Evolution of Functional Pharmacy & Supportive Conferences | TWIRx

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1:19Welcome to This Week in Pharmacy. Twirks is the weekly pulse of the pharmacy profession. And now, here's Pittsburgh native bleeding black and gold, pharmacy's first podcaster and founder of the Pharmacy Podcast Network, the RxPodfather, our host, Todd Urie.

1:43Hey, welcome to This Week in Pharmacy. It's November 13th, 2026. It has been a tiring week. I don't know how you're feeling, but I'm pretty tired. I need a weekend. Just got to see somber i didn't know this guy's name was shane anybody know somber's name was shane what a performance uh ppg arena in pittsburgh got to take my 14 year old daughter and her friend and i was quite impressed uh it was like 80 percent women there uh there were guys but mostly a women's concert and um i like his music i i loved his music i his performance is crazy It was excellent. I haven't been to a concert in, embarrassed to say, maybe like 12 years.

2:37So I need to get back to concerts. And I enjoyed that one. I don't know if anybody else saw Somber in your neck of the woods. Great, great time. I hope you guys had some kind of fun this week in pharmacy. Hey, we got news coming up from this week in pharmacy. And now here's the latest in pharmacy coming up on twerks news. Hey, FDA is requiring updated safety labeling across GLP one receptor antagonists because of a potential increase risk of neuropathy. And the acronym is NAION, and it's a rare condition that can cause sudden potential permanent vision loss. This analysis is 126 clinical trials data pushed into a bunch of cases that came out of this approximately 6.4 cases per 100 ,000 among these users.

3:50The risk remains rare, but they definitely want our pharma system physicians to know. and I think prescribing expands. We know it's going to continue to expand. GLP-1 prescribing and pharmacists are critical in the safety of this and discussing with your patients the self-administering of these medications I don't think is a good idea. What do you guys think? I think that pharmacists should be more involved at least with checkups as people go through a pretty, I mean, we've downplayed it because it's been out for a while now, GLP-1s and weight loss, but maybe it's time to slow down a bit and require that there's some kind of cycle.

4:41Either it's telehealth, meeting up with your pharmacist, going through maybe once every 30 days, at least getting a check-in of how you're taking these medications and the outcome as you're moving forward. identifying concerns and symptoms and support for safe medication management. And our community pharmacists sufficiently integrated into the clinical monitoring of patients receiving GLP-1 therapies. That's the question on this news. Hey, next up, we found out America lost, this is crazy, America lost more than 3 ,000 community pharmacies in just two years. Think of that. Think of the significant impact on public health.

5:34I think that that is more significant than what we all realize because we're living it. When you're in the trenches, you're not really paying attention. But I think studies that are going to be coming out of public health departments from the state perspective as well as the federal perspective are going to show that's massive news. Coming out of Drug Topics, drawing on the Journal of the American Pharmacists Association documents a significant decline in the nation's pharmacy infrastructure between 2022 and 2024. 7 ,240 closures in total over the studied time between 2022 and 2024. And then from 2024 to 2026, an additional 3 ,000.

6:27we did see that there have been pharmacies that opened and that has pushed the loss to a total of about 3 000 that's where they're coming up with this number so 7 240 closed 4 178 opened and that left us with 3 ,000. All right, so Medicare's access model could create new opportunities for pharmacist-led chronic care. We know this is also an issue in getting this. I'd love to know if the opportunities are happening now, if you're noticing. Medicare's access model could create these new opportunities for pharmacist-led chronic care. Makes me think of C-P-E-S-N in the home state of Pennsylvania. The pharmacist care, Pennsylvania Pharmacist Care Network.

7:36So this model emphasizes technology-supported management of chronic disease, including diabetes, hypertension, chronic pain, depression, with payments tied to outcomes rather than traditional dispensing activities. This is on top of dispensing activities. participating pharmacists and pharmacies must meet applicable program and clinical requirements. This is exciting. Do you think this could help advanced pharmacies transition from dispensing-centered reimbursement towards sustainable payment for longitudinal and expansion of patient care? I think it could. And could outcome-based Medicare reimbursement become the first financial foundation for the next generation of independent pharmacies?

8:30That is the question. Pharmacy management system that's on top of this is one of our clients. It's on our network, Outcomes. Outcomes.com. If you reach out to Outcomes, ask to speak to one of their consultants and ask the questions about getting paid. and if you want more information on that reach out to me too last name Uri at pharmacypodcast.com hey next up on twerks

9:23Thank you.

9:53Thank you.

10:23counsel patients about these therapies, the medication adherence, the drug interactions, and the bleeding risks? And will this be a factor in needing additional counseling when these medications are used to become an important new option in that secondary stroke prevention and what will be determined for the full adoption moving forward? We'd love to hear from you on this. All right, we have a great episode with Rob Kress, who is known as the functional pharmacy godfather, the godfather of functional pharmacy. And how much work he has done over 25 years in functional medicine is leading to a new kind of conference.

11:16and I really can't wait for you to hear this concept and I'd like to see this spread. I'd like to see Rob train pharmacists throughout the country in different regions to put on these kind of conferences. You're not going to want to miss this. We'll be right back with more twerks.

11:41This episode is sponsored by Independent Pharmacy Cooperative, widely known as IPC. Established in 1983, IPC is the nation's largest group purchasing organization owned by independent pharmacy. With a mission of maximizing the success of community pharmacists, IPC works to provide members with access to effective programs and services designed to enhance profitability for independent pharmacy. Read more about our mission by checking out our website at ipcrx.com. That's ipcrx.com.

12:24Hey, welcome back to This Week in Pharmacy. Special guest, a returning guest. Someone's been on the show several times. If you're watching on YouTube, you'll see his gorgeous hair, which I think is very famous. It might be your calling card, Robert. It flows. It's usually flowing with the wind when you're walking outside. Nice to have you back. Well, I hope it doesn't stop with that. I can't get mine to do the puffiness. And if it does, it gets too puffy. So I don't have the way it lays back. So I'm envious. That's the only reason I mention it. Thank you. Hey, it's nice to see you. You and I had a plan.

13:08and we were trying to stuff a conference, very meaningful conference, unlike anything else I've ever been to in 25 years of conferencing. We were trying to get it into October of 2026 and it slammed up against all the other shows I think I was part of. I think I went to four or five different conferences in less than three months. And it's really put a place setter in our minds to be able to share such a conference with pharmacists and pharmacy professionals that are listening right now. I want you to give our listeners an overview of the concept of this engagement conference that's happening outside four walls of a conference hall that, like I said, I've been going to conferences for 25 years.

13:58So just start right out. If people don't know Robert Kress, the godfather of functional pharmacy, a little bit of background on yourself, but then let's jump into what this means for the pharmacy profession. Yeah, absolutely. And thanks for having me on, Todd. It's good to see you again. So yeah, you're the one that actually coined me the godfather of functional pharmacy, and I'd like to say I'm certainly one of the pioneers in it. Been teaching this since 2010, I guess, you know, integrating functional medicine into pharmacy and how that can parlay out. Now, I've also kind of evolved it into a lens of medicine that I call orientation-based medicine.

14:41And what's really interesting is how we were trying to push and force this thing into a small window is exactly against the concepts of orientation-based medicine, because the basis of it is we need to recognize that our environment influences our orientation, right? And our orientation dictates our capacity and what we have to make change, what we have to implement to grow and to make things happen. So we were trying to force something in that I think the natural element of life said, no, not right now. But I think it gives us some great foresight on where we can take this. So as you probably know, I have not been a traditional, sorry, wants my attention, a traditional, what should I say, conference goer.

15:34I actually met you at Nashville one time, just because we were going through. But, you know, I've always been one who, and you might know, I don't like to be stuck inside too much within the four walls and nothing against it, because the learning that's shared and the interactions with others is the values that we certainly take up from these events. But, you know, I started thinking and you and I started talking and we just actually got back and I'll kind of show it here. It was our first OBM immersion and we did that in Zion National Park. And it was basically on the concepts of orientation-based medicine, recognizing how the change of one's environment influences their orientation and then it provokes of questions to ask.

16:16So this is kind of the concept here. It's not keeping people inside four walls and fluorescent lights all day long, but to offer some insights, to ask the questions and to let them go out on their own. Or maybe it's a guided hike like we did to actually embody these things in these principles. So we're not just taking home business cards. We're not just taken home concepts we learned, but full embodiment of how that can relate to ourselves, as well as our practice and how we integrate with our clients and our patients and employees as well. I think it's timing and environment as well. So if you had chosen an area that you understood, you had been there before, you walked it, the planned it.

17:00I remember when I started paying attention to conference designers and um there have been several conferences that i've gone to that are are dynamic but people will people will go to the venue first maybe a year in advance and they'll check it out they'll walk it they'll see it the what you are what you're proposing what we're hoping to do in 2027 is be able to gather a more smaller intimate group for an experience to be involved in a conference that also involves their environment so that the environment's a big part of it. And then the timing is, depending on how long it takes to walk from point A to point B to point C, by the time you get to point C, on an average of how long you think it's going to take you to walk that point, you did it on purpose so that you arrive at a position so that the next part of the conference is taking place.

17:59But when I think of movement and I think of my pulse going up just a little bit because of that movement, fresh air coming through my lungs, my brain becoming a little bit more clear, listening to a person's voice as I'm walking and really taking the time to think of the concept that you're really digging into. this is a whole different way of absorbing information in this space. And I'm so, you know, blown away by that concept. But what else do you see of being able to piece together for this so that it becomes structural in a way with a lot of freedom in a way? So kind of like on both ends of the scale of what a normal conference would be, but kind of give our listeners some of the immersion opportunity that we would present.

18:57Absolutely. So, you know, we come to it with structure, right? We don't come to it with, okay, this 30 minutes is for this, this 30 minutes is for this, this 30 minutes is for this, because we need to actually recognize that the environment allows us to dictate how we orient and might even open up opportunities to go a different path instead of trying to force it the whole direction. So it comes to it absolutely with a structured plan, a structured, I mean, I guess we could say certainly curriculum. It's got a facilitator instruction mode to it as well, because listen, a lot of us pharmacists, we are leaders, but we haven't claimed that, right and how can we actually lead the groups of people that we interact with and we engage with every day and where can we take that so um you know it's uh a structured meeting in the morning um talking uh about what that day will represent and then going out and allowing the environment of nature which is one of the most unpredictable things because you know i've been to Zion many times before, but I haven't been to this part of Zion, right?

20:09So I had the suggestions where people could go after we met and before we met again. I chose some trails that we could go on. I explored areas that I've never been to, such as East Mesa, alone by myself in the deep canyons and the deep rain. And, you know, one of the things I really loved about it was when it was one day of hiking, everyone was out. We weren't together on this particular day, but how many people actually enjoyed the rain, you know, like this environmental change that might cause you to go inside or reset your plans, but instead they actually welcomed it and the feeling of it. So I think when we get into, you know, when we say our environment, we can be speaking of where we work, our home, a conference setting, but let's also not forget what nature has to offer.

20:56And there's a direct nervous system response that we learn from. We learn about our adaptations, how we actually respond to life and how that's been developed. And then we ask, is that serving us anymore? So it's very much an embodiment, a hands-on process of the concepts that we learn and how we can actually integrate that in each and every day. So the gamble of such a conference is, in fact, something that we can't control, and that is the environment that we're within, the weather that we're, you know, is there at the time. However, in my limited opinion of such a thing, you've at least experienced it, this is an opportunity to say la vie, take it on as it happens and be like, hey, we're here.

21:47We're going to make sure that we're prepared for, you know, just about anything. But that can be controlled and limited on a level with the actual area that you choose. So what are these areas throughout our beautiful country that you might actually choose in order to be part of an immersion experience? Yeah, absolutely. And, you know, first, what I want to say is, I don't know if I'd look at it as a gamble as much as an opportunity, especially when we come prepared. And certainly not taking anyone to the top of Everest. That's not within my goal. I want safety involved. But as I said, we just got back from Zion National Park.

22:29And the next stop, actually, we're bringing people to Sedona as well. So I think what I'm looking for is areas around the country. And I mean, you and I talked about your neck of the woods, you know, which is a beautiful area and perfect for it if anyone's ever been to Western Pennsylvania. So I think what the land brings is exploration and the ability that people can choose their own path. Like when we did Zion, people had the opportunity to say, you know what, I'm going to explore today. Maybe I'm going to wander today, or maybe I'm just going to restore. So that's the opportunity. If you want to, and I mean, the one day I did all three, I hiked East Mesa, I got lost wandering a bit, and then I came back and I sat in the hot tub and I restored myself.

23:14So, you know, it brings all that in together. And then you come together in a connection and community of a dinner and sharing each other's experience and then gaining a lot of insight from that. So, I mean, areas like Maine comes to mind. You know, we have some areas of California, but it's a weather dependent type thing. But, you know, I'm a big fan of how we can integrate different types of nature, which would be usually it's going to be some type of hill or mountain setting to envelope that in some type of trails. It's open to all levels. And that's the beauty of it. You know, it's, I used to live in Jackson Hole, Wyoming, and it's almost like every ski run was a black diamond.

23:58And they've since modified the mountain a bit, but you don't have to be a seasoned hiker in the best of shape. The idea is to experience what environment can offer you and what you can take from that. Something else. Topics and the untraditional. When we go to conferences, when you and I showed up at the NASP, there were thousands of people there. This is a much smaller group that gives us the opportunity to share and talk with everyone, expecting to learn and talk to everyone, and involving them in material, involving them in concepts, and a preface to what that material is about so that people do come prepared mentally, physically too, for that matter.

24:51So let's talk to the listeners about that too. This is a limited future opportunity to do something that you've never experienced before at a pharmacy-oriented conference, what are the numbers that we're looking at for people that would attend? I mean, I think you and I spoke, and I think we'd like to max this out at 15 to 20 people. And I think it's a nice offer in that, you know, and this is what we did at Zion. You know, people can bring their spouses, which really open things up because conversations went everything from business to entrepreneurship to relationships, right? And it's because all this stuff affects how we show up in the pharmacy and especially how we come home.

25:34So it's a whole world benefits of that. It's absolutely the concepts of orientation-based medicine. It's what kind of programs you can decide or, you know, where you are right now and where you want to take things. But I think to keep it intimate, to keep it certainly hands-on and allow people to step in as much as they want or even hold back as much as they want. You know, that 10 to 20 range, I think, seems pretty good. I agree. And it's interesting about bringing your spouse. People that run pharmacies, there's a very big chance that their spouse is involved in that. And sometimes it's two pharmacists that end up getting married.

26:19But your spouse being involved in such a conference, I think it's very special because when I go to conferences, I don't ever get to engage my wife in something. She's always on a separate schedule, doesn't really understand even what the conference is about. this would be much more holistic in preparing a couple to get ready for the next phase of their lives and professionalism and building something. They might be building it together or they might be building it indirectly together because your spouse is always there and supporting you. One of the biggest determinants of success to any entrepreneur is that special partner and what that means for stress levels, what that means for home life in order to recharge, to prepare for what's happening at your work.

27:15And so I think it makes sense, Rob, to have your special summer with you. You know, one of the topics that came up as we were sitting around the dinner table is what happens when men go quiet, right? And from a woman's perspective, they didn't understand because oftentimes they want to know. and I do a lot of men's work as well. But sometimes from the man, it's to a point of, you know what, I'm just navigating things right now. I'm just putting things together. It's not a communication issue, but communication issue is it hasn't been shared. So when you can actually have, and, you know, in this one, we had pharmacists, we had functional medicine practitioners, we had farmers, we had entrepreneurs.

27:57So it was a really unique mix of people, but there were similar threads that came about it. And that's what I found really interesting. And, you know, for Kay and I, you know, Kay Corpus, you know, she's my partner. And I think we received and walked away with from it more than we even expected as we were kind of facilitating this process. So, yeah. And I just think that that always matters. And, you know, I like your example. And, you know, whether we're even a retail pharmacist and we're coming home, you know, oftentimes we're in shutdown just because we have to integrate. what just went on for the last 10 hours of chaos, you know?

28:36Exactly. Yeah, the stress that that sector of pharmacy has. I mean, all sectors of pharmacy come across some level of stress, but sometimes that's the most volatile of all of them is how the public treats our technicians and our pharmacists, as well as, in a lot of cases, how the pharmacists and technicians are expected to perform, and it becomes more transactional than it does really about healthcare. So having a detoxic opportunity to detox from all of that stress, I think is very meaningful. Pharmacy Podcast Network listeners, be on the lookout. We're going to post some blog information. I also want you to pay attention.

29:25If you go to functionalpharmacy.com, it's going to be in the show notes. Rob has an amazing blog section and he has some mentions of OBM, orientation-based medicine. He talks through that and connected to thyroid timing chronicles, hormone and estrogen, metabolic timing. Great material on your blog, Rob. Is there anything upcoming that you want to share with the listeners that you're going to be working on? Yeah, absolutely. And probably the most up-to-date stuff you'll find would be my social media. So robcressfrx Instagram. And I think that goes for LinkedIn as well and functional pharmacy for Facebook.

30:13But what we're doing at the end of April, beginning of May, but it's actually, so we're doing an immersion in Sedona, Arizona, and this is called Beneath the Rocks. And we're walking people through four different distinct pathways. But the side of this, we're also offering a facilitator program that starts in January. So it's four months online coaching facilitating from both Kay and I to actually how you can actually take your wisdom that you have and create that next special thing that you're looking to. And you might not know what it is, and that's okay. You know, from the results or the response that we got back from Zion, It's been pretty profound.

30:55You know, I know I've talked to this before, but I talk a lot about Nietzsche's parable, the camel, the lion and the child. And one of the messages I got back from one of the participants was, you know, he was kind of there for the immersion. But it was when he got back, he saw his lion emerge. And that was pretty profound. And, you know, this individual is also looking at the next step of facilitatorship. Is he a pharmacist? No, but he doesn't need to be. That's the beauty of it all. It is. But I'm really excited about that one. I'm excited what you and I can put together here and how we can kind of customize it for your audience and how we can make it special bringing in these concepts that we have created.

31:34Well, I'm going to have you back because we're going to talk about the next, the cultivation of this. And by the time you come back, we'll have it named and dates picked out and preparing for it so that our listeners can engage and reach out. But in the meantime, I want you to reach out to Rob Kress if you go to functionalpharmacy.com. And like Rob said, he's active on social media as well as Instagram is probably one of my favorite places to watch what you're doing. Rob, it's always a pleasure to have you on twerks. We appreciate you being here. Appreciate you having me. Thank you, Doug. All right.

32:13We'll be right back with more twerks.

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33:13Hey, we are back this week in pharmacy. I do want to say something quickly. We're going to make it a short twerks today. I want to encourage you to vote for the pharmacy 50 awards. Please go to pharmacy 50 dot us. Once again, that's pharmacy 50 dot us. This is our fifth annual celebration of the most influential people in our pharmacy profession, supported and voted by people in our pharmacy profession. Go vote for someone. Go nominate someone that you know has made a significant impact to this profession, to health care, helping patients. there are so many people that i want to vote for i obviously i'm not voting i don't do any of the nominations but i want to encourage you to we're talking about independent pharmacy specialty pharmacy chain pharmacy long-term care pharmacy technicians student pharmacists student pharmacists are p2s and threes and fours that are doing incredible things there's a there's a an award for them advocacy leaders are technology leaders social media influencer that was huge last year so don't forget about people out there influencing health care influencing better decisions based on the use of social media and we hold those people to a higher standard if you're a pharmacist.

34:52You cannot be using social media to spread unverified, non-evidence-based information. So if you are a pharmacist, we encourage you, I encourage you to use social media, but you better be damn sure that if it's very specific to recommendations or discussions on clinical subjects that, of course, is evidence-based. But if you're an influencer on social media and it's just fun, or if it's just talking about our profession, then by all means, go crazy. I mean, we want more of that. Compounding pharmacy, hospital system pharmacy, our medical science liaisons, and then we have another section called Other.

35:39We want to hear from you. Are we missing sections? Are we missing parts of our healthcare system? that are growing and pharmacists are having an impact. Once again, this is the fifth annual Pharmacy 50 Awards. Go vote. Pharmacy50.us. And make it a good week. We will be back next week with more twerks. Have a great weekend. I'm headed to Florida. I'm headed to go see my dad. It's his 80th birthday party. Heading down there today. See ya. Thank you.

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