Independent Pharmacy: Power, Policy & Patient Care | TWIRx

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1:19Hey, welcome to This Week in Pharmacy.

1:26Welcome to This Week in Pharmacy. Twerks 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 Rx Podfather, our host, Todd Urie.

1:47Hey there. Hey there. Welcome to This Week in Pharmacy. We have a lot. We have a packed show today. I'm going to jump right in to Twerks News.

2:02And now here's the latest in pharmacy coming up on Twerks News.

2:10Hey, first up, FDA and compounded peptides. This is behind the counter intelligence. The FDA. they have this they've submitted this thing called the interim access policy for compounding using certain peptides to the white house for regulatory review and there's an important distinction a policy this policy is still under review nothing has been actually finalized the report suggests that the FDA may consider temporary enforcement discretion allowing licensed compounders to prepare certain peptides. And that's why we're labeling this one developing, not done. Todd, could a legitimate compounding pathway actually protect patients who are already buying questionable peptide products online?

3:02Well, the protection comes down to the pharmacist being in charge of compounding in the first place. Shout out to the APC, the Alliance for Pharmacy Compounders. They do amazing work assuring the public safety by policies that are put into place. So let's keep an eye on this, but still developing. Hey, next up, here's some significant clinical news. The FDA has approved GSK's Hibsago and antisense treatment for certain adults with chronic hepatitis B, as in boy. In recent third-stage studies, about 19 % of the eligible treatment patients achieved functional cure, meaning sustained viral control and loss of hepatitis B surface antigens after stopping the therapy.

3:58This isn't a universal cure, and patient selection and monitoring will be important. But Todd, when we're talking about some patients potentially achieving lasting control without indefinite treatment, that deserves attention. It does, and I'm excited to hear more. So I'd like to reach out. If you are a specialty pharmacist working in hepatitis B specifically, reach out to us. We'd like to dig deeper into this. Hey, let's follow the money on this one. Celeron RX in specialty pharmacy. The Elevance Health Celeron, or Carillon, I should say, business just reported$19.3 billion in quarterly operating revenue and$900 million in operating gain, with the company pointing in part to Carillon RX product growth and improved specialty pharmacy profitability.

4:56That's big news. And that's the intelligence here. PBMs, insurers, specialty pharmacies, and healthcare service companies continue moving closer together. Todd, when one organization touches the insurance benefit, the pharmacy benefit, and specialty dispensing, is that better coordination or too much control under one roof? It's not so much each of those individual parts. It's about choice, and it's about flexibility, and it's about access. Yes. So if all of those parts, if our pharmacy benefit, the specialty dispensing, the care coordination is all coming from one entity and they don't allow another pharmacy to be involved, they don't allow some of our independently owned ones to be involved.

5:45That's where the problems arise. It's not so much having everything in one place. Hub services really help to manage things. It's just who it is, a.k.a. like Aetna and CVS pharmacies really put a pinch on care. Hey, next up, rare disease, bitopertin. Is that how you say it? B-I-T-O-P-E-R-T-I-N. Bitopertin? This next story reminds me what clinical trials numbers can actually mean to a patient's life. Disc Medicine reported positive phase three results of bio or bitopertin in an ingestinal treatment for rare disorders that can take exposure to sunlight. Make it extreme painful if you're in the sunlight.

6:43And that sounds horrible. Patients receiving the drug experience significantly more pain-free time in sunlight compared with placebo. Sounds like good news to me. The drug isn't FDA approved yet, but this is why patient-centered outcomes matter. Sometimes success isn't just a better lab value. It's giving somebody part of their normal life back. All right. Behind the counter, Reddit workforce chatter. I have always had a problem with Reddit's negativity, but every once in a while we have positive stories. And they heavily discussed Reddit thread this week had pharmacy technicians describing prescription backlogs, nonstop phones, frustrated patients, and inadequate staffing.

7:32There are anonymous accounts that we cannot independently verify that their individual workplace claims is disastrous. This is not good for patient care, and it's just showing a continuing issue around fast food pharmacy in the mega chain environments. But very frustrated for our pharmacists and technicians of how workplace disasters are cultivating based on all the work that is expected, putting different quantity needs on and regulations internally into like vaccines. And it's just hard, man, to be on the front lines. But frontline chatter can still tell us where to start asking questions. Todd, if pharmacies really are struggling with prescription backlogs, are we experiencing a workforce shortage or a shortage of business models capable of properly staffing a pharmacy?

8:36um i think it's the system grinding away the joy of being in the pharmacy business solely for profit and not paying attention to the human working behind the bench behind the counters not being engaged enough with uh with the the public and the public's hard the public is terribly unmannered and in some of the most disgusting people out there sometimes the way that they treat technicians and pharmacists. However, I'm a glass half full guy. So I think that we'll see improvements to this. I think that we have to educate the public of what pharmacy is expected to do, what they are doing, what the stresses are.

9:25It's hard, man. It really is hard. I shout out to our retail pharmacists and pharmacy technicians. You guys are absolute champions.

9:51Up on twerks today, special interview with Mark Kinney from IPC.

10:05And I'd like to congratulate John Colvello, who has been promoted to Vice President of Government Relations. John is a familiar face throughout the pharmacy community, bringing more than 40 years of state and federal policy experience, including two decades focused on independent pharmacy advocacy. I have worked now with John for more than two decades. He's a professional. He's very good at what he does. And I'm really excited for his promotion and what he means to IPC. Coming up next on This Week in Pharmacy, a special update from IPC. We'll be right back.

10:50This 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.

11:33Hey, and on this week in pharmacy, big news coming out of Independent Pharmacy Cooperative with headlines. If you haven't seen the press release, it says IPC expands advocacy efforts. And this is Independent Pharmacy Cooperative strengthening national government relations, their government relations team with experienced policy leaders to advance PBM reform, fair reimbursement, rural health access, and the future of independent community pharmacy. I'd like to welcome back my friend and government relations lead, Mark Kinney, to the show. Welcome, Mark. Todd, it's always great to be on the program.

12:14Well, we're excited to have you here. Big news, like I said, coming out of Sun Prairie, Wisconsin, with the added members to the government affairs team, the investment that IPC is making to policy and to making to government relations state to state and national is huge. And Mark Asenza actually said, independent pharmacy advocacy has never been more important. And I just want to echo that. So tell us about the expansion of your team. Yeah, Todd, you're absolutely right. IPC is expanding its government relations team, bringing even more talent, experience, and energy to the fight for independent pharmacy.

12:56And I think the timing can be better. As you know, community pharmacy continues to navigate challenges around PBMs, reimbursements, patient access, healthcare policies, and IPC is doubling down on one thing, making sure independent pharmacy has a strong, effective voice wherever decisions are being made. Yeah, you're expanding this team specifically under leadership of your team, Vice President of Government Relations, John Covello, with four decades of federal and state policy experience. But also joining the team is Mr. Dylan McGarry. Tell us a little bit about Dylan. Yeah, Dylan comes to us with over 20 years of experience in the healthcare advocacy.

13:53He's familiar both with federal and state advocacy efforts. He was recently served as president of Franklin Strategies out of Pennsylvania. So the really nice thing is both our candidates that we're bringing on are almost unicorns in the sense that they have both federal and state experience. And they also come with health care backgrounds. I love it. All right. And then we're also rounding out the team. with, I don't know if we're calling him a pinch hitter or not, or the main pitcher, but Henry McQuaid, former congressional staffer, that's so important to really understand how things work internally.

14:36But tell us a little bit about Henry. Yeah, he comes out of Iowa. He has a lot of state experience there, worked for a big healthcare hospital system, as well as worked with representative to Lopsack out on Capitol Hill in Washington, D.C. for a few years. So once again, we're making the investment to bring people in that have the talent and the experience to really make a big difference for independent pharmacies. I love it. All right, Mark, give us an update. What are some of the state policies and state bills that you guys are working on that you'd like our listeners to really get an update on and understand?

15:22Well, I think the commercial floor reimbursements that's now passed in more than 10 states across the country. More recently with Montana, Colorado, Iowa, Kentucky, these states have recognized that it's really important to have those local community pharmacies as part of the healthcare solution. And as you know, there's a lot of deserts now, pharmacy and healthcare deserts, not just in one state, but really across the country. And what we're seeing is this is an opportune moment for, I think, especially independent pharmacy that have served these patients many times for generations, is there's a lot of momentum and support in both the state legislatures, as well as I think out in Congress as well, as evidenced by passing some pretty good PBM reform legislation this last year.

16:29So in the states, we got great momentum, PBM reform, provider status. We are on the lookout for some restrictions around compounding that may not be reasonable. And we want to make sure that we're also looking at potential legislation that could be harmful, not just running our legislation that we think benefits community pharmacy. Yeah, we see huge numbers coming out of CMS with their Rural Health Transformation Program representing$50 billion investment spread over the next five years from 2026 through 2030. and how much those funds are needed to fill in the gaps where we're seeing a lot of pharmacies collapse.

17:19The close of Rite Aid has really caused a lot of problems and independent community pharmacies are stepping up. Matter of fact, three pharmacies just in my local area have now been, which were closed, they were two Rite Aids and a Walgreens. Those locations have now been adopted by independent community pharmacies to assure that those pockets of community still have access to medication management. So this is a huge opportunity for our independents to step in with some of the legislation and the bills that you guys are helping out in. And I would encourage listeners that if you're curious about those kinds of opportunities, I want you to reach out to the IPC team because they have their finger on the pulse.

18:06And if they don't have a pharmacy in a location, they'll tell you what locations are open and available. But, Mark, this is important to combine not only our government relations, but strategy about where pharmacy pockets are open, where there's those rural areas that just don't have any services at all. Yeah, that's that's Todd. That's exactly correct. And again, I think state policymakers understand this now, and that's why we have such support to make sure that in those areas, you know, they do have, you know, many times the local pharmacy in these small rural towns, they are the primary health care provider, right?

18:54They may not have a hospital there and they may not have local physicians. And so it's really important that patients have a point, an access point to health care. And many times, again, that might be that local pharmacy. Absolutely. Well, shout out to John Covello. We love dealing and working with you, John. Congratulations on your promotion. Congratulations to Dylan McGarry and Henry Marquard. Mark, this has been a great update. We appreciate you. We appreciate IPC. Thank you for sponsoring today's This Week in Pharmacy. Thanks, Todd.

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20:34Hey, on This Week in Pharmacy, let's talk about rural health. does not run off the tongue easily when you say rural health. Is it Royale Health, Royal Health? Healthcare out there in the boonies. I live kind of in the boonies. Fayette County, Pennsylvania, south of Pittsburgh. We don't have as many independent community pharmacies as we'd like, especially when you start going up into the mountains where Nemecolon is at. There was a report that just came out in October from Drug Topics, and the title was Rural Health Transformation, Community Pharmacy as an Essential Piece of Infrastructure for Healthcare.

21:16I want to welcome back Shelly Bailey with IPC. Shelly, you and I have talked about this before, but it's great to see you again. And you've been all over the world with your adventures in pharmacy land. So how are you? Oh, I'm well. Todd's alluding to the fact that I just returned from Portugal with my family and was able to visit, unfortunately, some pharmacies in Portugal when I was there too, but I'm as rested as I could be coming back this week. Todd, it's fun to talk for me about rural health too because I live in Oregon and a lot of, you know, Oregon is rural and actually where my family is from there's one stoplight in the whole county and the joke is that they know you're from out of town if you actually abide by the stoplight because everyone that's local just is like well it's kind of like a suggestion right it's not really like the only the out-of-towners use it so rural house is very near and dear to my heart so i'm very happy to talk about it today uh it's uh it's very relevant in preparation when we start thinking of the new year and some of the strategies that our independent pharmacies are going to be putting into place.

22:29Independent community pharmacies serve as the primary health care safety net is what they're calling it in rural health areas where 76.5 % of all pharmacy locations are independently owned and 88.9%, let's just say 90 % of residents live within five miles of a pharmacy. And as part of the federal Rural Health Transformation Program, which is known as the RHTP, a$50 billion, that's with a B, billion-dollar initiative managed by centers for Medicaid, CMS, Medicaid and services. Independent pharmacies are shifting from traditional pill dispensing models into frontline clinical care hubs. I want to give a shout out to my friend, Dr.

23:19Jem Hammons, who works in the Virginia Appalachian Mountains. And she tells me some of the nightmares of what people have to go through just to get healthcare services because of how spread out they are. And I'm sure Oregon has pockets, very big pockets of areas that are the same way. But Shelly, let's talk more about this for our listeners and the opportunity before them. Yeah, no, absolutely. It's like so many things in our industry, right, Todd? It's fragmented because while it's a federal program, it's up to each of the governors in each state to decide really how they want to intake the dollars, how they want to use the dollars, how different grants are done.

24:03And so probably picking a few states as examples will probably be a little bit easier. But ultimately, you know, pharmacies aren't the only type of health care provider that these RHT funds are intended for. You know, they in very large part, health systems are obviously, you know, one of the groups of stakeholders that is very much leaning in to rural health transformation. The other thing that also won't surprise you, Todd, is when the announcements came out about RHT, also a lot of tech companies leaned in trying to be the, you know, back in infrastructure to be able to support this. So it is a bit still, in my opinion, a little bit of a land grab of people trying to figure out like we're trying to apply for grants, but like we don't even quite understand how the governors are going to disseminate the dollars.

24:54So it's like we're kind of building the airplane in the sky, I think, a little bit related to RHT. But one of the really great parts of that still, though, is that pharmacies are actually able to apply for these funds, you know, coordinate with their pharmacy state associations and kind of work in tandem so that there are some of these opportunities available. Right. So I know like I'll say in Oregon, I think Oregon pharmacies were awarded about four million dollars for the twenty twenty twenty seven. It could be partially twenty twenty six. But so like in their use case, what some of the state pharmacy association decided in some of these grants was that they would also request funds for like remote dispensing.

25:43So some independent pharmacies own the remote dispensing devices. So in areas where a patient might drive 80 miles to get a medication, maybe they drive five because there could now be like a remote dispensing machine that one of the independent pharmacies use. So like that's an example. Some of the other examples, you know, we we know that staffing is very much a challenge for community pharmacies right now. So some pharmacies in part of the grants that they've written for rural health transformation may include, you know, monies awarded to be able to help support the pharmacy, like with AI workflow, to be able to, you know, simply be able to move more scripts through their ecosystem since they're struggling to be able to find labor to support that.

26:27But I think one of the most consistent uses of rural health transformation grants is really, and scope of grant, is very much focused on clinical services, right? So being able, you know, we obviously know that there's a shortage of primary care providers and things, being able to support pharmacies with technology and tools so that they can do the work that they're already capable of doing, right? but so that they have the platform and a like an EHR system that can support you know documentation so that they can be able to bill for some of these services and you know there's all sorts of vendors out there that offer great products one thing to me that's really important when I'm thinking about when I talk to a pharmacy how they might want to consider operationalizing it is I I also like to work with technology partners that push and pull into the exchange.

27:24And I know we've discussed that you'll have other speakers that are way more in-depth at this than me, but it's nice to be able to do things not in a silo, right? So if you're going to prescribe for a certain patient, right, you have access to your pharmacy dispense data, right? That you could do, but it's still a little bit of a silo. So some of these vendors are really able to support polling from the health information exchanges, kind of a broader picture of what someone's health profile looks like so that when they do go to prescribe, possibly through a collaborative practice agreement or something, they're really going to be able to feel more secure that what they're prescribing is really going to be clinically appropriate because they can see the whole picture.

28:08um some examples of that would also be that a lot of these vendor partners then already provide like the clinical protocols just like a standard EMR would at a medical office so that once you know what someone's symptoms are the clinical protocols can help guide the pharmacist through the prescribing process um you know for documentation and for patient safety so you know gosh we've talked about clinical services Todd like I mean I remember Marissa in 2004 or something like a long time right we this is not a new topic but what's exciting to me is there's now monies available that pharmacies can work together on grants for to kind of offset some of the expense to be able to do this because like with meaningful use no one cared about pharmacies back then like we got charged and everyone else got money to upgrade their systems that I mean we know we could do a whole episode on that and politics.

29:06But this is now an opportunity where there is money available to really help pharmacies become that connected healthcare hub that we've talked about for 20 years. I know I don't look old enough to talk about it for 20 years, but we have, but we have, right. But to really be able to operationalize it. And so that's what's exciting to me. What what is challenging, right? It's like there's there's all this good. Now we now we can do something but it gets kind of down to the how how do we do it and each state's governors you know have already received you know when they applied for the money for for this year but it's it's then becomes a scope of what what does the state association's influence look like in that state how did everyone work together at a state level to be able to apply for grants so that you could scale the access.

30:04I think I know you'll again have other speakers probably could talk to this more, but I think Iowa is a good example of a state that's been able to lean into some of the rural transformation funds that have been available. Ohio is obviously a state that for years we've been talking about and has really been able to push some of the innovation. I know their governor proactively worked with the pharmacy associations to be able to coordinate with them and say, what do you want? What's going to be the most meaningful? What's going to support your bottom line to be able to really build the foundation for everyone to grow on?

30:45Because those funds will be released every year based on grants and how you apply. So I look at this year and maybe even next year to an extent as really foundational years to kind of reimagine, you know, IPC always talks about the, you know, freedom to farm, you know, tagline that we use, but it's really to build the foundation so that, you know, this pharmacy 2.0 or 20.0, whatever we want to call it, you know, is we're really at a little more systematic level, able to be able to do these things together, which really also means talking to each other. And I think that's one piece. I'm not going to suggest that I'm a technology expert, but that's why I like to work with partners that are plugging into the exchanges so that anything we do as pharmacies is not in isolation.

31:38Yes. And IPC has always been good at that, of plugging into partners that already have infrastructure in place so that we can pull levers and actually make money and not have the bottlenecks that came to us when we were trying to do incident to billing way back in freaking 2009 or 2010. I like that you mentioned the pharmacy associations. I want to give a shout out to to our listeners. If you're not members for your state pharmacy association, make an investment in your business, buy a membership now and then prepare for 2027 of what they're going to be doing. Shelly mentioned Ohio. The Ohio Pharmacists Association won a$2 million award to connect independent community pharmacies through technology platforms.

32:30Individual community pharmacies are also securing direct grants, including$500 ,000 award for an island pharmacy in Alaska and remodeling grants in Mississippi and dedicated in other states, including Pennsylvania. Shout out to my own Pennsylvania Pharmacists Association. We have PPCN who works in 46 of our counties throughout the state to bring more clinical services that are also tied to grants. And that's because of the deficit, Shelly. They say by 2036, not very far away, the U.S. could face a deficit of up to 86 ,000 physicians with rural communities being hit the hardest. Pennsylvania's Rural Health Transformation Plan, the RHTP, recognizes pharmacists as key stakeholders, now state leaders, to be able to recognize and do something about that.

33:32And that's where the PPCN plays into this. They're already ready to go. And that's part of the CPESN initiative, which once again is another partnership of what IPC is invested in. So the infrastructure is there and ready. You just have to reach out to the right organizations. If you're listening, I'd like you to start with IPC first and just ask lots of questions. Number two, buy your membership for your Pennsylvania, obviously for PPA, but for your state membership to prepare and dig into that membership to say, hey, what grant opportunities have you already greased the rails so that by the time we hit January 1st, 2027, we're ready to go?

34:16Yeah, no, I mean, absolutely. The other groups like the APHA Foundation too have been really focused on being able to help kind of secure a foundation for pharmacies. And this, I think this is also really a better together period where it is not an exclusive like independent pharmacy solution i think pharmacy in general across retail is supporting each other and being able to do these types of initiatives because everyone you know if a chain is able to advance something it actually still benefits the independent to then learn and be able to advance it too you know todd your comment about state associations i always remind myself when I was like 19 at my first NCPA fly in, Danny Cottrell made a comment that was really meaningful to me about state association and national associations.

35:08He said, you know, we all buy liability insurance to protect us from like errors that we make working the bench, you know, every day. But Danny taught me, you know, 25 years ago that you also should be investing the same amount in your state and federal associations because that's your insurance for the broader group and not just for your own, you know, errors and omissions. And like, that's, that's like a, that was a little word of wisdom that really has, you know, I've tried to keep with me in my pocket throughout my career is you have to invest just as much in your state and federal as you would do with professional liability insurance, because together you need all of those pieces.

35:49And that's also part of why, you know, in the 25 years plus I've been associated with IPC most of that time as a member is why IPC also leans in so heavily to supporting stores in government affairs, right? Because again, you know, that's another piece of your kind of protection. I know at the most recent McKesson Ideashare, one of the IPC MVP pharmacies said something like, you know, we look at IPC as the bodyguard for all the things that, you know, I'm working to do. And that's where diving into things like RHT and things that when you're working the bench, pushing through 450 scripts a day, you don't have the bandwidth to be able to learn about it.

36:30You listen to this podcast at night when you're driving home and things to try to try to pick up some of these nuggets, but then lean into partners like IPC who are devoting, you know, employee staff time to be able to help you as a pharmacy owner operationalize these things, which ultimately helps your business and helps your patients. And I want listeners to know there are grants for different things. And one part of the grant that we can't forget about is connectivity. So there are sections of the rural areas. I know we have them in Pennsylvania. I actually live, the whole reason that I set up a studio in the beginning, this was

37:152019, 2020, I had zero internet connection to my house on the road that I'm at. There were pockets of houses that were less than a half mile away from me that had cable. Then I went in the other direction. There was houses less than a mile away that had, but I was in a sleeve of area, rural area of country that all that's out here, a bunch of cows, that we had zero connectivity. So I tried a company called HughesNet, which was a satellite company. It was complete crap. And then I moved into the town. I set up my studio. I paid rent. I, you know, it was very, it was a wonderful opportunity experience.

38:00But now I moved back into my home because of Starlink. And I know that Starlink has grant opportunities through coupons that they're doing with different state associations. So not only is it the programs that are ready to go, but also remember about the connectivity so that your patients have connectivity so that you actually can do things, remote patient monitoring, telehealth services, different things for follow up, especially for those people that are dealing with obviously chronic disease. Todd, I'm really glad you said that. I have Starlink also, at one of my parents' house, we had to negotiate with a neighbor three properties over to put a satellite or a dish in his tree because he had the tallest tree.

38:46And I managed that process and it was a disaster before Starlink. But to your point, it's not just connectivity for your pharmacy, it's for your patients. So those patients that have pacemakers and all these types of devices that aren't just like nice to have remote monitoring things. These are, have to have, you have to have that kind of connectivity. Actually, Starlink has a program. This is not sponsored. I know, I wish Starlink was sponsoring today's episode, but they're not. This is a natural discussion, but Starlink even has a program that you can sign up for their, like approximately as of today, like$55 a month.

39:23And then you can downgrade it to like a$15 a month plan, which is something that we have in our home. But I think that to your point, getting that type of information out to your patients, you got to connect yourself and your pharmacy, but then you have to be able to connect to your consumers. So Todd, I did not expect we would talk about Starlink but I think it's a really important piece of that accessibility because if a patient can't access it, whether it's point of sale, getting their prescription, getting it in the mail, They also have to be able to access the internet to even be able to, for patient safety.

40:00Absolutely. Shelly, we love having you on the shows and on twerks and on IPC special features. We expect to have you back soon. I want the listeners to reach out to you with questions. We're going to put a link into your LinkedIn profile in the show notes so that people can actually connect with you. Shelly Bailey, IPC, thank you so much for being on twerks. Absolutely. Thanks for having me today.

40:36Hey, next up on twerk special interview with IPC Kelly Stovall and their announcement in a technology upgrade. You're not going to want to miss this.

40:55Special announcement feature this week in pharmacy is an announcement that was put out on September 30th of this year. IPC and Tanovi collaborate to advance patient care and clinical services in independent pharmacies. We have two guests that are going to unravel this for us. no mystery to the pods, I should say. Kelly Stovall with IPC. Welcome back to Twerks. Thank you, Todd. Always a pleasure to talk with you. Excited to talk about this topic today. I think it's very relevant when we look to the future of independent pharmacies. We have a special guest today with us. Brandon, introduce yourself to the listeners.

41:50Hi, everyone. Todd, Kelly. I'm thankful, grateful to be here to talk about this and continue the conversation. But my name is Brandon Haig. I head up Tenobi in terms of the pharmacy, PBM, payer relationship and expanding sales, partnerships, and growth in that particular area. Kelly, we have heard a lot every time we go to IdeaShare or any of the conferences that we cross paths, we're talking about RPM and what this means for clinical management, what this means for revenue building, pushing out additional services, especially to those homes that have people that just can't get out of their homes.

42:32The long-term care pharmacy at home is the new buzzword in term. The partnership between Tenovi and IPC and the members' access to that remote patient monitoring technology and the remote therapeutic monitoring, the RTM technology, this is huge. I want you to kind of lay out what this announcement means. And by the way, listeners, if you want the full press release, we'll have a link in the show notes. But, yeah, Kelly, give us an overview of this. Thank you. I'm really excited to talk about this because I'm pretty passionate about how this specific service or category really, I feel, is going to expand community pharmacy in a way that we haven't seen previously.

43:21Remote patient monitoring, remote therapeutic monitoring, and really at the basis of that, the basis of that is remote monitoring. What can we do with remote monitoring overall. I'm really excited also to hear from Brandon. They've got some incredible devices out that is going to transform either other disease states that we haven't worked in before. And how this will really, you know, I mentioned earlier that I think it will transform independent pharmacy, but I think it will transform community pharmacy, the whole industry. And so this is pretty cutting edge. And I think if you're in community pharmacy, it's something you really should be alert to and open your mind to what you can do with this, how you can expand it.

44:08Because I think it is going to be an answer to taking care of any sort of rural health issues as we go along, population health, just a whole gamut of those that have issues with accessibility and care.

44:25Yeah, I wanted to jump into this and understand the rollout, the implementation, how independent community pharmacies can become involved. And is there disease states? Are there conditions where this is the sweet spot? And then how do we continue to extend that into other treatments?

44:46I would love, Brandon, if you would like to share just a few of the devices. So Tenobi has some fantastic remote devices. You know, it starts with something, right? This is collection of data, whether it be RPM, RTM, patient is collect. We're collecting patient data. And with that, we get to act on that in a really intentional way. But let's take let's let's go to some of the devices, because I think that sets the stage really on on how this process starts. Yeah, absolutely. Thank you, Kelly. you know, it's really about, you know, treating the whole patient. So that's why we have over 60 different medical devices in our portfolio, you know, in the toolkit, if you will, to be able to help people with chronic conditions.

45:34And, you know, at the heart of it, our goal is to, you know, improve lives by simplifying remote care. It has to be simple for the patient to use. It can't be complicated. Otherwise, that utilization adoption rate just doesn't happen. And so that's the reason why we've kind of taken a unique path of not using an app, not using Wi-Fi, just really using a simple cellular gateway that sits in the patient's home that is used to collect those readings and then get them in the hands of the care team. and in this case, community pharmacists. So they have that ability to get insight into what's happening at home and really shift that conversation from reactive care to proactive care.

46:19And for us, what we want to do is provide that portfolio of devices that are going to be necessary to help treat the chronic conditions that folks in these areas are dealing with and the challenges there and just make it simple and easy to use so that there is the collection of that data, because the more data, the better decisions that can be made. And then ultimately, that's going to lead for better outcomes for the patient. And, you know, when you think about the community pharmacy, this is data, right? Data is data, but someone has to look at that data. Someone has to monitor that data, act on that data.

46:56And that's really where the pharmacy sweet spot is. Someone that can can you know really have the pulse on that if you will and and then be able to intervene or you know talk with the patient talk with the provider decide what that next step is really to to progress that patient to a better outcome health-wise i'd love to hear that you know i there's so much to talk about in this space sometimes i think it's hard to know where to start You know, if there's anyone out there not familiar with remote monitoring, basically you have a device at a patient's home. They check their blood pressure or maybe do their pulse ox or something.

47:41That data is fed into a platform. The pharmacist can view that platform and then they can, you know, see a trend. They can track that for the last 30 days. where is this and it also helps with patients to look at their own health and see you know if it's a cgm if it's a glucose monitoring then they know perhaps there's certain actions that they had or took certain things perhaps in their diet that really you know caused this change too so they can be more aware as well but i think one of the just fascinating things to me is i was looking at the latest offerings that tenovihid in devices you know outside of like i'd love to hear a little bit about the pill bottles the the the medication reminders even the fetal doppler like there are some really cool things out there um now that will you know it won't you know in the future it won't just be blood pressure or glucose it's going so far beyond that that i think that's fascinating and that we really need to stay on top of and see how we can utilize our industry to continue to evolve in this space.

48:54Yeah, and I think that's what's really great about working with community pharmacists. I mean, I grew up in a town of 600 people. Like I was, my grandmother had a chronic condition. Like I went to the pharmacy when she needed medication. So I saw the care that was being provided there. So I was always a firm believer in that because I saw a loved one being taken care of. And I saw the compassion and the enthusiasm, like the care that was being provided there. So, and I think what's great about it is that also what's great is that as we're moving up and creating more high tech and all of this, you know, the reason why these programs are able to be done is because of technology.

49:32But technology can be scary to a certain age group or subset of the population. and what the community pharmacist represents is that element of, and the program is the high tech, but also the high touch of a community pharmacist. And I think that's what's really, really beneficial. Kelly, you touched on a couple of the other devices that are in our portfolio. We know that medication adherence is a big challenge, whether patients forget to take their medication or they need reminders or anything like that. So what we want to do is put together an opportunity to collect on that data and be able to make decisions or intervene.

50:15An example I always give as we talk about some of our medication adherence devices, which are a smart pill box, a smart pill cap, and a device that we'll be launching very soon. So stay tuned on that one. Some really interesting and innovative things that are going to be proprietary just for us, which I think is going to be an opportunity to take this an even bigger step forward. But the example I always give of medication adherence is that if you see somebody stopping taking their medication, let's say it's a hypertension or something like that, after a few days, you may not know until that refill is not picked up or the refills just keep going and you don't know if they're actually taking it.

50:55And it might have been something that there was a side effect that occurred and they didn't know that there was another option out there. So instead of that conversation maybe happening a month later or two months later, you move that conversation up and you can keep that patient medication. Like you can make that switch and get them on something that we know is going to help them out. So those types of pieces of data are the reason why we build the devices to be able to allow for those conversations to happen. and across a lot of different spectrums. You mentioned our fetal heart rate monitor.

51:30We're getting bigger into maternal care just because we know that it's a huge need across the United States. And it's very unique and there's only certain devices that are actually approved for that level of care. So we wanna make sure that those are in our portfolio so that we truly have no patient left behind. I love what you said about adherence. I think, you know, and it works, it works so perfectly, I think, in the pharmacy space when, you know, perhaps it is a side effect that made someone stop taking the medication. A lot of times the pharmacist will know that first or, you know, they'll see that that's not filled.

52:09Maybe they've made the call. Are you ready to have this refilled? No, I'm having trouble with that. And a lot of times it may be six months later that a patient has an office visit for that. So you really have that opportunity then to move that to now. So that patient continues to be cared for and in that disease state and continues to improve rather than become stagnant or goes backward, you know, in whatever condition they're being treated for. Absolutely. That's the reason to be for that one for sure.

52:49what's the rollout of this kelly when i think of the year 2030 is supposed to be the high point of our baby boomers which means you have another 15 to 20 years of people that are going to be needing extra care more care more monitoring what are we how are we communicating the prep for this surge of need to our community pharmacies? That's a great point you bring up, Todd. 2030, you know, that population, the boomer population, massive population of need there. And I think, you know, one of the things that we want to communicate to our independent pharmacies and community pharmacy actually across the board is we have to remote monitoring not in the boxes it's in now yes yes we can think about cms rpm rtm those those things that are covered by medicare and that population but i think we also have to expand our thoughts our thought thought process and in building a remote care model because i think and and and you know i've talked before todd cash like we we always want to look at cash services for for independent pharmacies as well but there is such a potential for cash services in this space you know if you'll think about maybe an aged parent and the maybe the son or daughter lives out of state and they want monitoring for this parent and they're willing to pay for that you know perhaps there's an this of an assisted living and assisted living where a pharmacy could contract with an assisted living to care and monitoring this data and share it back with family.

54:37There is such a potential for growth in this space outside of the areas that we see as traditional now. And I think that's really our message to our pharmacies is let's think outside of the box here. What can you do outside of the CMS guidelines that still really offers a very needed service to a population that needs this monitoring. And, you know, so you're not following exactly that, those Medicare guidelines, but you are building this business of your own to fit the needs that we know people will be wanting to have. Because we see that all the time. It's no different than telehealth. Like, you know, how many people on a regular basis, you know, they have their physician, they have their primary physician, but it's a convenience thing.

55:30Like, maybe I'm traveling. Maybe I don't maybe I can't get into my clinic, but I'm going to dial into a telemedicine visit, right? And so that's, you know, and that's cash. So we have to think of this in that same way. How can we build this outside of that traditional model to really serve the convenience and the needs of the expanded population?

55:57Brandon, what about you and your company being that's the finger to the pulse of what's going to be happening with the future of remote patient monitoring, remote therapy, delivery and monitoring? There are other things you you you just not just seniors, not just people that are are not able to get out of their homes. There's going to be other applications. I know that you can't give away all the secrets per se, but can you tell us some of your research that's being done of how remote patient monitoring and therapy monitoring will expand? Yeah, really, I think it's about the outcomes, whether they're on CMS.

56:38If you're dealing with a chronic condition, it doesn't matter your age, doesn't matter where you are. It's really about are you getting the help that you need? And do you have a system that allows for that help? I spent a lot of time in hypertension before joining Tenovi. And we did the focus groups and research. And what we found was that upon a diagnosis of hypertension, if a patient didn't go and purchase a blood pressure monitor within seven days after that diagnosis, they didn't buy one. And that's problematic. They don't call it the silent killer for nothing. Like it's for that reason. So I think what's very beneficial about RPM and even like as Kelly was saying about offering additional services and that to either the patient or the family is that there's a level of oversight that can happen in a sense of like, hey, rather than you being instructed to go buy a monitor, how about we just send you one?

57:36And then you're enrolled in this program and it's, you know, it reduces that friction point for the patient and you get that adoption. And, you know, having something where anytime you can bring family involved, and I'm glad you said that, Kelly, in terms of like thinking outside the box and offering these types of services. I mean, it truly takes a village to be able to get change. I mean, anyone who's made a, you know, a Jan 1 New Year's resolution knows that it's difficult and you need a support system. Same thing with chronic conditions. And the way that we as an organization look at this is that we always put patient first, like what are their needs?

58:20Like what are their, what's going to help them? And then you kind of work the process backwards of like, all right, who's involved? Where does the data need to go? Like, what does it need to look like? Those are the things that we're trying to help with is basically catching that and putting it in the hands of the people that can actually make a difference.

58:40Kelly, you and I like talking about cash-based opportunities to expand business. We need more of that than just the dispense fee of a prescription. However, there are reimbursement models, too, that are connected to state reimbursement systems. Tell us a little bit about that that you've researched. Is it Medicaid or is it Medicare Part D or B or what sector of reimbursement is going to be plugged into remote patient monitoring? Well, it's not. That's a great question. It's not going to be D, obviously. That's drugs. So we're really looking at more of a B, perhaps in some situations to see billing.

59:26But Medicaid, too, in some states, depending on state regulations and what they allow in that state, we've seen remote monitoring come into the reimbursement space in that as well. And Brandon, I know you can probably expand on this as well. And what we've also seen is more commercial coverage on some of these spaces, too. So you've got maybe your Medicare Advantage plans are starting to cover some of this space as well, which is fantastic. And I think that we do still have some work to do really on the reimbursement space with pharmacy. And 2027 will really be a year where we see what CMS kind of settles on, on how this can be built and how pharmacy can fit into that.

1:00:17Brandon, we'd love to hear your thoughts on that. Yeah, obviously that's very top of mind for anyone that's already in and participating in an RPM program and for those that are considering it. And I think there's a lot to unpack in it and I'll give you my opinion and we're all kind of anxiously waiting for it. But I think it's going to continue on. I think what we're going to see is that there's just going to be a better, a larger emphasis on outcomes and then, you know, proving that what you're doing is actually having an impact. And I don't think that's wrong. I mean, if we look at some of the cues that are coming out in terms of like, you know, the access program, they're tying some of that reimbursement to outcomes.

1:01:00And I don't think that's wrong. I think, you know, what's great about this, if you look back to 2019, when the first codes were, you know, were available and RPM really was in its infancy and started, adoption has been great. Like those numbers have ticked up exponentially. And I think that's awesome. Like it helps people in rural areas and the oversight and all the stuff that we've talked about in terms of having that and additional care team to be able to help out. I think it's really about now, great, what is it working and how do we move the carrots if necessary to be able to deliver those outcomes.

1:01:41Because if you look at the numbers for the dollars that go out, I mean, we're all in business, right? There has to be an ROI associated with these things. So I think what you're going to see is not maybe drastic changes right now, but more so next step kind of things that are going to be more tied to outcomes. And I think a lot of the responses that CMS is getting from the market is like, look the programs work and and and we need to have like if you go back to having just you know provider patient oversight like in just a clinical setting there and not being able to allow care organizations or community pharmacists to participate in this one you're going to leave a lot of patients just now in the lurch of already on a program and being cared for and then you're going to see adoption go way down because the reason why a lot of care organizations or community pharmacists or anybody else that's participating in these programs and providing that support the reason that they're doing that is because the providers themselves didn't have the staff or the time to be able to to do that so long story short i think it's going to maintain the integrity and the spirit of it i think there's just going to be some more framework around delivering outcomes associated with with the payment and the reimbursement there that actually brings two things to mind one of the we did a pilot with a store that was in a very rural area and it was a small pilot it just had like 10 10 patients but it was phenomenal and the feedback from those patients I mean, it was just gold.

1:03:29It was in an area where the providers at the time were only there part-time. So they would come in a couple of days a week to that area. And some of the feedback that was collected from the patient set that went through the pilot was, we feel more followed than we've ever felt before. You know, it was like it was hard for them to get talked to the physician if they're only there twice a week. You know, it was hard for them to connect. And they really felt like they were more monitored than monitored than they had ever been. And they had someone that they could call that day if they were experiencing problems, which was not something that they were used to in that area.

1:04:15So I think that, you know, that's important for our care agencies, CMS, to understand that dynamic. And as there are areas across the United States that just aren't accessible for patients to really access their doctors, their nurses when they need to. And this is really an answer for that. Yeah, and you mentioned earlier just the 2030 and then the baby boomers. And if you just look at the numbers, it's a sobering reality in a sense that there's just not, one, there's not going to be enough beds in hospitals or care settings anyways. People are going to have to age in their home. and they need somebody that has a local presence to be able to help them.

1:05:05And I think that's, again, another huge opportunity for community pharmacy to play that role. And we all read the headlines. I mean, hospitals are closing in rural areas and we've got nursing shortages and there's burnouts and all of that. Like the reality is we need to recognize that and start to have conversations like this to be in front of that. we're not playing catch up and it's it's it's again you you dig your well before you're thirsty like it's we have to take that approach i absolutely agree and i think and it's not just our opinion and i think that's what's great in this space it is not just our opinion there are there's many studies out there even in the last year that proves this same point and and that's unique for us right is this industry a lot of times we'll we'll talk oh this is a great idea we know this works we've seen this work but the fact that we have so many studies now that can back that up um and you know on the outcome level you know 100 and also the financial level and i think i'm glad you mentioned financial um as well because i think that's a that we have to look at this in the space because it it has become and will become even more um you know an insurance company a payer understands that they can save dollars on overall patient care um with this model a lot of dollars you know when you look at some studies show it was a 20 percent decrease in readmissions, that's massive.

1:06:43That's a ton of money. And so I think that puts us in a unique space here where not only can we talk about it, we know we can see these outcomes and we can get this feedback from patients, but we also know that this is going to save healthcare dollars across the spectrum and big money. I was going to say big money across the whole industry. And, you know, it aligns with what you had said earlier in terms of like commercial adoption and where you see kind of that going is, you know, back in 2019, 2020, when this first came around, it was a hypothesis. It was, hey, if we collect this data, if we can intervene earlier, like we can deliver clinical outcomes.

1:07:31And then there's obviously going to be a financial component of that as well. And then now you fast forward to where we're at, so much data, the evidence is there that it does have an outcome. And, you know, you look at what, you know, one year for one patient on a remote monitoring program might cost versus an ambulance ride from a rural area to a hospital. Like the numbers are so just, you know, they don't even line up that it makes so much more sense to invest in there and just invest in prevention as opposed to something else. That's really the key, isn't it? It's prevention. It's actually allowing us to be proactively preventing problems, which is huge.

1:08:13I always know that the pharmacists that I talk with, I just got back from a conference on entrepreneurship, they're so interested in being much more proactive than reactive. And when I think of remote patient monitoring, I think of heart failure issues or COPD with oxygen monitoring and diabetes, hypertension, and of course, medication management, remote therapy monitoring and remote patient monitoring. This is a huge opportunity that this represents savings for the states. And as a matter of fact, I wonder if the physicians that are prescribing specific medications or see patients that they know that they have social determinants of health, they don't have transportation, they're stuck in their home.

1:09:04Should we be training these physicians to say to these people that are in their care rooms as they're observing them, hey, you are a candidate for remote patient monitoring. I'm going to give you this form. Here's a QR code, whatever, whatever it is to activate. And let's be a little bit more proactive from that physician kicking this off and then handing it to a pharmacy who would go pharmacy, pharmacies and pharmacy operators that understand this. They want to do it. So it's just like we need to connect the dots where we have to educate our physicians and saying, hey, when you come up with this condition and you know that your patient doesn't have transportation or they're considered a shutdown, in or something that, you know, the bus brought them to the clinic, that automatically kicks it into this proactiveness that the providers go into action of saying, hey, listen, you're a candidate for these services, for these monitoring services.

1:10:06And I love that you brought up heart failure because that is such a fantastic example of that Todd you know on a preventive proactive preventive level I mean a weight scale and a daily weight is the difference in and really a readmission and that you know and that is that's it sounds easy right you get on the scale every day and and and you think well well why can't they just weigh themselves well a lot of times you will get on a scale or maybe you won't get on a scale and you'll make excuses well i've probably gained four pounds today because i had popcorn last night without sodium but you know in a heart failure patient you have to monitor that so closely and that really is that that symptom that can um really change the outcome and and so that was a great example todd of how as even the technology here can allow us all to be so proactive and quickly get to a positive outcome instead of the opposite.

1:11:15Yeah, and I think the thought that comes to mind is something I always talk about in some of these program design meetings is it's the what and the why. And you can explain to the patient what they need to do. And Kelly, in your example, heart failure is we need you to weigh yourself every day. And that's great. But then when the patient understands the why associated with it, that's where you start to really get an impact because it's not, hey, I'm big brother looking over, you know, looking at you or, hey, because there's an internal personal thing too. Like, okay, like weight's a sensitive topic.

1:11:53Like, you know, even if you're, regardless if you have a chronic condition or not, right? Like, but if they understand why a four pound gain or three pound or whatever might be in a short amount of time, like why that's impactful, then they start to understand, all right, I can maybe get over the personal, maybe the situation, you know, with it and be willing to share that data and be more frequent about it. So if we can get them to understand or make that connection between activity and, you know, an outcome or prevention, I think we can really make a big difference. And I really think that's where the pharmacy can come in so beautifully, if you will.

1:12:35You know, there's a there's a good relationship usually between the pharmacist and the patient. They see each other a lot. And, you know, if if if I'm kind of worried about this weight that I just checked on myself, Am I going to call the doctor if it's a three and a half pound? Probably not. But I probably would call my pharmacist, right? Because I'm, you know, I'm more familiar with that relationship. And the fact that I can get the pharmacist, I can walk in the door and have that conversation. And that really, which makes this the perfect space for pharmacy to fit. And I love that you brought that up because I think that really is a great example of how pharmacy can really transform this to a different level because of that relationship.

1:13:21Yeah, it's accessibility. Being able to call and someone's going to pick up and it's going to be real human or I'm in town and I'm going to stop by and I feel comfortable having uncomfortable conversation with someone about my health. And I think that's the biggest thing is that leveraging that compassion and the empathy that is being delivered at the counter. So Kelly, is this an opportunity for our independent pharmacies to send some kind of notification out to their physicians within their areas? They already know these physicians. They've done work with the patients that the physician is taking care of as that primary care, sending an email, something in the mail, a presentation, an invitation to come to a webinar or something to notify the physicians, hey, we have these services now.

1:14:23We're ready to go. We're taking care of people with different issues, hypertension, heart failure, whatever it is, oxygen monitoring. Therefore, the physician are now like, oh, okay, this is already in play. So if I have a patient that is candidate for this, I could recommend that they look into it. Absolutely. It's a great opportunity and it's really necessary. And I will say, I love this industry. You know, I've been in it for many, many years now. And so I feel I can be real about it too, is that that's what pharmacists don't do well sometimes is really tell people what they're doing, you know, and market themselves and kind of stand on a pedestal and say, hey, I'm doing this and this is how it can help you.

1:15:09But that is so incredibly important as we go forward, especially in a space like this, that we let the clinics around us, the providers around us, the facilities around us understand that we have this. This is how it can help you. This is how it can make your job easier. This is how it can take a patient population that perhaps is not thriving, that you're struggling with, with hypertension perhaps in this clinic and help you get to the goal that you need as well. Yeah. One potential, sorry, one thought that comes to mind on that topic of the provider and Todd, to your question, like how do you engage that conversation and then have, you know, Kelly, your point on how to have that conversation is sometimes a challenge.

1:15:57And I think one of the friction points I've seen or potential is that, you know, if there's a, it could be perceived as like, I'm trying to outsource you or like out replace the provider. And that's certainly not the case. We need all parties involved. We need, and in fact, sharing data across, I mean, it just, it strengthens that opportunity for everybody involved. So I think there might be some hesitancy because you never want to bring something to the provider and say, I'm trying to take your patient away from you or something like that and that's truly not the case here but you could see how that if if delivered the wrong way the perception might be off and that might be a friction point uh for the the pharmacist to have that conversation and maybe be reluctant to have that conversation

1:16:47i am more than positive there are electronic health record systems out there that are prepared for the collection of data and being able to have that pharmacy management system being connected to different systems and then passing specific data back to an EHR. I don't see that as an impossibility at all. So I think it's just continuing to be the treatment provider moving forward after something's been prescribed, after a treatment's been put in place by our physicians, that the quarterbacks running with the rest of the play. I know pharmacies and pharmacists are ready to do that.

1:17:33All right. I want to give our listeners an opportunity to learn more. So reaching out to IPC is a very good first step at ipcrx.com. And that link will be in the show notes. but also Tenovi, T-E-N-O-V-I.com, Tenovi.com. Brandon, this has been terrific. I actually would like to encourage you to come back on the shows. Let's bring a pharmacy or two in with us next time to really go over the outcomes of what's happened to their business since implementing Tenovi Technologies and remote therapy monitoring technologies. And Kelly, we'll have you here. Of course, we love talking with you, Kelly. You always bring us great insights, and we really appreciate both of your time.

1:18:24Thank you, Todd. It's a pleasure. Yeah, thank you so much. Looking forward to the next one. Looking forward to bringing some great stories and some great information and data back on outcomes. Hey, thank you for listening to Pharmacy Podcast Network's delivery of this week in pharmacy special feature announcement between a special partnership between Independent Pharmacy Cooperative and Tanovi. We thank you so much for listening to the Pharmacy Podcast.