I was just going to say, yeah, you talked about accreditation, you know, 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, you know, we're employing 100 different people within our community.
We have health insurance fees for them to pay as well as benefits, and so it becomes
very challenging when you have such a very small margin to be able to be competitive in
the market for 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 PDMs, so it is the first step 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 Falcowski'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 to choose a healthcare 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 provider, 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 want to 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're asking for.
We talked earlier about that 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 of hospitalizations,
these things are making a difference in overall reducing healthcare dollars spent.
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.
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 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 to 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.
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 a memory issue and doesn't remember all the medications
they're on.
Absolutely.
Yeah, it's a very true statement.
I be get asked all the time just because of accessibility, people will walk in, you
know, I have a question regarding this, or I have a 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 your pharmacy and we're going to help
you.
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.
Yeah, 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 is to, 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
at the cost of this medication.
So it's not me making all the money 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 want to ultimately do.
And it's hard to do that if you get to the point where you have to close doors.
Yeah, yeah, 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, you know?
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, you know, 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, you know, with the lack of regulation
for patients purchasing outside of the country 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 U.S. and it was a Crohn's medication that needed to be refrigerated
and so they just got to trust that it was going to get here in front of me.
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, you know, appropriately viable for the patient is very concerning.
Anything else you want to add?
I guess my final statement is, you know, some people say that the system is so broken that
that's not, that's why they're not sure that PBM 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 health care team.
So PBM's are just so powerful that they are, we 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.
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 area.
I've had specific pharmacies say that they believe that they were specifically targeted
because they tried to stand up to the PBM 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.
Give you example, a miscalculation of a day's supply, they can take away the whole 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 claims 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 air, a small error and shouldn't allow money to be taken away
but there are PBM's who will take money away from those and they specifically target a
high dollar drugs, they're not looking at the inexpensive ferosimides 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 two.
So it kind of forces you to be on your back heel all the time around PBM's.
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 to 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 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 or PBM's can take away that claim.
So it's 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.
Yep.
Those are all my questions.
Okay.
I think I did okay.
Yeah.
I think you find something in there.
Yep.