Community Pharmacy Freedom, Cash-Based Models & AI-Powered Medication Optimization | TWIRx

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1:21You are listening to the Global Network of Podcasters dedicated to the pharmacy profession. Welcome to the Pharmacy Podcast Network.

1:56Hey, we are here with Rick Seip. He's back on Twerks. Rick, it's so good to see you. It's great to be on the program and thanks for coming and visiting us. We get to be at Value Drug Company's headquarters here. It's Duncanville, right? Duncansville, yes. Duncansville. We're so happy to have you here. Well, I got to tour the facilities and I was blown away. The modernization, the automation, the conveyor belts. But as John DeJames said, the cleanliness of this facility is just amazing. And it doesn't, I was talking to Kathy and she said, we're about 10 years old. This place looks brand new. Really appreciate that.

2:37The team has a lot of pride in what they do every day, making sure we're supporting our pharmacies. But if you can't keep the warehouse clean, that's the product that are getting into patients' hands. So we're trying to make sure that everything is ready and ready to use for our patients. Values Drug, Values Drug Company, your growth is phenomenal. You've reached your 90th year. Yes, we're actually, this is year 93 for us. And the changes from my perspective is pharmacy is going through massive change in and of itself. We're leaning much more into clinical services. We're spending a little bit more time with the clients or the patients that are dealing with our chronic disease states, backing that up with products that are constantly there.

3:27Last time you were on Twerks, we were talking about the importance of getting the product, the timeliness of it, the shipping of it. today, we're going to shift into the same element of change. And some of that change starts falling into that cost plus model. Shout out to Mark Cuban, Cost Plus Drugs, and what they've done throughout the nation and bringing attention. Not so much him as a source. That's not where I like to go per se. I'm always about the independent community pharmacy and value drug company. But he brought a lot of attention to the term and people got curious. People started digging in and they realized, holy cow, PBMs and the way that their yesteryear model is now being forced to change because they're just not accepting it.

4:17So talk to us about the evolution of how value drug is now that next generation wholesaler, full line wholesaler, and not kind of like the way it was 20, 50 years ago. Absolutely. And, and we're very proud that we partner with all of our pharmacies and our shareholders and even our non-shareholders. So any independent pharmacy, we're happy to service and, but it's not just servicing, it's partnering. And when you're partnering, you need to make sure you understand where they're going and meet them there. So as you mentioned, we're happy. We want to make sure the product is getting there securely and without problems and clean.

4:56But at the same time, the pricing models are really important as well. So as reimbursement has continued to be less and more restrictive, there's some evolution to cost plus and cost plus pharmacies, especially the pharmacies that just won't accept third-party contracts with PBMs. And they're trying to make sure that they can service their patients efficiently, effectively, and have that patient care. And they could do that for minimum cost. And we have two very strong partners out in the Pittsburgh market in ForwardRx and Blueberry Pharmacy. And we have been very happy to pilot with them our cost-plus program for the last several months.

5:37We're finishing our pilot here in the next month or so. And then we will be rolling that out to any pharmacy that like to within our area. And really, it's a matter to get them cost of goods, very reasonable for generic products. so they can turn around and then have even more patients to be able to be serviced by them and take care of many of those burdens that they would have otherwise. They don't have to contract with third parties, et cetera. And at that point in time, it's a win-win for them and their pharmacies. They don't have to worry about the issues that they run into with other wholesalers and just eases that burden.

6:15There's a freedom in that. The relationship that you have with your patients as an independent community pharmacy there's freedom just at that starting point. But then when you add into that a cost plus model, you really get to drill down into care much more. And you're not being dictated by a formulary. You're not being dictated by pricing changes. I think it's a safer environment in a lot of ways too. More of this information is going to come out of the practice. More pharmacies throughout the nation are moving to cost plus drug. I've talked to several owners throughout the nation who say when they're opening stores that have been closed down based on Rite Aid closing or someone going out of business and they're picking up stores, they're taking a time out and saying, maybe this needs to be my cost plus.

7:04And now they have four or five stores in the traditional model, and now they have a new store that's coming out in the cost plus model. We see more and more of those type of different, I'll say, classes of trade or subclasses of trade pharmacies for sure. And I think you'll see more evolution even in third-party payers as well, going to a cost-plus basis in the next probably five years, even for brand products as well. The changes that are happening from regulations from the federal government and making sure that costs are controlled and contained and pulled out of the system really lead to that.

7:38But the most important piece is that they're able to care for their patients. Just visited one of those Cost Plus pharmacies in the last several weeks and talked about really taking care of those patients and talking about them holistically, not just their medication, but nutrition and other areas as well. And that should be really what's happening in that frontline engagement with patients in the pharmacies, because we are really the most readily available provider for healthcare for patients. And they're taking advantage of it, which is so great to see. And then there's ability to add on. So as I'm walking through the warehouse and I'm realizing the OTC products that are available, the creativity that your client base could shout out to the rep that is the value drug rep and saying, hey, let's start carrying something on purpose in order to a back to school special or something seasonal.

8:35But something that's exciting me is with the cost plus drug models, it's going to become the creativity of the owner in DME, for example. And the reason is, is because the element of long-term care pharmacy at home, that's the buzzword right now. And now you can surround them with more than just a product or more than just a medication. So talk to us about the other product portfolio that really complements not only cost plus drugs, but also the element of long-term care at home. Oh, that, yes. And I couldn't have said any better than what you just did because it's the holistic patient, right?

9:11It's not just giving the medication for diabetes or for a cardiovascular issue that someone has. It's anything from an over-the-counter to durable medical equipment, home health care. Those are the items that are also impacted when that wholesaler partnership and relationship with a pharmacy in that cost-plus scenario. Many of those costs that they're used to seeing are different in a cost-plus type of environment and allows them to have better products for their patients at a cheaper price and be able to let them treat and have more time with their patients. And then you get to that whole patient.

9:47The long-term care at home patient needs some additional assistance. Part of that qualification in that long-term care at home setting really leads you to have a more diverse portfolio to care for them and to let their families know. Because often it's not just the patient, it's other caregivers. And it puts their mind at ease that the pharmacy really can give everything they can to them. And so one of the things that we have is the full portfolio, all the durable medical equipment, products that they would need, or home health care, et cetera. All right. And then part of that long-term care pharmacy at home, we're crossing into the element and we're starting to see reimbursement for remote patient monitoring and blood pressure cuffs and things that are kind of tied into that.

10:34Talk to us about some of the technology products that you actually are having too. Yeah. So we continue. We have our pharmacy strategy team. And so we have a team of pharmacists. I know you mentioned John and there's Sydney and Nicole also on our teams because those are folks that we want to help to support our pharmacy partners with. And we continue to bring our partners, not only our team members, but our partners outside of Value Drug as well and bringing them forward to allow those different types of initiatives forward. So RPM continues to be a focus for us. We're bringing other partnerships forward to our pharmacies.

11:12And we see that that is really just an avenue for the future. And it's not only just that direct patient, but it's also collaboration with their provider as well. and those are billable events that then helps in the the overall profitability and care for a patient so that patient now is more than just that atenolol prescription or that diabetes medication it's their holistic how is their blood pressure how is their diabetes and making sure that you can pick up on things that could help with their outcomes and at the end of the day we're all in this industry or hopefully we're all in this industry one is there's some profitability but But at the end of the day, you're hopefully here to help care for the patient.

11:51And we can be a partner with them to bring forward those services to help them care for their patient. And you have to be. This isn't the way it was when I entered pharmacy. 2004, goodness gracious, 22 years. I'm getting old, Rick. And you know what makes me really feel old is Kyle McCormick and Brandon Antonopoulos make me feel old. because I remember when they were P2s and I met them first time at one of the Pennsylvania Pharmacists Association annual meetings and Brandon and both Brandon and Kyle were so aggressive about patient care and they were creative and they had these ideas and both of those servant leaders have transformed an idea at a student level to a business model that they're running right now.

12:40and to back that up with a wholesaler that can keep up with those kinds of changes, it's a must. It has to be partnership. And really, it's that collaboration of coming together and seeing that next generation come forward is just so exciting. Both of them are future leaders of the Pennsylvania Pharmacists Association. And I won't say future, but current. And then going to be taking the leadership reins is really exciting. And to see, how does that change? How does that transform what we do in the state from advocacy from within the state and really just changing pharmacy practice? And their ideas, as you said, as it was nurtured as students and then allowed to grow is really making an impact in their communities.

13:26And you could see it. You could see it as people walk in off the street and walk into their pharmacies. And that's so exciting. And it's exciting to be a partner with them to help them in that process. It kind of, it gives you some pride, but you don't own it. They own it and they've done such a great job and you just want to be there to help them through the process. And it's exciting to let us change to evolve with that. Just like they've, they've started that evolution and, and you're a part of that too. And having those conversations and bringing these topics forward is really important because that's how we change the profession and changing the profession and evolving it is critical.

14:02I remember literally manual claim forms within my time as being a pharmacist, and we're so far away from that, it's not even funny. So it's so exciting to see and see pharmacists having the interaction that they're having, like what you're talking about, remote patient monitoring, is something that was never dreamed of or really done then. So it's exciting. Thanks for bringing that up. Oh, yeah. And I like the fact that you're right there. It's not something that your clientele and your customers have to say, hey, value drug company, you think you could get into? uh-uh, you're already in it and you're ready to go.

14:34And that's our goal. Our goal is to hopefully get ahead of them so we have things prepared. And there are some times where, you know what, we're not, but you want to listen to them. And we're happy if someone wants to bring something to us, we're happy to work with them because you want to figure out a way to say yes, not a way to say no. So hopefully we can say yes as many times as we can and be that good business partner. Hey, Rick Seip with Value Drug Company. We'll be back on twerks. We're going to be talking about what's that next subject we're going to be on. I think just expansion expansion, being able to help in those different areas and expanding what we're learning here and going into other areas of the country.

15:14Tune in next time on this week in pharmacy with Rick site and the value drug company here on twerks and the pharmacy podcast network. Thank you. Appreciate it. Your patients need convenient and cost efficient healthcare and in the increasingly competitive pharmacy environment, independent pharmacies shouldn't have to struggle. That's where Value Drug Company steps in. At Value Drug, we treat our members like family, providing first-rate, personalized service and the support they deserve. While you provide exceptional care for your patients, we provide you comprehensive solutions to help you become efficient, productive, and profitable.

15:52We offer online ordering and mobile capabilities with our state-of-the-art Distribution Center to maintain quality and control. We help your community pharmacy get connected to the right service providers and access your market. And we don't stop there. Learn more about how Value Drug can help your pharmacy thrive at valuedrugco.com. That's valuedrugco.com. Value Drug Company is a proud sponsor of the Pharmacy Podcast Network.

16:24Hey, welcome back to This Week in Pharmacy. There is a pharmacist out there that I've, I guess you could say, I'm a little bit of a stalker. Not a dangerous stalker per se. Someone that really admires what pharmacists are doing. Entrepreneurial pharmacists. And I ran in to Yuna Kim years ago, 2019. and I think Yuna was with Proteus at the time, which was so innovative and it was fascinating. But then all of a sudden, when I was following her on LinkedIn, she was a founder of Areen. And now I get an opportunity to bring her on to twerks and to feature her and her work. And also I get two for the price of one.

17:10Dr. Jenny Behan is with us as well. Welcome to twerks, Jenny and Yuna. How are you? Thank you for having us, Todd. You know, I've also been stalking you and your podcast. So the feeling is mutual. And we are so happy to be here. I'm especially happy to be here with one of our lead pharmacists, Jenny, who can really outline what impact we're having on patient lives. I am super excited, Todd. Again, I've kind of I've been with the company for almost six years now. So I watched a lot of it being built from the ground up and we continue to expand into new areas of pharmacy and have new improved impacts on our patients.

17:55And again, the goal is always to make the experience of working with patients easier and honestly more joyful for our pharmacists and our practitioners. So I'm very, very excited. Kind of how you have expanded with your podcast. It's just exciting to watch the journey. Yes. And if you would have said these things 10, 15 years ago, it would have been like you had two heads and four eyes and people would have looked at you strange. They would have tried to push you into the MTM box. They would have tried to stuff you in medication therapy management. And we know now today with specialty rare disease and things that are happening in people's lives, the expense of guessing, God bless our physicians, but throwing darts at a dartboard with a blindfold on trying to think of, you know, how is this medication going to work and how long are we going to give it to titrate or get into their system and metabolize the right way and blah, blah, blah.

18:57So to be able to reduce hospital admissions by 40%, being able to drill down into the complex disease states and mitigating risk, this is a mission, Una, that you had in mind and it was in your heart. And I think that's what's happening to pharmacy care is the cream of the crop pharmacists are bubbling up and they're saying, time out. This is not about getting the medication as quickly as possible to the patient just for getting it into their system for that sake. It's actually taking a little bit of a pause and saying, why did we go to school in the first place to become pharmacists? Yuna, give our listeners a little overview of the organization and your dream.

19:45So Todd, you're spot on. Areen's mission is to ensure a safe and effective medication therapy. So going right back to the core and the Hippocratic Oath that we take in pharmacy school. And the way that we do that is through our medication intelligence platform that can take in all available data and turn it into actionable recommendations around who needs the medication change and what should that right drug and dose be in order to improve patient lives and ensure that they are living the healthiest lives possible. From our customer perspective, who are payers and the risk-bearing providers, this means that they do see a reduction in utilization and a reduction in total cost of care as a result.

20:30So it is a way to provide more care and at the same time save healthcare dollars. and create a more sustainable system. So extremely passionate about what we're doing. At Proteus, as you know, we're focused on medication adherence, and being there, I started to ask myself, and back then everybody was focused on adherence and dispensing and delivery solutions, but nobody was focused on the core root. Is it the safest and most effective one? So that's where we wanted to put our focus and solve that core root problem. Jenny, you get out of pharmacy school, you're thinking, hey, what do I want to do now that I have this extremely expensive degree?

21:18You get beat up in retail for a while, but that's so necessary to really connect with patients and understand so much of the mix of what's happening in healthcare and how much of a messed up jigsaw puzzle it can be. and these patients will look you in the face and not really even understand why they're taking medication or what they're doing. So this platform that's been built out, talk to us from your perception and your perspective, you know, what this means for patient care. Yeah, Todd, I think that's such a great call out. And I did start in retail, actually, even before I went to pharmacy school, I was a technician and I loved the work and definitely saw like, Like, hey, these pharmacists want to spend time talking to a patient, but there's a big red X flashing on their screen that they're not going fast enough and their assembly line has slowed down.

22:12And that's one of the outcomes that, again, retail is looking for. And we need our retail pharmacists, right? They still are some of the most trusted professionals. And I did love my rotation in retail after that. I was in substance use and mental health with the Department of Public Health for many years. and that was an absolutely enlightening journey that has helped me at Areen because what I really noted is, you know, you talked about the speed of the prescription getting in the hands of the patient, right? And there's the speed, but there's also the knowledge gap. So why am I picking up another prescription?

22:48And then there's many, many patients that the prescriptions are just sitting in their closet or they're picking and choosing when they're going to take them. And so what I love about ARINE is we're diving in, calling these patients. Our platform is kind of presenting patients. It could be a sentinel event. It could be it's looking at labs and things are going in the wrong direction. And you're getting the patient at the right time and able to spend time diving into kind of the meat of what's going on. How is this medication working for you? that shared decision-making is such an important piece of getting a patient on the right medication, right?

23:30And sometimes they're at a doctor's visit starting a new medication or getting a new diagnosis. And that is a very time-pressured scenario. And they walk out of that appointment and they're not sure what the impact of the medication is. So having a platform that highlights, Again, impactful medications highlights the full picture. You know, we can see a lot of medical claims, hospitalizations, what's going on with this patient? How has their health been changing over time? And it's really packaged for us to highlight. Here's some areas of concern that we need to dive in with the patient. That opens up time to give the patient a chance to also talk about their concerns.

24:15Because I know if you've ever been in like a busy visit with a patient reviewing something, You have your own agenda. And then if you're digging through and trying to document, it's really taking away time from the patient experience. So I think that's what I love about Areen. Its platform is really built to take the pressure off the clinician of the documentation, of writing out your recommendations. It has a lot of canned kind of recommendations that are ready to go in patient and provider language. And then it gives you back the time by highlighting needs. And if it's not the patient's goal, right, you kind of have a prioritized list of like, okay, this is not the patient's goal right now.

24:58Their diabetes is very out of control. They have an A1C of 11. But right now, their PHQ-9 is through the roof and their depression is what their main focus is. So it's very helpful for allowing us to kind of navigate through that. you know um i think of what makes sense and like i said back up 10 15 years ago and you you know they look at you strange and what are you talking about but now payers are looking for you and they're like this has to make sense these medications are expensive the insurance has gone through the roof. If it doesn't align, if it doesn't work, if it's not helping, then why are we doing it?

25:47You had some massive success. I want to just give a shout out. Irene secured 30 million series C raised for AI based medication optimization platform. However, you did not release the genie out of the bottle. The genie I'm talking about is AI, the craziness of AI right now. You built the system first and then you brought AI into it. And by the way, that's my roots is pharmacy management software and all of those organizations that are out there that are racing to get attention. AI, AI over here, AI over there. That's great. But if you don't do a thing meticulously and set some foundations and you start trying to build it from an AI perspective first, I think, in my opinion, it's the wrong way to go for cybersecurity and for HIPAA and for issues of API integration.

26:39So you set this up, this powerful system first, and now all of a sudden you're starting to wrap AI into it. So talk to our listeners about how that has made a huge impact, especially with connections to these payers. Sure, sure. So first, shout out to the pharmacists because the pharmacists were very instrumental in helping to develop our platform. So we've employed pharmacists from day one. They've been on the product development side, on the tech side, and then also on the clinical care side where Jenny sits. And by having our own clinical care team, that essentially functions as our R &D lab.

27:17We can ensure that our platform is surfacing the right information so pharmacists can provide the best clinical care and work at the top of their license. The foundation of AREN, it's a data platform at its core. So our goal is to surface really meaningful insights, again, on proper medication use and the medication recommendations. So from the beginning, we were using things like machine learning models to identify the right patients to target. And then we have our recommendation models, which look at the full patient picture, what medications have been tried and failed in the past? What are the comorbidities?

27:53What are the social demographic characteristics in order for us to really surface very targeted recommendation given that patient's circumstances? Now that we set all of that foundation, we have added other elements now of Gen AI. So now we have AI agents who are making calls to pharmacies to identify where prescription status, help patients facilitate refills, take away that extra step. We also have ambient listening within our platform as well. This, again, auto takes notes for the clinicians like Jenny, automatically creates next best action. And then from an intelligence perspective, what it allows us to do is really hear the patient conversation, identify patient sentiment, other needs that the patient is expressing about their medications.

28:48And we can actually feed that into our learning models so that we can continuously improve and personalize our recommendations. So we see it as an additional tool that allows us to actually achieve better outcomes more efficiently and effectively. But certainly, AI has to come with its guardrails, and that's where we have the clinician testers. We have an AI governance committee in-house. And at the end of the day, we are an outcomes-focused company. So we know that our solution is working when we can keep patients out of the hospital and when we can reduce total cost of care and when we can improve quality of care.

29:29I have to say, Todd, like because from a user experience, right, there's this unit talking about our ambient listening tool that's kind of documenting for the provider. And we see this in a lot of health care systems now. Right. I know Kaiser is using one and the provider will say, hey, is it OK with you if I use this? and help me take notes. And then they're looking at you the whole time. And so the first time I had someone using AI in a live setting, I was like, wow, this is bizarre. Like the doctor is looking at me and speaking. And there's been many times, right, where their back is to you and they're taking notes.

30:04And there's so much literature on how much interruptions there are just in the way we currently think and learn. Even the buzzing of a phone or looking at a phone can totally interrupt your flow. And so from the user side, what they're able to do is focus on the patient. And that is, I feel like a game changer, right? Like, I don't know any clinician that would ever tell you, hey, Todd, I love documenting. That's my favorite part. I think that's where everybody just gets very bogged down in health care. So having a system that can help you write follow-up notes. So whoever takes, you know, the patient calls in and you're not available and they see, hey, here's what Jenny and, you know, Todd talked about.

30:54And here was Todd's goals. So I can I can just go in quickly and ask about that. And and yeah, and that hands free focus on the patient. You lose insights when you're trying to note take and also pay attention to someone. So it's been a big win. And our clinicians are just have really embraced. Thank you. the way we're going to drive outcomes and do even better shared decision making and listen for sentiment cues at a more heightened level is to take some of this pressure off the clinician to be doing too many things at the same time. Jenny, I show up at graduation day in 2012, University of California, San Francisco School of Pharmacy.

31:36And I come up to you, you got your cap and gown on. And I say, I know this is going to sound crazy, Jenny, but I'm from the future. and you're going to use artificial intelligence to help manage very complex, rare diseases, and you won't necessarily be dispensing anything. How crazy would you think I was standing there before you? Pretty crazy, Todd, I would say. Todd from the future. I think that sounds like a beautiful future, but I don't know if I trust it. And still everybody are like, AI, what do you mean it's going to help me? And it's, like I said, a game changer. You're in there using your skills, communicating back and forth with the patient with full focus.

32:22And I absolutely love it. And I can't say enough, Todd, you mentioned earlier, like, hey, you have to be very careful about AI. And we have students coming in. You're just very supportive of, like, get our newest people in so they can see where the industry is going. And they are very quick to use Dr. Google and the AI answers. And I have them do some exercises of change your tone, because what you'll see if you change your question is Dr. Google and some AI tools will come back and give you the answer that it thinks you're looking for. And so I love that about our platform that we can trust it.

33:02It's constantly being updated by real guidelines and by the amazing team of clinical pharmacists and specialists that Yuna has put together. You know, our pharmacy technicians have come a long way, just as our pharmacists have. And if we have a 15, 20 year pharmacy technician veteran that's doing some pre-work, maybe order entry or something in order to prepare something, helping to jettison a prescription or care plan in process, it still comes back to the licensed pharmacist to do the due diligence and to do everything that they would to double check and triple check the safety, the drug, drug, the allergies, the labs, everything that comes in.

33:49That's the whole purpose. So AI is no different, in my opinion. It's a tool. It's not anything that's to be relied on as the end-all, be-all. It always comes back to the pharmacist. So talk to us about practicing at the top of your license and how AI can become a powerful tool, but it's always going to come back to the pharmacist decisions. Yeah, absolutely. You know, as Jenny mentioned, that shared decision-making between a patient and a clinician, a pharmacist, is so important in understanding their goals of therapy. So AI is a tool in that it can remove some of the administrative tasks from a clinician's plate.

34:29And in fact, we actually employ pharmacy technicians too. So our goal is to use every care team member at the top of their license. And our workflow engine will automatically create tasks for the appropriate care team member. So if it is seen in a pharmacy technician conversation, we hear from that ambient listening that there is a clinical need and some sort of counseling point that the pharmacist needs to convey or dive deeper into. There is an automatic task from there that will be created for the pharmacist to follow up. So that workflow cue is, again, meant to guide who's a right care team member for that intervention, and then tools like ambient listening help generate that next best action so the right care team member from there intervenes with the patient.

35:16And yes, ultimately, it is the clinician's choice as to what recommendations to finalize and send directly from our platform is the pharmacist choice. It's so important. And we really discuss that all the time with our clinicians that AI will never replace you. It's actually here to support you. Like you said, take administrative burden off. It may be, you know, bubbling up a recommendation based on what, you know, it's learning about the patient and kind of the whole host of inputs that it takes into consideration. And then it's presenting it to the pharmacist, but it's still ultimately going to be based on their critical thinking, partnership with the patient, and it will present the guidelines.

36:03So it's like, hey, here it is. This is where I'm getting this from. And if the pharmacist is comfortable, that makes sense to them, then that's a recommendation they will send. And if it doesn't, then they go ahead and they decline. And so we're collecting that data to kind of how it gets smarter on like what clinicians are accepting and declining. But it's It's very important. I don't think we can say it enough. Like the pharmacist, the individual who's taking care of the patient, they're not being replaced by AI and it will never be 100 % correct. Yeah. And Jenny, you bring up an important aspect of our platform as well, the learning loop, the adaptive learning loop.

36:42So as we learn, again, which recommendations are accepted and implemented and then ultimately improve patient outcomes, that's being fed back to both our models to select which patients need interventions and also our recommendation models. So it leads to continuous learning and improvement. You know, one thing I want to, we always repeat constantly to ourselves at Aurene is that it's not what AI does, it's what outcomes AI delivers. And that is important to our core and important to our mission. Yeah. And Todd, some of what it's doing is not just a recommendation, right? Like, for example, we have very quick kind of feedback loops, which is really helpful for our clinicians.

37:31So when we get a new population, our clinician team is kind of inputting information based on barriers they're seeing. And then we're getting the feedback of, okay, in this specific population, they're reporting cost as a barrier to X, Y, and Z medication. And then we can kind of pivot and have our clinicians directly address that in a different way. And what's great is we get to do a lot of testing of, okay, how do we get patients to open up more? If they're not comfortable talking about costs, but we definitely see that as a barrier, how can we change the way we open them up or we dialogue? And when we start getting better outcomes, sharing that through our platform.

38:13So it's not always clinical recommendations. It's also like learning about like what are the specific barriers and how do we address them for very individualized populations and health care plans. So I want to give a shout out to your team. You should be very proud of yourselves for three years in a row. You have been voted into the Inc. 5000. This is a prestigious award that's well known throughout the United States. and how very, very few companies can make it to this list. And then on top of that, the success that you've had, Yuna, for once again, three consecutive years. I just want to say congratulations.

38:59Thank you. We feel very privileged and grateful. And at the end of the day, really our most important customer is the patient. So I think if we continue to focus there, then the rest will come. Absolutely. Hey, if you'd like to learn more about Irene, please check them out at A-R-I-N-E. That's A-R-I-N-E dot I-O. Once again, Irene dot I-O. Promise me, Jenny and Yuna, that you'll come back to Twerks. Let's bring a payer with us. Let's bring a scientist or someone in labs and let's start digging into maybe some specific examples of how this system is moving pharmacy care very much further into the future and what we need and also expanding what pharmacists really want when they come out of pharmacy school.

39:53Our new PharmDs, some of them don't want to be in retail. Some of them don't want to necessarily go to health system. They'd much rather be working in the consultative space and certainly embracing technology. So thank you both for being on this week in pharmacy. Thank you. We'll be back. Thank you so much. That's awesome. Thank you so much for twerksing with us. Hey, listeners, we appreciate you. Hope you had a great week. This was twerks for August 28th. I cannot believe that we're almost to September. 2026 is going fast. Continue to do what you do. Love every one of you out there, pharmacists, pharmacy technicians.

40:37Tune in next week for more twerks.