Why Your Dermatologist Cannot Get Your Medication Approved

Insurance denials are one of the most frustrating parts of modern healthcare, and in dermatology, they can delay medically necessary treatment for weeks or even months. Recorded live from the AOCD meeting in Florida, board-certified dermatologist Dr. Kristi Hawley joins us to explain what’s really happening behind prior authorizations, PBMs, formulary restrictions, and “peer-to-peer” reviews.

We talk about the real impact these delays have on patients living with eczema, psoriasis, and other inflammatory skin diseases, along with what patients can actually do to advocate for themselves. If you’ve ever been told your medication “isn’t covered,” this episode breaks down why and what happens next.

Transcript

When Denials Turn Deadly

SPEAKER_01 0:00

People that work for the insurance companies, and we actually have a colleague that worked that uh worked for an insurance company doing denials, and she was approving everything because everything made sense for the patients, and she got fired. Literally, the day before the medication got delivered, he killed himself because he was so miserable from his eczema. We all have to have a voice now. We definitely need patients to start stepping up with us because we have obviously are losing this battle without them.

SPEAKER_00 0:26

Welcome to Dermot Trotter, Don't Swear About Skin Care, where host Dr. Shannon C. Trotter, a board-certified dermatologist, sits down with fellow dermatologists and skincare experts to separate fact from fiction and simplify skincare. Let's get started.

Why Doctors Feel Powerless

SPEAKER_02 0:44

Welcome to the Dermitrotter Don't Swear About Skin Care podcast. We're coming at you live from the AOCD meeting down here in Florida. And I'm excited to have Christy Hawley on the podcast today. Welcome. It's great to have you here, Christy. Thank you. Me too. Christy's a board-certified dermatologist. She's owner of the Durham Institute of West Michigan, and she's a strong advocate for physicians and patients. And that's what we're going to talk about today. All the things that drive us crazy that, you know, patients are concerned about and physicians as well. So I really want to find out, you know, when did you finally kind of get this notion that a big part of your job was going to be, you know, working with insurance companies, trying to figure out how to navigate that for patients to provide quality care?

SPEAKER_01 1:27

You know, when we I think all of us have become doctors because we have been so excited to take care of other human beings. We have all this amazing training that has prepped us to do the right thing for patients. And as soon as you get out into the real world and you start trying to prescribe the right medications for patients, immediately you find out. But it really, really hit me once I owned my own practice. I started my own practice so I could have maybe more autonomy, make more decisions. And then again, I realized that us physicians don't really have a lot of say in patient care. And it is so disheartening and so frustrating. And I don't think a lot of patients realize that either. They think that because you're coming to see your doctor, the person that you trust, that they'll do the right thing for you. And I promise you, we are trying. But these corporations and insurance companies are truly the villains in healthcare right now. And they are dictating everything that we do, and unfortunately dictating what patients get prescribed without any medical training.

SPEAKER_02 2:24

Yeah, I would agree with you. I think, you know, patients have a little inkling because now, you know, you're calling them like, sorry, try to get you this medicine, but it was denied. We're gonna try to appeal it, but there's another roadblock. So I think on the patient level, they're getting frustrated too. And I even had a patient come in and say, Hey, you don't get to prescribe, the insurance companies prescribe for you. And trying to kind of sift through what's true and all those obstacles is hard because we just want to do what's right for the patient. And we understand insurances are businesses as well, but I do think there could be less roadblocks for us to really achieve good patient care.

SPEAKER_01 2:56

And I I want to say greedy business. I don't want to give them too much. Then listen, you said something about swear, and uh, and I'm gonna try so hard not to swear, but insurance companies make me want to do that a lot.

SPEAKER_02 3:06

I I don't think you're alone in that. I think there are a lot of you know physicians, other healthcare providers, and definitely patients that have wanted to swear a few times at their insurance company. So you're not alone in that. I I think what's really hard too is you know, definitely on our side, we feel like we get blamed a lot, right? That, you know, that there's something that we're doing wrong or we don't understand the system or there's a problem with you know what we're prescribing. How do you answer those types of questions when patients are like, hey, do you even know how to do your job? Because you can't get me my drug.

SPEAKER_01 3:36

I know it is really heartbreaking when patients are misdirecting their anger at me when most people don't realize I'm spending hours behind the scenes after their office visit to try to fight insurance. I have a whole team that spends hours on the phone fighting insurance, trying to do the right thing. And insurance companies, the people that work for them are truly, and I'm not just exaggerating, are truly incentivized to deny claims. So if I choose a medication for a patient with horrible psoriasis, if it is uh a medication that they don't feel like paying for, they will deny and deny and deny. And they put all the burden on us to fight it to the death. And I am one of those physicians that will fight to the death, but I think all of us are burning out a little bit because of that, because we want to do the right thing for the patient. So I try to explain. I have a lot of political advocacy talks with my patients, like little snippets. My staff is so sick of hearing about it. But I think it's so important that the public knows what's truly going on. Yeah. And that your doctor is fighting tooth and nail for you. Yes. It's just almost only so much we can do. We don't, we don't have the big pockets like insurance companies do.

SPEAKER_02 4:38

Very true. And and what you mentioned, I think is important for patients to recognize. And I try to, you know, highlight, you know, when they're actually in office, right? We see them, we look at their skin, we talk about a treatment plan, counsel them, and then they leave. What people may not realize is we're actually doing a lot of work then after that visit to provide the care that they need. And while, yes, we get reimbursed or paid for the actual visit for those people we have to hire that sit on the phone for hours or help us create a letter to appeal. We don't really have funds, especially for those of you in private practice, to cover that type of expense.

SPEAKER_01 5:14

Exactly. People are always like, oh my gosh, that's how much it was for my office visit. I will tell you, I am barely pocketing any of that. I am giving it to uh my overhead, my staff to help fight for your insurance, um, my front desk, my billing company, my EMR, everybody is taking from that office visit. Uh, but I'm not gonna quit and I'm not gonna give up. It's I'm not doing it for money. But I will say I think it's important for patients to recognize that the doctors aren't pocketing that entire office visit that you're paying for. And patients are now responsible for paying almost paying for everything. Their premiums have gone up, but insurance has passed all the costs back on to the patient. So I'm like, what's the point of insurance at this point when you have a $6,000 deductible? Uh so I I understand patients' frustration, but I am incredibly frustrated with them because it's it is the system is not about patient care anymore. It has become corporate greed and money. And so this is where I'm doing a lot of advocacy. I'm trying to fight against all this to take back power for the patient and the physician. But again, it's been a battle.

SPEAKER_02 6:16

Well, and then the blame gets passed around, right? So there's blame that's put on, you know, physicians and providers, on, you know, us that we're prescribing medications that are too expensive. And then there's blame that definitely falls on the insurance companies because they're not covering things, or maybe even the pharmacy. So one thing I wanted to talk with you about is, you know, what is a

PBMs Explained In Plain English

SPEAKER_02 6:37

PBM? Because I'm willing to bet some of our listeners out there, whether they are patient or even physician or another healthcare provider, they may not even fully understand what a PBM is. And I sort of want to bring them into the mix of what I would call that blame game, because I think they escape a little bit of the responsibility. So, do you mind touching upon PBMs for a moment?

SPEAKER_01 6:55

I love this topic. Okay. So PBMs, they're called pharmacy benefit managers. And I'm using air quotes because the only people they benefit are themselves. Essentially, I don't know why they were created, but they are these middlemen that have that are responsible for negotiating drug prices from the pharmaceutical company to the pharmacy. And so essentially they'll go to the pharmaceutical company and they'll be like, hey, we want to buy Zoloft from you, but we want to only buy it for $5. And then they go to the pharmacy and they're like, hey, pharmacy, if you want to be able to dispense Zoloft, you have to buy it from us, but we are gonna charge you $10. They have risen drug drug prices astronomically. I think they came into the mix trying to pretend that they were gonna lower drug prices. And I will say, you know, pharmaceutical companies aren't perfect, but they are not corrupt like they used to be. They have a ton of um legislation around them now, and they're not the ones that are raising drug prices anymore. Takes about a one to two billion dollars to bring a new drug to market. And these PBMs are now paying so much less for the drug and then charging pharmacies um astronomical amounts and then passing all that money or passing all that cost on to the patients. And now they've all integrated with insurance companies, so they all work for each other. So what they'll do now is if an insurance, if a pharmaceutical company won't give the them the best deal, then they won't put it on formulary with the insurance company they're working with. So this is why a lot of your medications won't be covered or the or the formulary will change because it's whatever best deal that they can get from the pharma company and the pharmacies and whatever rebates that they can they can siphon off of everyone. They're even stealing patient copay cards and rebates. So instead of you being allowed to have a copay for your medications, the PBMs have decided they're gonna keep it instead, and you are still gonna have to cover your costs of meds. It is so corrupt, you guys.

SPEAKER_02 8:45

So the question Paul, you are asking is like, how is this even allowable, right? How does can this even occur? And I think what I want to find out from you, what's kind of going on, what do you feel like is happening to maybe reform this process?

SPEAKER_01 8:57

It's amazing they have flown under the radar this long, but legislation is finally paying attention. I know in Michigan, our governor is uh putting some fiduciary responsibility on them and some legislation. And there's a couple, it's Holly, and there's one other, and I can't remember who it is, that is finally paying attention to insurance and PBMs. But without them, without the government paying attention, we would have gone nowhere. So I'm so grateful. Hopefully that will all change. Um, but you guys are all feeling the PBMs without even knowing that they're like the villains in this story.

SPEAKER_02 9:26

And so for patients out there, they might be wondering like, how do I know if I have a PBM or what is my PBM? Uh, and is that decided by their insurance? They have any control over it.

SPEAKER_01 9:36

Uh unfortunately, when you are signing your insurance contracts, there is so much fine print that I really encourage everybody to read. Um, but you likely have no idea that you're working with a PBM. But if you join with United Healthcare, they have their own PBM in-house and they're actually the most profitable PBM in the country. Um, I think they siphoned like $4 billion from pharmaceutical companies alone last year. Um, but that's why they've been in the news a lot and people are starting to pay attention, but they just have so much money and so many lobbyists that they're able to sh, you know, kind of sweep things under the rug a lot more quickly than we can uh advocate. And keep up with, I'm sure.

SPEAKER_02 10:16

Because I I feel like too, you know, as a you know, you know physician practicing, we it's not even a player that people have thought about for years. Like you said, they've been sort of incognito. And then now with I think patients coming and understanding where their medications have to go, and then us understanding who covers what, it's now come to the surface. So reform is coming, but it sounds like mostly reform is it more at a state level, or are there things being done like with Congress at the federal level too?

Who Really Makes Denial Decisions

SPEAKER_01 10:40

There are some um uh federal legislation that's paying attention now. It was just in the news, I think two weeks ago. I got so excited because I was just starting to feel like there wasn't a lot of hope for the healthcare system. Uh-huh. And I literally like woke my husband up and I was like, babe, they're paying attention. Like, this is so good. Because my voice-he appreciated that. Yeah, he did. He's excited too. So my voice, you know, unfortunately, my voice is just not enough. We just need some big powerhouses. And the more patients are aware and the more patients fight back too, the more success we'll have. Because you guys are the cons we're you guys are the constituents, you guys are the clients for insurance companies. They need you. Um, but without you guys and without patients understanding what's going on, you probably haven't not, you don't even realize you need to fight, right?

SPEAKER_02 11:22

You know, no, it's true. Because I think again, whether it's been done intentionally or not, a lot of the blame again gets put back on us, right? Those that are prescribing that we're the problem because we're prescribing certain medications and not following maybe what the PBM wants us to, because maybe they profit off of certain medications and people don't understand that yes, the almighty dollar and profit is driving a lot of this in our healthcare system. So when these decisions are made at this level, you know, I think a lot of people are curious, like, okay, if this decision's being made, whether or not my medicine's being covered, it's probably being made by, you know, in our instance, dermatology, another dermatologist. But I think you and I know that's not true. So I think we need to uh, you know, take the wool over everyone's eyes to take it off and tell them who's c who's making these decisions.

SPEAKER_01 12:06

Yeah, it's um people that work for the insurance companies. And we actually have a colleague that worked that uh worked for an insurance company doing denials, and she was approving everything because everything made sense for the patients, and she got fired because they are incentivized to deny. And so they are choosing whatever physician is okay with that model. So I might have a psychiatrist that is, you know, uh denying my medications. I bet they'll have AI soon that just auto-denies, to be honest. I'm sure that's the next thing coming. But there are no dermatologists that are making these decisions for patients who have the training. Some of them I don't even think are physicians, to be honest.

SPEAKER_02 12:42

So I mean, that's astounding because you would think, you know, in this what they call peer-to-peer process, right? And peer being somebody you would think that'd be on the same kind of level of your role or education that they would be making that decision. So that's kind of scary, right? It is absolutely scary. And I have you had an experience, have you ever done one of these peer-to-peers with somebody? Yeah, I was so frustrated. It was with a psychiatrist, that's why I use that example.

SPEAKER_01 13:03

Yeah. And I almost just you do everything you can to fight for the patient. But eventually you're just like they say no so often that you just end up being like, okay, fine, we will try this other drug. You end up playing the game for them. You give it the three-month trial, and then you can get them on the right drug. And so my patients and I are have no problem playing the game. If they're gonna play games with us, then fine, we'll play it back. But it would be so nice to get to a point where what is right for the patient, we make that decision together, that's what the patient gets, especially how much everybody's paying in insurance. They can afford to pay for these meds, but these PBMs are the ones that that are making these decisions because they want to profit.

SPEAKER_02 13:45

Yeah. Well, and it's kind of ironic that you were talking to a psychiatrist because I feel like you could have then launched into how much stress and anxiety like all this has caused you. And he and he or she might have understood that. But the dermatologic medication you were trying to get, they probably were clueless about because they've never prescribed. Yes. So it sounds like, you know, this this really

How To Fight Back As Patients

SPEAKER_02 14:05

hasn't, you know, the narrative has shifted. It's more about true profit than really providing what's best for the patient. You know, if patients are out there wondering what they can do, or the things you tell your patients, like, hey, you know, part of this process, obviously, my office, my crew, we're gonna do everything we can to get this medication covered. But this is what I'd like your help with. Or what do you tell them? Like so they can be active in this fight.

SPEAKER_01 14:25

Yes. So again, people don't listen to physicians. They think that we're just rich and greedy. And to let you all know, physicians' salaries only account for 7% of healthcare costs in this country. Okay. So, but again, they're gonna listen to you more than they will me. So I tell them, call your insurance, say why you deserve this medication, you know, fight with me. Or sometimes I have a really bad uh insurance company in my area. I will encourage them to switch off of it and I will put it in my chart. I am very savage. I'm like, this is so unethical that party health is done. I will name drop them. Party health is doing this to my patient. This is, you know, I encourage patients to move on from this insurance. So it's just more making sure that you're educated on what you're signing with your insurance companies and then fighting yourself. Give them a call and then you will be frustrated because you will be on hold for two hours and then you'll understand what we do, but with you know, 40 patients a day. Yeah.

SPEAKER_02 15:15

Yeah. And I think that's what people don't realize the the amount of work it takes. Or, you know, one of our people that loves to kind of help fight these battles, you know, she was really getting burnt out. Then, you know, the paperwork, the administrative burden, and you know, and we are trying to use things to help make the process better. As, you know, artificial intelligence is now trying to craft these appeal letters. The insurance companies are using it on their side as well to craft denials. So we're kind of both fighting fire with fire. Where sometimes I think if we just had reasonable guardrails in place, we wouldn't have to waste this time. But it is nice to have that willingness and that fight. And for somebody like that that's getting burnt out, I actually brought her into the room to say, remember how you fought for that drug for this patient? They're here today. I like to see the impact it had on their skin. But that's valuable and just to kind of reinvigorate somebody. But to the point that we have to constantly do that to keep the battle going, it's exhausting.

SPEAKER_01 16:03

We're all burning out a little bit, right? So, you know, I encourage you, be kind to your doctor. Realize that they are fighting the good fight for you. But this healthcare system is really just there's so much burden put on us every day more than just fighting for medications. Um, but you know, if you have the time, we need patient advocates too. So anytime I go to the Lance, which is our capital in Michigan, um, I bringing patients means the world. They again will listen to you more than they will me. So if anybody is interested, you can reach out to your state societies and join, join the fight.

SPEAKER_02 16:35

Well, and you mentioned the impact on patients. But I want to know is can you like come up with a story or a patient that sticks out in your mind where they needed a medication and how it impacted them that they didn't get maybe the one you wanted or there was a potential delay? Because I think too, it's just understanding you know the consequences where we can just sit here and obviously talk about it. But this affects people in the real world.

Burnout And The Human Cost

SPEAKER_01 16:57

I have a really sad story. Can we go really sad? Yeah, we can. So this wasn't me. This is one of my colleagues. He um had this patient had some of the absolute worst eczema, like wasn't sleeping, scratching, bleeding. And it took so long for his insurance to approve a life-changing medication before, like literally the day before the medication got delivered, he killed himself because he was so miserable from his eczema and didn't feel like there was any hope. That is like so heartbreaking. And there are other stories like this, like insurance with cancer patients. They're, you know, oncology is having a hard time too with insurance and PBMs, and people are dying because of denials and delays. And so it's serious what they're doing with people's lives. They're it's all they don't value human lives, they only value money. And as a physician, I know that you and I, that breaks our heart because all we do is surround is prioritize our patients in human lives.

SPEAKER_02 17:53

Yeah, and we're in an era where you know we're trying to be more, you know, cost savings, but at what expense, right? You know, and and when they're trying to use that, you know, as a rationale, it's so steeped with irony, I think, because it's the PBMs that are driving cost up, yet the denial they're particularly make, they're saying they're trying to save money at the same time. Exactly. And to see the impact to the point of yes, I mean, I can't imagine. I feel so bad for that patient and their family that I think people forget the consequence. They're looking at paper, right? They're looking at numbers.

SPEAKER_01 18:24

They forget that there's humans behind yeah, this paperwork, you know, beside behind the money and all that.

unknown 18:32

Yeah.

SPEAKER_02 18:32

So from your your standpoint, do you feel like, you know, from you know, patients getting involved, obviously, you know, us getting involved as physicians and advocating and I guess like the best case scenario, do you feel like there's a role for PBM with Gardner's, or do you feel like there's an alternative plan that we should be looking at in healthcare?

Misconceptions About Doctors And Costs

SPEAKER_01 18:51

I I still can't understand the role of PBMs. Um, so right now I don't feel that there is one. I think that we need to completely restructure how insurance companies run. They have no anti-tort or anti-kick, anything like that, that kickback, like they have no legislation that surrounds them. They are monopolizing and taking over. And monopoly in medicine is not good for people. So we really just need uh more legislation around guardrails around insurance companies in general, um, to protect patients and to protect all of us from just being stolen from left and right, money-wise. And they shouldn't be making that much money. Yeah.

SPEAKER_02 19:33

I mean, and really, I mean, I think that's what, you know, I think people are shocked to hear is that there's somebody else in this game that people probably didn't even realize was a part of the puzzle. So beyond, you know, medications denials with PBMs, you know, what other things do you feel like surrounding, like, you know, healthcare, do you think there's misconception for patients out there that we're creating part of the problem or costs? Do you feel like it's procedures we're recommending or you know, the fact that, you know, the you know, doctors don't want to see patients? Like, what do you think are the misconceptions that are out there you want patients to talk about? I know.

SPEAKER_01 20:05

Yeah, I think one of the biggest things that's happening to physicians is we're constantly are getting put uh more and more burden on us, administrative burden. We suddenly have to make sure our notes are perfect and finely tuned, or else insurances won't even reimburse us for the visits that we're seeing. It takes like three to six months to even get a payment from insurance because I have to hire billers to fight and call and beg the insurance to reimburse. The government is putting on a lot of other uh burden on us to make sure that I don't I don't even really understand why, but more and more. And so hospital systems are pushing physicians to see more and more patients so that they, the hospital can make more money. It's not given to the physician that's being forced to see the patient. And so all of that is just making it probably feel like you are less cared about when you're seeing your physician because the physician that is a person and is burning out and is being forced to do a lot more things in their day while still maintaining really good care that we didn't always have to do before. And so when your physician is running an hour behind, it's probably because the hospital system they're working for stuck on too many patients that day. But your physician wants to give you the time and dedication. They want it to sit with you. And so when they are behind, it's because another patient needed more time than what was allotted. It's one of the nice things about having a private practice is I can control that. And so my patients have almost no wait times. But when you're going, when you're going to somewhere where a physician's, you know, working for a corporation, it they don't have a lot of say all the time. So be patient with your physicians and understanding. They don't want you to be sitting in the waiting room. I hate, I hate that it, you know, it irks me and I know it what it does for you too. Um, but there's just so many things that we can't control. The only thing I feel like I can control is that moment I'm sitting in front of the patient and that interaction and that care I can give them. But then after that, it's kind of out of my control. It's up to I call it insurance willing instead of God willing. Like

SPEAKER_02 22:02

No, but but I think you're really speaking the language that maybe we don't express often enough to our patients, right? Uh you know, patients come in and you're right, it's conception, you know, of you know, their perception, I should say, of kind of who we are. And sometimes doctors in particular, other providers, we kind of get a bad reputation, right? That we're just about the money, or when we've been advocating for Medicare reform, it's just because we want to make more money and that you know it's all about you know what we do with that, and we have people have cars or vacation homes, and that's all we care about. And that's sort of how we've been portrayed, right? And I think that's what's very misleading. And then when you know, the they convince you, I feel like sometimes even going to the pharmacy, I've had my patient go and said, Well, they said you shouldn't prescribe me this medication, you should have given me the generic.

SPEAKER_01 22:48

Yeah.

SPEAKER_02 22:48

And I said, But do you know they're incentivized to give you generics? And then they're like, wait a minute, I see the other side. I think for far too long, as physicians, we've sat quiet. We haven't been a part of the conversation, and then we've let everyone else then dictate the narrative, right? Of who we are. And yes, there's always bad apples in every bunch, right? There are some of our colleagues and we know who they can be, and maybe some we don't that yeah, you know what, then maybe they are a clock in, clock out, and they they got into medicine to get the fancy car or house. Okay. Yes, there are those folks. But the majority of people that are in healthcare are here to help people. Yes, but we can't help people and we constantly have these roadblocks that are put up that don't make sense.

SPEAKER_01 23:25

And I swear that they want us to be too busy so that we can't fight them. I mean, we have been drowning so much that you know these PBMs and insurance companies have snuck in and done all this like with that while we were taking care of patients. And maybe if we had noticed, we could have stopped it before it started. Because once it's, I mean, trains off the track. So it's so hard to reverse it now.

SPEAKER_02 23:45

Yeah. But but the point is, I mean, conversations like this, I think, will help because we want patients to understand that this isn't something that you know we sort of let happen or that we wanted to happen. But because, you know, our focus is the patient, we don't want to be distracted by all this chaos, right? Because it is basically it is like a game, and the rules become so complex you don't even know how to play it. So the hope is you're just going to give up. And I think that's what happened for quite a while.

SPEAKER_01 24:13

And it happens, yeah, too, right? I mean, how you can only fight for so long before you just feel jaded and disheartened. And but we're not giving up. Not yet. No, not at all.

SPEAKER_02 24:23

Yeah. So I think then, you know, as you look at healthcare as a whole, how would you see the patient role versus the physician, other providers in healthcare, how would you see these roles kind of different in this fight? And also like, how do we work together to really

Partnering For Advocacy And Change

SPEAKER_02 24:39

make change?

SPEAKER_01 24:39

I think it's so important that we partner. I think what's happening now is the patient sees the physician and then they're like, okay, my role is done. As a patient, I can just go home. And then I, you know, and the way that healthcare has changed so much that we all have to have a voice now. We definitely need patients to start stepping up with us because we have obviously are losing this battle without them. And so, you know, discussing this with even your physician or just again finding societies in your state, they would love, and I know you are huge in your society in Ohio and do a lot of advocacy work too. They can reach out to you. Um Ohio could collaborate with Michigan, maybe on this one.

SPEAKER_02 25:19

Yeah, football, uh, not so much.

SPEAKER_01 25:22

Oh, yeah, yes, yes. Um anything that writing letters to your insurance companies can help. You know, why we're gonna, we're having a huge issue with Blue Cross in Michigan right now, and we're gonna recruit patients to write letters because they're gonna lose access to care based on the changes they're making. Patients won't have, they'll have longer wait times, and it's horrible what they're doing, and we don't have any say. So we're gonna have to start recruiting patients and they'll listen to you.

SPEAKER_02 25:47

Yeah, and I think patients, because that's the impact, right? You know, things look good on paper, but when you see how it impacts patients, you know what our system's truly doing to, you know, hurt, you know, people across this country.

Closing And How To Support

SPEAKER_02 25:59

So, Christy, I just want to thank you so much for coming on the podcast today. This was fantastic. Thank you.

SPEAKER_01 26:03

I love talking about this stuff.

SPEAKER_02 26:05

So well, and hopefully you've motivated people. We've you know taken, you know, that opened up, you know, this page where now patients and physicians, other healthcare providers, we can all collaborate for change that's effective here in our healthcare system. I love it. Thank you so much. Of course. And stay tuned for the next episode of Dermotrotter Don't Swear About Skin Care.

SPEAKER_00 26:23

Thanks for listening to Dermot Trotter. For more about skincare, visit dermittrotter.com. Don't forget to subscribe, leave a review, and share this podcast with anyone who needs a little skincare sanity. Until next time, stay skin smart.