Mark Cuban Cost Plus Drugs

Speaker 1 (00:00:00):

Um, I wanna welcome everyone. Uh, this is an exciting, uh, webinar for us. We're gonna turn this into a podcast so that we can break this up into pieces so that we can really understand what's happening in, uh, in the, the marketing and the, the manufacturing and the business development of how a, uh, drug manufacturer can become much tighter, uh, to the community pharmacy. And in becoming involved in really concentrating on specific disease states placing a lot more of that control and information in the hands of the pharmacist that is, is caring for your patients. And don't have to tell you, you are the pharmacy, you're the champions of your community. As a, as a, as a pharmacy owner. I have been in the pharmacy market, um, in industry since 2004. And I started in long-term care pharmacy, privately owned long-term care pharmacies, and the challenges that they have were very, very similar to community pharmacy.

Speaker 1 (00:01:01):

Um, and, and it was just compounded by volume in, in what they went through in controlling formularies and understanding disease states and how it ties into, um, ultimately patient care. So my passion is connecting with organizations and people that believe in community independently, owned community pharmacy, and important is that there's more control at your community level. And, um, I think that that, um, that has, has become a, a gong that has become a megaphone for many of the national association, such as, uh, the national community pharmacist association and many of the strategies that they are building, um, including the, uh, community pharmacy enhanced services network known as C P E S N. However, um, I feel like we're building a big jigsaw puzzle here and there are other players out there that really, um, I don't wanna say stand in the way, but do create interesting obstacles in, in marrying the, uh, patient care from the community pharmacy and pharmacist, and, um, the pharmacy podcast network with 32 hosts that do nothing but focus on the business and the clinical and the exercise and the collaboration of pharmacist to physician.

Speaker 1 (00:02:21):

This is an important opportunity for our, and this is the first of a monthly webinar that we're gonna feature, uh, stakeholders, um, subject matter experts, technologists, um, pharmacists, physician conversations, disease, state experts, and even manufacturers who are gonna come on with us to speak to our communities. And before I go any further, I want a introduce my co-host and somebody who has become, uh, close to me, uh, since joining the pharmacy podcast network in October of 2020 someone who is no stranger has been around, um, longer than me in community pharmacy and has worked for all three wholesalers understands the plight and the struggles the community Pharmac has gone through. And what's really interesting is we are collecting new. We are collecting established, we are collecting veterans in order to put together a think tank that is going to continue. This will not stop. This is gonna go, and this is gonna keep progressing, and we're gonna continue to find champions out there to once again, putting together a jigsaw puzzle with the community pharmacy in mind, the one and only Bruce neon. Um, thank you so much, Bruce, for, for host. Co-hosting this with me.

Speaker 2 (00:03:33):

Well, thank you. And, and, uh, hello, uh, podcast listeners. We're, uh, we're gonna glad to have you, and we know we've got some, uh, remarkable things to share with you on this, uh, episode today. Um, I get to be the, uh, host of a, of a podcast called pharmacy crossroads. And when Todd and I were kind of, uh, conversing about this opportunity and came across the name, it both struck us as perfect for, for the, the content that, uh, I try to bring to you. And, and the background that certainly, uh, uh, provides the opportunity for me to talk. And that's pharmacy is at a crossroads and that's not good news. That's not bad news. It is just news. Um, good things are happening, bad things are happening. And, uh, I think they happening at an accelerated pace now that requires us to reach out and bring people like Dr.

Speaker 2 (00:04:26):

Alex to you, so that we can think about opportunities, uh, as opportunities rather than obstacles. So, um, you know, many things are going on. One of the things that I, that I like to share with pharmacists when I have an op opportunity to chat with them is there's, there is this crossroads where, uh, some people are thinking that the, that pharmacists are the people who fill prescriptions and they are that. Um, and I argue that we ought to own the pharmacy pharmaceutical part of, of, uh, health healthcare, but above and beyond, uh, uh, managing the prescriptions. We need to realize that there's an opportunity to step up and be a true healthcare professional. And, um, the, the challenges in healthcare are enormous, but with challenges comes opportunity. So if we can find ways to reach across to prescribers, yes. Even to payers and, uh, we've got a wonderful PBM person on the panel today.

Speaker 2 (00:05:33):

Uh, prescribers payers, family, caregivers, uh, and community assets and resources who care for the health people and wanna make sure that they get the care and treatment that they provide. So there's a wonderful opportunity comes with challenges. We need to find ways to get paid. And those are emerging. And Todd's mentioned C P E S N, and other groups who are tackling that on an organized be, uh, platform. One last thing. And then I'll, I'll be quiet for a while is to realize that the opportunity that has presented with the, the COVID, uh, situation, terrible situation. I remember, uh, sitting in a meeting a year ago where somebody postulated that we might lose 250,000 people in a year, we've doubled that. But from a pharmacy standpoint, what has the doors that have been opened? The recognition that has been given to the prof fashion chain and independent for the ability to, uh, administer this vaccine, vaccines is enormous. And, uh, we need to use that, uh, door opening opportunity to move forward in other areas, which when we talk to Dr. Alex will see what some of those new ones are. So Todd, that for me, you can turn this back over to the experts now.

Speaker 1 (00:07:01):

Well, I appreciate that. And, you know, I wanna, I wanna concentrate on a, on a word that we hear a lot and maybe it was a buzzword, but it, it it's today. It's really a focus today and that's transparency, transparency to me means trust. So I've been the market place. I've been in pharmacy long enough to find organizations and find people who have done exactly that they've built their businesses on trust, trust in their community, number one, but number two, within their industry. And there's a man that I met, uh, sometime ago over 10 years ago, his name was Jim fields. And Jim fields was a pharmacy owner. And he was getting, he was getting punched in the head, just like the rest of the pharmacy owners by many of the changes that were happening in the PBMs. And he got fed up. He's a very passionate man.

Speaker 1 (00:07:50):

And he had two sons and he had a son that went the way of becoming a pharmacist and pharm D and his name's Ken fields, and his other son very much more driven like myself because I'm not a pharmacist either. And his name's Kyle Fields, and this family has built a community pharmacy, but they've also built a, a PBM that could help local employers. And what's happened now is that has spread across the nation with many of the customers and, uh, employers that they serve. And it's always in mind of being able to keep things in control. And they've taught me a tremendous amount. I can't believe how many times I drove over to Ohio to meet with them and learn from them. And I sat in awe, as I listened to Jim, um, you know, talk about his passion. Now he's given those companies and, um, and really the reigns to come to the next level, uh, to Kyle who leads, um, who leads app RX. So app RX is a PBM who I've trusted for years, who has really taught me about what it is to be a fiduciary driven, uh, trust based, um, pharmacy benefit organization. And it, and it's the way things are supposed to be. So I, I am very proud to introduce, uh, Kyle Fields, the CEO of a R X as part of this think tank. And as part of this, uh, of this trusted group, Kyle.

Speaker 3 (00:09:10):

Yeah. I appreciate the introduction. And again, yes. Um, I've always said that, uh, you know, PBMs a three letter word, most pharmacies view it as a four letter word. And my job is to make it back into a three letter word again. But, um, like, like you said, there are a lot of things in the industry that are, are not correct or, or intentionally, uh, made to be, uh, confusing, uh, to the, to the consumer, the payer. And in a lot of ways we found even this week where some of our competitors have found, uh, and met their guarantees by not paying pharmacies. Um, in this case, it was every fill on a particular thyroid was, was a negative of $150 for that chain pharmacy. And again, we just, we just don't do that. And, and, and couple of our tag lines just to throw it out there is disruptive simplicity, uh, and clinical decisions are fiduciary decisions. So we built this as a, as a clinically based PBM and, and we're starting to, as we grow and approaching, you know, quarter million covered lives and, and, and hopefully continuing to go to the moon with this, uh, we think that it will be a, a very positive impact, not just for payers, but for pharmacists as well.

Speaker 1 (00:10:22):

Thank you, Kyle, you know, in my journeys, I've, uh, had a, you know, a sweet spot because of the nerdiness in me to really drive answers to pharmacy owners and pharmacy operators through technology. And te G really becomes a common denominator in so many facets of, of, of our industry because of its math background. And if you think of technology, it really is based on science and math. So the common denominator that kept coming up from the time I was entered pharmacy in long term care specifically, was adherence. And the ability to who build, uh, ways, you know, if you're a dart thrower or even a pool player. And I love darts, I'm not that good is I knew that if I kept aiming at the same spot away for me to correct where I was moving that dart in order to get closer was to make just small adjustments so that I could find my consistent pattern.

Speaker 1 (00:11:17):

And dad's a, a bow person too. And he always taught me find that consistent pattern so that you can move well. That's exactly what adherence is. So a champion in technology that I ran into about six years ago was Mr. Bill Holmes and the passion that alluded from this man and being able to put technology in the hands of the operator. So you could constantly do things just like the dart over and over and over again. So you could make those very microscopic minuscule corrections so that by the time you get to operation, you're not looking to the pharmacist to make such corrections in, in photographing the way that a pill looks in, in photographing the way that a caps is, and being able to collect massive amounts of data and use that data in a system and in a process to ensure that safety is number one, so that the adhere of a, of a patient is driven by the relationship between that pharmacist and that patient, so that we don't have to worry about the technology.

Speaker 1 (00:12:21):

So we don't have to worry about the packaging. So one of the trust people in my, um, I don't wanna say Rolodex makes me sound old, but literally in my contact database, in my Rolodex is bill Holmes and his team. And that's why that they're here today. That's why they're helping to host this webinar is because I trust him. I trust his team, and I trust that what they're looking out for is the efficiency and the profitability of community pharmacy, and ultimately the patient safety. So I wanna introduce, um, Mr. Bill Holmes and Brady Chatfield from RX safe.

Speaker 4 (00:12:56):

Uh, thank you, Todd. Uh, it's a pleasure to be here today, uh, addressing all of your audience and to be in such fine company with the rest of our, our, uh, co-hosts here and, and, uh, our, our experts on the panel, uh, Brady Chatfield here next to me is wave your hand Brady. So put a face with a name Todd and I have known each other for a long time. And I think we have a, a mutual respect for, uh, a couple reasons. First of all, what we all care about all of us here on the, on the screen or on the podcast care about first and foremost, the reason we get up in the morning, what gets us in the car and down to down to work is we will want more than anything to improve community health, to have patients have healthier lives and to live more fully through prep, uh, uh, pharmacists who are practicing at the top of their license.

Speaker 4 (00:13:50):

So what does that mean? That means that the outcomes we seek will reduce deaths. Uh, we have under under 125,000 unnecessary deaths a year, my dad was one of 'em. It's very personal for me. We wanna reduce the half trillion dollars of waste in spending in healthcare that comes from people who aren't taking medications correctly, experiencing med errors or other similar difficulty that put them into an emergency room or a hospital or a critical care unit. And that isn't just expensive. It affects the lives of the patient and their families and all their friends. It's devastating to the community at large. And as Todd said earlier on, we have, uh, an opportunity of the 21,000 or thereabouts independent pharmacy owners. We have an opportunity to work together and I'll call it what I would like us to start referring to Todd as the world's largest chain.

Speaker 4 (00:14:50):

CVS has 10,000. Walmart is 10, uh, 4,000 Walgreen says 10,000. And, and then it goes down from there, but no group is larger than 21,000. So I'd like to start thinking holistically of us as a chain, a competitive chain, we have advantages other people don't built back. Doesn't have a local presence, large corporations lose continuity and, and, and contact with their patients at the level. I know the caregivers give an independent independently owned pharmacies. So we are here on that mission. We think that pharmacies are going through a transformation now. And I think we spoke to that just a moment ago. The trans is to have pharmacists thought of more highly in the community. If that's possible, they're already the most trusted, uh, profession. And, and to think of it now as not just that you're most trusted profession, but, but a services provider, not just a pill counter, or just an advice giver profession.

Speaker 4 (00:15:49):

And so to practice at the top of your license, you need to get out in front and start talking to the people who need you, your patients, and provide them advice and guidance, not just on medication, perhaps on nutrition and perhaps on, on supplements as well. And we think the transformation can be assisted and can be guided and accelerated in pharmacy. That transformation will come through adherence packaging, you know, a simple box with a strip pills in it with a single med time staffed on each pouch, patient specific information included for people then to go from seven and a half average refills and vials, and in, uh, chronic medication, chronic disease medication to 11 and a half. We know it's well documented. Patient health will go up dramatically. People will take the right medication, take it on time. My dad had had one of those boxes.

Speaker 4 (00:16:44):

He would still be here today. That's important. It's very important to the community, but it's also important to the pharmacy owner for the financial health of the pharmacy. If the pharmacy's not financially healthy. And here we are today, talking about PBMs that are destroying your financial health. That's our goal here today is to, is to find a way to start to transform and, and, and reverse that trend. But if you're not financially healthy, you don't have the resources of the time to help your patients be healthy. And so we have to attack both issues. And from a, from a financial health point of view, there's no better demonstrated way to improve the financial health of a pharmacy than have adherence packaging. And as a typical example right here behind me is a through packaging automation system that will fit in your pharmacy. And when I say fit, it will fit physically.

Speaker 4 (00:17:35):

It's only 33 inches wide. It will fit financially as a very good return on investment. Typically one year cashflow and as little as cashflow break, even in as little as three months, and it will fit from a workflow point of view. It's a single, uh, streamlined, automated workflow system with little or no rework, the pouches on the lake, uh, other systems. So we are here on this mission. We applaud everyone else. Who's trying to see it the same way and to provide the same kind of, uh, nurturing to help our pharmacies become financially healthier. And ultimately, as I say, we all were improved patient health. Todd, thank you for this opportunity.

Speaker 1 (00:18:16):

Absolutely. So the, um, the, the guest today, the special guest is someone that I met about, uh, two months ago, who was on a podcast because I saw a press release about mark Cuban, getting involved in drug manufacturing, which if you see that and you follow, uh, mark Cuban, who's an absolute, um, you know, genius when it comes to entrepreneurial initiatives to build something, um, as a, as a conduit to extend, um, a, a solo somewhere else and starting in telecommunications and, and coincidentally, I came from, uh, sprint business and at, and T before I got into pharmacy, it was really interesting to see that he was jumping in so aggressively into drug manufacturing in finding, um, a, a company and, and enhancing investing in a company where it could really make an impact in order to circumvent some of the status quo that we're all experiencing in this pharmacy market.

Speaker 1 (00:19:19):

So I wanna give, um, the, the, the, the megaphone and the speaker to our, our guest of honor today, um, someone that, um, I think a lot of that's, that's very passionate about patient health as the number one, uh, goal of, uh, in all of this, um, Dr. Alex Oman, Oman Osky, um, welcome to this webinar. And, um, I'm so glad that, that you're here to really be part of this, um, this collective, and that's exactly what it is. It's a, it's this jigsaw puzzle of healthcare, and, and there's so much to, there's so much work to be done and having a drug manufacturer involved at this level at this intimate level, um, between, um, patients and, and a pharmacist is pretty special. So welcome Dr. Alex.

Speaker 5 (00:20:07):

Oh, thank you, Todd. Uh, we really appreciate all that. That's very kind of you, uh, no, absolutely delighted to, to be here today and to, to be able to, to talk, uh, about, uh, you know, some of our initiatives, some of what our plans are going forward. Uh, you know, we just put out a, a little trickle of information into the public sphere, uh, about, uh, you know, some of our plans for, uh, becoming air coming two years and, you know, would be delighted to, you know, sort of put a little bit more context around those plans and kind of the direction, uh, that we're going. Um, so, you know, uh, mark Cuban cost plus drug company, uh, right there in the name, uh, you know, we're planning to, uh, make low cost versions of, of high cost drugs, uh, and, uh, oh, there's our webpage.

Speaker 5 (00:20:56):

Uh, and yeah, uh, basically reveal to the public what our, our manufacturing costs are. Uh, so, you know, disclose publicly what our, you know, uh, input costs are, what our ma machinery costs are, what, uh, our distribution costs are, what our salaries are, uh, and then put a flat, uh, 15%, one, 5% margin on all of the, the drugs we produce. Uh, and yeah, uh, essentially, you know, uh, building out a sterile fill finish facility, uh, uh, in Dallas, Texas now, uh, the groundbreaking ceremony will be this, uh, this Friday, after many years of work. Uh, so excited about that. Um, that'll be focused specifically on sort of rare disease, uh, shortage, orphan drug products, um, and that's one part of our business. Um, and kind of the other part of the business we haven't, uh, you know, sort of, uh, gone into detail with, in our sort of media appearances so far is the, the private label side of our business.

Speaker 5 (00:21:59):

Uh, so here we're, we're sourcing drugs that other manufacturers are making, uh, typically, you know, your, your ultra high cost, uh, generics and just putting our label on them. So our own NDC code, um, and then setting a transparent, uh, AWP and w price, uh, uh, which is 15% above what, you know, with the WAC price being 15% above what it cost us to, to distribute the, the actual product itself. Um, and, you know, part of the idea there is, you know, in the, uh, you know, in sort of any capitalist market, uh, you know, where you have a opaque market where the buyers and sellers don't know the price that that's being sold or bought at, and you have sort of artificial prices in between the, the, the winners are not either the, the buyers or the sellers, uh, in this case, the pharmaceutical manufacturers and the, uh, uh, the pharmacies and patients at the end of the day, it's the, the people who are brokering information in between are to winners of those kinds of markets.

Speaker 5 (00:23:00):

Um, and in here you have that in spades, you know, uh, independent pharmacies are struggling. Uh, the actual generic manufacturers are, you know, working on razor and margins, uh, barely profitable if at all, but, uh, you know, the, the PBMs and wholesalers are all fortune 20 companies, and that's even before they all merge together in a, you know, sort of monopolistic he scape. Uh, so, you know, uh, clearly there's some, you know, clear, uh, clearly there's something, something wrong with the system where patients can't afford their medicines and yet, uh, no, uh, pharmaceutical companies can't, can't break even. Um, so what we, so, you know, our part of our solution is to, uh, build sort of a, a parallel supply chain, uh, with good actors, like we have on us today, uh, on the panel with us today, uh, with independent pharmacies that basically works in per that works in parallel to compete with the sort of big vertically integrated monopolistic supply chain. So, you know, in there, we act as a wholesaler, you know, a Def defecto wholesaler, um, when have our own three PL solution to, to distribute products, uh, and basically just publicly advertise the price, uh, and, uh, yeah, hope to, to drive business to independent pharmacies from there. Uh, so sorry, I've been sort of ramping and monologing, but, uh, but yeah, excited for the, for the discussion today.

Speaker 1 (00:24:25):

So you are the guest that we wanna talk with. So we want to hear rambling and we want to hear kind the ideas and the scalability. And that's the first thing that came to my mind when I originally interviewed you. And I'm not sure if anyone has listened to that interview, but I will put it in the show notes, um, so that they can, um, you know, consume that information on their own time. But let's talk about that scale. What are the first steps in order to engage and get your product to community pharmacy, people that have been in pharmacy marketplace for such a long time, they're used to a very specific distribution model and sure, of course the very first thing I think of is, you know, the buying groups, the, it have been key in, in success of, uh, community pharmacy, and being able to collectively come together and be able to negotiate as a, as a group.

Speaker 1 (00:25:16):

And then number two, uh, the, obviously the wholesaler and how that wholesaler, uh, works. And we're talking about the, obviously the big three, and we've all experienced over the years, some of smaller wholes sellers, too. Um, I used to work directly with HD Smith and I built actually a pharmacy buying group that was through HD Smith. And of course, um, based on how the markets have changed, um, those companies have been gobbled up and, or have gone out of business. So the very first question I have is the distribution model. Would you be able to describe that to our audience of actually how that would work?

Speaker 5 (00:25:52):

Sure. Uh, so, you know, I kind of view our competition, uh, not really so much as the actual generic, uh, pharmaceutical companies themselves. Um, you know, we do, uh, pitch ourselves that way to the public. Uh, part of that is just, you know, uh, you know, the general public doesn't know, you know, I'm sure if you stopped, uh, no offense Kyle, but 99 out of a hundred people on the street, uh, they would have no idea what a pharmaceutical benefit manager is, uh, agreed. And so no offense, uh, but, uh, you know, and similarly, you know, if we were, and we're going out to the public, uh, to innovate in the whole sailing marketplace, no one, no one would either, you know, that would not get, but, but everybody intuitively understands what, uh, a pharmaceutical company is. So that's part of our marketing there, but I really view our more competition more as the big three wholesalers and the big three PBMs, um, in terms of introducing transparency into the marketplace to, to really get past them.

Speaker 5 (00:26:53):

So, you know, uh, for that reason, we're not really looking to, um, you know, distribute our products through the big three wholesalers. Uh, but that being said, the buying groups are, are an incredible resource for us. Uh, so I do think it makes sense to, to go through the, the independent pharmacy buying groups. And we are in discu, you know, I have non-disclosure agreements in place, but we are in discussions with some of the, the buying groups to, uh, distributor products. Uh, and of course, you know, there's, uh, going directly to the independent pharmacies themselves. Uh, so, you know, uh, you can order our products direct from our, from our webpage, uh, you know, set up an account, uh, and yeah, go from there. Uh, you know, I know it's, it's challenging, you know, at the moment it's not too bad because, you know, we only have one product publicly announced at the moment available for purchase, but, uh, you know, eventually you reach an inflection point where, you know, the big three wholesalers demand that you get 90% of your products from them, or you lose a rebate.

Speaker 5 (00:27:54):

Um, and yeah, that is, you know, I think part of the challenge is just providing data and analytics for, or for independent pharmacies saying that, you know, I, I know it feels like you're beholden to that rebate, but at the end of the day, just getting it at transparent prices is gonna be less expensive than actually putting it, putting up with, uh, sort of malfeasance from the big companies and, and waiting to get that rebate. Um, so, you know, that's part of the challenge is, is getting the structure in place to be able to, you know, provide everything necessary, whether that be through, through partnerships with buying groups, uh, but, you know, be able to find ways for independent pharmacies to get around, uh, you know, sort of their, their large wholesale contracts and actually bring more value, uh, save more money for the independent pharmacy, uh, that rather than working with, uh, with the big three wholesalers,

Speaker 2 (00:28:49):

Hey, Hey, Todd, let me, uh, uh, uh, interrupt and ask a question here. We had a couple questions about people wondering, uh, the types of products. And, and I know right now, Dr. Alex, you've only got one. I, I don't know that you're in a position to hint at what some others might be or how soon, but might be helpful if you took a MI a minute and told us about the product that you have and, uh, what that does and, and what you're doing with it. It might give our listeners a, a better view as to this, you know, the, the niche that your company is gonna fit in the industry.

Speaker 5 (00:29:22):

Absolutely. Absolutely. Thank you, Bruce. Um, so, you know, I think, uh, you know, Albendazole is great because it's a great case study about these sort of bad market dynamics and, you know, sort of the things that have gone wrong, uh, to, to make this drug so expensive. Uh, so, you know, Albendazole is an anti parasitic drug. Uh, you know, it's used to, to treat a variety of conditions, uh, it's actually indicated for, for NACY psychosis, but is often used to treat a wide variety of, of other different parasites, including hookworm, um, and, uh, for, for several indications, you only need two tablets for a complete course. Um, you know, uh, patient takes a pill day one, a pill day two, and their hookworm infection is, is typically cleared. Uh, and in most of the world, uh, you know, each tablet of Ole retails for about 50 cents, you know, it's, it's a drug that's been around for, for decades, way off patent.

Speaker 5 (00:30:16):

Um, but you know, what wound up happening in the us, uh, is as it is a relatively small market niche drug, um, and it was very inexpensive. Uh, the manufacturers of the products, uh, gradually dropped out, uh, and chose not to manufacture it anymore until only one manufacturer was left. Um, uh, and that, and essentially that manufacturer became the, you know, quote unquote bad guy of the story at that point, when they realized, Hey, we're the only person with an active and the, on this product, we can, we can charge whatever we want. Uh, and they did. Um, so, you know, they drove, they brought the price up, uh, dramatically at that point. Um, and you ha and, you know, uh, essentially it came up to $500 for a, for a two pack of a benol, something like that. So, you know, literally, you know, a thousand top percent times, not the thousand percent to 10000% more expensive than in anywhere else in the world.

Speaker 5 (00:31:14):

Uh, and yeah, essentially other pharmaceutical companies saw this and thought, Hey, we can profit on this too. Uh, so the course of the next several years, you had, um, several other entrants join the market for, for veil. And you find that the actual, uh, you know, dead net price of veil has, has dropped precipitously over the, over the last year, two years. Um, but, uh, the list prices is still high. So, uh, who becomes kind of the, the bad guy of the story at that point. Um, so, you know, I, I don't have this information available directly to me, but some, uh, well, some of our, some kindly Pharmac have dropped the knowledge to me that at least last time they checked, um, you know, the list price for, uh, a two pack or per tablet of Alveo, I should say, uh, is, uh, $120 from McKesson.

Speaker 5 (00:32:10):

Um, apologies if that's out of date, but as of about a month ago, it, it, that was told it was accurate. Um, and so, and at the same time, we are able to acquire the ol again, you know, in the context of nondisclosure agreements, won't be precise, but for about $10 a tablet, uh, and certainly McKesson has dramatically more buying power, uh, than we do. Uh, so presumably they're getting an even better price. Um, so, you know, who's capturing that Delta in between the two, um, and yeah, that, that, that it becomes the, uh, it becomes the wholesaler effectively. Um, and if you, and what's true is if you look at, you know, whole, uh, you know, the secondary wholesalers who pass on the true cost for the most part of the drug, you'll find is comparable with our, our product. Um, it's just that price is not publicly disclosed.

Speaker 5 (00:33:06):

So if you are a cash pay patient, uh, you don't know that, you know, I've had patients reach out to me and go, you know, I have been living with hookworm for three years and it's miserable, uh, but I can't afford, you know, $500 to, to treat my hookworm for two tablets of hookworm. Um, and yeah, uh, you're like, wait, this is actually, you know, you can, you can get it for, you know, 20 bucks, like that's, you know, it's crazy. So for those cash pay patients, uh, suddenly becomes very valuable, uh, for there to be an alternative to that product, which is transparently priced. Uh, and that makes up somewhere around eight to 10% of all, patients are still cash pay patients. Uh, and similarly for patients with high deductible plans, uh, you know, their, the amount they're actually paying for the drug, uh, is, uh, is based on the AWP sort of artificial list price.

Speaker 5 (00:34:02):

Uh, so, you know, you have this group of patients that's, you know, paying many times more in co-payments than the drug actually actually winds up costing. Um, so, so yeah, our, our goal is to introduce transparency and help those patients by, uh, basically revealing what the price of the drug act actually is. Um, and having, yeah, having it sold for, for those accurate price points, uh, and, you know, saving, uh, the, uh, independent pharmacies, uh, money along the way by off by offering it that, you know, those true price points, rather than the, you know, McKesson, Cardinal AmerisourceBergen price points.

Speaker 1 (00:34:42):

We have a question from Devon tr that says, so a really good new secondary, and not replacing the big three as a primary wholesaler for independence. I think you've already answered that question. You're really, you know, this is a starting point, um, overnight this isn't, you know, a, a full skew, whole seller per se, but can you kind of address, uh, the plans of the future? And I don't think you would've put in this amount of time, uh, to just have one skew, matter of fact, I know, so,

Speaker 5 (00:35:13):

Yep, absolutely. Todd. So, uh, we are planning to, to scale dramatically and hopefully we'll become, uh, the, you know, a full, uh, competitor or to, to the big three wholesalers at, uh, at some point in the future, uh, you know, how quickly we scale, you know, I'm hoping it'll be, you know, a year, two years rather than, you know, 10 years for, for obvious reasons. Uh, but yeah, we should be, uh, releasing several other, uh, you know, cautiously optimistic about, you know, a hundred other skews. Uh, later this year,

Speaker 1 (00:35:46):

I wanted to go to another question by Michael uh Toko and he said, could you please discuss how you will compete with rebate and discounting and the inflated billing opportunity it provides for PBM health plans and larger chains?

Speaker 5 (00:36:02):

Oh yeah, absolutely. So, uh, so, you know, that's part of, kind of an, an, an active conversation and experimentation that we're kind of playing with. Uh, part of the reason we launched with only a single product was the kind of experiment there and see how the reimbursements, uh, while up working, um, you know, part of our plan. Um, you know, we're very fortunate in that we have essentially a celebrity spokesperson, uh, in addition to a, to large lo you know, in addition to an investor, um, and he can begin the process of kind of like educating the public about why rebates are problematic. Uh, you know, why these things are, are bad. And, you know, if you know, the, the big three PBMs, uh, kind of refer, refuse to play ball, then, you know, he can kind of call them out on that and say, you know, why aren't you honoring the price points that we, that we actually use?

Speaker 5 (00:36:52):

Um, and part of it also, I think, is, you know, partnerships like with, uh, with Kyle, um, you know, hopefully we can work with, uh, you know, uh, honest, transparent organizations along the supply chain pathway, uh, to, to get actual value to the patients and find out who those good actors are, uh, that we can, that we can work with to, uh, to get our, you know, products out there at those transparent price points rather than being forced into, or, you know, what, we won't be forced into it, cuz we just will refuse to play ball. Uh, but who, you know, rather than working with the bad actors who insist on, you know, obscuring the two price of drugs for, for their own interests,

Speaker 1 (00:37:30):

Kyle, I think this is a good segue to, um, you describing, how would you work with a manufacturer who's prepared to be transparent to, with you to build out specific formularies based on disease state or however that may work. Kyle, if you had the ability to, you know, work with a, um, a drug manufacturer, how would your PBM do so

Speaker 3 (00:37:52):

Again, I'll start I'll, I'll pull back just a little bit and, and kind of answer in a, in a more broader way, uh, to also include that answer is the, a PBM unfortunately has become the gatekeeper for, for medications, for medicine, for, for pharmacy and, and they shouldn't be, they should be a conduit, uh, but not a, not a choke point, uh, for, for, for medications. And, and I I've spoken in front of drug manufacturers in front of other PB industry partners. And again, it's, it's Dr. Alex touched on how very few people know what a PBM E even is. And that's, it's quite unfortunate when you're dealing with, with getting drugs to the marketplace, you're dealing with costs, et cetera. We built this PBM as said, my brother and I, along with our, our father is to be, to be not just transparent, but the epitome of transparency, where every decision we make is based upon the, the best clinical interest of the patient.

Speaker 3 (00:38:48):

And then the, the secondary piece of that is we found out is that the more clinically based we are the better financially off the patient and the employer or payer has become. So, so to answer the question, if we find a medications out there that is, that is works better and, or less expensive, it should be, have access to the marketplace. And one of the, and since most people, uh, post Obamacare are, are, have prescription insurance from one way or to another, there's no reason that that a PBM should be a, a choke point and a gatekeeper of that medication to reaching the marketplace. So again, what we do since we don't have a vested interest in what's filled where it's filled, or how it's filled, we wanna put the best clinically foot, our best clinical foot forward. That if, if, if Dr out goes up with a drug that cures cancer, the first question should not be what's the rebate gonna be back to the PBM.

Speaker 3 (00:39:43):

It should be, how are we gonna get this as seamlessly as possible to the, to the consumer, to the patient, uh, as, as, as affordably, as possible as well. And so, again, it's, it's a, it's, it's working with, with Dr. Alex, it's working with pharmacists in the marketplace, pharmacists each, and every pharmacist in the United States should be their own PBM in a way they should be the conduit to talk with employers and people that they service in their areas of, of, of, you know, of how they can save money of how they can get medications to who their patients and how that, that particular pharmacy can service to them. Um, independents are unique in independent. Pharmacists are uniquely qualified to do this. And some may not believe that some may not, uh, even understand how, how to accomplish that with the way to do that is to take PBM technology, to take, to take your degree, if you will, and, and know that you are the one that's making those decisions for those employers, cuz you know that you're clinically based and you're gonna make the best clinical decision on their behalf.

Speaker 3 (00:40:46):

Yes, we're all capitalists. Yes. We want to make money, but you want to know exactly what your PBMs being paid, you know, on a per claim basis on per member per month basis either or again, true transparency. What are their S street do we have out there where you don't know what you're paying for? You don't know what, again, you don't know what you're paying for and you don't know how much it's costing and, and all pharmacists in a lot of ways, all they see is, are negative claims. You know, we see that being a pharmacy owner, owner myself at the end of every day, we all know our print offs at the end of the day or in the morning, we, we all see those negatives or anything under a dollar and we do what we can to rectify those. So what we did is we found if we can control the plan, we can become a PBM and start going to employers and picking off the good pieces that are out there.

Speaker 3 (00:41:32):

This medication over that medication, take this, not that here's the clinical reason why and the potential cost savings associated with it has been life changing for, for countless employers that we represent. And with Dr. Alice coming to us and saying, and, and my, my thoughts, his thoughts together, how do we get this to the marketplace, go to, uh, the good PBMs, get it to the, get it to the marketplace. There's no unnecessary markups, there's no rebate games. And in the end, the patient gets a medication that is cheaper. The employer is paying for a medication that's cheaper and again, the cheaper medications and all the studies out there that the cheaper something is the more compliance and, and adherence that you'll have.

Speaker 2 (00:42:14):

Can I ask a question, Kyle?

Speaker 3 (00:42:16):

Yes.

Speaker 2 (00:42:17):

So in this scenario, I mean your PBM is not likely to be the PBM. That's gonna be a customer coming into any particular pharmacy. Can you address that issue of the pharma, the physician rights for the, the, the drug and the patient comes in with their, uh, PBM payment card. Um, and the co-pay is 50, 60 bucks or whatever, but the cash price is 30 or 40 H how do you, how does a pharmacist deal with, uh, massaging that so that the person pays cash, but they're paying cash less than the copay?

Speaker 3 (00:42:59):

Well, again, I would definitely refer to the laws of your local of your, of your respective states, but I know the state of Ohio, they, they, uh, got rid of any of the gag laws here in the state of Ohio, which has been excellent for the freedom of a pharmacist to, to find the lowest price for the patient. Um, so if, if there are particular Galos, again, I, I don't know specifically where each one of our viewers is, is, is viewing from, but, um, it it's, it is working with the patient, uh, to, to see if they're, again, independence are so much better at this and, and chains cause chains will just take the loss anyway. Um, we, again, we do out with that all week, uh, this week with one of our clients, uh, going from going from Optum to us, you know, we found out that one of the pharmacies that, uh, chain pharmacies, uh, uh, was, was taking between 150 to $200 loss per prescription on a brand name, uh, thyroid medication.

Speaker 3 (00:43:54):

And, and the, the employer was wasn't aware of it, the patient wasn't aware of it. And they're wondering why their costs went up a little bit, but it really, they would be given a gift. And the PBM was the one that was, that was, uh, making the pharmacy take a loss. So again, to your question on defining what is the cheapest price, um, again, I would, I would refer back to the, your local laws, the state of Ohio. We, we make sure that we give the option to, to the patients, um, as a pharmacy owner as well. Um, uh, we run through, you know, any of the options that are out there. And again, if it's cash, it's cheaper than the insurance, which is mind numbing, the fact that that would ever be the case, but, um, I would just have them, you know, run those scripts.

Speaker 4 (00:44:40):

Uh, I, can I jump in just for a second because I think that's a very, uh, uh, good lead in to a point I'd like to make. Uh, I know that Todd has, has had a lot of, uh, interest in helping, uh, communicate, uh, a really important message as has a safe. And that is that the state of Arkansas, uh, passed a law years ago written by, uh, mark Reil, or at least coauthored by Mark Reilly there, uh, to, uh, eliminate those, uh, crazy practices in, uh, in laws that were essentially, uh, encouraged or lobbied for by PCMA to, uh, prevent legally prevent pharmacists from saying to someone at the window, um, your copays, uh, 50 bucks, but the cash price is 20 bucks. You couldn't do that in Arkansas. So the state's attorney general, Leslie Wrightly, who is a great Le leader in this industry.

Speaker 4 (00:45:37):

And, and I think is, uh, running for governor and hopefully will get a lot of people's support because of her, uh, her affinity for community pharmacy and what she's done to help, but they, uh, they passed the law that was overturned by the, uh, uh, by an intermediate court. Um, I believe the, uh, eighth circuit and, uh, the, uh, decision finally made its way to the Supreme court, uh, uh, not long ago, about a month or two ago in a very famous case, uh, called, uh, Rutley versus PCMA. And the, what was at stake was the ability for a state to these practices that were contradictive to independent pharmacy owners and ultimately patient health and patient finances. So what, what happened there was that the, the, uh, Supreme court heard the case and that case, uh, was very rapidly, decided upon months before schedule. And it was eight to zero in favor of supporting the Arkansas law of allowing transparency in that industry.

Speaker 4 (00:46:40):

18 other states are currently considering legislation to do exactly the same thing Ohio's already done it. So, uh, I would focus our attention here as a community, uh, a, a large chain of 21,000 independent owned pharmacies to support NCPA who sponsored and paid for that legislation. And is currently now suing HHS, uh, for some of the exact same reasons about D IR fees. So we have a very active, very successful, very capable group, very long term, longstanding in the industry, E N CPA are safe and other, uh, uh, sponsors. Um, I won't name them because I'm sure I'll leave one out. And I don't want to do that. Have contributed to help that legal defense fund collectively with the, um, audience of a recent podcast for NCP talking about this exact case just before it went to the Supreme court for decision raised over $130,000 to help pay for that legal defense that N CPA is undertaking. They need our financial support on an ongoing basis for the work they do, which is directly germane to the problem we're talking about today.

Speaker 1 (00:47:56):

Thank you for that. Um, I do want to get to some of the questions and realize also based on some of these questions that this is not going to happen overnight. Like the, the business model the we're trying to build, which is not the status quo is going to take, um, comradery. It's gonna take continuing efforts. It's gonna take brainstorming your questions. It's gonna take real life. Um, you know, it's not pie in the sky. We need to boil this down to how it actually operates day to day and month to month in an independently owned, uh, com community pharmacy. So, um, we wanted to a ask Dr. Alex again, are you able to disclose any disease states or any medications that you have on the horizon, um, that you'd be coming out with in, in a, in, in addition to the one that you are, are launching your, your, uh, business model with,

Speaker 5 (00:48:48):

Oh, sorry. I, I think that was part of your last question. And I just got, uh, got lost in my own answer. Um, so we are being relatively confidential about, uh, you know, which products we will release next. And, you know, part of that is competitive and trying not to be boxed out of certain arrangements if we disclose what we wanna do ahead of time, and then bigger actors come in and under cut, uh, sort of thing. Uh, but, you know, I think it's not so much disease states. We're looking at it's more individual opportunities to, to benefit patients be that, uh, you know, diabetes, cancer, cardiovascular, um, you know, uh, antibiotics, anti and infectious disease medications, uh, you know, think we look across all those sort of product portfolios and see which individual products, uh, you know, for our initial launches, uh, will drive the most value to, to patients and to help systems, uh, rather than, you know, saying we're gonna be a, a diabetes company per se. Uh, so it's less so it'll, it'll probably be across states. Um, I do think itself safe to say that, you know, a disproportionate amount of these products tend to be in infectious diseases. So that'll probably be a significant number of them. Um, but you know, it it's, uh, it's actually gonna be pretty broad, I think.

Speaker 1 (00:50:07):

Thank you. So I'm also, um, wondering we have, have, uh, a pricing question from Devon uhone again, he says, will these, uh, drugs become the new w and then submarine those who do not get the, uh, drug from cost plus. And the reason that he, he said this is, he says, I'm worried that the big PBMs will include those prices for reimbursement and pharmacies not buying from cost plus maybe, uh, Sol, um, they will for sure be selling the drug below cost. So there's gonna be aggressive tactics. I'm sure Dr. Alex, that you're already aware of. You've actually told me on the previous podcast about organizations already trying to buy you out from the very beginning, um, in going directly to, um, Mr. Mark Cuban, uh, to try to kill this before it even grows into something. So I think there's worry here, but can you kind of address, um, the concern of, of, of the question?

Speaker 5 (00:51:05):

Sure. And, uh, you know, I think, uh, paradoxically, it might actually wind up working out the other way. Uh, so the products we don't make, uh, you know, effectively, we, you know, if I'm being intellectually honest about it, we're revealing the prices we're sending them close. Uh, remember I was talking to a academic pharmacist, uh, in California and he's like, how could you possibly do this? Like, uh, like this, you know, he just didn't believe me that we actually had these prices and weren't losing money. He was like, you know, uh, like it's this a scam of some kind. I was like, no, we're actually affiliated with mark Cuban and you know, all this stuff, but, uh, you know, why, why I say that, uh, is, you know, intrinsically the other companies can actually undercut us, uh, if they want to, because we're buying from them and adding our margin on top of their margin.

Speaker 5 (00:51:54):

So if anything, you know, what we've seen with Alend is the NADAC listed price has dropped approximately 50% since we went public. So I think what'll wind up happening is the cost to acquire these pro what I predict will happen. And, you know, we're still seeing it playing out in real time with our first product is the actual cost that you guys, as pharmacists will wind up paying to anybody would be that, you know, mark Cuban cost plus, or, you know, any, any of the other wholesalers, uh, I think that pro or other manufacturers, if you purchase direct from them will drop down precipitously, uh, after we bring out these products. So the people I think will, will wind up hating us are, you know, the one, the people that can no longer afford no longer charge those, you know, exorbitant markups as intermediaries in the supply chain.

Speaker 5 (00:52:39):

Um, but you know, I think if anything, we will, you know, and this has, this is a business problem for us and ensuring sustainability, uh, is how do we actually remain, how do we remain competitive on price, uh, after we reveal what the prices actually are, cuz we can be undercut on those prices. Uh, and you know, there's various solutions we we're going to experiment with with on that. But, uh, but yeah, I actually think it's the other way around. I don't think, uh, you know, the, the big manufacturers will, you know, uh, that we will demand everyone in our path. I think it'll be the other way around to be honest. Uh, but just things will be more honest into transaction process.

Speaker 1 (00:53:18):

So I'm gonna ask, um, the audience to, to give me this answer, if you know this answer and of course I'm opening this up to the panel as well. We know of another company that is also, uh, doing a direct, um, relationship with community pharmacy, Medicare out of Canada bought Marley drug, Dave Marley's, um, pharmacy out of North Carolina and Marley drug was mail service pharmacy that had license in all 50 states, which was very strategic of Medicare to be able to distribute their medication through Marley drug, which was brilliant. And, and, and we applaud that. So mark Cuban cost plus drugs is not necessarily the first, but does the team, does the panel know of any other manufacturers who know who are now also going in the direct, um, the direct, I don't wanna say direct to consumer, but the, the consumer being the community pharmacy, but to direct, to, to pharmacy model so that we can stay ahead of this.

Speaker 1 (00:54:21):

And the reason why I have this panel put together and the way, the reason why we have, um, you, you know, um, pharmacy owners involved in this on live is because we wanna get ahead of this. We wanna embrace, um, models, like, um, like Dr. Alex's company and Medicare, and really build this, you know, this, this coalition so that we can encourage this. I mean, we have to encourage this so that we, we can be, um, patrons, we can be, um, partners and that we can get other organizations saying, wow, there's a business model here to cut out the status quo and to really start partnering with, um, 21,000 as, um, as bill, um, alluded a 21 would be the largest group of pharmacies in the nation if we did. So. So, um, you know, our strength is that we're independent. Our weakness is that we're independent. Um, that's always been the, the ebb and flow, but, um, does anyone know of any other, uh, companies other than Medicare or Markus, uh, mark, uh, Cuban cost plus drugs, uh, that is a, a manufacturer going directly to pharmacies. I don't see any notes in the, in the, but bill or Ken or I'm sorry, uh, Kyle or, um, or even Bruce, have you heard of any other companies other than Medicare or, um, or Dr. Alex?

Speaker 2 (00:55:47):

I have not. I have not.

Speaker 6 (00:55:50):

No,

Speaker 2 (00:55:53):

The, uh, you know, with, with that said the, the pitch that I would put in here for Dr. Alex to contemplate, um, is, uh, I, I think in a previous conversation we talked about, uh, many people could benefit from this particular or drug, the one you have now, but the cost is prohibitive. Um, but yet if physicians knew that there was a, an affordable version available, they could write increasingly more prescriptions. And what I would wonder about is, is what tools you might be able to give to pharmacies to approach their physicians, to increase the prescriptions so that people can get care to this terrible. Is there, is there a business model that you foresee where you would, uh, encourage perhaps even compensate and have no idea what the legalities around that would be, but it, it get pharmacists to build demand?

Speaker 5 (00:56:57):

Oh, no, that's, that's really interesting, Bruce. Uh, so, you know, uh, you know, obviously within the context of stark laws, you know, um, yeah, you know, we, we have to always consider that. Uh, but, um, you know, we have had, we have been doing direct physician outreach as well, uh, to change prescriber models. Um, you know, and in particular, amongst the, for Ole specifically, let's say among the, uh, physicians that prescribe specifically, uh, that specialize in parasitic diseases is a relatively small community. And in most of these, uh, rare, hot, uh, rare disease orphan disease categories. You find that there are sort of subs, subspecialist doctors, and generally in a relatively small community, which really focus on these individual patient communities. Um, and it's pretty easy to reach out to the them. Uh, generally they struggle with this, uh, these problems significantly like they, their pro you know, all of their patients, uh, have this problem with affording their medications.

Speaker 5 (00:57:54):

Um, so in terms of, of drug I, in terms of growing the actual market for these products by, uh, by decreasing their cost, I think that, uh, you know, absolutely a possibility, um, you know, I think, you know, for example, you know, to take a example from the J the branded drug world, you have, uh, Aldi, so, you know, to cure for hepatitis C, um, and, you know, clearly the market for that is everybody with hepatitis C at the moment. Uh, but, uh, everybody with hepatitis C doesn't it, because it's, you know, it is so expensive that it would bankrupt health systems, um, to, uh, to actually, you know, to actually make it, uh, for available to everybody simultaneously. Uh, so, you know, can you move things on the supply demand curve, uh, to that inter to that intersecting X point? I do think where we're at a point, uh, on the, the supply demand curves, uh, for several products where, you know, the market is not what it is because, uh, the cost, the supply is low, the cost is too high. Um, and, you know, can we move that back? Uh, I think that's very much a possibility.

Speaker 2 (00:59:04):

Thank you,

Speaker 4 (00:59:06):

Dr. Alex, could, could I ask you question? I'm not sure if you're free to talk about it, but, you know, mark Cuban is, is the, is the, um, celebrity behind your, uh, your moving forward here? Uh, I'm wondering if you could talk about his interest and passion in the space and his commitment to what's happening here, because it always takes, you know, there's a lot of little guys in this equation. Uh, he's not a little guy.

Speaker 5 (00:59:33):

Yeah, no, absolutely. Uh, thank you, bill. Uh, yeah, you know, it's, it's been surreal, I'll be honest. Uh, so, you know, if you've ever watched his, his TV show shark tank, um, you know, you hear, uh, over and over again, uh, this description that they work really closely with their portfolio companies, um, you know, they, they help 'em very directly. And at first, you know, as a, you know, jaded viewer of reality television, I figured that was, you know, just what they say for a good story. Uh, you know, cuz you know, I had, I'm sort of a serial entrepreneur, I've run companies in the past. Um, and generally, you know, you, you get investors and they give you, uh, their investment and you know, they offer to help and you know, generally they do, they make connections or whatnot, but for the most part they disappear and, and that's actually a best case scenario, you know, and sort of a nightmare is, you know, if you get a, an investor who gives you a really hard time, but you know, I've, I've been very fortunate.

Speaker 5 (01:00:25):

Um, had good investors who sort of give me investments disappear and then are happy to cash out when, you know, the company is eventually sold. Um, not necessarily what we're planning here, you know, we have no plans to, to sell the company at real, really any point that would kind of defeat the purpose. But, uh, but yeah, my a is, has not really been like that at all. He is very involved, very personally passionate about it. You know, I certainly don't wanna speak for him, but you know, he's involved in company operational decisions on at least a weekly basis, if not, you know, emailing several times a week, uh, about what is going on, helping with, with sorts of things. So, you know, what they projected on the shark tank TV show is actually true. The investors are actually very involved in day to day operations of the portfolio companies and uh, frankly I'm flabbergasted.

Speaker 5 (01:01:14):

He has that much time. I have no idea how he manages his life, uh, between all the different things he's, he's got going on. But, uh, you know, it's one of those things I always feel bad because when I take like a couple hours to respond to an email or out forbid a few days, uh, because he always turns things around within five minutes, regardless of when you email him day or night. Uh, so yeah, he's, he's, uh, at least my impression is that he's very passionate about these issues and very personally invested on multiple levels, uh, in the outcome of, of, of what we're doing.

Speaker 4 (01:01:45):

And how did you guys come together for my desk?

Speaker 5 (01:01:48):

Oh, I, uh, I called emailed him, you know, uh, he has, uh, an email account M Cuban gmail.com. Um, and you know, I sort of emailed on a, on a whim, uh, not really expecting anybody to read it. Uh, but, uh, but yeah, no, he personally reads all the emails that come in. Uh, and if people pitch him, uh, you know, uh, you know, uh, it's not like one of his minions, uh, he personally reads all, all the emails. Uh, again, I have no idea how he has the time. Uh, apparently he get, I think he, I saw him on an interview somewhere say that he gets like two, 300 cold pitches a day, uh, and God bless him. He goes through 'em. Um, and, uh, yeah, and I know that because some of the healthcare related ones, he forwards to me and it's like, what do you think of this one? Uh, so yeah, I think he, so yeah, uh, know he read the email, uh, invested a small in the entity at the time, uh, which was called OSHA's affordable pharmaceuticals and yeah, it just became more and more enthusiastic, uh,

Speaker 7 (01:02:49):

Great story.

Speaker 1 (01:02:50):

I wanna go back to a question about, um, what Bruce had to say about marketing this, uh, service. And I think, you know, we start with a Grasso it's effort, you know, there's, uh, there's 200 plus that initially started out listening to this presentation and there's another, uh, probably thousand to 2000 over the next course of 30 days who are gonna consume this via the pharmacy podcast network. So let's just take the 200, if you 200 pharmacist com uh, we're committed to educating your physicians, that you now have a service that's gonna save money for their patients based on a disease state, based on ringworm, for example, um, that could create orders, which is going to accelerate this. So I think this is we have to start off grassroots. We have to look to the community pharmacy, um, to the community pharmacy, um, as the educators, uh, to the physicians and to the patients, uh, letting them know that there are options in this specific category and then just accelerate that, um, I'm 48 years old.

Speaker 1 (01:03:56):

You know, I hope to be around in this business for another 25, 30 years, uh, God willing, and I'm gonna continue to beat the drum. Um, as the stars of the show are the community pharmacy owners, and they are passionate about their communities. They're passionate about their patients. Um, and I'm gonna fight the message and, and do everything I can to get it out, but that's not as powerful as 200, uh, additional of voices or 400 or 500 to 2000. And then coming back to what Bruce said, 21,000, you know, pharmacists, uh, imagine if you threw the magic switch overnight for every ringworm case, um, that we could flood orders to, uh, Dr. Alex's, you know, website for that medication, um, going to increase, and that's going to start the ball rolling to get other NDCs and other, uh, medications on the list and get, um, that acceleration.

Speaker 1 (01:04:51):

But, um, we have to start somewhere. So, um, you know, are we, are we saying that this is the magic bullet and this is gonna solve all the problems of community independent pharmacy? Absolutely not. But I am saying that this is a new model. This wasn't here a year ago, it's here right now. And I think we need to concentrate on it and start if we're ever gonna make man, you know, monumental changes, we're gonna have to take this in stages and we're gonna have to support Kyle. We're gonna have to support bill and his company. We're gonna have to support, uh, listening to these podcasts and forwarding these podcasts. We're gonna have to support Dr. Alex. So, uh, this is about supporting each other. We're supporting you and we expect that you're gonna support us as well. And, um, that's what my call will be to the audience today is, is, is send Dr.

Speaker 1 (01:05:38):

Alex your, your contact information, tell him that you heard this podcast, tell him that you were on the panel, tell him that you were part of this audience, ask questions. You know, it let's be as transparent as possible, um, share your, your frustrations with me or fr or Bruce, Bruce. And I both have mammoth, um, network and connections back of what we can help you. I wanna help you. I wanna help every, every single independently owned community pharmacy out there some way somehow. And the so does Kyle Kyle is so, has soaked since he can remember. He can't even remember not being part of community pharmacy his entire life. So there are champions on this call and we need to continue, continue to build out, um, this coalition and this list and these strategy sessions. Um, next month, we're gonna have Medicare on, we're gonna have, um, Dave Marley and Medicare on, and we're gonna do this thing all over again. And I wanna build this, I want this to become a collective and a thought leader, um, way of thinking together so that we, we can make, um, sustainable, scalable changes to, um, to supporting community pharmacy.

Speaker 1 (01:06:47):

I know that we have a couple more questions. I, I did wanna ask from Devon. Conley has asked why is Mac pricing necessary? Transparency into Mac lists is nice, but what isn't the using maca necessary? If a RX, uh, could use the N a D a C um, Kyle, did you wanna answer that?

Speaker 3 (01:07:08):

Um, yeah, the, again, uh, I think Mac still had to be involved just to make sure that pharmacies are still buying correctly, not necessarily for the, the Dr. Alex's of the world, but to make sure that it's fair are to the, to employers. Um, very rarely do, um, uh, pharmacies in our network get, get maxed per se because, uh, uh, because of the PBM activities, because, uh, they're, they're buying poorly, um, uh, either from their, they bad deal with their, their PS AO or their, uh, uh, wholesaler that they're currently, uh, working with. Um, but we do make sure that, especially with our acquisition plus model, that each, each pharmacy is profitable every time a patient walks into the door and they, and a claims process, but we also wanna make sure that employers are not overpaying for, for medications, uh, because there still are bad actors out there and in the pharmacy space, um, in independence change regional chains to make sure that our job as, as the manager, um, uh, we're looking out for everyone. Um, and so the, and we all know, I think all the pharmacists know out there that, uh, you've had reimbursements, uh, when brands go generic of hundreds, if not thousands of dollars, if that's because the PBM hasn't updated their system yet. And, um, and we make sure that we monitor from both sides of the angle. So pharmacists are reimbursed a fair price, and then, uh, the, the employers are, are charging the same amount as well. So again, back to that price transparency,

Speaker 1 (01:08:38):

Thank you. We do have, um, another question. This is, um, coming from, uh, Patrick lave, and he said, are you planning to bid on GPO contracts, group, purchasing organization contracts to get your product out there faster and become more competitive quickly? And because of your model, will you then offer your products to all GPOs at the same price without backend discounts or charge backs?

Speaker 5 (01:09:13):

Uh, it's a short answer. Yes. Uh, yes, all of the above. Uh, so in particular, the want products that we are actually manufacturing through our, our sterile fill finish facility, a lot of those, uh, you know, are actually directed to the inpatient, uh, hospital space, uh, rather than to the retail space. Um, so there, it makes, uh, a lot of sense for us to go through the, through the GPOs, um, uh, again with full price transparency, uh, to the buying groups. Uh, so, you know, we operate through a third party logistics firm and that is quite expensive. Um, so to the extent that, uh, you know, we ask that they charge the same wholesale price, no matter what we do, uh, to, to everyone who buys, uh, but to the, the extent that they can save us, um, you know, money in terms of that expensive, you know, shipping and distribution part, you know, they can capture that Delta, but so long as every, no matter who sells the drug to at the wholesale level charges, the same price, uh, you know, we're basically okay with it. Uh, but again, um, you know, insisting on price transparency along the way, whether that's our three PL that does the logistics or another wholesaler that does it for us in terms of a buying group, so to speak, right.

Speaker 1 (01:10:30):

Oh, very good. There's an interesting question from Alex Alexander MLO, who said he owns four retail, uh, pharmacies in one long term care air pharmacy, and he's associated with the McKesson health Mar franchises. And he wants to take advantage, of course, of, of any of these buying opportunities. He has, uh, been bound by performance metrics that are contract based, which require a certain percentage of purchases through McKesson. Um, and I know where he's going with this. He will wants to know, you know, how will this impact and affect him. And my comment is, you know, health Mar and McKesson have a very tight relationship, but, uh, ne is it Neish Javery or ha Hava, uh, Bruce, I can't remember, but, uh, Neish, uh, Hava is, is their CEO, their president he's very passionate about community pharmacy models are changing. The old guard is going away. So if organizations like health Mart, a, um, which could be looked at as kind of like a buying group that, that wanted to get involved with this in order to stay ahead of the progression of this coming Medicare and cost plus drugs are not the, are not going to be the last manufacturers that are gonna enter this market because, um, because the competitive, the competitive nature of what's to in place.

Speaker 1 (01:11:54):

So I would say, um, to Alexander, you need to write a sincere, uh, letter, uh, or email, um, or I actually say letter, you wouldn't believe people open mail more than they do email, by the way, that's a, that's a trick that you can do. You send them a physical piece of mail and they'll open it. Um, but if you send him an email, I have that guy's, uh, email address, send him an email directly, and let's just cut out, you know, the, the bull crap and just start saying, Hey, are you gonna be open to the evolution of what's happening in the drug manufacturing and distribution marketplace? Um, and you would, uh, strongly suggest that health Mart, um, pay attention to, um, what's happening in the marketplace in order for the survivability and, and viability, um, for, uh, community pharmacies. But thank you for that question.

Speaker 2 (01:12:43):

Let me, let me jump in because I am the wholesaler in the group. So, um, uh, I, I know that, uh, Dr. Alex is aware of these performance, um, uh, creeks and the, and the rebates he's made mention of that. I, I would ask whether he's, uh, in, uh, thinking about aware of, or investing in the technology, that it would allow people to, uh, know whether they are open to buy from his, uh, from his company at any particular killer time. Um, I know there's a number of companies, uh, you know, uh, uh, uh, specialty distributors who specialize in that kind of stuff. And just wonder if Dr. Alex, are you aware of that technology and are you open to looking at it?

Speaker 5 (01:13:31):

Oh, yeah. Most, uh, most definitely we're, you know, open to anything at this point, you know, still despite, uh, our bravado still an early stage company. So anything that, uh, yeah, really, really helps us, uh, get through, um, though, you know, at the end, you know, I think our end goal is to get rid of the performance metrics, to be honest, uh, cuz you know, that's just another way the sort of pseudo monopolistic and entities keep their pseudo monopolies. Um, so you know, how do we break through that entirely? Uh, you know, that's the, you know, high level, you know, ambition rather than to just, you know, play within those rules and get help people get around them. It's just, uh, you know, uh, I don't know how many people watch watch game of Thrones, but you know, to, to break the wheels, so to speak, that's, that's keeping everyone, you know, sort of trapped in these, uh, sort of bad market practices. Um, so, uh, so yeah, certainly something we, we consider, but uh, but you know, I think our, our longer term ambitions are, um, you know, to, to just get, you know, find a way to get, get the performance metrics out of the system. Basically.

Speaker 2 (01:14:37):

Good, good answer. Thank you.

Speaker 1 (01:14:42):

What else there are other questions coming in. Um, you know, I, I'm excited that this is even happening. I think it gives us, I think this gives us all hope that my models are coming and players are coming into the marketplace to, to disrupt, uh, what is the status quo? And as, as I'm a, I'm a faithful, um, participant and a faithful partner to community pharmacy, to those that empower community pharmacies like RX safe and like app ORX, uh, they're so important to, to continue to, to come up with events like this, as well as thought leadership and round tables. Um, we're gonna continue to do these. I wanna do one of these once per month to bring on subject matter experts and leaders that are doing things differently, not just the status quo, not something that's already been, uh, thought of. And like I said, uh, next month on, on April 6th, we will have another one of these we'll be interviewing, um, Medicare and, uh, and Dave Marley, who's just a phenomenal, um, owner, uh, of a, of a community pharmacy Marley drug started, uh, pharmacist United for truth and transparency, um, put, uh, in, in there to just a, a, a fighting organization for the advocacy and, and, and promotion of community pharmacy, and the, the, the ability to just run your businesses without having to have some fee come back two, three months later, um, you know, in the form of a, a D D I R fee and the, the frustration that that brings.

Speaker 1 (01:16:12):

But, um, I wanna ask, uh, Dr. Alex, would you, um, give us a way to, to do some follow up with you, whether that be either through email or maybe even if we collect a bunch of questions that we can get to you, and then I can easily create a distribution mechanism to get that information out so that you don't have, um, you know, hundreds or thousands of, of E emails coming in. Um, obviously the pharmacy podcast we're producing content six days a week, so it would be easy enough to just have you back on, um, the show to, to answer a lot of these questions, but I see a couple emails coming in. If you want to send questions to us, you're more than welcome to do that. Like I say, I, I fight for not only pharmacists, but community pharmacies every day. Um, so you can send it to publisher the word publisher@pharmacypodcast.com.

Speaker 1 (01:17:04):

Uh, once again, that's publisher@pharmacypodcast.com, but Dr. Alex, we'd like to stay in touch with you. We would like to support you continue to really promote some of your messaging. Please keep in touch with us. Um, Bruce neon is just a, an, um, you know, a megaphone out there with his show. Matter of fact, I could see Bruce having you on, uh, pharmacy crossroads, um, also staying in touch with Kyle and the fields family of what they're doing, um, with the transparent PBMs. And I think there's some insiders information and knowledge that they have that could, that could help, uh, cost plus drugs. And we wanna do everything that we can to, um, to support this model and future models, um, like this, uh, Dr. Alex. So thank you.

Speaker 5 (01:17:50):

Well, thank you, Todd. Uh, you know, I, I really wanna echo what you say is that, uh, you know, I, I think it's gonna be a coalition of, of good actors that are really gonna be transformative and, and break down these systems where people who are not involved directly and in patient care are the primary, be beneficiaries capture the most value. Um, you know, I know that a lot of the frustrations I hear from, from independent pharmacists, uh, you know, believe it or not, you, you get the exact same frustrations from the other end of the market, from the generic drug manufacturers, even from the branded drug manufacturers. I was talking with the, the CEO of a large branded drug company, uh, last week. And, you know, it almost surprised me that he's like, yeah, I hate the, you know, uh, the rent seekers in the market, you know, they're capturing a lot of this value and yeah, it should be the independent pharmacies that are making more money.

Speaker 5 (01:18:39):

It should be the pharmaceutical. I know this sounds weird for me to say, given our messaging, but the generic pharmaceutical companies should be making more money. Cuz they're the ones taking the Val, taking the risk CA you know, doing all work. Um, you know, you, uh, independent pharmacies are the ones that are, you know, caring for the complicated patients. Um, so, you know, but, uh, you know, no one entity is going to be able to, to do enough things to really break through the system. So it's really all about joining forces and, and having these con conversations and collaborations going forward, uh, where we, we build things together. And, uh, yep. Uh, I do apologize, you know, I put my public E email out there, but, uh, you know, especially right after we went public, we were getting, I was getting like 10, 20,000 emails a day. So, you know, my, my response times have not been great. Uh, so, uh, so yeah, I think that's, that's brilliant, Todd, uh, if you'd be able to do that, uh, sort of aggregate questions altogether for, for us to communicate.

Speaker 1 (01:19:36):

Absolutely.

Speaker 4 (01:19:37):

So Todd it's, uh, it's very simple. It's just restore a free market to the space with visibility and transparency. And, uh, and we'll go back to where we were pre PBMs and pre PCMA where farmers earned a good living and deserved it. And so did the generic manufacturers, uh, this is a scourge, you can't call it anything, but that it's an accident that happened through, uh, unintended consequences from, you know, legislation. And, um, you know, we, we now have a problem because of the size and the lobbying capability. Um, you know, PCMA is putting up billboards in these 18 states, considering legislations actually say the independent pharmacy owner is the reason you have high drug prices, it's unconscionable. They will do anything to maintain the greed they have in the space. They need to be stopped. And so for every, everyone with a courage and mark Cuban in particular to stand up and try to write the ship, uh, you have my heartfelt thanks.

Speaker 5 (01:20:45):

Yeah, bill 100% agreed. You know, the system is madness and yeah, the status quo cannot hold. Um, you know, for, uh, you know, it, it's not gonna be easy. It's gonna be a, it's gonna be a battle, but, you know, uh, the more, the more people we can have fighting by our side, the better

Speaker 4 (01:21:04):

We have a unifying force here, guys, we have 21,000 in our group. We're the largest chain in the world. And if we unite and focus on this problem, we will achieve success.

Speaker 8 (01:21:18):

Great,

Speaker 1 (01:21:19):

Answer a question. This is being recorded. We ask that you forward this to a fellow pharmacy owner. We ask that you forward this to, to, um, even a state legislator, somebody that doesn't understand how this works. And I think a explanation in some of the information that Kyle shared was very important. I think things that bill has said will resonate and make sense. And I think, like I said, this is a jigsaw puzzle. And if we can put this together, it's gonna be very powerful as we move forward as organizations and, and people that are committed to community pharmacy, but ultimately working for the patient to ensure the patient's getting, um, a, a fair cost of, of drug and that they can go to their community pharmacy with the questions that they have. They're very worried and, um, and get the answers and, and continue to build the trust that the community pharmacy puts in place.

Speaker 1 (01:22:12):

And I think that, like I said, I started, I started this presentation in this webinar with the word transparency and trust, and I wanna end with it that way. Remember that, um, that's what it, where this really all comes down to is, is trusting each other. And, uh, there's no reason that we can't be so successful in this. Um, but we have to help each other. We have to be there for each other. Um, I wanna thank, uh, Kyle Fields and your family for the years of service that you've put into this marketplace and, and with your heart and your blood, sweat, and tears, literally. Um, uh, thank you, Kyle. I wanna thank, um, bill Holmes and Brady for hosting this event in helping the pharmacy podcast network to reach as many, uh, we got over 500 responses to this event, which means that there's lots of interest in this.

Speaker 1 (01:23:01):

Um, I wanna thank Bruce Neland for being a champion and someone who I look up to as a, as a conduit of information for community pharmacy. And then finally our special guest, Dr. Alex, thank you for being available. I know how busy you are, and I just wanna let you know that the community pharmacy is keeping an eye on you. And, um, the pharmacy podcast network will be here as a, as a me go phone for you so that we can continue to get, uh, this messaging out. Every time you guys come up with a new NBC, we wanna be able to tweet LinkedIn, Instagram, Facebook, and push out the messaging of, of what you're doing so that we can get it in front of as many community pharmacy owners as possible. I wanna say, thank you. Thank you, you to all everyone. Thank you, Kyle. Thank you, Bruce. And thank you, bill and Brady and thank you, Alex.

Speaker 9 (01:23:53):

We're. You're welcome wrap. Appreciate it. Thank you. Back,

Speaker 1 (01:23:56):

Uh, April 6th, let everybody know. April 6th. We will be back talking with Medicare.

Speaker 10 (01:24:02):

Thanks. Thank you guys. Thanks everybody, everyone.