What were you going to say?
I was just going to say, yeah, you
talked about accreditation.
We do that in your
registration.
I mean, there's just, you name it,
there's fees at the top of fees.
And then we're trying to also be
an employer.
We're employing 100
different people within our
community.
We have health insurance fees for
them to pay, as well as benefits.
So it becomes very challenging when
you have such a very small margin
to be able to be competitive in the
market.
People to want to work here.
How much would,
what is in this whole
bill, how much would
it have a direct impact
on your ability
to stay afloat?
So I'm going to say it's the
first step.
We need this transparency.
We need some
minimal requirements for
PBMs.
So it is the first in helping.
But we need it on a greater level,
also with the federal level.
And we need some consistency across
states.
So we do need it to
happen at both.
The state level.
So this with Senator Falkowski's
bill is the state level.
And then we need it at the federal
level. So CMS and Medicare
can also make sure
for the Medicare Part D patients
that we are serving that we're
getting again paid appropriately.
Is there anything else
in the bill
that stands out to
you that you want to describe?
To me, the big things
about the bill is it allows
prescription processing
to
be dispensed to patients
in the model that I believe should
exist, which is, one,
a patient gets to choose where they
want to go, just like they
want a choose a health care
provider, a doctor,
an advanced practice nurse
practitioner that feels right
to them that they mesh and
takes care of them.
It would allow them to have access
to that type of healthcare
providers, the pharmacy and
the pharmacist that they want.
I believe it continues to
allow us to be able to operate
at the top of our scope of practice,
to continue to serve our patients in
the way that really motivates
us. I talk about, we get up in
the morning because we wanna
truly help serve our
patient.
And if we get paid fairly,
for the product that we're
dispensing, we can do those
additional services that we are
asking for.
And we talked earlier
about that, you know, for patients
with asthma, we did a study
with the Pharmacy Society of
Wisconsin and showed that when they
sat down with the pharmacist on two
30 minute interventions,
that they reduce the number of ER
visits, the number hospitalizations.
These things are making a difference
in overall reducing healthcare
dollars spent.
And this is the stuff that
really motivates pharmacists
to want to continue to practice.
And it only increases access for
patients, so they can
continue to be compliant with their
medications.
And to me, when
we also just look at the mail order
model, there is potential
for harm in that model.
Because if you're getting all of
your chronic medications
through a mail order service.
What happens when you need an
antibiotic today or you go to the
emergency room and you get
prescribed some type of medication,
now you go a local pharmacy who
doesn't have your entire profile and
a lot of patients don't know all of
the medications that they take.
And so how does someone do a proper
review of that total drug
regimen to make sure there are no
interactions, duplications of
therapy or potential for adverse
effects?
So this was something that was
discussed 20 years ago when I was
in pharmacy school.
About patients not having multiple
pharmacies, but having one pharmacy
be able to be
part of their healthcare team.
And maybe, you know,
that's something people don't quite
understand until they have a lot
of medications.
They have a parent who
maybe has memory issues
and doesn't
remember all the medications they're
on.
Absolutely, yeah, it's a very
true statement.
We get asked all the time,
just because of accessibility,
people will walk in, you know, I
have a question regarding this, or I
have question regarding my blood
sugar monitor.
Can you help me learn how to use
this? And we are accessible.
Pharmacists and pharmacies are one
of the most accessible healthcare.
You can't walk into your doctor's
office and say, help me with this
inhaler, I'm not sure I'm using it
properly, but you can walk into you
pharmacy and we're gonna help you.
Um,
you know, thinking about
coal walking in and
being told now this is what
your medication costs and having to
see that patient walk away, what is
it like to be a pharmacist
and see patients
going through something
like that where
they can't get their medication,
where they're confused,
they're scared,
what does that like for you as the
That's what we went to pharmacy
school for. That's why we wanted to
help.
Because we want patients to
optimize how they use their meds,
be able to have access to their
medications so they can
be healthy and well.
That is our ultimate goal.
And when we have
policy and regulations
that are in the
middle that don't allow us to
do that job at the ability that
we are able to do it.
Is heart wrenching.
I mean, we've had patients crying in
our office, in our pharmacy,
just because they either
can't afford their medication, and
we tell them, I'm not even getting
reimbursed of the cost of this
medication, so it's not me making
all the money, and
or that we
had another patient that because
the reimbursement was
so low, they went to
two different pharmacies and then
finally came to us.
To be able to get a glucose monitor
for their daughter.
And they were denied service by two
other pharmacies because when they
sent the claim through for this new
patient, they were losing money on
it.
And so being able to provide
that service to patients and
to be part of making sure
that they are taken care of is
really what we wanna ultimately do.
And it's hard to do that if
you get to the point where you have
to close doors.
It's exhausting.
You know, it's very difficult.
We have been in business for
over 70 years, and we
look at our financials
every month.
And it's scary.
And we think about how
long can we last?
How long do we have it in us that we
can continue to do what
we do, do what we love,
continue to serve our community,
continue to employ.
Other members of this community
working locally,
paying taxes within our community
versus sending it out of state or
out of the country.
We know that we also provide a safer
alternative for patients.
With the regulations of,
or the lack of regulation for
patients purchasing outside of the
county unsafe,
who knows what type of medication
they're getting or what they are
getting.
Yeah, someone told me about
being on an alternative
funder, and their
only option was to get a medication
not from the US.
And it was a Crohn's
medication that needed to be
refrigerated. And so they just
couldn't trust that it was
going to get here.
Yeah, it's scary.
You have medications that are
extremely costly,
being, you know, patients coming
having to get them from out of
state, and then the potential
storage issues, especially in states
like Wisconsin, where we have
extreme colds and extreme
heat.
And knowing that this medication
needs to be in a small window
to stay appropriately
viable
for the patient is very
concerning.
Anything else you want
to add?
I guess my final statement
is some people say
that the system is
so broken that
that's why they're not sure
that PVM reform is the way to go
is because it's
only a small drop
in the ocean.
And my answer to that though is this
is the hand we're dealt and this is
what we have to deal with and we
have to continue to make.
Progress and this is the first step
that we need to continue to make the
progress that we need and give us
a chance to continue to get our
voice out there of what needs
to happen so we can go back to
the model that we had 10-15 years
ago where we were serving our
patients and
being a part of their healthcare
team.
So, PBMs are just so
powerful that they
have the ability to be predatory in
many different ways,
like audits, for example.
The bill made it sound like
you do one thing
to challenge
a PBM and they will come in
with an
audit that feels retaliatory.
Sure, yeah.
Audits, unfortunately, can go back,
I believe, seven years.
And so, I mean, how do
you try
to recoup something that happened
seven years ago from your patient?
Your patient may not even be in the
area or even alive anymore in
the areas.
I've had specific pharmacies
say that they believe that they were
specifically targeted because
they tried to stand up to
the DM.
And they had that.
I feel fortunate that we haven't.
I don't believe that we've had that
type of reaction for us personally,
but it's not unusual to
hear that from other pharmacies
in our state and across the nation
that they're hearing that type of
thing.
So the PBM itself is
performing the audit.
Yes, and they will defend themselves
that they have to do this because
that was part of CMS's
requirements to potentially
look for potential waste
in the system.
And so they wanted to make sure that
there was no fraud, waste, or abuse.
However, in doing this,
I believe sometimes these become
predatory and they look
for reasons.
To give you an example, a
miscalculation of a day's supply,
they can take away the claim.
Wrong indicator, which they're not
supposed to be able to take back
money on claims for clerical
errors.
However, we've lost money on claim
because we didn't say whether it was
an actual hard copy prescription
or whether it came through
electronically.
To me that seems like an
error, a small error and shouldn't
allow money to be taken away.
But there are PBMs who will take
money away from those.
And they specifically target
high dollar drugs.
They're not looking at the
inexpensive ferrosamides or
the common things like that.
They're looking at very costly
medications and
even if you were off by a
day or two on your day
supply calculation, you're going to
lose the whole dispense, not just
off by the day or 2.
So it kind of forces
you to be on your
back heel all the time around
the PBM.
You definitely have to have your
ducks in a row and you have
to make sure that you
abide by every
regulation, every rule
that is made.
And sometimes you have adjust
because sometimes one
of the things that have
changed is with
insulin products and how you
calculate those days supply,
sliding scale insulin so patients
adjusting based on what their blood
sugar is.
Have been very common for years and
years and years.
And so, you know,
but not having proper documentation
on those that give a maximum day
supply or maximum amount that could
be used for the day.
If that's not on there, it's easily
that drug companies can or PBMs can
take away that that claim.
You know, so it's adapt constant
adapting because there's always
loopholes that are being found
to be able to continue to find ways
to take money back from pharmacies.
What about the
gag order, or like the gag
clause on pharmacists,
like you can't tell patients
about a cheaper
place to get a medication?
I'm not well versed in that,
so, sorry. No, that's okay.
Um,
those are all my questions.
Okay, do you think I did okay?
Okay. Yeah.
Okay. You find
Do you find something in there?