DIR Fees 2024, DIR Fees, Independent Pharmacy Accounting, Pharmacy Growth

The Bottom Line Pharmacy Podcast: Transforming Your Pharmacy: Supplements, Strip Packaging, and PBM Reform

One of biggest pain points pharmacists face is patients taking their medications regularly.  

In fact, research from the NCPA shows that the average refills for chronically ill patients at pharmacies is 7 ½ out of 12.  

One of the innovative ways to help serve the need for patients to take their meds more consistently is through Strip Packaging with RXSafe 

On this episode of The Bottom Line Pharmacy Podcast, we sit down with William Holmes, the Founder of RXSafe and Matt Gilbert, the VP of Business Transformation and Major Accounts with RXSafe to discuss opportunities with LTC, supplements, PBM reform, and more!  

Join the discussion with us!

The Bottom Line Pharmacy Podcast is your regular dose of pharmacy CPA advice to fuel your bottom line, featuring pharmacists, key vendors, and other innovators.

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More resources about this topic:  

Podcast – LTC at Home with Lindsay Dymowski

Podcast – LTC and Cash Flow with Paul Shelton

Podcast – NCPA 2023

Article – Managing DIR Fees

Article – The ROI of Adherence Packaging and Automation

Article – Maximizing Adherence Packaging for Patient Health and Pharmacy Growth

If you prefer to read this content, the video transcript is below:

Scotty Sykes: All right, everybody, welcome to another episode of The Bottom Line Pharmacy Podcast with your host Scotty Sykes and the star of the show Bonnie Bond, of course and today we have Bill Holmes and Matt Gilbert. Bill Holmes is the founder of RX Safe and Matt Gilbert VP of Business Transformation and Major Accounts so thank you guys for joining us today and having a conversation with us.  

Bill Holmes: It’s our pleasure. I always look forward to reaching out to the community and I think we’re going to have a lot of fun here today. 

Scotty Sykes: Compliance Packaging is not going anywhere that’s for sure. It’s certainly got all the room in the world to continue to grow in my opinion, especially with the long-term care at home now, opportunities that are there and continue to hopefully expand in the future. What do you see there, Bill, with the changes in the long-term care at home space potentially down the road? You know, how do you see that unfolding or evolving rather?  

Bill Holmes: The LTC at home, sometimes called medical at home space is interesting because a very large number of current patients that pharmacies serve qualify as what is referred to as medical at home or long-term care at home. And NCPA is doing a lot of work, Ronna Hauser is working every day to try to get better reimbursements for pharmacies, recognizing that, you know, as we have 10,000 people every day turn 65 years old, that this baby boomer generation, I’m right smack in the middle of it. You know, we hit the market, we hit every part of the American economy, starting from hospitals not having enough birthing rooms, to kindergartens not having enough teachers, to elementary school, grade school, high school, college, and then the first home and the first car. And every segment of what’s happened has been affected by this giant watermelon in the state called the baby boomers. And so now what are we going to do with 10,000 people a day turning 65 as they enter into their senior years where they’re going to require more health care and more medication and more personal care? There just aren’t enough nursing homes. And as we saw with COVID, nursing homes aren’t just necessarily a great place to be. And a lot of people don’t want to be there. Who’s ever heard of a family story where the kids sat down with grandma and said, “well, you know, grandma, I think it’s time that we need to move you out of the home because you can’t take care of yourself. We’ve got a nursing home in mind.” And grandma said, “fantastic, let’s do that.” That never happens. It never happens. 

Bonnie Bond: Let’s do this.  

Matt Gilbert: Next time will be the first time. 

Bonnie Bond: I‘ll go pack a bag. 

Scotty Sykes: Vacation! 

Bill Holmes: Yeah, my dad was a perfect example. You know, my mom had passed away 10 years earlier and he was a proud World War II veteran. And he didn’t, he didn’t want to, you know, have any help. He was suffering from wet AMD, which is macular degeneration. Your eyesight starts to go from the middle out. So your acuity ends up dissipating. You can only see peripherally. And, you know, he was, he was struggling with that. But, absolutely refused to leave his home, absolutely refused to have live in care. He was just gonna take care of himself. And he was doing great until one day he mixed up his medications and didn’t take them correctly and ended up in an ICU for six months and never got out of bed. So for me, it’s very personal, very, very personal. And when you see people like that, 10,000 of them a day going into that phase of their lives, what are we going to do to take care of them? What’s the number one reason people are advised to leave their home and go into a care setting? Can’t take their meds correctly. My dad is exactly that person. And so, the consequences are grave. The need is high. How are we going to help people stay at home, live at home and be healthy at home longer? Because there aren’t enough nursing homes being built. There’s not enough money in the economy to pay for it. And yet these people are going to need our pharmacies to find a way to support them in their lifestyle. The only way is adherence packaging. That is the only way. Now these people will qualify for medical at home or LTC at home as LTC as a NCPA wants to call it. Very simply, you get an attestation form which is simple 8 and a half 11 piece of paper that says I can’t do my own gardening. I can’t dress myself. I can’t bathe myself. I can’t cook for myself. I can’t get to the pharmacy without assistance. You only need two of that list of things that you can’t do to qualify for long-term care at home billing as opposed to retail billing. And so pharmacies, and I think Matt, would this be a good place for you to jump in. How does a pharmacy benefit and how do they become a combo shop in order to take advantage of these existing patients who are already at home and they’re already getting pharmaceuticals in many cases delivered to their home already?  

Matt Gilbert: Yeah, yeah, most partner pharmacies we deal with, they don’t even realize that they’re serving that big of a population already. You’re already delivering to them. You’re doing it in compliance packaging, using pouch to get it out to them. You offer these high-level clinical services that are required for LTC medical at home billing. So the easy way to get going with it is to partner with GeriMed or MHA, get the contract rolling because that takes, you know, three or four months to get up and in place. And what they do is they set you up with dual NCPDP, dual NPI, and it all sounds like a lot, but it’s really just a little bit of work on the front end. And you’re billing those in the same pharmacy software that you’re using today, and you’re serving those patients exactly the same way that you already were… 

Bonnie Bond: Right  

Matt Gilbert: But you’re getting, you know, two to $5 more reimbursement per prescription for doing the same exact work. So, who wouldn’t be on board with that?  

Bonnie Bond: Right.  

Bill Holmes: And through that mechanism, you can partner with NCPA, you can partner with GeriMED, you can partner with MHA, they will all have advice and assistance to get you into that model. But you can then use the contract you have with your current wholesaler through, for example, GeriMED, and you get lower costs and many of the drugs that you would acquire for this use for medical at home or LTC at home. You also get higher reimbursements because there’s a recognition by the payor that you’re doing this adherence packaging, and it costs more. And then, of course, you get the absolute avoidance of DIR fees because they don’t apply to LTC environments. So, when you think about lower costs, higher reimbursements and no DIR fees and their patients you already serve, it’s an absolutely undeniable benefit to pharmacy owners. Add to that other services that you can bill for. Matt, maybe you could dive into that. 

Matt Gilbert: Yeah, yeah. And, you know, one thing people get hung up on too is the LTC part. Well, I’m a retail pharmacy. I’m stuck on the bench. I don’t have time for this. You know, I don’t want to expand and serve in skilled facilities. And that’s not what we’re talking about at all here. We’re talking about partnering with Happier at Home, home health agencies that are local to you really serving these nurses well and treating their patients that are residing at their own individual homes really well and building them into your orbit. But to take it to the next step, which is what we as a company have focused on for the last, call it 12 to 18 months, is not only taking the patients to pouch on that journey and the medical at home billing journey, but getting our pharmacies up and running with RTM programs. So now we’re serving a patient in a pouch and instead of putting it in a regular paper box, like is in front of Bill there, we put them in a dispensing box that looks basically the same, but it tracks the patient as they move through the month. And they’re making sure we’re accurate with every dose that it’s being taken. And all that’s monitored, and that’s a billable service out to CMS. So you take those, again, those same patients that you’re already serving, you’re already delivering to in compliance packaging, get the GeriMed benefits or medical at home benefits of it, and then take an enhanced reimbursement and open yourself up for some more clinical services whether it’s in-home immunizations or RTM dispensing. 

Scotty Sykes: Talk about the RTM, how does a pharmacy get going with the RTM billing? Side of it. 

Matt Gilbert: Yeah, yeah, so we’ve got a few partner RTM companies that we work with currently. So, we’d be happy to refer people on to them. But what they do is an initial analysis of your existing patient population. They show you who qualifies out of your entire roster of patients currently. And the way they do that is mapping back and forth between the drugs, the GPI, and then to the therapeutic categories that are billable. And they do all that heavy lifting. You just download a report out of Pioneer, Liberty, whoever you’re using, and they analyze that. And they’ll say, here’s the direct correlation revenue wise if you move these patients over to this type of billing. And for most of these patients, there’s no out of pocket expense either. So, it’s not like you’re going to a patient and saying, hey, I’ve got this great new service, but it costs 50 bucks a month. There’s no out of pocket for the majority of those patients. So, it’s a pretty turnkey solution. 

Scotty Sykes: Easy enough. What about Matt, talk to us about, you mentioned earlier about supplements in the Compliance Packaging. Kind of expand on that and your experience in that area. 

Matt Gilbert: Yeah, yeah. Well, we’ve got a few different ways people are playing it. You know, we’ve got a lot of great customers, got over a thousand customers altogether and they all do it a little bit differently. We’ve got some guys, they’re doing standalone vitamin packs. So it’d be a women’s pack, men’s pack, bone health pack, heart health pack. Some of these guys have 50 different packs that they’re out there and they keep their patients sticky by being an adherence pouch packaging. So, you know, if you missed your morning’s dose.  

Bonnie Bond: Right. 

Matt Gilbert: And I always correlate back to my dad takes one medication and he takes it out of a vial every single day. And I can’t tell you how many times I’ve been over their house, “hey dad, did you take your Lipitor this morning?” “I don’t know, let me back count it, let me see.” And then he can’t figure it out. So, he says, well, heck with it, I’ll catch back up tomorrow. Well, that doesn’t happen with pouch packaging. If I go and I see my morning dose is still there at 11 o’clock and I missed it at 8 a.m., I’m gonna take it and get back adherent. So, we’ve got a lot of our folks who are they’re doing standalone supplement packs. But I think the overarching theme is to look at nutrient depletion that your current patients are having affected by their other medications they’re taking. And they might be going out to Costco or some big box store and buying those vitamins and don’t even know about it.  

Bonnie Bond: Yep.  

Matt Gilbert: The easiest lift that I tell our partner pharmacies to do is every patient, every month whether they drop off their scripts or they pick up their scripts. You have a prompt in their POS system, hey, are you taking any new vitamins or nutraceuticals outside of us? And then counsel them based on what they’re taking and then try to rope that into their compliance packaging. And then it keeps them sticky and increases those turns. 

Scotty Sykes: And pharmacy, pharmacists should be the experts in the supplemental area, but you see supplements everywhere. GNC is it, or even pop-up shops selling…. 

Matt Gilbert: Yeah. Online stuff. 

Bonnie Bone: Gas stations. 

Scotty Sykes: I mean, it is crazy. The opportunity for pharmacies with supplements, I think, is huge out there. 

Bill Holmes: Yeah, there’s a lot of anecdotal stories. We had a panel discussion at the MLC show a couple of weeks ago, and Joe Williams, who is serving seven counties, soon to be nine counties in southeastern North Carolina, an excellent operator, has been running a rapid pack now for about four years. He was reluctant because his patient population is rather low income to sort of recommend, you know, you should be taking this vitamin, you should be taking this nutraceutical, you should be replenishing the depletion that this drug causes, because he didn’t think they just couldn’t afford it. And recently he’s become aware that those very same patients who he’s reluctant to talk to are buying one of these on TV ad commercials that some athletes holding up saying, you know, take this medication and it’s going to be a whole different life for you. If you read the little white print on the bottom of the screen is it’s not been verified by, you know, any entity and we don’t claim any results. And, you know, people are spending $30, $40, $50 a month on these subscription models. And he’s basically now saying, well, let me, let me find out who’s doing that because they’re wasting their money. They’re not buying the right nutraceutical for… their current clinical requirements. And he’s now converted a lot of people over who thank him for that because they’re healthier and they’re spending less money and they’re taking them correctly. We’ve got people like Easton Bryant, who’s another rapid pack owner, very successful, that got into a good web advertising campaign about strip packaging, nutraceuticals, and has customers buying from him as far away as Japan. And so, he’s now mail ordering this stuff all over the country. In fact, probably mailing to some, so to one of our listeners in their back door to a customer that’s, you know, one of their pharmacy customers. And so here’s an opportunity that’s ripe for the picking. We’ve got Kelby Gorman down in Texas doing Matt. How many packs is he doing?  

Matt Gilbert: He’s doing over $50,000 a month just in standalone supplement back sales. 

Bonnie Bond: Wow. 

Scotty Sykes: See, that’s what I’m talking about. Just about every pharmacy should have that opportunity. And I’m not. 

Matt Gilbert: Yep. And it’s not, it’s not, it’s not a heavy lift. You know, you, you’re bulk ordering this stuff and you don’t have to make up a thousand boxes at a time. You know, you’re just replenishing … your shelf and you see what works out there… 

Bonnie Bond: Mm-hmm. 

Matt Gilbert: with your current patient base, because it’s different in every area, right? You know, there’s going to be certain price points that you want to target, but you want to have them have good quality, you know, vitamins and nutraceuticals and not, not just junk that’s not going to work. If they see the effects and they’re on pouch… 

Bonnie Bond: They’re gonna keep using it. Yep. 

Matt Gilbert: They’re going to stick with it. Yeah. 

Bill Holmes: Yeah. And it’s, you know, it’s a higher margin business than pharmaceutical, typically 50% or greater margins and no DIR fees. And once you get somebody in your store who’s interested in buying your nutraceuticals, what are you going to ask about the cash register? Are you filling any prescriptions down the street? Why don’t you bring them here and I’ll combine them in this package for you. 

Bonnie Bond: Yep.  

Scotty Sykes: A lot of opportunity there. Yeah. 

Bonnie Bond: It’s a no-brainer to me. I mean. 

Scotty Sykes: So, talk to us about the automation space just in general. I mean, shoot, we still have a lot of pharmacies that have no automation. I mean, we still see pharmacies with no automation whatsoever. Obviously, payroll is very expensive these days outside of cost of goods and DIR fees in years past. Payroll was the top expense in a pharmacy. With your experience, Bill, Matt, expand on how you see automation cut down on that payroll expense and what opportunities there are for pharmacies. 

Bill Holmes: Yeah, it’s an interesting topic. And I’ll start by saying, I get this question all the time at all the trade shows. And we do about 35 trade shows a year. Gee Bill, I love this automation. I’m here covering it up. It’s expensive. I just don’t think I’m big enough. Maybe I’ll think about it in a couple of years. And typically in the past, when you thought about a vial filling robot from Prata or ScriptPro, for example, it was true. You’d have to get to 150, 200, you know, vials a day to make it sort of pay off because those robots produce 100 to 150 vials an hour. When you think about spending $200,000 for a piece of automation that you only use an hour a day, you have to question, is that a good use of your capital? Because it really doesn’t make sense to have an idle piece of automation in your pharmacy. And so those decisions, you know, sort of get to scale, then buy automation, get to scale, then buy automation. And, you know, I think of that and even with our, our RxSafe in the corner here, this tall white machine, that would be a true statement. You do need enough business to make it make sense to get a return on that investment. But when you start talking about strip packaging, it’s a completely different topic because as opposed to an efficiency tool like that, this is a growth tool.  

Bonnie Bond: Right.  

Bill Holmes: This can help you actually add patients and grow your business much faster than you can do any other way. You go to pharmacy school for five, six, seven years, you come out, you do not have a business degree, you do not have a finance degree, you do not have an operations, you know, industrial degree, you’re a pharmacist. And it’s tough to say, well, okay, now I’m going to become a marketer, I’m going to become a salesperson, I’m going to go into my market space and grow it. That’s difficult and most of our pharmacy owners really struggle with that. Well, Matt’s group inside of RxSafe is specializing in that. He will physically come, or his staff will come to your facility and go with you to other pharmacy opportunities. And Matt, if you could just expand on that for a second, be interesting to see how do we help you grow because you can get this machine in the earliest stages of starting a new pharmacy and say, okay, it would have taken me a year to get to a hundred patients, two years to get to 200 or whatever. We can accelerate that because this is a viral thing. When patients take this box home and they become adherent and become healthier, they’re gonna tell their family, they’re gonna bring at least one family member to your store, and they’re gonna tell their friends and bring at least one friend to your store. And then you look at the geometric progression of it. They tell their friends and they tell their friends and they tell their friends. We’ve got pharmacies like Cleveland Clinic, for example, doing 900 patients a month with one or two people operating that. And if you just assume it’s 10 prescriptions and let’s say a thousand patients, that’s 10,000 prescriptions a month with two technicians. Nobody can match that. Matt? 

Matt Gilbert: Yeah. And what, what my team specifically does is we want, really want to make sure that the end customer, in our case, the pharmacy is successful and out of all, I talked to thousands and thousands of pharmacists and pharmacy owners every year and 99% of them tell me, Matt, I’m not a sales guy, I’m not a marketing guy. I don’t have a sales team. I don’t know how to market myself. I don’t know who to target. How do I do that? And that’s, that’s where our team comes in. So, what we do is we do a total market analysis of all the home health agencies, group homes, ICF IEDs, assisted living, skilled if they want to go tap into that market, corrections. And then we fly out there for two days and we take the pharmacy owner with us. And sometimes it’s the PIC that goes with us as well. Sometimes it’s a super tech that they want as part of that adherence packaging. But we show them how to market pouch packaging and into each of these different silos, because they’re all different, right? You’re gonna have skilled and assisted living are gonna have their own pain points. Home health nurses are gonna have their own pain points. ICFs are gonna have their own pain points. So, we go and we pick up on whatever that pain point is and drive home pouch packaging as part of the solution. So, getting that initial entry into the door and show them how to have that conversation, now we’re teaching them how to fish, right? 

Bonnie Bond: Nice.  

Matt Gilbert: So, going forward, they’re looping back with those same director of nursing, the same assisted living administrators, the same, I’ve been in more jails. I’ve never been to jail outside RxSafe, but I’ve been in more jails and prisons in the last three years than I ever thought I would be. But these guys need it. You know, if you’ve got 300, 400 inmates that you have to do a morning med pass, a noon med pass, an afternoon med pass and a bedtime med pass…  

Bonnie Bond: Yeah, it’s perfect. 

Matt Gilbert: How long do you think that takes doing bingo cards? or vials? It takes hours. By the time the next med pass shows up, they’re not ready. So, we had a customer, a Rapid Pack customer down in Kentucky. He had a jail right down the road from him, 200 beds, all cash. So no, no DIR fees, no PBMs. And I said, man, are you serving that jail down there? He said, no, I’ve tried a bunch of times. I can’t get in there. At the time before the Rapid Pack, they only had blister cards. He said, I’ve talked to him a ton. They just won’t move. We went in there, had about an hour conversation with the warden and said here’s what we can do on pricing. Here’s the modality we’re gonna distribute in the rapid pack pouch packaging. And he got that deal. And that was something he had knocked on their door for five years before and couldn’t do. And we did in about an hour. So, you know, to really partner with our pharmacies, we wanna make sure they’re successful. Cause if they are, we are. 

Bonnie Bond: Yeah, that sounds like a great program. Matt, does that have a particular name? 

Matt Gilbert: Yeah, so it’s the business transformation program and I’m over that. I got some teammates that work with me on that, but we do it every week. So we’ve done hundreds of them at this point and sometimes two or three a week, depending on the volume. 

Scotty Sykes: So y’all fly out to the location? 

Matt Gilbert: We do, yeah. We do the flying; we do the driving. We’ll take the pharmacy owner around and we have 15 to 20 meetings each day that we’re there. And they’ve got a whole roster of follow-up notes and key contacts and everybody that they’ve got to pursue after that. And then we’re here in perpetuity as far as, hey, Matt, I got this assisted living, they’re asking for this, I have no idea what they’re talking about. Okay, sure, let’s hop on a call. So, it’s not a hand it off to them and you’re on your own. It’s… 

Bonnie Bond: Right. Support… 

Matt Gilbert: I’m getting customers that I worked with three years ago that I just had one yesterday that called me asking about MedCarts. What type of MedCarts should I get? All right, we’ll help you out with that.  

Bonnie Bond: Yeah, that’s fantastic. 

Matt Gilbert: It’s not just about pouch packaging. 

Bill Holmes: Yeah, I think it’s a great point to interject that if you’re a pharmacy owner and you’re looking to find an automation solution that you should find somebody who’s willing to partner with you. A lot of people are in the I’ll sell it to you. Thank you for the business and handshake and on to the next thing. We’re not we’re not like that here. We look at our, our customers, and our pharmacy owners as partners. And for me, it’s very personal because you know, we’ve designed and developed all of our own equipment at RX Safe. We don’t import anything from South Korea, we don’t import anything from Japan, we don’t import anything from Holland, it’s all our own creation. And it’s next generation, latest state of the art stuff, because we don’t copy other people. If you look at the other strip packaging machines in the world, they’re all the same. They all use these silly little plastic cassettes that were invented in 1907. Look at, Google it, this first, the first evidence of a rotary disc with a pill of a certain size that has to drop through a hole in the bottom was 1907 in the form of a gumball machine. The other thing I really object to about the rest of the state-of-the-art stuff is there’s this hole in the bottom of this cassette. That’s an open container Scotty any way you cut it any way you describe it the medication in here is exposed to air and moisture for hours weeks days even months and everyone knows when you own a pharmacy or you work in a pharmacy, first thing you wanna make sure you do every day is you put that cap back on the bottle and you tighten it. I ask every pharmacy owner if you had a bottle on a shelf with a cap off of it, how long would you keep it? And would you serve a patient with that? And the answer is a couple hours, that’s it. And so here we have open containers and I really object to that. So we’ve developed everything that we’ve done here based on people coming to us at trade shows and saying, hey, I’m worried about this. Could you guys do this? Is there a way to do this better? What would it look like if this were to happen? And how can you help us? And all of this stuff is not my idea. All of it is their idea. And so we get that and we’re very proud of that. We partner with people in order to, to facilitate that. And that’s a long-term partnership as Matt describes our success in different markets and it’s ubiquitous. I can’t think of a place that we’ve gone that we haven’t driven new business into a pharmacy just by being asked to do it. But if we can get you 30 new patients, with 10 meds each, with $10 profit per med, you’ll have $3,000 more profit in your pharmacy per month. $3,000 a month. That’s more than the lease payment on the equipment. And that’s just 30. You can play with the math. If you think it’s $5 reimbursement, then make it 60. It always works out to be the same thing. It’s easy to drive this. And we have programs that postpone payments three months as much as six months with our leasing partners, like Advantage Financial, Pete Davison. So, a lot of our owners have bought this equipment using Pete’s plan haven’t made a payment for six months and have easily got to that three, four thousand five thousand dollars a month more profit before they had to make the first payment. No cash out of pocket. And I know that you can talk Scotty with great authority about section 179 and the benefits at the end of the year. So, you know that the relative cost of machine is down and maybe is it 60% this year? 

Scotty Sykes: Bonus depreciation 60% this year with the chance of that being changed with the tax law that’s pending out in Congress right now, so we’ll see where that goes but… Depreciation is still aggressive you still got 179 where you could potentially write off the whole piece of equipment. So, it’s gonna be an interesting year from a tax planning perspective because you know how this year’s starting off is a rough go with the DIR Fees and the change in reimbursements. So, there could be some opportunities for pharmacies here towards the latter part of the year to artificially create losses, offset other income, and get some refunds back in their pockets. So, there’ll be some tax planning opportunities, I’m sure, for pharmacies with the rough year so far this year. 

Bonnie Bond: Yep. 

Bill Holmes: Yeah. And talk to a lot of owners. As I said, we’ve been around a long time and go to a lot of trade shows. The strong industry leading operators that we’ve already mentioned earlier here all tell me that they think we’re in the bottom of the trough. What does that mean? Well, DIR fees, low reimbursements, the PBMs and their aggressive, draconian practices have reached the attention of Congress and lawmakers in a serious way. RX Safe was instrumental in raising money for the Legal Defense Fund of NCPA just before the Supreme Court ruling on the Arkansas case against PBMs in that state. And we were successful, if you recall, the justices voted 8-0 in favor of Leslie Rutledge and Mark and the law they passed in Arkansas. So, things are coming back. They’ve gone too far. Everybody knows they’ve gone too far. But I think it’s an optimistic time. I think we’re coming out of the trough. I think DIR fees are going to be less and less as time passes. I think the visibility in January of DIR fees, while we still have that overlap of old DIR fees and new DIR fees, people now understand when they’re losing money. And if I could point to a conversation I had with Doug Hoey, the CEO of NCPA a while back. He and I were commiserating about this and he said, you know, Bill, I hate the thought of this, but I think the reality is maybe it is time for pharmacy owners to look at a patient and say, I’m sorry, Mrs. Smith, I can’t continue to lose $100 a month filling this prescription for you. Will you please take this one to CVS? And I believe that’s happening now. 

Bonnie Bond: Oh, it’s happening. Yeah. 

Scotty Sykes: It is. 

Bill Holmes: And when that does, when that continues on and, you know, let’s take CVS is the bad guy in this model. They have an insurance company, they have a PBM, right? So they, they kind of own the problem. And, and now it’s going to come home to roost. You know, if they’re asked to keep filling these prescriptions at a loss, maybe they’ll wake up some morning and go, ah, reform doesn’t sound so bad. 

Bonnie Bond: Right. But it’s definitely going on. We hear that every day now from our clients. 

Scotty Sykes: Yep. Well, they’re in front of Congress right now talking about PBM issues. You know, they’re holding signs out in front of Congress about reform PBM, this and that, so it’s definitely got the attention there in Congress. It’s, it’s just gotta happen. They got to get it to the finish line. And you know, Lord only knows with Congress, because I think that same tax bill I was mentioning is also wrapped into the PBM, reforms, if you will, in Congress as well. So, 

Bill Holmes: Yes, they are. 

Bonnie Bond: Yep. 

Scotty Sykes: It’s just got to get to that finish line, but we’ll have to see and cross our fingers.  

Bonnie Bond: I hope you’re right though, Bill. I hope we’re starting to move upward. 

Bill Holmes: Well, guys, listen, you have you always been a strong advocate and supporter of the independently owned pharmacy market and industry as we are. 90% of our businesses independently owned mom and pop pharmacies. I am every day I wake up and I tell Matt and the rest of our team, every decision we make today has to start with one most important fact, and that is, are we doing something to improve patient health? Number one is this vendor or that vendor is this cost or that cost is this is this trade show or that trade show important everyone as well. Is this going to improve patient health? That’s number one. Number two is how can we improve the financial health of our pharmacy customers? That’s number two. They need to be strong. They need to be financially solid. They need to continue doing what they’re doing. And then third, what’s the best thing for RXSafe, because we’ll take care of that automatically through number one and number two. If we lose the independently owned pharmacies in this country. And the number has diminished year over year over year over year. If we lose it, we’re going to take that healthcare that’s available five minutes from everybody’s front door and make that far less accessible and far more expensive and patients are going to suffer. We cannot turn this over to chains. We cannot turn this over to big corporate environments. We can’t turn it over to healthcare systems. They’re not close enough and they’re not the…front lines that we need. And we saw that during COVID with vaccinations. So we need to help, all of us need to help independent pharmacy owners become stronger. And I think we’re in the bottom of the trough. I’m very optimistic about the future. I think that if you’re considering automating and doing strip packaging, improving your adherence programs and your other programs, do it sooner than later, because I think the community really, really needs your help. 

Bonnie Bond: I agree. That was a heck of a bottom line there, Scotty.  

Scotty Sykes: That was…are you going to go into our bottom line segment? Why don’t you take it? 

Bonnie Bond: I mean, I think Bill just took care of it. Do you have something else to add at the end of each podcast we always have a bottom line, but I think Bill kind of wrapped that one up. Matt.  

Scotty Sykes: Yeah, I agree. I’m going to, I’m going to step in here. I agree with Bill. I think, I think we are at the bottom of the trough. And I think there is a lot of opportunity ahead Independent pharmacy is just too vital in this country. You know, you can’t just get rid of all independents. That’s not gonna, that can’t happen. And so that’s that opportunity in pharmacy, I think, where these independents can really, and we say this all the time, can evolve into that healthcare center in their communities. And that’s just gonna continue. And that’s where I think the future is with pharmacy. That includes the long-term care at home space. That includes just general healthcare supplements, deficiencies, vitamin deficiencies, I mean, the list goes on and on, but accessible, easy healthcare, five minutes down the street, you don’t have to have an appointment, you walk in and get a various array of services. I mean, that is the future of pharmacy and that’s where it’s gonna go. So, I believe there’s a lot of opportunity, they’re just gonna have to get through this PBM crap before we get there. But again, like I mentioned, they’re in front of Congress now with these signs, reform PBM, so that’s never happened as long as I’ve been around in pharmacy here, so I think there is a bright side on the other on the other end but that would be my bottom line Matt, how about you? 

Matt Gilbert: Yeah, my bottom line is the pharmacist is the most trusted practitioner, health practitioner that any patient is going to deal with. And they’ve got the buy-in of that patient because they trust them. They’ve known them for years. They can go to that store and they know the person working the cash register, and they know the tech that’s filling their prescriptions, and they know the pharmacist has their back when it comes to their medications. So, keeping all these pharmacists head above water we’re trying to help them do that in any way that we can. So that’s my bottom line. We’re here to help in any way that we can. So, whether it’s pouch or card or vial filling, you know, we’ll do whatever we can to make sure they’re successful.  

Bill Holmes: And one lynch pin that I want to leave everyone thinking about here as we end this hour together is seven and a half to 11 and a half. If you look at any statistics today at NCPA, which is this year in and year out, the average refills for chronic patients on medication are seven and a half times out of 12 for a year. Average, seven and a half. If you ask doctors what’s the most frustrating thing about patients who keep coming back because they’re not recovering, they’re not healthy, they’re having issues or complaints. The number one thing they discover is their patients aren’t taking the meds correctly. Recently I did a speech in front of a bunch of pharmacists, and we had about 500 people in the room and I asked a simple question. How many people here who run a pharmacy think that their patients are taking the medications every month that they prescribe? Not one hand came up. Not one. And we know the statistics are well documenting this fact. If you have patients on adherence medication, like this strip packaging, it goes from seven and a half refills to 11 and a half refills. So that’s great. My first point is patient health. We’ve improved patient health. You take your drugs correctly and the doctors will thank you, the families will thank you, and the patients will thank you, and your bottom line will thank you, you’ll go up 40% in revenue and 40% in profit because you’re losing that in your current patients today when they don’t come back for refills. So please consider adherence packaging. 

Scotty Sykes: Very nice. Well, thank you guys for hopping on with us today on the Bottom Line Pharmacy Podcast. Always great to have, be with you Bill on the panel. We’ve been on a couple panels together and we certainly appreciate you hopping on today. So I’m sure we’ll see you at a trade show this summer and thank you all for listening in. 

Bill Holmes: Thank you, it was a great opportunity. Appreciate it, Bonnie. Appreciate it, Scotty. Thank you. Take care. 

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