0:00:02 - Briar
Hello everyone, welcome. My name is Briar Harvey. This is the voices of neurodiversity And today I'm really excited about this conversation. Y'all, i'm here with Breck Rice. We met on Lunch Club, which I have talked about before, and we just had a really lovely conversation and I really wanted to get him here for all of you. So first, Breck, tell us about yourself.
0:00:36 - Breck
Yeah well, thanks for having me first off, Briar. It was a pleasure meeting you and getting to know more about your mission and a lot of parallels here. So I've been in healthcare now for over 20 years. I got started back in 2003 when I was recruited to go to work for a technology slash health organization back in Memphis, Tennessee. I was the grandfather of the industry back in those days of doing electronic billing, and claims processing for community pharmacies, and so that's why I got my introduction to healthcare and helping community pharmacies better help the patients they were serving And had a great career there.
I came in pretty early on in the company so they were growing rapidly And we eventually had the majority of all the pharmacies in the entire country using that platform specifically for their workers compensation claims processing, and so a big pharmacy benefit manager, big PVM, saw the opportunity to acquire that company and funnel all of that claims data into their company and make millions and millions of dollars. And so that's eventually what happened to that company that all these community pharmacies loved and trusted and counted on for fair reimbursements, and so that left a hole in the marketplace where there was no longer a true third party payer that was looking out for the best interests of community pharmacy, and so I got to help, co found a new third party program, which we call serve Rx, and continue that mission of helping community pharmacies. A lot of our independent small regional chains, and a few of the bigger chains as well, that use our platform to better serve patients and help those injured workers get the medications in a timely manner. During COVID, though, there was a lot of companies that weren't you know, didn't have the doors open, didn't have employees in, and so some of our independence were really struggling to stay alive, and we had to tighten our belt as well as an organization, and so I started looking at other services that we could introduce to community pharmacies to help them, and that's what got me looking at some wellness platforms and bringing in clinical services into community pharmacies, and with that mission and purpose, i've been asked to serve on a board of a new health and wellness organization called the fountain of youth. You can't trade more the fountain of youth, so they just call it FOI. The acronym FOI, foi, foi, therapy is bringing clinical services, wellness services, into community pharmacies, and even though these pharmacies are the head, you know the location of the clinic.
It's not the traditional Oh, let's go to the pharmacy to get a prescription to mask a symptom. That's exactly the opposite of what we're trying to do. We're actually trying to get to the root cause of disease states and sickness and aches and pains and and not just treat smoke anymore but get to the fire. And so that's a lot of the focuses on preventative wellness And analyzing, you know, labs looking at blood markers, identifiers to tell us what you know that patient may eventually have later on down the road. Analyzing nutrition levels you know we have a way of getting a score of some of these antioxidant levels to see how low they might be and what we can do to improve on those. There's new technology that was just approved by the FDA that increases circulation, reduces inflammation. Interesting thing about inflammation out of the 45,000 disease states that we know of over 90%, it's actually 93% of those diseases originate from inflammation. So if you can reduce the inflammation, have higher antioxidant levels, less free radicals, you're going to prevent a lot of diseases.
0:05:20 - Briar
Well, and there's a difference between preventative care and curing disease, right.
0:05:29 - Breck
Yeah, yeah, what is that? they're all saying that the you know, an ounce of prevention, you know, is worth more than a pound of cures. So that's kind of the focus now And and you know I consider myself a disruptor in healthcare because that's not the popular thing to do if you're in pharma right.
Big pharma makes billions and billions of dollars and trained the general population very well to have the mindset of oh, if you have something that's telling you, just take a pill for that, They make something for it. You just pop a pill and you'll just not. it's not alleviating anything, It's not making anything go away. It's just masking the symptom or not allowing your body to feel that ache or pain.
0:06:17 - Briar
And that's how we end up with our modern day narcotics crisis.
0:06:21 - Breck
Yep, yeah, absolutely. And you know you start looking at what some of the side effects of these synthetic drugs are And you know you can obviously see it in our elderly patients that we're doing more damage than we're doing good. I think the you know the US, or Western medicine has some amazing things to offer. We're really good at acute care. If you have a broken arm, there's no one better than an orthopedic person to put that back in place and make sure it's all lined up correctly. I mean that is perfect. If you have an infection, there's no better thing to do than to get rid of that infection, than to get on an antibiotic, and so we were really good at acute care. But for chronic care, long term care, we're doing more damage than good with Western medicine.
0:07:17 - Briar
Because we're not seeking to prevent, we're only looking to medicate to maintain. I think a really good example of that right now is the Ritalin and stimulant shortages for ADHD right.
0:07:37 - Breck
Yeah, yeah, there's. You know, we've been hearing a lot about that. We have a lot of compounding pharmacies in our network, and so we've even reached out to them to see if there's, you know, if there's a way of, you know, replacing the supply chain with actually manufacturing or making it in-house, and it's a very difficult process.
0:08:03 - Briar
Not just because of the stimulant nature of it, but because of the regulation that prevents. I mean, Adderall has been around for quite a few years at this point in time, So producing it shouldn't be a problem.
0:08:27 - Breck
Right, yeah, absolutely correct, and it's interesting too. You look at a lot of medications and if you look at the pedigree where they started and what they have become, you find that a medication or a drug developed, the science behind it was developed for a specific purpose, but then they find out through, you know, clinical trials, that it's also benefiting another area, and so you quickly see them shift their whole focus in marketing to capture the largest group of patient population. So you see medications that were, you know, in pain management, that were intended for end-of-life care to make somebody just feel comfortable for their last days, mainly in oncology, right, and now those are being brought right into mainstream. Oh, you have a work-related injury. Let's give you this narcotic that was originally developed for, you know, helping somebody feel comfortable when they pass this life.
0:09:37 - Briar
I remember when I was first diagnosed it was the 90s and there were so many pills available to me they just basically threw them at me, which I think increased my own personal tolerance. But I also suspect that some of the problems that I have were drug-related And there's no there's no real tracking or awareness of any of this. Is there?
0:10:13 - Breck
Yeah, and it is pretty interesting right, We talked about this last time we met is that? you know, the first two or three medications really have a purpose, right, They're intended to help alleviate some symptom, But by the fourth, fifth, sixth medication, those medications now are counteracting the negative side effects of the first two medications And then it just daisy chains from there. I work with a lot of clinical pharmacists who are now focusing on deep prescribing, identifying which medications are doing more harm, think good, and taking those medications away from that patient. We have one patient that I'm aware of that was on 28 different medications. They were able to eliminate 20 of those, but still the medical providers that they were working with really had a strong case for keeping those last eight medications for this particular patient. But to eliminate 20 meds that's incredible if you think about that. And they were all counteracting some other side effect of one of the first prescribed medications.
0:11:30 - Briar
Well, part of this is the benefit of having a relationship with a pharmacist, which I don't think many people actually do nowadays. But what is a functional pharmacist-patient relationship supposed to be like?
0:11:50 - Breck
Yeah, and that's one of the missions right of FOI is to bring that clinical setting right into the pharmacy so you have that interaction And more and more pharmacies are focusing on what's considered MTM, so a medication treatment management and actually having these consults with patients. But you have to schedule those right, because when you're at the counter and you get the new prescription and they always ask, do you have any questions for the pharmacist? And 99, 999, 9% of the time that person is in a hurry and they just know to a day, one before breakfast, one at dinner they're out the door and they're not going to really sit down and be consulted, and so that's why I think pharmacogenomics is so important right now to be able to have to Tell us, for the people who don't know what pharmacogenomics is.
Yeah, so it's basically a DNA test, right? It's identifying the individual patients, their genetic makeup and how they metabolize certain medications, And the reports are so easy to interpret. You have a stoplight approach. You've got the medications that are in the green category. These are ones that work with that individual patient's genetic makeup. You've got the ones that are in yellow proceed with caution. And then you have the medications in red. These might kill you. It's basically how that's broken down. Now, medications also have the drug interactions too, And so you have to be very aware of that. If you're on a green medication doesn't necessarily mean that every other medication that's green is okay, because those two medications could counteract each other or have a drug-drug interaction.
0:13:53 - Briar
Pharmacogenomics is something I have educated medical practitioners about, and they did not even know that it existed. So where is the disconnect between knowing what works for me and my body and having that be a standard practice of care?
0:14:23 - Breck
Yeah, i think we can point fingers a lot at Big Pharma that they're in there to make as much money as they possibly can And they have really developed some amazing life-saving drugs. But they do have shareholders to account to and they're trying to turn as big of a profit They're for profit And so sometimes we lose our way in actually focusing on the patient care aspect of it.
Then, if you look at the medical practice side of things, you've got people going through med school who they only spend a certain portion of time I think it's like one or two semesters on pharmacogenomics, on the pharmacy side. And then you've got these PharmDs who have doctorates in pharmacogenomics. They understand the drug interactions, they understand the chemistry behind the medication that was developed. So there's a big disconnect between the provider who is prescribing, and sometimes those prescribing habits are based off of what a drug rep is feeding them in their ear. And hey, this is going to do so much for your patients. You're going to solve this problem, this problem, this problem, this is a miracle drug And they're writing a prescription based on that little bird in their ear, not really fully understanding what some of the interactions may be. Where the PharmD has that higher level of knowledge on the pharmacogenomics side. Now again, i wouldn't go to my PharmD to set my bone or do some things that I need to provide.
0:16:13 - Briar
But your pharmacist is still a doctor. They went to medical school. They have this entire comprehensive medical training, with the additional component of the chemistry that makes all of this interact with the body.
0:16:28 - Breck
Right, and that's why I think it's such a beautiful marriage to bring clinical services right into the community pharmacy. You think about the olden days when they'd have to ride the horse into town to go get the doctor and he'd come out and come riding out to the farm to see the patient And he brought the pharmacy with him. He had his old black bag that he brought out with him and kind of brought the pharmacy with him. And so we're looking at going back to those simpler times where you can just go to one place, one location. you don't have to go to an urgent care provider or wait around for months to get in to see your PCP, your primary care provider. that you can go to one place on your community pharmacy and have some clinical services done and be right there if a medication is needed.
0:17:24 - Briar
Because, again, we're focusing on holistic care. So what does that look like for someone who has no concept of preventative treatment?
0:17:39 - Breck
Yeah. So a lot of it is education right, and you can find studies, clinical studies that have been done on proper nutrition that have reversed illnesses by having proper nutrition, a 50-year-old study on diabetic blindness that can be reversed with proper diet. You're not going to hear very much about it because it's not real profitable for a big pharma to tell patients eat better, right, have a healthier diet. That's correct. So statins are big moneymaker things that are controlling cholesterol And very few people know that there's certain natural things that can lower your LDL, your bad cholesterol, better than even the highest performing drug. Probably a handful of Brazil nuts will lower your LDL by 20%.
0:18:52 - Briar
But that brings up another issue, because there's a Brazil nut shortage And particularly in the United States, food is not always at a level of quality that is actually going to make a difference.
0:19:16 - Breck
Yeah, and you can look at regions of the world, too that have been overusing the soil right And they're depleting nutrients from the soil, and so they'll be missing certain elements in their blood work that can allow disease to creep in, and so there's some really interesting studies that's being done on that. It's so important the science behind growing crops and rotating the crops and making sure that you're using organic matter to replenish the nutrients in the soil, rather than chemicals that are basically burning out the soil. It's a science on its own, but we certainly don't have the same nutrition level. Even if you're eating the greens and all of the fruits and vegetables and nuts and seeds that you should be consuming, you're not getting the same level of nutrition out of those that maybe our ancestors did when they were out there growing it themselves.
The other thing, too, is in food science. A lot of produce is sold by the pound, and so you need bulk in order to maximize your profit, and so you'll see citrus oranges that'll have really thick skins Well, that's on purpose, because there's a lot of weight in there or you'll see blueberries that are the size of grapes they've been genetically modified So many different things that have genetically been modified to produce weight or bulk rather than nutrition.
0:21:19 - Briar
So if food is the cure and the food is bad, what do we do, sir?
0:21:29 - Breck
You know, you just have to eat more of the good food, right? Knowing that maybe it's not as the same nutrition level, but we just have to consume more of it. And that's not our typical Western diet, right? We eat a lot of processed things, And so to try to get back to, you know, eating more fruits and vegetables and understanding that's kind of the purpose behind one of the technologies that we're bringing into these clinics is doing you know, I call it, you know, a bio scan.
It's basically checking the antioxidant levels of patients, And so that gives them a base score And then you put them on a program to improve that score, to consume more antioxidants, and that can also be you know, that can be ideas, like you know in your, in your breakfast oatmeal you just need to add a quarter teaspoon of cinnamon. you can get more antioxidants out of a quarter teaspoon of cinnamon than most anything else that same bulk. But there are there are supplements that also can be added to diet in order to improve that score as well. So it's kind of a test therapy test. so you're getting a baseline putting a patient on a therapy, then you're retesting to make sure that they're improving.
0:22:58 - Briar
So how do we consciously incorporate these things into our life and our diet?
0:23:14 - Breck
Yeah, you know people only respect what you inspect, and so there's got to be something that's measured. And that's that's why these analytics is so important to sit down and actually measure them with the patient and then have them return and report. They come back in and six to eight weeks you retest again to see what improvements have been made And if there aren't any, you're recommitting that patient. But you now have the evidence behind the theory that if you don't make these corrections, this is what's going to happen down the road, and the easiest example of that is is diabetes. Right, you keep consuming processed food. You keep consuming things that are high in sugar content. I mean, just go to your local grocery store and just look at the grams of sugar on things you wouldn't even think Oh, i'm getting wheat bread. This has got to be healthy. Turn it over and look at the levels of sugar that are in bread.
0:24:20 - Briar
American bread, though, is classified as a dessert in most of Europe because of the sugar content found in it.
0:24:31 - Breck
Yeah, yeah, you know I love fruit and yogurt parfaits And that's kind of my thing, with some healthy granola or something like that on it And I moved away from the traditional you know, ganon, whatever, because of all the sugar content and moved to a more Greek, no sugar added, and let the sweetness of the blueberries and the strawberries and stuff come out and sweeten that. And now if I go back and have a regular yogurt, it's nasty to me how sweet it is. It's just like I have to mix it with Greek yogurt or something because it's just too sweet.
0:25:18 - Briar
Because it's too sweet. Yeah, once you start removing and I have a problem with sugar. Sugar is my own personal nemesis and it's rough, it's, it'll sneak in and everything. It's in salad dressings, it's in bread, it's although I don't eat that anyway although it's still in gluten free bread. You'd think we've removed the wheat, we would also remove some of the sugar, but in fact we do not.
0:25:46 - Breck
No, no. In anything that's processed, the manufacturers know, in order to get consumers to like the product and buy it over and over again, they've got to put something in it that you know that stimulates our brain to say, oh, that's delicious, i got to have more of that. And sugar happens to be that refined sugar you know has happens to be that that ingredient that seems to be working.
0:26:16 - Briar
So what can people do to integrate more prevention into their lives?
0:26:27 - Breck
Yeah.
I think, again, it goes back to the education right, understanding why or why not if they don't. And you know, that kind of brings me to, you know, to a little social media campaign I launched at the end of last year. That that's surprisingly blown up and started to get quite a bit of a followership, and and it's information that's available to everyone. When you go pick up your prescription, you go get a commonly prescribed medication and it comes with the whole list of information that that goes along with that medication, not only how to use it, when to use it, you know how many times a day. All of that, the quantity and all that, but it has all of the things to be aware of that could have negative side effects that you should look out for. But how many people actually look through that material? they take the bottle out of the bag and they throw all the paper away and start taking the prescription.
And so I launched a campaign called scary drug facts where I simply list off the common side effects of prescribed medications. And you know I started kind of on the pain management side and and my you know my post on tramadol has like close to 3 million views. There's so many people that had questions about one of those side effects or how long they've been on it and what are the short term use versus long term use, and so that really kind of went viral and blew up, and so now you know there's over a hundred thousand patients that are now following that. These posts that I put out I try to do it, do it daily, but sometimes I get busy, so I get them out as often as I can.
0:28:28 - Briar
And we've discussed this. The issue isn't the drug in and of itself. In many cases, the drug is important, it's valuable, it does save lives. The issue is the overprescribing of the drugs.
0:28:45 - Breck
Overprescribing and the dependency of it. So most, you know, most medications unless, like I said before, if you're, you know, in pain management, unless you're a terminal, you know, patient, that is is, you know, just trying to make them comfortable through their end of life. Most medications are developed for acute care but we so often put people on them for, you know, a injury and then they become dependent on it and now every little like can pay me another one, or they you put somebody to help them with a mood adjustment and they become dependent on that and want to have that, almost like a security blanket. And there's, you know, there's, some really fascinating research that is coming out on on different herbs and different spices that we don't normally add to our diet because, you know, there are things that seem to come from, you know, maybe Asia or someplace. So other parts of the world have been using different, you know different, food enhancement, you know, flavoring with spices and things like that that are have so many health benefits that we're not even aware of here in Western.
0:30:11 - Briar
Turns out, monosodium glutamate is good for you.
0:30:16 - Breck
Really.
0:30:17 - Briar
I read some research on this one fairly recently that, because of its umami characteristics, it's actually really great for people who need to reduce sodium intake. So if you replace table salt with MSG, it reduces your overall sodium consumption, which is incredibly beneficial to certain illnesses and types of people who struggle with sodium consumption, but we demonize it automatically in so many instances. The alternative there, though, is I know people who have been on antidepressants for decades, and that's not how an antidepressant is supposed to work.
0:31:06 - Breck
Yeah, and that leads me back to the research that's being done right now. There's over 500 researchers working on herbs and their benefit to mental health and you know, focusing on depression, anxiety, you know mood therapies, that the evidence behind it, using that, going a natural approach, that's amazing what the science is saying. You know, we told, follow the science, what the science is actually showing through these studies and through these over 500 researchers, and they narrow it down to some pretty specific herbs that we should be focusing on. And you think about that. It's natural, right, so it's not going to be chemically based, it's not going to have you know anything in there that's going to have all these side effects.
But even natural remedies or products can, you know, obtain too much of something that that you know you should. You know you could take to a certain level right, but then you shouldn't be resuming that. For instance, you know to get that efficacy of dropping your LDL by 20% is literally four or five nuts a month is all If you consume, you know, handfuls a day, you'd be taking in too much of. You know something else that could be, you know, harmful to your diet.
0:32:47 - Briar
And the research always. I read recently about serotonin and that we are now unsure of its effects in chronic and chemical depression. So if serotonin isn't what's causing depression, then all of those SSRIs selective serotonin reuptake inhibitors are probably not the drugs that people should be taking.
0:33:22 - Breck
Correct?
yeah, yeah, it's. You know, if you look back at again, you know Western medicine is saving lives. There's no question there. And but if you look back at, if you follow the money in where Big Pharma came from, it traces all the way back to big oil. And you've got, you know, you've got the Rockefellers who control a lot of the finances of the early, you know Americas and big oil And as byproducts were experimented with, to say, okay, what can we do with some of these byproducts? That's where chemicals come from And that's really what where the birth of Big Pharma came from.
And so, you know, if you think about it from those standpoints of putting, you know, putting petroleum based chemicals into your body, you would think that would wake a few people up and say, hey, maybe I oughta look at it. You know going a different route here. And you know one of my sayings is that you know medications have a purpose, but when the side effects outweigh the benefits, that's when you need to do something different. And if you look at the list and these are listed clearly on the manufacturer's website you can go to some other really great resources that I use all the time our WebMD and the Mayo Clinic. I mean, i love the Mayo Clinic because the way they lay out where the drug interactions could be that you need to be aware of and it shows what the common side effects are.
It shows what the rare side effects are and then it can show it basically says undetermined, meaning that some patients experience that but they don't know if it's directly related to that medication. It could be something else going on in their, you know, in their genetic makeup. But there's a lot of you know undetermined reasons why. But when those side effects start to pile up and outweigh the benefits you're actually getting from the medication, that's really when people need to reflect and say, hey, i need to do something different. I'll give you a personal example. Okay, love spicy foods, always have, i've always loved spicy food and it was almost a challenge to get it. The spicier the better. Well, unfortunately, i started to get older and I started to get, you know, the heartburn and everything else.
0:35:54 - Briar
I have also experienced this trauma and loss.
0:35:57 - Breck
yes, So I had like a chronic sore throat and I didn't know what the issue was. And I go to the doctor and I thought it was just drainage from allergies. He's like, no, you've got acid reflux, your acid. Some acids are actually burning your esophagus and so we need to do something about that. So they put me on omeprazole, wonder drug. Oh my goodness, i could take just one of those a day and continue to not change my diet or do anything different and continue to eat my spicy foods. And, man, that was a perfect solution for me for a few years. And then I went in after being on the medication for about, i guess, three years. I went in to get it refilled and met with a different primary care doctor, because now it moves in a different area. And finally somebody explained to me who I've been working with pharmacists for 20 years explained to me you know that this medication is robbing bone density, right? I'm like, oh no, i didn't know that. Yeah, so it was taking bone density away. And I was like, well, yeah, that's something I should pay attention to.
That very winter we were up skiing and snowboarding in Val Colorado and I was coming through the trees and hit some steep mobility area and just hit a bump just right and completely blew out my ankle. I mean completely blew it out you know where the tibia broke in two, and one piece of it slammed into my malleolus, the little ball on your ankle, knocking the malleolus completely off. So now I've got a screw and a washer to put that back in place. I've got a plate to put my bone back to, to put it back in place, all because of bone density nutrients being robbed out of my bones. So, hey, then I had to wake up and say, okay, i need to start looking at a different alternative here And, like most medications, once your body is used to that, it is really hard to eliminate that from your diet. The acid reflux, the heartburn, came back with a vengeance.
0:38:31 - Briar
Oh, I'm sure it was worse the second time around.
0:38:33 - Breck
Absolutely. it was a horrid And trying to change your diet it didn't matter, even staying away from acidic foods. my stomach fats were just trying to re-regulate and it was a horrible, horrible experience. So the sooner that patients realize hey, this is doing more damage than good and moving away, the easier to get off of or not have those withdrawal symptoms that come with a lot of medications.
0:39:07 - Briar
And the issue here really is that so many patients don't have a kind of relationship with their primary care physician. Listen, if you're Canadian, your odds of even having a primary care physician right now are like one in eight or something. It's absolutely ridiculous. So how am I supposed to know any of this stuff?
0:39:34 - Breck
Yeah, that's why we launched little educational campaigns like Scary Drug Facts. It's to get people to start asking questions, get people to sit down with their pharmacist for a consult, and it doesn't have to be in person, they can do those consults right over the phone and we can do them virtually. We're doing a lot more virtual care. There's actually study out that shows that virtual primary care will surpass in-person primary care very shortly And that one thing that we have to thank COVID and the pandemic for is telehealth wasn't really catching on.
There were a lot of telehealth companies out there but they really didn't have the masses going to them to utilize them and tell the pandemic. And now it's more natural right To actually have a visit through through a computer screen like this rather than be there in person. And I would argue that you actually might even get more time with that provider than going into the office because you have a scheduled slot of time that you're meeting with that concierge doctor or primary care provider. You're not meeting with their PA or their nurse. That's doing the vitals and all of that. It's usually the doctor.
0:41:03 - Briar
One of the things that we like to talk about here on this show is particularly how this affects all of us. And you say concierge doctor, and I go. Well, that's expensive. What are we doing to get better care to people who cannot afford it?
0:41:23 - Breck
Yeah. So one of the interesting focuses with the FOI therapy or the fountain of youth is that if you look at the expenditures or the weight on the healthcare system for cost, it's actually about 30% less to come to a clinical setting at your community pharmacy. To do a telehealth visit, to do remote patient monitoring, works out to be about 30% less of a cost if someone was having to pay for it out of pocket. Or it's less of a financial burden to the healthcare system than going to an urgent care or a walk-in clinic. It's probably 200 or 300% more cost effective than going into an emergency room too as well.
0:42:23 - Briar
Absolutely.
0:42:25 - Breck
But what's interesting is some of the technologies that we're bringing in. We're making sure that it goes through the whole Medicare Medicaid process so that those insurances can kick in, and we're doing that with a lot of the elderly patients, making sure that, like the pharmacogenomics, for instance, is used to be a very fairly expensive test still expensive, but it's come down quite a bit. But now to get the payers to actually pay for those tests. Correct, Yeah.
0:43:00 - Briar
That is often a problem, because insurance doesn't like preventative care. You would think that they would love it.
0:43:08 - Breck
Right That they're not gonna have people with obesity and diabetes and blood pressure issues and heart problems down the road, and that's why you see more and more companies putting in programs that are self-care type programs. If you join a gym membership, you can get reimbursed for that gym membership with a lot of insurance, but where's the accountability You could have the gym membership? are you actually using it? And so doing remote patient monitoring, actually checking in with patients and seeing what progress they're making, i think is gonna have some real huge benefits. We have a technology partner who is developing the gamification of patients doing what they need to be doing. And think about it.
If you're a big warehouse, like an Amazon setting or something like that, and you have all these people on the floor that are having to go pick the parcels or the products and get them ready for shipping and everything And it's a lot of physical activity Well, if they're not prepared that day for that physical activity, they're gonna either be less busy or that physical activity they're gonna either be less productive or they're gonna have an injury, and so a lot of the warehouse workers have a higher level of work related injuries. Well, what if there was some kind of a mechanism to make sure that they were physically ready for that shift And they would get points for that And those points could be turned in for a set of air pods or something like that. Well, i'll tell you, a $250 set of headphones is a lot less expensive for that employer than covering-.
0:45:02 - Briar
Then workers comp? Yes, it is.
0:45:06 - Breck
Exactly exactly.
0:45:09 - Briar
And the issue continues to be how do we integrate these systems in now? We're aware that these things aren't working. We're aware that warehouse workers are going to get stress related injuries because it's a stress fracture type job, But we're not changing things institutionally. So how do people help bring about this change?
0:45:45 - Breck
Yeah, we look at things as being status quo. You have people in positions that are making decisions not necessarily in the best interest of the organization, but in their own best interest, and so that's where you get into the status quo And let's just keep doing what we've always done. Well, we know that that's also the definition of insanity doing what you've always done and expect a different outcome. And so you somehow have to educate, and usually it's with showing the cost lost costs and what the overall cost savings can be for an organization to adopt some of these healthier approaches. And that's usually the only way you can get through to it. And again, it's not one individual. It would be great if there was a Mr Corporate America that you could just go sit down with. No, there's layers and layers, right? So there's a department over risk management and then a whole separate department that's over benefits, and then a whole separate department over finance. It's getting them, all of those stakeholders, in a room together and explaining. This is why you need to make this change, because this is what the cost benefit, where the savings is going to be, to your organization.
So there are a lot of companies that are focusing on that. We happen to focus on that, on the cost containment side of pharmacy specific to work related injuries. So we have a program that helps self-insured employers save about 30% off their pharmacy costs by just going a different route. That isn't the status quo. And sometimes you've got the good old boy networks where their buddies sold them the pharmacy benefit program, the PBM program that they're with, and they're loyal to that buddy and not realizing that that buddy's company is putting about $100 in their own pocket every transaction. Well, what if you took that middleman out and dealt directly with folks who could manage that for you and not have that big spread pricing going into to make a billion dollar organization on the backs of self-insured employer groups?
0:48:21 - Briar
And it's a complicated question, but I do think that certainly there are more solutions to be looked at when we cut out the middleman.
0:48:35 - Breck
Yeah, in workers comp we estimate that it that's not exaggeration that it's about $100 going to the organization that's just processing the claim. They don't even own the medication, they don't have the overhead of the pharmacy, they don't have the staffing, all of that. They're simply the processor and they're putting more money in their own pocket than the pharmacy. Who owns the medication? who's consulting with the patient and dispensing that med to the patient? They get about $4 or $5 reimbursement. Sometimes it doesn't even cover their acquisition costs of the drug. But the big PVM is putting $100 in their own pocket. That's why you have help big pharmacy chains that have 10,000 locations selling anything and everything, but yet they're PVM. That they own actually accounts for 80% of their total profit for the entire organization. It's not from the pharmacy side.
0:49:41 - Briar
It's not from all the retail.
0:49:42 - Breck
You have 10,000 retail locations but 80% of the revenue comes from that PVM, that pharmacy benefit manager who's working off of spread pricing. You've got a big employee help benefits company, one of the largest in the world, that has 65 million lives that are paying their premiums into this health company for benefits health benefits, the companies are paying. Is this the one with the duck? No, this one. what is there? I don't even know if they have a logo. It's a big company that owns their own PVM and 75% of their profit margin comes from the PVM side, not from all of the revenue coming in from premiums of 65 million people.
0:50:39 - Briar
I know that other countries negotiate with pharmaceutical companies and get prescriptions at a lower rate, but why have we gone the opposite direction here?
0:50:57 - Breck
It is super complicated, right? Because where was the medication developed? Where did all the research happen? 90% of development is by US companies, and so they're recouping all that cost of the research to development. By the time that medication has gone through that whole process, it's been approved by the FDA, it's out in the general population and it runs its course for branded medication. Now it can be redistributed or remanufactured as a generic drug.
Most of the nationalized health systems that you hear about, where drug costs are so much lower, is after that medication has gone to off of brand and is less expensive In workers' compensation. in our industry 90% of the prescribed medications are generic medications. That's a big cost savings by using the generic med versus the brand medication. It gives you some idea of what a huge delta there is between the branded price and the generic price, unfortunately. it's great that we're involved in the research and development here in the US, but with that comes a price. We do pay the higher prices for the manufacturer to recoup all of that upfront investment into the research and development where other countries on national programs aren't contributing to that research and development in most cases.
0:52:47 - Briar
I'm not sure how it fits into the ecosystem, but I'm familiar with Mark Cuban's drug program and what he's doing to get low-cost drugs into people's hands. But part of the issue there is awareness. People actually have to know that these programs exist.
0:53:10 - Breck
In his case, he owns a generic manufacturing company. This is after the drug has gone off of brand and they can now buy the rights to reproduce it. Now it's a generic. He was getting beat up from the pharmacy benefit managers taking their spread pricing and wanting him to take a lower cost of medication so they could improve their spreads.
That's the game that they played. He got so frustrated with that that he started his own pharmacy benefit management company, his own PBM that they call, where they say, okay, it's full disclosure, you can know exactly what the costs are. It's a transparent PBM showing where all of the costs are associated. Your traditional PBM, your pharmacy benefit managers, the big ones like Optum, expressgrips and CVS CareMark those are the three big PBMs that control 80% of the lives of US citizens. Just those three 80%. going through one of those three, they work off of this spread between what the wholesale cost is of the medication and what the payer is going to pay for the medication.
In the workers' comp side there is usually an established fee schedule. The state of jurisdiction wherever the injury happened, they have a state industrial commission that comes together and say, okay, this is a fair reimbursement that this medication should be reimbursed at. Well, the big PBMs may give employer groups a discount. They'll say, okay, we'll give you a discount off of what that fee schedule is. We're not going to charge you that full percent, but on average it's only like a 5% discount that they're giving the employer groups or the insurance companies in those states of jurisdiction.
So there's a whole lot of money being made here off of that, right, but they're asking the pharmacy who owns the medication, who's dispensing it, to take a 65% discount And so that 5% that they promised back to the payer, they've still got 60% spread in there to make on each transaction. Yeah, it's a racket. It's the closest thing to organized crime.
0:55:50 - Briar
Right, I was just about to say that I am Italian. I know what organized crime looks like. This looks like organized crime to me And they spend millions and millions of dollars on policymakers, on legislation, on lobbyists, saying this should be a certain kind of You can look up your congresspeople and know who they take donations from, and I wonder how many of them have PBM donations.
0:56:21 - Breck
Yeah, i'm in Arizona and we fought a battle here for many, many years in our own home state to make it possible for physicians who were treating work-related injury patients the ability to go ahead and okay, we're going to treat you here And then we'll have a small formulary of medications that are commonly prescribed for whatever that specialty. You can go ahead and get your pharmacy stuff here too as well. So there was point of care dispensing, which was something that has been from the beginning of time. Remember my analogy of the doctor riding his buggy out to the farm to help little Mary Ellen Olson or whatever, a little house in the prairie. That whole thing brought his pharmacy with him.
From the beginning of time that's been a right of a physician to also be able to dispense a medication, and the PBMs wanted to outlaw that because it was bypassing going through one of their pharmacies where they were going to get their cut. And so they legislated for years and we fought them for years saying hey, no, this should be the right of Think out what this is doing for patient care. We had a big provider down in Tucson who was an anesthesiology pain practice right One of the largest in the state, so patients were going there that had severe injuries, where they were having to basically get a spine block to block that pain. Well, the last place they want to go after that procedure is to go wait at the pharmacy for two hours to get their prescription filled. And so he was just dispensing what would be needed until the next time they could come in or were eligible the payers were eligible to allow them to come back in for another spine block. It was a convenience and it was also, if you think about it, compliance. The compliance went up, goes way up, because they Let's think about the guy now that gets a procedure now thinks he's got to go wait around for two hours. Or they say, okay, you got to come back at four o'clock. He's like I got to go lay down, and so he doesn't go and pick up his medication. So now what is he going to do? Now the procedure, pain is really kicking in or war off, what do I do? And so that's where you get patients that start looking at alternative measures. So let's use something that maybe wasn't prescribed to me. So your compliance goes way up when it's dispensed at point of care.
But their argument was there's no controls here in place, you know, and it all came down to the dollars. It had nothing to do with patient care. It came down to that $80 to $100 transaction fee that they were putting in their pocket. They were missing out on that and they needed that to return to their shareholders and say, hey, we're super profitable, we make $163 billion a year and that's not enough, we've got to get more. So let's outlaw that in this particular state and every state that they possibly can. Probably the next one that's being considered legislation for that right now is Florida, because they're missing out on millions and millions of dollars, those PBMs by positions during point of care dispensing in Florida.
1:00:01 - Briar
And it's important that healthcare, as such a large industry, affects politics on both sides of the aisle. Everyone has their fingers in this particular pot, yeah.
1:00:15 - Breck
Yeah And not everyone is as educated as you are that there are places you can go to see who you know who the donors are. So I would like to that to incorporate a NASCAR approach to our politicians They should wear a jersey that shows who all their sponsors are. That way, it's right there in the open, You don't have to go searching for that.
1:00:38 - Briar
That's amazing, okay.
1:00:41 - Breck
This politician brought to you by Pfizer.
1:00:45 - Briar
I would prefer to know that Truly, I would.
1:00:48 - Breck
Yeah.
1:00:49 - Briar
And I think that the more that we're aware of how inherently political healthcare is, the more we're willing to stand up for our rights.
1:01:01 - Breck
Yeah, absolutely. Very well said.
1:01:05 - Briar
Okay, any final thoughts for us today.
1:01:09 - Breck
No, this has been fun to visit with you again, Briar, and you know, if anyone has any specific questions that are listening to your podcast and want to reach out to me, please do. And the only Breck L Rice on LinkedIn, so that's a really easy way to find me. That's one of the benefits of having a unique name is that I'm pretty easy to find.
1:01:32 - Briar
Indeed Well, Breck, thank you so much for being here. Y'all, thanks for watching, and we will see you again in two weeks. This has been the voices of Neurodiversity here on the Neurodiversity Media Network, and if you're not a subscriber, you can hop on over to Neurodiversitymedianetworkcom and join us there. It's free to subscribe. Paid members get access to our Masterclass series, where we'll take everything that we've learned here today, write it all down, give you some resources and some reading notes so that you'll have more to come back to and dig into this topic in greater detail. Thanks so much, y'all, and we will see you again next time. Have a great one.
Transcribed by https://podium.page
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