Transcript
Kristin: [00:00:00] Hey, will. Hey, what’s up? I’ve been thinking the US healthcare system, it needs some improvement.
Will: Yeah, it’s, it’s, there’s room for improvement for
Kristin: sure. Yeah. It’s a confusing, scary place for everybody involved.
Will: Absolutely.
Kristin: Physicians, families, patients, everybody.
Will: Everybody. And I’ve experienced it from both sides, right?
I’m a physician. I’ve also been a patient, so I wanted to use my platform to give people practical education, really the only way that I know how by making jokes. So, Dr. Glaucomflecken really fun and super uplifting. Guide to American Healthcare is out, and it’s a free resource that includes all my videos from the 30 Days of Healthcare series, alongside deeper explanations, also reliable facts.
Emphasis on reliable. Yes. All right. Uh, uh, figures, uh, numbers, insights into how each of us can fight for a more humane, better healthcare system. Also it has jokes. Did you mention the jokes? I did. I [00:01:00] jokes. Okay. Yes, definitely jokes. Well,
Kristin: this guide is great for anyone looking to learn more about US healthcare, but especially if you are experiencing it from the clinician side for the first time.
That’s right. We really hope you’ll check it out.
Will: Get the free guide sent straight to your inbox by signing up for our mailing list. Glaucomflecken.com/healthcare. Enjoy.
Kristin: Knock knock,
knock, knock. Hi,
Will: hello and welcome to Knock Knock. Hi, with the Glock Flein, I’m Dr. Glaucomflecken, also known as Will Flanary.
Kristin: I’m Lady Glock Flein, also known as Kristin Flanary. That’s
Will: Pharmacy Day. What’s your experience when you go to the pharmacy? Do you have any idea how much you’re gonna pay or something when you go there?
Kristin: No idea. Me neither whatsoever, neither in any healthcare setting. I just, for anything
Will: that’s true. It’s like, it’s just kind [00:02:00] of like, I just tell me what, what I owe and I’ll just,
Kristin: I mean, like, I gotta have the, well, you know, I gotta have, gotta have thing, gonna have to pay, gotta have
Will: a thing. Uh, and we are learning all about what goes into that payment.
Yeah. And guess what? It’s not great for the pharmacists
Kristin: or the patients
Will: or the famous or the, or the patients or the pharmacists, the patients. It’s not, it’s not good for anybody but the PBMs, it turns out. Yeah. So before you start blaming the pharmacists. Mm. Or the physicians mm-hmm. Selfishly, I’ll put them in there before you start blaming those people for what you pay at your pharmacy.
Mm-hmm. Listen to this podcast.
Kristin: Yeah.
Will: Because turns
Kristin: out there’s some man, it’s stuff going on.
Will: Yeah. Under the surface, this, these purposefully, uh, a shadowy organizations, these pharmacy benefit managers, the, the health insurance companies, they’re, [00:03:00] they’re, they’re all in cahoots. Yeah. And, and they, um, turns out, yeah.
And so listen to what we we’re talking to Deborah Keaveny, who’s president of Pharmacist United for Truth and Transparency Hut, PUTT, uh, which is an organ, a nonprofit that’s doing a lot of great advocacy work on trying to just get the word out about what’s happening to independent pharmacists and just pharmacists in general.
Kristin: Yeah. And patients, and then by Yeah, by proxy patients. Yeah, exactly.
Will: Uh, because it’s, it’s a lot of things are not going well. A lot, some things are going well, the tide is turning a little bit. Yes. There’s more, more attention being paid to the, the issues afflicting pharmacists and patients. You know what it reminds
Kristin: me of there?
I, there’s just so many parallels. It’s like they’re following the same business model. Uh, PBMs are, oh, let’s do SAT, PBMs are two pharmacies. What prior authorization slash all that stuff
Will: Yeah.
Kristin: Is [00:04:00] to physicians. There, there,
Will: there is some overlap for sure. It seems
Kristin: very parallel.
Will: I I will say, I think certainly the PBMs are just way worse.
Kristin: Yeah.
Will: There are so much more evil. And what and how they, they do their job and Yeah. But I think like
Kristin: if you’re a physician listening, you’ll recognize a lot of these tactics from the prior auth world.
Will: And this, this episode really drives that home. Yeah. So, um, uh, uh, Deborah Keaveny, great person, great interview, uh, a lots of of amazing insight into this issue.
And so, um, and a lot
Kristin: of really good advocacy work. Yeah. They’re working hard and making progress.
Will: Check out, check out truth rx.org and you can find lots of great educational resources about like, what the heck is at PBM, uh, all the all and, and, and like any legislative efforts that are going on.
Kristin: Yeah. And
Will: so, uh, let’s get to our interview.
Kristin: Let’s do it.
Will: Here’s Deborah.
Hey Kristin. [00:05:00] Hmm. I know I like to talk to you about the little dex mites. Mm-hmm. And little tiny guys. Mm-hmm. Thought we could give that a break and just talk about the, the eyelid disease that they cause when there’s an overgrowth of Dex
Kristin: I like that idea. No mite talk.
Will: So dex blepharitis it, it gets missed, it gets misdiagnosed, uh, because a lot of the symptoms overlap with other eye conditions.
Kristin: Mm. Okay. So what are the top symptoms that people should be looking out for?
Will: Itching, swelling, irritation of the eyelid margin redness.
Kristin: Mm. Yeah. That kind of sounds like it could be allergies or something else. Exactly.
Will: It could be a several different things, but the key is if your doctor spots little crusties, that’s, they’re called collarettes, but you know, they like little crusty technical term.
Exactly. Uh, then, um, uh, that’s dex blepharitis. You just know it.
Kristin: Hmm. I like that there is a clear sign to know.
Will: Yep. And once you’re diagnosed as a prescription eye drop treatment. Available for Dex Blepharitis. Whew.
Kristin: That is good to know.
Will: To [00:06:00] learn about the common symptoms of Demodex blepharitis and more visit mites love lids.com.
Again, that’s M-I-T-E-S-L-O-V-E-L-I-D s.com. To learn more, this ad is brought to you by Tarsus Pharmaceuticals. Kristin, I gotta tell you about a new podcast that every clinician should know about. Good.
Kristin: Tell me.
Will: This is the sepsis spectrum. Okay. It’s by the Sepsis Alliance and Critical Care Educator, Nicole Kic.
This is really important. Each episode is about confronting blind spots and sepsis and antimicrobial resistance education. A lot of this stuff usually doesn’t make it into textbooks or compliance training.
Kristin: That’s weird because it’s super important.
Will: Yeah. Everybody needs to know about this stuff. You can listen to the sepsis spectrum wherever you get your podcast, or watch it on the Sepsis Alliance’s YouTube channel.
To learn about how you can earn free nursing CE credits just by listening. Visit sepsis podcast.org.
All right. We are [00:07:00] here with, uh, with pharmacist extraordinaire, Deborah Ke, thank you so much for joining us.
Deborah Keaveny: Yeah, you’re welcome. This is gonna be fun.
Will: Yeah, I, I’ve got, um, I don’t even know how we’re gonna get to everything. We’re gonna try to, but I, I just have a, a lot of questions about pharmacy, about, um, about GoodRx.
I wanna make sure we talk about that. Uh, PBMs, they just, uh, so many things and, and what my goal for this episode is, uh, is just to, to demystify like pharmacy for people. I want, I want the public, I want people knowing both the public and healthcare professionals, uh, to, to understand the, the strain that pharmacists are under right now.
What, what the, the pain points are and uh, and, and how that kind of relates to just the healthcare system as a whole. Uh, that, that’s an easy thing to do [00:08:00] in like half an hour, right?
Deborah Keaveny: It is not, but we will do what we can.
Will: Um, I I figured a, a good place to start might be PBMs. So the topic of, of pharmacy benefit managers, this is something that, you know, I’m a physician.
I didn’t, I’m not even sure I heard the term pharmacy benefit manager until I was already out in practice. And I think this is a, a big disconnect between like the world of pharmacy and the rest of healthcare is, is like, is, is just the understanding of, of everything that goes into a. To, to, you know, uh, paying for medications, dispensing medications, all the people that have different, their hands in different parts of it.
So if you could, uh, let’s start though. Let’s just talk about pharmacy benefit managers. ’cause I know you’re, you’re, you are, you know a lot about the history of pharmacy benefit managers, um, and [00:09:00] how it’s changed over the years.
Deborah Keaveny: Certainly. So pharmacy benefit managers, um, have actually been around for decades.
And initially they were transaction companies that, uh, facilitated getting a pharmacy paid for the prescriptions that they dispense. So think of it like a MasterCard, visa. Um, you charge something, money’s due, money gets to where it’s supposed to go, and that’s it. What they figured out was there is a lot more money to be gotten in healthcare and they just kept expanding what their role was and they got bolder and bolder and bolder because nobody said no, nobody stopped them.
Nobody really actually knew what they were doing. And there is so much money in healthcare that they could grab the millions and billions of dollars and nobody really noticed until
Will: recently. So, so they started out as
Kristin: like payment processors essentially? Exactly. Is that,
Will: yeah.
Deborah Keaveny: So in, before the pharmacy benefit managers came into play, a pharmacist used to fill out paper forms, send it to the health plan.
The health plan would then process a check and send [00:10:00] it back to the pharmacy. The PBMs came in and said they could do it electronically, make it faster, make it more efficient, save everybody time and money in the long run. And that’s how they started and that’s what they should be and only be,
Will: but then they eventually morphed into, into what they are today.
Um,
Kristin: and yeah. What kind of things are they doing today? Where, where. You mentioned that they have basically just started doing more and more and more. So what are the things that they’re doing now? I’m not in healthcare in any capacity, so like, this is all Greek to me. So it’s a genuine question.
Deborah Keaveny: Oh no. And this is so complicated that, uh, it, it’s tough to understand.
So the next thing pharmacy benefit managers do is they started managing formularies. So they get to decide what medications you can take if you wanna use your pharmacy benefit card. So they decide. Um, and not really based on anything that’s healthcare related. Um, it’s based on how much the manufacturer is going to pay them to put their product on the [00:11:00] formulary.
’cause if a drug is not on the formulary, it loses market share because nobody is going to pay cash for the drug, basically. I mean, in the generics where it’s cheap, yes, but in the brands, no one can afford to do that. Normally that would be illegal and a kickback, but, uh, they were able to get an exemption to that.
And so what you’ll see now in the formularies, it isn’t necessarily what’s good for the patient, it’s what’s good for the pharmacy benefit manager to be able to collect those rebates. Mm-hmm. And so this
Kristin: sounds an awful lot, like prior auth in the physician world.
Deborah Keaveny: Oh, it’s even worse than that. I mean, with, with the prior auth, you now have a, so the pharmacy benefit managers will also, um, tell the health plans that we’re going to protect your patient.
So we’re gonna put prior authorizations in place so that, you know, we’re using the most efficient medication for that patient. Um, we’re gonna deny, you know, some prescriptions, things like that, that would maybe not be inappropriate. What you don’t know in the background is you [00:12:00] have algorithms and artificial intelligence that are actually denying care to patients.
And it’s pro, the decisions are made probably not even by a licensed, um, professional. It’s, it’s all AI and people that don’t have a license that are making these decisions, and it’s clearly and absolutely financially driven.
Will: Now, the, the argument that I’ve seen from the pro PBM lobby on social media is that the PBM protects patients from the big bad pharmaceutical companies.
Kristin: Oh, big pharma.
Will: Is that the idea? Big, yeah. Big pharma. Okay. Like I, they, I think they’re really good at, at weaponizing the idea of big pharma. Uh, and, and you need PBMs to, to protect patients
Kristin: from big pharma,
Will: from the big pharma companies. Like I’ve seen that argument over and over again. It’s
Kristin: the exact same model.
It real like.
Will: So, so well, I [00:13:00] want to hear from, uh, Deborah’s crazy. So what do you, what would you say to that?
Deborah Keaveny: So, so you’re not wrong. Um, pharma is culpable to a degree, but if pharma doesn’t play the game with pharmacy benefit managers, pharma doesn’t get their products on the formularies. Pharma loses market share.
So in a sense, the PBMs are forcing the manufacturers to compete against each other to pay to play, or they fail. Now, the other argument that the, uh, pharmacy benefit manager, um, lobby will say is, well, if we weren’t there, gosh, prices would be astronomical. We are here to bring down prices
Will: because the manufacturer could theoretically charge whatever they want.
Is that that the idea? Yeah, pretty much.
Deborah Keaveny: But, but when was the last time your premiums went down?
Kristin: Yeah,
Deborah Keaveny: right. Seriously. When was the last time your co-payments went down? So if they’re so damn good at keeping prices down, where is it?
Will: Yeah, it’s, it’s all, it, it kind of gets jumbled up in, in. So let, let, let’s actually do [00:14:00] this.
Let’s, let’s, uh, what would the patient experience like, so when, when you have PBMs doing all of these things, you know, deciding what a, what formulary, you know, a medication should be on, or, you know, whether or not a, a medication should be on the formulary. Um, what is the experience of, on the, the, the, the, the end user, the, the pa, the, the patient, the customer comes to the desk at the pharmacy?
What is it, what is the PBM doing that, um, and what is the experience at that end? So let’s help put, help, help put this into, into perspective for people showing up at the pharmacy to get their medications.
Deborah Keaveny: Okay. So let’s say you come to the pharmacy with your prescription card and you present your prescription to the pharmacist and the pharmacist gets a little bit of history and, uh, actually, um, sends the claim through to the, through the PBM.
That’s all done in real time with the [00:15:00] pharmacy. So within a millisecond, we’re gonna know whether or not it’s covered what the patient’s copay is, um, and all that kinda stuff. So a couple things happens behind the counter that the, the patient maybe never even knows. Sometimes the prescription is rejected because it’s not on the formulary, and we go ahead and contact the physician, get a change, get the new prescription for the patient, send ’em on their way and everything is fine.
Will: That might be, that might be a prescription they’ve already been on for years.
Deborah Keaveny: Oh no. Sometimes they’ll show up at the pharmacy with something they’ve never been on, but we’ll get that rejection from the pharmacy benefit manager and then we try to help the patient. The background, we’ve gotten so good at that.
A lot of times the patient don’t even know what’s happening. Hmm. Sometimes there’ll just be a rejection. Um, it’s not covered. There’s no alternative. Um, sometimes we’ll get a rejection saying that, um, you are forced to go to mail order. Uh, you can’t get it filled at your local pharmacy. And so we are the people that go down to the pharmacy to explain to the patient, I’m really sorry, but we can’t fill your prescription and here’s why.
Then we have to give them alternatives. Um, you can try to [00:16:00] opt out of mail order, you can, uh, call your health plan and complain. Um, give ’em things like that. But, uh, solely the pharmacy benefit managers are dictating the rules for everybody.
Will: It’s funny you mentioned the mail order thing because, um, it was just yesterday.
I, I got a, a, a call from my, my plan, you know, suggesting very gently suggesting Yeah, maybe you should consider, you know, going to mail order. Um, and so what I wanna,
Kristin: well, hold on. Yeah, go ahead. Before we get off of that, why do, what’s the incentive for them to, to do mail order? What’s the mo role there?
That’s why would they want patients to be using mail order?
Deborah Keaveny: They own it. ’cause they own the mail order and they can pay themselves whatever it is that they want.
Kristin: Gotcha.
Deborah Keaveny: So where they would pay me a dollar 75, they would pay themselves $500 for the same thing, and there’s nobody stopping them from doing it.
Kristin: Interesting. Okay. [00:17:00]
Will: So if you’re keeping track so far, we got the, the PBMs and the health insurance companies and the pharmacists, pharmacies that are all under the same umbrella
Kristin: they’re owned by.
Will: Yeah,
Kristin: yeah,
Will: yeah. So, and that’s the question I have for you is, ’cause initially PBMs were independent, right?
They’re just their own thing. They’re just a PBM company. At what point did they start, you know, getting, were, I guess, were they bought up by the United Healthcares of the world? The, the, you know, Aetna’s, um, you know, CVS, they all started this, this, when did this vertical integration start happening?
Deborah Keaveny: Um, about the mid two thousands.
Um, I used to work for PBMA hundred years ago. That was back when, uh, Merck and Medco. So you had a PBM that was owned by a manufacturer, and then I worked for DPS, which was owned by SKF. The FDC finally did bust them up, but that was the initial start of where, wow, we can make this formulary, we can control it.
[00:18:00] Therefore our parent company makes drugs. Let’s put all of our parent company’s drugs on the formulary and we’re all gonna march into the sunset. Happy and rich. Once that got busted up, the PBMs got a taste of how much money that was and how much fun it was. Then they started integrating and that’s where you see, especially CVS we always use as an example, because they’re one of the biggest, one of the big three.
But I mean, they own the pharmacy, they own the health plan, they own the, uh, pharmacy benefit manager processor. They own labs, they own mail order, they own specialty, everything. Same thing with um, UnitedHealthcare. The only thing missing is UnitedHealthcare and OptumRx. It doesn’t own a pharmacy chain. But if you could control everything within that silo and control every place that that patient is touched, you can control the dollars like crazy.
And if you’re the only one doing it, you’ve got no competition ’cause you’re referring to yourself. There’s nothing to stop you from charging your or paying yourself, whatever it is you wanna pay yourself.
Kristin: How [00:19:00] come this is allowed?
Deborah Keaveny: Well, great question. Um, for a long time, uh, pharmacists were gagged in our contracts from talking to patients about, did you know your pharm, your, uh, pharmacy benefit manager wants to charge you $175 for this?
If you, uh, pay me cash, it’s gonna cost you 17. We were, we were restricted from doing that right up until a couple, a few years ago. Now there’s still a gag clause in place that says, I can’t tell the employer what I’m getting paid and look to see what he’s getting charged. That that gag clause is still.
Down the street. I may have an employer that, uh, is using, you know, prescrip pharmacy benefit manager for their employees. I may be getting paid a dollar 75 for something, but the plan may turning around and charging him $70 for it. And I can’t tell him, and he can’t talk to me about it because of the gag clauses.
So they really do need to [00:20:00] function in the darkness so that we don’t figure this out.
Will: Well, it sounds like pharmacists have figured it out.
Deborah Keaveny: We have. Um, yeah. And, and we’re, we’re just now starting to get, we’re not starting, we’re, we’re finally getting a voice. We’ve been screaming about pharmacy benefit managers for years, but now legislatures finally know what A PBM is and they know that they’re bad and they’re now starting to help us.
So we have a lot of legislation that’s gonna be rolled out that’s gonna help us, but for a very long time, there, this is so complicated, that explaining it to people, their, their eyes would glaze over and it’s like, ah, I don’t even think I can tackle this. Now they’re starting to get it.
Will: Yeah. And I wanna, I wanna get to legislation, uh, here in a second, but first, uh, help us understand the effect that this has on independent pharmacists because I, I have, I’ve talked to a few and, and, you know, I hear grumbling, I follow some people on social media, I hear grumblings about it.
And, and, um, uh, but help people [00:21:00] understand kinda how, how this is pushing out the, the, the actions of PBMs, how it’s pushing out independent pharmacists.
Deborah Keaveny: Yeah. Well, they, they are underpaying us like crazy. And that is by the, the contracts that they’re sending us. And, and the argument back is, but you sign that contract, and you’re right, I did.
But guess what? If I don’t sign a contract for the, you know, Caremark, the Optum or the Express Scripts, I can no longer fill prescriptions for 30% of my patients because basically those three own 85, 90% of the market. If I don’t accept that contract, I can’t fill prescriptions. I’m in a small town at 2,500.
If I say goodbye to a third of my business, I’m not functioning. So I’m hoping that I’m going to make it up in other things. The problem is, is the downward pressure and what we’re being paid, you can no longer make it up in selling toilet paper and greeting cards and gifts and things like that. So most pharmacies right now have a side hustle that helps support their store.
So I have friends that also own gun stores, [00:22:00] also own liquor stores, um, coffee shops. Wow. Sell baked goods in their pharmacy. I’m an insurance agent. I sell insurance, and that’s how pharmacies are able to survive. So the economics of pharmacy is just broken. I mean, 90% of my business is prescription filling.
90% of my prescriptions, that price is dictated by somebody else. I have no control over that price. And we start looking at that dynamics and you’ve lost control, and they keep paying me less and less and less. It’s not sustainable unless you have another side hustle.
Will: And I’ve actually heard, I’ve actually heard that sometimes you have to, you sell things at a loss like prescrip all the time.
A loss
Deborah Keaveny: all the time.
Will: I help me wrap my head around how that happens.
Deborah Keaveny: Well, there are some pharmacies that have decided not to even dispense brands anymore because we lose money on most brands because of the way that Rio reimburse. Now, that’s a risk. You can send that prescription to CVS or Walgreens or one of the other, you know, big things.
But pretty soon that patient’s gonna get tired of having to go to Deb’s [00:23:00] store for some stuff and another pharmacy for other stuff and they’ll just take everything with them. Or you are like me, I have a lot of group homes and nursing homes that we fill for, and part of my obligation to take care of those populations is to make sure that I am a fully stocked pharmacy.
So I will do brands. I did not feel real comfortable saying, Martha, I will fill your brand because you happen to live in a nursing home, but Susie, I’m not gonna fill your brands because you live down the street. To me, that wasn’t an ethical decision. I was either needed to be all in or all out. So we were all in.
Again, supplementing the income in the pharmacy allows us to do that, but more and more pharmacies are just going outta business. They, they can’t sustain it anymore. Yeah. And pharmacy, you used to be able to sell a pharmacy, so you, you put 25, 30 years of your life into a small business. You used to be able to sell a pharmacy and they used to be part of your, um, your retirement, you know, for your family, things like that.
Now, when we get to the point where we’re gonna sell our pharmacies, most of us are praying that we’re gonna get outta debt because we’ve had to take loans out in [00:24:00] order to keep operating, to keep doors open, to take care of our families and take care of our communities.
Will: So, who’s, who’s buying up the pharmacist?
Yeah, that was pharmacy. You know, when you, you have to, you know, close up shop, what, what happens?
Deborah Keaveny: It used to be the chains. Walgreens and CVS, however, they have denigrated the value of our store so much. They know that they can wait us out and we will just go under and then they will get the files or the patients, you know, by attrition because they’re what’s left.
Well, that’s depressing.
Kristin: It sure is.
Deborah Keaveny: Yeah. So what do we do? Well, and, and, and while pharmacy is, is kind of in a depressed state, I’ve never felt more optimistic than I have now. I mean, we have a lot of good legislation, things, the states have gotten very strong legislative wise on a state basis. And when you look at state legislation versus federal legislation, kind of have to play the game.
Because if you are complaining to your department insurance, department of commerce, whoever is supposed to oversee a pharmacy in a particular state, p been is [00:25:00] very good about saying, you know what, I know you’re arguing with me, Deb about this, but guess what? State of Minnesota can’t touch this claim because it’s erisa because it is a part D claim.
Because, um, it’s a Department of Labor claim, whatever reason, and the federal can’t help you with state claims, you know? Right. What happens in the state level? So we have to walk legislation hand in hand. Federally, it works extremely slow. Um, the states have gotten really good, so we had a lot of good legislation in the last couple of years that have kind of put the pharmacists in check and hats off to Arkansas.
Um, their, their last bill that they had passed was phenomenal. Um, they’re making the PBMs choose, are you either licensed as a pharmacy or licensed as a pharmacy benefit manager? You can’t be both. Oh, that’s great. That was brilliant. And yeah,
Will: I heard about that legislation. So it’s, it’s kind of helping to break up that, that vertical integration.
It, it’s a start. You can’t control kinda every aspect of, [00:26:00] of the drug market, so to speak. Yeah. It’s a
Deborah Keaveny: start on a federal level. We’re working with, uh, pharmacist Fight Back Act was, uh, introduced last year. It’s gonna be reintroduced this year that basically set a floor for what you can pay a pharmacy for, a claim that takes away the underwater ness of it.
And then, uh, Elizabeth Warren, uh, has the pharmacist or the PBM, the patients before Monopolies Act that’s coming out too. So a lot of good things on the state, a lot of good things, but legislation works slowly. Things get watered down by the time it actually gets passed and signed, then it goes through rule making, things like that.
So we’re also doing a lot of litigation. We’re trying to hurt ’em both ways and get, get attention both ways. And it’s, it’s, we’ve gotten more traction this last couple years than we have any time before.
Will: That’s amazing. What, what, what would be your ideal piece of legislation? Like what would that do? Like g give us that, like you said, it gets watered down.
So if you could have your
Deborah Keaveny: most potent form. Yeah, yeah. What, [00:27:00] what,
Will: what would you like it to, what, what do you want it to look like?
Deborah Keaveny: I would like it to set a floor for pharmacy pricing. Meaning that we get paid for the cost of the drug itself and our operating costs, because we ought to be allowed to make a little bit of a profit so we can keep the lights on, pay our employees, that kind of thing.
But I think we should also set a ceiling for it so that we don’t have the, um, profit grabbing that’s going on now. So make, make it fair. That’s all we would ask
[music]: for.
Deborah Keaveny: And then stop some of like the, um, the steering. So, uh, my patients get letters all the time calls like you did, you know, Hey, don’t you think you ought to go to, you know, a CVS pharmacy, a mail order, pharmacy, whatever.
Um, stop that. Let the patient choose. And if you have the, the prices set. Then it’s set for everybody. Then there’s no advantage to go to mail order, go to your local pharmacy, go to CVS, go, I mean, wherever you wanna go. If the price is, the price is the price and it’s the same drug, the same drug that I’m dispensing, and then getting paid a dollar 76 for [00:28:00] Express Scripts is, uh, dispensing and getting, paying themselves $500 for, there’s no difference in it.
So if you can take that away, take away the games, um, stop the, um, oppressive audit. So right now a lot of pharmacies are going through audits from the PBMs and it’s not because we’ve really done anything wrong, they’re more gotcha audits. It’s uh, you didn’t get a signature from that patient in 10 days, 10 that they picked it up.
You got it in 11 days, therefore we’re gonna charge you back for the whole thing. Or it’s just, it’s dumb. Things like that.
Will: Let’s take a short break and then I’ve got a couple follow up questions to that.
Alright, we are back with Deborah Kennedy. Uh, so Deborah one. It just, it boggles my mind that like talking about the phone calls and soliciting your, your customers that, that they can do that while, while you have a gag order basically preventing you from
[music]: Yeah.
Will: From saying anything negative practically [00:29:00] about, you know, the way PBMs function and their, their, their pricing and everything.
Uh, and, and so are you, have you seen legislation that’s starting to do away with the gag clauses, like completely? Is that, is that on the table?
Deborah Keaveny: Well, the gag clause between the pharmacy and the patient has been lifted, so we can now talk freely to patients. Okay. Where we can’t talk is, is the end payers and, and that’s not really brought, been brought up an awful lot lately.
I see. Um, with patient steering, I mean Minnesota, um, fined CVS for patient steering and it was the largest fine that they had levied against any private company in the state of Minnesota. Um. Wasn’t enough because two weeks later, CVS is still steering my patients and I’m still sending in, uh, complaints.
How much
Will: was it?
Deborah Keaveny: Um, how much were they
Will: fined?
Deborah Keaveny: $125 million. So like a
Will: Tuesday morning.
Deborah Keaveny: Oh. It’s like spit in the ocean to those guys and it wasn’t enough. And so we continued to complain [00:30:00] and um, you know, they brought action again. But we kept telling the commerce department, you need to make this billions to get their attention.
I mean, a few million is aligned on their, their, um, their balance sheet cost of doing business.
Will: Yeah. How about the formularies? What are you, uh, how, how are you doing on kinda revamping, you know, their ability to steer formularies in one direction or the other?
Deborah Keaveny: We don’t think they should be allowed to set formularies.
Period.
Will: Has that been a, a part of any successful legislation so far?
Deborah Keaveny: It, it’s been part of talks. Um, it’s not been involved in, in legislation, but, um, we really do need to decouple formularies from pharmacy benefit managers.
Will: I see. Um, mark Cuban talking a lot about that. And, and, and that, that actually speaks to how, for lack of a better term, mainstream, the, just the discussion around PBMs is becoming is that you’re, you’re getting some very famous, very well-known people talking about PBMs.
So I, I’d actually be curious to hear your thoughts about, uh, you know, cost plus drugs [00:31:00] and, and his approach to, to, to pharmacy.
Deborah Keaveny: Yeah. Mark’s a good friend of independent pharmacy. He, he understands the value that we bring. He understands that we are there to take care of patients. And he has had quite the trip trying to get to where he is today.
I mean, um, his cost plus. Is nothing real new because when we set our cash prices, we’re doing on a cash plus basis, we just never called it that. But Mark has done it on steroids. And the fun thing about Mark is he tried to get into the branded side also to be able to offer brands on the CUS Plus side ran into a huge wall because the PBMs and manufacturers don’t want Mark playing in that arena because it’s gonna shine a light and a lot of things that they don’t want light shine on.
So we absolutely love Mark. In fact, we use Mark’s cost plus uh, examples for quite a bit when we’re trying to show the comparison on what somebody could pay for a cash basis for a prescription versus what your insurance company is gonna charge you or what your insurance companies charges [00:32:00] your employer for it.
Will: So with that, actually I’m a little confused why, why would the manufacturers be so against it? Because it seems like they’re beholden in a lot of ways to the PBMs. So help me understand that dynamic.
Deborah Keaveny: So let’s assume I’m a PBM and I wanna keep. A branded drug on my formulary because I really enjoy all that money that I’m collecting from the rebates.
Kristin: Hmm.
Deborah Keaveny: Now, if that branded prescription or manufacturer sells that brand to Mark Cuban, um, there’s no rebate involved. ’cause Mark’s not gonna ask for the rebate. Um, there’s no pay to play.
Will: So, so yeah. From the manufacturer side of things, they, they like having the status of being like a preferred medication on a formulary.
And so that’s, that’s what they get out of the, out of the, yeah.
Deborah Keaveny: And, and they do. And I, and I think they don’t mind being villainized for it because if they don’t play the [00:33:00] game, they lose market share and their product isn’t on the, the formulary. Right. It’s that simple.
Will: Um, alright, well let’s, let’s, uh.
Let’s pivot a little bit away from that. I wanna talk about something else that probably a lot of of people who this is
Kristin: making you cry, pivot, tear.
Will: I, I’ve, I’ve, I, I’m, I’m, I’m so, so sad, uh, at the state of, of pharmacy, but, you know, I, it is nice to hear the, some of the more, uh, positive aspects of kinda where things are going and, and the attention that it’s getting, which I think is, is, is fantastic.
Um, but I wanna talk a bit about GoodRx, uh, because that’s something like, I came outta med school, like thinking, oh, let’s just, let’s you know, look, GoodRx, you can get, go to this website. Look, you can get the medication for this amount. And, and this is great. And, and, and I, it wasn’t until, you know, based on through social media, I actually heard pharmacists talking about how harmful [00:34:00] like GoodRx can be to pharmacists that I realized, oh wait, this is maybe isn’t all it’s cracked up to be.
So, can we talk a little bit about this?
Deborah Keaveny: We can. So GoodRx, um, is a discount card. They don’t provide care. They do nothing except set prices. And they, when, so let’s say most independent pharmacies don’t accept GoodRx because we don’t think we should pay somebody a fee to set our cash price. That’s number one.
Number two, GoodRx has been sued by the FTC and fine by the FTC for selling PHI private health information. I don’t wanna be a party to, uh, my patient’s information being sold. Now they claim that they’re not doing that anymore, and that’s, that’s all good and well, but once they, once you’ve been there, you, you don’t get my trust back that, that well, right, right.
Um, it’s interesting that the pharmacy benefit managers and health plans are also working with GoodRx. They have [00:35:00] GoodRx RX discount pricing embedded into the algorithms that they are using to set prices for both patients and, uh, pharmacies. Now the interesting about that is the PBMs are there to save money.
The PBMs are there to make sure that the patients get a good deal. So if the PBMs are doing such a great job, why are we needing to use GoodRx embedded into the whole process? I thought that’s what they were supposed to do. Secondly, and this is part of the lawsuit, um, that’s going on right now. So pharmacies are suing GoodRx on a class action basis.
There’s actually 13, uh, separate class action lawsuits out there, um, surrounding this that are in the process of being combined into one. The courts are gonna make it, uh, more efficient so that they don’t have to fight this on 13 levels. They can do it on one, but what was, what’s going on in the background is GoodRx pricing is being embedded in there, and they’re sharing prices in the background between the different PBMs.
That’s gonna get real in the weeds and real confusing. [00:36:00] But if I’m sending a claim to CVS Caremark. And they’re also looking at GoodRx. They’re also looking across the spectrum of all the pharmacy benefit managers all have their own discount plans, things like that. If they go out there and find something that’s cheaper, they will bring that back, whether it’s a GoodRx or CVS, it could be an Express Scripts, it could be an Optum, it could be a single care, it could be something else.
They bring that back. That’s the price that they’re using for the pharmacy. So there’s all this price collusion going on in the background. What’s important about that is there’s a fee charged to the pharmacy in the background that we don’t have any choice of, and that fee is split between the PBM that we sent that claim to the PVM that had the lowest price in GoodRx.
So how is that helping the patient and how is that not just driving up healthcare costs? All in all. So we have a lot there, there are so many fingers in the pot of the healthcare dollars. And if we could get [00:37:00] all the middlemen and all the shenanigans and all the charlatans out of it, imagine how much money we could spend on actually taking care of patients, of actually doing healthcare and wellness and what we’re supposed to be doing.
Kristin: So from the patient point of view, I can’t, I like to be fully transparent. I’m not following a hundred percent of this, but it sound, from what I do follow, it sounds like if patients knew this model was the model, even on a very general level, I don’t think they’d be happy about it. Right? Like, this is not doing anything good for the patients, it sounds like.
Deborah Keaveny: Well, from, from a patient standpoint, if you come to my pharmacy with a GoodRx card, um, and your, your prescription card, we’re gonna explain to you that GoodRx is not insurance. So you can either use your insurance card or your GoodRx. And if your insurance, so
Kristin: GoodRx is essentially a coupon? Yeah, that’s far.
The patient is concerned. Yeah. Good way to put [00:38:00] it. Okay. But, but you
Deborah Keaveny: can’t use it in conjunction with your insurance? It’s, it’s either or one or the other. Okay. So let’s say we send the claim through for you and it comes back with a really high copay and the patient says, but I’m looking online and I can get that cheaper with the GoodRx card.
So now pharmacy has three choices. One is we explained that yes, we can reverse the claim for you, but it’s not gonna count towards your deductible or you know, your Yeah. Uh, maximum amount of pie, anything you know, on in the insurance side because they’re no longer gonna see that. Claim. Number two, if we send it through GoodRx, just understand that that is not insurance and we won’t do it.
So we’ll send ’em on to the CVSs, the Walgreens and Walmarts. Anybody else? ’cause I won’t do it. I won’t participate in GoodRx. Or we can give you the Keaveny drug or whatever independent pharmacy cash price, which many times is right at about real near what the GoodRx price is. So now you’re gonna get the good deal without having your PHI your, your private healthcare information out there, you don’t have a third party involved and your pharmacy isn’t paying a [00:39:00] fee to give you the price you could probably get at the pharmacy anyway.
Will: What do most people decide to do? Like, what do, what do, what do the customers do? A lot of times they like, no, I want the GoodRx. I’m gonna go to cvs. Or like,
Deborah Keaveny: rarely Mo Mo. Most of the time they’ll say, well, I’ll just take your price. Or, gosh, I didn’t know that. Or, I mean, they don’t know. But with all the advertising, the wonderful things that, you know, you see on social media about good rx, yeah, people don’t know.
Kristin: So who would be, if you had to choose one group, that it would have the most impact for shining a light on all of this stuff? Like is there one group that does not fully realize what’s happening? Maybe that’s patients, maybe that’s pharmacists, maybe that’s, I don’t know. Help. Physicians, uh, you know, if, if there’s one group that you want your message, yeah, we should be educating about this.
Who would that be that would make the, or who would you start with? ’cause it makes the most impact.
Deborah Keaveny: I would probably start with the [00:40:00] patients, mostly because pharmacists have been yelling about this for years. And it wasn’t until we started getting our patients engaged and having our patients fight with us, um, that we started getting more attention, more people started listening more.
And the nice thing about talking to patients is we had to get out of the weeds and talk to patients on their level. Like, like you, I mean, we, we’ve been fighting this for so many years, it’s old hat to us to talk about it. But when you start talking to someone that’s not familiar with it, you’re almost 10 years ahead of ’em.
And you, you gotta take a, a real step back and, and, you know, get back down in their level until they come up to speed.
Will: I’m a, I’m gonna ask a question from a physician standpoint. So seeing, you know, sitting there with a patient, um, we’ll use dry eye as an example, something that I, I treat all the time and, uh, lots of different treatments for dry eye.
Uh, what, is there a way, like if I wanna start a patient, patient on Restasis, is there a reliable way for me to, to find out for [00:41:00] that patient before I prescribe it? Like, roughly what it might cost them? Is there a resource? Is there, because, you know, I could do Restasis, I could do Xiidra, I could do, there’s, there’s different things I could choose to do.
And I am more in tune now to healthcare costs for patients, like probably than I used to be. And part of that’s just because of what I do on social media, but also my own health history. And so for, for the, the practicing, you know, healthcare professional, is there a. Yeah, what can we do to, to, to help figure out for patients, you know, costs?
Deborah Keaveny: It might be a, might be a pain in the fanny, but you can go to their, uh, health plans formulary and you’ll see what’s a tier 1, 2, 3, 4, 5 to see where those drugs fall in the formulary. Um, the patient can call the one 800 number on the back of their card and ask, Hey, if my doctor writes a prescription for this, what’s my copay gonna [00:42:00] be?
The pharmacy can go ahead and run the claim, but then we won’t know if it’s covered, not covered until that claim comes back. And by the way, the PBM charges me every time I transmit a claim to them, just because they can. So, looking at the patient’s formulary would be a good place to start. Um, forming a relationship with an independent pharmacy, um, is, is another good thing.
They’ll give you a good idea. There are also manufactured coupons available out there for many, um, on the name brand. Um, products and independent pharmacies are pretty good at finding those resources for patients.
Will: Those are good tips like that. Good. Like, just find it. But I mean, I guess part of the problem is don’t, how often do the formularies change?
Because it sounds like that’s, that’s a problem as well, right? Based on Oh yeah. They can change the
Deborah Keaveny: formulary anytime they want to.
Will: Um, at the drop of a hat, a like the drop of a
Deborah Keaveny: hat. So there has been legislation, um, proposed, hasn’t gotten very far, that says if I’m gonna sign up [00:43:00] for your health plan for one year, you should not be able to change your formulary for one year.
Because, especially in the Medicare world, because today I’m picking my plan based on my conditions today and what I’m taking for medication, not what you’re gonna change the formulary to next week. Right, right.
Kristin: None of this sounds legal.
Will: Uh, it’s, I
Kristin: mean, I am cynical enough now to believe that it is, but it sounds like it’s only legal due to sneaky loopholes.
Like none of this
Will: Yeah, it almost should be legal. It almost just seemed like government was just like, kind of said it and forget it kind of thing. Like, oh, you’re just not
Kristin: paying attention to how it’s gonna let run wild.
Will: We’re just gonna let pharmacy just kind of figure itself out and, and then look where it got us kind of thing.
I dunno.
Deborah Keaveny: I, I think it’s a little more sinister than that. I think the pharmacy benefit managers are 10 years ahead of us and they have things embedded in our agreements that we haven’t even thought of yet to [00:44:00] protect themselves from things that might come down the road.
Will: Yeah.
Kristin: I mean, I hate them because they know they’re, they know the kinds of things they want to try.
They’re geniuses, they stick that in there. Yeah.
Will: Um,
Kristin: evil geniuses.
Will: Let’s do, uh, we have, I have one more thing I wanna do with you. Um, Deborah, this is kind of, kind of a game, but, but not really. So, you know, Kristin’s not in healthcare and, or, you know, and so she’s kinda learning a lot about this and just from what I tell her about, which is probably not much about this kind of stuff.
Uh, and so what, what I wanna do is I want to give, uh, I, I have a list of 10 terms, uh, that some of them are real. Some of them are, uh, that I made up. Alright? And so I’m gonna pose a term to, to Kristin and she’s gonna tell me if she thinks they are, it is real or fake. And then Deborah, you’re gonna tell us what that term is, if it’s real.
Okay. What it means. These [00:45:00] are all related to pharmacy. I think. I hope I did this right. Yeah. Alright. So you
Kristin: could tell us it’s not
Will: So here’s the first, here’s the first one.
Kristin: Okay. I’m not gonna look, you really need to get a second screen I for you to use. Okay. I’ll pull these up. You can’t see pull. I’m just gonna block it.
Will: Uh, Kristin.
Kristin: Okay.
Will: Clawback fee. Real or fake?
Kristin: Clawback
Will: fee. Clawback fee.
Kristin: That sounds too brazen to be real. So I’m gonna say fake.
Will: Deborah, tell us about clawback fees.
Kristin: That is real. They’re real.
Deborah Keaveny: Here’s how it works. You come to the pharmacy to get a prescription filled, I tell you that your copayment is $150.
You pay the $150 at the pharmacy. When I get my remittance advice and my check from the pharmacy benefit manager, it will have clawed back $75 of that to keep.
Kristin: And they literally call it that. That’s why I thought it must be fake because it’s, it’s a very accurate description of what it is, but like to [00:46:00] just point it out like that in the name is bold.
Yeah.
Will: It happens every day. And it can, can’t it, can’t it also happen like months later?
Deborah Keaveny: Absolutely. Absolutely. So imagine,
Will: imagine getting, you know, a, a certain amount, like a hundred dollars into your business.
Kristin: Yeah.
Will: And then like,
Kristin: and you think you have that for operating expenses or whatever. Four
Will: months later they’re like, Nope.
Give it back. Wait a second. No, I need that money. Like that, that’s preposterous. I, when I heard, when I first learned about clawback, I was like, I cannot believe this is a real thing.
Kristin: Yeah. And there’s no regulation around like, uh, like a time period where they have to,
Will: has that, has that been a, I’m sure that’s been a topic of conversation.
Deborah Keaveny: Yeah, it’s, it’s, it has been. Um, and there’s some states that have, uh, successfully gotten legislation through Minnesota being one of ’em. Uh, we have nine kickback or, uh, uh, clawback. No, no retrospective. Uh, what do they call it? Can’t remember the name, but no re retrospective clawbacks in, in state of [00:47:00] Minnesota.
And we have, uh, taken a few PBMs to task on that. Uh, what happened is, is, but gosh, Deb, that’s an ERISA claim. Gosh, Deb, that’s a federal employee claim. Minnesota has no jurisdiction over it. Therefore, we’re gonna keep your money.
Will: Hmm. All right. Let’s do the next one.
Kristin: Okay. These are depressing. All right.
Will: Spread pricing.
Kristin: That sounds real.
Will: I do think that’s real.
Kristin: That is real. That’s
Deborah Keaveny: where they will pay me a dollar 50 and charge the employer $5 and keep the spread.
Kristin: Oh, that’s not what I was hoping it was.
Will: Uh, what’s the largest spread that you’ve seen on a medication?
Deborah Keaveny: Oh, hundreds of dollars. And sometimes that’s on a very inexpensive generic. They will just stupidly set. The patient’s copay. And then we have the hard conversation with them saying, you know, your, your [00:48:00] insurance company wants to charge you hundreds of dollars.
If you do my cash plan, it’s much less. What do you wanna do? Um, before the gag orders left, we couldn’t say anything about that, but now we do
Will: pharmacy loyalty tax real or fake
Kristin: tax? Oh, I, I mean, I’ll say real.
Will: I made that up.
Kristin: Okay, good,
Deborah Keaveny: good. ’cause I was just gonna ask you what that was.
Kristin: I was afraid that what it was is if you were loyal to your independent pharmacy, you get taxed.
Will: I made that up. I’m glad
Kristin: that’s not real. Alright,
Will: here’s one performance based adjustment. Is that a real thing in pharmacy or a fake thing?
Kristin: Performance based. I feel like I need more context. Like who’s performance, but I’m, I’m not giving
Will: you any context.
Kristin: Okay. Then. Real That is real. Deborah, is
Will: that real?
Yeah, that is
Kristin: real. [00:49:00] So here’s the way that works. Um,
Deborah Keaveny: my performance is judged based on nothing that I can actually do. So the performance is based on did you come take your medication, uh, adherence your me medication? Did you get your refill done on time? Um, did you, are you a diabetic? And you are also on a statin.
Uh, there’s, it’s, it’s the, the matrix of the performance is entirely outta control of the pharmacy. Furthermore, um, the things that. I’m judged on as far as performance may not even be appropriate for the patient. We have no way to say it. So if you’re a diabetic, they want to see you on a statin. Maybe you’re allergic to statins, maybe you can’t take them.
Doesn’t matter. You’re not on a statin, I’m nicked for it. So then what the pharmacy benefit manager will do, or retrospectively look back at my claims for the last six months and they will extract money or claw back more money because I didn’t perform. Now these matrixes are made to where I will never perform.[00:50:00]
Mm-hmm. So they like to say, well, we’re gonna pay pharmacies to perform, we’re gonna pay pharmacies that are, you know, really good at what they do. The matrix is written to where we can’t win.
Kristin: Right.
Will: Yeah. When, when has it ever been like an Oh, we’re gonna pay you more because you, you’ve done well. Right.
It’s, that’s probably not gonna happen.
Kristin: Right.
Will: Um, how we doing?
Kristin: I need a nap.
Will: I hope people are understanding who are just now learning about the pharmacy side of things. Like there’s, there’s just, it’s like, it’s like death by a thousand cuts. Yeah. That’s what it feels like. Right? It’s just there, there’s just so many different ways that they, they, they, that PBMs and, and can just, you know, take it out, take a chunk outta you.
Um, all right. Here’s one.
Kristin: Okay.
Will: Underwater reimbursement modifier.
Kristin: Um, gosh, fake.
Will: That’s totally fake. Okay, good. Yes, absolutely.
Deborah Keaveny: But I will say we do [00:51:00] get underwater reimbursements all the time.
Will: Oh, that’s, oh, that’s a real thing. That, that real
Kristin: thing that’s part is real. It’s the modifier that’s fake.
Will: That’s, that’s whenever, uh, I assume that’s when you’re, you have to sell things at a lot, be like you sell at the, and you just don’t get reimbursed.
The cost, the full cost of the medication. Is that what, when Correct. Underwater. Okay. Gotcha. Alright, here’s, here’s, here’s, we’ll do one more DIR fees.
Kristin: That sounds real. Yeah, I think I’ve heard you talk about that.
Will: Maybe that’s okay. Yeah. I made a video about dir r fees. Yeah, yeah. Tell us what DIR fees are.
Deborah Keaveny: Well, DIR fees are direct innuation fees. They were never intended to be used on pharmacy. And basically what they are is gives the, uh, pharmacy benefit manager the ability to go back and look at our claims and then claw fees back. So, uh, this is in the Medicare world. Um, we fought really hard to get DIR fees dissolved entirely.
Um, the only [00:52:00] success that, uh, one of our national organizations had was to move them to the front end. So DIR fees have not gone away. They are still there. The only difference is instead of me getting those D fees taken away from me in four to six months, where I have no idea what, how to marry up, you know, what, what exactly are you taking the fee away from me from, what did I do?
How does that work? And by the way, patients had that medication and taken it six months ago. But here we are, you know, reconciling the DIR fees. Now what’s happened is, is the I fees are actually put on the front of the, um, the equation, so at the point of sale. So instead of me waiting for six months to know how much I got screwed, I know how much I got screwed right away.
Will: Super. At least you know how to say, you know, earlier.
Kristin: Oh, nice of them.
Will: Yeah. Well, um. Deborah, I want you, I wanna thank you so much for your time. Now, before we go, I want, uh, people to know about some of the, the organizations, the, the things that you’re, [00:53:00] that you’re heading up and, and, and actively participating in.
There’s the, the put organization, right? The Pharmacist United for Truth and Transparency. Uh, tell us a little bit about the work you’re doing.
Deborah Keaveny: Yeah, so, um, you can go to truth rx.org and kinda learn about us, but, uh, we are a nonprofit that is, um, responsible for educating, uh, the populations and legislatures about pharmacy benefit managers and all the yucky things that they do.
Um, as well as, um, shining light, um, on a lot of things. And the project that we’re working on right now is to audit tricare. Um, TRICARE is the, um, plan that takes care of the prescriptions for our service members and also Tricare for life, our vets. We are finding out that, um, express Scripts is, uh, not treating our service members, our independent pharmacies, our vets, or the taxpayers very nicely at all.
So we have asked the [00:54:00] government to, um, audit Tricare based on their pricing. Um, the example that we use as Atorvastatin is a very cheap medication. Um, express Scripts will pay, uh, retail pharmacy anywheres from a dollar 77 to like nine bucks. But amazingly enough, they force and incent their members to go to Express Script, mail order, and they pay themselves $519 and 62 cents for the same medication.
So we would like somebody to look into that. To protect,
Will: yeah,
Deborah Keaveny: protect our service members and, you know, protect our best.
Will: Is that, is that the, is that the FTC that, that’s, that should be responsible for something like that? Um,
Kristin: you know, don’t, that’s
Will: the, yeah. What do you think is the, the group that should be.
I,
Deborah Keaveny: I know we’re getting it through, um, a few committees, um, yeah. Okay. You know, through the Senate and also through the, the house side. So, um, somebody at some point’s gonna take a look at it and decide that that’s the wrong thing to do. I mean, maybe ways and means, ought to be looking at it. [00:55:00]
Will: Good. Well, you can, uh, I know on, um, a lot of social media platforms at Truth Rx, you can, you know, keep up to date with, uh, all the, everything going on in, in this world.
And I, I just encourage, you know, especially the, the, you know, healthcare professionals, um, I’m always talking about, you know, making sure you get active in your state medical societies and your specialty medical societies. Um, and, but there’s, there’s so much overlap in, in what we do. We all need to be more educated about what’s happening on the pharmacy side of things because it affects everything.
It affects what we do as physicians, uh, certainly the patients and, uh, pharmacists. And so, um, just. Be informed, that’s just keep your ears open, you know, if there’s legislation, um, you can, I’m sure you can find all about whatever active legislative efforts are going on through Truth rx. Is that correct?
Deborah Keaveny: Yeah, that’s correct. And then the other two [00:56:00] things that we are pushing for is gonna be the legislation that’s coming out on the federal side. Um, buddy Carter has a couple bills right now that we’re very supportive, uh, but the pharmacists fight back act and then also patients before monopolies will be two big things that we will continue to push and all, all it’s gonna do is protect patient access to pharmacy and keep our doors open and, and that’s why we fight.
Will: Perfect. Well, we’ll end it there. Thank you so much, Debra, for joining us.
Deborah Keaveny: Yeah, thank you. This was a lot of fun.
Will: You know, we, I we try to be as uplifting as possible on this podcast. Yeah. Sometimes it’s just hard.
Kristin: It’s hard. Things are things sometimes ’cause are, things are
Will: happening. Yep. But I do wanna highlight the, the, the headway that’s being made.
Kristin: Yeah.
Will: Right. On the legislative side of things.
Kristin: Right. Because
Will: that, that is something that you can take away as like, oh this is, things are happening.
Kristin: Right. Yeah. Like she said, she’s never felt more optimistic, said,
Will: right. We all, we also need to, we need to support those efforts. Um, alright, let’s, should we get [00:57:00] into a comment from a listener?
Kristin: All right.
Will: Let’s do it.
Kristin: Let’s go.
Will: Uh, so this is from Anna. This is great. Uh, so who knew an ophthalmology podcast could be so interesting you that.
Oh wait. It makes perfect sense for me because I’m a giant nerd and I never met a science, I didn’t like story. Here’s the story. Story number one. I got a spider in my eye on my honeymoon.
Kristin: No, thank you.
Will: We rented a cabin in the mountain. Oh boy. And there was a spider web from the tree. From a tree down to the car.
And I didn’t notice before walking through it. How often have you walked through a
Kristin: spiderweb? I, well, I try not to
Will: Do you see it, but sometimes you can’t see it. The very small spider got stuck in my eyelashes and I couldn’t manage to get it out. I ended up smushing it and then its dead body got stuck on the surface of my eye.
And when I tried to blink it out, it only moved further around slash behind my eye. So probably just got stuck underneath the eyelid. Uh, I swore I could feel its corpse inside my eye socket all day, but [00:58:00] my partner told me it was just my imagination and kept me busy with things like go-karts, amusement parks, slingshot rides, et cetera.
Uh, would anything be able to distract you from that? Mm-hmm. Okay. That evening, after dinner, I absentmindedly rubbed my eye. Not too hard, don’t worry. And my hand came away with a spider body covered in tears. Of course, I immediately showed it to my spouse and said, I told you so. Mm-hmm. And they admitted they had believed me all day, but knew it would eventually come out on its own and didn’t want me to have a bad day worrying about it.
I’m just trying to, that
Kristin: person does not have a ACH phobia. I can tell you that. That’s the difference between me and that person. I’m trying, I mean, nobody would like that experience, but there’s no way I could think about anything else if that had happened to me. I’m trying to, I would gouge my own eye out.
Okay. Before I just like let that go.
Will: Well, yeah, I’m, I’m trying to imagine how you would react. There’s no way I could, I’ve told you, I could be like, if I, [00:59:00] if I just said, Hey, don’t worry about it.
Kristin: No, no. I’d be like, love you. Just,
Will: have you met me? Let’s just try to have a fun day. Don’t, I’d be
Kristin: like,
Will: it’s just a, I’d
Kristin: have some choice words.
I
Will: loved, uh, spider Corps. That was great. I could feel its corpse.
Kristin: Inside
Will: my eye, eye sock.
Kristin: You know, what I was afraid of is that she was gonna say like, she went to sleep and then the next morning it was in like the corner of her eye. You know, her eye had flushed it out.
Will: Ugh. Thanks for that story, Anna. I think we have a second story from Anna.
Oh boy. But let’s, let’s save it for the next episode. Let’s save it. I think one, I think a spider body in your eye up, uh, uh, story is good. So,
[music]: okay.
Will: Next week, we’ll, we’ll, we’ll, we’ll tell you other, Anna seems to live an interesting life story. Alright. Thank you for sending that in. And you guys send us your stories about eyeballs or otherwise.
Uh, you can email us, knock knock high@humancontent.com. Visit us on our social media platforms so you can go to, um, our Human Content Podcast family on Instagram and TikTok at Human Content pods. [01:00:00] Thanks to all the great listeners leading feedback and reviews, if you subscribe and comment. On our favorite?
On our favorite or your favorite podcasting app or on YouTube At Glaucomfleckens, by the way, that’s our YouTube podcast channel. We’ll give you a shout out like at. Dive. Pixel 25 on YouTube said hilarious episodes. So much fun to watch. I assume they’re talking about just all the episodes are hilarious and so much fun to watch, so thank you.
Thank you for that. Uh, we also have a full video episode drop every week on that YouTube channel at Guac and Flexin. They also have a Patreon, lots of cool perks, bonus episodes where we react to medical shows and movies. Other members of the AKA community are there and they’re wonderful people.
Everyone’s is anybody who’s not wonderful. We put in jail, uh, early at free episode, access to interactive QA livestream events, much more. patreon.com/ Glaucomflecken. Speaking of Paton, community Perks, new member, shout out. We have two Jessica. Ooh. Jessica s and Jessica M Thank you, Jessica’s. Jessica’s for joining.
Shout out [01:01:00] to the Jonathans as usual, Patrick, Lucia, C, Edward, K, Mr. Granddaddy Caitlin, C Brianna, L Mary, H Keith, g Parker, Muhammad, L, Kaylee, A David, H Gary, M Eric, B Marlene, s Scott, m Kelsey, m Brian, s Sean, m Jessica, m. Hawkeye md, bubbly salt and
[music]: shiny honey.
Will: Oh, and an extra shout out to Brian s
Kristin: Yes.
Will: We’ll shout at him twice at this episode because we missed the last time.
Kristin: Yeah, so the Thank you. Brian S
Will: So thank you, Brian s, patron roulette. Random shout to someone on the emergency medicine tier, Laura t Thank you for being a patron, and thank you all for listening. We are your hosts. Hello, Kristin Flanary also knows the Glock of plugins. Executive producers are Will fair, Kristin Flanary, Aaron Corny, Rob Goldman and Shahnti Brooke.
Editor Engineers Day Support. Our music is by Omer Ben-Zvi, and what a musician he is sure
[music]: is
Will: to learn about AKA’s program. Disclaimer, ethics policy submission. For verification, licensing terms and HIPAA release terms, go to Glaucomflecken dot com or reach out to us Night Neck high@humancontent.com with questions, concerns, or fun medical puns.
Night Neck High is a [01:02:00] human content production.
Thanks for watching the episode. You can find more on that playlist over there If you prefer to listen or you just had your eyes dilated, you can binge full episodes wherever you get your podcast or join the party over on Patreon where you get early access episodes. Hang out with us, get lots of exclusive bonus content, help you subscribe, leave a comment below, let us know what you think.