Independent Pharmacy: AI, Consolidation & Fighting for Every Dollar | TWIRx

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1:18Hey everyone, Jesse McCullough here with the 31-Day Challenge. I'd like to start out just by giving thanks to Todd and the whole team at the Pharmacy Podcast Network. I appreciate the opportunity to share some unique challenges with the This Week in Pharmacy audience. For those of you who may not be familiar with the 31-Day Challenge, this is actually our second year to implement the 31-Day Challenge. This is something that coincides with American Pharmacist Month. And the idea came from, is there something that we can do to encourage and equip and enhance and empower pharmacists throughout American Pharmacist Month, no matter what discipline of pharmacy you find yourself working in, whatever that area of practice may be.

2:08And the idea became this 31-day challenge. And the way it operates is on a daily basis. There's a new video released primarily on LinkedIn. And now this year, I'm on YouTube. I got sophisticated. but the challenge features just some little thing that you can do that would make life better for you or your team or the people that you serve. So with that, the challenge kicked off on October 1st, yesterday, as of this recording, and I want to invite you to be a part of that. Follow along, you know, find a couple of people to follow along with. I think you'll find it to be well worth your time and it'll be a fun and encouraging and uplifting time.

2:58That said, Todd asked me if I would give a special challenge to the This Week in Pharmacy audience. And that's what I'm here to do today. I'm going to give you a special challenge. This is a very simple thing. It's something that you can actually do right now. Obviously, you find value in the Pharmacy Podcast Network. You find value in this particular episode that you are listening to. And what I want to invite you to do, what I want to challenge you to do is to share this episode with at least two colleagues. Find at least two colleagues that you can just hit the share button from however it is that you're consuming this content and invite them to be a part of it as well.

3:42Now, I also understand that the Pharmacy Podcast Network has a number of different shows, a number of different hosts, and they all deliver tremendous value. What I would also encourage you to do is find one of those shows, find one of those episodes, find one of those hosts, and take one of those podcasts and share that with some colleagues as well. For those of you who say, I don't know which colleagues to send this to, feel free just to share it on social media, on whatever your platform of choice is. But do something to help elevate and get the word out. And, you know, just give some type of encouragement to our fellow pharmacists that are out and doing the good work that serves our communities so, so well.

4:24With that, I'm going to wrap up this particular edition, but I will see you back here next week with another challenge. Have a great week, everybody. This episode is brought to you by Hendren AI. Specialty pharmacy teams are being asked to do more than ever before. Between patient outreach, refill coordination, prior authorizations, and the endless volume of phone calls, valuable clinical and operational time is often consumed by administrative work. At Hendren AI, we believe the people caring for patients should spend less time managing workflows and more time delivering meaningful outcomes. That's why we build AI-powered solutions designed specifically for specialty and infusion pharmacy organizations.

5:07Our platform helps automate repetitive phone-based and administrative processes, streamline operations, and improve the patient experience while fitting into existing workflows. Hendren AI is focused on a simple mission, turning human labor into software so healthcare organizations can scale more efficiently while keeping patients at the center of care. To learn more, visit Hendren.ai and discover how AI can help your team work smarter, not harder.

5:42You are listening to the Global Network of Podcasters dedicated to the pharmacy profession. Welcome to the Pharmacy Podcast Network.

6:18welcome to twerks news on this week in pharmacy we head into ncpa 2026 with independent community pharmacy front and center, from artificial intelligence and consolidation to supply chain economics and policy reform. We start with the twerks rumor mill, behind-the-counter intelligence, looking at three developing stories worth watching. First, another massive pharmacy transaction may be coming. The owner of Walgreens Boots Alliance is reportedly nearing a deal to sell UK pharmacy giant Boots to the Weston family in a transaction valued at roughly$9 billion, dollars, including debt. The Westin interests already control Loblaw companies and Shoppers Drug Mart in Canada.

6:57No final transaction has been announced, so this remains one to watch. Twerks take pharmacy consolidation isn't slowing down. As major organizations continue reorganizing, buying, selling, and vertically integrating assets, what does that mean for independent pharmacy, and where does scale become too much scale?

7:20national community pharmacist association super bowl of independent community pharmacy is this week coming up october 3rd 4th 5th 6th or october 4th i don't know the dates it's like it's coming up people and um i'm here this week in pharmacy with john booze from hendron ai John, you were on Torx on September 18th. It was a great time to kind of find out who was Hendren. What's the background? What's your background? Now we're headed to, like I said, the Super Bowl of Independent Community Pharmacy. Are you excited to be going to Kansas City? It's actually my first time, Todd. I've never actually been to Kansas City before.

8:03I was born and raised in New York. I've never been to conferences. I usually go to conferences East Coast, West Coast, Vegas, sometimes in the South, but never to Kansas. All right. Well, if I'm planning a conference for a bunch of pharmacists to meet up, especially our independent community pharmacy pharmacist, I'm not going to Kansas City. I'm going to go to Orlando. I'm going to go to Orlando. I'm just being honest, NCPA. Shout out to NCPA. You guys are awesome. But I'm going to go to Orlando. I'm going to go to Vegas. I'm going to go. I'd like to know if they're having it at Kansas City, why can't we have a conference in Pittsburgh.

8:39Pittsburgh has a huge convention center. We're a tech company. We got MIT and Pitt and Duquesne University School of Pharmacy. But yeah, I'm excited. The reason why I'm all fired up is meeting up with independent community pharmacy owners who are ready to change their lives and ready to change their businesses. I've noticed that when we have pharmacy owners investing in these conferences because they're so expensive to go to, the flights, the hotels, meeting up places. These people want to make things happen. So when they show up, they want to engage and they want to talk with vendors and people who are just as passionate as they are about their business and really making changes.

9:23So I want you to talk with our listeners, especially if they're going, let's talk AI in independent community pharmacy right out of the gate, what's kind of the hot button when it comes to implementation of AI? What's that one part that is like, if you're using AI, you've got to be doing this. Right. So if you got to use AI, I think the best next step is to use AI agents, numerous AI agents doing things simultaneously. And what I usually tell people, if you have a technician and you have certain productivity that's coming out of that technician on the screen or over the phone. Imagine having a team of AI agents working simultaneously, calling numerous providers for numerous patients simultaneously without actually having to expand outside of your walls.

10:14And I typically get this question all the time where they're a corner store pharmacy or they have a small chain. We're trying to grow outside of our walls, but we're unable to, because of staffing problems, unable to find really talented folks within the market, whether they're pharmacists or technicians that have the know-how, but at the same time, they want to obviously increase the volume of prescriptions and the patients that are actually coming into the pharmacy. So how do they get that bottleneck removed and really clear in a way that they can expand in a proficient manner without really losing quality care?

10:49So the voice AI agents are definitely the way to do it in terms of being able to have those AI agents' productivity with payers, providers, and at the same time communicating with those patients via the phone and text message. Text message follow-up, being able to ask questions, pulling that data back to the pharmacy management system, and then cataloging what was said so that you can follow up on it, and then personalizing it. Because I think if the patient, if there's a follow-up either with a phone call or they're in the physical pharmacy and then the pharmacy technician, the pharmacist are reading through the notes to be able to say, hey, we reached out to you three days ago and you said that you don't have any refills left.

11:41Did you lose the medication? What's going on? That kind of personalization can really make AI much more fluid with caring for that personal personalized patient experience. And now it's like, wow, these people really pay attention to not only what I texted, but what I'm saying. And if you can merge those two things together, that's why I think, once again, I've never operated a pharmacy, but I've, I've been documenting this through podcasting 20 years now. And it's like, boy, if I can, if I can get the best out of it, where my techs, I might, techs might be doing less now because AI has taken over some of their busy work, put them on customer service and romancing your customer, romancing your patients of getting the vaccine.

12:28Right now it's the fall season vaccines. You have a better ROI on vaccines than you do actually dispensing. It's interesting that you mentioned that Todd, and we talk a lot about the patient journey memory and being able to have the memory of the patient journey from beginning to end. And at the same time, since we walk on both sides of the aisle, so we're able to communicate with the Epic, Cerner, Athena, eClinicalWorks, and at the same time, the pharmacy management softwares that are out there, we're able to have that kind of patient journey memory and prescription journey memory for that patient and be able to basically communicate those kind of things in a HIPAA compliant manner so that they'll be able to communicate at ease without having to risk that kind of protected health information.

13:12All right. So interaction with the patient, whether that's text, whether it's voice, personalizing the experience, what other things? Let's talk about submit administration. What about inventory, purchasing? What about the cash flow side of things. Right. So that's more of like a CRM QuickBooks. We really don't touch those kind of things. What we essentially do is look at administrative and clinical path flows in terms of inventory modules. That's on the roadmap, not there yet. But in terms of being a CRM system, we are not a CRM system where we're essentially maintaining that kind of inventory of customers.

13:52every PMS system has all those customers there to begin with. But to have like a CRM system, for example, typically most corner store pharmacies have like a CRM system to reach out to providers, right? And I've been with pharmacies before where we essentially try to market the pharmacy to providers to make sure that these pharmacies are actually getting those prescriptions from those providers. And to me, that would be a CRM, essentially, that you would want to find out how you can look at the demographics in the area and making sure those providers are essentially sending those prescriptions at the patients that are visiting your pharmacy and you'd be able to deliver mail it or essentially any pathway to be able to get that medication to the patient but yeah we don't have that in place a crm system for the providers or inventory because most of the systems out there already have an inventory system uh so we don't run into that problem Well, that's good to at least identify what you definitely do versus what you don't.

14:52And I think that that helps to bring clarity. We have talked with some other AI developers. And when they talk with pharmacy operators, especially like in the independent community pharmacy space, I've heard back from those owners of saying it's hard to clarify what it is that they do because they keep saying, oh, yeah, we can do that or we can do that. And I'm like, yeah, that's true. If you've become an expert in something specific, that can build strength. And then at least I know where I stand with an organization. So it's good to know what Endrin is doing. I think you have a special relationship with several pharmacy management system softwares out there that are doing inventory and are doing all the things that we're talking about.

15:37One of those is DRX, which you can learn more about them by going to getdrx.com. Once again, that's getdrx.com. But talk to me about DRX. Like what's going on with that organization and kind of the relationship with Hendren AI? So DRX is the primary platform. So it's a pharmacy management software. I would say probably the most robust out there because it is a SQL-based. And a lot of them, like the competitors that are out there, are mostly on-premises, so they're not sitting on a cloud. So Dan and I have been in communications for the past couple of months, and we've noticed a great opportunity to be able to work together to essentially leverage our secondary platform on top of its primary platform so that we're the intelligence automation to be able to leverage those AI agents that I mentioned via voice, data entry, to be able to get those prescriptions in and scrape them and essentially map them into the pharmacy software.

16:40And then looking at some of the opportunities where essentially we can grow together in terms of implementing that kind of technology. So we're very thankful to be working with DRX and having that API and sandbox environment to really work, I would say in a tailored approach with some of these pharmacies. And I know some pharmacies want that kind of experience and you just pick up the phone and call. And we have that kind of experience with us. So you can just pick up the phone and get in touch and head in at our 1-800 number and we'd be able to get in touch with you to try to see if we could build something tailored specifically for your pharmacy.

17:15Yeah, and just a shout out to our listeners. If you are going to the NCPA in Kansas City and you want to connect with us, if you want to be part of our interviews, we're going to be at two of the booths. We're going to be at Ural Pharma, probably going to be at DRX Pharmacy Softwares. We'll be confirming that, but stay close to the mic. Text me at my phone number. I'm going to put it in the show notes, 412-585-2251. That's 412-585-2251. Let me know where you guys are at. Hey, if somebody wants to buy me a drink in Kansas City, I'm all for that. Like, if you're from Kansas City, you got to tell me what kind of food I should be eating.

18:06Because if you come to Pittsburgh, I'm going to take you to Primanti's or I'm going to take you to some place up on Mount Washington or something. But I don't know what's good to eat out in Kansas City. Do you? I have no clue. See? Tell me. Nobody knows. Like, what's going on in Kansas City? Like, let's get something together. All right. Hey, I'm excited to be seeing you, John. We spend a lot of time on Zooms and on calls, but being in front of you is going to be fun. Really appreciate the work that you guys are doing, the support that you're giving us as press coverage for the upcoming NCPA. And we'll see you in Kansas City.

18:49Hopefully, you have a safe travel, uneventful travel. That's what we're wishing for. That's all we can wish for, Todd. Thank you so much. Really appreciate it. All right. See you soon. And hey, stay tuned for more twerks. Independent Pharmacy is the heart of community care. At Independent Pharmacy Cooperative, we believe your success strengthens the health and well-being of the communities you serve. As the nation's largest member-owned GPO, IPC helps pharmacies thrive with competitive pricing, profit sharing, and the support of a team who shares your vision. Let's build the future of Independent Pharmacy together and gain the freedom to farm.

19:27Visit IPCRX.com to start the conversation with an IPC representative today.

19:57its specialty operations positioned as major growth drivers. Twerks take, follow the money. Specialty drugs, rare disease, biologics, infusion, and complex medication management continue to reshape pharmacy economics. The question for community pharmacy is, how much of this expanding market can independence capture?

20:20Hey, it's This Week in Pharmacy. I'm your host, Todd Urie, founder of the Pharmacy Podcast Network. Hey, there is news happening this week in pharmacy. Excited about this and not sure if you heard, but Independent Pharmacy Cooperative, who's been a huge supporter of the Pharmacy Podcast Network, they acquired a company called Integral RX. And I've heard of Integral. I knew that they were associated with Smith Drug and didn't really understand exactly what they did. But that inclusion into the independent pharmacy cooperative is very important. And a leader of the organization who has roots in the pharmaceutical manufacturing, as well as distribution and pharmacy care, is with us today.

21:09Yvonne Dominguez, it's so good to have you here on Twerks. Thank you so much for having me. I'm not going to make you twerks, but sometimes I've tried. My butt is too. It's too skinny, so I can't twerk, but I've asked other people to do it, and we've tried, and it doesn't work. So nobody can see it. Most of the people that are listening are just listening on audio anyway, so they can't hear the thumping of the twerks. We can fake it. All right. So a big weekend for me. I'm in Los Angeles for the USC School of Pharmacy panel that are going to be talking about the future of business in pharmacy and how pharmacists are changing.

21:54I'm headed to the NCPA in Kansas City where it's the Super Bowl of Independent Community Pharmacy. Obviously, Independent Pharmacy Cooperative will be there, always there. Supporting independence. This kind of goes back to the very beginnings of my career in independently owned long-term care pharmacies and their focus on seniors. But you also have a rich background. I want you to share it with our listeners. Introduce yourself and let us know how you got involved in the pharmacy industry. Excellent. Thank you so much. So, yes, I started in this industry at Goldline Laboratories, who is a private label company.

22:41At the time in our business, I believe the perception was that generic drugs were made out of someone's garage. The brands were considered, you know, the boutique and the high end of the industry. And consumers were a little skeptical and afraid to take generics as a copy. I would like to think that Goldline, as a private labeler who bought directly from manufacturers, helped change and shape that. Michael Orlov owned it at the time, and I was lucky enough to spend five years with them. Learned a lot about the industry in a variety of capacities there, from sales to collections to chargebacks.

23:24And that kind of trajected me into retail independent sales capacity. From there, I was lucky enough to be the first inside salesperson who sold the generic source program for Cardinal Health and was with them for nine years through all of their acquisitions. I was with them when they were just one facility. And we, in turn, after nine years and a lot of growth with Whitmire and the different distribution centers, a change came up that allowed me to go to the Northeast and work for H.D. Smith. H.D. Smith at the time had just purchased J.J. Ballin. They were interested in posturing themselves as a primary in the Northeast up against some of the big ones.

24:20in an area that was very populated with the retail independent pharmacies. So I was with the inside sales team there. And over time, was actually having the opportunity to work with the field team as well. So inside, outside. And continued on to Anda Pharmaceuticals, who I chased around my entire professional career in the generic drug business. They were amazing. I was with them for five years. And then was with Smith. I got to work for both Smith families, taking on the Integral program. Integral RX was a or is a generic secondary program that was under the Smith drug umbrella. So the acquisition, Independent Pharmacy Cooperative acquires Integral.

25:13We put this press release out. We were excited to announce it. I was also really excited to have you come on twerks and just give us an overview of this. What does this mean? How does this benefit the independent pharmacy community? Well, it was really important that this program be acquired and taken over versus having Smith Drug just, you know, kind of sail into the sunset and remove us from the industry. You know, the independents are consistently behind the eight ball and chasing profits, chasing margins and trying to strengthen their stance in the business. The generic drug industry is very competitive, as are the independents constantly competing with the big box stores.

26:11There are so many areas in the country that don't have support of pharmacies. And so if we don't continue to strengthen this category in our business, that is going to continue to erode over time. Um, it needing being able to source generic drugs from credible, uh, manufacturers and supply them at a rate that allows the store to gain more margins is incredibly important. It helps offset the expensive brands that stores are experiencing. Um, you know, this category is the most important. It is, you know, everybody knows that the brands are basically sold at whack minus and having a competitive generic price that allows them to offset those, in some cases, negative margins is incredibly important.

27:15So we were grateful that this program can continue. Yvonne, I want to go back to something you said. I'm going to read a quote from the press release. And this is from the CEO of IPC, Marcus Senza. And it says, at its core, this acquisition is about preserving and strengthening the relationships that Integral built with independent pharmacies. Integral RX earned the trust of its customers by delivering value, personalized support, and genuine commitment to independent pharmacy. Those same principles have guided IPC for decades. We believe this combination creates the best possible outcome for pharmacies preserving what made Integral Rx successful while expanding the opportunities available to its customers.

28:09Now, when I mix that statement with what you just said about the importance of generics and the profitability of independent community pharmacy, it's two sides of a coin of doing business. It's one side that has to be, we have to make money. You have to make money to stay in business. There's nothing wrong with making money. There's nothing wrong with making profit. But the other side of the coin is a sense of service. It's a sense of trust. It's a sense of preservation and respect for things that have proven successful for independent community pharmacies. And your reputation, in your participation, you specifically, is part of that.

28:56So the reason why I love working with IPC is when the announcement was made that Smith Drug was closing, the attitude of the IPC team was, how do we help independent community pharmacies that relied on Smith Drug and had trust in Smith Drug to treat them like a business partner and like friends and like people you can trust? and Mark made a statement in an email that was an internal email that basically said to the whole IPC team, we are here to serve these people and to assure that they feel stabilized and that they feel insured. And he even made a statement about if they don't choose IPC, help them find someone else, help them find somebody that they're comfortable with and that they can work with.

29:51And that's what I love about the owners of this organization are independent community pharmacy owners. And that spills through the entire organization. It's that practice what you preach, walk the walk that you talk in order to ensure that our independent community pharmacies stay in business and stay successful because that spills over into the communities that they're part of. and the health of those communities is literally on the line. Because when you shut down an independent versus shutting down a chain, those are two very bad things. You don't want to see the chains go out of business.

30:34I don't want to see independent community pharmacies go out of business. But when the independent closes because of whatever reason, financial pressures, PBMs, the change of a major vein of wholesale in this case, it cripples the health of that community in so many ways. In so many ways that sometimes the chain doesn't because there's more of an intimate relationship between the independent and their community. There really is. I'm so glad that you said that because what Mark says cascades through the whole organization. And how could you not be motivated and want to continue that when you get to work with a team that cares.

31:21I am super grateful. We're excited at what this means is giving customers and staff a soft landing in a time when, you know, this is disruptive. We had a variety of people that reached out in the industry that were very caring, asking, you know, are you okay? Is it okay? Ironically enough, today is Smith's last day where I have the person that I work with was there 27 years would pick orders off the line. And today is his last day going into that building. So, you know, it's really important that and if you look at IPC's model, they meet the pharmacies where we need them to be. If they're interested in a buying group opportunity, if they're interested in distribution, They have an incredible, robust group of resources like yourself that will provide the information, provide the marketing tools.

32:18It's really exciting to be part of this next steps and getting to continue on serving an industry that we love. A benefit also is I got to link up with you. I didn't get to meet you before this. This was like our first chance of meeting. So this is awesome. This has been This Week in Pharmacy. Yvonne Dominguez with Integral, now part of IPC. Yvonne, where would you like listeners to connect with you? What's the best place to do that? Is it email? Is it LinkedIn? It's both, actually. Yvonne Dominguez at LinkedIn. Yvonne.Dominguez at IPCRX.com. And I'll see you at NCPA. Yes, NCPA. We're coming to Kansas City to celebrate the independent community pharmacy.

33:11We're so excited. Before we go, there is another big announcement from IPC on This Week in Pharmacy. IPC and Tanovi collaborate to advance patient care and clinical services in independent pharmacies. This is about Tanovi's remote patient monitoring and remote therapeutic monitoring technology. And just like Yvonne said, if you are a pharmacy that is looking at increasing revenue, remote patient services is huge. huge. And there's reimbursements coming from different Medicaid systems, Medicare systems. Please talk to IPC about how Tanovi and remote patient monitoring can impact your business and how there are people out there who need these connections.

34:01They need to have the monitoring happening so that you can catch things early and be more preventative. Yvonne, this has been terrific. This has been fun. Thank you for being on TORX. Thank you.

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35:17Visit SweetRx.com to learn more and schedule a demo. SweetRx, empowering pharmacy innovation.

35:33Last up on TWERX News. AI is moving from pharmacy experiment to pharmacy infrastructure. Just as NCPA prepares to make AI implementation one of the major topics at its 2026 annual convention, health profession regulators are increasingly discussing governance and accountability surrounding AI. NCPA's programming includes real-world AI implementation and operational applications for community pharmacies. Twerks take. The conversation is changing from should pharmacy use AI to how do we use it responsibly, profitably, and safely. Hey, welcome back to Twerks. This week in pharmacy, big Friday. Getting ready for the NCPA, National Community Pharmacists Association, the Super Bowl of Independent Community Pharmacy.

36:22The reason why I'm so excited about this is I feel, I don't feel, I know. We're preparing for 2027, and there's never been a time in pharmacy in general, not just our independence and community, where we have a bunch of initiatives that have been percolating and have been preparing for a year that's going to be filled with additional services that weren't traditional to our pharmacy operators and our pharmacists, like they are going to be very value-based, very clinical tracking. rare disease. We just got back from the NESP and talking about how artificial intelligence is going to now push data into the EHR and exchanging it with the pharmacy management system to really drill down on specific conditions.

37:11So this is the time, and this is why NCPA probably puts their event towards the end of the year. It's the preparation for what you are setting up as a strategist in your long-term care pharmacy, in your specialty pharmacy, into your community pharmacy to get ready and make 2027 the most profitable year of your operation because that's good for your patients because that means you get to expand and you get to invest in your company. You know what? This Week in Pharmacy has been so blessed to be able to connect with, it's our number one podcast on the network. And the reason is because we bring in some of the most brilliant minds in pharmacy.

37:56A reoccurring correspondent to us is Jessica Daly, a fellow Pittsburgher. Go Steelers. We need all the Steeler wishes that we need right now. But Jessica, welcome back to Twirks. Thanks, Todd. I think we're going to have some overload here because all of us, all three of us now, you, me, and David, all Pittsburghers. So we've, we've overloaded the twerk stream with Steelers. Heck yeah. You introduce our guest today, special guest, David, thank you for being here. Introduce them and let's get going. All right. Sounds good. Yeah. Thank you so much again. Todd, thanks for having me on the call. And I, I love that you say you bring the brightest minds onto the podcast because that makes me feel good today on this lovely Friday, as you're getting into NCPA.

38:42One of the things that you bring me in to talk to your audience, usually about things and challenges that your audience is facing. We talk a lot about drug shortages, about the financial pressures that your listeners are facing. And I'm really excited today to have David Hargraves with us because yes, we are going to talk about a challenge, but I think the spin that we're going to put on this today, again, as your listeners are getting ready for NCPA and for all of the great things that are coming in 2027 is that there is some positive movement. So one of those challenges that you face, there's actually a bright light on the horizon.

39:17So with that, David Hargraves is here to join us today, and we're going to talk about reverse distribution, pharmaceutical reverse distribution. David is the CEO of Pharma Logistics and has been in the pharmacy and in the supply chain organization for many, many years. And we've worked together, and I've been fortunate to work with David. So let's go right here. David, why don't you tell us a little bit about yourself and about pharma logistics to get us kicked off? I will, but for the listeners in here, Jessica and Todd, thanks for having us on today. And Jessica, it's always great to see you.

39:54I'd say one thing. I don't really want to talk about pharmaceutical reverse distribution today, but rather I want to talk about some remarkable work that pharmacists themselves had done. Todd, some of them might actually be at NCPA next week, but the work that they did does impact my industry and the pharmaceutical reverse distribution. So it's not about me, not about pharma logistics. It's all about the pharmacist. We'll try to tie that together for you here. Just quickly from a credentialing standpoint, as Jessica mentioned, I'm old. I've been doing health care supply chain at least the last 25 years.

40:28I used to run clinical supply chain for UPMC, a large health care provider, Western Pennsylvania. spent nine years at Premier leading their supply chain businesses, including their national GPO. And now the last two and a half years as CEO of Pharma Logistics, who is the number one market share reverse distributor for independent retail pharmacists and also very large in hospitals and health systems. So the part of that that I want to make sure that the listeners get across is the thread that ties those all together. They're acute care hospitals, working for a large national GPO, and then the work here in reverse distribution is this.

41:05The question that's been driving me and the passion is, how do I help our healthcare providers? How do I help them keep more of what they earn? How do I help them improve profitability? How can I make it such that they are sustainable and that they can do what they're supposed to do, which is taking care of patients? So that's really the thread all across it today, Jessica. And as I alluded to, some of the work that's been done recently by pharmacists is fantastic because it's 100 % aligned with that. No, I love it, David. It's any time that we can promote and show pharmacists how they have power and strength and influence, it's such an important topic.

41:44So let's just pause for a second. I think most of the audience will know this. But how about give us a little bit of an idea of what reverse distribution really is? What does it mean so that we can level set for anyone who doesn't maybe deal with that part of the pharmaceutical supply chain? Absolutely. Good point. You know, in this particular audience of listeners, I think we'll be in good shape. This is a really tough one to explain sometimes when you're out in the world in general. But but for folks to understand here, when we look at pharmaceutical reverse distribution, here's the core of it.

42:16Whether it's an independent retail pharmacy down the street, whether it's a hospital outpatient pharmacy, all dispensing pharmacies end up with some type of excess unsaleable inventory. Typically, it's when the drugs reach its expiration date prior to being dispensed to a patient. But one of the things I want to make real clear, sometimes people misinterpret it. It's not bad management. This happens. Prescribing patterns can change. A patient can switch their therapy. A shortage can cause you to maybe stock up in advance of it, or maybe you've got, or you break the pack of it, you've dispensed 90 out of a bottle of 100 and you have those left over.

42:55The fact is there is always some excess inventory for every pharmacy every year. But what is lesser known is that that excess inventory often can still have value. You can still take that and extract value from the manufacturers. And when I say value, I mean cash, money that goes back to the dispensing pharmacy to help them with their operations for it. But getting it back is complicated. And that's where the pharmaceutical reverse distribution comes in. Every manufacturer has a different return policy. Some have none. They're sold non-returnable. Controlled substances need DEA paperwork. And then everything has to be destroyed ultimately in a compliant fashion and documented.

43:37So that's, if you say, what's reverse distribution? It's end-of-life supply chain, specifically for pharmaceuticals. It is nearing expiration date and expired drugs that otherwise are being wasted. The reverse distributor inserts themselves and then adjudicates those drugs and seeks to go get value for the dispensing pharmacy, returns that in the form of cash back to them. So it's sort of like a pharmacy's collection department for expired inventory, if you will. So the pharmacist can focus on the patient. They can send the drugs to us. We will do all the work we can to get them the maximum amount and then return that value back to them.

44:18And in the end, the better they do managing inventory, the better we do getting them value recovered from those expired drugs, then the more profitable they are and they can continue their mission to the point we made earlier. Yeah. So let's talk then, because there was a very important, in my opinion, I think you'll agree, a very important op-ed that was released in Health Affairs. And you are one of the authors of that op-ed. So you and another former colleague of ours, Shomi Saha, PharmD JD, wrote specifically about some recent changes to state law regarding reverse distribution. So let's talk a little bit about why you wrote that article and why that's so important for this audience and their ability to manufacture value.

45:05Fantastic. I love it. You're right. That was really the genesis for why Todd thought it might be good for his listeners here. So for folks, if you want to bookmark this or find it, the article is called To Protect Patient Access, States Must Modernize Drug Return Laws. And so that is, if you search on that, you'll go and find it. It is published in Health Affairs. It's not behind a pay firewall, so you can read it freely. And what we were doing with that article, and the reason we published it, is when I learned about the news, and we learned about it because we have to adjust our content to adjust to these now updated state laws in a couple states.

45:44So let me explain to readers what this is, why it's important to them. So you have a couple states, Virginia and Mississippi, where the pharmacists got together, and it's so appropriate here with NCPA coming up. They got together and they worked through their state legislature and they passed new laws. And the new laws that they passed, and we can go into it in some more detail, essentially change and override Trump, the manufacturer's return policies for certain classes of drugs. And when I saw that, I went, well, look, there's so much that's outside of the dispensing pharmacy's control. They can't control reimbursement.

46:26They have trouble controlling labor costs and labor availability. PBMs are part of it. But for expired inventory, that is actually something that they can control. But the way that Virginia and Mississippi controlled it was amazing. So fundamentally, we wrote the article because I wanted to shine a light on pharmacists and lawmakers in those states working together what they accomplished and mostly to encourage other people to build on it. It's really a tremendous accomplishment that they did. And so I got with Shomi Saha, Dr. Shomi Saha, another PharmD like Jessica. And she used to run the Washington lobbying office for us at Premier.

47:09And so she and Jessica and I did a lot of great work on the Hill with legislation in the past for the benefit of our health care providers. I saw this and I was like, hey, show me. First off, help me understand it because of her background, what they did. And then we decided to publish out that article again just to shine the light on some pharmacists and the great work they did to really change their situation as it relates to drug expiration and manufacture return policies. So what is it that Virginia and Mississippi actually did? Because it sounds like, and I know that's some sort of leading the witness a little here, right?

47:45It sounds like there's a lot of variability. So what have Mississippi and Virginia done that is so groundbreaking? Sure. Well, let's say, I'd say at the highest level, they did locally what has never been done federally. So if we put that frame first, I think it's important for the listeners to understand return policies are specific by manufacturer. And even in any given manufacturer, they can be different by drug or by the date of sale. So there's a lot of complexity into how manufacturers' return policies work. And some manufacturers effectively have, you know, they're sold non-returnable. They effectively don't have a return policy for it.

48:27So what What happened in these two states is they went and said, hey, listen, I think in my state, if you want to be part of my state drug assistance program, this would be the Mississippi example, they said, then you're going to have to have a return policy in order to do so. And so they tied the benefit of that state drug assistance program to the need for having a return policy inside it. So said another way, they said, hey, listen, as a pharmacy, I shouldn't have to eat the cost of the expired drugs all by myself, me, the pharmacist. So what it says is that starting in 2025, manufacturers have to accept returns of outdated drugs, full bottles and partials.

49:10That was one of the material differences for up to six months after the expiration date for either full credit or full replacement. And that part where they went from full bottles to partials, that's huge because that's actually the biggest material change, a change folks will notice because many of them did not allow credits for partials. The other thing is because like the Mississippi law actually had a version going back to 27, 2007, but in this modern one in 2025, they added some teeth to it. And that was the part that I mentioned. So in Virginia, if a manufacturer doesn't comply, its product can't be used for therapeutic substitution in the state.

49:50So a pharmacist can't dispense it as an equivalent generic. And then in Mississippi, as I mentioned before, a non-compliant manufacturer can get shut out of those state drug assistance programs. So two states, both improving their situation, to pharmacist activism with their state legislator changing those rules and putting some teeth behind them to ensure and really just better their situation. That's the core of it. You can read all the detail incredibly well written by Shomi, who also happens to have a JD. So she did a great job inside there writing it. And that's the part where I want to highlight for the listeners.

50:28So I know we're getting up on time here, but I do have two more questions for you, David, just kind of rapid fire for you here right now. So we're talking about states making changes, but why not the federal government? Why are we looking to the states? Yeah, there's two views on that, Jessica, to go quickly. The federal government has largely been silent on this, this issue of manufacturer return policies outside of controlled substance. It's important for listeners to know there is no federal requirement that a manufacturer take back expired product from a pharmacy. Every one of those is a commercial decision by each manufacturer.

51:05And like I said, there's a lot of variability. I don't know that that's a bad thing, right? Because you're letting the manufacturers commercially do it and there's increased competition and decision points. But could Congress fix it someday? Sure, they could. Here's the thing, though. But today, pharmacies are closing. Actually, NCPA themselves, if you take a look, they published a stat out there. And the stat is pretty significantly. I want to say that at NCPA, they said roughly 450 communities in a given year lose their pharmacy. That can lead the pharmacy deserts. That can lead to decreased patient access.

51:43And so it's a bad thing for us. So could the federal government fix it? Sure. What I like about it, though, is there's hospitals, or excuse me, pharmacies that are closing now. And states have the ability to act. So act now. You don't have to wait for Washington. A state legislation can do it in a single session. And now you've got two states out there that have already have a model, maybe so that some other pharmacists in their association would want to follow. All right. So I think that really brings me right to that last question in the next 30 seconds, David. Right. You've got the audience here listening.

52:14They're learning about what's happening in the states that they might practice in. What would you tell those pharmacists that they could do today or tomorrow to move this forward? What I would say to them is they probably don't understand the power that they have. When pharmacists can unite, typically through state associations or national associations, like the one that Todd is going to, their voices amplified, can be heard, and absolutely can make change that in turn benefits them, which in turn benefits the patients. So there's no reason not to act. I'd encourage everyone to take a look at this article, understand the models before it.

52:53And listen, we all have challenges in our industry. This is just a great example of people choosing to act to make their situation better and ultimately to improve patient access. And that, just again, as I mentioned at the beginning, it's what I've been doing the last 25 years. I love it. It's inspiring. And it's actionable. There's work that can be done today. That was the whole reason for it, to put it out here. And I appreciate, Todd, having Jessica to have the opportunity to talk about it here today. This is awesome. Thank you, David. This is awesome. Thank you, Jessica, for such a great guest.

53:26David, we have to have you back. Probably I'd like to have you come into the studio and be able to chill out together instead of always being on a Zoom. Yeah, absolutely. I would love the opportunity, Todd. Thank you so much. All right. If you're headed to NCPA, make sure that you connect with me. I will be around the entire exhibit floor both days. the first day we're going to be at your Raoul Pharma's booth and we'll be ready to talk about clinical discussions as well as some of your business discussions reach out to me you can find me on LinkedIn if you want to email me Uri that's E-U-R-Y at pharmacypodcast.com we will have a connection to Jessica and David's LinkedIn in the show notes take a look at that and thank you for listening to This Week in Pharmacy.

54:46Thank you.