Pharmacists at the Center: Public Health, AI & the New Pharmacy Model | TWIRx

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2:50Alex J. Adams, PharmD, MPH: You are listening to the Global Network of Podcasters dedicated to the pharmacy profession. Welcome to the Pharmacy Podcast Network.

3:25Robert “Rob” Maher, PharmD: Hey, special this week in pharmacy. I am pinching myself because I get an opportunity to interview a superstar that you may not know as a pharmacy podcast listener and listening to twerks week after week. Dr. Alex Adams, PharmD, Assistant Secretary for the Administration for Children and Families. the ACF, and I have a Pennsylvania, my own state leadership here, Dr. Robert Mayer, PharmD. He's the president and chief operating officer of the Pennsylvania Pharmacist Care Network. Gentlemen, welcome to Torx.

4:03Alex J. Adams, PharmD, MPH: Glad to be here. Thanks for having me here. Thank you, Todd.

4:06Robert “Rob” Maher, PharmD: All right. We got to get this out of the way, Alex. Just the softball question before we start drilling you with some hard stuff. And that is, why did you want to become a pharmacist in the first place.

4:17Alex J. Adams, PharmD, MPH: I kind of followed the family profession. Dad was a pharmacist. Grandpa was a pharmacist. Great-grandpa was a pharmacist. So I was born to be a fourth-generation pharmacist. They joked that my blood type was RX positive. I married a pharmacist, and we had a future pharmacist that we're raising. So it really followed the family business. And I believe deeply in what pharmacists, especially in community settings, can do. I will say, you know, prior to graduation, I got probably more interest in the policy side of the profession and, you know, found every pharmacy speech has the same elements. We're the most accessible healthcare professionals, we're among the most trusted healthcare professionals, but we're the most underutilized professionals.

5:10Alex J. Adams, PharmD, MPH: And I don't know that I ever had the patience to stick around, hoping that somebody would recognize our potential and utilize us. I wanted to knock those doors down. So I did pivot early in my career to the policy side of the profession. Yeah.

5:25Robert “Rob” Maher, PharmD: And you really jumped in and dug in deep with Idaho's Department of Health and Welfare as their director. Talk to us about the inception of that and then where that led you next?

5:40Alex J. Adams, PharmD, MPH: As I said, I married a pharmacist. My wife is an Idaho pharmacist. She used to work at APHA and AACP, so kind of the alphabet soup of pharmacy family here. When we decided we wanted to have a family, looked at moving back to Idaho, which is where she's from. The skies opened up from the heavens. Around that time, we were talking about moving back to Idaho. So the executive director of the Idaho Board of Pharmacy position opened up. So I applied and he was fortunate to get that. As I said, I never was one for patients. So I said, well, if I'm going to do this and I'm going to move across the country and I'm going to take the board of pharmacy position, I want to be the state everybody looks at with envy.

6:24Alex J. Adams, PharmD, MPH: Before that, you know, frankly, we had to look at Canada with envy, you know, Alberta, Canada of all places, pharmacists had independent prescriptive authority. They had the ability to adapt prescriptions. And, you know, I remember one time presenting at the University of Pittsburgh, telling their graduates, if you want to practice at the top of your education, the top of your training, you got to go to Alberta, Canada, of all places. And I wanted there to be a place in the US that would rival that and frankly, I wanted to go further in Alberta. So when I started the board of pharmacy, we started with about 100 pages of regulations.

7:06Alex J. Adams, PharmD, MPH: And when I ended, we get it down to like 20-ish or so pages of regulations. We got rid of all the ticky tacky stuff of how hot your hot water has to get, how much light has to get to the back of your counters, what type of doors and hinges you have to have. But more importantly, we created breathing room for prescribing. And it was a very iterative process. Initially, when I started, I started taking packages to our legislature where we would allow pharmacists to prescribe for very discrete things like naloxone and tobacco cessation products and tuberculosis skin tests and things like that. And it just, it wasn't sustainable.

7:45Alex J. Adams, PharmD, MPH: Each one of them, you had to run a bill. Each one of them was opposed by other professions. Each one of them, we then had to learn up with training requirements on TB skin test and annual continuing education requirements and all of that. It just wasn't sustainable. I think the thing that really changed the trajectory was when we ran the tobacco cessation prescribing bill, you had a physician get up to oppose it, who basically argued, and I'm saying basically argued, was it was safer to smoke than it was for pharmacists to help people stop smoking. It was such a disingenuous argument and so shrill that the legislature said, let's get out of this business and let's just give pharmacists broader prescriptive authority.

8:32Alex J. Adams, PharmD, MPH: So I worked with a couple of legislators. We drafted some broad language that rather than saying drug by drug, drug category by drug category, that pharmacists could prescribe anything that didn't require a diagnosis, was preventive in nature, was for a condition that was minor or self-limiting, or for things that can be used in an emergency situation. And that was the first time a U.S. state had opened broad prescriptive authority. But it also put the onus on the board. We had to then write regulations defining what is a minor and self-limiting condition. And we ran into the same problem. You know, I ran a slate of regulations at the board that included like 20 to 30 things on it.

9:15Alex J. Adams, PharmD, MPH: It was medications for urinary tract infections, medications for flu and strep, medications for cold sores. And every single one of them was opposed. Like the most vivid memory I have was a representative of, I believe, the board of medicine opposing those one by one. And for cold sores, she got up and said, how is a pharmacist going to distinguish between herpes labialis, a cold sore, and genital herpes? And I remember saying anatomical distance. And it just got to the point where, like, we started looking outside the profession. How have others done this? There's no way nurse practitioners had to go through this for every drug category or physician assistants.

10:01Alex J. Adams, PharmD, MPH: We stumbled into standard of care regulation. Rather than identifying everything as an itemized checklist or list of permissions, that you flip the script. If something is not prohibited, it's allowed as long as it's within your education, your training, your professional experience. So we pulled in some folks who had regulated in the medical professions and nursing professions and say like, what regulation says after open heart surgery, you have to remove the sponge from the chest cavity? Well, there isn't one, but it's the standard of care. So really immersed myself into this standard of care philosophy.

10:45Alex J. Adams, PharmD, MPH: And we were the first state to get rid of all of those regulations, got rid of everything around immunizations, smoking cessation, TB, skin tests, all of those things that we had run one by one, fought battle by battle. We ended up just eliminating all of that and said, pharmacy practice is going to be governed by a standard of care. Pharmacists can do anything within their education, training, and experience as long as it's not prohibited. So, you know, I remember going around and doing a bunch of presentations to pharmacists throughout the state and saying, you know, the answer to darn near every pharmacy law question is now, it depends.

11:22You know, can I prescribe for X?

11:26Alex J. Adams, PharmD, MPH: Well, it depends. Is it within your education? Is it within your training? Is it within your experience? You're polled in front of the board of pharmacy. Would how this was in the best interest of patient care. And it was a very, you know, I will say uncomfortable mindset for a lot of pharmacists because many pharmacists, I'm sure not all of your listeners, but many pharmacists are just very type A personalities and don't do well with gray area. They like things black and white and rule-based. And it depends is a very uncomfortable area. But for this profession to be sustainable, for this profession to really be able to be utilized and not just sitting at pharmacy conferences grousing about being underutilized, you really have to be governed like other health professions, specifically the medical and nursing professions, which is by a standard of care.

12:20Alex J. Adams, PharmD, MPH: So we got that done about 10 years ago in Idaho. And it's really great to see other states are now embracing that and seeing that as a model of reform.

12:32Robert “Rob” Maher, PharmD: Thank you for that. I see some contrast and some comparison opportunities with Pennsylvania's initiatives with the PPCN, the Pennsylvania Pharmacist Care Network. Rob, what are those kind of variables in comparing what Alex shared at a federal level? What's happening at Idaho? Now it's pulling it into a federal level. But talk to us about the PPCN here in Pennsylvania.

13:01Alex J. Adams, PharmD, MPH: I mean, a lot of our contracts and why we created our clinically integrated network, which was being created right around when CPSN and it was a natural fit, was we had a way to talk to payers about what we can do. And pretty much most of our contracts are within our scope of practice here in the state of Pennsylvania because every state does, just as Alex said. Now, the problem we have and we've grown very well of showing how we can impact and improve asthma outcomes, diabetes. And in fact, one of our newer ventures, which kind of lines up with where Alex's role is, we're doing a maternal health program, which is very important because a lot of our counties don't have access to OBGYN care.

13:48Alex J. Adams, PharmD, MPH: And when we're working with our Medicaid providers, they're going, you know, this is a need. And so, but where we run into limitations, and that's why I'm excited that our state, that our state association, PPA, and our Pennsylvania Society of Health System Pharmacists are really starting to look at standard care. We got a long way to go, but we're getting leaders together to talk about it because I'll go to a payer. I'll give you an example. In Pennsylvania, pharmacists can do testing lab-wise for RSV, influenza, strep, and COVID. But if we want to be able to do hemoglobin A1C, which now is a self-test at home, we got to get a full lab license and we have to get a medical director.

14:38Alex J. Adams, PharmD, MPH: And that is not an easy feat, especially when a lot of our physicians work for health systems and may not want to partner. But, you know, when we talk to our payers, what's the most needed thing? Getting an accurate hemoglobin A1C tied to their value-based contracts, but also the pharmacist needs that information to provide care. So I think that we've come a long way in what we do, and we've gotten Medicaid provider status, which has been slowly growing in our state. But that standard of care, I echo what Alex said, that instead of doing this mother may I, having the ability to practice what we do.

15:19Alex J. Adams, PharmD, MPH: And for those naysayers who say, well, I don't want to do it. Well, you may not have to if your organization does it. And then, you know, I grew up in a community pharmacy, but I also had the privilege of, you know, doing a residency, working in a physician clinic. And I worked some in the VA. And we've been doing this in the VA model for years, you know, credentialing. And as far as I know, there's not too many pharmacists that have caused harm. And I liked your analogy that we're also extenders because, you know, with this whole rural health transformation in Pennsylvania, we got Pittsburgh and Philly.

15:53Alex J. Adams, PharmD, MPH: but there's a lot of rural in Pennsylvania. This is really something that is needed. Hopefully that kind of echoed what our conversation was.

16:06Robert “Rob” Maher, PharmD: Yeah, Alex, what you were saying and setting the stage for, we were diving into Pennsylvania, but we want to see this spill out throughout the entire nation. And I'm not sure if that's provider status. I'm not sure if that's a new way of thinking of what a pharmacist is capable of doing within the setting. When we talk about specialty rare disease, much different than senior care, much different than pediatrics, much different than general community pharmacy, immunization programs, birth control, for goodness sakes, where we have different centers that are closing for one reason or another, and now it's our pharmacists that are picking up the slack.

16:44Robert “Rob” Maher, PharmD: This kind of ties back into your missions with caring for families, caring for children. Talk to us about other initiatives that you're working on, Alex, and how even Pennsylvania and other states may be able to back up, repeat some of the things that you're doing so that we can fortify.

17:03Alex J. Adams, PharmD, MPH: Yeah, a lot to unpack there and love your framing of it. I think the first thing I would start with is pharmacy is primarily governed at the state level. So I know there's a lot that look to Washington for action, but this is really an issue where you should be interfacing with your state legislature, your state board of pharmacy, and others because your scope of practice is defined at the state level. Second thing I would say is a lot of people tend to look at changing the law as the endpoint. It's my experience that changing the law is opening the door. Whether or not people walk through that door relies on all of these other factors.

17:48Alex J. Adams, PharmD, MPH: And, you know, Alberta was always a perplexing example for me. As I said, prior to getting standard of care in Idaho and seeing that kind of sprinkled other states like Alaska and Iowa, and it sounds like Pennsylvania is having some of those conversations, Alberta was really the model exemplar in North America. But there were studies that showed five years after pharmacists getting independent prescriptive authority in Alberta, only 5 % of pharmacists had actually prescribed a drug. So I think there's a tendency to think changing the law is the end point. I initially would say I was frustrated by low uptake, but I also think that's a sign that these things work.

18:30Alex J. Adams, PharmD, MPH: Not every pharmacist has to move forward. Not every pharmacist might add the education, training, and experience to do some of these things. Not every pharmacy organization wants to move forward with some of these things. So law opens the door. Whether or not people walk through it is a complex dynamic of payer policies, patient acceptance and demand, corporate policies, risk mitigation, liability insurance, and personal preferences and choice. Oftentimes what you see, you know, like when pharmacists started immunizing, it took 20 years from the first pharmacist immunization law to pass to when half of the profession had become credentialed as immunizers.

19:14Alex J. Adams, PharmD, MPH: So some of these are playing the long game, but there are certainly things, organizations, that's what Robert's organization does. They're helping get pharmacists comfortable and ready and able to walk through those doors and fill in those gaps that laws can't. I will say federally, though, this is a moment of opportunity. I have the privilege to serve here at the U.S. Department of Health and Human Services. And there's been a number of things that we think can help. One is in the Rural Transformation Fund that CMS issued had expressed points given, and the points helped influence how much funding went to each state, and some of the points were based on what your pharmacy scope of practice laws are with a specific suggestion of broad independent prescriptive authority.

19:59Alex J. Adams, PharmD, MPH: One of the things I oversee, ACF, the Administration for Children and Families, one of my top goals is to prevent foster care entry. One of the top reasons for foster care entry is parental substance use disorders. One of the ways you can prevent or treat, most importantly, treat parental substance use disorders is medications for opioid use disorder. And earlier this year, we announced a federal funding match for medications for opioid use disorder. And then subsequent to that, I teamed up with Dr. Oz and Chris Carroll, who was running SAMHSA, and we put out a letter to states encouraging them to fully utilize their pharmacist workforce as independent prescribers of medications for opioid use disorders in accordance with a standard of care.

20:48Alex J. Adams, PharmD, MPH: So there is a federal match available for those medications, available to pharmacists, but you would have to work with your state child welfare agency to identify the population who's eligible. So a moment of opportunity, but still contingent on local interface with state agencies.

21:11Robert “Rob” Maher, PharmD: I love the dominoes that can fall. But like you said, just because there's a law that's been passed, it's the implementation that's the most important part. And it is controlled wherever the state is in their progression. Robert, it reminds me of PPCN and the different buckets of what you're concentrating on where you're going to the health systems and hospitals, you're going to the independent community pharmacies, you're helping out with the grocery store standardization of care of how we're using food as medicine. Talk to us about PPCN and how you're helping the state to move forward and unpacking some of this to make it a reality rather than just laws or policies.

21:52Alex J. Adams, PharmD, MPH: Yeah, so, I mean, we've had the opportunity both through PPCN and we're a subsidiary of our state association of partnering with our Department of Health and also our local departments of health that are in the counties that have them. And one of our biggest initiatives recently is our Momentum project, which is to help with maternal health. And it's not just maternal health from before the child is born, but it's also after the child is born. because we know that there's issues after the child is born in terms of postpartum depression, also dealing with vaccines and continuity of care. One of the things that we have in a lot of our pharmacies, especially in underserved areas, which underserved doesn't necessarily mean rural, but it could also be an urban area, is getting that person to an OBGYN.

22:58Alex J. Adams, PharmD, MPH: We have a pharmacy here in Pittsburgh that identified a woman who's been pregnant for almost a whole first trimester and has not even seeked maternal health care. And so the risk. And this person was somebody that had substance abuse. So there's things that we can do that can impact that. And, you know, we've seen what pharmacists can do via vaccines, but, you know, that extension, because it's hard to get in to see your health care practitioner. All right. You know, my wife was going to get a physical and she needs to for her nursing job. And the doctor canceled, even though she had an appointment a year ahead of time.

23:40Alex J. Adams, PharmD, MPH: Now she can go see the PA or whatever, but just getting access to care because the way our system is right now. So I think those are the things that, you know, when people push back about, oh, can pharmacists do this? We can. We're trained to do it. We just have to give that confidence level. And I think having our network, what it does is it provides a confidence level for that payer and for those partners that we're working because you got to hold quality. Because if you don't hold quality, then people aren't going to trust you. And that's one thing that we can do, help that.

24:17Robert “Rob” Maher, PharmD: And the payers have to see the results. They have to see the outcomes in order to continuously continue to fund it and then be attracted to those programs. I love that. Alex, you know, this has gone by way too fast. I want to just put an invitation out to you. Even after your time at the federal level, when you go back to Idaho, I want you to remember Pharmacy Podcast Network. We have 40-some shows with all themes of the senior care, our pediatricians practicing our specialty rare disease. This is an open platform for you. If you ever have something going on, you want to team up with a state organization, you want to kind of dig into something to get more attention around it, I would love to have you back.

25:03Robert “Rob” Maher, PharmD: But really appreciate you being here on TORX.

25:06Alex J. Adams, PharmD, MPH: Appreciate it. Thanks for all you do. Thank you, Alex. And also, you know, you're a perfect example of what our younger professionals need to follow is that if we speak our mind and we keep talking, we can change this profession one by one. So thank you. I want to give my own personal professional thanks. Appreciate it. Thank you.

25:26Robert “Rob” Maher, PharmD: Shout out to our pharmacy students out there. Listen to this interview. You have a future in pharmacy leadership. If that's what you want to do, press for it. Link up with people like Rob Mayer on LinkedIn. Reach out to me. I'll get you tied in with other people. But keep pushing. Leadership in health care starts with you. And don't ever say, don't ever take no the first time. Keep pushing. Keep seeing what is possible and what you can do as a pharmacist. and listeners, you're the champions. Thank you, pharmacists. Thank you, pharmacy technicians for what you do. And thank you so much for listening to This Week in Pharmacy.

26:02Robert “Rob” Maher, PharmD: If you run a specialty program,

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26:38Alex J. Adams, PharmD, MPH: Real-time outcomes reporting gives you the performance data manufacturers and payers actually ask for. And your prescribers get the visibility that keeps referrals coming back to you. It's fully white-labeled. Your brand, your patient relationships, your data. It runs on top of your existing pharmacy management system. No rip and replace. Grow volume, prove value, keep what you've earned. OneJourney by Cassian.com. OneJourney by CassianRx.

27:04Robert “Rob” Maher, PharmD: Hey, welcome back to twerks. What a great episode. What a great interview. Thank you, Rob Mayer and Dr. Alex Adams. What a place setter for pharmacists to think, hey do you belong in public health do you belong in public health leadership the answer is yes you do that was a trick question hey on our next um segment here one of the most effective aspects of your business of pharmacy i don't care what sector you're in i don't care um if you're a consultant pharmacist or in specialty or any any factor long-term care pharmacy is being able to define how are you going to use artificial intelligence in your operations and how is it going to parallel the infrastructure you already have to make things more efficient, to make things work better, but then also thinking of it from a strategy perspective and not just slap it on because it's the hot button or it's the trendy thing to do because you don't want trends involved in your business.

28:17Robert “Rob” Maher, PharmD: You want solid solutions that absolutely make sense and that are proven. That's why I bring the best of the best on. I want to introduce John Booz. He is the CEO of Hendren AI. John, welcome to Twerks. Thank you for having me, Todd. Excited to have you here. You and I are headed to the NASP Inspire 2026. We're going to be doing some interviews there. We're going to be diving into how does AI impact rare disease, digital therapeutics in specialty pharmacy, therapeutic interchanges, decisions around reimbursement, lots of things to talk about. But today, we want to introduce you to the listeners.

29:00Robert “Rob” Maher, PharmD: We want to get the Hendren name out there to let everybody know. By the way, go to hendren.ai. Once again, and Hendren.ai to learn more. But John, right out of the gate, give us some background and overview on Hendren.ai.

29:19Alex J. Adams, PharmD, MPH: Sure. First, the name, it's the Viking God of Knowledge. Everyone asks me, where'd you get that name from? So I was looking for all of the gods of knowledge and wisdom, and all of them were taken. Probably one of the worst gods of knowledge was Isis, so nobody wanted to have that name. So in terms of picking out names, I actually found Viking God of Knowledge and thought it was a great idea to be able to name Hendren after that. And in terms of being able to really show the God of knowledge or God of wisdom and being able to correlate that with some of the pharmacy disruption that we're essentially pioneering within the platform, with this intelligence platform within the pharmacy.

29:57Alex J. Adams, PharmD, MPH: So from end to end, looking at first principles thinking, and at the same time, how do we do a platform redesign of this from the beginning? And the things that we've spoken about prior to this was how do we add point solutions? And point solutions by themselves, like pharmacy management softwares, weren't enough. So this intelligence platform really solved some of the problems that we've been experiencing in pharmacy amongst handling phone calls, on the screen, spending numerous hours talking to patients because patients want the Amazon pharmacy experience. And we found that to be able to do that, not only just for really independence, but also at the same time, chains, mail order pharmacies and specialty pharmacies.

30:42Robert “Rob” Maher, PharmD: For people that are driving or walking or doing something, you're just listening to your podcast. First of all, thanks for listening. But for those that are looking, if you're seeing us on YouTube or watching us on LinkedIn streaming, a system under load, the health system and pharmacies are absorbing the same pressures of staffing and rising costs and administration and workflow. If you can leverage artificial intelligence, John, it's a game changer, but you have to have an organization that knows what they're doing. And like I said, this cannot be a trend. This needs to be delivered through proof.

31:20Robert “Rob” Maher, PharmD: And we come from an organizations, we come from specialists and providers that rely on evidence-based knowledge. And I almost feel that AI in pharmacy needs to go through some kind of standardization or criteria around delivering something that is truly evidence-based and always remembering that. But talk to us about the hot buttons and some of the things that your clients are experiencing in using AI through the power of Hendren AI?

31:51Alex J. Adams, PharmD, MPH: So essentially the customers are looking at it from a de-risk basis. So you're a pharmacist, so we like to look at evidence, objective, subjective, and what clients are typically looking at is a de-risk product. So essentially understanding that it comes with its troubles, comes with its goods, and we usually get questions like, are there any hallucinations? will this start going off the guardrails? And what we usually comfort them with saying is that there's going to be rule-based control over the AI agents' ability to go back and forth and what lane they can stay in, and there's guardrails. So that's essentially some of the, I would say, the major questions that we end up having in terms of being able to say, will these AI agents on the screen or over the phone do their own thing outside of the guardrails that we end up training it with?

32:39Alex J. Adams, PharmD, MPH: And really, the answer is no, as long as they're being monitored, right? And there's some instances that happened actually with NVIDIA and Hugging Face where essentially OpenAI and their bots were able to go out there and essentially go to Hugging Face, and they were trying to attack Hugging Face. So there are possibilities where OpenAI really didn't do enough monitoring. They have millions of agents working simultaneously, and they haven't had any oversight, but that's not the case with us. Our DNA is security and compliance and making sure simple top compliance is very important to us. HIPAA compliance is very important to be able to have a seesaw within our organization.

33:18Alex J. Adams, PharmD, MPH: Managing those things is really what gives us our competitive advantage and moat against the competition that's in the market right now. And not many organizations can say that. A lot of the folks that are really in the market right now have glanced over those kind of things. And we're dealing with large enterprise organizations from large meal order pharmacies, specialty pharmacies, health systems that are essentially leveraging this kind of technology. And the security clearance is not easy. So this isn't a court in a pharmacy that you have one key decision maker. You're just getting an agreeable answer to them.

33:51Alex J. Adams, PharmD, MPH: These are really bureaucracies and enterprise organizations where there's a whole security department where we're answering 120 controls, making sure that we're compliant.

34:02Robert “Rob” Maher, PharmD: Talk to me about why pharmacy, though, in comparison to so many other sectors of even healthcare. What is it about pharmacy? I mean, I know that you're a pharmacist yourself, but where did you see the opportunity to jump into this?

34:19Alex J. Adams, PharmD, MPH: Well, it was very early. So I would say around the end of 2023, probably a year after ChatGPT came out, we realized there was an opportunity to be able to leverage voice AI. And there's a lot of companies out there that were doing voice AI, even now, it's become a plethora of those. But what we really pushed forward was the vision language models. And if you understand vision language models, and I'll really explain it very easily, is usually a chat GPT that runs on OpenAI's platform essentially is a large language model. And the vision language model essentially just reads what's on the screen.

34:56Alex J. Adams, PharmD, MPH: And vision language models also could read what's on a camera. So what we said was these prescriptions are typically coming in handwritten. And how do we leverage those vision language models to be able to gather that information with OCR and then be able to map it into the pharmacy software? And that's really what got us going, because voice AI was really present at the time. But when it came to vision language models, even the talent in the States right now is very minimal in terms of understanding what vision language model can do. And we're not just talking about pharmacists. We're talking about computer science engineer graduates, folks that have been in really the career.

35:33Alex J. Adams, PharmD, MPH: This is not something that's quite present. So you could have, for example, New York City cameras run with vision language models to look for terrorists and burglaries and all this stuff. But not many folks have really geared into the understanding of how can we leverage this vision language model to be able to do work, be productive, operate AI agents on the screen, to be able to do some of the things that technicians are typically doing in the pharmacy. And we know there's a shortage of technicians, there's a shortage of pharmacists in terms of it's more of an outflow since COVID. And that's where the opportunity really aligned in terms of productivity.

36:07Alex J. Adams, PharmD, MPH: and we know that margins have really tanked for independents out there that are running at 2 % to 5 % net margins. So we said technology is essentially deflationary and how can we improve those pharmacies net margins by really implementing this technology by using AI agents, voice AI and automation to really say whoever's out there in terms of a primary platform or a pharmacy management software will essentially API into your organization to be able to give that pharmacy the plumbing of the intelligence platform on top of their pharmacy software without losing any security.

36:44Robert “Rob” Maher, PharmD: So there's something on the website that talks about perspective and projected savings, and it's very impressive. So kind of review that with our listeners, because this really got my attention.

37:02Alex J. Adams, PharmD, MPH: Yeah, so the cool thing about AI agents is you can have numerous of them. So in terms of thinking about it from a logical perspective, if you have one technician and they're doing, for example, eight hours on the phone for a 12-hour shift, that's where you really get your savings. With voice AI, you can have numerous agents. You can have 10 agents making phone calls simultaneously to 10 providers about 10 different patients. So think about it. If you're calling 10 different providers, about 10 patients per provider, that's really where the savings comes. And in terms of what we typically look at is an hourly labor cost for a technician.

37:40Alex J. Adams, PharmD, MPH: So if you're in New York or California, you're paying your technician$30 an hour, and you're able to use this kind of technology for down to 10 cents a minute, you're able to factor in a lot of the labor costs into the AI cost savings because you're only being charged when those calls are being made. But at the same time, we obviously can't discount the fact that technicians are doing work outside of the screen and outside of the phone, right? So they're stocking shelves, accepting orders. Some technicians are actually giving vaccine shots this fall. So, like, you have a lot of things going on with technicians, but at least we can relieve them of the burden of handling at least half of the phone calls that are coming through.

38:18Alex J. Adams, PharmD, MPH: And at least handling the OCR part of it through AI agents and not having to do, like, sort of a first pass where you're essentially eyeballing a script and entering them into the computer system.

38:30Robert “Rob” Maher, PharmD: something i also found really interesting just as some backdrop for our listeners that probably don't know is your work with pharmaceutical manufacturers and how that is becoming blended into the operations of pharmacy because of direct to consumer and how that's going to continue growing so give us some backdrop on on how you've worked with some of the manufacturers

38:53Alex J. Adams, PharmD, MPH: So the ICP is very important because at the end of the day, the pharmacies, the essentially health systems and the pharma companies want to work together so that patient care is improved and that patients have access to medications. So pharma companies are in the business to remove those barriers. Unfortunately, some insurance companies are in the business of putting up more barriers and essentially trying to get those medications to the patients becomes a problem. So what we're in the business of as pharmacists to get those medications real quick, obviously, we're not bypassing insurance companies or PBMs.

39:25Alex J. Adams, PharmD, MPH: What we're doing is automating whatever needs to be automated that's requested by the insurance company. So if it's filling out a PA form and if it needs a diagnosis, for example, for an exemplary, right, we have APIs with Epic, Cerner, Athena, some of the small EHR systems that are out there. And if it's missing a diabetes diagnosis, we can go straight into Epic and pull that diagnosis code and fill that information. Previously, you have to call that provider, figure out what their diagnosis code is, go in there and try to figure out all these things. But in general, if you think about some of the hurdles that are really running from the provider side, obviously pharmacies cannot do PAs, right?

40:04Alex J. Adams, PharmD, MPH: But so what ends up happening is the providers have to do this, the office managers, and probably these PAs won't be taken care of. What will happen is there'll be like step therapy. They'll say, well, that drug is not covered. We'll figure something else out that could be covered, right? So from our perspective is we've gotten APIs from the provider side for all the EHRs. We've gotten APIs for most of the pharmacy softwares. And what we've done is said we're going to work on both sides of the aisle. And pharma has come in and said, let's remove those kind of barriers. How can we remove the barriers that the patients get access to it, specifically in specialty pharmacy?

40:38Alex J. Adams, PharmD, MPH: So we've been working with Assembia to try to figure out those kind of hurdles with them, with the pharma companies. And we have a handful of pharma companies right now that we're working with to be able to remove those barriers. All right.

40:53Robert “Rob” Maher, PharmD: So you and I are headed to Inspire 2026. I'm really excited about this year. There's a change in the venue from being called NASP to Inspired, and the inspiration that that brings to people that are digging into specialty care. How does Hendren AI work in the specialty pharmacy space?

41:20Alex J. Adams, PharmD, MPH: So very similar to what I mentioned to the pharmacy space, the only caveat is the module where we would essentially look at bad debt. We would essentially look at credit reports. Because, for example, if there's a medication there that's$50 ,000, no specialty pharmacy wants to essentially give a patient a medication, they'll never end up paying after insurance covers whatever it covers. So the extra module that would be there is looking at bad debt, credit checks, pinging insurance companies with a change healthcare ping. Obviously, we don't want those in your corner pharmacy or your typical mail order pharmacy.

41:56Alex J. Adams, PharmD, MPH: Their profits per prescription is nothing in comparison to specialty pharmacies. So those modules stand out for specialty pharmacies so that you'd be able to get those kind of features that they requested. And for us, those are really caveats that specialty pharmacies have come up to us. I mean, I remember in Assembia in last April, we actually had a dozen organizations come out to us and say, we want you to build out a PMS system straight with AI intelligence, including these modules. So this is basically based on demand from the group that's out there in specialty pharmacies saying, hey, we need you to really do this because this is what's missing in the market.

42:32Alex J. Adams, PharmD, MPH: And we've specially looked at those kind of requests and made them real.

42:37Robert “Rob” Maher, PharmD: We are looking forward to spending some time with you in Washington, DC. We're going to be digging into more of the Hendren solutions. We also have a special series coming out from the Pharmacy Podcast Network all about Hendren AI. It's going to drive a lot of our listeners to demystifying how to leverage AI and partnering with Hendren and your team. I am thrilled to have you part of the pharmacy podcast network. John really appreciate you hopping on twerks at the last minute. You did this as a favor to us. Thank you so much for showing up. I will see you in DC. I can't wait.

43:17Alex J. Adams, PharmD, MPH: Me as well, Todd. Thank you so much. I really appreciate the opportunity and we're going to see you next week, everyone.

43:23Robert “Rob” Maher, PharmD: Absolutely. Hey, stay tuned. We have another interview coming up with our ex blue. Just hold right there for a commercial break. We'll be right back with more Torx.

43:36Alex J. Adams, PharmD, MPH: Pharmacy teams today are expected to do more than ever. Process prescriptions faster, manage growing workloads, navigate constant interruptions, and still deliver exceptional patient care. That's why Outcomes is introducing a new pharmacy experience across both RX30 and ComputerRx, designed to help pharmacies work smarter, move faster, and operate with greater confidence. RX30 delivers a modern, intuitive workflow with streamlined navigation, guided processes, unified work cues, and automation that reduces manual effort, while preserving the trusted foundation pharmacies rely on every day. At the same time, ComputerRx continues to evolve, with enhancements focused on performance, workflow efficiency, stability, and practical automation that remove friction from daily operations.

44:30Alex J. Adams, PharmD, MPH: Together, these investments are centered on a single goal, helping pharmacy teams spend less time navigating software and more time focusing on patients. Whether you're an Rx30 or ComputerRx customer, you'll benefit from a pharmacy experience designed around real-world workflows, reduced complexity, improved efficiency, and continuous innovation. The future of pharmacy technology is about changing how you work and making every step work better along the way.

45:01Robert “Rob” Maher, PharmD: Hey, welcome back to This Week in Pharmacy. This is the third part of our segment today, and it is packed with information. One of the pieces of information, my favorite piece of anything with regards to what is pharmacy really has always been technology. It's where I was comfortable. And marketing and selling technology, pharmacy management, software technology. I met Vince. I don't know if it's been, has to be more than 10 years. We're getting old, Vince. but rxblue you can find more information at rxblueblu.com vince welcome to this week in

45:44Alex J. Adams, PharmD, MPH: pharmacy thanks for having me always great to see you and talk with you my friend yeah the evolution

45:50Robert “Rob” Maher, PharmD: of rxblue is coming a long way it's the third variation i believe it is the third variation of your website and it looks freaking amazing the logo has been upgraded smarter workflow faster fills fewer interruptions. I can't wait to dig into this and figure out what's happened with RxBlue and how it's evolved.

46:13Alex J. Adams, PharmD, MPH: Yeah, happy to have you do that. And thank you for the kind words at putting these websites together. They're always a work in progress. They're ever-changing, moving with the paradigm. We're trying to be at the forefront of everything that we do.

46:26Robert “Rob” Maher, PharmD: pharmacy technology has evolved tremendously when i started uh at softwriters in 2004 it was the first sequel based system in the pharmacy land and indefinitely an institutional pharmacy and long-term care and now we jettison to 2026 where artificial intelligence that's everything everybody wants to always talk about that and i found that there are a lot of outside organizations that are trying to creep into the pharmacy management space. And I'm not trying to be, you know, biased per se, but I only kind of trust AI in the hands of organizations that have taken the punches in the face and have been around a while to kind of layer up their databases and the structure and the workflow and understanding pharmacy, and then adding AI to it, which then of course can become, you know, 10 times more efficient or effective than, than what it is.

47:28Robert “Rob” Maher, PharmD: But what's your view on how technology has, has been evolving over the, really it's, it's, it's on the fast track over the last three years.

47:38Alex J. Adams, PharmD, MPH: Yeah, that's absolutely right. And, and what we try and do is, is make sure that the technology understands the pharmacy's workflow and adapt that technology to said workflow. So the question we ask our pharmacy clients, whether they're onboarding or current clients is, how does your pharmacy work? What can we do to adapt our technology to meet your needs? Perhaps there's some new items that they come up with that would make their workflow just feel like it's over the top. So we work with our clients to implement not only current technologies, some, you know, we call it pharmacy automation, which is kind of our homegrown AI that we have.

48:31Alex J. Adams, PharmD, MPH: And I think that that difference of applying that technology to our product line is fundamental to who we are.

48:40Robert “Rob” Maher, PharmD: yeah i i also know that you've been around long enough to see um the shift in the plate tectonics of what is pharmacy technology and this is a industry that that's where i started my career and i've seen systems and pharmacy software um peripherals other systems like workflow systems or data document management systems get gobbled up by bigger organizations. And when I look at what's happened with PBMs and how vertical integration has impacted healthcare because of it being more about the insurance and more about the payment and more about the money than it is about the care. So that bothers me.

49:29Robert “Rob” Maher, PharmD: So I know what pharmacists are going through and what pressures are put on pharmacists because of those models. So I hope that with all of the PBM reform that's coming, that that's going to change and maybe we can break some of that up. Well, guess what, listeners? That's happening in technology too. And I wrote a pretty fiery, passionate blog back in March, and it said vertical integration in pharmacy software system. This is a risk to pharmacy stability. And I don't know if you've read this yet, Vince, but when you do read this and readers, if you haven't read it, just go to pharmacypodcast.com, go to our blog section.

50:10Robert “Rob” Maher, PharmD: It's called the PPN Pulse. But I'm meticulously analyzing that if you put too many systems and too many pharmacies and too many organizations and all these businesses on the same exact platform, and you also have a switching organization and you also have document management. I mean, it sounds wonderful in concept. It really does. As a person that loves technology, of course, being able to do that. But I think it poses a massive risk to the independent pharmacy provider. And I think it poses a massive risk to data integrity and so many other things that we could go down the line. But what do you think has happened over the years, Vince, with all of the buyouts and VC coming from the outside of the industry?

51:03Robert “Rob” Maher, PharmD: And to me, it just seems like a, it really does. I'm sorry, I'm going to say it. It really seems like more it's about the money than it is about. We love pharmacy. This has been our lives for how long, Vince? I mean, this is our, pharmacy is literally our life. So what do you think of what's happening?

51:21Alex J. Adams, PharmD, MPH: Yeah, decades, my friend. decades. You know, the industry is a continuous whirlwind of acquisitions, consolidations, and companies that are now accumulating multiple pharmacy systems. So somewhere along the way, that relationship with the pharmacy became increasingly transactional. And at Blue, we deliberately chose another path. We are proudly privately owned. We're accessible. We listen. We are that yes, we can company that wants to work with you to be your business partner. So we make decisions based upon what makes sense for pharmacies and for the product, not the other way around. A pharmacy should never feel that it has to move to a particular system because a large organization owns it or because everybody else appears to be moving in that direction.

52:09Alex J. Adams, PharmD, MPH: There's no need to keep up with the Joneses here. If a pharmacy is not happy with their current software company, moving to another PMS owned by that same parent company will equate to more of the same. I encourage pharmacy owners to inquire as to who owns the software that they choose to use. All pharmacies have a choice in their PMS. The pharmacy owner should ask one question. Who do I want as my technology partner? That decision is much bigger than choosing software.

52:43Robert “Rob” Maher, PharmD: Yeah. Yeah, your partner is important and understanding their legacy and understanding what their plan is, you know, what's the end game really and what's their focus. Um, so yeah, let's talk about that. And you've, you are part of that philosophy of transparency and, and doing what's right for the, for the client, for the pharmacy operator so that they can move their practice forward and they can make more money. They can be better. They can get more patients and do things. So what does that mean in, in practice in your philosophy about transparency? transparency?

53:23Alex J. Adams, PharmD, MPH: Well, we are a very transparent organization. We don't operate on bait and switch. A pharmacy should know exactly what it's buying, what the costs are, and what it's going to receive. So it's important that people realize that free upfront conversion in software should not become mysterious fees several months later to pay back those said fees. And that's what happens with a lot of these freebies. And we're very deliberate about that. We also do not believe that every good idea needs to become another module with another charge attached to it. If one of our pharmacies identifies enhancements that improve workflows and make sense of the broader platform, we want to hear about it.

54:11Alex J. Adams, PharmD, MPH: Tell us. We're very open. We very often say yes to change requests and deliver them fast. And we take a tremendous pride in that. So our thought is that that's what being a partner is all about.

54:29Robert “Rob” Maher, PharmD: Yeah, that makes sense. So talk to us more about what makes RxBlue different in comparison to some of the other systems that are out there.

54:38Alex J. Adams, PharmD, MPH: Sure, sure. So I think the difference with RxBlue is why we do what we do. Blue was created because we believe pharmacies deserve a better relationship with their technology company. We've been in this industry for a long time, as you said, Todd, and I can name names of pharmacy systems that are no longer with us and that were acquired multiple times that are now owned by large VC firms. So at a certain point, we just decided to jump ship and create Blue using modern technology, cloud connectivities. And that's exactly what we do. So we believe that pharmacies should have control of their pharmacy and that the technology should be simple to use.

55:21Alex J. Adams, PharmD, MPH: Customers should have a voice in how the product evolves. And that is such a large point that their input makes the system what it is. They use it every day. We provide a piece of software that is their livelihood. And if we can make that livelihood better, we'd love to hear about that. At Blue, we believe that support should actually mean onshore support. At Blue, we have a product that we call in-house our pharmacy concierge client care. And that's exactly what it is. It's concierge, white love service, all onshore, answering the phone calls live in most cases and resolving issues on that first call.

56:06Alex J. Adams, PharmD, MPH: And we believe that independent pharmacies deserve a technology partner that values their independence. So why does RxBlue exist? And I think that the why is in everything that I just stated. And once people understand that why, the product makes a lot more sense. You're right about these modules. I've watched it and I consulted and worked with companies that would come out with the new module, the POS system, the workflow system, the document management system, the

56:42Robert “Rob” Maher, PharmD: reimbursement auditor system. And there's a lot of add-ons that we've evolved with in the way that pharmacy management systems have evolved in itself. And it's no fault of the systems that are out there. It was kind of like what was happening between 2005 and 2015. It just feels different to me now. So what's the next thing that you think is going to happen? because is it necessarily another pharmacy management system? Like where could this go? Like my vision is marrying, depends on what sector of pharmacy you're in. If you're in community pharmacy, if you're in long-term care, if you're in specialty, or if you're a mixed bag for goodness sakes, because there's tons of pharmacies out there that are now doing a little bit more compounding.

57:38Robert “Rob” Maher, PharmD: They're doing some more assisted living. They're doing long-term care pharmacy at home. That's explosive right now. And having a software system that could do everything. And then on top of that, you put a CRM system, a customer relationship management system on top of it, where you could literally like manage relationships and build patients for life and connect in the EHR. Like, what do you think is going to happen to the next gen pharmacy management system?

58:06Alex J. Adams, PharmD, MPH: Well, you're absolutely right. And the technology that's all around us has made our lives so much simpler. from your smartphone, your smart home, the car you drive. It's sometimes overwhelming. I often kid that I sometimes walking around with the world in my pocket, hence my cell phone is more of a blessing or a curse than a blessing. So yet in pharmacy, we routinely hear from onboarding clients, their previous software does not work with their desired workflow. And my response, again, is to why. Why should pharmacy be stuck or need to change successful workflows simply because the software was designed a certain way?

58:50Alex J. Adams, PharmD, MPH: So we like to tell people, tell us how you want to operate and let's determine how technology that we have can best support that workflow. That is what technology is supposed to do. And we believe pharmacists expect more from the companies that can provide that. i like that and i like the fact that there's other things that are that our pharmacists

59:16Robert “Rob” Maher, PharmD: are going to be creative as business owners they're going to come up with and it might not fit a you know a pharmacy management software system it it might have to be something that they build or they they have to buy another piece of software for so talk to me about the evolution of what you're doing. And because you mentioned to me, what is the pharmacy operating platform? Like what's the coming of this model that could lead to something that you and I were describing for a pharmacy operator? What is POP?

59:54Alex J. Adams, PharmD, MPH: Yeah, well, thanks for that question. And we're excited about what that means and all it entails. So if we think about what a modern pharmacy actually does, it manages prescriptions, workflows, patients, communications, payments, deliveries, so much. The list goes on and on. And that's much bigger than simply managing prescriptions, everything that a pharmacy does in today's world. So we started asking a very simple question. What if the next evolution of pharmacy technology isn't another pharmacy management system? Because pharmacies don't simply manage prescriptions. They operate very complex businesses and that technology underneath that business should help operate the pharmacy as a whole.

1:00:38Alex J. Adams, PharmD, MPH: And that is the transition we see from the traditional pharmacy management system PMS model to what we call the pharmacy operating platform or POP.

1:00:49Robert “Rob” Maher, PharmD: That's a visionary statement and understanding what that could become. So from your perspective and for the listeners, what does that mean? What do you see the pharmacy operating platform or POP, what do you see that becoming? So we see that becoming the level above the pharmacy management software that is currently

1:01:18Alex J. Adams, PharmD, MPH: used today. So one single company that provides everything you need to operate on a daily basis, all your workflow, communication, deliveries, et cetera, but also a telepharmacy piece, a pharmacy connect care for LTC that can be connected to from nurses, doctors, facilities, a delivery system that's either something that's more for an independent or for a large scale enterprise clients. We have a lot of pieces and parts of our system that we built out that not everybody has. Very few systems have their own integrated IVRs, and most people have POS these days. But again, we feel like we are the one-stop, single-source solution of robust products that create the pop.

1:02:15Alex J. Adams, PharmD, MPH: And we have this today. It exists. It's not something that we're building out. We knew that the industry did not need another acronym. However, we feel that POP as itself defines the higher echelon of software companies out there that can provide that single source solution for all their software needs. Why would a pharmacy want to purchase product from seven different companies and have seven different invoices and seven different support staffs when they can just come to one single source that truly wants to be their business partner and give them world-class service? That's what Poff is.

1:02:58Robert “Rob” Maher, PharmD: That's awesome. So just for the listeners to know, just to learn more, if you could go to RxBLU, once again, that's RxBlue, B-L-U dot com. Take a look at this system. It's very different. You're going to be very impressed with some of the screenshots and the look and the feel of it. Go through what it means to be a pharmacy concierge client and then reach out to Vince. go to their contact section, ask questions. Is RxBlue the next system that you should be investing in and it being much different? And you and I talked before that fits very well to the concept of RxBlue. We talked about the blue ocean strategy and how going into a direction of the ocean that is not touched, where everybody else is churning in the red.

1:03:54Robert “Rob” Maher, PharmD: And that's a play on the blog that I wrote out too, because the big red is just gobbling up existing systems. Is there really innovation? Is there really, is there something happening that's part of the evolution of the pharmacy market? Or is it just about eating up their, um, their competitors? And it's, it's a churn of, of the blood in the water. That's the red ocean. RX Blue's concept is about that blue ocean. And I still believe you're on that, you're on that trail and you're in those waters. So it's, uh, it's good to see you to continue that philosophy events and we're, uh, we're rooting for you.

1:04:32Robert “Rob” Maher, PharmD: Can't wait to see you at, um, are you going to, are you going to NCPA?

1:04:36Alex J. Adams, PharmD, MPH: We will not be at NCPA. No.

1:04:39Robert “Rob” Maher, PharmD: All right. Well, we'll have to catch up at some conference, but, uh, look forward to meeting up with you next, probably diversify our X, uh, profit summit we'll, we'll be at.

1:04:48Alex J. Adams, PharmD, MPH: For sure. Yeah, we will be there. We have a close relationship with Lisa Faust and Heather Harrow. I can't say enough positive things about those ladies. They're truly moving the mark in this industry.

1:04:59Robert “Rob” Maher, PharmD: Yeah, absolutely. They don't sit still. Yeah, they're going to be part of the Next Dose pharmacy conference where we just talked to Jordan, Dr. Jordan, the founder of that, before you came on Twerks today. And that'll be exciting. So, but Vince, thanks for being here and being on Twerks.

1:05:19Alex J. Adams, PharmD, MPH: Thank you for having me. and hopefully I'll see you in PA in October.

1:05:22Robert “Rob” Maher, PharmD: Yeah, we'll see you then.

1:05:24Alex J. Adams, PharmD, MPH: Take care, Todd. Thank you. You've built your pharmacy through hard work and determination, and the right partner can help give you the tools to take it further. At Independent Pharmacy Cooperative, we're more than a GPO. We bring your team, your purchasing strategy, and the tools to expand your pharmacy. From digital health and connected care to new programs that give you a path to growth. That means smarter buying that protects your margin, modern tools that expand patient care, and new revenue streams that actually stick. Because when everything works together, your pharmacy doesn't just keep up, it grows.

1:06:07Alex J. Adams, PharmD, MPH: Independent Pharmacy Cooperative, giving you the freedom to farm.

1:06:12Robert “Rob” Maher, PharmD: Hey, special This Week in Pharmacy feature from sponsors that have been helping to get great content out through the Pharmacy Podcast Network. A shout out to First Data Bank. Thank you so much for your support at the NACDS Total Store Expo. And now we're meeting up in Washington, D.C. for the NASP Inspire event, the National Association of Specialty Pharmacy. We're all gathering in National Harbor to talk about the future of specialty pharmacy and how First Data Bank has extremely special interest in what it means to be a specialty pharmacist and how to support specialty pharmacist operations.

1:06:57Robert “Rob” Maher, PharmD: But today on twerks, we're talking about something that came up in the news recently. This just came out at the end of August where FDB moves ambient listening beyond notes with AI powered prescribing agent. This is the first commercial deployment of the FDB script agent with Tebra converts ambient encounter dialogue into structured prescriptions for clinical and clinician review, grounded and trusted medication adherence. And with me here from FDB is Dr. David Delaney. David, welcome to twerks. Thanks.

1:07:38Alex J. Adams, PharmD, MPH: I really appreciate you having me on the show. We're huge fans of twerks and the great work you're doing. So really glad to be here today.

1:07:44Robert “Rob” Maher, PharmD: I won't make you stand up and twerks, by the way. I'm feeling much more relieved now.

1:07:50Alex J. Adams, PharmD, MPH: My anxiety level's dropped now.

1:07:52Robert “Rob” Maher, PharmD: I think I just hurt my back doing that too. So let's see what I get. Hey, this is great. Great news. You know, I hear a lot about AI. I think just like if I back up to make everybody know how old I am, and I feel old when I say this, But there was a time in U.S. history called the dot-com gold rush. And that was between 98 and 2003, where industries flocked to doing anything internet-enabled and internet-involved. And a lot of it was chaos because they weren't exactly sure how to apply it. AI is in that same situation right now, especially in healthcare. And in healthcare, by the way, it's a lot more sensitive because these are people's lives that we're talking about.

1:08:43Robert “Rob” Maher, PharmD: Organizations like FDB make me feel better, make me feel like I can exhale and be more relieved because of the infrastructure of how you use data and technology over the past 20, 30, 40 years of how you've staged. So now when AI comes along, it's not like you just came out of the box with this. This is something that has been fortified. Tell our listeners about this announcement and what this means for our pharmacy clinicians.

1:09:15Alex J. Adams, PharmD, MPH: Well stated, Todd. I think there's just obviously huge potential with this AI revolution we're in the midst of. I think your analogy with the whole dot com situation is really apropos. So, you know, when you're going through it, people kept on saying everything was going to change and everything. Businesses were completely obsolete, old businesses, and everything was going to be brand new. And I think the human tendency is to over-index on how quickly things change, but under-index on the size, magnitude, and scale of the ultimate change it brings. And I think when you look back at, you know, that whole dot-com revolution, you know, it's just pretty incredible now.

1:09:57Alex J. Adams, PharmD, MPH: pretty much every facet of life has changed. And maybe not at the pace people had originally thought, but it's virtually unrecognizable from before that. And I think the same thing's happening with the AI revolution now. But as you state, I think a fundamentalist is that the technology of large language models are probabilistic, right? They estimate the likelihood of a word falling in a sequence. And while that can be highly accurate, hallucinations are real. And when you're dealing with things like medications, ensuring accuracy, absolute accuracy in a deterministic fashion is absolutely paramount.

1:10:39Alex J. Adams, PharmD, MPH: And so that's exactly why I believe FDB is well situated to be a major player in it. We're actually turning 50 years old next year. So So, yeah, so we're going to have some great celebration for the company being around 50 years. And so, I mean, we're a Six Sigma shop. We have honed our editorial and how we approach and manage data over decades. But don't mistake that for not being agile as well. And so we are very much embracing AI. But it's from the context of having a foundational bedrock data set, which is carefully honed with humans in the loop and is accurate and basically leveraging that to ground AI.

1:11:24Alex J. Adams, PharmD, MPH: Thinking about it, it's almost as if we're having a trusted pharmacist for AI to ensure that what comes out of it is accurate and actionable. So I think that's a net for us overall. And regarding this announcement, I mean, really, this is the first move toward the capability to ensure that all inbound prescriptions are complete, correct, and covered the first time. Like, full stop. And I think when you look at where your audience spends their days fixing things today, that is, I think, a really laudable, very, very important goal.

1:12:01Robert “Rob” Maher, PharmD: David, it's the clinical documentation that always held up prescriptions back in my long-term care pharmacy technology days when there wasn't proper document management, not only the systems in and of itself, but the connection to the prescription, the tracking of the prescription and the documentation to support it. So we already seen how ambient AI transforms the clinical documentation. Why is moving from simply creating notes to actually generating a structured prescription such? Why is that so important for the next step for health care? I think it's a great question.

1:12:39Alex J. Adams, PharmD, MPH: When you look at ambient, first of all, it's gaining tremendous traction. And really, I think we're at the tipping point where, in terms of source of prescriptions, Ambient is going to be larger than things traditionally entered through an EHR order entry system, right? When you look at clinicians' life, the prescribers, where their friction point at heartburn is, it's what they call pajama time. And that's the time spent once people are home catching up on the administrative work. doctors and providers doing prescriptions, they talk all day long. They're not tired of talking, but they're tired of sitting down at a station doing data entry and checking and doing everything else.

1:13:24Alex J. Adams, PharmD, MPH: So I think it's very natural to expect that when their conversations are being captured and turned into notes, that that piece of it, the prescription piece also happens and reduces that administrative burden and friction point.

1:13:39Robert “Rob” Maher, PharmD: So what do you think about that? You look a little bit into the future, not that far because it's happening pretty quickly, but the technology scales into ambulatory care, hospital system, specialty pharmacy, shout out to the specialty pharmacist out there. There's so much documentation in that sector of pharmacy. So what happens downstream for pharmacy. And what I mean by that is, is could AI generating clinical support, it could reduce the friction, it could save time, but talk to us about other benefits that you could see coming from this.

1:14:16Alex J. Adams, PharmD, MPH: Yeah, I think the net is, when you talk to a pharmacist, taking this job has been really great. I'm a physician by background, I practiced for a dozen years. And as I've gotten deeper into kind of the space here, first of all, my apologies to all the pharmacists in your audience for prescriptions I probably wrote that were not well-formed and caused effort. Like, you know, no one does this with intent. It's just not knowing kind of what's happening downstream and perhaps the chaos that we might be kind of creating by just being quick or not being really, really clear. So, but I think the opportunity is particularly for FDB, We sit at the prescription side, at the prescriber side.

1:14:54Alex J. Adams, PharmD, MPH: We also sit at the fulfillment side. And with Vila, now we also have the pipes that connect the two. So we can see what's happening, where the abrasion points are on the fulfillment side, where rework occurs. That if we just had better information at the fulfillment point, we could avert a callback to try to figure out what's going on. And so it really comes down to leveraging that insight at the fulfillment side upstream. And the proverbial one ounce is better than pounds of cure. If we can just prevent the error from occurring or send through information that lets the pharmacist know clinician is aware of something when they prescribe it so they don't have to make that callback.

1:15:33Alex J. Adams, PharmD, MPH: And it's really that cycle creating a flywheel of improvement that we're aiming for.

1:15:37Robert “Rob” Maher, PharmD: For the listeners, we brought up a prescription that Dr. David Delaney wrote back in 2015, and this was a scribbly mess.

1:15:49Alex J. Adams, PharmD, MPH: That very well could be. I always used to tell people back when we used to write that when I went to medical school that I tested out of the bad handwriting class that I make all the doctors to ensure we all had sufficiently bad chicken scratch. So I tested out. I was so good at it already coming in.

1:16:05Robert “Rob” Maher, PharmD: All kidding aside, though, I remember when I was intensive between 2004 and 2013-ish, the pharmacy management system realm was changing. Databases were changing. Accessibility to custom reports was changing. A part that was still missing was documentation and was also predictive next steps in processes that really took up a ton of time. I see that already happening with artificial intelligence paralleling the strength of pharmacy management technology and then systems like FDB has in place. This is exciting because now we're going to be able to drill down into specific things happening in disease state management.

1:16:56Robert “Rob” Maher, PharmD: And that's kind of like my next question for you. What are you most excited about when it comes to artificial intelligence in health care and what might come of the future? If you put on your future goggles, what do you see coming soon out of AI and health care and patient management?

1:17:17Alex J. Adams, PharmD, MPH: Yeah, I think the possibilities are endless. Again, I think when we look back, how we practice today will be virtually unrecognizable in the future. What I really believe as a clinician who practiced for many years is that a lot of controls today are very clumsy. If you try to prescribe something, a lot of times you get down to the very end and then on the prescriber side and there'll be an alert saying, hey, this was a really bad idea. And while that's useful, like the clinician would very much prefer to be told upstream, you know, kind of be guided there. So I think kind of thinking through very good assistive driving on a car is something that is kind of there always in the background helping you if you're about to do something that might not be good to give you an alert.

1:18:06Alex J. Adams, PharmD, MPH: and also when you need it, like to be able to pull in for counsel. You think about as a clinician, if you had essentially a virtual pharmacist at your side and you go to prescribe something and the patient has like a pen allergy that includes cephalosporins and you need to treat a certain illness, what would your best medication be to prescribe? And really being able to distill the knowledge of maybe an ID specialist and a pharmacist to be able to consult in line as you're working to kind of have that intelligence there. So I think it's very assistive, human in the loop, just ensuring that we're practicing with the contextual knowledge, not only to help us make better decisions, but more quickly with less abrasion.

1:18:53Robert “Rob” Maher, PharmD: David, this has been good. We are excited about our continuing work with FDB and getting information out, getting this kind of information out for the listeners driving in your car, doing something where you're not looking at a screen, don't worry. In the show notes, we're going to have a link to the FDB announcement so that you can read more about this advancement, the FDB script agent, and what this means for you as a pharmacist. David, you got to bring other pharmacists back with you next time on Twerks. Let's Twerks more.

1:19:30Alex J. Adams, PharmD, MPH: Sounds good. Thanks so much for time, Todd. Thank you.