Main Street Pharmacy Podcast
Join host Kevin Houlihan, CEO of Workflow Service and ImageMover, and guests as they explore the latest news, insights, and implications behind the Main Street Pharmacy Access Act (formerly ECAPS).
Main Street Pharmacy Podcast
B. Douglas Hoey: How the Main Street Pharmacy Act Supports Healthcare Infrastructure
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B. Douglas Hoey, CEO of the National Community Pharmacist Association (NCPA), joins Kevin to discuss the Main Street Pharmacy Access Act, the role of pharmacies in expanding access to care, and why Medicare reimbursement is a critical next step for clinical services in pharmacy. They also cover pharmacy infrastructure, chronic disease management opportunities, the Access and Bridge programs, and practical ways independent pharmacies can prepare for what’s ahead.
Learn how to be reimbursement-ready on day 1 for the Main Street Pharmacy Access Act at our knowledge hub for pharmacy industry professionals: https://workflowservices.com/main-street-pharmacy-access-act
Introduction
SPEAKER_01Welcome to the Main Street Pharmacy Podcast. I'm your host, Kevin Hoohan, CEO at Workflow Services. Today I'm terribly excited to be joined by Doug Hoy, Chief Executive Officer of the National Community Pharmacy Pharmacists Association, which represents nearly 20,000 independent pharmacies across the U.S. Doug is a licensed pharmacist who grew up working in his family family's pharmacy before leading NCPA for more than a decade. He also serves on the boards of PTCB, Shure Scripts, CPSN USA, and the World Pharmacy Council, making him one of the most respected voices in community pharmacy policy. Doug, it's great to see you again and thanks for joining me. Yeah, happy to be here, Kevin.
SPEAKER_00Thanks for the invitation.
SPEAKER_01Yeah, and a little note for our listeners, we're in season two of the podcast. We were the ECAPS Watch podcast, but with the evolution of that bill, we've uh we've renamed the podcast to match the bill or the Main Street Pharmacy Podcast. So I had our last guest uh was Mike Weissong, and we kind of teased it, but we we've made it official now. So welcome officially to season two. Thanks for being here, Doug. Yeah, it's my pleasure. This is something super important for the profession. Yeah, but so there's a bunch of things I'm excited to talk about today, but along with the change in name of the podcast that um that was sort of triggered in sort of evolution of the legislation that we've been tracking, which is all a part of delivering clinical services through the pharmacy. But you, I think, have been super involved in what's going on with the legislation and spent time in DC. So I would just love your insight into where you think we are specifically with the Main Street Pharmacy Access Act. Um, I think there's a broader ecosystem of things going on and evolving. But can you just give an update from where you're sitting on what you see around where we are with the act and what you think might happen?
Legislative Update
SPEAKER_00Yeah, so of course the act's been kind of bouncing around there for a while. And I would say for those who've been um tracking it for the the years it's been moving around, this is probably the most promising um that that it's been, and the most promising position that it's been. It's it's been um referred to the House Energy and Uh Commerce Committee subcommittee. And uh they are uh taking a look at it. Um uh it has bipartisan support. It's got 128 co-sponsors in the House and 31 co-sponsors in the Senate, and on the on the Senate side, it's 16 Democrats and 15 Republicans. So you know it's shockingly bipartisan. And it's 31 divided by two. You couldn't get a half person in there, so um, and on the on the house side, it's 59 Dems and 69 Republicans, so just almost as as um 50-50 there as well. So very few things bipartisan in this town, and and this is one of them. So it's got a good shot. Um, prospects-wise, maybe something that moves in the in the fall. Um, it's an election year, midterm election year, so that always throws uh a wild card into things as far as how things could play out. Um, but it's it's decently positioned. I mean, there's there's a good shot um that this that that it could be passed this year.
SPEAKER_01Yeah. Yeah, we're excited about it. I mean, it's an interesting thing. And I, you know, I watched um some of the last hearing, and it was really interesting to, you know, I haven't spent that much time um focusing on how you know the lawmaking in our country works. And for something that I was super passionate about and really um interested in, it was interesting to watch that hearing and sort of hear the voices and kind of see how the legislative machine works. And so there's some surprises and some delightful things and some some interesting things, but it was cool to see it move forward and hear some of the voices around it. So, you know, I'm hopeful and optimistic. One of the things that came up a lot in that conversation was that there is a limited scope to this, right? We're not, no states are saying that now all of a sudden pharmacy pharmacists can do things that they weren't able to do before. We're just recognizing that for a big chunk of the population, they're now able to get it covered through the pharmacy, right? Um, with the um, you know, Medicare reimbursement. So I think that's an interesting thing. I am optimistic that this is the first step to broaden scope for more other things and more coverage by um Medicare for other kinds of services. And I know that's an area that you've been one of the loudest, most valuable, and passionate voices on is just access to care through the pharmacy. And there's other things happening there, but tell me a little bit about why you're passionate about that and and what you've seen in terms of the difference a pharmacist can make in better health outcomes and access to care across the country and in a time where we have a provider shortage in general.
Medicare Payment
SPEAKER_00Yeah, yeah, Kevin, there's there's a there's actually a lot in that question. Uh I I do want to touch on what you talked about as far as what the bill does. And and for especially for our member listeners or independent pharmacy listeners. I mean, this this bill and and you know, chain operators, staff pharmacists, uh, all pharmacists, um, this would allow pharmacists, frankly, to to do some of the things they're already able to do as far as point of care, point of care testing for um a portfolio of different conditions, uh, RSV, COVID, strep, uh things like that. Um and as you said, per state practice acts. So, you know, it's up to the state. The feds are not coming in and over uh usurping um the sovereignty of the the state. So that that's important, I think, from a political standpoint, um, that it's not big brother coming in over states. Um, so for a lot of pharmacists, I mean, this isn't going to be like all of a sudden the skies parted and sunshine comes down and rainbows start going through as you know, as far as payment. It is, though, as you said, a very important first step. It's one of the first ways in which pharmacists would get paid from uh Medicare. And and we need um Medicare, we need Medicare payment because for the most part, with a few exceptions, we pharmacists do not get paid through Medicare. So it is incremental, but every journey starts with the first step. And this would be an important first step, not just a first baby step, it would be a first, you know, big step towards pharmacy payment. And then to your bigger, your broader question, the importance of pharmacists. Pharmacists provide um, of course, with the dispensing services, which often get overlooked, how important the dispensing services are, people just kind of kind of um float by those that, oh, those are you know taken for granted. That is a service. And in addition, pharmacies provide an incredible um healthcare infrastructure for this entire for the entire country. And that's something we want to talk about more is just how important that infrastructure is to the safety and well-being of the entire country. Um, and I know that sounds maybe a little hyperbolic from someone who's, you know, one of the leading advocates for independent pharmacy in the country, but it's true. I mean, so uh, you know, you could take to the small, I think sort of small ball of um you know, pharmacies weren't around. Where does that parent whose kid just got in the poison ivy where where do they go? Or the insect sting? Or hey, I I haven't been able to see my doctor, but I've got this pain in my left shoulder radiating up and down my arm. What should I do? Um, those kind of questions, that kind of infrastructure, if pharmacies weren't there, it would really be damaging to our country. And even from a national defense standpoint. I mean, God forbid, something, you know, an attack on the country or something like that. But pharmacies provide uh a layer of uh of defense. And so I think this the Main Street Pharmacy Act is one step towards recognition of that important vital infrastructure that pharmacies provide to our country.
SPEAKER_02Yeah.
SPEAKER_00And so it's it's an important first step. And like I said, um not to be repeat myself, but every step, every journey starts with a with a first step, and that's what this bill represents. And and getting paid from Medicare Part B is uh would be something that the profession has been trying to do since I've been a pharmacist, which is several decades
Access Equality
SPEAKER_00now.
SPEAKER_01Yeah. And just to highlight one thing, we've talked about it on the podcast a few times, but you sort of mentioned it. Today, there are pharmacists who are offering these services and having insurance companies pay them to do the services for some of their customers. And then another customer comes in who has Medicare and they can't get paid for that customer. Two customers next to each other in line, and there's just a difference in how those two customers can access care in the pharmacy in the same on the same day, in the same hour, in the same store, in the same state. And that I think is to many people, reasonably seems crazy. But like that's the thing that that I think we're excited to like just equality in in a single store from a from a single pharmacy. And so, like it is every time I talk about it and think about it, it's a surprising thing. And so it's just like, man, it seems so non-controversial. And I guess back to the bipartisan support. Like that's that's what's great to see about that. It's just like evening the playing field.
SPEAKER_00Right. And if you think about, you know, so well, to your point, seniors shouldn't be second-class citizens. I think that's almost an alliteration. Someone more clever can make that an alliteration. Uh, seniors shouldn't be second-class citizens. Um, and not only, not only for that reason, but when they're able to get tested for, you know, again, an RSV or COVID or some of the different conditions that this bill will pay for, that's going to help them get treatment faster. It's going to result in referrals to a to a physician's office or to a prescriber to take some medication, probably, not always to take medication, but very likely. And hopefully uh head off hospitalizations, the the the higher costs, the really big bills that the country pays. So it's both from an equality standpoint and from just smart economics, smart economics and smart healthcare policy, it's it's a smart thing to do.
SPEAKER_01Absolutely. And we we've seen some amazing stories about that, of just the efficiency of delivering care and access to care in the pharmacies. To kind of, I don't know, maybe it's shift up to the next gear a little bit. But talk so the Main Street Pharmacy Access Act lives kind of in the ecosystem of a bunch of different things that are going on. And the thread there, I think, is um the value of care delivery in the pharmacy. There's a bunch of other things that are happening. Before we get into those, I always love to ground um the value in a in a story or two. And I'd love to hear a story of yours. We've had some other folks on the podcast share stories about you know catching a UTI with a patient who was in early and at least guiding her to care, even if you can't do it in the pharmacy. And I heard a great story from one of our pharmacy customers a couple weeks ago where someone was in filling a prescription and they took the time to step back and say, Hey, let's actually do an assessment here. And rather than just fill the prescription and have the had the patient out, have a little bit more of a conversation. And the patient was saying, Man, I think I'm really doing a good job with this medication. I'm not exactly sure what it was. I'm not a pharmacist. Sometimes I'm gonna try and play one on TV here. But they said, I'm taking the medication all the time, but gosh, I am just having a terrible time sleeping. I'm waking up. And the pharmacist said, Okay, hold on, let me take a look. You know what? I think your dose is a little bit high. And the pharmacist was in a state where they were allowed to adjust that dose, right? And so you think about, and there, I think that conversation was the time that they spent there was covered by insurance, actually, which is great. And you think about like, well, what does that mean? Think about the lower friction for that patient. They would have had to book an appointment with their doctor, make sure that they get over there, deal with the parking, get in, um, explain all these things to the doctor. It's take time away from work, likely, all those sorts of things, because it's really impacting their life. They're trying to do a good job, they're staying inherent, but they're waking up in the middle of the night, all these sorts of things. And the pharmacist is just so perfectly positioned to understand how the medications work. They've already got an interaction with the patient. The patient is here, it's close to their house, it's open at a time, it's convenient, all those sorts of things. And you talked about the value to the country of the cost of delivering that care. Put those two things side by side, right? Like, which one is better for the healthcare delivery system in our country to provide that guidance and adjustment to the patient in something that's actually making a real difference in their life? Right. That's the kind of story that for me brings it home and it's like, oh, it totally makes sense. Like that is the perfect kind of example. There are so many of them. But I'm curious if there are any that stick out to you that are like, ah, here's just such a great example of how the pharmacist is making a difference in care delivery beyond just dispensing.
Medication Experts
SPEAKER_00Yeah, I'll give you a story, but just on on your story with the the medication that was a little bit high and the the pharmacist adjusted it. It's hard to explain. Um but as you're telling that story, pharmacists love that kind of stuff. Like as you're describing it, I'm picturing looking at a patient portfolio going through their medications, like thinking about what the strengths are and what the normal dose is. And we geek out on that kind of of puzzle to try to figure out a solution for it. Yeah. And just what a I mean, call us, call that wonky or or or or geeky or whatever, but that's a really important skill that pharmacists have. We are the medication experts. Yep. We geek out on medications because we're really good at it. Yeah. And we're better than anyone else. And like this is no knock on any other healthcare provider at all. They probably geek out on the things they're good at. Yeah. But no one, no one is gonna look at that medication port profile the way that we are, the way that we're gonna like, oh, I can't wait to try to solve for this. So sorry, just a little side side geek trail there from the pharmacist side. Um, one of my favorite examples, most recent examples of pharmacists providing care. And this is part of a pilot um project um that that NCPA is working on in rural health, and the results will be coming out soon. I'm not supposed to give away all the results um because they're up for peer-reviewed um consideration publication. But one of the stories from this is um so the pharmacists were uh and and community health workers, so technicians trained as community health workers, which we're very pro and very in favor of, um, helped screen an entire town for AFib. Okay. So the entire it was a small town.
Rural AFib Screening
SPEAKER_00It is a small town, 200 people, but 170, I believe it's 170 out of the 200 people in this town got screened for AFib. How do you for asking for a friend, how do you screen for AFib? It's actually a pretty, pretty simple um it's with technology. Um, you it's it's a pretty simple device that um patients you you hook them up and it'll it'll uh measure the rhythm of the heart and can determine if something's out of out of rhythm. Um and there's a lot of reasons why heartbeat can be out of rhythm, but it can detect that. Even like some of the smart technology, your smart watches and things like that can have some detection. But of this hundred, you know, 85% of this little town, uh, everyone was was almost everyone was screened. I'm not sure who the 30 people are who didn't get screened. Um they were probably on on vacation. Um they were able to refer some of those patients to a physician to get screened, to take a look, uh, because AFib is predictive of a lot of other potential conditions. I mean, there's a there they find that AFib is a risk factor for other other cardiovascular conditions, as well as some neurologic neurological conditions and so uh and and others, other things. So being able to screen for that can head off a lot of other um major conditions down the road that'll affect quality of life. So that's just one example. And so that was a very you know rural area where healthcare providers are often harder to find. And that pharmacist wasn't trying to pretend to be a doctor. He or she were not doctors. We don't want to be doctors, doctors do their thing and they're great at it. But we were able to screen and triage patients to get to a doctor to get the appropriate treatment from the entire healthcare team, including the pharmacist.
SPEAKER_01Right.
SPEAKER_00And so that's that's one of my favorite stories about how pharmacists being able to practice, you know, well beyond dispensing is important, but in addition to dispensing, um, can really help primary help bolster primary care in the United States. And again, that pharmacy infrastructure, having a strong pharmacy infrastructure. And I have to add, have a strong pharmacy infrastructure, you have to pay farm the payment for the prescriptions has to be decent. Um and that's that's really the biggest threat to the pharmacy infrastructure right now is payment on prescriptions, which I know that's not the subject today, but they go hand in hand. If you're not paying the pharmacist for the dispensing side, then they can't do the clinical services side. And the two are incredibly complementary to each other. There, they neither one lives by its dispensing. There's a few cases where it can live by itself. It used to be able to live by itself completely. Um, but now you need services like vaccinations, point of care testing to be able to have that mix. Um and the two are very complementary. So again, the Main Street Pharmacy Access Act will help to enrich that complementary relationship between the dispensing side and the services side. But, you know, for any payers listening out there, gotta pay pharmacies decent on the dispensing side to be able to do these services that are gonna help help patients cross-country.
SPEAKER_01Yeah. When you talk about infrastructure, do you mean like the physical buildings that pharmacies are in or a broader, a broader concept? Do you want to speak a little bit more about when you think about like the you know the infrastructure is important? You talked about national defense a little bit and the proximity of these pharmacies. Any any more you want to add to just about the infrastructure comment?
Pharmacy Infrastructure
SPEAKER_00So infrastructure does include the physical building, but it it's I mean, that's a uh a means to an end. The physical building is a means to an end. Yeah, the the infrastructure in place is really who's in the building and those access points. So, along with infrastructure, you know, when we talk about pharmacy access, we're really talking about uh an infrastructure. When we talk about um bridges and roads in our country, that's part of our infrastructure. Right. And there's a lot that's been written about how our bridges and roads need to be uh fortified and updated. You know, some of them haven't been updated in in decades and decades. But without a great interstate system, I mean the interstate system changed this country 60 years ago. It helped bolster that infrastructure. Um, if it's weakened, we're weakened as a country. Pharmacies are part of the healthcare um protection infrastructure. And when they're weakened, our health care is weakened. And when they're strengthened, our our health care, the healthcare in the United States is stronger. And we've we've lost 15% of all of the pharmacies in the country. We're at the lowest point. We have the fewest number of pharmacies in the United States since 1994. Wow. Our population has grown by 90 million people since 90 mil since 1994, but our the number of pharmacies, so that infrastructure is in a delicate, fragile place. And so um without that infrastructure, it health care overall is weakened. We see more people, you know, more people show up in the emergency room, more people in an urgent care, more people um just won't get care because there's not that pharmacy there. So that's what I'm that's what I'm I mean by the the infrastructure is that it's a it's a it supports infrastructure supports health care in this country, and pharmacy is a pillar of the healthcare. Infrastructure of this country. And when that pillar is weakened, all of healthcare is gets on shakier ground.
SPEAKER_01Yeah, absolutely. So the Main Street Pharmacy Access Act is a part of expanding care delivery, but it's not the only thing that's going on. And there's some other kind of newer stuff that we haven't talked about that much actually on the podcast, but I think you have a ton of knowledge on. So I'd love to hear your thoughts on those things, what you're seeing, what else is coming, what else we should be keeping our eyes on.
Access Program
SPEAKER_01Teach us.
SPEAKER_00Yeah, well, as part of that infrastructure, and I think very complementary to the Main Street Pharmacy Access Act, there's a program. Speaking of access, there's a program coming out of CMS called the Access Program. And you said I'm very knowledgeable about it. It's uh one of those where I'm accumulating knowledge as as I go. Yeah. But this program, it's not just for pharmacists, it is for healthcare providers. And it's something that the um that has come out of the administration fairly recently, um, fairly recently. There's a lot of um technology. Um, there's an emphasis on technology with this act, but but the net of it is is to really look at managing chronic care. And so there are several conditions that healthcare providers, again, it's not just pharmacists, but pharmacists are healthcare providers and and can apply to monitor these conditions. It's for seniors, so it's for Medicare patients, um, which is you know 40 million plus patients. And for independent pharmacies, uh, we serve a disproportionate number of our patients, are uh Medicare patients. And it looks at things that the two conditions that really, well, really four conditions that really grabbed me or you know, shook me by the lapels are hypertension, um uh uh elevated A1C or diabetes, uh hypertension diabetes, and then pre-hypertension and pre-diabetes. Okay. If you look at those four conditions, there are very few people over the age of 65 who aren't at least pre-hypertension or pre-diabetes. There's some, there's definitely some, but not very many. And then, of course, a lot of people with hypertension, a lot of people with diabetes, you know, cardiovascular disease, still the number one killer in our country. Um, so the what excites me about this is that this program pays healthcare providers, and including pharmacists are eligible, to monitor uh those four conditions, as well as some others. There are a few others. Um the but it excites me because there's so many patients that are eligible. A lot of times we get into these clinical care programs and it's there's not the there's not the the scale, there's not the number of patients to really you know put into the system. If you're looking at all Medicare patients who are diabetes, hypertension, pre-diabetes, pre-happertension, that's gonna be a lot of patients.
SPEAKER_02Yeah.
SPEAKER_00So the payments not huge. Um, I think it's you know $15 to $20 a month per patient. There is a requirement that the patient does better, that you know, you measure that, you know, their blood pressure. And after six months, a year, they're getting closer to goal or they're at goal. So there is an expectation for performance. Um, but I I I'm excited for that opportunity for pharmacists. Again, um, not just pharmacists. So there, you know, it could be and and again, a lot of emphasis on technology. So there could be some uh entrepreneur who comes up with a bunch of AI type bots that are the network reaching out to seniors, which of course we think would not be the greatest thing for pharmacists for obvious reasons. But I think it's complimentary. I think uh it shows that the the administration is open to looking at chronic disease, which you know, our country spends very little money, uh, like most countries in the world, we spend very little money on chronic disease because we're too busy, you know, putting out the fire versus preventing the fires. Right. So it shows some emphasis on chronic disease, which to me is very complementary and synergistic with the Main Street Pharmacy Access Act.
SPEAKER_02Yeah.
SPEAKER_00Because that's also um much more focused on not chronic disease, but preventative disease. Right. Um, to you know, put out the fire before it becomes an inferno. Yeah. Um, so I think you know, seeing both of those, this is supposed to roll out uh uh in in the summer. Um it's there's a little bit, uh it seems you know, they're they're they're they're building the plane while it's still up in the air a little bit. So that's another reason why, as far as details, we're still learning details. Yeah. But this access program, I think it's an opportunity for pharmacists to do well, prove our metal, and hopefully, when there's a phase two from Main Street pharmaceutical, hopefully, you know, get to the phase one, get that passed, and there's a phase two, we'll have data to show, hey, pharmacists were able to get patients to goal with hypertension and diabetes and and save money, yeah, um, and and improve quality of life. So I again I think there's some good stuff going on. Um, again, we need that infrastructure. We need proper payment for prescription dispensing to keep that infrastructure strong. There's some good stuff going on in in our um in our pharmacy world. Good patients. There was another, was there a third program that you've been watching beyond the
Bridge Program
SPEAKER_00the there's one coming out uh in in it starts July 1st called the Bridge Program. Okay. And that's focused on GLPs. Okay. And so that program, it's it's more on the dispensing side than the cognitive services, but you know, pharmacists are always providing cognitive services when we dispense. That program, um, I I'm kind of enthused about that one too, because again, seniors, Medicare patients, it will allow it, it will Medicare will pay for um obesity diagnoses for patients with who are diagnosed with obesity who are overweight. Um they have to have uh, I think it's a 27 BMI and other um uh other conditions, like uh I think as an example, like diabetes and a 27 BMI as an example. Or have a BMI over 35, I think. So if the patient has that, the physician attests to that, and then the patient's able to get a GLP for $50 a month. Okay. So which you know GLPs, their their list price ranges anywhere from you know $600 to $1,200, depending on which one and kind of which program. So to get them to get one for $50 is is is quite a good deal. The pharmacists, um, we've had extensive conversations with CMS um about why pharmacists have not been dispensing GLPs and other because of the the the terrible payments. And and they somewhat listen to that. So pharmacists will get paid um uh whack plus a um a small dispensing fee. There it's not a um super lucrative dispensing fee, but it is at least on the on on the positive side versus in the red. You know, again, 40 million P 40 million plus Medicare patients. I I don't know the numbers on how many of them would qualify, um, or will be newly qualified, but I would think it would be several million patients that are going to be able to walk into pharmacy's doors and get these GLPs and for the pharmacist to be able to have those conversations to help them get the best um use. And again, it shows the administration thinking about chronic disease. Like, hey, if when people lose weight, usually blood pressure goes down, diabetes gets in better shape, uh, easier on the joints, the knees, the back, the hips. I mean, so you know, it it just shows a mentality that I think is very positive for pharmacists who can manage chronic disease and help um with prevention, which gets us to the Main Street Pharmacy Access Act.
SPEAKER_01So, about that bridge program, let me let me ask, let me learn a little bit more. It sounds like there's maybe two parts of it. One is trying to at least improve the reimbursement for dispense, because that has that's got a lot of problems with it. So this might make that a little bit better, and that's part of it. Is that I have that part right?
SPEAKER_00Yeah, it and yes, and on that note, this is even though it's Medicare patients, it does not go through Medicare Part D. So the PBMs aren't involved. Okay. The Humana has an involvement with the attestation with the physician, but you know, most Medicare Part D flows through a PBM. Okay. In this case, this goes around the PBM.
SPEAKER_01Okay. And then tell me about the non-dispensing parts of the activities. You mentioned something about identifying the patients, or or is there an encounter part of it, or is there an ongoing monitoring, or do you need you mentioned a physician has to attest to it? Can pharmacists sometimes fulfill that, or how does that part work?
SPEAKER_00No, it's got to be the physician or the prescriber has to attest that this patient meets the um the BMI requirements. And then they they enter that, they they send that to a database. Um, I believe Humana is um uh involved in in the uh pre-qualification or taking the input in from the physician and saying, yep, the physician filled this out correctly. Yep, they said um that the patient has diabetes and a 20, you know, 28 BMI, um, more than 27. So therefore, when this claim is um adjudicated, it'll it'll uh it'll go through. Um but it's not so much on the pharmacist side, even the PA aspect of it is not so much on the pharmacist side. Um, it is something for for listeners. Um we've had we we've hosted we hosted a webinar recently, just a week or two ago, with CMS to help um pharmacies understand. And I believe that webinar has been recorded. I and I believe it's on our website. Um, so it's like an hour listen. We also have, I think, um some resources on our website to help um pharmacists be prepared and understand the nuances of it. But it's not it's not so much the pharmacist doing there's not a lot of clinical services of the pharmacist as far as what they're paid for with this. Um but of course, with every patient encounter, there's gonna be the potential for cognitive services from the pharmacist. It's just there is not a payment stream in the bridge program to pharmacists for the cognitive services. Got it. It's for the the dispensing services are paid for and hopefully paid for reasonably.
SPEAKER_01Yeah. So we've talked about a bunch of things that like have started and are coming. Um, what are you telling your members and the pharmacy community in general to do today? What's your advice? What what should someone who's listening go and start or keep doing?
Pharmacy Advice
SPEAKER_00Well, as far as keep doing, I mean, on on this, it really is a mix. The services make the dispensing more valuable, the dispensing makes the services more valuable. So, you know, table stakes are vaccinations, uh at least, you know, so if we think most of our, we know most of our um successful pharmacies are doing vaccinations and are looking for other ways to do vaccinations. So that's one. The another is um medication synchronization. Yeah. And I know, and I want to be, I want to explain that because we've been talking at NCPA. I remember we did um some research with um uh uh Ole Miss, University of Mississippi back in like 2006, seven, eight, somewhere in that range, had a bunch of symposia on the research that they did on medication synchronization. And so it's you know, it's almost 20 years. What we're finding is that most of our pharmacies do some form of medication synchronization. But what we're also finding is that they're just they're just scratching the surface, tip of the iceberg. That there's actually there's more there. There's more to mine out of that medication synchronization services that'll help improve their efficiencies, help further improve their efficiencies, help further improve their cash flow, help further improve, you know, freeing up time for their for them and their staff. So that's the second thing, I guess I would say is and and I again I have to explain it because people most people are, I already do that. Yeah, if you're like the average person, you already do it, but you're still leaving, you're still leaving a lot on the table. So medication secretization, vaccination. Um you know, from the dispensing side, really scrutinizing which contracts you accept, working with your PSAO. Um, like I said, there's 15% fewer pharmacies today than there were uh in 2019, just um uh seven, eight years ago. So really scrutinizing what you sign, what you don't sign, paying attention to those opt-out contracts that come to your facts through your facts. And um, you know, making that you have to make that independent decision as to whether or not you want to uh be included in that. Um but I think that's more important than ever is to really, you know, put on your best business person hat as to do I want to accept the terms of this contract or not. Um, those are those are three things. I mean, there's always, you know, marketing, putting yourself out in the community, getting out from behind the counter to the extent you can where you're not chained to the counter. Yeah. Um, those are all, I think, important things. But I think those first three, the um vaccination, medication synchronization, you know, digging into that more and really scrutinizing your your payment con your reimbursement contracts on dispensing, working with your PSAO if you have one, those would be my, you know, I prioritize those three first.
SPEAKER_01Yeah. One of the things that we always talk to with our customers about is a lot of these things that we've talked to are about an expansion of payer coverage, like the Main Street Pharmacy Access Act, right? But in those states, you can already do these things. And often, you know, we're helping our customers, our pharmacy customers, get paid by Medicaid and commercial already today. And so we'd love to add Medicare to that. But there's there is a market and an opportunity there already. Um, and a lot of it requires, you know, medical billing, which is, you know, kind of what we do. But we also we talk to them about don't shy away from it. There's a lot of opportunity there already today. And sometimes we I think there's the perception of like, well, it's not time yet. We have to wait for some of these things. And our view is like, no, for many, many pharmacies, there's a lot of opportunity where the time is today. And you kind of got to find the things that make sense. Um, you know, when we talk to a pharmacy, kind of the first question is, well, what state or states are you in? Okay, here's what you can do in those states. Here's what insurance will pay you to do, here's what they might pay you to do. But then on top of that, here's what the community of your customers will really benefit from. Because we have some really enterprising, very proactive or progressive pharmacists that are doing some really interesting services that are very specific to their little geography. Um, and in general, that's not what we would suggest you roll out as a large regional plan or something like that. But if you match what you can do, what you'll get paid for, and what the community wants, there's a lot of good opportunity out there already today to get paid for clinical service delivery and get paid for services. And, you know, there's we and others are making it easier uh and very um uh, you know, making the implement implementation super viable to actually get started and make it happen. And so we want it to get better. A lot of these things are gonna make clinical services and medical billing better, but don't be afraid to start today. Like there's a ton of opportunity out there today. We see that in addition.
SPEAKER_00Yeah, and I think that you know, getting out from behind the counter, um, which is again, I don't say that lightly. I know that's hard to do. It's it's like telling me to, you know, leave it, leave the office at 5 30. Okay, sure.
SPEAKER_01Right.
SPEAKER_00Easy to say. Um, you know, it's not gonna happen. Um, but I think that's really important. Uh with COVID, there were three ingredients that really made that successful, in my opinion. Um, as far as pharmacies saving the country with uh administration. One was proper payment for the service, you know, $40 a shot was you know decent. Right. Um one was we were able, our members were able to get the encounter in work in workflow. It's got to be in workflow. Can't be jocking back and forth between a bunch of different devices and screens. It's got to be in workflow. And the third, and this is one is often the most difficult, is it had scale. Like it wasn't three patients a week that were coming in for 40 bucks. It was, you know, 50 patients a day, 100 patients a day. Um, and even when it tapered off, you know, 50 patients a week or whatever the numbers were for each individual pharmacy, that is often a missing ingredient. Um, so in some of the things you said, Kevin, like if you've got great payment, you can have less scale. If it's okay payment, like the $40, then you need more scale. Right. And so looking for those opportunities in your community that you know either have the scale where okay, it's 40 bucks, but there's a lot of them, or the payments there. Let's just say I make up a number, it's 400 bucks, but there's not a lot of scale, but hey, it's 400 bucks. Yeah, those two things, and I and I agree with you, those opportunities are out there. And I I think independents are very well situated because we know, you know, a lot of those opportunities come up in conversations with uh people in the community that hey, I've known that person. I and a lot of times the conversation goes something like, Hey, hey, hey, John, um, you've been a pharmacist here for 20 years. I've known you through, you know, community organizations, church, school, whatever. Um, I didn't know you did that. Oh, yeah, I do vaccinations. I didn't know you did um unit, you know, the packaging, special packaging. Right. I didn't know that you'd go out to a company and provide, you know, smoking cessation services, A1C, vaccinations, etc. That's usually how the conversation goes. I didn't know you did that.
SPEAKER_02Yeah.
SPEAKER_00And I think that's another, you know, getting out from behind the counter. Let's head off the I didn't know you did that to here's what I can do.
SPEAKER_01Yeah. Yeah. Well, it has been awesome catching up with you today. I there's so much happening. I would love to have you back anytime we get kind of a next, you know, next milestone or next update. So open invitation, always come back, talk to the audience, talk to the community. Love to have you here. Any parting thoughts you have? We talked about a bunch of stuff, but anything we haven't covered that you want to leave the audience with?
SPEAKER_00Well, you know, on the Main Street Pharmacy Access Act, again, this is something that we've been talking about for a long time. And so, you know, some people could say, I've been I've heard that before. You know, it's probably six or seven, eight years ago. Um, I did a podcast, and I think I said something like, it's gonna happen. It wasn't called the Main Street Pharmacy Access Act at the time, I forget which iteration it was, but it just makes too much sense for it not to happen.
SPEAKER_02Yeah.
SPEAKER_00And so it is going to happen because it just makes makes too much sense for pharmacists to get paid for services that they're providing. And and when it does, um we we need to be ready. Yeah. And so um, for any uh skeptics out there, um, and I would understand why they were uh why they would be skeptics, because we've been talking about it. Um it it it is gonna happen, and whether it's that whether it's this year or next, and when it happens, be ready.
SPEAKER_02Yeah, I love that.
SPEAKER_01I love the sentiment. That's the exact same thing that we're telling everyone. Be be ready. We'll help like you know, it's kind of a bit of a steal from the home depot, but you can do it. And and we, you know, there's a whole bunch of folks, including us, who who want to help. So yeah, I love the sentiment. Well, Doug, thanks for joining today. It was great to see you again. Great to have the conversation and look forward to having you back as things continue to progress.
SPEAKER_00Yeah, I look forward to coming back after the next milestone.
SPEAKER_01Yeah. And so thanks to the audience and join us on the next episode of the Main Street Podcast.