on who we are and what we do for
3:32
Speaker 4: the industry and.
3:33
Speaker 5: Just talk topics, right.
3:34
Speaker 4: And I'm very happy to have my friend Brian Crook
3:36
Speaker 4: here as well, if you want to give him a
3:38
Speaker 4: little bit of an introduction.
3:40
Speaker 2: Absolutely, Brian, welcome to this three part series. This is
3:44
Speaker 2: important and give our listeners some background on yourself and
3:48
Speaker 2: what you've done throughout your profession as a pharmacist and
3:52
Speaker 2: as a leader over on the on the West Coast.
3:54
Speaker 5: You're over there, right, Yes, I'm in Eugene, Oregon.
3:59
Speaker 1: I have been in the pharmacy industry for over thirty years.
4:05
Speaker 1: I started out working as a clerk in a pharmacy
4:07
Speaker 1: right out of high school, and then I worked with
4:12
Speaker 1: a pharmacist that was really encouraging of me to look
4:14
Speaker 1: at this seriously as a profession.
4:17
Speaker 5: Back in the day, I was working for Long's Drugs.
4:19
Speaker 1: I don't know if you remember Long's Drugs several years
4:22
Speaker 1: ago before they got bought out I.
4:23
Speaker 5: Think by CVS.
4:26
Speaker 1: Kind of went to the pharmacist school at Oregon State University.
4:30
Speaker 1: I graduated from there in nineteen ninety six, so I've been.
4:35
Speaker 5: A clerk in a pharmacy. I actually became a technician.
4:39
Speaker 1: I was one of the very first technicians in the
4:40
Speaker 1: state of California at the very early stages of them
4:44
Speaker 1: certifying technicians and licensing them. Then it became an intern
4:48
Speaker 1: and a pharmacist, and for about fifteen years I was
4:53
Speaker 1: the vice president of pharmacy for Buymart Corporation. That ended
4:57
Speaker 1: about I'm going to say three and a half years
4:59
Speaker 1: ago when the company decided to sell their pharmacies to Walgreens.
5:04
Speaker 1: When that ended, I was trying to figure out what
5:06
Speaker 1: I was going to do. There weren't a lot of
5:09
Speaker 1: positions anymore on the West coast because of pharmacy consolidation
5:13
Speaker 1: and chain consolidation going on. So I looked at some
5:16
Speaker 1: other options and other states, other industries and things like that.
5:20
Speaker 1: But at the end of the day, my business partner
5:23
Speaker 1: and I decided that we were going to try to
5:25
Speaker 1: open our own pharmacies. I had a unique knowledge of
5:30
Speaker 1: the communities around here due to my running the Buymart pharmacies.
5:35
Speaker 1: And there were two communities that are kind of bedroom
5:37
Speaker 1: communities of Eugene. One is in Venita, Oregon. The other's
5:41
Speaker 1: in Junction City, Oregon. One is a little bit west.
5:44
Speaker 1: There was a little bit north that really became underserved
5:47
Speaker 1: with the closing of the Buymart pharmacy. So Venita was
5:49
Speaker 1: then left without a pharmacy altogether about a fifteen mile
5:54
Speaker 1: twelve to fifteen mile drive into town for people to
5:58
Speaker 1: get pharmacy services at that point. And then in Junction
6:02
Speaker 1: City there was just one pharmacy that was left, one
6:04
Speaker 1: chain pharmacy left, which was overwhelmed by all the new
6:10
Speaker 1: business that they got. So we just saw an opportunity
6:13
Speaker 1: there and we took it and we have been open.
6:17
Speaker 1: We opened in May of twenty two in Veneida, and
6:19
Speaker 1: we opened in September of twenty two Injunction City, So
6:23
Speaker 1: we didn't just.
6:24
Speaker 5: Open one in the one year.
6:25
Speaker 1: We opened two, and so I primarily run one of
6:29
Speaker 1: the pharmacies out in Venida and my business partner, Scott,
6:32
Speaker 1: he runs the other location up in Junction City, and
6:36
Speaker 1: kind of that's how I kind of got here.
6:37
Speaker 5: So Brian and I.
6:39
Speaker 4: It's interesting. So Brian has a long history obviously with Buymart,
6:44
Speaker 4: and that's kind of how our relationship began. So we
6:46
Speaker 4: were one of his supplier partners, worked with his team
6:50
Speaker 4: for a number of years. And I always found it
6:52
Speaker 4: interesting because it took me three flights to get home
6:56
Speaker 4: from Eugene, Oregon from Cincinnati, so traveling to the office
7:00
Speaker 4: was was always a feat. But I got to say,
7:03
Speaker 4: one of the most beautiful parts of this country. If
7:05
Speaker 4: if you have not been to Eugene or the Pacific Northwest,
7:09
Speaker 4: it's it's gorgeous up there. So Todd, that's how uh,
7:13
Speaker 4: that's how Brian and I got to know each other.
7:14
Speaker 4: And I think he brings a unique perspective to this
7:18
Speaker 4: podcast episode because he has worked in this capacity and
7:22
Speaker 4: a large regional chain and now he has his own uh,
7:26
Speaker 4: you know, community pharmacies, and he's seen kind of both sides,
7:29
Speaker 4: both sides of the coin to say, in this industry
7:32
Speaker 4: too drastically, you know, different classes of trade, but servicing
7:37
Speaker 4: the same type of customers. So I'm excited for him
7:39
Speaker 4: to be here with us.
7:42
Speaker 2: So we have a topic that keeps coming back once
7:45
Speaker 2: in a while, maybe not as as many times as
7:50
Speaker 2: it should, because it is an issue, and that is supply.
7:54
Speaker 2: And that's kind of the first part of how we're
7:57
Speaker 2: going to break down this discussion in kind of three parts,
8:00
Speaker 2: the supply, the trust, and then the business of pharmacy
8:03
Speaker 2: and what that means and how to stay thriving so
8:06
Speaker 2: that you can continue to provide the services that several
8:12
Speaker 2: and many and millions of people are needing. And there's
8:15
Speaker 2: communities out there that we're seeing pharmacy deserts, and now
8:19
Speaker 2: all of a sudden, we have supply issues. So I
8:22
Speaker 2: want to be that fly on the wall and really
8:25
Speaker 2: hear the both of you talk with each other, and
8:29
Speaker 2: then obviously listeners listen in. And that is you know,
8:31
Speaker 2: when the shelves go empty, Wow, Like there's a huge
8:36
Speaker 2: ripple impact of what that means so talk to us
8:40
Speaker 2: about supply.
8:42
Speaker 5: I could start a little bit.
8:43
Speaker 4: I think that you know, supply is driven drastically by
8:48
Speaker 4: the economics of profitability, and it goes all the way
8:53
Speaker 4: back to the manufacturer sometimes, so for those that are
8:57
Speaker 4: you know, versed in how it may manufacturer might bring
9:01
Speaker 4: a product to market in the generic world, they file
9:05
Speaker 4: an abbreviated new drug application in A and.
9:07
Speaker 5: DA, sometimes not knowing how many.
9:11
Speaker 4: Competitors there will be on that particular item. So you
9:14
Speaker 4: might have one molecule that has eight to ten players.
9:17
Speaker 4: And I think an interesting new to market launch was
9:22
Speaker 4: Generic and Trusto that just came out within the last
9:25
Speaker 4: sixty days. It was very sought after, a high velocity product.
9:30
Speaker 4: I'm sure Brian can speak to that point. And we're
9:34
Speaker 4: talking a seven hundred dollars brand that now sits at
9:37
Speaker 4: a generic price of sub twenty dollars almost.
9:40
Speaker 5: So it's you.
9:42
Speaker 4: Factor in these parts of why does supply disruption happen? Well,
9:47
Speaker 4: there's always API shortages or active pharmaceutical ingredient shortages for manufacturers.
9:54
Speaker 5: But I think a.
9:54
Speaker 4: Lot of people need to understand maybe were the economic
9:58
Speaker 4: stress is and you know, influence why you would or
10:03
Speaker 4: you wouldn't use a line in your production to make
10:07
Speaker 4: a low cost generic That might not make sense, That
10:10
Speaker 4: might not be profitable for you as a manufacturer. So
10:14
Speaker 4: that was just one piece I wanted to highlight. But Brian,
10:17
Speaker 4: tell us a little bit about what you see. You're
10:19
Speaker 4: on the front lines, you're working the bench. You know,
10:22
Speaker 4: you're managing patients, you're managing your staff, you're managing procurement.
10:28
Speaker 4: I'd be interested to see, you know, or hear what
10:31
Speaker 4: you're seeing out there right now.
10:34
Speaker 5: Yeah, I think you know. The supply issues.
10:36
Speaker 1: It kind of comes and goes a little bit depending
10:40
Speaker 1: on what's happening in the you know, the manufacturing side.
10:45
Speaker 1: You know, when there's a big recall on something and
10:48
Speaker 1: they're recalling a bunch of product and the other manufacturers
10:51
Speaker 1: don't have the supply to provide, you know, enough medication
10:55
Speaker 1: for that void that's then suddenly been created on a
10:58
Speaker 1: giant recall.
11:00
Speaker 5: It can become an.
11:00
Speaker 1: Issue patients having to call multiple pharmacies. I think one
11:04
Speaker 1: of the big ones for us is, you know, the
11:07
Speaker 1: constant unavailability of like the generic adderall products. I think
11:12
Speaker 1: that's somewhat partly because of the production limitations by the
11:17
Speaker 1: DEA and the manufacturers things like that. But it creates
11:20
Speaker 1: a burden for us both we're trying to find it
11:24
Speaker 1: from a wholesaler that has it. Creates a burden for
11:27
Speaker 1: the patient because if we can't get it, and then
11:29
Speaker 1: they've got to call around find out who does and
11:33
Speaker 1: try to get it there. And the other side of
11:36
Speaker 1: that is that when there's a supply issue, what typically happens,
11:40
Speaker 1: and I'm sure you see this all the time, is
11:43
Speaker 1: that the suppliers that are left that have products suddenly
11:47
Speaker 1: become more expensive, and especially on the generic side, on
11:52
Speaker 1: their third party contracting, we're you know, we're filling at
11:56
Speaker 1: MAC pricing maximumal allowable cost and they don't revisit those costs.
12:01
Speaker 5: Very often or often enough.
12:03
Speaker 1: And so typically if there's a long, longer term shortage,
12:07
Speaker 1: you're going to see prices or costs i should say,
12:11
Speaker 1: increase on those suppliers that still have product out there
12:14
Speaker 1: to sell. And then so suddenly you're buying at a
12:16
Speaker 1: higher price, but you're still getting paid the lower price
12:20
Speaker 1: from the third party. So it creates potentially an economic
12:23
Speaker 1: issue for pharmacies out there to continue to supply even
12:26
Speaker 1: if they can get product because they're paying more and
12:29
Speaker 1: they're getting reinversed less. So then you're forced into a
12:31
Speaker 1: decision of do I just not bring it in altogether
12:34
Speaker 1: or do I just eat it? And if I eat it,
12:36
Speaker 1: how long do I have to eat it? And how
12:37
Speaker 1: long can I sustain that? So, you know, there's just
12:40
Speaker 1: a lot of potential issues that supply chain problems create
12:46
Speaker 1: for pharmacies, and you know, both independent and large chain.
12:49
Speaker 4: It's interesting that you mentioned, you know, do you eat
12:53
Speaker 4: it right? Do you eat it for the sake of
12:55
Speaker 4: the patient, maybe their overall the overall opportunity to have
13:00
Speaker 4: their whole you know, medication book of business, right to
13:04
Speaker 4: serve them as a whole. And I always always find
13:08
Speaker 4: I always find that intriguing, Like you're operating a business.
13:12
Speaker 4: You can't operate for free. Right you have the suppliers
13:16
Speaker 4: to pay, bills to pay. You have this the patient
13:19
Speaker 4: side of the support that you want to take care
13:22
Speaker 4: of your patients and do right by them. Do you
13:25
Speaker 4: ever see a point where and I heard this some
13:28
Speaker 4: time ago last year when GLP ones were being filled
13:32
Speaker 4: at a significant loss, where unfortunately, you know, they were
13:35
Speaker 4: turning prescriptions away for that and for you know, certain
13:39
Speaker 4: adderall based ADHD based medications because supply was bad and
13:44
Speaker 4: costs was not favorable for them.
13:47
Speaker 1: Right, yeah, I mean we see that and frankly, as
13:51
Speaker 1: a pharmacy, we do some of that as well. I mean,
13:55
Speaker 1: you know, in terms of deciding whether you carry something
13:58
Speaker 1: or not carry something. It's always a balancing act in
14:01
Speaker 1: terms of you know, especially like when we're more rural pharmacies.
14:06
Speaker 1: You know, we are considered critical access pharmacies here in
14:08
Speaker 1: the state of Oregon, and so people have transportation issues.
14:13
Speaker 1: It's not like they can go across the street and
14:14
Speaker 1: get it, like if they were in a town that
14:16
Speaker 1: had you know, twenty pharmacies, like you know in Eugene.
14:19
Speaker 1: So you know you've got to balance that, you know,
14:24
Speaker 1: cost versus you know, losing money and how much are
14:28
Speaker 1: you losing? And then you know, is it a long
14:30
Speaker 1: term problem? Is it a short term problem? Is it
14:32
Speaker 1: going to be like this for a long time? And
14:34
Speaker 1: and trying to figure that out is always kind of
14:37
Speaker 1: a challenge. You know what else there other meds they're
14:40
Speaker 1: on you know, am I doing okay? As a balance
14:44
Speaker 1: on the whole patient's profile. You know, things like that
14:47
Speaker 1: go into into a lot of those considerations, but we
14:49
Speaker 1: decided a long time ago we weren't going to stock
14:52
Speaker 1: GLP ones. So as a business, I think you've got
14:56
Speaker 1: to figure out how to survive, right and and so
15:00
Speaker 1: we kind of went into it with the attitude that
15:04
Speaker 1: we are most things for most patients, but we can't
15:07
Speaker 1: be everything for all patients and continue to exist. And
15:11
Speaker 1: that's just that's just the business decision that we've had
15:14
Speaker 1: to make. And it's a tough one again because we're
15:18
Speaker 1: in more rural areas, so there's things that we don't carry.
15:20
Speaker 1: People have to go into town to get them. But
15:22
Speaker 1: you know, we won't stock the GLP ones. We won't
15:25
Speaker 1: stock you know, things that are one thousand bucks, fifteen
15:27
Speaker 1: hundred bucks, and you know some of the expensive items
15:32
Speaker 1: like that that you know, we just don't carry. Both
15:36
Speaker 1: from a you know, paying your bill standpoint every week
15:39
Speaker 1: and waiting for the reimbursement and as well as whether
15:43
Speaker 1: you're getting reinversed appropriately or not. So that's that's always
15:48
Speaker 1: a balancing act and we've had to make some I
15:50
Speaker 1: guess tough decisions on what we were going to do.
15:53
Speaker 1: But you know, I feel like that's part of the
15:55
Speaker 1: reason that we're we're still here three and a half
15:57
Speaker 1: years later.
15:58
Speaker 2: I think it's interesting to listen to the two of
16:00
Speaker 2: you dig into this because there's aspects of long term
16:06
Speaker 2: growth that enable us to sustain the dips that are
16:12
Speaker 2: caused by PBMs and reimbursement. And because you have kind
16:16
Speaker 2: of fat on the cow. So when there's a time
16:19
Speaker 2: where you're you're you're desperate and things aren't going as well,
16:23
Speaker 2: you're not a fragile organization that's crumbling. And I think
16:28
Speaker 2: there's lessons to be learned from from what right Aid
16:31
Speaker 2: went through, and the collapse of right Aid was. You know,
16:35
Speaker 2: as much as I was watching chain pharmacy close up
16:40
Speaker 2: in certain places, the acceleration of the pharmacy deserts has
16:47
Speaker 2: it's just sped up because of right Aid. So this
16:51
Speaker 2: all ties back to supply. Now. Now, this next subject
16:55
Speaker 2: is the subject of crust and that is the currency
16:59
Speaker 2: that can't be re burst and and the relationships and
17:02
Speaker 2: the business, and let's dig into that subject about discussing
17:07
Speaker 2: and cultivating trust between your you know, between your partners
17:12
Speaker 2: and your and your employees and your and your customers.
17:16
Speaker 4: Well, I'll start off a little bit about it's hard
17:19
Speaker 4: when when you're making economic decisions that impact your your business,
17:23
Speaker 4: you know, your family's livelihood, you don't. You don't just
17:27
Speaker 4: trust anybody, right. So, my my philosophy always been has
17:32
Speaker 4: been doing business with my pharmacy customers is do right
17:35
Speaker 4: by the customer right. There are there are opportunities, and
17:38
Speaker 4: there are supply opportunities for us. But sometimes maybe we
17:41
Speaker 4: won't make a profit or very little profit in order
17:44
Speaker 4: to fulfill a gap need, as Brian mentioned, maybe on
17:47
Speaker 4: a product that they're getting macked on and they're losing
17:51
Speaker 4: on or making very little on. So I think, you know,
17:54
Speaker 4: the aspect of the long term relationship for me, I've
17:57
Speaker 4: always had a long term vision and partnerships with my
18:00
Speaker 4: pharmacies is there might be short term losses and I
18:04
Speaker 4: think that's the state of the industry right now. And
18:08
Speaker 4: you know, Brian and I have done business for many,
18:10
Speaker 4: many years, going back to his tenure as VP at Buymart,
18:16
Speaker 4: and I think, you know, one of the things that
18:18
Speaker 4: we did really well was if we said we were
18:20
Speaker 4: going to do something, we did it right. If we
18:23
Speaker 4: said we were going to be primary support for you
18:27
Speaker 4: on X and we were going to segregate inventory, we
18:31
Speaker 4: would segregate inventory. So I think a lot of it
18:34
Speaker 4: goes back to the basic principles of you know, you know,
18:38
Speaker 4: do right by your customer and do what you said
18:41
Speaker 4: you're going to do.
18:41
Speaker 5: So I'll just start with that.
18:43
Speaker 1: Yeah, I echo that. I mean for us in our
18:48
Speaker 1: situation as a pharmacy, it's the trust of the customer
18:52
Speaker 1: from the customer facing standpoint, and I think that's one
18:56
Speaker 1: thing that we've been able to establish pretty good in
18:59
Speaker 1: our communities, is the trust of the community.
19:03
Speaker 5: And I think you know.
19:04
Speaker 1: A lot of that is just right medication, right patient,
19:08
Speaker 1: you know, each time, and being able to service the customer.
19:12
Speaker 1: I mean pharmacy today. I mean if you go to
19:16
Speaker 1: one of the big chains like they there's days they
19:19
Speaker 1: may not be open, or they're clothes for lunch, they
19:22
Speaker 1: can't staff it, they're not getting their medication, or they're
19:25
Speaker 1: waiting in line for an hour. I think that trust
19:29
Speaker 1: out there is hard to maintain in that environment.
19:33
Speaker 5: And we have more control of how we're staffed.
19:36
Speaker 1: We're not publicly traded, and you know, I think that
19:40
Speaker 1: as challenging as it has been to staff, technicians are
19:44
Speaker 1: not easy to find. Pharmacists frankly are not easy to find.
19:46
Speaker 1: These days, we have been able to get the patient's medication,
19:51
Speaker 1: get it right, and get it to them on time.
19:53
Speaker 1: I mean, we never have more than a fifteen or
19:54
Speaker 1: twenty minute maybe twenty five minute wait during himanization season,
19:58
Speaker 1: and people are in and out and and there's usually
20:00
Speaker 1: not much of a line out there, and if there is,
20:02
Speaker 1: it gets taken care of very quickly. And I think
20:05
Speaker 1: patients really appreciate that, and they've come to trust us
20:08
Speaker 1: and enjoy come in and do our pharmacy, and it's
20:11
Speaker 1: it's just something that we pride ourselves on. And I
20:14
Speaker 1: think part of the other difference between being an independent
20:17
Speaker 1: pharmacy is, like, you know, we close at seven o'clock
20:19
Speaker 1: last night, I was there till eight thirty, eight forty five.
20:22
Speaker 5: Like it's immunization season.
20:24
Speaker 1: I'm given I don't know how many flu in COVID
20:27
Speaker 1: shots yesterday, and all the other stuff just kind of
20:29
Speaker 1: is is there for me to check, and I stay
20:33
Speaker 1: until I get it done. And so the next day
20:34
Speaker 1: we're all cleaned up and we're not behind. And I
20:37
Speaker 1: think that's, you know, something that people and patients don't see,
20:42
Speaker 1: but when they come in, their stuff is ready and
20:44
Speaker 1: then you know, on the other side of it is
20:46
Speaker 1: just on the buying side.
20:48
Speaker 5: Yeah, you've got to be able to trust your business.
20:50
Speaker 1: Partners and you know, hope that and know that they're
20:53
Speaker 1: going to do like Andy said, do what they're going
20:56
Speaker 1: to say when you know, and follow through on that.
21:00
Speaker 1: And Andy and I do go way back. I mean
21:02
Speaker 1: we used key Source at buy Maart. You know, at
21:05
Speaker 1: one point we didn't have a warehouse, and you know,
21:08
Speaker 1: during my time, uh, you know, I created the first warehouse.
21:12
Speaker 1: We didn't stock a lot of a lot of products
21:14
Speaker 1: and a lot of SKUs in that warehouse, but that
21:16
Speaker 1: helped us a lot in bringing some items in and
21:20
Speaker 1: saving a lot of money on the buy side. And
21:22
Speaker 1: so key Source did you know, provided stuff for the
21:26
Speaker 1: warehouse as well as you know, directly to the stores
21:29
Speaker 1: and things that we weren't going to warehouse. And that
21:31
Speaker 1: was an important relationship to have. And so when I
21:34
Speaker 1: opened my own pharmacy, one of my first phone calls
21:37
Speaker 1: was to Andy saying, Hey, I've got my own pharmacy.
21:40
Speaker 5: Like we want to.
21:41
Speaker 1: We want to you know, because of our business relationship
21:44
Speaker 1: and the trust that we had developed over the years.
21:46
Speaker 5: Uh, we buy from from Police source as well.
21:48
Speaker 4: Yeah, I think it's interesting, Brian, And definitely it's been
21:52
Speaker 4: a great partnership for all these years and friendship. And
21:56
Speaker 4: I think one thing Todd that was going to reiterate
21:58
Speaker 4: with Brian said, is like there's a huge delineation between
22:02
Speaker 4: the community pharmacy that gives the type of service that
22:06
Speaker 4: almost it's almost nonexistent anymore and the large chains and
22:12
Speaker 4: funny story you talk about lunch hour. I went to
22:17
Speaker 4: one of the large national retaillers remaining unnamed to grab
22:22
Speaker 4: my son's prescription, and you know, drive throughs closed, pharmacies closed.
22:29
Speaker 5: It's like one o'clock.
22:30
Speaker 4: In the afternoon, and I had just a few minutes
22:32
Speaker 4: to grab this medication, and I couldn't get it because
22:35
Speaker 4: there was nobody there staffed unfortunately for that lunch break.
22:39
Speaker 4: And you know, it doesn't take a rocket science to
22:42
Speaker 4: figure out that maybe you could have staggered lunches, so
22:46
Speaker 4: there could still be you know, you could do right
22:48
Speaker 4: by your employees and give them the time they need
22:53
Speaker 4: off and the brakes they need off, but there's obviously
22:56
Speaker 4: that other component of profitability that probably supersedes that. So
23:01
Speaker 4: I just thought it was interesting to hear Brian, you
23:04
Speaker 4: say about you know you care for your patients, You're
23:07
Speaker 4: taking care of them, You're staying late past the time
23:11
Speaker 4: of closure to keep up on your script fills and humanization.
23:16
Speaker 4: So today when you come in, you know you can
23:19
Speaker 4: do right by the customer, and that to me is
23:22
Speaker 4: it's a fleeting thing in pharmacy these days.
23:27
Speaker 5: Yeah, I agree with you on that. I mean, I think,
23:30
Speaker 5: like I said, I think.
23:32
Speaker 1: At the end of the day, your patients are getting medication,
23:36
Speaker 1: whether you get it from us or a national chain
23:39
Speaker 1: or anywhere else, it's the same medication, right, So the
23:42
Speaker 1: differentiation is your service and that's or at least one
23:46
Speaker 1: of the main differentiations is your service. And that's you know,
23:49
Speaker 1: I think what we are able to excel on. I mean,
23:53
Speaker 1: we're the only pharmacy Invinita, so we have a little
23:57
Speaker 1: bit of an advantage there. But I mean in Junction City,
24:00
Speaker 1: where one of two pharmacies, we by far have the
24:02
Speaker 1: most market share there. And I think again that just
24:06
Speaker 1: goes back to the service we're able to provide and
24:08
Speaker 1: get people in and out and get their medication right
24:11
Speaker 1: every time. And I mean I think the community appreciates that,
24:17
Speaker 1: and you know, we have a lot of staff that
24:20
Speaker 1: have you know, kind of been with us as we
24:24
Speaker 1: you know, evolved over these last couple of years, and
24:27
Speaker 1: so they get the same faces. Uh, you know, might
24:30
Speaker 1: have a clerk that's just outstanding in terms of knowing
24:33
Speaker 1: people by face and by name, and I mean people
24:36
Speaker 1: appreciate that and they really they really like that, and
24:40
Speaker 1: you know, they they You're on a first name basis
24:43
Speaker 1: with a lot of them. You see them every day,
24:45
Speaker 1: they know you, you know them, and you know their
24:48
Speaker 1: health history, and that's very helpful. You know, we don't
24:51
Speaker 1: have random floaters floating through our pharmacies, you know. And
24:54
Speaker 1: then they get a different person every day that has
24:56
Speaker 1: you know, no idea of their healthcare background or or
24:59
Speaker 1: they're medications and things like that.
25:04
Speaker 2: Yeah, I think of the passionate pharmacists who are working
25:08
Speaker 2: for some of those larger entities and organizations that have
25:13
Speaker 2: been forced to commoditize and build processes that are an
25:18
Speaker 2: increase of volume of prescriptions, but really forgetting the importance
25:24
Speaker 2: of connecting with your patient and how that pharmacist that's
25:29
Speaker 2: at the checkout counter that says, hey, do you have
25:32
Speaker 2: any questions about this medication? They're saying that knowing that
25:36
Speaker 2: they have fourteen things backed up and prescriptions to check,
25:41
Speaker 2: and they have the phones ringing, and there's a line
25:45
Speaker 2: for immunizations and shots, and it's just it sucked out
25:50
Speaker 2: the life of what it was supposed to be like
25:53
Speaker 2: when not that they're community pharmacies and the independence and
25:57
Speaker 2: not saying that you're not crazy busy sometimes, Brian, because
26:00
Speaker 2: I know your operations get like that, but it's not
26:04
Speaker 2: a policy of your organizations to drive out the human
26:09
Speaker 2: connection that makes all the difference in care and slowing down.
26:13
Speaker 2: And what if you're reviewing a one time medication and antibiotic,
26:20
Speaker 2: for example, with a mother of a child, and then
26:23
Speaker 2: all of a sudden you start observing something a skin
26:27
Speaker 2: color of the child, or maybe they're having breathing issues,
26:30
Speaker 2: or you're picking up something, and that's the part that
26:34
Speaker 2: we can catch things that don't lead to more serious issues.
26:40
Speaker 2: And the only defense of the patient, the advocate of
26:43
Speaker 2: the patient in that situation is the community pharmacist. And
26:49
Speaker 2: so I'm excited this is kind of plugged into our
26:53
Speaker 2: next section, which is the business and where's the business going?
26:57
Speaker 2: But I want to throw something up to both of
26:59
Speaker 2: you and that is the fusion of the trust and
27:02
Speaker 2: of the supply from organizations like key Source. But now
27:06
Speaker 2: let's talk about strategy and how we move forward and
27:10
Speaker 2: what is the business of pharmacy, because it is it's
27:13
Speaker 2: going to become less and less about just the dispensing fee,
27:18
Speaker 2: and it's going to become more and more about chronic
27:21
Speaker 2: care management and remote patient monitoring and all these other
27:24
Speaker 2: things that if we can leverage and start making some
27:28
Speaker 2: revenue there. Now we can go back to the infrastructure
27:31
Speaker 2: and the relationships between our suppliers and have that increase
27:37
Speaker 2: business based on the greased rails of the machine that
27:41
Speaker 2: you've built. So I want to hear both of you
27:44
Speaker 2: on the future of the business of pharmacy.
27:47
Speaker 1: Pharmacy has to evolve like any other industry would. I mean,
27:52
Speaker 1: we're the only healthcare profession that I can think of that's,
27:56
Speaker 1: you know, simply makes money on a margin of what
27:59
Speaker 1: you can sell something for versus what you can buy
28:01
Speaker 1: it for. And you have little control of what you're
28:06
Speaker 1: going to be able to sell it for because ninety
28:08
Speaker 1: five percent of your business is dictated to you by
28:11
Speaker 1: their party, and so then you know you've got the
28:17
Speaker 1: buyside and at some point you can only you're only
28:21
Speaker 1: going to pay so little for something. I mean, at
28:22
Speaker 1: some point you know the whole the manufacturers aren't giving
28:25
Speaker 1: it to you for free. And so I mean things
28:30
Speaker 1: that you know, I think you know to be able
28:34
Speaker 1: to get there, though, I mean, I think a lot
28:35
Speaker 1: of things have to change, and some of that's being
28:38
Speaker 1: recognized as providers being able to provide services. I think
28:42
Speaker 1: some of that state Board of Pharmacy rules and laws
28:44
Speaker 1: in terms of what pharmacists can do and can't do.
28:48
Speaker 1: I think some states are more progressive than others. For example,
28:51
Speaker 1: I think Idaho is pretty progressive in their pharmacy laws
28:55
Speaker 1: and rules and made some.
28:56
Speaker 5: Changes a few years ago.
28:57
Speaker 1: When I was with buy Maart, we had stores in Idaho,
29:00
Speaker 1: but we never really got an opportunity to really get
29:03
Speaker 1: into programs based on what pharmacists could do in the
29:08
Speaker 1: new laws before we ended up selling off the pharmacies.
29:11
Speaker 1: But you know, they have rules like tech can check
29:14
Speaker 1: tech techs can take transfers from between stores. I believe
29:20
Speaker 1: they can take new prescriptions over the phone from providers.
29:23
Speaker 1: A lot of that then just taking some of the
29:25
Speaker 1: workload off the pharmacists.
29:27
Speaker 5: Because in Oregon.
29:29
Speaker 1: Those are things only the pharmacists can do, right so,
29:32
Speaker 1: and then you know, they had a much more robust
29:36
Speaker 1: number of things that pharmacists could provide care for antibiotics,
29:40
Speaker 1: birth control, and I can't remember off the top of
29:44
Speaker 1: my head because it's been a while, but you know,
29:46
Speaker 1: things like that are going to have to change for
29:48
Speaker 1: pharmacists to be able to evolve and get into some
29:50
Speaker 1: of that billing on the medical side.
29:53
Speaker 5: And it's been tough.
29:54
Speaker 1: I mean, I know, we've been trying as a profession
29:55
Speaker 1: for years to get recognized as a healthcare provider, to
29:59
Speaker 1: develop programs, and there are some out there. They're just
30:03
Speaker 1: not in a large enough scale to sustain a pharmacy.
30:06
Speaker 1: And so right now we're still stuck in the you know,
30:10
Speaker 1: reinbursement side of things in terms of trying to make
30:15
Speaker 1: a profit off of what you can buy and sell
30:16
Speaker 1: something for. And until I think, you know, we can
30:20
Speaker 1: get a better foothold in that, you know, it's it's
30:23
Speaker 1: going to continue to be what it is. And and
30:26
Speaker 1: I think that's why you're seeing the industry evolved the
30:29
Speaker 1: way it has, why you're seeing pharmacies close while you're
30:32
Speaker 1: seeing chains go bankrupt. Why you're seeing chains close locations
30:37
Speaker 1: and I think you know you're you're shrinking the population.
30:42
Speaker 1: I mean here in Oregon, you know, we now have
30:45
Speaker 1: fewer pharmacies per capita, I believe than any other state
30:49
Speaker 1: in the country after the final rite aids here have closed.
30:55
Speaker 1: But flu shot season, COVID shots, things like that, imanizations,
30:59
Speaker 1: they are really for us. What's what in my opinion
31:04
Speaker 1: has kind of kept us afloat because they're the one
31:08
Speaker 1: thing I think that we can do that has some
31:11
Speaker 1: decent margins still left in it. And so you know,
31:14
Speaker 1: we're also working with the State Health Authority OHA and
31:18
Speaker 1: doing clinics off site for some of their facilities and
31:22
Speaker 1: things like that. So you know, that has been an
31:25
Speaker 1: important piece of our business to kind of get put
31:27
Speaker 1: in place and be really successful.
31:29
Speaker 4: At Brian, interesting to hear about your success with immunizations.
31:36
Speaker 4: Question for you, have you seen a decline or a
31:44
Speaker 4: or a steady pace on the COVID vaccine COVID vaccinations
31:48
Speaker 4: in your area.
31:50
Speaker 1: I think, you know, we've seen probably a decrease overall
31:58
Speaker 1: in number of people getting vaccinated on the COVID vaccine.
32:02
Speaker 1: I think I read somewhere and you know, I could
32:04
Speaker 1: be wrong, but I think last year only twenty percent
32:06
Speaker 1: of the population got the COVID vaccine. I can't remember
32:10
Speaker 1: that's correct, but it was a pretty pretty low number.
32:13
Speaker 1: I think in our community we see a fair amount
32:16
Speaker 1: of people getting it. But I think, you know, I
32:20
Speaker 1: don't know if that's partly vaccine fatigue because people had
32:23
Speaker 1: to get so many shots for so long the recommendation
32:27
Speaker 1: and you know, but we probably gave you know, as
32:32
Speaker 1: many COVID shots as flu vaccines last year. So I
32:35
Speaker 1: think we're still getting good traction in our communities with
32:39
Speaker 1: the COVID vaccine.
32:40
Speaker 5: And I know.
32:42
Speaker 1: This year we were kind of late in being able
32:44
Speaker 1: to provide them because we vaccinated by state protocol Oregon
32:51
Speaker 1: what used to base their protocol or bases their protocol,
32:55
Speaker 1: and the CDC and ACIP recommendations, which I'm sure you
32:59
Speaker 1: are well aware. I kind of had some issues this
33:03
Speaker 1: year getting some recommendations from the CDC and ACIP and
33:07
Speaker 1: some challenges there. And then Oregon, Washington, California, and I
33:12
Speaker 1: think Hawaii created their own Western States Alliance, which then
33:16
Speaker 1: came out with their own protocols, so we had to
33:18
Speaker 1: kind of wait for those to get put into place
33:20
Speaker 1: before we could start vaccining, so we really just have
33:22
Speaker 1: only been given COVID vaccines for about a week, but
33:26
Speaker 1: people are coming in form still.
33:27
Speaker 2: Ryan, this has been great. I really appreciate the insights,
33:31
Speaker 2: and thank you so much for being a guest on
33:35
Speaker 2: a series that's important to us to get better information
33:39
Speaker 2: out and to get novel information out, updated information out.
33:43
Speaker 2: Things change so fast. I just get blown away by
33:48
Speaker 2: what I was talking about in January of twenty twenty
33:50
Speaker 2: five and now what we're talking about, and how it's changing,
33:54
Speaker 2: and how it's how AI is expediting so many different
33:59
Speaker 2: things that are happening. And as long as it's under
34:01
Speaker 2: the control of a pharmacist and physician and the team up,
34:06
Speaker 2: I trust it. But I just don't want it to
34:08
Speaker 2: get out of control and forget the human part of it,
34:12
Speaker 2: the removal of the human and so many things and
34:15
Speaker 2: pharmacy and fast food pharmacy and in some of the big,
34:18
Speaker 2: huge chains, and of course now with AIGs, it's like,
34:23
Speaker 2: let's not forget what we're caring for and what we're
34:26
Speaker 2: doing and what our purpose is out there. Thank you
34:29
Speaker 2: so much.
34:30
Speaker 5: Yeah, thank you, Andy.
34:31
Speaker 2: It's been great. You're always a wealth of information for us.
34:35
Speaker 2: We very much appreciate your insights on this third part
34:39
Speaker 2: of our three part series with key Source and can't
34:43
Speaker 2: wait to talk to you next. Where are we meeting
34:46
Speaker 2: up next? Is that going to be at NCPA twenty
34:48
Speaker 2: twenty five most likely?
34:50
Speaker 4: Yeah, the show season goes on right, So it's been
34:54
Speaker 4: a pleasure, Todd, It's always nice to chat about the
34:57
Speaker 4: industry and Brian, thank you so much for being here.
35:00
Speaker 4: This was a great episode, so look forward to sharing it.
35:04
Speaker 5: Yeah, thank you.
35:05
Speaker 2: Hey, check out key source. Go to keysource dot com
35:09
Speaker 2: once again, that's keysource dot com and send us a message,
35:13
Speaker 2: send us some feedback. Share this with a fellow pharmacy
35:16
Speaker 2: operator and owner, and if there's any questions, ask Andy.
35:20
Speaker 2: It's his fault, so just send all all of your
35:23
Speaker 2: complaints to Andy through his LinkedIn or something and he'll
35:27
Speaker 2: get you all fixed up.
35:28
Speaker 4: All hit hit me up.
35:30
Speaker 2: I'm there, all right, gentlemen, Thank you so much,