Manufacturer Direct D2C and the Future of Independent Pharmacy | TWIRx Special Series

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

1:55Hey, the landscape of pharmacy, I don't have to tell you, goodness gracious, is undergoing a massive play tectonics structural shift. Our manufacturers are now direct sourcing and direct to consumer, which is known as D2C pharmacy models. They're rapidly accelerating. and it's been pioneered by organizations like Lily Direct and Pfizer Direct and these portals and TrumpRx and it's very confusing. It needs demystified. We need to know where it's showing up, how it's being leveraged, how it's going to impact our independent community pharmacies. And therefore, we have to reach out to people that know what's going on.

2:38I want to introduce a friend of mine who's been in my network for, I'm going to sound old saying this, but it's been over 15 years, maybe 20 years. I don't want to say 20 years, but it could be. Shelley Bailey, welcome to the show. How are you? Oh, hello, Todd. Thanks for having me. Yeah, you just aged both of us. So thanks for that. But no, thank you for having me here today. You know, I work on different strategic initiatives here at IPC, and some of those initiatives include partnerships with manufacturers, which is why we're having the conversation here today. But I do want to welcome Sammy Salem to this conversation.

3:16Sammy. Hey, Shelly. How are you? Thank you for having me on this podcast today, Todd. I am a retail pharmacy owner. I'm also the owner and CEO of Virus Compounding Pharmacy, as well as the executive board member with AAPA, an affiliate under IPC. So pleasure to be on this podcast today. and let's get to it. All right. So I want to set some groundwork and I'm going to turn this over to Shelly because that's why we have you here today is that authority and understanding. And like you said, the relationships that you're building with the manufacturer are so key and things are changing. PBMs are changing.

3:55Payment models are changing. How things are being paid for, access is changing, supply chain. So when I think of the threat to manufacturer, to consumer, of what that means for education and safety. When I think of the opportunity that manufacturers have to the end all source, which is of course our outputs, our pharmacies out there, there's a lot that goes into this. So kind of open up from the beginning, let's set the stage, direct to consumer in the future of independent pharmacy. Shelly, give us the groundwork here. Yeah, absolutely. I like to kind of start things usually by talking to people about where things have been up until very recently, kind of with the explosion of direct-to-consumer or direct-to-employer.

4:45I would say over the last three years, I mean, especially heightened when Pfizer launched their direct program for vaccines, we started this new world where pharmacies were traditionally used to, we have a PSAO, we sign up, we get all of our PBM contracts through that channel. We don't have too much discretion related to that. And we just kind of move forward with claims adjudication. And as all these novel programs came out, you know, there wasn't necessarily a role in a more strategic way for retail pharmacy to benefit. So retail pharmacy kept, you know, really helping the nation during a really critical time where we needed all hands on deck to pull through, you know, healthcare access for people.

5:30But as these more, this explosion of D2C really started to happen, you know, retail wasn't, wasn't at the table. And so for the last few years, you know, what we find from pharmacy owners, I was a, you know, pharmacy owner myself, which is how I met Todd probably in 2010 or something. But, um, you know, while retail pharmacy was out there, you know, saving lives, these innovative models started to pop up. And, you know, until recently, retail pharmacies just weren't, haven't been really strategically included in the D2C or D2E space. And so, you know, we'll talk more about it throughout our discussion, but I think it's really exciting now to be at a position where, you know, through partnerships, you know, like what we've built here with IPC, that we can really bring retail pharmacy to the table related to D2C that, you know, clearly benefits patients, it benefits the pharmacy, it benefits local payers, you know, in a more strategic way in the past.

6:29And, you know, I guess from my perspective, Sammy, as you have, you know, still your pulse on working the bench to seeing all this kind of play out in real time, you know, have you seen any shift from what commercial payers are doing, what cash pay is doing and then also kind of where things are headed to DTC. And, you know, are you finding that you've been historically carved out? Are you finding that you've had to refer people out because you couldn't match the DTC price? What are you really seeing kind of in real time, you know, up until some of these new programs that you've been participating in?

7:06Yeah, Michelle, really there isn't a true access to these opportunities or to these programs for for the likes of our standard retail independent pharmacies. Our pharmacies are reporting back where these scripts are leaving, right? They're seeing it leave, and our pharmacists are not identifying it as a channel shift. They're calling it just a loss in a prescription, right? Their patients are coming to the counter and saying, you know, my doctor told me to go to this website, or my insurance on the cover, they asked me to go to this manufacturer for support. That's how they're identifying these type of opportunities or these manufactured programs as it pertains to, you know, what's happening at the retail side.

7:51Has there been a true opportunity or access to these type of programs for retail pharmacies? There hasn't been until this point in time with, you know, with the programs that you're creating through IPC. And it is a very good program. I mean, some of the patients that I've worked with recently through this program have, you know, appreciated the opportunity to gain access to certain medications that they just didn't have access to before in a more affordable fashion. And frankly speaking, the economics and the pharmacy level have been favorable and in many cases more favorable than, you know, the traditional model.

8:23So it's been a welcoming program to be a part of. Well, thank you for sharing that perspective, Sammy. I mean, I guess so one of the things I think of when I've been listening to you speak right now is kind of how in some ways everything ended up a little bit fragmented, even more fragmented than before. Let's say kind of post-COVID with the explosion more of digital pharmacies and things. So maybe some of these new programs are kind of bringing it back so it's more manageable for a pharmacy to be able to deploy these programs. When you think of how cash used to work, where the patient would pay an out-of-pocket, there was an expense associated, you know, the pharmacy would adjudicate.

9:04When I think of how manufacturers can be more strategic in a, you know, closer relationship, whether that's D to C or D to E, you know, from my perspective, I think a lot about, I always think about policy because I'm a pharmacy nerd and I like to think about nerdy pharmacy things like policy. You know, I think of some of the laws like what West Virginia did related to point of sale rebates. That was a law that West Virginia passed. But as you try to figure out what the heck a point of sale rebate looks like, how does it ultimately benefit the end consumer? I think a lot of it's easy to talk about, but hard to do, right?

9:44So when I think of these types of manufacturer-supported and manufacturer-sponsored programs, I think of these really as no better world to create an opportunity for a real point-of-sale rebate than these types of programs. I get asked, I don't know if you do, Sammy, and you're hearing from consumers or local companies and organizations you work with. a lot of people have told me lately with some of these manufacturer sponsor programs, Shelly, this sounds too good to be true. Like who's losing in these types of arrangements where the pharmacy makes more, the patients pays the same out of pocket.

10:25I mean, I have my perspective on who might be losing and maybe some will share, some won't, but like, do you see this as a lose lose or, you know, I mean, just does every, does one person win and one person lose, or can everyone kind of be better together when you look at the supply chain, how rebate structures work? Is there a loser in this or, you know, is there kind of a mutual win-win? My honest opinion is that when you gain access or when you provide access to these types of services or programs, you're actually putting more product onto the market. These are individuals, these are patients that have not been able to gain access at an affordable price point previously, right?

11:06So if you're able to put more product into the marketplace, I don't think anybody within the supply chain or within the vertical is going to have any issues with that directly, especially in a situation that it's almost in a very transparent model, right? We're seeing a situation where right at the point of sale, we're seeing what the front end, what the cost is to the patient, what the reimbursement is, or what the quote-unquote rebate would be for us at the pharmacy level. And it's really straightforward. I mean, there's no hidden, you know, costs associated with it or DIR, you would call it, you know, any type of, you know, back end, clawback.

11:45It's really a model that makes sense across the board. And going back to your question, who's losing in this? I mean, ultimately, we're here for the patient. We're a patient-centered approach, no matter what we do. Every one of our pharmacies operate in that manner, we would not be around here if we didn't have that patient relationship, which is what we value at the independent pharmacy level is maintaining that relationship with our patients and making sure that we're there for them. And ultimately, if they're their ultimate benefactor in this relationship or in this transaction, then guess what?

12:14There is no loser. Well, Sammy, I'm glad that you shared that perspective because clearly community pharmacy certainly is patient-centric because if they weren't, they wouldn't be selling a lot of these branded medications because so many of the commercial payer arrangements have pharmacies very significantly below just cost of drug, not cost to dispense, but cost to drug. So I appreciate that you reinforce the concept that no matter what programs are on the market, no matter what you can access, what you can't access, what drives retail pharmacies, community pharmacies is always patient first, right?

12:50Related to, from my perspective, who might win, who might lose, You know, a lot of stores since we went live, you know, with our new network have said, wow, Shelly, isn't this somehow bad for manufacturers? Like, I have a much better reimbursed rate. The patient's paying the lower out of pocket. Like, isn't this bad for manufacturers? And, you know, why would a manufacturer do this? And, you know, from my perspective, we all know how, you know, and this program is, you know, a rebate-based model, but really just a true up of the patient out of pocket and a reimbursed adjudicated amount. But in the rebate world, in the funded space, right, we all know how that works.

13:30A claim adjudicates 180 days later, there's a bundled rebate from the PBM or from the manufacturer to the PBM. And whoever's carrying that cost, which is often the plan and the employer, there's a huge days to cash related to that. And then the pharmacy loses because of the aggressive network rate. From my perspective, doing these things, you know, manufacturer rebates are so aggressive in the funded space, and they have to be for formulary management and all those sorts of things to be able to have key product placement. I look at this as like there's one big middleman in this discussion that is eliminated from doing this.

14:12And so when you do that, there's a lot more money to be shared, right? So pharma's not giving more than they otherwise are giving to one of the big five. Pharmacy's benefiting. The patient's benefiting. But I also think there's an empowerment piece of this, both for the pharmacy and also for the manufacturer, right? Because the manufacturer now has a world where they can work with community-based pharmacies in an economic model that works for the pharmacy and also works for the manufacturer, which also improves affordability and access to the consumer. And so I think it's funny the number of calls I get that people are like, oh, Shelly, these programs are from a strategic perspective.

14:57Why the heck would you ever do anything like this? You're never going to be friends with a manufacturer ever again. But the reality is, you know, the manufacturers are really leaning in. They're leaning into this direct-to-consumer channel. They're leaning into direct-to-employer. They're leaning a little bit out of the traditional PBM model, right? And while we're all pharmacy owners serving patients, a lot of our patients own companies. They're employers, right? We can be the ambassador and market access team for, I mean, we can do so many things at the pharmacy point of sale that really help pull through new innovation.

15:41You know, when I explain what IPC is or what we do to stakeholders outside of independent pharmacies, I always explain this as how many voters are through our wingspan of ecosystem, right? Because when you're talking externally and you're really trying to gain support for PBM reform or, you know, other strategic initiatives we have, you know, pharmacists, you know, as medical providers and all these types of things, I like to explain that if we want to be successful in being able to improve affordability for more patients, right, we're empowering all of our strategic partners when we lean into these types of innovative programs.

16:21And so I know that was a super long-winded question to use, Sammy, and in response back, but I just get pretty excited about how these, you know, types of programs work. I mean, I want to ask a dumb question. How the heck does a pharmacy get paid? I mean, how are they, that's the, I've watched the economics of all of this. And I'm wondering, like, how do they actually make money? Well, in this program or in the traditional model, because I'm still trying to figure out the answer to that question when it comes down to the traditional model, Todd. So that's another podcast in itself. How's that?

17:06Well, and on this program, I'm happy to lean into the how, right? You know, I kind of, you know, when we think of the how, you know, there's different mechanisms for how in some of these new programs that's working, we know how it works with IRA, right? There's the MFT that kind of lives in the middle and trues up a pharmacy. That's very complex. There's all sorts of challenges when you're trying to do things like that. Different states are trying to do things like that with their drug affordability boards and things. And that's why with this program, I think it's the cleanest way that I've seen an opportunity to build margin, lower out-of-pocket expense, is because it's built in the same workflow as other adjudicated transactions.

17:51So, you know, Todd, to answer that question in these types of models, the pharmacy doesn't have to work with manufacturer by manufacturer, right? So they're not calling the drug company and trying to work something out. So all the opportunities are kind of bundled under one solution, right? Once a pharmacy joins into one of these solutions, claims adjudicate within standard workflows. So, you know, you have it in product dispense, you adjudicate the transaction just like you would a funded claim. The patient pays whatever is the identified patient out of pocket. The remaining delta from the contract rate and the patient out of pocket is paid just, you know, in the same type of workflow as a covered benefit claim would be.

18:39So a third party administrator pays the Delta just like in a commercial claim or a Medicaid claim or something. And so I think that's really interesting because we've always had pharmacies for the last 10 to 20 years trying to do unique things with local payers or with other strategic partners. But it's always been how much do you ask a pharmacy to go outside of workflow to be successful? And I think we could have another podcast about that and all the other types of things that we ask pharmacies to do outside of workflow. But what we know is if we want to be able to empower the pharmacy to help themselves, we have to work within standard workflow.

19:18So what's exciting to me about, you know, making sure that a pharmacy is paid the right rate, they're paid timely, they're paid all these things, is to make sure that things adjudicate no differently than any other standard transaction that a pharmacy might participate in. Yeah, and I'll follow up on my personal experience within the program that I'm currently enrolled with with IPC. Usually within 21 to 25 days, I've seen reimbursement in. And frankly speaking, that's, you know, in a very, very reasonable timeline. So, you know, to answer your question, Todd, normal workflow, like Shelly just answered, You know, the pharmacist doesn't experience any type of additional type of strain or, you know, another channel they have to go through is submitting a claim and getting reimbursed.

20:07And actually a more aggressive timeline than some other payers do. And I think for seamless like reconciliation and things like that, the payment actually still is facilitated through a traditional PSA agreement. So the pharmacy still gets the A35. They can track, you know, the timing of payment and things. And so it just, it works within traditional workflow. I know if I was a listener, because as you know, Todd, I've been a listener for a very long time. When I was, you know, building my own retail NSP, if I was listening right now, obviously something I would think about is rates, right? Like I'm just going to address the elephant in the room here.

20:45I'm a straight shooter, as you know. And I can say that, you know, while rates we can't get to the exact specifics of in this type of format, what I can say is I haven't seen these types of reimbursement rates to a pharmacy available at scale in over a decade, right? So, like, I remember when, you know, the market really shifted, you know, over 10 years ago now. But, like, rates, I haven't seen rates this favorable for 10 to 13 years. And again, someone's going to say, well, that sounds too good to be true. Where's all this magic pot of gold that wasn't otherwise available? There is no magic pot of gold.

21:26It's just more of that money is coming from the manufacturer direct to the pharmacy. And that is what excites me is to be able to build that margin back to the pharmacy. I like that. I like the sound of that. It sounds good. But if I, let's play make believe, if I melted the system down and started all over again, there's a trend happening. And actually, I'm very proud to say in the Pittsburgh area, there's two of them. So it's not even like it's condensed because these two pharmacy pharmacists and pharmacy owners went to school together. Kyle McCormick and Brandon Antonopoulos have cost plus pharmacies in their community.

22:12and they dictate everything. They get to do whatever they want and they're not subject or hostage to any payment system. So if I went back in time and I melted it all down and we started all over again, is that the, you think this is the future? Do you think cost plus and direct to consumer and getting the pharmacist as the only gatekeeper between a medication and the patient once the physician prescribes, Like, is that where we want this to go? I mean, Sammy or Todd, you're asking me the kind of nerdy stuff that I love to talk about all day, every day. So, I mean, I would say yes. I mean, I think there's already a trend in this.

22:55And I, you know, we're really interested to see what Sammy sees at the counter as well. But I think there's a huge trend on all these sorts of, you know, off benefit models, right? I think 2026 is going to probably be the biggest year of commercial coverage for programs like GLP-1s under the traditional funded benefit. Because now there's all sorts of innovative programs like what we're working on, what other partners in the industry are doing, where employers are getting smarter. And they're like, look, we're going to have maybe a watered down drug benefit, like an ICRA plan or something. Like, here's a, and I know this isn't directly your question, but I'll get to the more direct answer.

23:37But I think drug benefits are going to be narrowed considerably. Everyone's going to know where the top 20 high impact drugs live from a gross to net access ability for payers. And if I'm the total rewards manager at a large employer or self-insured employer or something, I'm going to say, these 10 NDCs, you go to this partner because they're already getting the point of sale rebate. I don't have to wait to get my money. You know, these other 15 NDCs, you go that way. And I cover it on an HSA or a debit card. So in many ways, we're going backwards. So I remember in the late nineties where my grandparents' medicine shop pharmacy, every drug we did was cash.

24:20And once in a while, someone would come in with a covered benefit and we didn't even barely know how to build a third party. And you just prayed no one came in because you had no idea how, I mean, you prayed to no one with a funded benefit, amen, because you had no idea how to even build that transaction. And so I think that there'll be a, like the, what's covered on benefit will shrink. The PEPMs that are charged to employers will shrink, right? You hope, that's probably a bad assumption, but it might work. And then all these pharmacies that want to do, you know, cost plus, I think there's, there's limitations on cost plus, you can control a piece of that.

25:02I think in the generic space, it works real well, you can factor in your cost to dispense. It's like a NADAC plus, it's like a average actual acquisition cost. I'm from Oregon. So we do all that kind of stuff. But you're gonna be limited on the high impact branded drugs because you'll never be able to do cost plus in a way that works for the patient or for the consumer. And that's where when more of these types of programs, you know, come to life, you could open a pharmacy, you could grab the programs from the partners you want and kind of make sure if you're those two Pittsburgh pharmacies that you've leaned into your own cost plus for, you know, lower whack items.

25:42And then you plug the holes on the high impact drugs with programs like this. So I think that we're going backwards in a good way, I guess, is how I would frame it. But Sammy, what are you seeing related to, are more patients just paying out of pocket because they can't access like a high deductible? From my perspective, Shelly, I mean, honestly, if you look at it at a macro level, the amount of people that are uninsured nationally and the amount of people that are underinsured nationally is at an all-time high. And that's why, you know, Todd, the two individuals that you mentioned in Pittsburgh are, you know, went into this area and opened up these cost-plus pharmacies because the fact of the matter is there is a good market out there for people to gain access to medications or therapies that are available in a cost-plus fashion that's fully transparent to them, that they're not being overcharged on, and they're gaining access to these medications.

26:43I mean, that fact of the matter, that's exactly what's happening nationally, no matter where you look or turn. And it's because of the simple fact that we have a ton of people that are underinsured and uninsured. Even at the government level, when you look at Medicaid and Medicare, and a lot of states, the majority of the states out there have adopted the cost plus model with their Medicaid reimbursement. I know in Michigan, I have a lot of experience, You know, AEPA as a GPO pushed for legislation and passed it, you know, in the state of Michigan and has helped NCPA advocate for it at the federal level.

27:17But what I will tell you that that cost plus model has saved, for example, that, you know, the state of Michigan nearly 40 to 60 million dollars, depending on the year and revenue to the bottom line in the Medicaid program. And that number, if you look at it in an indirect fashion, can be much more higher. Right. if you look at what they were able to do with respect to their rebate model within their preferred drug list. But with that being said, this is kind of what this whole program is all about. Like what this direct-to-consumer manufacturer program that IPC and Shelley has created is being able to feed into that system, right?

27:52Being able to feed into that uninsured, underinsured, or that carve-out that some of these payers or commercial plans are putting their members into because they just can't afford to be able to serve an entire, to manage an entire drug benefit program. It's hard. Will that be a program that's sustainable long-term? I do believe that managing drug benefits are going to be front and center for any type of health plan moving forward because it's always the anchor of the premium, the cost associated with it. Do I think that we're going to be in a world or in a situation where we can be creative like these type of programs or a cost plus cash pay model that could help drive down premium costs, you know, kind of carving out some of the drug benefit.

28:40I do think that's going to happen in the near future. And it will be beneficial for the pharmacists because they will be able to control that conversation like we're doing right now with this program with IPC. So, Sammy, you mentioned quite a few things that I wanted to make sure to lean into. Now, I forgot a couple of them, but one thing that came top of mind when you were discussing this made me think of, you know, was also 340B, right? So I think something that comes up, you know, for me a lot is, you know, when you talk about kind of cost plus, that's kind of what sliding scale was 20 years ago, 15 years ago and things.

29:18But with the new 340B rebate model, and we know that, you know, a lot of independent pharmacies and just retailers in general are contract pharmacies. As we know, that model is shifting, right? There's going to be, in my 25 years, people have been telling me 340B is going to change. And, you know, I continue to move forward as I did. but I do believe now there will be changes, you know, in the next 24 to 36 months, even quicker with the rebate. But I think this is also another way that kind of gets to the cost plus for some of the individuals, you know, that need to benefit from it and gets to the kind of the net that a lot of, you know, pharmacies are trying to support for their local employers and things, keeping in mind that 340B is changing.

30:13And so, but as 340B changes, manufacturer direct to consumer, manufacturer direct to employer is going to increase. So you're a pharmacy now doing contract pharmacy. You're going to see, I mean, just speaking Frank, you're going to see a reduction in 340B claims ultimately at some point in time. But can you lean into these types of programs to give you a lift that gets you the patient. It still keeps affordability at the forefront for the consumer, but also helps keep margin to the pharmacy so that the pharmacy can keep their doors open. We always said when we owned our pharmacy, we have to make money to help people, right?

30:55If we don't make money, we cannot help anyone, right? And so as 340B, that's something that we're all talking about right now. Now we're all very much closely watching these types of, you know, manufacturer supported programs, I think, are a way to bridge the gap for both consumers and for, you know, and for the pharmacies. Sammy, I have this glass half full mentality. I can't help it. It's my, I wake up in the morning, I say some prayers, try to get some breakfast, try to get some exercise in, and I want to light the day on fire. So I want good things to happen. And I hear about how the future of pharmacy isn't just the prescription.

31:40It's not just the dispensing fee. It's immunizations. It's treatment management. It's getting paid for remote patient monitoring. It's digging into supplement business and managing that. It's preemptive services that can help people live longer, healthier lives. Is that a realistic way of thinking? Is that the future of our independent community pharmacies? Well, Todd, I think it's a part of it. I don't think it's, when you say is it the future, I do think the core of who we are as pharmacists, independent pharmacists, and providing a service or a level of care to our patients is always going to be the dispensing piece, right?

32:22But what accompanies that, or what comes with the type of service that our patients are going to expect out of us is providing those type of services. right? And the ability for our pharmacists to be able to adapt to those type of the ability to provide those services. And I know we spent a lot of like a lot of states and nationally, the ability to provide some of those services, whether it be immunization, or the types of monitoring that you're referring to, whether it be remote therapy monitoring, or RPM, or chronic care management to a degree that to work with our with our providers that we work with on a day-to-day basis, primary care providers, that is.

33:01I think that's all going to be a part of who we are as pharmacists in the future, 100%. Simply because the ability for the patient to access us on a daily basis. You know, they touch us, they feel us, they're able to see us, they're able to communicate with us freely. And we have to be a part of that conversation. We will be a part of that conversation. But is it solely the future? when people talk about that, I think some people envision the dispensing side going away. And I don't think that'll ever go away, right? I mean, every patient's going to come in and need that type of service, whether it's an urgent care medication or whether it's a maintenance medication or whatever it may be.

33:42Pharmacists are going to always be there for that, for all levels of service. And one thing that our pharmacists need to be a part of is being able to adapt to that ability to offer those other types of ancillary services. I want the listeners to listen in and maybe listen to this podcast again, but reaching out to people like Shelly and reaching out to IPC and reaching out to AAPA and Sammy and people that know what's going on to demystify, to understand and where to go. Shelly, help our listeners understand how to get the pharmacies involved, how to get the pharmacists involved, How to kind of corral this so that they can feel in control and getting involved with direct-to-consumer and tighter relationships with our manufacturers?

34:30Yeah, absolutely. Thank you for asking, Todd. I mean, I would say just a very low-level way to get started would be for those that want to access programs like this would be to reach out to the IPC digital health team. Sure, Todd, for the notes for the podcast, you'd be able to put that contact information there. I think that's just a really dip your toe in the water kind of way that gets started. You see how it works. You know, you then can see in real time if those economics are in alignment with what works for your pharmacy, right? I believe I'm a trustworthy person, but, you know, every pharmacy has a different model of, you know, what reimbursement works for them and things.

35:10I believe strongly a model like this will work. But again, I would just encourage people to try. And then once you've dipped your foot in the water, you've tried a little bit, again, I would continue to, I mean, just being the pharmacy person I am, it's listening to podcasts, more of the different podcasts that you do, Todd. My favorite time to listen to you, Todd, was always like 10 p.m. to midnight when I was working on prior auths, right? But, like, listen and learn from others that are already doing these types of things. Listen to more webinars that, you know, IPC has a myriad of things that we're doing in this space.

35:47And just learning, you know, from others, attending conferences, attending all the independent pharmacy conferences that are coming up, the wholesaler conferences that are coming up. But it's really, I think, trying to not have the visceral reaction of these new things are happening. I don't like it. It isn't good for me. So I'm not going to participate. You know, someone told me way back in my 20s, if you're not sitting at the table, you're on the menu. And I think we all know that that's been something that for going a couple decades back, right, I think pharmacy struggled with a little bit.

36:25And now we've been racing to catch up over the last 20 years and things that we're all doing together, but we're, we're all better together. So the more of us that can lean in to empowering the partners that we want to work with, right, empowers ourselves and empowers our patients. And so I would just really ask stores to be, you know, um, open and curious and use these types of tools. You know, this is one tool in the toolbox. Clinical services, billing for clinical services, that's another tool, right, Todd? Whatever shape, weight, and form 340B is another tool in the toolbox. Remote monitoring is another tool.

37:05And so I see them all working together, but it's keeping an open mind because, you know, we're traditionally pretty cautious of any sort of payer relationship. And so it's listening to others. It's listening to other podcasts on similar topics and just giving it a try. Yeah, I'd like to add something to that, Todd, if I may. The first thing is this doesn't cost anything to any pharmacy to be a part of. You know, and that's the first thing that everyone says, what's a catch, right? I mean, Shelly said it a couple of times, you know, who's losing? You know, what's going on here? And as far as the pharmacist is concerned, you're not losing.

37:40You're actually winning. So don't worry about anything else. Second thing, from an AAPA perspective, like, you know, our account management team led by Kelly Sneed and Shem Sibley. So you've had the pleasure of meeting Todd before. They spend a lot of time talking to our members about these type of programs exactly. Day to day is when these opportunities come up, you know, a lot of my members, you know, will send me messages off, you know, off topic. Sometimes, hey, Kelly and Shem took a lot of time to talk to me about this MTM program or this, you know, whatever it may be. And I know a lot of these pharmacy GPOs, including IPC, spend a lot of time training their account management representatives and calling their members and getting them aligned on these type of programs and getting them on board with them.

38:23So I think that, you know, from the AAPA's perspective, from my view, a lot of our members are very receptive to this type of engagement, are usually very highly engaged on these type of programs because of our account management team and the ability to reach out to them and their level of trust with us. So the way I see it moving forward is how do we get these pharmacies on board with these type of programs is leveraging all the great things Shelly and IPC are doing and making available to their affiliate pharmacies. And, you know, and encouraging and training and getting our account management team to be able to properly push this information out and get these pharmacies on board is is critical moving forward.

39:04I mean, that's going to break the ceiling, the glass ceiling that's above us when it comes down to offering these type of services. Listeners, as Shelly said, in the show notes, if you're driving, you're doing something, jogging, chopping vegetables, chopping broccoli. Remember that, Shelly, from Saturday Night Live. If you're doing something, you can't look at your screen. Don't worry about it. Wait till you get back somewhere safe. Go to the show notes. There's going to be links there to get you access to these people and these experts and be able to ask questions and be able to understand how to get going.

39:39And that's just it. It's prep right now. You have to start thinking, what are we doing differently? What are we doing to build a new infrastructure to enter 2027? Not starting, but moving into a new program and moving into new marketing. And this is another thing. And IPC has always been good. And shout out to AAPA too. I've worked with them at the IPC conferences. Amazing group. They're good at marketing. They're good at communications. They're going to teach you and help you push programs out to your community to make it understandable and to get your community involved, get them asking questions back to the independent community pharmacies and become the source of information, become the healthcare hub that you are in your communities.

40:28I am so honored to have had both of you on the show today. Thank you so much, Shelly, for bringing such a great guest to us, somebody that's in the trenches that cares about his community and cares about what's happening in healthcare today. Sammy, this has been great. I want to thank you both. Pleasure's mine, Todd. Thank you so much. And Shelly, as always, we love to work with you guys and hopefully we can continue all the good work. Absolutely. Thank you both for having me today. Hey, you were listening to the Pharmacy Podcast Network, one of our programs sponsored by Independent Pharmacy Cooperative, IPCRX.com.

41:07Take a look, ask lots of questions. Let's get ready for a new year coming up this fall. And if you're going to NCPA, make sure we connect. We will be there as press covering the event. Make sure you connect with Shelly and the IPC team. and just take time to meet each other. It's so important that we get together. I say together, Rx. Hey, we'll talk to you next time.