Direct Patient Relationships: Insurance-Free Pharmacy with Kyle McCormick, Pharm D of Blueberry Pharmacy

In this episode of My DPC Story, host Maryal Concepcion, MD sits down with Kyle McCormick, owner of Blueberry Pharmacy in Pittsburgh, Pennsylvania, to explore his unique cost-plus pharmacy model. The conversation sheds light on McCormick's decision to operate without insurance, allowing him to provide better pricing and service to patients. With a focus on direct care, the discussion touches on the collaboration between McCormick and Direct Care Physicians of Pittsburgh, highlighting their shared commitment to making healthcare more accessible. McCormick shares his experiences in opening Blueberry Pharmacy amidst the challenges of the pandemic and offers insights on how his approach is changing the landscape of pharmacy care. By emphasizing transparency and affordability, McCormick offers a compelling alternative to traditional pharmacy practices. This episode is crucial for listeners interested in innovative healthcare models, the evolution of pharmacy practice, and the collaborative efforts to improve patient care in the direct primary care environment. Tune in to discover how McCormick is redefining pharmacy services to prioritize patient needs over insurance bottlenecks, building a community-focused service that truly values individual care.

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Transcript

0:57

Hey there, my DPC story listeners this week on my DPC story, we're doing things a little differently. I had the incredible opportunity to fly back east to interview some amazing DPC patients and hear their stories firsthand. And while I was out there, I was also grateful to sit down with Kyle McCormick, owner and founder of Blueberry Pharmacy, a name you might recognize from a previous conversation with Dr. Natalie Gentile of Direct Care Physicians of Pittsburgh. She mentioned how they worked together during the pandemic to get people access to vaccines. And even now, over five years later, they're continuing to deliver value to their community. Together. This episode is a bit different from our usual physician interviews, but it's just as important. I want you to hear the conversation with Kyle because he's built his pharmacy around the exact same principles that we have in Direct Primary Care, caring directly for patients, and making healthcare truly accessible. Many thanks to Kyle for the conversation and to the students who got an unexpected but invaluable, deep dive into what it means to say, I don't take insurance. I care directly for my patients. Now onto the interview!

Dr. Maryal Concepcion: 1:59

Direct Primary care is an innovative alternative path to insurance-driven healthcare. Typically, a patient pays their doctor a low monthly membership and in return builds a lasting relationship with their doctor and has their doctor available at their fingertips. Welcome to the My DPC Story podcast, where each week you will hear the ever so relatable stories shared by physicians who have chosen to practice medicine in their individual communities through the direct primary care model. I'm your host, Marielle Conception. Family, physician, DPC, owner, and former fee for service. Doctor, I hope you enjoy today's episode and come away feeling inspired about the future of patient care direct primary care. Can you tell us your name and what is your professional role?

Kyle McCormick: 2:52

My name is Kyle McCormick. I'm the owner of Blueberry Pharmacy here in Pittsburgh, Pennsylvania. And, we're a different kind of pharmacy. We're a pharmacy that's called a cost plus pharmacy, which means that we don't take insurance. And that allows us to offer better prices to our patients, better service, more efficient service. And we started five years ago.

Dr. Maryal Concepcion: 3:10

Love it. And as a direct primary care doctor, I, identify with all of those things. It's amazing. You are in Pittsburgh in a place where there's a lot of different stores, even within your, business location here. And there is another pharmacy, there's CVS, there's Walgreens in a world where there is, the default same thing in medicine is that a pharmacist will go to pharmacy school and then work for a corporation. What drove you to do things differently?

Kyle McCormick: 3:38

Yeah, I always think back to, My whole career so far, I graduated in 2014, but even before that my time was in an independent pharmacy. So I've always been in an independent pharmacy, so I think I had a lot of influence growing up seeing, the small town community pharmacy in Somerset, Pennsylvania, who had wooden nickels, still in their attic, that they would hand out to patients, bring back, get free candy. So I just really like the get to know people. Aspect of pharmacy, which exists certainly in the corporate world and some stores have a lot of it driven by the individual pharmacist practicing versus the corporation. But I've always wanted to do independent pharmacy. But why I did something different, not offering insurance, goes back to a patient who was on Vesicare, um, Medicare and, um, Part D, so they hit the donut hole. It's probably like 2018. And their Vesicare was going to be 300 for one month's supply. And I looked at the bottle, we're a small pharmacy, so I could see how much we bought it for. We bought the bottle for, 5. So it was generic Vesicare, Solifenicin. So I thought to myself, well, you know, she's paying 250, 295 more than what we bought. Surely there's a world where I could just sell this to her for 20. I'd make some money. She's happy. We're both happy. And so, fast forward two years, I explained to my wife, I've got to move closer. I was driving an hour and a half a day to get to work. So, I've got to move closer. Why don't I, instead of working for somebody, why don't I just open up my own pharmacy?

Dr. Maryal Concepcion: 5:06

Yeah.

Kyle McCormick: 5:08

Just try it out and see what

Dr. Maryal Concepcion: 5:09

happens. It's incredible! And I think it's wonderful that you were able to see what an independent world looked like, because I know one of my best friends from high school, she was primarily working either at an air force base pharmacy, so through the VA, or, like one of retail stores, the big national ones. So when it comes to you deciding to then open, how did you approach that? Because you have a pharmacy degree rather than an MBA. I don't have an MBA. So that's definitely a question I'd love to know.

Kyle McCormick: 5:38

Yeah. I just learned on the fly for the most part. Um, There's resources out there, but a lot of it is just, the application process is standard, state by state. I've always been drawn to business and, so I've always listened to business podcasts and, so I feel like I knew something about business prior to, but I didn't know anything about the paperwork associated with running a business. Uh, didn't know how to read P& Ls, didn't know how to put together a balance sheet. So that was just, trial by fire and I was fortunate in my previous role, I was kind of in charge of our clinical programs, second to the boss, the owner, and so she was pretty open sharing whatever I wanted to learn. In fact, previous roles as well, I was thinking about maybe buying into the different pharmacies, so I, was looking to take a, little bigger role, so I would ask a lot of questions. What I've found out, it's easy to open a pharmacy. It's hard to build a pharmacy. So probably similar, it's easy to open a practice, but to actually grow it is where it really gets hard. Yeah,

Dr. Maryal Concepcion: 6:37

absolutely. So, bring us to opening day, because in a primary care practice especially, some of us have already practiced in the area, our patients know us, you were driving from an hour and a half away, and then you opened a pharmacy, it's a storefront, it's a brick and mortar place. How did you start getting the word out that, hey, Blueberry Pharmacy is here to help the community?

Kyle McCormick: 6:59

Yeah, that was and still is the challenge, is the education. Two fold because, historically pharmacies have been able to just open up, put a sign in the window that says accepts the most insurance plans, and patients start coming to you. that part would have been easy. Second part is, explaining why we don't take insurance. So, we're still educating on that second part. The first part is a good point. All my relationships were in Indiana, Pennsylvania. So, add to the fact that we opened March 20th, 2020, and then the state of Pennsylvania shut down for two weeks on March 23rd, 2020. So, I wasn't allowed to go to doctor's offices. Patients were locked in their homes for two weeks. Nobody wanted, to learn about our new pharmacy. So I became a mask and hand sanitizer salesperson for, six months, trying to call places, just trying to put some ads in the papers. Just telling like social media, but we really had our stride a couple of months in whenever some doctor's offices learned about, how we could save their patients money. And then we got more targeted with our approach, like knowing which drugs really make a lot of sense in the cost plus world and calling the prescribers of those drugs, whether it's, the federal I take us in calling up cardiology offices, explaining, Patients, regardless of what type of insurance they have, they could get it for 18 bucks here. So then, getting referrals through that network. And then, just building up, positive, patient experiences. And really, our two biggest drivers are physician referrals and also patient referrals. So, patients say, hey, my niece gets her prescriptions there and I've heard good things. I looked at your price checker and I'm going to come there too. So, really building up the brand of the pharmacy so that patients could feel comfortable when they heard about it from somebody else, whether a prescriber or a friend, say, well, this is a real thing it was crazy early on, a lot of our concerns that we face with patients where. Are these drugs legitimate? Like, are you, are you getting them on the black market? Uh, how are you able to do this? I have insurance. I want to use my insurance. A lot of it was like, are you getting these illegally? It's like no, they're just that cheap. So a lot of it was building up the brand and, the reviews and such that patients would feel comfortable coming to us. Regardless of how they heard about us.

Dr. Maryal Concepcion: 9:06

Yeah, and it's interesting because, even though we're in two different professions and the way we operate our business is primary care versus pharmacy. I think that when we look at small business and when we look at how much the onboarding experience, how the like the first impression really makes a difference as to whether a person stays or shares the word about what your business is, I think that's awesome. Like when I called, to schedule this interview, the, hi, it's Kyle from Blueberry Pharmacy on the voicemail, which I think is not a standard phone tree is what I'm getting at and I think that just isn't it. Already makes a person think differently about what am I even getting into? What is this? And then, when it's still connected me to a person on a Saturday, that's incredible. So props to you guys for thinking about, the entire customer journey. We,

Kyle McCormick: 10:34

want to kill all

Dr. Maryal Concepcion: 10:35

phone

Kyle McCormick: 10:37

trees.

Dr. Maryal Concepcion: 10:38

So tell me about how, because at the time, Dr. Natalie Gentile, um, was at Gentile Family Medicine. Now she's part of the direct care physicians of Pittsburgh, but that's how I learned about you because, and I laughed earlier because the pandemic is when so many of us as small business owners opened up and we're like, yup, and I'm still thriving. For you, how did that conversation go? Because Dr. Gentile is a direct primary care physician like myself. So she thinks very much in alignment with what you're doing already. How did you guys nurture that relationship to be able to especially impact people during the pandemic when, like you said, you're not able to go to offices the same as if you would pre pandemic.

Kyle McCormick: 11:22

I think the relationship kind of formed naturally in that, historically, a lot of direct primary care, do their own dispensing. And I think that's born out of not desiring to do their own dispensing, um, but out of looking around and saying, Hey, I can buy this bottle of rosuvastatin for 20, and if I send my patient out into the world, they get charged 20 for 30 tablets, like what's up with that? I will just now dispense it to them. and so I don't want to misquote her, but I believe Dr. Lynn, Kirsten Lynn, if I recall her conversation was something like, she had like 400 different SKUs, in her practice. And at the time we were a new pharmacy, so we only had like 500. So she basically was operating a full fledged pharmacy, from the volume of SKUs. Okay. And I think she said something to the effect of, I went into medicine to practice medicine, not to become a pharmacist and basically saying, in direct primary care, when you do your own dispensing, you can spend an hour a day just refilling things or, dealing with the hassle of dispensing. And I went into pharmacy school because I love dispensing medication, making sure it's safe and effective for the patient and have built a whole model streamlined around that. So I think. Whenever they looked around and saw, hey, well, there's this pharmacy that's actually charging prices correlating to what the drugs actually cost. Why don't we just figure out a way to work together a little more closely? And then, then we don't have to do all of our own dispensing and refilling and all that stuff or stock our own vials or, print our own labels and have a whole separate, workflow around that. And so I think that's kind of how It came together quite nicely. They held a whole bunch of different flu clinics, during that time, so we would help. We were, authorized to administer injectables, so we'd, suit up and, deliver a vaccine. not just flu clinic, but also during the pandemic for COVID shots. We helped out with their COVID vaccine clinics. So, it's just been a lot of fun getting to know the crew there, caring for patients just this morning. I had, one of our students on, Dr. G's, EHR. And I think that's a cool collaboration too, where, instead of having to bug doctors by phone, just being within their existing workflow in their EHR, collaborating on, patients, Dr. Scott, another one of the physicians of Pittsburgh, just yesterday I think, it was a whole long list of, herbal supplements and stuff and basically asking are any of these interacting, and so running them through our interaction detector that allows for the different supplements and everything to kind of look at everything and putting that note right back into the EHR so that she doesn't have to, merge anything between text or email or anything like that, it just all sits right within the EHR. It works out really nicely, so.

Dr. Maryal Concepcion: 13:59

I think it's incredible, and I think that it really holistically feeds into the education about the community, because even though you guys are two separate businesses, technically, the fact that you guys are working together, from the patient's perspective, it looks like I go here for direct care, and I go here for direct pharmacy, and it's one ecosystem, which I think is so helpful.

Kyle McCormick: 14:21

It's what the health systems that are vertically integrated state that they do. Yeah. That's their end goal is to have that level of care and detail, but the two systems, like even within the health center, they don't talk to each other. So it's like, whereas we're two separate businesses in theory, shouldn't be as integrated as we are, but somehow we figured out a way to make for a better patient experience.

Dr. Maryal Concepcion: 14:41

Yeah. That's totally amazing.

Kyle McCormick: 14:42

Yeah.

Dr. Maryal Concepcion: 14:43

That's awesome. So, Other than, like, are these drugs off the black market, what questions do you get about healthcare where you are, where you have unexpectedly been an advocate for people in their healthcare insurance, but also their pharmacy benefits? Because I'm sure that because you're doing things differently, people ask you questions about, like, Well, my sister has this, does she need da da da, or, what types of questions do you frequently get from customers, because they want to know more?

Kyle McCormick: 15:18

Yeah, education is the key, I think, to your comment earlier about, UPMC being right here. All that we get marketed in Pittsburgh, if you look at, all types of ads, is the UPMC high mark, like billboards, that, commercials on TV, that, so you think that you can't live in Pittsburgh and not have UPMC. You know, those cards in your wallet with those two brands on them. And so a lot of it's like, well, I have insurance and, you know, I want to be able to use it. It's like, well, great. Just like you have car insurance. You don't try to use it for your gasoline, your oil change, your windshield wipers, like you literally try not to use it. Like that's the goal. Every other insurance product we try not to use, and healthcare, we think it's. It should be the other way around, we should want to use it for everything. So a lot of it is just explaining and drawing, I love the oil change analogy and I know it's used often in the direct primary care, I probably stole it from the direct primary care space. but bringing those analogies in so that it makes it more relatable for patients, that's often the most common question we have because about 90 percent of our patients do have insurance, it's not like we're caring for all just uninsured patients. So really helping them to understand why we exist. A lot of them as well, I have 0 copays, on this. Why should I want to get it from you? Well, you don't have to. I'm not trying to get you to do it. But the reason you should want to is, 0 doesn't mean free, right? And there's always a cost. So I explain, as a patient, so I want to hear this, but your premiums will go up next year. The more often you use a 0 program, it's not free, so they're just adding up those totals. That's what they raise the premiums by next year. so there's some of that education, but we'd rather have free in the moment and pay for it later.

Dr. Maryal Concepcion: 16:57

Yeah, totally.

Kyle McCormick: 16:58

Then, pay for it now. But then there's also the, service component. So if you're coming about, phone trees and stuff, if you want your zero dollar co pays, you're going to have to go to the pharmacies that offer them. And those pharmacies like CVS have eliminated talking to a person. Unless you go on the doctor line. And pretend to be a doctor. You can't talk to a human. You get put through to voicemail and then you leave your message and within some amount of time later you'll get a call back. So if that's the level of service you want, then 200 will work for you. But advocating for, the higher level of service, and I had a patient today that I was sharing, what's the cheapest way to get food? And he's like, well, eat at home all the time. I'm like, do you eat at home all the time? No. We go out to the restaurant sometimes because we want that added level of service. Or better quality food, or similarly in healthcare, if you want better quality, often that means potentially higher cost. Not always. Majority of our patients, 80 percent of the drugs we get sent here because it's actually cheaper. It's our model. But there's, patients that actually value the level of service that they get such that they don't really care about the costs, they just want that level of service.

Dr. Maryal Concepcion: 18:00

Yeah. And I think about The avatar that we really cater to in the direct care movement, and I think that those people do think about what is the overall cost, including if I continue to do this, does my premium increase next year for whatever it is? And we saw that with Medicare last year, like, Now, it's 170 plus dollars a month and people are like

Kyle McCormick: 18:23

with a$5 billion prepay. Yeah. From the federal government. Yeah.

Dr. Maryal Concepcion: 18:28

Totally crazy. And I think also, one of the things that I love about your pharmacy is that you exist. Like, whatever we see happen with Medicare Advantage. Medicare Advantage historically is privatization of Medicare. Mm-hmm And so when we have people who are even more affected. One of the most frustrating and saddening things we see in primary care is you don't get care because you're afraid to go bankrupt to access the care that you need to be preventative so it doesn't get bad, later on down the line. In addition to like the best of care, have you had, a patient story that really sticks out where a person literally could have gone down a completely different pathway had they not had access to

Kyle McCormick: 19:10

you? Yeah. One of my favorite patient stories, one of my favorite couples was one that got referred to us early on because of the cost for her husband's nebulizers. And it's silly of me for not thinking, Why is this an issue for the patient? Because I'll get to that story later. But, uh, so we were able to get his duodenal nebulizers down from through the marketplace, 100 plus dollars a month, down to 20 some dollars for the nebulizers. And then we did that for all of his generics and all of her generics. Fast forward, a month and she's like, well what can you do for my insulin? Because it's 100 dollars a month for the insurance and I just don't have that. So, we looked at what she was using, called the insurance company, three way call, figured out the different tiers, thought that the basic LR would just be 50 a month, but then there would be a coupon, called Giant Eagle, got the coupon applied, called the doctor's office, got them to switch it, so we don't stock brand name products. So we did all that, got the basic LR down to, I guess that one was 5. No, that one was free. So then fast forward, nurse calls three months later said A1C is still not where we want it. We want to add a GLP 1. Which one should we use? And I thought this is what I went to pharmacy school for. Physician, prescriber coming to me with a diagnosis asking my opinion on what drug to choose. Like, this is awesome. Uh, so, you know, did the same thing. Called insurance, looked at the different coupons out there. And, found out that her Ozempic would just be 5 for a 75 day supply. Got them to call that in, got that applied. Couple months later she came in. She comes in all the time. I said, I'm down 10 pounds. My A1C is headed in the right direction. It was still 8 or something like that. But, headed good. So then, I started a month in the, the, uh, The husband's like, well, you know, my wife had a lot. What about my Brio? It's like, I didn't even know you were on Brio. Why did you, because we get a full list, whatever the patient reported. But in the back of my head, I was like, I should ask why you're using your doing them so much lesson. He didn't tell us about the Brio cause he wasn't taking it cause it was too expensive. So did a kind of analysis why he was on it. It was for your COPD. It turns out he probably should be on triple therapy anyhow. Called the doctor, got it, called the pulmonologist, got it switched to Trilogy, called John Eagle, made sure they applied the coupon correctly, turned out he called me two days later after he picked it up and said, Kyle, I can breathe again, because he's now using a maintenance inhaler for his COPD. so that's probably my favorite couple story of, just helping them not only lower the cost of their care, but actually moving metrics on. and the whole care collaboration was really cool aspect of it too, so, uh, yeah. And I, I think the one interesting thing is a lot of pushback we get from maybe peers within the pharmacy world is, well, you're creating, or even, you know, healthcare is a large, we're creating maybe, we're fragmenting care a little bit because we're involving more than one pharmacy. I push back and, and, yeah. We're a generalist whenever it comes to pharmacy. No pharmacy can carry 100 percent of drugs. There's just too many, too much of a cost difference, like nowhere else in the world will the same company sell a penny product in a multi million dollar product, which is what exists in the pharmacy industry. So that's not possible. So we have to use more than one pharmacy, but the real difference between what we're doing versus elsewhere would be that we operate from the base assumption that we don't fill everybody's prescriptions. And therefore, we better make sure we know what the patient's on. So the story I shared with you, we missed one key drug, which was the Brio that he was supposed to be on, but he wasn't using, but we still get a full medication list prior to filling every prescription just to make sure that everybody's on. We understand what they're taking, checking for interaction. This is crazy, but some of the chains don't actually allow for you to check for drug interactions on outside meds. So like you have to free text that in the big chains. I won't mention them. and so just think if that system, if somebody is filling something somewhere else, not only are they likely not asking for those types of questions, but even if they did ask the question, they have no way to put that within their workflow. Okay. to make sure therapy is safe and effective for patients. Yeah,

Dr. Maryal Concepcion: 23:23

absolutely. And if they're even allowed to because, I've heard from pharmacists More knowledge is more

Kyle McCormick: 23:27

dangerous, yeah.

Dr. Maryal Concepcion: 23:29

I mean, even when a person goes to a typical nationwide retail pharmacy Yeah. Um, I mean, that, the, um, the tragedy of the, the son who needed, um, I, it was, I think albuterol. It was Advair. Yeah. So Advair, yeah. And, you know, it was, it was 500 and the, the kid didn't pick it up because they're not going to pay that and then had an asthma attack and died. And it's like, that type of stuff, it's like, Most people know about, for example, GoodRx, and if you're going to even go to a pharmacy where you don't have an option of having a mom and pop, quote unquote, independent pharmacy, and that's your only way to access cash pricing, I think it's, it is so sad when we talk about, Corporate medicine, we usually say like it's usually not the doctor's problem It's the system, but when you have an individual who knows that like for example, I sent a patient Who needed a steroid to go along with their new start? treatment for multiple myeloma and instead of saying we actually have the decadron and in these doses the one that I had ordered was not available and this a couple had to drive 30 minutes one way to get to the pharmacy to be told we don't carry that. And then I had to call to say, do you have it in a different dose? Sure enough, we do. But I think that just, you know,

Kyle McCormick: 24:52

we're not allowed to use our brains. Yeah.

Dr. Maryal Concepcion: 24:54

And I think that, the system

Kyle McCormick: 24:55

doesn't allow us to use our brains.

Dr. Maryal Concepcion: 24:56

Yeah, and I think that the fact that you're a operating from an advocacy perspective and I totally hear you like the braille like lesson learned that's definitely you know always going to be in your workflow now but the idea that you have the ability to ask the time to ask and then the time to change your workflows based on what you find or your team finds I think that like in direct primary care the patients love the relationship that they have with their doctor it's the same thing that you're doing with your patients because they know oh I go get my medicine from Kyle at Blueberry because I know him. He's not whoever is the locum's like coming in today to run the register. And I really also love that as a pharmacist that you get to use your training in clinical pharmacy and not just like I know how to work the cash register. Yeah, that's amazing. That's amazing.

Kyle McCormick: 25:46

Yeah, and to a lot of our conversations around insurance, I'll just share that most You Other systems aren't allowed to use their brain or don't have time to use it because of that model. The only reason we're able to have time to spend with patients is because we do charge for that time, right? It's small amounts, but a lot of pharmacies, they make pennies per prescription and it takes a lot of prescriptions to pay is the salary of everybody working in the pharmacy. So they literally don't have time to think, what other Dekadron do I have on my shelf? Yeah. Which is just like crazy. Not only like to think about, oh, I do have other Dekadron, but the fact that it would take, 20 minutes to make that call to, uh, to physician and make that change, versus just telling the patient, I don't have it. Sorry. We just default to the system. I don't have it. Sorry. Yeah, totally. Yeah.

Dr. Maryal Concepcion: 26:36

Totally. So clearly you have students coming in to, see what's going on here. What are really high level things that you tell everybody who is a student in pharmacy, especially coming in? Or if there's a DPC physician or soon to be DPC physician who is wanting to know how you're integrating with the direct care physicians of Pittsburgh.

Kyle McCormick: 26:58

Yeah, the students, we have like topic discussions, and we kind of just like throw them in, so So we throw them into workflow, because I feel like the best way to learn is just to get Thrown in, with safeguards. Obviously we're, we're a pharmacy. But yeah, so a lot of it's just, experiencing it, from an outsider from say, whether it's a DPC or we do a lot of presentations to different patient groups, support groups, legislators, politicians, we've had many people rotate through here. Even talk to Mark Cuban, CEO, of Al drugs. Back in the day. So, whether it's that outsider perspective, I usually walk through examples is the easiest way to talk through how things work. So, pulling up a drug, showing them, the one slideshow I have that I usually use is how the system operates. It takes this 10 Duloxetine Generic Cymbalta, jacks it up to 1, 700 to bill the insurance. Insurance only pays 1, 100 and then claws back 975 fee. All to present the patient with a zero dollar copay, but put them in the doughnut hole four fills later. It's very complicated, but that's literally what happened with this one example. So seeing how complex that is, how many people make money off of it, and the hoops the patient, has to jump through in that model versus just showing the patient a 20 copay, right? And getting them out the door same day. So I think walking them through, just kind of giving examples, showing This is what it costs in the traditional system. Here's where its money is made in the traditional system Versus here's how much it costs in the hospital's model and how quickly we can get it out the door. Some of our most common dispense medications are actually chemo agents. So, maybe number one, is actually capecitabine. The practices that write for it are used to sending it off, waiting a week for troubleshooting to happen with a specialty pharmacy, denials, high copays, etc. Comes back to us and they're like, well, you know, we finally got the auth approved and it was going to be a 900 co pay and we know that you just charged 50. I'm just like, wow. So we get out the door the same day, patient or patient comes to pick it up. When we ship it to them, usually gets there next day. So within 24 hours of us receiving this prescription, it's already in the patient's hand. So I think that's eye opening for them to just realize that, We haven't quite convinced them to just send it to everybody. Forget all that complexity. Forget that, you know, making specialty pharmacies, millions of dollars off that complexity to send everybody here. I understand. But we're working our way towards, convincing people that, even if you get it approved, it's unlikely to be less than 50. Even if it is less than 50, was all that hassle worth 50? So those are some of the remaining hurdles that we, come up against, but showing those examples in real time, where it's like, patients who've gone through chemo or are about to go through chemo, scariest period of their life. And you're showing that like they've just fought a week with an insurance company. The amount of relief that you can hear on the phone of like, are you kidding me? We did all this in the past week, delayed care, all that over. Sometimes it's less, sometimes it's like 32. Yes, that's exactly what the system did for the last week, was, mess up, your life for 30 bucks. So, when you share examples like that, especially like legislators and, they start to, Really understand it.

Dr. Maryal Concepcion: 30:15

Yeah, and I'm sure you've heard tears on the phone of relief also, because I can just I've heard swear words, not you, but Tears, too. The opposite of what I was saying. So, if patients are hearing your words, and they're like, I totally get it, but I don't know what to say to other people, because just like you said, education is a huge factor in being successful at business in the direct healthcare space. So what would you say to those people who are patients to help empower them to elevate what you are doing in their own words? Because I do think that absolutely story and sharing their own story is always going to bend the ear differently than, a journal article, especially these days.

Kyle McCormick: 30:57

Yeah. Patients are tricky cause they don't know what to believe. And having a trusted healthcare professional definitely helps, but if it's like their first time hearing it, I really believe they've got to hear it from multiple sources. Unless cost is significant enough of savings, I was like, well, that's a no brainer, I'll try it. I think to, like my own family, my sister, who, took two, three, four, Three and a half years of me being in business to finally understand, like, start filling it out. So, it just takes convincing. It takes people having enough of the existing system to just be like, you know what? I'm done with that model. It takes, patience, maybe it didn't make sense, but then they get prescribed something that, is huge difference. And they're like, oh, I see why you exist now. That's what we were trying to tell you. So for patients it's a lot around, having those aha moments and just hearing it multiple times. for direct primary care they tend to already come from, if they're interested, they come from the model, or from the, I get it already, so it's not so much, uh, you know, too much. Um, also, outside of that world, legislators, you know, general public, um, Yeah, showing the egregious overspend is usually the most successful. So like our favorite example is Medicare did as public. So we can just come through that and find examples. One of the ones I posted about recently would be Aberatoran, Zytiga. 2022, they spent over 830 million, on Aberatoran throughout, serving X number of patients. Those same number of fills would have only cost 15 million here. So, on one drug, the U. S. government could have saved almost a billion dollars just shipping them all here. Not only that, but there was probably a decent number of patients that decided not to get their treatment in 2022 because of the cost. So not only could we save money, but we could actually have treated more patients. so yeah, it's just showing those numbers and, And then you're like, well, I mean, anybody that looks like that number is like, that's acceptable is. There's people that do that, but you're telling people profiting off the system or just can't understand the system, but yeah.

Dr. Maryal Concepcion: 33:02

And I think that you doing your part in educating the community, even with a set of slides, but also being at the level of, speaking to policy makers. I think that that is also so needed because it is like old school, way of doing medicine in the modern day with just transparent pricing. Like you have your neighborhood https: otter. ai a margin to be able to stay in business and to get paid for your time and quality, but you're not doing, well we're going to increase it 1700 percent and then start, dicing and slicing the price down to zero magical deductible. When you talk to pharmacy students or people who are interested specifically in knowing that there's a different model, what do you say to them to encourage them to, think about all of the options out there? Because I feel that, in training at my residency, it was not, it was not even an option to, think about hanging your own shingle? And we did have, I think maybe a day or two of exploring like what a private office was, but that private office was still in the fee for service space. So what do you say to people? Because there's also for example, UOP pharmacies, that's the pharmacy school near myself geographically, they can go out of state to do rotation. So like,, what do you have to say to people who might not have a blueberry pharmacy or, an independent near them?

Kyle McCormick: 34:34

generally a lot of the same slides. I'll be honest, I recycle slides a lot. but it's a lot about, here's how the system works. And a lot of students who, especially students who experience the system, while they're working at one of the chains, seeing patients, not be able to afford their medication, having to deal with all the, patient pulls up with, Single care card, good or X card, dark saver card, Amazon card, and it's like, try all these. And it's like, well, shoot, if I already didn't have enough to do today, yeah, let me try all those cards for you. Dealing with prior authorizations. And they kind of know, that the current system doesn't make much sense. And then showing them a model that's just more intuitive. I think helps them to kind of put pieces together and then showing examples. So a lot of the same examples of just like you can actually help your patients that have insurance and make it cheaper by not using their insurance that's like mind boggling to people. And then, being a rotation site so that students can actually live it out, experience it, challenge whatever preconceived notions they might have about the model. I think it's super important. But yeah, I think also just it's a lot of education, so, I think, being active in the schools of pharmacy, is important, it's a lot of work, but it's important, to state organizations, things like that, because unfortunately, and I'm sure this happens a lot in the primary care space as well, there's really not people in those schools. institutions practicing, and so they're teaching a lot from books or lived experience from 20 years ago, which was valid 20 years ago whenever they lived it, so, it's not real life examples, and so I think that as much exposure to what's actually happening and. What are some solutions to those? Uh, is important. So, yeah, I try not to focus too much on the negative system, more offer up here's how we can just make it better. I was at a CE this past weekend, and it was students, and, a friend giving it, so I, and he didn't get Leanne because he's operating his own costless model. And so the three people that presented before him were talking about all the different things that pharmacies are struggling with. All the different closures of pharmacies. Here's how they may lose a hundred dollars every time they fill a Nosempic. Here's all the negative things. Here's how much you, as students, cost our pharmacy. It's like, it went up to, like, Brandon. It's a good presentation, but. 90 percent of it was so depressing. Like what? Like, That's not gonna get students to want to go into community Like, you need to flip that 10 percent on like the negative 90 percent on here's how much it could be better. So I think a lot of it could be, on being better.

Dr. Maryal Concepcion: 37:05

Amazing.

Kyle McCormick: 37:06

Real quick though, on your, paying for things and chicken eggs and whatnot, and the, doctors of the past, This is a doctor in Pittsburgh. He doesn't do direct primary care, but it's probably similar. You might have heard about his model. It's a health clinic. So I was once explaining to my mother in law cause he was one of her probably earliest prescribers who kind of learned about the model cause we've practiced both in Indiana, Pennsylvania. I didn't realize he was coming off to Pittsburgh to open up his own insurance free primary care practice. He didn't realize I was coming to Pittsburgh to open up my insurance free pharmacy practice that we get here, April of 2020. He's already been in practice for a couple months and he sees the newspaper article and he's like, Hey, we should talk. And I was like, okay. Well, his model is, 40 and then 10 for each additional problem. And so I explained to my mother in law how this works. It's just like an insurance free pharmacy. Like, what's up with that? I said, well, take this primary care example, right? You walk in, you see a doctor. It's the actual doctor. You pay him 40, 10 for each additional problem. Doesn't even have a secretary or like anybody. And, you can treat everything pretty much. And then you walk out, you're treated. And she's like, that sounds a lot like what it used to be in the 70s. She's like, I remember being taken to the doctor and I think we paid five bucks. And, we just see the doctor and, generally not have to wait very long and, we just get out real quick, be treated. And wouldn't you know, I went to an inflation calculator and 5 back in the 50 years ago equals 40 today. So I was like, literally, it's the same thing. We just went through a 50 year period of insurance dominating everything only to discover what we were doing was a lot better and cheaper. So I just thought that was interesting that like the math worked exactly to the inflation calculation of yeah, we just need to go back to how primary care was practiced, A community primary care physician who doesn't have to see an inordinate number of patients, who charges fair prices, somewhere in pharmacy where you can actually, exist without taking insurance and prices are actually fairly affordable.

Dr. Maryal Concepcion: 39:05

Yeah. That's amazing. Well, I appreciate you, sitting down and, and chatting because, you know, I think that absolutely, education needs to happen, and this is a way that we are educating people to share examples of your patients and how they've been affected, and how you as a pharmacist, not a cashier, is able to deliver quality pharmacy care to your community. So I appreciate

Kyle McCormick: 39:27

all you're doing. You give people voices, so I appreciate that, and being able to spread them worldwide, that's awesome.

Dr. Maryal Concepcion: 39:38

Thank you for listening to another episode of my DBC story. If you enjoyed it, please leave a five star review on your favorite podcast platform. It helps others find the show, have a question about direct primary care. Leave me a voicemail. You might hear it answered in a future episode. Follow us on socials at the handle at my D DPC story and join DPC didactics our monthly deep dive into your questions and challenges. Links are@mydpcstory.com for exclusive content you won't hear anywhere else. Join our Patreon. Find the link in the show notes or search for my DPC story on patreon.com for DPC news on the daily. Check out DPC news.com. Until next week, this is Marielle conception.