Saving Lives: The Role of The Pharmacist in HIV

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Today’s episode is very special. We have a conversation with our guests today, Lucas Sullivan, who is an investigative reporter for the Columbus Dispatch newspaper in Ohio.

He’s been a journalist for 21 years and his work has helped in government corruption, shut down, faulty charter schools, pass new state laws for guardians and imprisoned, a lobbyist that offered illegal kickbacks to politicians.

He has also won an award for his investigative work on PBMs. And his work with Lucas and his colleagues has been instrumental in uncovering PBM abuse in Ohio and across the nation as a whole. So I am thrilled to have this conversation today with Lucas. Welcome to the conscious pharmacist podcast.

Lucas Sullivan

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What you will learn

  • Investigative reporter Lucas Sullivan & colleagues uncover PBM abuse
  • Listen to the insights of an investigative journalist
  • Implications of Supreme court docket No. 18-540 Rutledge vs PCMA

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Transcription

Michelle:
Welcome to the conscious pharmacist podcast. This is Michelle Sherman, president of [inaudible] pharmacist consulting and the host of the conscious pharmacist podcast. We’re also part of the pharmacy podcast network and today’s episode is very special. We have a conversation with our guests today, Lucas Sullivan, who is an investigative reporter for the Columbus dispatch newspaper in Ohio. He’s been a journalist for 21 years and his work has helped in government corruption, shut down faulty charter schools, pass new state laws for guardians and him in prison, a lobbyist that offered illegal kickbacks to politicians. He has also won an award for his investigative work on PBMs. And his work with Lucas and his colleagues has been instrumental in uncovering PBM abuse in Ohio and across the nation as a whole. So I am thrilled to have this conversation today with Lucas. Welcome to the conscious pharmacist podcast.

Lucas:
Thank you for having me, Michelle.

Michelle: So PBMs, that is the Goliath that as pharmacists as David’s are trying to slay, when I started working in HIV many years ago and working in pharmacy, we just build insurance companies. We got reimbursed a fair amount and our patients got taken care of. But since the 1960s these PBMs, these middlemen have credit into the fabric of our healthcare system. And now we have these mega behemoths, the express scripts, the CVS came ox, the Optima oryxes who are holding not only pharmacists as hostages, but patients and even drug companies as hostages making drug companies pay these ridiculous rebates or it’s like a mafia payoff to get their drugs on the formulary. And the cost of drugs is now, it’s, it’s, it’s just ridiculous. The cost of drugs is going up and reimbursements to pharmacies or, or like for every HIV prescription the pharmacy fills, they get a negative reimbursement. Where do we go from here and tell us a bit about the work that you’ve done in uncovering this egregious behavior.

Lucas: Yeah, I mean, as, as everyone in the pharmacy business will knows this is a, this is something that really just kind of exploded and, and call it pharmacist flat-footed in the, in the early two thousands, and it’s only gotten worse for those in that business because these middlemen pharmacy benefit managers have just continued to figure out ways to extract money out of, you know, the pharmacy supply chain. And then that’s not anything that you guys aren’t aware of and how we got into it here. My colleagues and I Marty Sladen, Kathy, Candice ski and Darryl Roland, they had started to do some initial reporting on the number of pharmacies that were closing in Ohio. And then we started doing uncover just some things that were, that looks just a little shady to us. Like CVS Caremark would cut reimbursement significantly in one month or in one week.

Lucas: And, and pharmacists would you know, would obviously would complain about that. And then CVS Caremark started sending these letters to pharmacists saying, Hey, we realize that business is tough and it’s hard, and if you’re interested in selling, we’re interested in buying. And they would just buy these these pharmacies and sh and in many cases, shut them down. And so that’s how we kinda got into it. And then we started to see like, well, wait, how did, how are these guys accumulating so much wealth so quickly. And so we, so then we started to see that they were cutting reimbursements for certain drugs at certain times. And in CVS Caremark’s case they did a drastic cut here in Ohio in October of of, I think it was, yeah, it was October of 2017 where they were in the process of trying to acquire another healthcare company.

Lucas: And so they needed money to buy, in this case, Aetna. And so we were like, wait a second, are they trying to, trying to increase their bank account on the backs of the pharmacist in order to help with this purchase of it? And then it kind of snowballed from there. And it w what we really was a really eyeopening for us, Michelle, is that, you know, we’re, we’re lay people just like, and this is the problem with, with understanding this problem, it’s hard for the public to understand it because once you start telling them formularies and and drug supply chain and, and how it’s regulated, their, their eyes kind of glaze over and they just can’t it. And in the beginning we were having a hard time getting our hands around how to explain the control that BBMs had on the formulary and how that manifested itself into them just extracting so much money on drug transactions.

Lucas: And so we actually had a pharmacist just crudely draw with a, it was an erasable marker on a white board saying, here’s what they’re doing. They’re there. And we, and we started with, with the department of Medicaid in Ohio because it allowed us to easy access to numbers. We could see there were, where the manipulation was happening. And so he showed us that on generic drugs. The price on generic drugs of the four had actually, you know, it was kind of bottomed out. As you guys know. And I think a majority of the public knows it has more manufacturers, their generic drugs enter the market. It causes the price of these drugs to nosedive. But what the PBMs were doing is they were still keeping the generic drug prices at a certain level and not giving the state that realization of what the market was actually doing and how they were duping the state was, at the end of the day, they would say, well, Hey, look, our contract calls for you for us to keep costs increases and within a certain percentage, and we’re doing that.

Lucas: And so the state, they kept a year, after a year, they kept showing that to the state and they would show them you know, these, these global pie charts and saying like, look, here’s what the brand name engineered market’s doing and here’s an overall, and here’s what, what we’re doing. We’re keeping your costs within the margin that we’re contractually obligated to do. So the state was like, okay, good. And so then we found out we found out that there were other pharmacists who were conducting a lot of Medicaid. They were filling a lot of Medicaid prescriptions as they were really being impacted because while, while the state, while it was while that they weren’t giving the state the realization, they knew what the actual market was on the pharmacist aside. And so, and then they were slashing those reimbursements back to the pharmacist even more.

Lucas: And they were extracting all that difference between the price they were telling the state and they were getting for generics and what they were actually paying the pharmacist from the generics. And that’s when it really blew open for us. When we started to see the numbers, pharmacist actually brought us behind the counter showed us their adjudication screens on individual drugs and we started to see just the, just the amount of money that the PBMs were striking on certain prescriptions. And then we just decided, well, give us all your data. And we went to multiple pharmacists across the state and we were, the pharmacist were concerned that someone would track what they were doing. So we actually went around the state and hand picked up a flash drives with, with all the data that pharmacists could give us on just how, just how much DVMs were manipulating their world. And we are able to show that the state was getting duped by hundreds of millions of dollars.

Michelle: It’s, it’s, it’s just mind boggling. And you know, you made a good point because it’s so complicated and so bait and switchy that the public at large doesn’t understand that, you know, the pharmacist gets shafted every time a patient comes in and has this ridiculous copay or something and in the patient’s mind they think, you know, the pharmacist is just making all this money. We’re in fact, you know, in, in, in, in the space that I’m in, in HIV and hepatitis, if pharmacists are losing money on every transaction because of these, these behaviors. And if, if people, if if you, I mean I was so pleased to see your work, you know, and USA today and in all these publications because people need to understand that it’s not the pharmacist, the pharmacist is just the conduit. That’s essentially, I mean, what business, you know, says I’ll pay for the drug. You pay me less and I’ll give you the drug anyway. And then thank God they, no, go ahead.

Lucas: No, I was going to say Michelle, you’re right. Because to the consumer, the drug supply chain is largely faceless except for there, for the pharmacist. That’s the only really the only person, the only human being that people interact with along the drug supply chain. So of course they’re going to think that somehow you guys are getting rich off of these things when in fact that’s not the case.

Michelle: No, exactly. And you know, it’s not that complicated. You know, they keep talking about drug prices and now we have to buy drugs from Canada. It’s like you, you’re barking up the wrong tree. Just get rid of the PBMs and everything will change. Drugs don’t need to be that expensive. I mean, when we think, you know, even of HIV drugs and people blame the drug companies and the prices are going up or the prices are going up because they have to pay off all these bribes, if you will, to a CVS Caremark or express scripts, optimal range to get the drug on the formulary. I mean the only people that are making money or the other or these PBMs, I mean when you see United healthcare’s profits at 260 billion, it makes me want to cry because people are literally dying because they don’t have healthcare.

Lucas: And that’s [inaudible] to your point right there that one of the most alarming, maybe the most alarming or, or most reaction we got from the public was a story that my colleagues, Marty Sladen and Kathy Kandinsky did was on a patient who had cancer. And as you know, just like HIV, drugs, cancer drugs, sometimes time is of the essence and it becomes a huge factor. And in treating the patient, and we found an example of a couple who went to a pharmacist and the drug was right there on the shelf. But, but in order to get that drug, the patient had to pay a significant markup that they couldn’t afford and instead of the pharmacist had to instruct them based on the instruction he was getting from the PBM, that he had to go through their mail order program and we two weeks to get the, to get his cancer treatment drugs that his doctor said he needed to start taking the next day. And when we publish that story, that had more ramifications that because the public finally got it. Like they, they said they, they weren’t, as they were concerned about the money and they were getting outraged just about how much they were manipulating the prices. But when they realize that a PBM could impact their ability to get treatment for cancer, even then, that’s when the outrage really started to take off in Ohio.

Michelle: Oh, I mean they, they just put as many hurdles in front of you. I think they’d go to default for the protocol is no, and you know, I think 99.9% of patients don’t get the, the drugs that they actually need because they accept the no or you know, the pharmacies or just the pharmacists are just so fed up or they have to go through the mail order. I mean, you know, I think mail order has a place if people want to go that route because they get their chronic medication through that route, great. But 99% of the time patients should be able to have the choice where they go to their local community pharmacist who they know, they trust, they like who they’d been going to all along. Who is their healthcare provider. We as pharmacists or healthcare providers, I mean, I make significant impacts to the outcomes of my patients. They should not be forced to get their drugs from elsewhere. It’s not like you ordering like furniture from Ikea or something. This is people’s lives we talking about and they just do not care.

Lucas: And I know that, and this is something when I’ve talked with pharmacists all the time you know, they, they, and they’re kind of helpless and, and I’m certainly not an expert, but the one thing I can say to them is that it, it, you have to continue to talk to as many of your patients, of your customers as you can. And even if you only can spend two or three minutes educating them on a certain thing it helps them to better understand if they can have that interaction. And unfortunately they’re not getting that interaction if they’re going to like a big change sometimes. But it, you know, that the community, it would help a great deal. I think the public, if they could, if th whatever communication pharmacists can provide would be helpful in understanding this works.

Michelle: Absolutely. And you know, thank goodness that gag closed rule was, was lifted. I mean, if you ever thought of that, we were going to hold you hostage. We’re going to put a gun to your head. We’re going to take away, you know, your livelihood. We can actually cheat the patients and the employers and the insurance groups. And you’re not allowed to say anything about it. I mean, just last weekend one of the, one of the pharmacies here in orange County one of the patients, his insurance wouldn’t allow him to get a month supply. He had to get like a three month supply, but he, he travels a lot. So they allowed a six month supply. So for every three months of, of the filling for his HIV medicine, gen, Voya, the pharmacy lost $740. So they were going to lose like over $1,400, but giving this person his prescription. So essentially they were giving him six months of his drugs plus one month for free. And you know, they told him about it and he had to go to another pharmacy because that’s not sustainable. I mean, who can conduct business like that and no pharmacist that I know is asking to make a fortune, all they want to do is not lose money. And then,

Lucas: Right, exactly. Just make it a little bit. And that’s where, that’s where the public did not understand about the transaction, how much a pharmacist is actually making it. We had explained that to them too. Like the EV, everybody thinks that since you, since you took that $20 bill from them for their penicillin or whatever, you’re, you’re pocketing that $20 bill and using it all to keep their lights on and everything else. Not knowing that you’re basically just passing that and maybe even that time, some more money back to the PBMs.

Michelle: Oh, absolutely. And that brings up a good point. You know, that cockamamie thing they made up with DIR fees, especially the specialty pharmacies. I mean, they pay tens of thousands of dollars that they just take back months down the line for reasons that they can’t even explain. And you know, I, I would challenge any PBM that the kid that I provide to my patients is so far superior to anything they provide out of their mail order pharmacy. And why are you taking money back? Because the outcomes in my patient are so superior to what you providing in your mail or the pharmacy when they don’t even get their drugs on time.

Lucas: Right? I mean it’s what, what, what needs to happen is that the public needs to start asking. And I know this is, I know probably a lot of pharmacists and people within the supply chain listen to this, but if you’re not, because PBMs are not being forced to give up control of a formulary and a formulary is, are the drugs that you’re in shock the insurance is approving for you to get. And so the PBM controls each drug and trust me, they go drug by drug as you will know, Michelle and decide which one’s going to be and they’re more advantageous financially than they are advantageous to you and your health. Sometimes, not every time, but sometimes. And, and, and as long as they allow the PBMs to control those formularies, you’re going to get it. We learned this the hard way here, Michelle.

Lucas: I mean, I’ll be honest, we thought, we thought that we kind of cracked a big nut on spread pricing here when we uncovered what was going on and what, what the PBMs were paying to stay versus what they were taking from pharmacists. All that money in between is what the spread is. We thought that we, we cracked that nut and we did, but all it did was the PBMs just, you know, we squeezed that into the balloon and then it calls the other end to fill up and that’s what we see now is because they are allowed to control that formulary, they can just, you know, develop another way to or another fee to extract more money out of healthcare plans out of you, out of your employer.

Michelle: Absolutely. And then you know, they, with this formulary business, like just if even in the HIV space, I mean HIV standard of care is to provide the best drug for that patient. So just, just like you know, HIV is an exception in Medicare. That’s how it should be across the board for all planes. All antiretrovirals should be covered on all planes, where the patient can get the drug that’s best for them. Now I see more and more these plans you know, requiring prior authorizations are requiring step therapy for HIV. It’s such inappropriate care. It just is ridiculous. And then you have to keep doing all these prior authorizations. One of the things I noticed over the last month was, you know in, in, in men with HIV, it’s very common for them to have like low testosterone, which is HIV related. So a lot of men are not testosterone replacement, but all of a sudden all these insurance companies and these PBMs are requiring, requiring prior authorizations for our patients for testosterone, which is a very time consuming process. And you know, I do those and the physicians I work with do those, but many, many do not. So patients are not getting the adequate care that they need. But all these hurdles being put in the way and it compromises care and increases healthcare costs. I mean we need a complete implosion of these PBMs in order to change drug pricing, not go and take all the drugs that are in Canada and bring them here. It’s not going to make a difference.

Lucas: Yes. And, and if to your point, if you need an example of that, you can see what happened in West Virginia, West Virginia, the state kicked PBMs out and decided to take all stake back control of its formulary and they saved in one year alone, over $34 million, just not paying a PBM to manipulate the market. So this has been done in a few pockets and it has shown significant savings. But, but as you all know, there’s a lot of there’s, there’s a still a big black veil over this that the public doesn’t know or doesn’t understand that translates to lawmakers. I mean, we have lawmakers here in Ohio that are pharmacists and if they are in positions to, to make changes, but they even struggle to understand this in the beginning. And by the time that they did it, it’s, it’s too late.

Lucas: And that’s why you start to see now States are taking the fight to the Supreme court and trying to get to kind of call back some of that regulation because now it’s at the federal level and there’s not much individual States can do. But, and, but you have pharmacists and you have an, I know, you know, there’ve been pharmacists that have grilled PBMs. You know, they drove myelin over the EpiPen. There were pharmacists on that subcommittee that knew their stuff, knew what was happening and, and, and the end of the day they still couldn’t do anything to turn this back at all.

Michelle: Yeah. And the, and they lobby is one of the most powerful in the country. I mean, we’ve had, California’s also done a great job trying to reign in PBMs. I’m the California pharmacist association is very aggressive, but there’s always that stumbling block, you know, the low pauses. But then how do you implement it? And that’s where I think, you know, this, the Supreme court case is going to be hopefully a game changer. And you had mentioned earlier that that your work cited in this, in this brief.

Lucas: Yeah. And the Arkansas attorney general is brief to the Supreme court. He sided the, the investigation that we did in Ohio and what it uncovered in the briefing. That is exactly what was happening in Arkansas as well. So it was a way to show like that, that I’m not making this up. This is happening here too and pointed to the numerous reports here.

Michelle: No, and I, and I think, you know, hopefully you know, the Supreme court will rule in, in, in, in the favor of this and you know, States should be able to make their own laws and, and call these opaque businesses to task. We, they become transparent and we pharmacists at least get paid the costs that you paid for the drug. That’s hardly asking for something like complicated.

Lucas: Yeah. And, and you know, I, I know we talk about and how it’s such a big thing, but that in order to get some change, it really just takes a few leaders in key positions to step up and say, this is ridiculous. And this, this has to happen at the federal level. So whether it’s the Supreme court you know, someone within the administration who oversees you know, the department of health and Medicaid to stand up and, and if you need an example of that, if you, if you ever want to watch a cool video, especially in anybody out there and interested in this, there is a meeting here when we put the video up on our website where the department of Medicaid heads who were largely you know, taking what the PBM, CVS Caremark was telling them as you know, factual and accurate.

Lucas: And they come before the committee that oversees our department of Medicaid in Ohio. And they were echoing some of the same talking points that the PBMs had heard. And the Houston, the lawmakers on that panel were educated, were ready had done their research and they fed these guys their launch at this hearing and told them that they were, that how, how could they be so callous that they were turning their backs on a public. I mean, and so that really started this in Ohio, this change, you know, CVS Caremark was later their contracts were negated. The state is in the process of rebidding all those and getting them in line. And so it, but it took that moment at that public hearing for them, for someone to finally stand up and say, this is ridiculous and we’re not going to tolerate it anymore.

Michelle: Oh, that’s it. Yeah. And that’s, and that’s exactly what you have to do. And I think in the show notes, maybe I’ll put a link to that video, put it on here. So, so people can see it,

Lucas: Less side effects. You can go there and it’s all there. And it would be, you know, I mean the video lasts like a minute or two, but you can just kind of see the moment that everything kinda changed. And it happened in that video. And in that room, as you will know, a Michelle, like in these rooms at the state level, there are lobbyists on all sides of the healthcare aisle. You know, the PBMs, the health insurers, the employees. And that room was filled with everyone on all sides of this. And they all had to sit there and kind of witness this this moment. And it changed it. It was a, it was a watershed moment for Ohio.

Michelle: Oh, that’s, that’s extraordinary. And that, and that’s what has to be brought to light because it is so complicated that the public at large doesn’t understand. But like you say, some pharmacists don’t even understand and law makers don’t understand. So that is why pharmacists have to get involved. I keep preaching like to two pharmacists. Do you belong to your local and your state and your national association? You have to do. And you have to, not only do we have to speak out, but we have to encourage our patients to speak. And you know, that’s happened before in small pockets. You know, a couple of years ago, blue cross and Cigna and blue shield, they all tried to force HIV patients to get their prescriptions from mail order because now HIV drugs are considered specialty drugs because they’re so expensive. And consumer watchdog had very successful lawsuits against these insurance companies.

Michelle: United healthcare, Optima X was one of them for discriminating against people with HIV. So they allowed them to get their prescriptions at any pharmacy. But now you can see them creeping in and Oh, you can go to any pharmacy. But then they start reimbursing the pharmacies in negative amounts and really trying to force the patients to do that. And it’s so egregious because as pharmacists, we just want to take care of our patients. What are you looking at the drug product? And that’s why I always encourage pharmacists, you know, we are healthcare providers. We’ve also got to start providing other services that impact our patient’s health. Besides just the prescription bottle. Were you relying solely on the reimbursement of the drug? We need to be paid for our consultations and our services we provide to patients.

Lucas: Yeah, Michelle and I and I would encourage, like I know it may not be the most comfortable thing all the time, but maybe once in a while turn those adjudication screens around and say, look, let’s look at what’s happening here and show some of your customers and some of your patients and, and as you take them, you know, a couple minutes will go a long way and you know, having that and that will in turn encourage them to ask questions of their employer and have it trickle on down the chain. And that, I think that’s the way that you, that you really, you know, help turn this thing around is educating people because they feel intimidated. They don’t want to feel stupid about not understanding it. So a lot of times they’ll just nod or they just want their medication and they, and you know, they Huff and puff about how much they have to pay. But in that moment, if, if, if it’s at all possible for a pharmacist to just kind of lift that veil a little bit when they see someone who’s, who’s like really bothered or struggling with what’s going on and really kind of start to explain things to them.

Michelle: Yeah, it is. It’s so important. And you know, California over the last year or so, the California pharmacist association and you know, pharmacists across the state have really started a whole initiative because, you know, they changed the way the medical or the Medicaid in California to reimbursement was going to be they started using that NAIDOC pricing and you have like a great tool on the side effect of website where people can go in and look how much the, the medication actually cost. But then NAIDOC is to me is also some arbitrarily made up thing where they going and taking invoices from pharmacies across the country as a snapshot and what pharmacies pay for that drug and then making that the gold standard. Well, you know, some way in the middle of like Ohio, Arkansas, and how much a pharmacist pay pays for something in LA or San Diego or San Francisco.

Michelle: It’s, those are two different animals. So how can you just start reimbursing? So that’s when the Medicaid reimbursement just plummeted here in California. And you know, they stopped the clawbacks on, on pharmacies here in California. And the judge is supposed to provide his ruling, which he hasn’t done yet, is as to whether those are even legal to like continue. But, you know, that’s, that’s a big problem that we’re fighting here in California. And they finding things, yeah. If they’ve got a PSA for patients, it’s, it’s in every state this has going on. And that’s why I think that Supreme court cases going to be groundbreaking because maybe it’ll set a precedent where each state can then, you know, manage these PBMs and pull them into, you know, submission somehow.

Lucas: Yeah. Then that, that’s the heart. That’s really the kind of the last not the last, or right now, the, that light is shining the brightest in terms of any kind of reform. If the States can somehow take back control and regulate, which is what the Supreme court is basically deciding then you will, then you’ll start to see some significant changes. And you know, Michelle, we talk about it and how, and, and you guys can talk about how frustrating it is. And this is another most sobering thing about even after all the work and all the stories we’ve done, because these PBMs control the formularies. We talk all the time about the price of drugs. And no one knows what the real price should be because the cost from the manufacturer is hidden. And the, and the rebates and the costs that the PBM is charging the manufacturer to put their drug on a formulary is, is hidden. And so no one really knows at the end of the day what the price of these drugs should be.

Michelle: No, absolutely not. And then you bring in three 40 B pricing. So, you know, the rule their administration wanted to implement with manufacturers have to put the price of the drug on their commercials. It’s just, I mean, you could just guess anything. Put $1 million per $10 it doesn’t really matter. I mean it’s just

Lucas: [Inaudible]. I mean, everybody’s pushing for transparency and that is not going to bring transparency.

Michelle: Absolutely not the regulation of these PBMs. And in my opinion, the complete elimination of them is the only way to fix this critically problem.

Speaker 5: Yeah,

Michelle: No, I mean you have, you know, Medicare beneficiaries who go to the pharmacy and are paying like $50 for a copay. We now the pharmacist could tell them what if you just pay cash with it, you know, high blood pressure pill or your cholesterol medicine. It’s $10.

Speaker 5: Yeah.

Lucas: And, and when we started our reporting here a couple of years ago in Ohio, pharmacists were under a gag order that they weren’t allowed to tell their customers that they could pay a cheaper price if they just paid with cash. That has since been lifted. But that, but that’s kind of where we started from just a couple of years ago.

Michelle: I mean, it’s ridiculous. It’s, it’s, it’s like absolutely criminal and people are just paying higher and higher premiums more for their prescriptions if they can even access them and people are just getting sicker and sicker. So I think hopefully this Supreme court case would be, you know, reach the pinnacle and then things can hopefully get better from the head.

Lucas: Yes.

Michelle: So do you have any other you know, before we end, like any other insights or little tidbits of wisdom for pharmacists out there?

Lucas: Yeah, the only thing that I, I mean, you know, cause every, we talk about this and it gets everybody all worked up and everybody’s sick of paying higher premiums every year. And so everybody’s like, well what, what do you do? And I, the one thing, and this is just the advice that we’ve gotten from pharmacists, from doctors, from lawmakers, is to tell people who are, who are interested in bringing transparency to all this is people can go to and can go to their employers and say, how much are prescription drugs? Or how much money is that a part of our total healthcare spend? Meaning every year, year, your healthcare premiums are probably increasing unless you’re in government work. And even in then they’re increasing and, and in many cases the prescription drug benefit is the, is has the largest increase year over year. And so that will then help lead to more questions of well, why, why are we paying more for prescription drugs when we’re, when we’re all doing mail order, when we’re all trying to do generic and get, and then get your employer to ask those questions to your HR people. I mean, the more conversations you can spark this, it will, it will create a better system in the end for all of us.

Michelle: Oh absolutely. And you know, to all the pharmacists out there, get your patients engaged every time you get a negative reimbursement show, show the patient, give them the tools, give them the phone numbers and tell them who to contact. Because so many times we just sound like sour grapes because we losing money. But for the patients it directly impacts their health and their outcomes. So the more that I hear it from patients, the more we can make change.

Lucas: Yeah, I bet your customers would be shocked and know that you’re taking a loss on filling a prescription.

Michelle: Yeah. And in half the time they don’t even know it. But if we could tell them every time it’ll, it’ll make an extraordinary impact.

Lucas: Yes.

Michelle: So Lucas, I can’t thank you enough for taking time to, to be on the show today and you know, sharing all your work. It’s, it’s extraordinary investigative work and you know, we need people like you across this country to shine that spotlight on these egregious healthcare behaviors so that people can get the health back and get the drugs they need, get the cancer treatments they need so that they can recover and be healthy and be healthy parts of their community and give back to their families, their communities and their lives. I want to thank you so much for being on the show.

Lucas: Well, thank you Michelle. And, and if, if I could you know, we’ve been doing this now for two plus years and our, our, our landing page that has cataloged everything we’ve reported on is is that dispatch.com/side effects. You can go on there. We have somehow two tools we have, we try to break things down. So you know, if you want to point to, to some of your customers or some, some of your patients to their to in layman’s terms to better understand what you guys are dealing with. We tried our best to put this into plain English and boil it down so people can understand it and not have their eyes glaze over when you start talking to them about some of the industry terms that get thrown around.

Michelle: Oh, fantastic. Thank you so much. And to all the pharmacists out there, remember we can do this be the change.

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