MOUD Prescribing Authority and Practice Implications

Access to medications for opioid use disorder (MOUD) remains a critical component of addressing the ongoing opioid crisis, and recent federal authorization now allows pharmacists to independently prescribe buprenorphine following appropriate training. This course reviews the regulatory changes, outlines clinical and operational considerations for pharmacist-led MOUD prescribing, and discusses the opportunities and responsibilities that accompany expanded prescriptive authority. You will gain practical insight into how integrating MOUD prescribing into pharmacy practice can improve treatment access while maintaining safe, evidence-based care.
 
HOST
Rachel Maynard, PharmD
GameChangers Podcast Host and Clinical Editor, CEimpact
Lead Editor, Pyrls

GUEST
Korey Kreider, PharmD
Pharmacist Owner
Medicine Man

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PRACTICE RESOURCE
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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe recent federal policy changes authorizing pharmacists to independently prescribe buprenorphine for opioid use disorder.
2. Identify clinical, regulatory, and workflow considerations associated with integrating MOUD prescribing into pharmacy practice

Rachel Maynard and Korey Kreider have no relevant financial relationships with ineligible companies to disclose. 

0.1 CEU/1.0 Hr
UAN: 0107-0000-26-150-H01-P
Initial release date: 5/11/2026
Expiration date: 5/11/2027
Additional CPE details can be found here.

Transcript

SPEAKER_00 0:03

Hi Healthbart Pharmacist, from your education partner CE Impact, this is Game Changers. I'm your host, Jen Moulton. And each week we have a conversation on a hot clinical topic that will keep you current in practice and position you as a resource for prescribers and patients. Thanks for listening in.

New Federal Law On Buprenorphine

SPEAKER_01 0:22

Welcome to the Game Changers Clinical Update podcast. I'm your host, Rachel Maynard. Today we're going to be looking at how pharmacists can support patients in increasing access to medications for opioid use disorder. That's because in December, the Support for Patients and Communities Reauthorization Act of 2025 was signed into law, allowing pharmacists to prescribe buprenorphine after completing an eight-hour training. This actually builds on prior legislation, but it further opens the door for more pharmacists to prescribe buprenorphine and increase patient access to care. So in this episode, we're going to clarify those changes, discuss how this may impact care, and review some key clinical and practical considerations for managing opioid use disorder. And to do that, I'm so excited to welcome our guest, Dr. Corey Kreider, who has firsthand experience in this area. So welcome, Corey.

SPEAKER_02 1:08

Thank you very much.

Corey’s Community Pharmacy Background

SPEAKER_01 1:10

So excited to have you. I know you've been on the podcast before and shared a little bit about your practice. But for those who aren't familiar with you, if you could just share a little bit about your background, your current role, and why you're passionate about this topic.

SPEAKER_02 1:21

Absolutely. My name's Corey. I've been a pharmacist for wow, 2014. WSU GoCooks actually came back to where I grew up and became a compounding intern to a pharmacist and then to I own four pharmacies now. I love my community. It's the type of community that my patients actually knitted all my blankets for my kids when they were born. Oh I'm very close to my patients and my community. And when this topic hit, I wanted to be part of it. I'm I'm the type of pharmacist that wants to try new things and also master those things. And this was something right up my alley. And just it's a big thing. And I love being a pharmacist. I love challenges and the clinical side of it.

SPEAKER_01 2:09

Amazing. Well, I even chatting just before we started, uh, I can tell you're very inspiring. And I'm so excited to have our listeners learn from that and be empowered by that too. So since you've been involved in the space of buprenorphine prescribing for opioid use disorder for a couple of years now, can you share what how how you got started into what the law allowed for you previously and what might be changing with these new updates?

SPEAKER_02 2:35

I have a very unique situation because the state of Idaho was it's the best state, and I'm biased, the best state to practice in. They made a rule with standard of care and they they got it passed, but pretty much it gave us full authorization to prescribe. We can prescribe anything with our practice of education and what we deem, hey, we can do this. And you have to prove it, of course. But with this going forward, it's these clinics around here started kind of running up the price on patients and they wouldn't bill Medicaid or insurances, so it was cash. And state board and some other higher people in the state Idaho were like, we need someone who can bill Medicaid and do this as a pharmacist and show pharmacists we can do this. Like, this is what we're trained to do. And I said, Absolutely, I'm in. Like, let's do it. And I did the training, I did the eight-hour and then I did the 16-hour MD course. I think the eight hour is the mid-level, but then I want it to. My state board inspector, Wendy, is amazing. She loves when I'm above board. She wants me over and beyond trained. And so no one can question what we're doing. So, of course, I did the 16 hour, I did the eight hour, I've done so many other ones just so I was prepared for this. I got my DEA, I was able to launch, and it was it was pretty much running from the start, getting patients. And the biggest thing was it's kind of funny at the time. Everyone thought it was not real. They're like, what? You can bill Medicaid? It's zero dollars for me. And I said, Yeah, they didn't believe me until finally someone did it, and they're like, I'm gonna take a leap of faith on you. I'm like, okay. And they're like, there's no hidden bill. And I'm like, no. And they're like, well, I'm used to paying$300. Is that gonna come later? Nope, it's zero. And that was the hardest thing at first. Then it spread kind of like wildfire, like, no, they're actually can bill your insurance. Then it started picking up, and people, again, I'm I love my community. And when they were telling me, like, Corey, you don't understand, I had people crying, saying, I can actually afford groceries or gas in my car or rent. Like, that to me was like that, we're winning, guys. This is what we're doing as pharmacists. Like, pharmacists are the probably the most accessible provider there is. I'm sorry, I'm not biased. It's you can pick up, you can call someone a pharmacy and talk to them within five minutes, unless, unless you're a big chain and maybe it, maybe it's a little longer. But you can talk to a pharmacist. You can't call your your your doctor, your provider, and be like, oh, five minutes? Oh, wait. No. Unfortunately, it just doesn't work that way with them. And for us, we talk to you within five minutes. We can talk to you. And that was the big thing we can offer. And uh I just love doing it, and that's the reason why.

SPEAKER_01 5:32

Yeah, it's amazing. I mean, I think you you highlighted a few really key points. The patient access side of things. So having you able to prescribe buprenorphine is a huge increase in access, especially in your community where even though they may have had other other options, as I'm hearing, it sounds like those were cost prohibitive and you were able to get the service covered by Medicaid. So providing patients with an affordable option to this important care for opioids disorder, the idea that you are supporting patients regardless of where they're coming from or who they've seen in the past, I think that's amazing. And also you you highlighted that Idaho is a bit unique in the ability to prescribe sort of more across the board than even outside of buprenorphine. And so what I think is different about this new legislation, and correct me if I'm misunderstanding, but the the it's opening up the path for federal allowal of pharmacists to be able to prescribe buprenorphine, whereas before there was prior legislation that had removed the XDEAY X number for prescribing. And then even more recently, there were pharmacists that in certain states that were able to prescribe, like you, uh based on that prescriptive authority. But now this is opening it up even more. States still need to have prescriptive authority or the ability for pharmacists to initiate therapy, is my understanding. But it's a broader swath of pharmacists who may be eligible to get involved in this service. And yeah, if you have any clarifying points for that, please, please share.

SPEAKER_02 7:10

No, you're absolutely right. With this federal act, it pretty much takes away a lot of those restrictions that maybe some states are a little more prohibited on, like, hey, pharmacists can't prescribe. Well, now federally you can, and that's what they want to take. Right. They kind of figured out we have the best access. Why not use us? It's it's no different from if you remember back when vaccines were only given a doctor's office. Right. And they're like great analogy. But pharmacists do this, and then it opened up. And to me, I feel like this is on a path to really have the federal government and Medicare actually recognize us as providers, like not just with our own state Medicaid, but Medicare on a national level. And this is why it's so important. Like, I do these talks, you're doing these talks, is to get more pharmacists involved because you can do this. There is, there, there are some restrictions, but now they've opened the gate where it's a lot easier. You just got to do that. You got to sign up, you got to get your DEA. Like, there's so many barriers that got taken away, which it did. It did inhibit a lot of people. Like, you have to find a practice agreement with another provider, who's going to take on a pharmacist? Like, there's that dynamic that people just don't like. And so they just, no, I'm not going to do it. This opens up the door and it's it's very, very attainable now. And it puts us on the path to being recognized as providers for uh Medicare. And this is why I love doing it.

Getting Started With DEA And Tools

SPEAKER_01 8:34

Absolutely. So you summarize that very well, knowing that there are still, as you said, still need to get the DEA number, still need to be allowed in your state, but this removal of the federal restriction and basically putting pharmacists on par with other prescribers of buprenorphine, that's a huge change that uh is going to allow more of us to get involved. So since you've already been doing this for a couple of years, can you share a little bit about how you started getting into this practice and and what you what you you needed to do to get started? And also whether you think this is going to impact your practice at all these changes.

SPEAKER_02 9:10

Absolutely. And so when I first started, um, I was very close with my state board and they're like, Corey, you got to get your DEA. Like, this is gonna hit. And I read it all. I had my team uh kind of help me with this, and we applied, we got my DEA, and I and the cool thing was is um I was the first solo pharmacist in the United States to get his own DEA without any agreement because I hit the ground as soon as it was approved. I I put my application in two days after. I got everything done. And then at that point, it was okay, now we have to gear up, we have to get a practice going. I I I was born and raised in a community pharmacy, and you understand that in most community pharmacy, we have to pinch the pennies. Like we have to start from the ground, but we got to be cost effective because pharmacy, there's not a lot of margin. We all know this, it's not a secret. So, how am I going to build a practice on try to do as much free trials as I can? Like I had Zooms for 30 minutes for free. And then so I was able to do a Zoom. And if I have to do another one, I had another account that I can set up and an EH offer.

unknown 10:20

Yeah.

SPEAKER_02 10:20

Like I did all the free things for to help build my practice until I was actually getting cash flow in. Because as community pharmacists, we know we have to have cash flow. We can't just do this in case it goes down. And I was very conscious on price. Like I know this, so and I also wanted to do this because that's a barrier to a lot of pharmacies, is cost. So, oh, we can't do that. It's it's too expensive. I wanted to eliminate that right from the get-go. And that's what I talked to my state board with was I want to make sure this can be done very efficiently, but also very cost effective because that's a barrier we can eliminate. And I can do free trials of the EHR, free trials of Zoom, I can do free trials of these e scripting things. I can show them where to get um prescription pads. Like all these things can be done so cost effective, that's not a barrier anymore. And that was what me and my team have kind of really built on. And now that we have cash flow, we have a little more efficiency and we have memberships and and stuff like that. But um, that's what I wanted for to start the hit the ground running. And then as soon as it was up and going, I think it was July 15th, July 20th, we had our first patient by July 29th. And that was the first one who kind of didn't think we were real. Like she thought it was a joke, like, no, you're gonna get me. And I said, no, I promise. And we did it. And then all of our patients, because we were also a pharmacy that these people were coming to were like, Hey, you do know we can we can do this for zero. And a lot of them are like, No, you can't. And when we first got that patient, it then hit. Everyone's like, Oh my God, you guys are real. And then it started hitting and coming, and and we started getting more patients and then developing relationships. So that's kind of how we got started, and then it just kind of hit hit the ground running and just building from that.

Workflow Design And Visit Length

SPEAKER_01 12:10

Excellent. So there are a lot of practical tips in there, thinking about the cost saving options with the free trials of this different software and tools that you may need to get started. How did you actually integrate it into your workflow? How are you able to take that dedicated time out of workflow? Because I think that's one of the biggest challenges. And also on that point, how do you how much time do you allocate for these conversations with patients? These, I'm assuming it's sort of an appointment-based model. So, how do you fit in, how do you fit it in and how much time do you dedicate to these sessions?

SPEAKER_02 12:41

And that's the thing is um, so first, to it's gonna be hard to dedicate a person to this. I was fortunate, I was able just to take it because I'm not on the counter. So I'm like, I want to, I want to take this over and I wanna I wanna build this so then I can hand it off to my team member and actually create a spot for them. And again, that was my cost-effective way. Like, well, I'm not on the counter, I'm not costing anything. So I want to build this until it actually can generate revenue and pay for someone to be there. So that's a way people can think of it because they always automatically think, oh no, I don't want that. Or the owner or whoever's not on the counter can take the place of that person who should be doing it. Like there's different ways to work on that, but that's what I'm like, hey, I can do it. I love this, let's get it going. And I put it on there and I said, okay, I want to see how this goes. And we first allowed 45 minutes to an hour. We don't know how these go. I'm brand new to but we also we didn't, we didn't want to sit there as if as you notice, and we've had a lot of complaints uh from other providers. They just sit there on a laptop and they just they ask the most random questions. How many hours of sleep did you get two days ago? What food did you five days ago at 5 a.m.? It's like, how is that even relevant? Like we're just writing soap notes just to fill the blank.

SPEAKER_01 14:00

Yeah, yeah.

SPEAKER_02 14:01

That's what my team and I were starting to feel. Like these patients were were asking all these like things like, oh, this is what they had asked. I'm like, why? That that makes no sense. Like, we would always, and that's where we develop a questionnaire like, hey, how are you doing mentally? Like, how's your stress level? How was it? Because with with addiction, there's gonna be times where it's gonna rise. You're gonna have like we had a lot of guys going back to school, so their stress level would rise. And it's like they're gonna use more because, hey, we have to kind of counter that. Like, were they not asking you that? No, we were a flat, this is all we got. And it's like, oh my God. And that's we didn't want to be robots. We wanted someone to actually talk to them and be a person. And when I developed that with my team, we said, we're not gonna sit there and be on typewriters and be like, nope, we're not doing that. We're gonna talk to them like a human being. We're gonna, we're gonna make sure patient care comes first. And so we would talk to them about their life, about their children, about the anxiety, about anything stress-related that can cause this, that can lead to them wanting to go use again. And that was the thing they were missing. They were asking these questions that had no relevance and didn't even need, they were just blank space fillers. That's all it was. And so we allot it for 45 minutes, and then we were like, hey, we we can maybe cut this down because we started getting more people. So we're like, we may want to do it at 30 and maybe less time about, hey, how did the pigs do at the state fair? Like, but we still like because everybody knows a pharmacist is someone you talk to, like, hey, did you catch anything for you at fishing? Like, that pharmacist knew I went fishing, or we knew like someone had pigs at the state fair. So we're like, how do they do? Like, I used to when I was little, so of course I'm like, that stuck to me. And next time I saw him, how did the pigs do? And they're like, Oh, reserve ground champion, like, yes, like those are the things we wanted to ask because that makes the person feel like they're part of society, they're part of being healthcare, and that was important to us, and yeah, it's not the standard of healthcare right now because to me, I want to flip it upside down. I think it's going wrong. I think there's lots of improvements that can be done and to treat people more as people and not as a soap no. And that's what I instilled in my team. This is what I want. I want them to feel comfortable to tell us anything because believe it or not, they're probably the most honest people I've ever said. I'm like, hey, how did this weekend go? And we've had people say, I relapsed. And that was a hard conversation. It's like, okay, hey, you addressed it, you came out, you told me. Now we go from here. And that was the thing. That's why we build these relationships so they can tell us the truth. So then we know what we're up against. Because doctors and and and nurse practitioners, when they give them a statin, they're like, Oh, yeah, you're using it, right? And like, oh yeah, sure, of course. And then the pharmacist knows you haven't picked that up in four months. Like, so what do they do? They increase the dose because they think, oh, it's not working. You're taking it every day.

SPEAKER_01 17:02

Yeah.

SPEAKER_02 17:02

So we want that patient to be as truthful and honest with us so we can give them the best health care that they need. And that's where it comes down to building your practice out.

Clinical Approach And Meeting Patients

SPEAKER_01 17:12

So you highlighted a few really important points, I think. Starting out with the fact that you started a little longer to help accommodate that learning curve for you all as your team understood what the process was going to be and how long it would take. And then you could make a more efficient process getting closer to 30 minutes, and especially because you've learned from your experiences and been able to develop that questionnaire, as you said, that's more targeted to what you actually need to know and getting that information from patients. But also, as part of that, what I heard is this idea of having those open-ended questions, that open communication, ensuring that patients feel heard, that they have a safe space that they can bring up their concerns, any potential triggers, any potential anxiety or stress that they might be facing, because that's such an important point when it comes to the risk of relapse. When we're talking about buprenorphine for opiate use disorder, the risk of relapse is huge. And so we want to ensure that there's that space for patients to share those concerns. So just really, really important points for us to be thinking about as anyone who might be getting started in the space. We've we've sort of jumped right into your practice, but I do want to back up and just get all of us on the same page for listeners who may need a little bit of a fresher about puprenorphine for opioid disorder. And we talked about its role in helping to prevent relapse, but maybe just a high-level overview of when it's indicated, what are the considerations you think about when starting it? And that could include how you help identify patients or when to prefer patients. Just help us uh get on the same page to make sure we're all aligned on what we're talking about here.

SPEAKER_02 18:41

Absolutely. Um, and buprenorphine is a tricky thing because there's um there's several different ones out there, which ones were there's injectables, there's the sublingual, there's other tablets. It's it's just you got to go from what the patient has used in the past or what they've had on, and then fortunately, this actually happened to us, what they're getting on the streets. And that's the biggest thing. Like, I don't do induction yet in my practice. Um, induction is where they're kind of going that right away entry level, gotta monitor them every two hours. I don't do that yet until I'm up and trained. And that was the important role I wanted to tell pharmacists is like, I'm not fully trained, and I'll I'll be the first to admit it. But there are stuff I am trained in that I'm capable of doing. But any induction, like if they have never had it before, like I will refer to them. I have built relationships in my community, say, hey, you can you set up an appointment with this patient because of this? And they're like, Absolutely, Corey. And then they would come back and say, Hey, Corey, I'm doing methadone. Uh, I'm gonna transfer them over to you in about six weeks. Uh and I said, Perfect, I will take them over. I know that conversion. And we we work together on patient care. And same, same, they'll get a new patient, like, hey, Corey, I got a new patient for you. I'm about two weeks away. Can they set up an appointment? I said, absolutely. They give me all their kind of background, and we go from there. And that's the relationship building. And uh, like I said, I don't do induction. The one, and I don't flat out say that yet because I had a patient who was, I would have to say, is kind of my shining star. Came in, never been on PMP, never had a prescription for it, got denied from a clinic because they don't accept Medicaid, and didn't have$300 cash. And somehow he got uh heard of us, got our appointment, got in, and he told us, he's like, they they denied me. I don't have$300. I'm sorry, I live in my car. And I said, Okay. And I said, I don't have any record. Have you ever done this? And he's like, Well, I buy them on the streets. And I said, Okay, and I flat out was just like, show me. He pulled out three tablets from his pocket. I recognized them immediately. I said, Okay, those are legit. Um, you need to tell me how are you taking these? And we actually treated that patient like he told me, and I said, Okay, I did a conservative approach. I kind of chopped it in half, but I I I shorted the increments. I said, Hey, you're gonna come back in 24 hours. You're gonna take this, you're gonna tell me how you feel. Then we did it 48 hours, then we did 72, then we started doing a week, then two weeks, and then four weeks, and but I was monitoring every day, I was talking to him every day. But if I would have just flat out denied him because of the production rule, I I I could have honestly that I don't think he may be alive to this day. He was he was doing heroin, he was he was a mess. He said he's just like I lost everything, and then now I can say fully, I think he's almost a year and a half sober. He has a job, full time job, he has an apartment, he actually is seeing his kids now. So it is pretty much my my best case, and it makes me happy to this day because that patient worked so hard, and if I would have shut the door, I don't think it would have ended very well for him. So So like I said, I don't do it, but I'm never out there. Like there's ways around things. They they get in the streets, they do that. And that's where you have to really have an open mind when you take these appointments and not go in there a bit and hard set, nope, I'm not doing that. They may and though they're on the street, guys. They they buy them from the streets. And that that's a real concept you have to realize, and you can't you can't cross it off. But buprenorphine is is uh it's a very effective drug. It works very well on how you dose it. Um I've had I want to say 10% I've gotten off now completely. Where again, this is a thing where it's unheard of to have people come off of it. And I always ask them these do you eventually want to come off? I do. Okay, we'll keep that in mind. I'm not gonna pressure you. And that's the biggest thing with buprenorphine is like you never want to take that away and force a taper. You want them to be, it's no different from smoking. Smoking sensations, and you have to let it be their decision. And that's what I've done with them. And you got to understand that with Beep because some people will be at two tablets daily, some will be at three, and you have to take in that consideration, and it's okay to increase. It's okay, guys. It's the everyone's like, oh, we can't increase, we just have to go down. No, that's not true. You have to see how the patient is feeling, how their stress factors are are are taking part of them on that part of his week. So everything changes by appointment, and that's the thing. It's not a a most consistent patient population. Yeah. And have a life-changing moment, the next thing you see, and it could be a really good one, it could be a really bad one. And we have to control those emotions, and okay, to up and raise the dose or decrease the dose. And that's the nice thing with buprenorphine. You can do that.

ER Starts And Rapid Follow-Up

SPEAKER_01 23:50

Yeah. So the idea of meeting the patient where they are, both uh really holistically, so both emotionally and also with the medication itself, and helping them uh reach a therapeutic uh effect that's going to be beneficial for them and allow them to continue to work, function, do all the things that they may not have been able to do if they were otherwise misusing opioids. So that's uh that's meeting them where they are and also being very aware of any stigma and not shutting down that conversation, as you said, when something that maybe is surprising to you, it's something that you can still navigate and have the patient's best interest in mind and really work with them to help overcome many potential issues with that. A couple questions quickly. Do you ever see patients starting it in the emergency department? Because I know that's something that is of interest in across the country. Yeah.

SPEAKER_02 24:47

Yes. We've had people who literally will say, Hey, I was just in the ER, I just got released, and they would show us their like, oh yeah, you, yep, okay. And we handle it from there. Now, what sometimes those ERs will give them a three-day treatment and say, Hey, go find your um your your provider, and some will refuse and we'll kind of take it like, okay, like we've taken two of those, and and I know those situations because it was happened on a Saturday and they were able to have enough until Monday. And I'm like, okay, we gotta act. And and that's the thing too, is like I always say open mind and try to be that that community pharmacy because there's some clinics that literally will just say, no, we're booked, make room. Like people it's such a critical time, it's such a critical time, especially with this population. Like, I I hate when people say, Oh, yeah, they're booked. You just got released, like you you almost died, like they can't fit you in enough. Yeah, we'll make it work. I'll take you on, or my other pharmacist will take you on. Like, be flexible because not only that, that builds trust. And believe it or not, a lot of these people know each other, and they all talk, the community talks, and they'll say, No, they got me in right away. Like they took care of me, and that's what I want to be known for. I don't want to be known for oh, they they they were full. No, you're never full. I'm sorry. And if you say that, you're you're just being lazy. And again, that's where my non-filter comes out. But I I nope, we made it work. We I I take care of the patient. Yep, we took care of the patient. Like pharmacist do that naturally anyway. Yeah, they could at six o'clock with an antibiotic. Nope, we will take care of it. That's just in our blood. So yeah, for us, it's not a problem. We will make things work. We literally juggle a million things as pharmacists. So yeah, it was a no-brainer, but yes, you are correct. We do get those patients very rare. Sometimes they go straight into a clinic, like a methadone clinic.

SPEAKER_01 26:49

Okay.

SPEAKER_02 26:50

We do get the rare ones that say, Corey, can you take yep, we got them.

Dosing Decisions And Supply Pushback

SPEAKER_01 26:53

Like well, and I would think that for pharmacists throughout the country, as we're seeing more of that induction in the ER, it is an opportunity to be collaborating and making uh other providers aware of the fact that you offer this services. This is something you're getting into because that's such, as you say, such a prime opportunity, especially if it's happening in a time when other clinics are not open. And so the pharmacist is able to provide that care. I just think I wanted to call that out because it seems like an important opportunity there. Also, you mentioned the dosing sort of variability and how that uh can change throughout a patient's course of treatment as well as bypatient. What is sort of I I feel like there's concern sometimes around max doses and sort of what target dose you're looking for. How would you address that question?

SPEAKER_02 27:39

So I I'm my when I first started, my expertise was hormones. Like I loved hormones. There was two arms to it: labs, how the patient feels. Like some are hybrid, take them both. Some are strictly labs, some are strictly on how they feel. I treated it the same way. Max dose, like, yeah, I'll never go over. Um, I think my max one is four tablets daily. But um, but again, I don't look at max as a like, oh, it can't do that. That's the max dose. No, I have lots of people on the max dose, and they work great. I have some people on one. It it's all on how the patients feel. This is why your your conversation is so important. Like, hey, how are you doing? Like, personally, how are you doing? I'm stressed, Corey. Like, I'm going through, like, we had people go through divorces, finals. Again, there's everyone has stress factors in life. So you got to see how they're acting. And like, okay, do you have any urge? Yeah, I do, Corey. Like, I just want to kind of use and forget. And I said, Okay, like those are key points that I need to say, we need to increase. Like, we need to get this now. Where and again, it's a stigma. Everyone's like, oh, we can't go on that. It's like, and I've I've battled with my wholesaler and DEA because they're like, oh, this is this is not uh clinical. And I said, Right, okay, you're your DEA, you are going after regulatory infections, kind of like that. That's what you are. Like, you don't have the clinical where I got to meet with the patient, I got to talk to him. You're you're missing all that. You're just going 10,000 foot view. Oh, no, max dose, too many max doses. Like, that doesn't work. No, look at the patient, interview the patient. Like, and that's where people have that fear of is like, oh, the DEA is gonna get mad, the FDA and the are bored or the the wholesaler now. Wholesaler has been kind of a pain in the butt, like, because they have, unfortunately, and maybe a good thing for them, but they have ex-DEA agents working for them for their ever since they got sued, what was that six years ago for that whole opiate uh thing? Now they have these DEA come and it's like, oh Corey, you you can't do that. Like, you know what? You're you have too many patients, you're doing too many medications of buprenorphine. I said, that's a problem. Yeah, that is actually. I said, okay, what would you suggest? And one of them actually said, maybe just order less. I'm like, so you should care. And they're like, no, no, no, I didn't say that. I said, no, no, no, you did. You just said it in an indirect way.

SPEAKER_03 30:12

Yeah, yeah.

SPEAKER_02 30:13

You're telling me to refuse. And then they flat out said, Well, well, maybe it would be in the best interest for you. Because right now we look at you as a liability. I said, Oh, a liability. Being a good healthcare provider provider is a liability to you guys. That's not the wholesaler I want. Like, you should be backing me. And again, I'm very vocal, and I will get heated in that moment when they come after my patients or my prescribing. I said, No, you're wrong. And I'm gonna tell you right now why you're wrong. And that's the thing is you guys are gonna develop these practices that are gonna get successful. They're gonna have the ups of all the patients because you guys are doing it right. You guys are you guys are the pharmacist. Everybody loves their pharmacists. Like, let's let's be honest, we're the most trusted one in the healthcare. You're gonna have those wholesalers say, Oh, you can't order that many. That's too much controlled substances. You're not looking out for the patient. You're looking out for that lawsuit you got six years ago. That's not my fault. That was your fault. Like, own it. I'm doing something good for my community. Either get behind me or I'll find a new wholesaler. And unfortunately, like that's where it's gonna have to come down to because you have to have those supporting roles. But also, pharmacists, you've got to realize hey, they're just saying that. Like, until you're doing everything right, then you stick to your guns. That's the biggest thing I have for you. Stick to your guns, do not roll over. And that was the thing. My my state board inspector was like, Oh, they picked the wrong one to kind of pick a fight with. I said, Yeah, because I knew my stuff, I don't roll over, and I tend to be a little mouthy. So all three of those, they they kind of tucked their tails and they they kind of got out because I wasn't gonna have it. That was kind of mama bearing me protecting my patients.

Misuse Concerns And Practical Safeguards

SPEAKER_01 31:55

Well, and I think it's not uncommon for pharmacists to have concerns about pharmacy teams to have concerns about misuse, overuse, depending on refill patterns, depending on number of prescribers, all these things, the dosing. So, how what sort of what sort of safety considerations do you have in mind when you have a patient on buprenorphine? And what sort of red flags would you be looking for in terms of concerns around misuse?

SPEAKER_02 32:24

Because And there's gonna be misuse. And that's the thing is the and I always say, like I in the very beginning, keep an open mind. If you go in there thinking that this population is gonna use an abuse and sell these on the street, you're automatically gonna have a barrier out. It's gonna be on your face, it's gonna be how you talk to them, you're gonna talk down to them. Patient's not gonna trust you. You have to go in thinking they're here to change their lives. Now, if you prove otherwise throughout this process, that's a different now. We've only had to fire one patient over three and a half years now. So three and a half years, one patient, because we continue to say, hey, stop filling early. Like, yeah, we've had the the deaths in the family, like that only adds up so many times. Like then we draw red flags, we we chart note it like, hey, filled early one day, fill that. Should have this many left over if they filled early to go to a funeral. Like, we document everything. We know, hey, this is happening. And to be fair with patients, we we kind of give them like, hey, is everything okay? You're you're filling early. And and some will say, no, it's not. I've been using more, more than my prescription. Okay, thank you for being honest. Now I can get on board and say, what's what's the issue? How do I solve this? instead of you're selling those on the street because you instantly say that they're gone, they're gonna go find another provider, and it's just you lose that relationship. So you gotta look at, you gotta chart note all those. You gotta make sure. And yeah, there are patterns. There are, you will see it. And we've had people who we've called out, hey, you're heading down the wrong path if you think you're going to just get this from us and use and abuse and whatever. And we've shortened them down to weekly fills, to, to, to two weeks fill. Like we've had patients, we've taken them all the way down, and then they gained our trust back. And there's one story in case, and this patient was the worst. And it was someone that we've had as a patient for probably 10 years, just with other providers, but still with our pharmacy. So we knew of this patient, but the patient kept kept there's a lot of lot of question marks. And so we finally had to have a conversation with this patient. And now the most perfect patient ever, like the patient fills on time, very respectful. Nope, Corey, you set me straight. Thank you. And that was what we had to do. Just be honest with them. And yeah, and now that that's another success story we talk about because you're gonna have those people who like to bend the rules just a little. Hey, I'll fill three days early here. I'll fill three days early here. Like, hey, pharmacist, chart it, note it if it's a pattern, call them out. Don't just sit there and I'm gonna fire them. Like, get to the issue, call them out, say, hey, you're filling this. We're gonna start doing this now because we're seeing a bad trend. And that's how you have to go with your practice. That's what worked for me. And again, that patient is amazing now. So it's just like how you communicate with that patient, if you store or call them out in a good way, like that's fine. But if you make them fill, they'll just they'll tucktail and they'll run, like they'll go to another office.

SPEAKER_01 35:38

It just goes back to that open communication and reducing stigma, all of those things that have come up multiple times already, just keeping that door open and ensuring that patients feel they have the safe space to be able to be open with you and and let them know you're working, partnering with them to improve their care. This is all for their benefit. So I love that. I I think that's just such such a good way to frame the concern about misuse, is that it's not it's not an automatic fire, it's a work through this together.

SPEAKER_02 36:09

Yeah, and find out what the root problem is. You may they may not be telling you. And that's the thing is you're quick to judge, and that's these people have gotten their whole life. That's like this is also why I've built a successful practice is we we honor them, we don't judge them. Like you want to, and a lot of people don't realize, like I said in the beginning, is some of these are principals, firefighters, police officers. Some made bad choices. You are right, but they're all in our society. You just don't know it, but you think they're all they're all drug users and they live on the streets. Like, that's the stigma. Get rid of that stigma, treat it like normal people. And trust me, you will have a great practice of trusting patients and someone they'll actually confide in you and say, Hey, Corey, I'm having this issue. Okay, let's solve it. Like, that's what all my pharmacists do. That's what I do, and that's the message I bring to you guys. If you guys start your practice, be open and honest with them and treat them like people. Get that stigma. That's the number one thing I hate. And that's why and a good thing, like I built my pharmacies on customer service and not judging, like bad guys, like it will kill your master than anything.

Mono Vs Combo And Surgery Planning

SPEAKER_01 37:21

And and I love how you call out that patients, these patients, they want to get back into society. They, if they weren't, they want to hold functioning jobs, get back with their families, all of these things that just going back to puprenorphine allows them to be able to go back to functional productive lifestyles, which maybe they were not able to do previously. And so it's so I think inspiring to think about how our role can support that recovery and and patients getting back to what they want to be doing. I I yeah, I just think it's really inspiring what you're sharing and such an opportunity for pharmacists to get involved. I have two very specific clinical questions that I want to just quickly get your feedback on because I know these are also questions that sometimes come up from pharmacists, regardless of whether they're prescribing buprenorphine or not, and sometimes raise questions about towards that misuse sort of concern. So, any opportun any considerations about when a buprenorphine only product would be used versus a buprenorphine naloxone combo product? So that's one question. The second question is around people who may need or are being considered for surgery or some sort of procedure and may need to go on an opioid or opioid may be considered for pain management after that procedure. So, sort of those two questions are buprenorphine versus buprenorphine and naloxone, and what to do with these patients on buprenorphine if they need an opioid for some other reason, or if an opioid is being considered for pain management.

SPEAKER_02 38:51

Perfect. So, question one, yeah, we have a mix of combo and single agent. And I would say our mix goes heavily favorite to our single agent. We know that. Uh, and as a pharmacist, when I wasn't even a provider, we knew kind of the side effects as far as like headache, uh, gastrial intestinal issues. Like this is the stuff they would complain about and they would tell us, and we just like, oh, okay. And I would always kind of just keep it up in my head. And then when I start feeling it with them, it's like, and being their provider, I'm like, okay, I actually heard this as a pharmacist. Like, this makes sense. And so then they're like, oh, but there's attempt for abuse with the single agent. And I said, Yes, I do get that. There's also attempt abuse for the combo, like, yeah, not as great, but still an attempt, like still a controlled product. So people who who, if it was a a non-controlled, then I'm like, oh, so the the attempt to abuse is not there. So yeah, I can see everyone there, but a controlled to controlled, still an attempt. So yeah, the single agent has a higher attempt. I get that. And that's where you you kind of monitor. I have people who switch from the single agent to the the combo because they're like, no, I don't like how it makes me feel. Oh, okay, let's try the combo. Hey, this works perfect. And people who won't come off the combo. Like, I've seen it in different worlds where yeah, they're it's doing great. The combo product is doing great, or it's it's not. So, and that's where people have to kind of get in their practice and know the person, not so much the clinical side as far as like, oh, it's sure where's the attempt? Like, they're both attempts to abuse. So let's get past that. Let's let's now move to the patient. Now you have to kind of diagnose that patient and be like, what have you been on? What has worked? And just be honest with them. And and a lot of them, they'll tell you, like, oh, the the combos worked fine for me. Like, I have no problem with that. Some use the film combo. And so it's like, done. So I have a wide variety. So I don't see that, but that's a stigma that a lot of people get from as pharmacists. And that's where it's like, no, guys, when you start your own practice, you'll see it, it varies. And you really just got to get down to the patient. And and yeah, there are there are a couple single agents out there that are highly marked that have street value that people are like, boy, we want that one. And you you have to monitor that because I carry, I think, four or five different brands, whatever. Like, um, to me, it's how does the patient feel on them? How are they doing? Like, explain to me. And and maybe there's a time, hey, look, I want to switch you. I don't have these. I want to switch you. And they're like, okay, hey, that worked, Corey. That was fine. Okay, no problem. And I've tested those little things and I've tested it on patients who are actually stable. So it's not like I'm like, I'm gonna roll the dice, like clinical judgment. I'm like, yeah, I'm gonna try this one. And it was only a three-day supply, but I'm like, I'm gonna try it. Uh, I trust this patient, we're gonna find out. And so it worked. Question two, we've had this many times, and this is the important thing is your communication to your patient. Hey, does your provider or surgeon know you are on this? No. They need to call us and we can talk to them. And we've had surgeons call us, like, hey, Corey, we're gonna put them on this, this, and this. I'm like, okay, I'm gonna stop a week before. We'll kind of maybe three days before it just depends on when their surgery is and how how big is the surgery? Like, we've had total knees, we've had small little incisions, like it just varies. But the surgeon will say, Yeah, I want them on this, this, and this. And I said, Okay, let's let's do that. And then when they're done with that, we'll he'll he'll assess quality of pain and control and all that, and then he gets back to me. Like open relationship with surgeons. And that's the important part with you guys is you gotta have that relationship with the with your patient to tell them they need to call us because you can't just stop this. There's gotta be right, right, a moment where you have to go on these to treat the pain, and then we kind of convert you back. And we've had that issue, and that's that's how you solve it, it's just the communication. And the surgeons are fantastic. Like everyone that I've dealt with, they're like, Oh, yeah, Corey, we've done this before. And and sometimes, like my first one, I was very new to this. And I'm like, oh, okay. And then I was trying to like read all the the stuff on it because I knew that surgeon was gonna ask all these questions. And he came in and I was very honest, like, yeah, hey, doc, this is my first one, like as far as kind of going back and forth. And he's like, Hey, Corey, I've done this so many times. Here's what we do. And I said, That makes sense. That was one of my options. He's like, Yeah, this is the most success I've seen. And I said, I'm gonna follow your lead. And that's me trusting that surgeon, like that surgeon's trusting me to take on the done with that, and that's that communication. And no one's perfect, I'm not gonna know every answer, and I don't expect any pharmacist to to do. And that surgeon, he had a history. It's like, oh no, Corey, this is the best thing that I've seen work. Great, awesome. He's like, I'm gonna follow your lead then, doc. And then it worked out great. And so communication, again, is so important. Yeah, and surgeon, like and and it's don't be afraid to have those conversations. You guys are pharmacists, you guys are trained in this. Like, I can go toe to toe with any doc on a lot of meds, but it's just getting their input too. Like, No one likes the superiority complex. Like everyone's afraid of a doctor, like, oh yeah, they're gonna say you're just a pharmacist. No, I'm not. Like, I'll be nice about it, but no, I'm not. I can tell you what you want to know, but don't treat me like I'm inferior. Like we all miss people.

Clinical Resources And Trusted Collaborators

SPEAKER_01 44:16

On both ends, right? It's it's just again that shared shared collaboration, accountability, role, expertise. Everyone has their own expertise and bringing both of those to the table. And so yeah, it's just I I again going back to that open communication, not only with the patient, but other providers. How do you what references or resources you talked about? How you get how you got up to speed and and you took the courses, but on a day-to-day basis, what could what kinds of tools do you use to look up these answers and and find pharmacist letter for one?

SPEAKER_02 44:49

Like I've done pharmacist letter, I've done PubMed, I've done journal research, I've done every uh what's the is it P P S C O. There's another one on there. Uh, but there's there's a lot of resources out there that I've used, and even uh pharmacokinetics like Lexicomp and stuff, like just to kind of see like how much is gonna be a half-life, how much is gonna be eliminated, like what kind of surgery are they using, anything that will really inhibit it. Like, those are the things like I was just checking the box as a pharmacist, like, okay, I gotta go through this. Like, was it relevant? Was it not? Like, again, I was just kind of dumping as much information, so I had somewhat of ground to stand. And then when you go to that provider and they kind of he knew I I was young at this and I was still new, and he kind of helped take that lead. And I was okay with him taking that lead. Yeah, that's great. And I and that was the mutual respect. And that's again, we all we're we're bringing our knowledge just to take care of our patient. No one has any it's hey, I'm okay with this because I'm still new to this, I'm still learning. It's no different from a brand new pharmacist to an older pharmacist. Like, hey, we know what we're doing, like we're doing it, and we'll show you. And he did that, and he was, and again, I still text him because now we we text back and forth because I'll have issues. Now I just built a long time person that I can have a resource in because hey, have you ever seen this case? And he's like, Yeah, because I just actually on phantom pain and amputee with Tramadol and Bupe. And I talked to him about it, and he's like, Oh, yeah, I see that a lot. It's everyone's like, Can't give Tramadol with bupe. And he's like, No, you're treating phantom pain, but you're also trying to teat the addiction so it levels out. And he helped me with that. And that was one of the things that DEA was kind of like, Oh, you can't do that. That sounds kind of intuitive. And I'm like, actually, it's not, here's why. And I actually had grounds to stand on because of that surgeon. And a lot of people don't realize, like, there's some of your greatest resources because they've seen it. That's their expertise. Right. I've never seen phantom pain with someone on bupe, like, nope, right. But he helped me through that and I can continue his therapy. And the patient did great. Now, someone from the outside be like, Oh, you can't do that. Actually, I can. Here's why. Man, that that guy shut up real quick. So that was great.

Billing Medicaid And Surviving Audits

SPEAKER_01 47:08

Well, I think, you know, just having that humility and also recognizing, again, everyone has different expertise, and we're all we can all learn from one another, I think. And just being respectful of everyone's role in this process, including the patient. I I, you know, we've talked about the practice side of things, starting out this conversation, then we moved into the clinical side a bit more. I do want to wrap up with one question that we haven't tackled yet, but a super important one, and that's about the reimbursement and billing. How do you get paid for this service? We talked about how to fit this into your workflow and then having the money come later. But how do you actually do this in practice? And what do pharmacists who might be thinking about getting into prescribing buprenorphine, what do they need to think about when getting started in terms of payment?

SPEAKER_02 47:52

So, biggest thing is gonna see with is payments is um as long as the ones that are prescribing inside the state, Medicaid is gonna be a big payer. Like they love this kind of stuff. So you have to know the rules with Medicaid and how they bill. Ours is nice because again, we were brand new to this when I started. So I was I was the guinea pig. We kind of were like, uh, I'm a pharmacist, I'm not a coder, I'm not a biller, I'm not, I'm not any of that. So it was very tough in the beginning, but uh the state kept having meetings and I'd fly down to Boise and be like, okay, that's what I learned. Like, and I'd I'd tell them my pains, like, hey, this was my pain. Like, can we can we train this? The problem is too with Medicaid, is they have to go because it's federal money, they have to go on standards of federal government money and audits. What does the Medicare require? And unfortunately, this is where I kind of want to turn healthcare upside down is we're so focused on soap notes of just crap, honestly. Like they're just it's just filler. That's all it is. It's nothing about the patient. Like they want they want six pages in a half an hour typed out, and that was my biggest concern. I'm like, I don't have because that wasn't 30 minutes, it was taking me an hour and a half. So it's like that's and you're expecting to pay me for 30 minutes, but technically I'm doing 90 minutes because you just want all the filler. Like that filler to me is is junk. Like, and I'll be honest, it was not about what the actual patient was going through. And that's where you're gonna have kind of those concerns as far as billing. You got to make sure to check their boxes if you want to be paid properly. And the other thing that I didn't like, like I kind of got into it with my state, is they treated these patients as non-complex. And I actually laughed in the meeting. I said, Is this a joke? And they're like, No. And I'm like, you don't think these patients are complex? Like they can literally use and die instantly. Like, how is that not complex? And they're like, Well, according to federal guidelines, and I'm like, okay, here we're we're doing this again. You're going off someone else's standards and not our own. But those are the challenges that I had to kind of adapt to as far as soap notes and doing that. And there's different rates on complex and non-complex, but for reimbursement, you're looking anywhere from you can go 67 to I think 123, depending on your time and what your Medicaid allows. You have to talk to your Medicaid, like sure. We have a cash price of our highest is 123, because you have to match their Medicaid up with that. But that's that's our cash price. And uh actually we stop taking that. We're at a good place where we don't even charge patients that, and that's not that gonna happen at any pharmacy, like if it's your guys' choice, but we felt like we can do this um because a hundred dollars out of is still a lot of money for patients, and yeah, I still don't like that. But those are the things you have to kind of kind of come together on and figuring out chart chart notes and making sure it's a wet signature. Like I learned all these things on audits.

SPEAKER_01 51:01

Okay, okay.

SPEAKER_02 51:02

The problem too is I'm not a fan of audits because I'm a fan of audits as far as like keeping us honest, but they're looking at how to get money back from you. That's their goal, that's how they're trained. So they're not looking at did the patient actually develop good care? Like, oh, they haven't used in 12 months, you're doing great. No, they're looking at, oh, you didn't have a wet signature on this. Corey, this says you were only there for 20 minutes. Like, we're taking it all back. Really? Like, okay, like that's not cool. Like that patient's been sober for 12 months after I got them. Like, how is that not considered? It's it's more of again, it's we've always talked to this of pharmacists as the the carrot in front of the horse. Like, we never get paid for what we actually do. And that's the problem I want to see change. And the more pharmacists kind of combat this and say, hey, we can develop care. And actually, I'm developing a new system for the state of Idaho, is I'm trying to say, like, hey, if I keep this patient clean, because your ER visit is going to cost them$15,000 one time. They OD, I did all the math, average is$15,000. If I ask for$100 every month and I keep them clean, boom, I get a bonus at the end. Like I maybe get an extra five or whatever, like to show a positive outcome. And get me the hundred dollars every time, and then all of a sudden, Corey, you did a year. Here's$500 because you saved us actually$10,000. What a concept. You actually treat to have a positive outcome, and you you didn't allow them to come back in the ER. And now I'm working on that right now with Idaho because I feel like that's important because I can streamline, I don't have to fill all the jargon and and filler with the soap. I'm I hate that as one of my biggest thing as providers is they're just typing, they're not listening, they just filling up their soap notes and because they don't want to get audited and be like, oh wait, I forgot to cross my T. Like, nope, they're taking Yeah, yeah.

SPEAKER_01 53:04

That's literally what I was just gonna say is crossing your T's, dotting your I's making sure. And I think that's still an important takeaway is ensuring that we are meeting the requirements necessary, expected for reimbursement so that we can lose out on it.

SPEAKER_02 53:18

You want to get paid, gotta meet them. But I'm always working, how do we improve this, guys? Like healthcare is why aren't we evolving in soap notes and why aren't we evolving in like patient care and outcomes and not looking at, oh, did you cross your four T's that you had on there and got your five I's like Yeah, well, and that's why I think it's great that you're also working towards this sort of pay-for-performance model where you're going to hopefully again working at the state advocacy level to effect change and and hopefully get paid for those improved outcomes versus the nitty-gritty of the documentation necessarily.

SPEAKER_01 53:52

So I think that's great. Yeah.

SPEAKER_02 53:54

Yeah, and that's the nice thing is like at least I have a goal that I want to achieve as far as still keeping everything right, do everything they want, go through their hoops, but there's a better way, and I can make it more efficient, more streamlined with better outcomes because you start overloading providers and pharmacists with typing, you lose patient care. And that's that's my biggest battle. And every time I talk about it, I'm like, you guys are losing patient care. There's a reason why we have more relapses, more of this, because you're so tied to your computer and like, oh, I gotta type six pages, I'll just fill it with fluff. Like, that's not patient care. And that's what I'm trying to get at with this state, at least the state level.

SPEAKER_01 54:33

Yeah. And and it's I just think it's great to see that an individual can advocate for that change and make it happen. And uh it just takes some maybe persistence and and determination to get there.

SPEAKER_02 54:45

But yep, definitely in a loudmouth.

One Game Changer Takeaway

SPEAKER_01 54:49

So we've talked about a lot of really sort of across the board concepts. Uh, but I think the main takeaway that I heard is that you know, this it this change is going to allow more pharmacists to get involved in being able to prescribe buprenorphine for patients with opioid use disorder and help them with recovery, preventing relapse, all of those great patient outcomes that we are trying to that it's life-saving care, really. It's life-saving care. We also talked about the need to be having these open communication and building those relationships with patients, reducing that stigma, and just the importance of safety documentation, ensuring that the patient is getting what they need and that we're also accounting for our own needs as well, making sure that we're getting paid and reimbursed for that whenever we can. So we talked about a lot, but to wrap up the discussion, this is you know the game changers podcast. And so, what would you say? We like I said, lots we talked about, but what is the one game changer that you'd want our listeners to walk away with today?

SPEAKER_02 55:52

Get out of your box. Try and get out of the box of the norm. And that was my biggest thing. The reason why the federal government opened this up is because we need more pharmacists. Pharmacists can do this. Don't be afraid to step out of the box and try. My biggest thing is even my state board, they're trying to get people to rally behind me because if I'm the only one out, I'm taking all the targets and all the spears, and I'll do it. I got a big back. We're fine. But you gotta have support with your other community pharmacists, your other pharmacists who can do this, like hospitals can do this, community retail pharmacies. Like we all can do this with pharmacists. You just gotta step out of the box and try. And it's okay to fail, guys. Trust me, it's okay. You're gonna have that patient that relapse. You're not gonna go a perfect hundred for hundred. Like we we get we you just have to figure out how to pivot and how to control it and how to move on and how to save that patient. And this teaches you exactly what we've been striving for as pharmacists is patient care. We want to be recognized as a provider for Medicare. This is our this is our shot. We stepped up with COVID, we did the shots, but we already did vaccines, guys. Like that was yeah, that was great. I still love vaccines, but this is our moment to show we're providers. We can go toe-to-toe with anyone and be part of a healthcare team. And this is where we need everyone to just step outside the box, try this, let's do something new and let's, let's, let's save lives.

SPEAKER_01 57:25

I love it. Such an empowering message, inspiring message, and just spot on for what we can do and the impact we can make on patient care. So I love it. Thank you. Thank you so much, Corey. Great, great to hear your story and your practical experience. And I hope others can really learn from what you shared. Thank you.

SPEAKER_02 57:43

You're very welcome. I hope so. And that's that's why I do these. I I love I love talking about it because I want more pharmacists to do it.

SPEAKER_00 57:50

Excellent. And that's it for this week. Be sure to log in to Healthmart University to claim your CE credit for this episode. As always, have a great week and keep learning. We'll talk to you next week.