The Medicare GLP-1 Bridge: Access, Affordability & the Pharmacist’s Role | TWIRx

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1:20Are you making the right impression with your potential patients or clients? Your website is oftentimes the first and potentially only chance you'll get to make a memorable impact. People are researching your business even before reaching out to start a conversation. And if your website is outdated, doesn't work, or inaccurately describes what your business currently does, you could be losing business. To step up your online game, reach out to our partners, Finch Marketing. They can create a customized, fully responsive website to help you get found by potential clients or patients, but also by search engines and AI.

1:54They offer quick turnaround on new sites and updates tailored to your brand style. Plus, it will look great. For a detailed website review or a fresh new look, contact Finch Marketing at finchmarketingsolutions.com to get started.

2:17You are listening to the Global Network of Podcasters dedicated to the pharmacy profession. Welcome to the Pharmacy Podcast Network.

2:57This is twerks. We're twerks in the works. I'm going to change mics.

3:10Got the brand now. I got the brand. The brand. We were talking about branding. You guys have trademarks. Do you have any brand that you're trying to protect? I learned the hard way about not protecting my brand, But big announcement out on LinkedIn this week. We trademarked, finally, the Pharmacy Podcast Network. So that's pretty cool, right? Let's celebrate that.

3:46Thank you. Thank you. Thank you. Thank you. Hey, welcome to twerks. My name is Todd Berry, host of twerks this week in pharmacy. the host of other podcasts, but I don't want to be hosts anymore. So shout out to you, you pharmacists out there and you pharmacy technicians out there. We are recruiting hosts for 2027. We're going to be building some new shows. We'd like collaboration. We want you to be a part of it. It's why we are the number one podcasting platform in the world for the pharmacy industry. It's because of you and you're driving some of the best content out there. and we want you to come and be part of the network.

4:28So if you've thought of podcasting, if you've thought of being part of something, maybe you don't want to run your own podcast. Maybe you want to be part of a bigger network as we have so many people that are part of this network. It's been wild. I'm inviting you. Reach out to me. Send me an email. My last name is Uri. It's spelled E-U-R-Y at PharmacyPodcast.com. Once again, that's Uri at PharmacyPodcast.com. We're going to get into a lot today. We have Dr. Hamilton that's coming on from Buzz Health. You're not going to want to miss that interview. Very interesting discussion and how AI is really transforming treatment management.

5:23And we're going to hear from Megan Urban from Outcomes, who is one of our sponsors for today's twerks. But first, twerks news. Twerks news is up. Medicare Part D paid nearly$588 million for ineligible over-the-counter drugs. And a federal audit estimates that Medicare Part D plans made approximately$588 million in improper payments between 2021 and 2023 for five medications that had transitioned from prescription to over-counter status. Health and Human Services Office of Inspector General attributed the problem partly to outdated FDA data and the absence of a clear CMS deadline for plans to stop covering affected products.

6:24CMS agreed with the recommendations to establish stronger rejection procedures. I find this really interesting, exposing a major coordination problem in the federal government. That in and of itself is not a surprise. The FDA labeling is an issue. Manufacturer responsibilities in communicating to CMS and Part D claims processing. Read more about that on Fierce Healthcare article. The link will be in the show notes. next up on twerks news fda and manufacturers respond to estradol patch supply pressure supply issues and the fda is working with six manufacturers to increase suppliers of the transdermal patches following a sharp rise in demand manufacturers are adding shifts increasing batch sizes, expanding specialized production capacity.

7:26Although FDA has not declared a national shortage, availability varies considerably by product, pharmacy, and geographic areas. Boy, pharmacists under pressure again because it's the patient at the counter that's looking at you and glaring at you, and they're all pissed off because they would like their patch. and they're serving as the conduit of information. Shout out to our pharmacists and technicians as the frontline supply chain creates problems for you, helping patients to locate those products and communicate with prescribers. Look to organizations like Value Drug, KeySource, reach out to them, ask them questions about supply.

8:13You might be surprised and try to stay ahead of it. But I feel bad for you guys this week in pharmacy because you just have additional added pressures and now it's the estradiol patch issue. Hey, we have next up on twerks news. And oh, that last article was from Reuters. I'll have that link in the show notes. um last up on twerks news pediatric and an obstetric obstetric um they and i don't really understand this from it's a release of a new rsv uh covid guidelines um and the american academy of pediatrics and american college um of obstetricians and gynecologists released an update on respiratory season recommendations covering RSV and COVID protection.

9:12So just a shout out to our pharmacist for clarification, a difference of RSV and COVID, or is this now one vaccine? Is it two vaccines, one vaccine? The professional societies are providing clinical direction while federal vaccine recommendations remain unsettled. so i'm a confused as everybody um once again it comes back to pharmacist oversight and pharmacist suggestion reach out to your local um state health and human services if you have suggestions and don't think that you don't have a voice you do have a voice and also your state pharmacy associations please reach out if you know something reach out to your state association and try to assist.

9:59Pharmacists may encounter conflicting recommendations, and that's why I'm confused around this. And it will have growing patient confusion. We're going to need some clear counseling, careful eligibility review, and coordination with pediatricians, obstetric providers, and will be essential for 2026 and 2027 respiratory season. there's an article out there on pharmacy times that's going to cover this and like i said i do not this week in pharmacy i do not feel um like i'd want to be a pharmacist necessarily a lot of the time in this week you guys go through a lot you're under so much pressure um but i I feel that there has to be a website that you can push patients to.

10:57And therein lies an advantage for our independent community pharmacies and for our long-term care pharmacies to create an information source that you know the information. And you're able to publish that information and you're able to assure people that what they're going to has been updated. because how this information gets out there and what's available. Last on Twerks News, this comes from DiversifyRx, and I was really impressed with the layout of this information. And this is the pharmacist remote patient monitoring comment playbook. CMS wants to cut contracted pharmacist out of remote patient monitoring and this document.

11:48If you go to diversifierx.com, you'll be able to find this. I'll have a link in the show notes. You have 10 days, 11 hours, and 29 minutes to submit your comments. On July 14th of this year, CMS released its proposed rule for the 2027 Medicare Physician Fee Schedule. There's a code. It's CMS code 1848-P, as in Paul, 1848-P. And buried in those 700 pages is one sentence that should make every pharmacist owner sit up straight. And it says that CMS proposes to pay for RPM, remote patient monitoring, and RTM, remote treatment management and monitoring services only when they perform by a clinical staff employed by the billing practice, not when they are delivered by contractors.

12:51So the translation that Diversify wrote up, if I can talk, if you or your pharmacist are contracted with local physician practices to run their remote physiological monitoring RPM or remote therapeutic monitoring RTM programs that an entire arrangement stops being billable on January 1st of 2027, unless enough of us convince CMS to change the course. One piece of good news, this proposal does not touch chronic care management, CCM, or advanced primary care management, APCM. Contracted staffing for those services continues as is, but make no mistake, if the employed-only rule sticks for RPM and RTM, care management could be next.

13:46We got to communicate to CMS this is a bad move for public health. I want you to read through this. I want to give a shout out to DiversifyRx for coming up with this. Thank you for putting this together. It'll take you through why your comment actually matters. There's a button here to submit your comment. Everyone listening to Twerks today, I want you to submit a comment. I don't care if you own a pharmacy or not. This is a public health issue and pharmacists need to stay part of this for your remote patient monitoring. It's a big revenue opportunity as well. And like I said, I will have a link in the show notes to take a look at this and to understand it better.

14:35This document is well done. So look it up. we have a quick message from one of our new pharmacy podcast network members outcomes hey Megan take it away hey Todd it's Megan Urban over here at Outcomes I'm really excited for the upcoming Labor Day holiday but I do want to be honest I'm actually even more excited for next week. Next week at Outcomes, I'm hosting a special webinar on what's new in RX30 and everything that's going on at Outcomes. If you are an RX30 client or are just curious about what's going on with our RX30 PMS system, I encourage you to tune in and listen. Until then, I hope everyone has a wonderful Labor Day weekend and we'll see you next week.

15:27Hey, thanks Megan for that update. We have a good show today. I want to give a shout out to Dr. Javi Hamilton with BuzzHealth and what they're doing. Another example of how pharmacists are in demand. BuzzHealth Bridge Program. We're going to go over that. We're going to take some time to listen in and to learn of what that means for you. and you should know for any treatment management of what this means for you. And we'll be right back with more twerks.

16:07Are you making the right impression with your potential patients or clients? Your website is oftentimes the first and potentially only chance you'll get to make a memorable impact. People are researching your business even before reaching out to start a conversation. and if your website is outdated, doesn't work, or inaccurately describes what your business currently does, you could be losing business. To step up your online game, reach out to our partners, Finch Marketing. They can create a customized, fully responsive website to help you get found by potential clients or patients, but also by search engines and AI.

16:42They offer quick turnaround on new sites and updates tailored to your brand style. Plus, it will look great. For a detailed website review or a fresh new look, Contact Finch Marketing at finchmarketingsolutions.com to get started.

17:02Hey, we're back on This Week in Pharmacy, and I have our favorite provider in the studio with me today, a pharmacist, PharmD. Holly Hamilton, how are you doing? Thanks so much for being here on Twrks. Yeah, thank you so much for having me, Todd. I'm doing well. How are you doing? I'm doing great. It's the end of the week. It's Friday. It's always my favorite day to get ready for the weekend. Do you have any plans this weekend? What are you going to be doing? You know, my husband and I and our two pups and a cat, we live in Portland, Maine right now. So this is the first year that we decide to not taking any summer vacation.

17:41So Portland, Maine and Maine in general, which is very beautiful in the summer and the fall. So we are just exploring farmers market, you know, like local farm, you know, like strawberry farms and things like that around here and exploring the beaches. So yeah, that's what we try to do every weekend, enjoying the summer while it lasts. When you have Portland as a backdrop for your life, it's almost like you can be on vacation all the time if you want to be, depending on, you know, where you're going and where the weather is. We're in the southwestern sector of the United States, and I never knew this until about two years ago, southwestern Pennsylvania is the third least sunshiny region of the United States.

18:26We get like 78 days of pure sunshine and it's not enough for me. So I'm a little bit down that summer is on its eve. You know, I was in Scranton, Pennsylvania for four years. So I feel for you. I know exactly what you're talking about. more sunshine more sunshine yeah exactly vitamin d for all of us hey i want to um jump into why you're here um tell our listeners and this is important for a couple reasons number one what's happening and how buzz health is helping the pharmaceutical delivery market pharmacy care market with the bridge program which we'll get into but then a side step and something that you might not have thought more about.

19:14Pharmacists are evolving, major evolution. And your role is very interesting in how you've evolved into becoming someone who's become an expert around getting things paid for and getting the roadblocks out of the way and how you've inserted yourself into BuzzHealth. So this is exciting because there are pharmacist listeners right now that are like, listen, I would like to make a career transition. I'd like to get on a different path. And you're kind of one of those pharmacists that did exactly that. You're a non-traditional pharmacist per se. So talk to us a little bit about your background, where you went to school, why you wanted to become a pharmacist.

19:58Yes. So I went to school in Auburn University in Alabama. So I went to the doctorate pharmacy program there for four years. And so I grew up in Vietnam. I came to Alabama when I was 16. Went to undergrad and pharmacy school there. Love it there. But I've just been all around the country. My background mainly is in clinical pharmacy. I work mainly in hospital adult internal medicine. I love hospital medicine, but I'm not going to lie to you. I mean, after COVID and everything, I feel like I'm speaking for all the healthcare providers out there. We are a bit burned out to say the least. So, you know, I think when I work in the hospital, you know, I see my role as a central person between the patient, the provider, the nurse, you know, like we are known as a drug expert.

20:56And I don't take that term lightly because I want to make sure that everything is safe, effective for the person who's receiving it. That could be somebody's mother, somebody's sister, sons and daughters. So we take the role not so lightly. So when I was working in the hospital, I realized that we can talk about therapy and guidelines all day long, but if the patient cannot afford the medication, you know what is the point of that so I started working for bus or it's now bus bus health um back in 2020 2021 between that during the pick of COVID so then um yeah I was a consultant for the company for a few years and then I come out full-time as their senior pharmacy director and we just focus on health equity and medication assets for everyone and now we just focus on the upstream part of the prescription journey.

21:56So like not so much at the counties anymore, but we are working every day to improve transparency and visibility for prescription pricing where you can act on it before the patient reached the pharmacy counter. I love that your role has transformed into someone who once again is advocating for the patient's health, assuring that there's less roadblocks to getting things paid for so that they can stay adherent, so they can stay on medications, and then you can make adjustments along the way. Talk to us about BuzzHealth. There's a bridge program that really has evolved and is becoming a lot more defined.

22:38Talk to us about what actually qualifies for this bridge program and where does the clinical fine print, where does that kind of fit into this? I think the bridge program is actually very interesting. And when I was talking to some family member the other day, you know, like there was like the bridge program, like why, why does it call bridge? And I say, well, I find it funny. And the irony is that, you know, like the bridge is not leading to anywhere, you know, like, because they was like, why, what is it called bridge? You know, but the thing is, it was supposed to be a bridge to a permanent program called the balance model.

23:17But as of April of this year, since Medicare, the CMS has not had enough plan sponsor. So, you know, they are put the balance model on hold for now. And but you know, like, with that say, I don't think the bridge program is a bad thing, you know, like is run from July of this year until December of 2027. So while maybe as of now, as we're talking right now, we don't know what is going to happen with the balanced model. But for a year and a half, we can see how is this model working. Because as we know, obesity is a problem, is an issue. We try to help a lot of people out there. And I feel like the Bridge Program is a good way to to help to expand the coverage of these very expensive GLP-1 medication that was not previously available to many of our patients.

24:19So specifically the BRIDGE program covered the GLP-1 for long-term weight management, right? So if you are Medicare beneficiary with prescription drug coverage, either the traditional party or just any prescription drug coverage with Medicare, here, you should be able to be eligible for the bridge program. However, if you have diagnosis like type two diabetes, then you should be able to use the GLP-1 medication through your traditional Part D coverage. Okay, so the interesting thing about the bridge program is that it's operating completely outside of your Part D coverage. So they have their own system to process prior authorization payment, all that.

25:14So essentially, all these plans that sponsor Part B has no risk in it. And I think that is definitely very interesting because and that's why they're running this as like a pilot or a bridge program, per se, to see how would all this work. On one hand, we have this program that eligible patients can get you know, these very expensive GW1 medication for weight management for just$50 a month, right? So compared to the list price of over$1 ,000, and you know, even when you are eligible for, you know, like the discount program, but the manufacturer is still a couple of hundred, a couple of hundred dollars.

25:55So that's not, you know, like that, that's not affordable for many people. So$50 per month fixed co-payment for the British program, I think that's a great way to see how does it work to expand the access of these medications to these patients. But the things that we have to keep in mind is that this$50, it would not be counted toward your deductible. So if everybody knows deductible, you might have like$1 ,000 or$2 ,000 deductible depends on your plans. And you're like, once you meet your deductible, that's when your plan benefit kicks in. So for our patient who receiving GLB-1 through the PRUSH program, you're like, this$50 would not be counted toward your out-of-pocket max or your deductible, right?

26:47So, and you know, like$50 is when we're looking at the list price of the medication, was like, well, that's a good deal. But you have to think about 50 times 12, that's$600 a year. And typically you will be on this medication long-term and the population, the people who are like Medicare beneficiary, typically a lot of these folks are on fixed income. So how does that play a part in the overall long-term picture? And that's the things that I'm very interested to find out and to learn by December of 2027. I'm so glad that you mentioned that because there are listeners right now who are in the long-term care sector of pharmacy.

27:35There's our community pharmacy operators who care for people that are retiring. There's lots of complexities in some of the changing systems. CMS confirms that retirees on employer-sponsored Part D programs, which is known as the Employer Group Waiver Plan or the EGWP. So we have more alphabet soup. But that hasn't reached most retirees. So why has that detail gone unnoticed? Well, you know, the Employer Group Waiver Plan or ECWP, right? So it can be very confusing because like those are the retiree who still receive, you know, like the Medicare benefit from the employers. So in a sense, it might look like, you know, like commercial insurance or like employee sponsored insurance.

28:33So a lot of them does not know, do not know that they might be qualified for the bridge program. And I think, you know, like we are oftentimes, you know, like when something like this come out the headline would be focusing on the$50. And you know, on one hand, you know, I think that's great, you know, like, everybody would be very interested in, you know, like, how do I assess, you know, this medication with$50 a month. But on the other hand, I think, you know, like, this is where, you know, like, access and communication and education come in handy. And this is why, you know, like, benefit, you know, like, managing your employee groups and even you like my people pharmacists, you know, like this is where we would shine.

29:15This is where education and talking to patient would would make a big would make a big difference in the and in the big picture. So you mentioned something I'm going to come back to it. you said that this runs through December of 2027. If I'm an employer, if I'm a benefits consultant, how should employers think about that window? Well, you know, like that's a long enough window for you to do something. But it's not long enough for you to like look at this program and see what they're doing what's happening and what are the outcomes so you can mimic something like this right if you are employer who and of course you know like by the end not not even by the end of this program but even right now there are other people out there who are not medicare beneficiaries looking at this program and think you know like why does you like if medicare can do this you like why can't my employer you like looking something like this for me.

30:23So I think there's going to be expectation change for that. So inside of, even though it is not a four or five years program, a year and a half is long enough for them to start this conversation, start the education, talk to your employees, see where they are, what are their expectations, their interests, educate them on, and even to start on incorporating different non-med program, lifestyle modification program into your benefit package as a jumpstart to long-term weight management would be ideal. So instead of not doing anything, I think definitely watch and learn and definitely see how this program is going and don't wait until December 2027.

31:27See right now, how is it going? How many people are able to participate in the Bridge Program? How are the$50 fixed co-payments playing a role in all of this? So definitely, because I feel like the expectation is going to change. So have conversation, education, to your employee, to other people, that will be beneficial. All right. I read on an article through Pharmacy Times a little bit about the BRIDGE program. Didn't really understand everything that was going on. It creates this new coverage pathway that's outside the traditional Part D benefit. But what should pharmacists know when an eligible patient shows up at the pharmacy and where the confusion or access barriers, how does that play into it all?

32:22I think, you know, like the pharmacist would be the first person, like that one face of the patient would see, you know, when they pick up the medication. So I think, you know, like with this, and I mentioned that already, but the fact that the$50 does not count, does not apply to the party deductible, I think that's huge. You know, like you don't want to wait toward the end of the year or even mid-year and somebody has been paying like$500 for this medication and they realize that, you know, why my deductible is not going anywhere, right? So I think it's definitely, you know, like while they are excited and happy that they're able to get this medication for$50, I think having this conversation is definitely, you know, like beneficial for the patients, That's for sure.

33:13All right. So we have pharmacists listening in, technicians who work on payment issues, obviously behind the scenes. What's that one thing that you'd want employers and providers and pharmacists to walk away knowing about the bridge program after your conversation here on Twerx? I think, you know, talk to your employees. and talk to the people in the company and see what they want, right? Like, instead of like waiting until the end of the program, you know, like stay up to date, you know, like to see what is going on with the CMS Bridge Program, you know, like how well they are doing. Because at the end of the day, you know, like access to medication is essential.

33:58But at the same time, payment model, payment pathway, and how sustainable it is, it's also very crucial because these medications are not medication that you will be on for three months. They are supposed to be for long-term treatment. So how sustainable it is for your company, how sustainable it is for your benefit package. So those are the things that you should definitely sit down and have these meaningful conversation with your folks and see what the expectations are, like what they're looking for and what is doable. And on the other hand, you can see what should the plan be so that it can be sustainable for everyone that is beneficial for your employees, but also is sustainable for the company.

34:49Hey, listeners, you are not alone in any of this. We want to surround you with more information. If you do have questions about this, if this still seems a little shaky or confusing to you, please look up BuzzHealth, which is buzzhealth.com. Once again, that's buzzhealth.com. Javi, you've got to promise that you're going to come back on Twerks, bring another pharmacist with you, because I can always deal with more pharmacists and more conversations about how we make a better health care delivery model in especially our pharmacy care. So thanks so much for being on twerks. Thank you so much, Todd.

35:26We need more people like you. Thank you. Thank you. Hey, we'll be right back with more twerks.

35:39Hey, back, back, back. What is up? Hey, we're running out to show. But as we were listing that interview, I was out on the Instagram spheres. and there's an update here that I want you to see from Sex Farm D, Dr. Nadia Archamba. Take a listen to this. We met with the FDA a couple of months ago and now they just put out this announcement. They're working with all six of the manufacturers to increase supply. Guys, this is the power of social media and this community. We demand better health care. We have to keep doing that every step of the way. Of course, I'm going to keep you guys updated on what happens next, but this is a huge step forward, and I wanted to share it with you.

36:25Is that good news? Is that good news? We just did twerks news, and the update is already out. I think that's amazing how social media can impact issues in public health. Your voice matters. September 4th, 2026, this was your episode of This Week in Pharmacy. it's Labor Day weekend I hope that you're getting some time off spending some time downtime, relaxing, doing something just to decompress get ready for next week feel like summer is coming to a close the kids are back in school we got a lot going on into the fall conference season coming up the NCPA Inspire 2026 that is the leading in a conference in our specialty pharmacy sector.

37:21It's going to be in Washington, D.C. That's the NASP. If anyone is going to the annual get-together at the Gaylord, please connect with me. I love talking with specialty pharmacists and pharmacists in general and business people in the business of pharmacy. I am excited to be returning to the NASP. They're a great group. They've been an amazing partner of ours. Once again, that is the National Association of Specialty Pharmacy, and that is the Inspire event, Inspire 2026. There's going to be a ton of people there digging into specialty pharmacy. A shout out to First Data Bank and Clearway Health, who are our podcast press sponsors.

38:19This is September 22nd through 25th at the Gaylord National Resort. I'm going to be talking about this more next week on This Week in Pharmacy. And I just want to thank you for what you do. Shout out to our pharmacy technicians. the impact awards are coming up with the NPTA shout out to Mike Johnson and his team the impact awards to raise up and celebrate some very very special pharmacy technicians the right hand of pharmacists out there we are so proud to be their media and press sponsors there's a press release out there that you can read more about the impact awards 2026 Thank you so much for listening to This Week in Pharmacy.

39:08Share the show and subscribe to the Pharmacy Podcast Network. We're out. Talk to you next week.

39:34Thank you.