Combining Telemedicine and Local Pharmacies | Vinay Patel, PharmD, Founder MakoRx

Speech to text:

Mike: [00:00:00] Vinay, for those that haven't come across you online, introduce yourself and tell our listeners what we're talking about today.

Vinay: My name's Vinay Patel. I'm the founder of MakoRx, and our goal is to change healthcare access and affordability for, using, community pharmacies across the country. there's definitely forces and challenges that are greater than ever before against pharmacy, community pharmacy, and the little tiny piece that we're doing to try to help pharmacies survive and thrive in today's environment.

Mike: So Venet, looking at your business online, I'm seeing something on there about. Telemedicine with the doctor's office, and it seems that everybody wants to get their hand in telemedicine, and I think a lot of pharmacists are thinking, well, as long as they're telemedicine, they're gonna go ahead and click a button and it's gonna send a medicine. And pharmacists are kind of left out of the loop. From what I'm seeing on your site. A big benefit that you're bringing is somehow combining with the doctor in telemedicine.

Vinay: So what you're referencing, Mike, is MakoRx Care Connect, and it's a website, and that's the website that you see these services on there, and. The way that we see telemedicine is the perfect partner for pharmacy for any in-person services that may be needed. I personally don't think telemedicine is the answer to healthcare.

I think that during the pandemic and now post pandemic, people are more comfortable using telemedicine. There are plenty of websites out there touting telemedicine for a lot of cosmetic conditions or lifestyle conditions that really aren't getting at the meat of medical care. 

again, in my opinion.

But I think that we can change that. and part of that is saying, okay, virtual care, you have all of these wonderful medical resources that can consult with patients and can give them,an assessment or diagnosis and prescriptions, which is what a lot of patients need, however, To really give high quality patient care and tools and access to these virtual care, resources.

We want to partner you with local community pharmacies that can serve as your last mile of delivery or access to brick and mortar in-person care. When your patients, the community that you serve, need access to it.

Mike: If I saw it right. Vinay, it was, if the pharmacy sort of initiates

Vinay: That's right. 

Mike: meetup and then it goes to a telemedicine doctor, but then funnels back to the pharmacy,

Vinay: yeah. No, absolutely. You're right. We want to help use or facilitate virtual care with the pharmacy saying, okay, I have a patient who needs some sort of care. They're my patient, they're in the pharmacy, or they come to my pharmacy looking or needing some care, whether it's being sick with a sinus infection or feeling like they have the flu or strep throat.

And so the pharmacy says, okay, great. I have this tool or resource, called Make RX CareConnect in my pharmacy. And all you have to do is go to the website, book an appointment at this pharmacy and I can give you a strep test, a flu test, or utI test. Or if you're just generally sick and wanna talk to a doctor, you can do that all here at my pharmacy we're trying to help establish that relationship with people knowing that pharmacies a new place, or local independent pharmacy, or hometown pharmacies are a new place where you can go get medical care. It's not just a drugstore where you can go get prescriptions, it's, services.

Mike: So, 

If I'm hearing that people are setting up a time to come to the pharmacy, and in a way it's like the doctor is in your pharmacy, like in a little, I know they're not of course, but they're like in a little office there, 

and then the people come out as if the doctor was right there. that's the guts of it

Vinay: Exactly. That's right. That's right. Think about like a virtual minute clinic or a virtual care provided right at your pharmacy and whenever you need in-person service. If you're having a consult with the doctor and they say, okay, well I need to rule out flu covid and strep. Go get these tests done.

Then you can say, I'm right at the pharmacy. Lemme go get that done. They'll have rapid test results for you within 15, 20 minutes and you can tell the doctor, okay, well it's not flu or strep, but it looks like it's covid and they can proceed on with their diagnosis and assessment 

and it sort of works in tandem.

Mike: Vene, I'm an old fart, but there's a lot older farts than I am. And I kind of picture that a little bit of the slant on this might be some people that are not real computer literate. That's [00:05:00] just the thought that comes to my head. Is that the goal at all in this or is it more just the convenience and the display of unity and so on, or is it part of it for the people that might need a little hand holding in this subject?

Vinay: So if I were to prioritize what we're focusing on from what we've built, it's definitely convenience, access, and affordability. are sort of the top three. And then, After that , we're expanding out from urban, suburban areas where we need to provide more access to care, which is in the rural areas.

And there may 

not be

folks that have access to technology and resources there, and they can go into their pharmacy and say, there is something in my pharmacy that I can use to connect to my doctor, or to connect to a doctor to help get me care, primary care virtually. and so yes, that's further down on the list and we definitely want to tackle and address that today.

We're. We're focused on these top three. get traction, convenience, affordability and access, to care when you may not have, or, you, you find like you need to go to the doctor's office and it just takes half a day to have a medical appointment. Something quick and easy is, and affordable.

When medical care or coverage insurance says,even if you have a high deductible health plan like I do, it's gonna cost $150 to go to urgent care. and we wanna address those issues first, but then definitely get to that, Hey, if you don't have access to technology, the pharmacy can host that for you.

 We provide every pharmacy that's part of our network that's offering care connect at their pharmacy, a tablet that 

tablet sits, and it's mostly pharmacy facing today. It helps to serve 

as a resource to order test kits 

or communicate with patients, see patient appointments, have them check in at the pharmacy tomorrow, that will actually turn around and be patient facing where they can, the patient can then access their telehealth appointment right at the tablet.

Mike: In our pharmacy, we have delivery and we, I was just talking to one of my team the other day, how it might be time to get rid of any in-store account. Most people now have a debit or a credit card. However,

Vinay: I think there's still a significant portion of people in our business that have financial issues.

Mike: You can just tell by the places they live and so on. So it's typically not a soccer mom trying to save some time. it's an elderly person who's maybe, well, not elderly, but it's a person that maybe has some financial struggles, doesn't have a car, and so on. There's a significant portion of.

People in that category that don't have things that we think about, whether it's technology, whether it's

a debit card or a credit card. A lot of times it's not because of financial reasons. It might be, think about it. If you have to sign up for a debit or a credit card, a lot of times you need a computer to do that or you need to drive to the credit union or something like that.

So you can set your business up however you want to, but there's a significant part of people I think, that need help crossing that divide.

Vinay: Absolutely. Absolutely. And the technology can hopefully bridge that gap and it can be right at your pharmacy. And, there's plenty of rural areas around the country where the pharmacy serves as a broader healthcare resource because of the access and maybe limitations of that area.

And the pharmacy is sort of the best place to go get healthcare. 

And they're asking their pharmacist first, Hey, do I have any refills on my antibiotic? Or What should I do? 

I'm, I'm feeling like I have, an eye infection, and so on and so forth. and so hopefully not only the technology, but the technology facilitating really high quality medical care where a certain component's virtual, but a certain, I believe healthcare needs to be hybrid.

It can't be all 

virtual, can't all be in person now coming out of the pandemic. And so this hybrid, the technology can hopefully connect us and facilitate the patient care rather than what we see in historically, which is everyone gets excited about a shiny object and 

tries to change healthcare with it.

Mike: Vene, what's been your biggest setback so far that you thought it was gonna go this way and it just popped up on you? 

Vinay: It's were a couple of things that surprised me. Take you back to November, 2022 when we finally got all the software platforms ready and the technology and everything's sort of working and we were getting ready to launch it and we thought, okay, we got a couple of services here.

We think it should be just across the year. Like you, urinary tract infections is, it should be just a regular service that pharmacies get, 

uh, that, isn't seasonal like flu 

and strep is. and we were surprised. So we haven't had the regularity in the urinary tract infection testing as we thought we would.

and marketing. Marketing has been really a tough one for myself and our team to figure out, okay, well how do we get people to be aware of this? We've done so many different campaigns online to support the pharmacies. We've done stuff in the pharmacy itself to get signage out and information about a, [00:10:00] about the services.

When we tell new people about it, they think that it's really neat. It's different. And that people would use it, but we still have some questions to figure it out. If we're calling this virtual care, but you have to go to the pharmacy, is that a misnomer and are people getting confused or thinking maybe in urban areas, I can do everything I can, that I need to for medical care virtually.

Why do I need to go into it? A location, maybe that's dissuading people. Are we doing enough to support the pharmacies that we have in our network to get them to be equipped to promote and sell and market the service? and so there's still a lot of questions we have or do we have enough access?

We started out with about 25 stores here in North Carolina pharmacy locations. And, maybe we need more, we need to expand that much quicker and really get the buy-in and. And then talking to pharmacists. There's still plenty of pharmacists that have told us they don't have enough staff time, energy to focus on a new program.

They're trying to figure out how to survive with what they have in dispensing prescriptions before they can move on to something new. 

and so it may be too early in the life cycle. We still need to look for early adopters instead of trying to go out to the market and figure out, who would, who would be the right fit for this?

So a couple different challenges, 

uh, in different areas. we're surprised. We thought there were other services that would just be steady and continue along. But, it hasn't worked out that way. And reality's, a good indicator the data that we're looking at is good reality to help us pivot and figure out, keep trying new things to see what will work.

Mike: All of us who've done business, I think a lot of times we come in and we say, we've got this service or product, and everybody is gonna line up for it.

And I think what we sometimes fail to reason, at least I know I fail to remember, is that. People in general are already getting the service somehow, or if they're not getting it, they're comfortable not getting it. they're like, well, I'm not getting my blood pressure tested enough, but, sometimes it's just a nice excuse to say, I can't get to the doctor so he can bitch at me about my salt intake or something like that.

And sometimes we almost approach new businesses, like, we've come to Mars and they've never seen this before. 

But the problem is they sort of have other options. Not the same one, but they're sort of comfortable and it's just hard to change people sometimes.

Vinay: Yeah, no, absolutely. We've seen that we are becoming more and more aware of what are all the other options that are available to people. Even so, we thought there would be a regular flow of people. My first hypothesis prediction before we started was that the rural pharmacies would have more traction in this program than the suburban or urban pharmacies.

Cuz, we live in the triangle where we're based out of in Raleigh, it's saturated. We have three health systems within 20 miles of us. And so maybe there's too much access to medical care here. but yeah, it hasn't been the case. We've definitely seen a little bit more traffic in the rural areas than we have in the suburban areas.

But there've been a couple pharmacies that have been pulling their weight in, even in the middle of, Charlotte as well. So,

Mike: Customers will come in and they'll say, Can I get a little bit more of, such and such, my SSRI or something like that? Because, I'm between doctors and you're like, all right, how many could I spot you?

They're like, three years worth, 

and that's the case. I'm joking, but that's the case where it's like they don't have a doctor. they're pissed at the doctor or the doctor scolds them or this or that. They just don't get there. I'll tell the person, I'll say then, well, Jim, you could try to get something online and get it sent this or there, but it would be pretty cool to be able to say, Hey, let's set up a schedule, come back, in three days at.

10:00 AM and we'll have you talk to Dr. So-and-so,he's kind of our doctor now. He lives in California, so he is not really our doctor, but you're gonna go in that room and get the same advice you would kind of, and kind of handhold somebody through that.

Vinay: That's right. Yeah, exactly. We've sort of staged this out, we started with a test to treat. So just specific testing that people would walk in for and get this testing and then get access to a doctor if they needed a prescription. And then the next phase was we moved into virtual urgent care.

So now we're expanding the conditions that can be treated by a pharmacy that may have a patient that walks in that says, Hey, I need a bridge refill, or I need access to something cuz I'm sick, or so on and so forth. some, temporary conditions. And the next phase of this is really what you're talking about, which is having an established primary care relationship that 

can then develop right at the pharmacy and say, look, I've come in and seen,

Dr.

Dr. Smith now for the last six months. He's my doctor. Whenever I need to come in, I'm coming into the pharmacy, I'm having my visit here, or I'm having my visit at home and. He knows that I can also come in here and he can refer me to get my blood pressure checked, or he can refer me to get my cholesterol 

checked or blood

work 

 right [00:15:00] at the pharmacy.

And now we have a primary care ecosystem that the pharmacy's at the hub, the doctor's virtual, but he can do just as much as an in-person visit because, or,just about as, as, uh, much as an in-person visit because the pharmacy's there to support 

them with all these in-person services that would keep this continued relationship,

uh, with a, with a, provider.

Mike: So Vinne, where has this gone? Is this all you wearing a bunch of different hats? do you have, I imagine you might farm some stuff out. Do you have full-time staff?

Vinay: Yeah, we do. We have three full-time staff that help us support this program. We got an operations team, we have a salesperson, as well. And so they're together. We're all, of course, we all wear multiple 

hats. It's not 

like I just do one thing, and we all do multiple things. but this is really an effort of a collaboration between all of us coming in and saying, okay, first and foremost, if there is a patient that we can help, or a patient that's coming to us with an issue, question or concern, how can we support them?

And so we have two full-time people just ready to answer the phone. If there's an issue, something that we do on our pharmacy benefit side is look at all of the prescription claims for the previous business day and say, are there any issues where we can help them resolve this before it even gets to be a problem at the pharmacy?

helping a pharmacy run a claim or 

helping them understand what's in our formulary, what's not. So on so forth, collaborating with the pharmacies and the physicians to solve some of these problems proactively. Or if there's an issue that comes to us where the patient's saying, I got a problem.

I, this medication isn't covered. What should I do? 

They're here to help support that and answer those questions. And then, of course, developing new relationships with partners through

our sales team. 

Mike: Alright, so Vinay, you've got yourself and three others now. I've talked to a lot of business startups and, a lot of times these guys don't look as well fed as I do because maybe they're getting the last of the crumbs that come from the business. I Know you've got another revenue source for the company 

How far along is MakoRx compared to this bigger chunk of your company?

Vinay: So, soif I could. Mike, just reframe it. So Make RX is the company and CareConnect is our newest product.

 We think of that as a product inside of Make rx. 

And then we have Make RX Complete Care, which is our membership healthcare services program for small businesses. And that's sort of our next oldest child, if you 

will. And then our

oldest child is our commercial or managed care program, which is pharmacy benefits for traditional employer groups offering health plans to their

employees. 

Mike: With your bigger commercial, plan.

Vinay: What would a term for that be? I hate to throw it out there, but would a term for that be a pharmacy benefit manager? You're a PBM for them.

So in the traditional sense, yes, we, you, we would be a pharmacy benefits manager. We're more in today's world in the role that we play. We're a pharmacy benefits administrator, so we 

are actually designing the plans collaboratively with our employer groups. They tell us what to do. We're not telling them.

We give them recommendations based on what they wanna do and tell them how it's gonna affect their plan and their members. And what's the clinical information you need to take into consideration Along with the financial information, we've gotten bombarded with, the, the newest hot thing, which is all the weight loss medications 

and employers wanna know how 

to handle that. What 

Does it mean, how much is it gonna cost? And so we've been able to give them some good context that they may not necessarily get from, from other traditional PBMs.

Mike: right. So Vene, like right now we're talking on a program that I didn't build, we're just using it along with how I'm gonna, mix this and so on. Are you guys the P B M, are you the thing or is there support for this for you?

Vinay: Yeah, absolutely. Our Claims adjudication system, if that's what you want to call it, our backend claims adjudication system, our platform, we work and we're proud to say we work with RX Preferred Benefits as our adjudication system. They help do all the backend stuff for us, to administer the plans that we put together for these employers and take care of all the day-to-day claim stuff that needs to happen so that we can do all the clinical staff and support all of these members that need access to these medications and implement effectively our plan designs for these employers.

One of the things that. Really sets us apart is our cost plus model. So we figured it out five years before Mark Cuban came to the 

table. Um, and we did it at over 18,000 local community pharmacies and grocery pharmacies and really effectuating that and getting people to understand when we go to a new employer, we're the ones talking to these employees and saying, you've probably never heard this [00:20:00] message before, but we're, we want you to work with your local hometown pharmacy.

And sometimes 

we get an applause and sometimes we get relieves 

 and sometimes we get stories of people telling us, I've always wanted to work with my hometown pharmacy. But for the last three to five years, the insurance people that came in here said we needed to work with the big box 

stores. Uh, and or sometimes we'd go into the local hometown pharmacy after our insurance changed.

And they said that they're losing money because of the plan that we're on. And so, We're really focused on helping all the hardworking people here in this region, North Carolina, South Carolina, Virginia, and all the employers that need help trying to sift through all of the smoke and mirrors that is pharmacy, but in, in a broader sense, healthcare.

and figuring out how to get more transparency. There's 18 different prices for medication. Why should it matter where I get it and 

what time of day it is and 

what site I use, or who my insurer is to figure out what the price of a medication is. And so we're able to show them here's the price that the pharmacy paid to the wholesaler to get the medication on average, plus a fixed fee.

And you're paying them that fixed fee because they're doing a lot of work that you don't really see 

today. Cuz pharmacy's

been relegated as a commodity. But we're trying to bring value back into 

pharmacy and how it integrates to help the health plan.

Mike: So when you guys go to a company and you're selling services slash products, you don't go now and say, Hey, I'm Vene and I use Microsoft documents for my computer. You're not telling them all of your support, tech and so on. Is that the same with your relationship with the adjudicator that you are going in and you're the face of the entire stack. You're not saying we'reMako Rx,supported by such and such. the employers don't see the resource of the adjudicator as much as they don't know what software you're using for your word processing or something.

Right. you're divorced from that.

Vinay: For the most part, I can tell you that on every membership health plan card that we print that has our pharmacy information on it, it has our shark logo and it says, powered by RX Preferred Benefits. And 

That's where in case any one of our members contacts our support team or their RX preferred support team, they know that we're working together.

We're collaborating from an employer's perspective, an HR person, a cfo, ceo. 

We're going and telling them, okay, we're doing everything that you are telling us to do. Any problems you solve, 

any problems that come up, we're solving them for you. And oh, by the way, we'll take care of you. You don't have to know about anything that happens in the backend.

Just trust me that, we're taking care of everything that, and fixing it as quickly as possible or implementing any changes you want in the plan or plan designs that you need on your plan to make sure that any ideas that you have on what you wanna change in the plan, we're the architects and we'll go make it happen in the back end.

But you don't have to worry about all the software, the tools, or the resources that we use to make that happen for your employees. 

They'll just know it works when they go to the pharmacy.

Mike: So the worst case scenario is that an employee has to figure outwhat's covered or, PA or something like that. The employer and the patient, they're never calling RX preferred benefits.

It's always through you guys.

Vinay: That's 

right, exactly. The 

employer's 

contacting us. 

Mike: It's not even close to saying that someone was a broker for one of the big PBMs. I mean, you guys are the face of all this.

Vinay: right. Exactly. That's right. The clinical support, the advice, the recommendations. Anything, anytime we have to interface to a member, it's our team calling the members, the patients, their family, to tell them, to educate them about their medications, all the alternatives and if they're having issues with.

A, a medication cost issue. It's our team and our pharmacist or pharmacy team that's contacting them and telling them, here's what options you have. Here's all the information you need about your medication that you're taking. And in, in tandem, in conjunction with the local 

pharmacies doing their part too.

We're not trying to overtake, 

uh, youI, I have this line that I repeat with our team. It's to stay in your lane and collaborate, and that's the name of our game. It's 

not take over the entire world like 

some of the status quo players have. 

Mike: So, When you talk about your staff of, three or four full-timers, they're helping with all this, not just the in-store

Vinay: That's right?

Yeah, they help with all of it. And so we have three different products, complete care Connect, and this managed care commercial pharmacy benefits, administration services, and everyone knows how to do everything. So 

our newest

baby, our newest process is sort of in its infancy as you know.

How do we help promote and advocate and support these pharmacies, set them up with the plan and get people to know about it. And so they do that and they can switch gears. On a dime and they get a call from a patient that needs help 

with, you know, their pharmacy issue with a medication coverage issue, then they're switching gears and helping that person take care of that over the phone as well.

And so, yes, they do. They know, we know about everything. It's just all an ecosystem for us to help move healthcare as it is today. Help pharmacies where it is today, dependent on dispensing revenue to get to a future [00:25:00] state where hopefully cash based pharmacies have access to cash based services.

That's good, strong def diversified revenue to help their independent pharmacies survive, and thrive today.

Mike: Vene, did you start all this?

Vinay: When you say start, I had the ideas for all of these things. Yes. it took our hardworking team to put it all into 

Mike: Oh, come on. Don't get me that.you're the founder of these three or four 

Vinay: Correct?

Mike: right?

Well, where'd that come from? You heard enough people being pissed off and you said, I'm gonna look into this, or was it a dream of yours, where did that start?

Vinay: The story starts with the pharmacy benefits piece. And so, five years ago a group, myself and a bunch of pharmacists have always been ruminating on, there has to be a better way. Why do we continue to get patients walking into the pharmacy saying they can't afford medications and employers overcharged or overspending on their medications and the systems, all kinds of broken in many different ways

and pharmacy 

suffering. 

Mike: live that? Were you in a pharmacy and heard those kinds of things?

Vinay: Yeah, no, absolutely. I've worked in community pharmacy for the previous to this, for about four or five years. We had a home delivery. It was a home delivery, a regional home delivery pharmacy. Served about 11, 12,000 patients. and, and we saw patients that would, report to 

us that there, there's trouble affording the medications and 

Why is it so expensive?

And we saw what the employers were getting charged and it was just egregious. And so, out of all of them, the previous to that, working in academia and clinical services, setting up doctor's offices with clinical pharmacy services and being exposed to hospital pharmacy , during pharmacy school.

So all of this sort of, it always bubbled up to, didn't matter where you worked in pharmacy, the invisible hand of the 

pharmacy benefits manager was 

they're telling you what to do, how much to say, how much you made, so on, so forth.

Um, and so we wanted to do the opposite of what we saw in the industry. If the industry had vanilla and chocolate, we wanted to be strawberry.

And so cost plus model, local pharmacies advocate that promote that. Put that together. With our programs, you don't only have to go to a local pharmacy. We have access to all the pharmacies in the country. When you go to CVS or Walgreens, you get standard copays, standard discounts there. When you go to a local pharmacy, preferred pharmacy, in our network, you have the benefit of employers and members of lower copays and the cost plus savings that you get with that.

Mike: You are working in one of these pharmacies and you're hearing a lot of bitching, or you're bitching right along with people. There's not many of us that have said, well, I'm gonna start a pbm. I mean, a lot of people have said it. I know, but there's not many that have done that. So you went from being an employee.

To then all of a sudden you're owning A P B M. How does that take place? Over what timeframe? And was this just,searching online for this stuff and you're like, I'm gonna do this, or how did that start?

Vinay: So the first I can tell you that I was thankful enough to have a couple of people that we networked with and contacted that could help us 

be the spark 

Mike: Who's we? 

Vinay: myself. And there were three other pharmacists in partnership that helped start what was before making Rx.

Mike: I gotcha. Okay.

Vinay: And so, so a group of us, we had enough context in the industry that we were starting to do research online and that we got a hold of that said, okay, here's where you need to start. Here's where, here's a good place to start. And that first step was we had to, because we wanted to have a new pricing or reimbursement model 

 We had to build the pharmacy network.

And for the first two years, what I did was call pharmacy, service administrative organizations, ps, aos, and ask them if they would be willing to take on a new model, understand, a new concept of how to reimburse pharmacies. No one was talking about it at the time, in 2018.

Mike: Are you employed at that time or, 

Vinay: This was after I had left and we were gonna start this thing. We had an employer that was interested in our model, and we were going to do it for a local, regional, health system at the time. And then it fell through. And so at that point we were, it had already started. 

I was down that path and we needed to now figure out how to make this thing happen. And so we started by building out the network for, because the first thing employers would ask us is where, which pharmacies can I use? And I didn't have the time and energy to go to each individual pharmacy, so we needed to aggregate them.

So we started by building the network

Mike: when did you take your first dollar from the company was it right away from any seed funding or was it 

late? So you had funding for it, you were able at least to take some income to support yourself and your family and so on.

Vinay: That's right. Yeah, that's right. Through the group of pharmacists that we had that started this previous company, we had a little bit of seed funding that we were using to take on a sales rep and start some of these processes with reaching [00:30:00] out. Thankfully, a lot of it was just time and energy we needed to put in.

There wasn't 

a lot of hard assets that we needed to buy, upfront. And so a lot of it, I took a portion of this, of a salary to, to keep running 

for, for two years and then we partnered with a lab in this area, on a project. And the project was so successful. That's really where our first revenue came from, that first project.

And,the lab was Meco Medical Labs here in Raleigh, North Carolina. And at the time, that project was so successful that they bought us out and we became mecox at that time.

Mike: Oh, that's interesting. So they bought you out. Now what's in that for you? Except more funding . Was Devil's advocate here, if I'm in your position, I'm like, oh, hell no. I've been pushed around my whole life in pharmacy and now there's three or four of us, and we're gonna be the C-suite of this big company and so on.

What's the benefit in a buyout? Was it too good to pass up? Were there some things that you were blind to that the reality hit and you needed more of this or that? What was the impetus to have someone buy you?

Vinay: Couple different factors. One was, We were at the end of our seed funding at the time, and we needed to figure out what the next step was. It was either we could go and partner with an existing pharmacy benefits company and just continue to do 

what they did or maybe take the network that we've established and embedded into 

there, or we.

Fold up and, go do our own thing, 

uh,our own way. And then the reality was that the stark reality was that employers liked the model. They understood it. they knew that there was a better path and they wanted to work with local, small, 

hometown community pharmacies.

But there were probably another six or seven layers in there that we could never see. There were consultants that didn't want to forego any revenue they were getting from whoever they were currently partnered with their current health plans. There was a lot of confusion in the marketplace in terms of understanding, well, how do you integrate something that's outside of our health plan, into our health plan today?

And, we're fighting behemoths in the industry that have a lot more money to throw at 

1. Essentially, it 

was, the name of the game was, well, if you don't, if you don't like us this year, we'll crank up the rebate dollars for you and, you'll be satisfied to continue us for 

another couple years.

Uh, so there was a ton, there were a ton of layers there. There 

was,third party administrators that would fight us to integrate 

with them and so on and so forth. well known today from us, but something that I didn't realize it would be, This much of a wall to hit, 

uh, and there are many layers and so on.

Any of that, all that took all this time up and now we're sitting there and we're figuring out, okay, what's next? It just happened that we had this relationship with this lab. They were 

doing a project, down in South Carolina, and we effectively, Pulled off that project and they wanted to then get into pharmacy because the project was so successful and that gave us access to an established company in the area that had a tremendous amount of marketing power and sales power, that we couldn't have gotten anywhere else.

And so those resources were essentially really, really valuable to us. Because we didn't have the brand recognition, we didn't have, people didn't know us, but people knew the lab in the area, people knew the lab in the state and in the region. They were well known, up and down, the east coast at the time.

and then also , we continued to be able to craft the model and use what we had built to continue our purpose and mission and vision for the company. And they allowed us to say, okay, well how do you want to build it? Let's have a conversation. They weren't really authoritarian or, focused 

on growth to the point where it sort of eviscerated the quality of the model of the program.

Mike: Well that's really interesting. Cause a lot of times you get bought out by somebody who's, either got a similar market share or a little less, or a little more, and they wanna bring you in and,but a lot of times you just go into their fold. But it's pretty cool that you were able to come in, get an associated name, an associated brand, but there wasn't that service in that brand.

And so you had quite a bit of freedom because of the name. But not too many restrictions 

because it wasn't there before.

Vinay: That's right. absolutely. The amount of creativity, this organization, the organization that brought us out already was embedded in their culture, as they were doing things differently in the lab space. And the way that they implemented those ideas in the, in the founders of the lab and how they thought about things, gave uh, me a tremendous amount of resources to say, think about this another way.

And that's really what created the next product, which was the membership product and then we also at the same time got connected with a health plan that was starting up just before Covid started. 

And that health plan aligned that, that health plan's called Hero health plans, they 

were aligned in the same way that we were in pharmacy to on the medical side.

So 

transparency, making sure we provide value, quality access, so on and so forth. And so that [00:35:00] partnership really is what solidified us not serving one single employer, having this project that got pulled off in South Carolina to now saying, okay, well we got over 2000 employee lies that we service here in, in the region and 4,000 members because of that partnership.

And so that was another sort of stepping stone that, that, that luck of who you know, or who luck 

is as it's called. and then once we started serving the traditional employers, then they start, we started saying, okay, what are we doing for the small business 

that can't afford to offer healthcare or the employees that can't afford even if the business can afford it?

And that's what started the membership program, which is basic healthcare services, two small businesses and now direct to consumers as well. That would be just virtual care, urgent care, mental health care, and access to over 300 medications at no cost from local pharmacies as well. and that's just basic care, not insurance.

Mike: Most of the pharmacy stuff that we see. especially our pharmacy. We just do generics. It's not insurance. You don't need insurance for that stuff.

It's like a place where you get new tires for your car and new windshield wipers and oil change that's not insured stuff. And so you're basically doing that for their employers. The employers they're paying you a fee, I imagine for that kind of a conglomerate fee, although it's not unlimited.

Vinay: You're talking about the membership program or are you talking about our managed care.

Mike: The membership, which we started talking about with the doctor in the pharmacy, that kind of stuff. that's not really insurance. 

Vinay: That's right. That's right. So it's not insurance. It's a membership program that for on a monthly basis, you can start and stop 

anytime you want. There's no 

enrollment periods, things like that. It's a subscription or monthly membership program for these basic healthcare services. You pay at the beginning of the month, you get access through the month for those services, and then it starts over again next month.

If you don't wanna participate or you have a change in staff, you can take people off, put, add people on, and you're just paying for who's enrolled and who's active on the

Mike: It's

paying 12 bucks to get all the coffee you want at Panera or something like that, you're not showing up there and saying, no, today I want prime rib and I want to feed, My family, 

Vinay: right. 

Mike: service.

Well, that's really cool.

Vinay: That's right. Different components to it.

Mike: So Vene, why am I here talking to you instead of the other three people that this started with? Did they leave and you're in place now, or,

Vinay: Good question, Mike. The other pharmacists that 

i started the business with myself, they have run their own pharmacies. They have their own successful businesses that they're running, and they invested in this. For me to 

essentially lead. 

 They've continued as investors and they have, 

you know, ownership in the company, but they're essentially doing their own thing.

We get together once a quarter or once a month to just discuss what's happening in our business and what we can do differently better, so on, so forth. And they get to see the numbers and then they say, okay, well let's keep going on and change strategy maybe once a year.

Mike: You still like those guys

Vinay: absolutely.

Mike: because you don't always get that. 

Maybe if you four were doing it still, maybe you wouldn't have relationship still 

Vinay: Absolutely. No, you're right. You're right. I mean, that's one of the toughest things working with a family. Not that I work with family, 

But when you work with family, it's like, everything mixes and it's so hard to change the relationship you had with that family member to step out and say, well, I'm your boss here and I gotta tell you what to do.

And, it gets it, it gets really sticky and you're absolutely right. If we would've stayed together and tried to figure out things, being friends before and now 

trying to get into a business environment may have been harder, but luckily it didn't turn out that way. 

And we're able to, yeah, to help support each other.

Do you know, everyone's doing their own things, but 

we're all aware of what's happening in other places and how we can help each other.

Mike: Vene will this goal, that you have, will this take you to your golden years, or do you think, I'm gonna take some other direction because I love that, grassroots, guts of this and growing it.

Vinay: That's, that's a really interesting question, Mike. I'll give you two. And maybe they're conflicting or contradicting answers, but one, one component of that is healthcare has so much that we need to fix, that we need to get right for the people that need it the most. Right? 

The patients, the people that access this thing every 

day, not just the providers they have, we have to fix something else for them.

But the healthcare's so large, so, tangled, so massive, so many different problems and challenges to fix that I don't feel like even in my lifetime, I could 

touch,a percent or a couple percent of, of what we need to help fix that. So there's plenty of work to do here. 

I could spend the rest of my life doing that work.

Here's the part that I don't know. As a startup, it's a different environment. It's a different culture to solve problems. Every day is 

something new.

It's moving quickly. It's changing. It's working in a small team to figure things out. 

I really enjoy that. [00:40:00] I don't know what the business will look like if, we're super successful and in 

three years we have a hundred people working for 

us and how different departments and things like that.

I don't know if I would, will or will not enjoy

that. Um, and, And And yeah, and I don't know what it would be like, I don't know what my role would be 

in that kind of organization where it is today. And so I may have a different answer for you in a couple years when we're, when we are super successful and we have a staff that's 10 or 20 times bigger than who we have today.

but we'll, you just have to learn and grow. The best part for me is the journey. And so 

Right now, every day is an adventure. You just wake up and enjoy it and live it to the best you can and take on all the challenges that you know, the good and the bad. you have the bad, so you can appreciate the good.

and it's not easy. It's been the toughest thing I've ever done in my life. I can say that if I were to have, if I were to do it all over again, I wouldn't want to do it any differently. I, there's 

much I've learned, there's so much perspective I've gained. There's so many people I've met and things that we've been able to do that just didn't exist before, that have, in our tiny world, 

that.

It's that, that really, this is the way life is meant to be lived. Not that everyone needs to be an 

entrepreneur or start a business, but 

you should at least have that mindset or think about things and be creative, allowed to be creative in your job. And it's hard to find that more, more so today than ever.

It's been a great journey and I appreciate what, they, the, the, experiences that I've had. Um, and we'll see where it goes. We'll see where it 

goes. Do

I, to answer the last part of your question, where I think you may have asked is, are there things that I'm interested in outside of pharmacy?

For sure. There's some, there's things I think about all the time, like, that this thing's worked out so well that could we do something else? It sort of floats by every now and then but I don't spend too much time on it 

still too many things to solve for our own company yet.

Mike: I think Vene, it'd be fair to say that you and I are probably similar in that, you like to problem solve and think about this stuff. And it's easy to say that, oh, with a hundred people though, you're gonna just be doing a bunch of paper shuffling and this and that, and, restart, get small again.

It's like, yeah, but if you're too small, you're spending four hours a day delivering pizza because you can't even 

do it here. Or you're going out to the, office place to buy a dozen pens or something like that, so there's a certain place where you can really be an entrepreneur, but it doesn't mean doing it with yourself or one or two 

people.

you might have a real nice go of that at like 50 people, so it's not so big that you're tied up here in a, in an ivory tower, but you still have, enough support to, to play a little bit, 

Vinay: 

Exactly. Vinay, what's your worst emotion that you bring to your career that you would say? If I didn't have that, that would be a little bit nicer for me. It's probably anxiety, I just get a little anxious sometimes. It's like, it'd be a little bit nicer if I didn't have that so much, and it's probably a blessing and a curse.

Mike: At your worst moments in your business, what do you bring? That might be better? That is if it was a little bit lower or higher.

Vinay: Or higher. Yeah. I would say that being shy and timid, is what I've noticed, is I need to be more, more extroverted and aggressive when we have a down point in the business to get the troops riled up, to get them to say, look, here's what I'm doing.

Here's what we need to go out there and do. We need to go meet 10 new people every week, and we need to really be aggressive in how we approach what we're selling to these, to this market. Because if we're not, if we're gonna soft sell, then it's not gonna be adopted as well, so on and 

so forth.

Then 

a little bit of what I've realized in 

myself

that has been, my weakness 

to date,in those, in, in certain time 

 in the business, for sure.

Mike: Who do you answer to in terms of MakoRx, it's MakoRx As a head company,

Vinay: That's right. Yep. 

Mike: Who do you answer to?

Vinay: We have a board. so the board controls the company, and so the largest investor in Mac, Exodus, Mako Medical Labs, which is the lab company, and there's a group of other, folks, the investors that we brought on in our previous company, the pharmacist, so on and so forth, they all sit on the board.

And my job is to go to the board and again, tell them, here's what we've done and here's where we're going and, here's what do we need to do differently? What ideas, what connections do you guys have that we need to implement and think about differently? I'm too close to the problem or too close to the solution to, to think about it that way.

Mike: How many other people are there like you? So you're doing this for like this division, let's say. 

Are there other people like you that have to report to the board? Also

like what about the lab? 

Vinay: Yeah. So the lab is its own company. Mako Medical Labs is its own company. They invested in MakoRx and the 

The lab has its own executive C-Suite. They have their own HR department. They have their own payroll, finance, and so on.

Mike: and their own [00:45:00] board also.

Vinay: That's right. Exactly.

Correct, correct, correct, 

Mike: so There's a board for the Mako Rx part of it.

are they people from the company or are they like outside? Part of them are the 

Vinay: They're investors right now. They're all investors. That's right.

From the lab and from ourselves. 

Mike: Do you physically sit in front of them?

Vinay: No, it's all virtual now.

Mike: Oh. But I mean, virtually Do you sit in front of them

Vinay: Oh. Oh. 

Um, 

Mike: from the screen?

Vinay: May. Yeah. Once a year. Yeah,

Once a 

year.

but other times it's just an email that we send out to them and we get feedback and we outline, here's the things that we need help on.

What, what, do you guys wanna know about us? So on a financial basis, we meet with, some of the board members to give them a monthly update, and that's in person and we, we sit in front of them, 

but from a broader board meeting perspective, it's just, it's not virtual or in person, except for maybe once a year

Mike: So, Vene, the pharmacists are listening to this or pulling into their driveway or into work. They've got a couple minutes to maybe think about us what would you recommend a pharmacist do, 

Vinay: Personally, I think that this is our thesis and our hypothesis. Diversifying the revenue stream. Trying to plant the seeds today for pulling away from dispensing. I completely applaud all the federal and state legislation that's out there that's tackling pharmacy benefits, transparency, and all of the practices that hurt farm independent pharmacies.

But I honestly think it's too little, too late. By the time that the legislation comes to fruition, I. the status quo. Industry's already created two or three models to, either go around those legislative issues or legislative regulations, or they've pivoted to another sector of making money 

from

pharmacies and plan sponsors.

and so we need to continue to fight that good fight. I wouldn't, you sort of lay everything on that as a business owner, I'm sure plenty of businesses have already thought about this, but what's the diversification? And one area that's been a big area of diversification is we need to do more clinical services.

But certain pharmacies that we've talked to say we don't wanna do clinical services unless we can bill insurance and we're waiting for that sort of credentialing to come through where a pharmacist will be a healthcare provider. I I don't think that's the answer. I think once we're able to get credentialed as a healthcare provider or we are able to bill insurance, there's again, three or four different layers that we can take from medical on, insurance, billing, reimbursement, headaches.

 We're gonna have the same reimbursement issues with how much we get paid for services through insurance. So I don't think insurance is the answer. And so we're trying to figure out if people will pay for cash services and they always have in little pockets and areas throughout the country for different services.

But as a whole, could we create a platform that has cash pay? Cuz cash pays the king of transparency. You know exactly 

what

the patient's paying and exactly how much you're gonna make on every transaction. And so, think about cash pay services, 

 uh, whether

you wanna sell them or not. There's resources that we can take on the hard stuff that pharmacies may not wanna do, which is 

selling to the patients.

And then you can provide the service, which is where we think that would be a great collaboration 

with pharmacies, 

seats. 

Mike: It's easy to think the government's gonna take care of something or the insurance industry or something like that. But if. you can't convince an individual somehow 

to somehow reach into their pocketbook and do something, even if it's a portion of this or that, or just a buck, if you can't convince them to do that, then your chances of government coming in and, legislation coming in,it's too little, too late if you can't at first 

have the patient cough up 

some of their own hard work and 

Vinay: energy that makes the dollars, you because that's really where the value is,

 tell a patient, here's what I can do for you and here's how much it's gonna cost. 

That's the value that people are saying, I want to 

pay this for the 

value you're about to give me. and we think that the cloak is health insurance sort of removes all of that value proposition.

But it does, and medical care is the number one reason for bankruptcy 

in America. And that's sort of because of insurance. It's 

like how much insurance costs when you need to access it. and people are spending the first three or $4,000 of healthcare on their own through these high deductible 

plans. Uh, and so we need to figure out a better, more transparent value base. What are we getting for what we're paying? And we, 

and you

a big question still in healthcare.

Mike: And before you could obfuscate it by having all these layers and stuff, but now the cycle is so much quicker with the internet and social media and all that is right away you have to have true value there, or you're 

gonna get lost quickly in probably rightfully so in the shuffle.

Vinay: That's right. 

Mike: Vene, thanks for joining us. It's cool to see where [00:50:00] you've come from, where you have gone and not have it be theory alone, to know that this is your livelihood and, this is the livelihood of others and it's moving along.

And so that's cool to see the guts of that. So thanks for sharing all that.

Vinay: Mike, thank you so much for having me on the show. I know you are your own rockstar online with the community that you've built and these,these interviews that you've had, how many interviews have you had,

Mike: we're at, uh, 200 and 215 or so.

Vinay: Wow. And the following you have with these really candid conversations you've had with people is, it's an honor to be invited and to share my tiny story with your community. Thank you.

Mike: Well, thanks Vanay. Keep it up. We'll be watching and we wish you all the best.

Vinay: Appreciate it.