Community Pharmacy at a Crossroad | Adam King, CPhT, RPhT, PRS

This transcript was generated automatically. Its accuracy may vary.

[00:00:12] Mike Koelzer, Host: Hello, Adam. Hi Mike. Thanks for joining us today. 

[00:00:17] Adam King, CPhT, RPhT, PRS: Thank you for having me. I appreciate it, 

[00:00:19] Mike Koelzer, Host: Adam, you and I go back quite a ways. Tell the listeners though who you are and why you're with 

[00:00:25] Adam King, CPhT, RPhT, PRS: us today? Well, in a year, I'll be probably the most oddly credentialed tech that you'll see. I'm working on a master of public health degree from Western Michigan university.

Right now, my career goes back 11 years. So I've been a technician now for 11 years, starting with the chain. Then I moved into a compounding, uh, independent pharmacy role. And I know you Mike through KCPA. So I'm very involved with the Michigan society of pharmacy technicians. I'm a board member for MPA for that.

[00:00:59] Mike Koelzer, Host: And the K CPA, just for those that aren't from the area is a Kent county pharmacy association or a subset of the state association in Michigan, 

[00:01:08] Adam King, CPhT, RPhT, PRS: correct? Yes. I left in October. I am now the pharmacy savings program manager for a very small company called health plan advocate. We're located here in grand rapids.

Okay. Now wait 

[00:01:18] Mike Koelzer, Host: back up here, Adam, you left, you left where 

[00:01:22] Adam King, CPhT, RPhT, PRS: I left pharmacy, which was an independent compounding pharmacy. 

[00:01:25] Mike Koelzer, Host: I didn't know that you left there for this news. New venture and, and that's called what again? Pharmacy savings. 

[00:01:32] Adam King, CPhT, RPhT, PRS: So I'm a, I'm a pharmacy savings program manager for a health plan advocate.

The company itself services companies that determine that they want to self fund their insurance mm-hmm . So I try to cut down the amount they spend on prescription drugs. And right now that reality is in pharmacy benefit land, a health plan spends about 15 to 20% of its annual spend on prescription drugs alone.

That trend is actually going to rise, especially now that we have the new gene therapies that are starting to show up. So, uh, Zelma yes, Carta those, those medications cost millions of dollars. And we'll be looking at ways of trying to contain those costs as well. Most of my day is actually spent being a patient advocate in, in doing that role.

So, wow. 

[00:02:28] Mike Koelzer, Host: All right. So I'm following closely. The one thing I'm not sure I caught is you're helping businesses keep their prescription cost 

[00:02:38] Adam King, CPhT, RPhT, PRS: down. Yes. And actually, I work both with the members and the health plan. So we actually, in some cases I'm helping go get copay cards and maxing those copay cards out to help both the insurer and the insured.

So in the case of brand name drugs, there are multiple mechanisms we can use to control the cost of those. I also help members find the lowest price pharmacy, because I can see the varied Mac list. I have a little bit more insight into how the Mac, the maximum allowed cost list works. And I can use that to contain the cost of prescription drugs as well.

So 

[00:03:19] Mike Koelzer, Host: do the people have, when you mentioned copays, do the people have prescription insurance through somebody. Else in this program. 

[00:03:30] Adam King, CPhT, RPhT, PRS: Yeah. So right now I'm working with five different pharmacy benefit managers to do this and, and they're relative third party administrators. So in the insurance world, there's a third party administrator I'm working with locally.

That would be like a secure one. And you probably will never hear these companies in pharmacy, uh, secure one ASR or, or even some of the labor unions. Uh, I have a couple of labor unions. I do 

[00:03:59] Mike Koelzer, Host: this too. It's almost like you were doing individual stuff or do you find the best plan for the business and then pick one of these places for a year or something?

What our 

[00:04:11] Adam King, CPhT, RPhT, PRS: program does if we actually tack on a tier. To their existing formulary. So in order to save them money, we take their, we take their tiers and we add a tier onto their formulary that if a drug costs more than $400, my company gets involved in helping find copay assistance because we would, we would give them this really high copay.

It roughly works out to about half the cost of the drug. But if they agree to being the, the member, the member, the member. Okay. So if the member agrees to go out and use the manufacturer coupon, then we would help them out in copay land and make copay adjustments. So I have a little bit more latitude with the pharmacy benefit manager.

To help out with that. But I also help out when it comes to infused drugs, too, because those are billed under the medical plan and trying to help members realize that there are ways to save themselves and their plan money that way too. 

[00:05:16] Mike Koelzer, Host: All right. So you, I don't know if words have gotten around the city yet, Adam, but I'm kind of slow.

So I gotta back up on this a little bit. Was that the rumor at your pharmacy that Mike's kind of, Mike's kind of, um, doesn't really have all his marbles upstairs.

I'm not, I'm not sure if that's a rumor going. No, just kidding. All right. So the insurance is used and we all know that what you want to be insured for is some of the higher price ones that could wipe somebody out with a cancer drug or something that's very expensive, but you want to be covered for that.

So with these plans, when it hits $400, Then the insurance doesn't cover it. And then you're allowed to go to the manufacturer and say, look at it, this, this person doesn't have coverage. What can you do so they can get this medicine? 

[00:06:12] Adam King, CPhT, RPhT, PRS: Um, not so much that it's it. The plan's still gonna pay for it. I see.

Um, we're going to use whatever manufacturer assistance is out there. I see once you hit 

[00:06:26] Mike Koelzer, Host: $400, you allow the copay to raise up so that their copay card will cover more up to their limit. And so on. Correct. Exactly interesting. Yeah. Cuz I know that my daughters are on some pretty expensive arthritis medicine and if the insurance didn't cover it or the insurance I guess could have raised their copay and, and I think the manufacturer would.

Supported, I don't know the exact details, but I know the expensive ones. It's like, if the manufacturer's out there, then let's raise it up to where we think they're gonna help at what level. 

[00:07:04] Adam King, CPhT, RPhT, PRS: Right. Exactly. And, uh, we do a little bit that's the bread and butter of the program. The other side of that equation is managing what runs through, uh, an infusion center or an outpatient infusion pharmacy.

The other part of my program is finding patients. The lowest cost place to get an infused drug as well. So when we talk about that, we're looking at chemotherapy, some of the new infused, uh, biologics for multiple sclerosis carry a pretty hefty price tag. Oh, crevice, for example, which is infused once every six months, if you get it done in the wrong place, it'll run you about $101,000 a 

[00:07:53] Mike Koelzer, Host: dose.

This sounds like more of a, kind of a free market thing coming in. So like versus a regular insurance where it seems like I wouldn't have to shop the rates. And it seems like the price of the insurance would sort of Bemed out. But it, but in, in this case, it sounds like there's kind of shopping the most.

Let's not say the cheapest, but the most economically sound one. Why is that there? Play in that. And then how does it benefit the members again? Tell me that again. 

[00:08:32] Adam King, CPhT, RPhT, PRS: Okay. So doing some price, shopping back in the day, and I kinda have to hit the rewind button practically you began your pharmacy career.

Mike

[00:08:44] Mike Koelzer, Host: We were on my back, always good. Cause we were on stone tablets back then, but

[00:08:53] Adam King, CPhT, RPhT, PRS: um, so if you hit the rewind button back, you know, when blue cross blue shield was probably first 

[00:09:00] Mike Koelzer, Host: yeah, 

[00:09:01] Adam King, CPhT, RPhT, PRS: yeah. Back in the First's the thing, right. You know, back 6 50, 60 seventies. Yeah. Mid seventies. I'm remembering, right? Yeah. So a blue cross blue shield came about and they said, okay, um, hi, Dr. Smith. I'm. I've got 1 million covered lives.

If you agree to take a 25% discount off a year's bill, you can have access to all my members. And that's how the preferred provider organizations got started. Gotcha. Back in, in the seventies and eighties. And a lot of them still do that today. Um, so many of them even still today are in the position where they go, okay, if you go to a hospital, um, we have a contract with the hospital and it's 25% off the bill.

If you go to a doctor's office, we take half off the bill. And that's how I preferred provider organization, uh, works to contain the costs. And the challenge I have on the medical side is there's really no way to. To know what the cost of the bill is going to be ahead of time. Hmm. In fact, you don't find out until about 14 days later after the claim is filed and paid on the flip side of the equation, I can actually use a pharmacy benefit manager to build the same drug and do it for less.

So going back to the autocars case, if I have a hospital bill, the medication crevice, and this is not an advertisement for a crevice by any such as the imagination, a crevice would run you every six months, $101,000 a dose. If a hospital were to bill it, I was able to convince the hospital that they needed to use their specialty pharmacy to be, uh, to bill it.

So we put a stipulation on the coverage that said it had to go through the pharmacy benefit. The cost went from $101,000 to $32,000. Gotcha. 

[00:11:01] Mike Koelzer, Host: Because. From my angle. I think the bigger pharmacy benefit managers for better, or for worse have kind of had to take it or leave it value. They have a Mac price on it where the hospital might say, well, yeah, here's a drug which doesn't have a Mac.

And we're also gonna throw in $50 for a bandaid and, you know, a hundred dollars for a ball of cotton and, and lunch and all that kind of stuff. Is that where that extra pricing or at least they could say it was 

[00:11:34] Adam King, CPhT, RPhT, PRS: So here's a dirty little secret: a hospital's law to make up their own price. Yeah. so in, in the hospital side of the equation, you can, you can realistically write your own check mm-hmm

And typically what you'll see is about a three to 500% markup on medications. Some of those are 

[00:11:56] Mike Koelzer, Host: maybe maced at some point, but in the meantime, if they're a little bit obscure or new or something like that, there's maybe not a set, a set going rate yet. 

[00:12:07] Adam King, CPhT, RPhT, PRS: Well, there is, but there's eight different pricing references you can use.

Mm. And, uh, typically what you will, you will see is whatever Medicare pay. Multiply that by about four or five. Gotcha. And that's what they bill for commercial insurance. And what you'll end up seeing is a hospital billing, a medication that costs them $30,000. And they might bill it out at $102,000 without those.

Right. And then the preferred provider organization is gonna come in and say, fine, we'll take 25% off that bill. But even then, uh, off of $101,000 drug, the claim's still gonna be $77,000. Right. And in self insurance land that could actually throw you into what's called, um, stop loss. You don't ever want a patient.

I'm finding out very quickly in my new profession. You never wanna land a patient in stop loss because stop loss carriers never wanna pay. 

[00:13:13] Mike Koelzer, Host: Hmm, stop loss is the, is the, Hey we'll take care of all these things, but when you get into these higher ones, you're in a new stratosphere and we've got a secondary insurance, that's gonna cover these higher ones, but they're very difficult to deal with.

[00:13:27] Adam King, CPhT, RPhT, PRS: They can be. So what, what happens is be, um, part of what my company does actually is the underwriting first stop loss carriers. Hmm. But, um, let's say it was your old pharmacy. Mike K pharmacy decides to go out and self-insure their own employees. And what the third party administrator would do is say, okay, you're on the hook for each of your members up to the first $40,000 in claims 80 to 90% of your members are never gonna hit that $40,000.

Okay. But if you get a breast cancer patient or right, you get a patient with multiple sclerosis, they're gonna run over that $40,000 without even blinking an eyelash. Yeah. Right. And what a stop loss carrier will do is, will they say, okay, well, for the first year, we'll pay that extra, whatever it is.

And let's say it's the hundred and $1,000 drug mm-hmm . So they'll pick up the other $61,000. Mm-hmm . But the following year, they're gonna get hip to the fact that that patient's got $101,000 in claims, and they're gonna come back to K pharmacy and say for that particular patient, you're gonna be on the hook for a hundred, $1,000 worth of medical bills.

Gotcha. And. I know what the cash flow of pharmacy is nowadays. Yeah. Right. If you, if you ever had a patient or one of your own employees cost you $102,000, that's gonna hurt, hurt and pocketbook quick. Yeah. So our goal is to actually prevent that from happening and in this. So crevice case by billing, the pharmacy benefit manager, and then maximizing manufacturer assistance on top of it.

Right. I got the cost for a year of her medication down from $198,000 down to $58,000. Wow. 

[00:15:17] Mike Koelzer, Host: Wow. So, 

[00:15:18] Adam King, CPhT, RPhT, PRS: so by changing some of the mechanisms and pharmacy benefit managers for as bad of a rep, I have a love, hate relationship with pharmacy benefit managers. Yeah. I know most of my pharmacy colleagues would go, I have a complete hate relationship with my pharmacy benefit managers.

yeah. Um, I have a love- hate relationship with them because there's times where they're absolutely key to what I'm trying to do. And then there's times where they're working against what I'm trying to. 

[00:15:43] Mike Koelzer, Host: Right. It sounds like there's some different terms that could be used. So when they talk about, when they talk about a business, one of your businesses being self-insured, it's like, well, it's, you could call it self-insured, but actually it's a really, really, really a really high copay and then a separate insurance kicks in L later.

Are there any companies that actually, that you know of Adam that fully self-insure like, like, let's say you have a company, you know, a huge company in town where they're gonna be like, totally self-insured and if someone costs $10 million for new transplant or something, they cover it, or you think there's always that secondary thing 

[00:16:26] Adam King, CPhT, RPhT, PRS: in there.

So pretty much any employer that has more than a hundred employees is more than likely self-insured 

[00:16:35] Mike Koelzer, Host: because, but totally even for the catastrophic. Problem or do you think they go somewhere else for that to the 

[00:16:42] Adam King, CPhT, RPhT, PRS: so, so the, where, where you hit catastrophic coverage, um, where, where, where you set your stop loss is how much risk are you willing to take on as an organization?

Sure, sure. So, so if you are a larger organization, And by the way, stop loss. It 's actually called a deductible mm-hmm . So if we're talking in the same terms, think of it as a deductible for your health insurance fund. Sure. Right. Depending on how much risk your organization's willing to take on. Yeah.

We'll determine how much actual risk you have as an organization. Mm-hmm so. 

[00:17:18] Mike Koelzer, Host: And probably the more people you have, the lower the chance of people getting this same condition or whatever. And that's one way, I guess, to do it. 

[00:17:27] Adam King, CPhT, RPhT, PRS: If you're a larger organization, say you have a thousand or so employees, the risk that you're gonna have 15 to 20 type two diabetics is pretty high.

Mm-hmm, the risk that you're gonna have. Somebody that's got rheumatoid arthritis is pretty high mm-hmm so you can sit there and probably have an epidemiologist sitting sure. Sitting in your human resources department, trying to figure out who's gonna have what? Yeah. But in all reality, it's how much risk there is as an organization.

Are you willing to take it before your stop loss carrier picks up the bill? Right. And I've seen that number as low as 40,000 and I have. Two or three plans where that number's in the hundreds of thousands of dollars. So the part that's under that you have to create a, you essentially create a fund for it's just like the escrow in your house.

Yeah. You have, you have to make that savings adjustment for your property taxes and your homeowners insurance and, and, and whatever else you have, you have to plan for that for each of your employees and your health insurance fund too. Yeah. So if you have a bank account with $40,000 sitting in it to cover your healthcare expenses, right?

The moment you trip over that $40,000, and that's where your stop loss carrier kicks in, um, your TPAs gonna, um, sending that bill over to the stop loss carrier. I. yeah. Um, then every year your plan gets reevaluated. Sure. And, and then that determines where your stop loss carriers are gonna place your specific deductibles.

Yeah. That's also going to determine which of your members, and this is called lasering, which of your members has a higher deductible. Um, so the more you can save money on the front side, the less your stop loss carrier gets nervous. Right. Um, and if you can put a patient in PA, possibly large case management, but you don't send them all the way out to stop loss.

Um, the stop loss carrier doesn't view that as high of a risk. As you would, if you were to flat out going straight into stop loss, and that was expected to continue for decades and years and years, and years and years, some of the side effects of being able to do work like this. I keep going back to the Ocrevus case because I'm on vacation this week.

So I don't have all my stuff sitting in front of me. Yeah. And two, um, that one sticks straight out in my mind. Sure. One of the side effects I can do with doing this kind of work is because I shifted Jane do Ocrevus from, from being billed as a hospital claim, to being billed as a pharmacy claim. Mm-hmm her, what she accumulated in out of pocket expenses actually goes down to, I think it was $520.

She would've kept her out of pocket expenses at $7,900 in one claim. Yeah, otherwise. So well, 

[00:20:36] Mike Koelzer, Host: Adam, I, I told you I ain't no genius, but if you're gonna pick an example of your work, you, you might as well stick with the one where you saved, you know, $70,000 and, and stay away from the examples where you maybe saved a buck or two.

Um, so I, if I were you, I'd keep that story going. 

[00:20:54] Adam King, CPhT, RPhT, PRS: I love that story. I don't 

[00:20:56] Mike Koelzer, Host: mean story as in an embellished fake story. I mean, it's, it's, it's a story, but it's an example, let's say a real example. 

[00:21:04] Adam King, CPhT, RPhT, PRS: It, it, it is truly a real example and, and that's actually where health claim costs are actually going to be headed.

Anyway, we look at, um, our, our, our medical director and I have looked at what's coming out in the drug pipeline and 75% of the new drugs that are coming out in the marketplace are going to have to be infused in a doctor's office. Hmm. And almost every single one of those drugs is gonna cost more than $10,000 per dose.

Hmm. So. We are going to be watching those drugs extremely carefully, because those are going to be drugs that are in oncology, multiple sclerosis, um, seeing a few new ones, uh, there's a new one for HIV. That's a biologic that's probably gonna be horrifically expensive. Um, the new ketamine nasal sprays that are coming out, uh, run about $7,900 a dose.

They have to be able to serve twice a week. So the medications that we're looking at coming out in the very near future are going to cost health plans a very large amount of money. We're going to have to find creative ways to fund those expenses, especially on self-insured employers. 

[00:22:25] Mike Koelzer, Host: And unfortunately it's gotta be very creative because if you take that to the, the end game, if, if you have, uh, If, if there's a million dollar drug and you and I are still talking seven years from now, and, and you're still using your example of saving, you know, $60,000, that's, that's good, but it's still, you know, a $940,000 drug.

It's just gonna wipe, you know, I, I don't know where it's all gonna end 

[00:22:54] Adam King, CPhT, RPhT, PRS: it. It's, it's getting, it's going to get worse before it gets better. Yeah. Um, biosimilars are not coming out as fast as we, we want them to. So it's, um, becoming extremely difficult to lower these costs. So one of the things I'm finding now is I'm making deals with hospitals and saying that they have to use their own specialty pharmacies to build their medications and build them through pharmacy benefit.

And that's just to save. The amount of money that I, the, the most amount of money I can, oh, they 

[00:23:31] Mike Koelzer, Host: would not do it through the patients, but bill it through their own specialty one. Right. So, so you see what they charge 

[00:23:39] Adam King, CPhT, RPhT, PRS: it at? Yeah. The consolidation of healthcare is really making this difficult. So we're, we're seeing a lot of, they call it vertical, vertical integration, but, um, you now have Cigna owns express scripts and you have several hospitals that are joining forces.

Ascension is outright huge compared to. The little hospital out in the middle of the sticks. Yeah. Right. And they basically write their own prices, essentially. So the only way to keep them from doing that to your health plan is essentially making them use a referenced based price. So 

[00:24:20] Mike Koelzer, Host: pharmacies got stuck a long time ago on that.

I'm not sure why the hospitals are so far behind. Maybe the doctors groups are better, stronger than the pharmacist groups were. The 

[00:24:32] Adam King, CPhT, RPhT, PRS: challenge we have with their systems. Their systems are still circa 1975. Yeah. 

[00:24:39] Mike Koelzer, Host: So they're being the 

[00:24:40] Adam King, CPhT, RPhT, PRS: hospitals, the major medical systems and in their entirety are still stuck in 1975.

Well, 

[00:24:46] Mike Koelzer, Host: You wonder if they do that on purpose so that they're not able to, so it's like they're able to have a little smoke and mirrors on the prices. 

[00:24:53] Adam King, CPhT, RPhT, PRS: Um, they do. And, um, Uh, one of the things that strikes you is odd. Um, when you're, when you're working in major medical land, uh, is the simple fact that there are no NDCs on your claims.

Hmm. So the national drug code doesn't exist, uh, on one single claim. So I don't know if a hospital's billing for a regular drug, let's say a Humira or its biosimilars. 

[00:25:22] Mike Koelzer, Host: And it's a, it's just a hick, it's just a, a hick pick code or a Medicare code of the diagnosis, but not, but not an actual, this is the exact drug that we 

[00:25:32] Adam King, CPhT, RPhT, PRS: use.

So, right now you have Hicks. And thick picks. Some of them are designed to have biosimilars and some of them are not, some of them are trainable to have the brand name versus the generic, but they are not required in many cases to send a national drug code along with the claim. Geez, you have no idea what they're really billing.

Geez. Um, and when people start complaining about getting surprise medical bills, this is where some of the surprises are coming. that's a term 

[00:26:06] Mike Koelzer, Host: when there's mystery there's margin, you know, when you don't know what it is, you don't know what it costs or right. Especially they can charge anything they 

[00:26:12] Adam King, CPhT, RPhT, PRS: want to.

Yeah. Especially when you look, I was reading a, a study last week, the top 10 hospital CEOs, um, and their salaries and Ascension came up, Ascension owns three hospitals that I can think of off top of my head, four hospitals that I can think of off top of my head in west Michigan, both of them in Muskegon, one of them in grand rapids.

And one of them in Kalamazoo mm-hmm , their CEO makes 11 million a year. Hmm. And, and he, they own half of the Detroit hospitals too. 

[00:26:44] Mike Koelzer, Host: So yeah. Yeah. It's a lot of that, that's a lot of, uh, aspirin or maybe, maybe it's not a lot of aspirin. Maybe it's one pill, the way that some hospitals bill it, um, 

[00:26:54] Adam King, CPhT, RPhT, PRS: probably it's probably like, you know, half a dozen infusions of, of.

Of, uh, biologics, but, 

[00:27:01] Mike Koelzer, Host: well, you know, the thing is, is, is going back when we talk about the, the early insurances of the, um, of customers, when, as I remember when blue cross started coming and in the mid eighties, when I was a little bit more involved, and then finally, as a pharmacist in the nineties before the time where you felt like these third parties were no longer on your side, we were trying to do these things in many cases, not to your extent of those things, but the, the attitude of pharmacists was there.

It's like, Hey, instead of doing a prescription for a five milligram and a two and a half milligram tablet where these both cost the same per tablet, that sometimes how they price 'em for those listening, let's save everybody money and let's go with a five and then say, take one and a half tablet. And that's, that's a small example of how pharmacists.

Used to work and now it's, it's gotten so nasty out there that, you know, some, some people are like, screw it. I'm gonna do, I'm gonna do like the doctor road and do a, a five and a and a two and a half. And if you're not, if I'm in a, if I'm in kind of a cranky mood today, I might even do three, two and a halfs, you know, or something like that.

My point is that the tables have changed on pharmacists, really giving a crap about a, a, a lot of these things, because they've been treated so poorly by the PBMs. It's kind of a way to legally kind of give 'em a little punch back. 

[00:28:33] Adam King, CPhT, RPhT, PRS: It is. And. I've been slowly finding out in what I do for a living is that the larger your pharmacy chain is the different kind of leverage you have mm-hmm

But if your K pharmacy or even your PS, a O you still only have the negotiating power, maybe. Two or 3000 pharmacies, Walgreens and the other chains. Um, if you take the big three, for example, the big three chains in the United States, you're talking about one that has 10,000 stores. One has 8,000 stores, the next one down after that has about 6,000 stores.

They can actually almost dictate to a PBM, especially a smaller PBM, what they wanna get paid. 

[00:29:19] Mike Koelzer, Host: And we saw some pushback though, with Walmart and I, who was it? Walmart and maybe express scripts this last year. And finally, a few weeks later, you see that Walmart says, yeah, they'll do it. I don't know if they are, I don't know.

You know, you never know where you're not in the room where it all happens, but you, you don't know where the, who, who pushed and who accepted the push. I, I see the 

[00:29:39] Adam King, CPhT, RPhT, PRS: follow it and I can tell you who won. So, so generic, generic Lipitor sticks out in my brain as a prime example of this. And I have seen claims come through for a penny too.

For the same 90 day supply costing $75. So, 

[00:29:58] Mike Koelzer, Host: oh, oh, that's what they're being. 

[00:30:00] Adam King, CPhT, RPhT, PRS: That's what they're getting reimbursed from the PB. Yeah, because 

[00:30:05] Mike Koelzer, Host: for, for those, I mean, I think as all pharmacists, mainly listening, but for those that don't know the system, it doesn't, it doesn't unlike the hospitals.

It doesn't matter what the pharmacist charged because they already have rules set up. They're saying you can charge whatever you want to. It's kind of like Henry Ford saying, you can get whatever, whatever model T color you want to, as long as it's black and so right. They can charge whatever they want to, but it's, but what you're saying is despite the charges that the payments going back to them were a penny and then $75.

[00:30:37] Adam King, CPhT, RPhT, PRS: So, so yeah, depending on what size pharmacy you are, I'll, I'll take the penny claims out of that because that's really only one chain out of, out of the dozens I work with. Right. But you would see, uh, generic Lipitor if it's generic Lipitor 20 milligrams, number 90, a number 90 claim. For one particular PBM would be reimbursed an in a range between $9 and $75, depending on which pharmacy was billing that 

[00:31:05] Mike Koelzer, Host: depending on which pharmacy, you 

[00:31:07] Adam King, CPhT, RPhT, PRS: Now, that's, um, I can tell you what the $9 pharmacy was.

And I can tell you what the $75 pharmacy was. 

[00:31:13] Mike Koelzer, Host: Yeah. I don't gimme names. I don't think, I think it would bother me too much, but, um, 

[00:31:17] Adam King, CPhT, RPhT, PRS: I, I will tell you the $9, one's an independent 

[00:31:20] Mike Koelzer, Host: oh yeah, of course. Yeah. And, and, and again, there's, it, it might be getting, it might be getting you, you you'd think it would be getting better with the internet and with maybe a more dissemination of the information and people being able to compare and stuff more, but that didn't seem to, that didn't seem to catch up, uh, as fast as the shenanigans were going on in the background with the 

[00:31:46] Adam King, CPhT, RPhT, PRS: PBMs.

Yeah. And I've, I've been playing around with, uh, a business model and I've actually seen a few dozen different pharmacies do this. I have been playing around with the concept of pharmacies turning into 5 0 1 C three organizations, almost unilaterally. 

[00:32:04] Mike Koelzer, Host: Interesting. Basically being a charity, but then, but then getting charity prices, but then paying themselves a salary, uh, yeah, 

[00:32:10] Adam King, CPhT, RPhT, PRS: exactly.

With that. You can still. Bill insurances, you would actually turn into like a federally qualified health center, right? There are places where you can get free meds. So if you have patients who need the free meds, you can get them the free meds that become your charitable purpose. And then you can still have a related for-profit entity that would then not be subject to income tax.

So 

[00:32:36] Mike Koelzer, Host: the savings would be in the income tax or the savings would be, and also it wouldn't necessarily change your rate with the PBMs by having, by being a nonprofit. 

[00:32:44] Adam King, CPhT, RPhT, PRS: No, you wouldn't. So you generally would essentially, you wouldn't have to pay corporate income tax. The only thing that makes a difference is, when you go to dissolve the company at the end.

Yeah. All the assets of the organization have to go to a charitable purpose related to the way your articles of incorporation are written. 

[00:33:02] Mike Koelzer, Host: Yeah. Well, I don't need a lot of time for ideas. I'm not gonna be around this planet too much longer. So, you know, if I have something that lasts a little bit of time, that's, that's probably, that's probably good.

So, Adam personally, then how did you decide to make this move? Uh, is this something that you kind of had in mind along with your, you know, masters in public health and things like that, 

[00:33:24] Adam King, CPhT, RPhT, PRS: or, well, I started going to school for a master of public health and, um, the position that came up for me, the position I ended up taking, I already knew that.

As a pharmacy technician and a community pharmacy, my master of public health is probably not gonna serve me very well. No, I mean, there's really not much I can do with it other than possibly going into diabetes education. Sure. Which, which is a thought that crossed my mind, but I'm. Still thinking about that, but in all reality, with a master of public health, staying in the community, pharmacy is probably not where I was going to land.

Sure. The position that I ultimately have now came up last. Uh, I started interviewing for it last August and it basically was, we want you to run our pharmacy savings program the way it was incepted originally, it was just basically fine manufacturer coupons and apply them to the benefit of both the plan and the insurance or, and the member mm-hmm it has since morphed into cost contained the entire pharmacy spec.

[00:34:33] Mike Koelzer, Host: sure. Well, you keep, you keep around that damn $70,000 story and they're your, uh, job. Description gonna go up. 

[00:34:42] Adam King, CPhT, RPhT, PRS: Yeah, my job ex my job description certainly got a lot longer. I've learned a lot more in hick coding. Yeah. Now than I, I ever wanted to know 

[00:34:52] Mike Koelzer, Host: in any way, has your. Technician degree and certification.

Has that been any benefit to you instead of a pharmacy degree? I mean, I know you, I know that the upfront was maybe an easier road, but are you finding any advantages in the corporate world of saying I'm not a pharmacist? I'm not, I'm not saying there is with the question. I'm just, I'm just curious.

Sometimes you get put into certain roles as in certain professions that maybe it's better sometimes not to be. Have you found any benefit of that? 

[00:35:32] Adam King, CPhT, RPhT, PRS: Um, in a job outlook standpoint, um,

if you had asked me that question, when I was, uh, graduating high school, I probably should have gone to pharmacy school back then. Now I graduated high school in 1996. Yeah. Had I gone directly to Ferris State University, right? From there. I would've been the last possible admitted class that could have gotten a BS farm.

Gotcha. So I would've been able to become a pharmacist in four years. Yeah. I went to, I went instead to, um, teach in college, 

[00:36:12] Mike Koelzer, Host: I think at the time that would've been typically a five year process already, but you must, you, you might have been able to speed it up for four, right? Yeah. 

[00:36:22] Adam King, CPhT, RPhT, PRS: So you probably would, it would've been a five year bachelor's, um, realistically, even in education bachelor's was five to six years, 

[00:36:29] Mike Koelzer, Host: But I mean, pharmacy was officially five years then, but you could have taken summer classes and that would speed it up to four.

Is that what you're saying? Yeah. 

[00:36:38] Adam King, CPhT, RPhT, PRS: So, so realistically I could have been a pharmacist in four, um, right outta high school. Yeah. Um, when I finally got into pharmacy in 2009, It would've been pharm D only in all reality, it didn't suit me then to go back to school to get my pharm. D the master of public health though has opened my eyes to a whole whopping world, right.

That we haven't seen before. One of the things I wish I would see, I know only know if one other technician getting a master public health mm-hmm right now we get the, we not only see what what's happening is boots on the ground, but we kinda get to see what's coming down the pike in terms of healthcare.

What, what does healthcare, the future generation look like? Yeah. And, um, it's a very scary prospect. When you start seeing it in those terms, we're gonna be in a pace here soon where we're gonna actually have healthcare expenses going up five to 10 times the rate of inflation. Here's 

[00:37:41] Mike Koelzer, Host: The problem I see is that one.

I think that there's. Maybe it's too late, you know, but, but there's gotta be, there's gotta be different levels of pharmacists. So the, the, I know that community pharmacists are doing more testing and things like that, but there's gotta be some levels of, uh, pharmacy in my mind should be a.

You know, it should be a two year degree basically. Well, first of all, the us, system's messed up where, when you go back to college, as I've got, uh, three kids in college, right now, you're repeating the first two years, that should have happened in a good high school. So there's no reason you should be going back and taking math and history and English and social science and all those things.

Again, that should have happened in high school. And then pharmacy pharmacist should be like a two year degree in community pharmacy and, and with four, but minus all the crap of the first two years that should have been done in high school. It should be a two year career and maybe Pharm D if they're gonna spend more time in the hospital.

And so on, maybe it's a three year degree, you know, take off the two, three, maybe another year of, uh, residency or something. So maybe it's a two year versus four year degree. But now my goodness, I think it's like a seven, seven year degree out of the gate of high school. I mean, 

[00:39:01] Adam King, CPhT, RPhT, PRS: I think it's six to seven 

[00:39:02] Mike Koelzer, Host: years six.

I, I, I thought I was, you know, Six. And I, I think it's at seven now and it's just, it's just, um, incredible. And then, alright, so that's one soap box. Here's the second one. The second one is a lot of pharmacists now losing their jobs, pharmacies, closing, things like that. It's not because anything got solved.

I mean, the average age of the American male at least has gone down from dying. You know, the per it was at 72. Now it's at 71 and a half or something. Infant. Mortality's not much better. Obesity's gone up. Heart disease has gone up. So it's one thing losing a market when something better comes out. So typewriters went away when computers came out, but now, you know, pharmacies are going away, but it hasn't because of prices, but it hasn't gotten better.

It's moving because of. Prices are changing, but not because of improvements. It seemed 

[00:40:07] Adam King, CPhT, RPhT, PRS: okay. Well, my soapbox will be, I, I would argue that pharmacists need to become health educators. Yeah. And that's a billable profession. Um, you can bill to have diabetes prevention classes as a pharmacist. You can bill for diabetes, self management education, and what Medicare pays for that is nothing to sneeze at.

So, um, so I think pharmacists really need to E especially in the community. I think we really need to take a look at our neighbors to the north, let the technicians deal with the stuff behind the counter and let the pharmacists deal with the clinical aspect of the business of pharmacy. Because the pharmacist really is in the ultimate position to, to actually sit down with patients and be educators and give them a lot more value for their money than what they got out of the doctor's office visit, where they were in the doctor's office for seven minutes.

[00:41:19] Mike Koelzer, Host: Yeah, I think there's something, I think that the key word there is education because people don't like to leave a doctor's office with education, they wanna leave with a prescription of some sort, you know, the magic pill and is there not enough education out there on the internet and so on and do people wanna get educated?

And I think pharmacists are in the right position to do it, but, um, as I have my. You know, third bowl of sugar cereal at night. I know I have enough education to know that's not good for me. So maybe it's education at the right time and place. And I guess pharmacists can do that. You know, they're more accessible and things like that.

[00:42:04] Adam King, CPhT, RPhT, PRS: And, and they're, they're uniquely positioned where they can provide those services. Um, uh, even if they're billing for it at a reasonable rate, you can, you can do diabetes education and bill it out at $75 an hour. And, realistically, um, that's something that should be done, type two diabetes is an entirely reversible condition.

And people don't realize that, you know, 

[00:42:36] Mike Koelzer, Host: back, back on my question, I was thinking about, I, I think that. You know, first of all, I don't know much about DS after seven years. I'm gonna jump back into a master's in public health. And so I think that, um, That could be a benefit there that you're not, you're not schooled out.

And now you see arguably a bigger picture of the healthcare problem than the average, you know, farm pharmacist coming outta school does. Now I think you maybe have the bigger, the bigger picture looking 

[00:43:09] Adam King, CPhT, RPhT, PRS: at the pile of textbooks over there. I'm 

[00:43:10] Mike Koelzer, Host: Pretty sure I do. yeah. I mean, you know, I sure as hell, ain't gonna go back, and take classes.

And I, I know someone who's, I know a handful of pharmacists that are maybe attorneys and things like that, but I think that you. You may be found the better, the better course of understanding of what's going on with the situation? I don't know. I mean, every pharmacist listening right now would, you know, very well may disagree.

But my point is that there's only so much education that somebody wants to get. And you've got quite a original angle now that with, with your, um, studies and the public health stuff, you know, 

[00:43:50] Adam King, CPhT, RPhT, PRS: it to solve our healthcare problems, um, we're going to have to get out of our silo. Hospitals operate independent of each other.

They all have 

[00:43:59] Mike Koelzer, Host: their own supply and they're all doing their own thing. 

[00:44:01] Adam King, CPhT, RPhT, PRS: Yeah. They're all doing their, their own supply and they're all doing their own thing. And none of us are talking to each other. That is how broken our system is. If you go to British Columbia in Canada, um, A pharmacist can type up on their computer and know every drug you're taking.

Hmm. And, um, the doctor's office can do exactly the same thing. And not only do they know every drug you're taking, they know how often you're filling it and how compliant you are with your therapy. And. We don't have that in this country. We had to build interfaces to actually make our systems talk to each other.

Yeah. And, and you've probably, I haven't listened to every episode of your podcast yet. You I'm sure you've have you've li 

[00:44:45] Mike Koelzer, Host: you've listened to 

[00:44:46] Adam King, CPhT, RPhT, PRS: some, I've listened to some well you, 

[00:44:49] Mike Koelzer, Host: Well, oh my goodness. I've found, I've found someone. You get, you get the, uh, you get the golden ticket. I'm gonna send you a candy bar or something.

[00:45:00] Adam King, CPhT, RPhT, PRS: I'm pretty diabetic. Don't do 

[00:45:01] Mike Koelzer, Host: that. Okay. All well, maybe I knew that I was off the hook

[00:45:08] Adam King, CPhT, RPhT, PRS: um, but, um, the, uh, the, the reality is we need some interconnectivity, um, To, to play the game right. And to, to improve the quality outcomes of this country. Um, but there's, there's a lot that's gonna go into improving the quality and containing the cost. Um, there was another study I read, um, from the German equivalent of the FDA and the German equivalent of the FDA actually has an extra piece that they do when they approve a drug, um, in order to not get priced in the same class as a, a lower cost therapy.

So let's say you're developing another one of those. Me too. Serotonin neuro epinephrine, uptake inhibitors. Yeah. I, if you're gonna bring out another one of those to the market, you have to prove to me in Germany that it is better than Effexor. Yes. Right. In order for it to not be priced like Effexor. Yeah.

Right. And if you go to our neighbors to the north, they, the, our neighbors to the north actually just took two countries out of their international pricing reference list. The two countries they took out were Switzerland and the United States, because it was causing outliers in their data. Hmm. But, in both cases, they do price controls, one as a quality initiative.

And the other one as a, how are we paying for drugs? How much are we paying for drugs relative to other countries? Mm-hmm and they picked five of the lowest cost countries to contain the cost of their medication. And I think we're going to have to start doing that here. 

[00:46:53] Mike Koelzer, Host: W was your reference on the, on the drug being different because in the US, for a new patent to come out, they don't have to prove it's improved.

They just have to prove that it's different. Is that what you, is that where you were getting at that there's at least improvement in other, other countries' laws. Yeah. 

[00:47:09] Adam King, CPhT, RPhT, PRS: So, in Germany you have to prove that it's clinically better, better. 

[00:47:14] Mike Koelzer, Host: Where, yeah, here we have the me toos of it. It looks different and I've got a different actor on TV doing it, and I'm gonna, I'm gonna slide it in.

And, uh, and hope. Hopefully we convince some people with our marketing and so 

[00:47:25] Adam King, CPhT, RPhT, PRS: on, right? Because you have the appropriate hydrochloride costs, about a hundred dollars, extended release costs, about a hundred dollars for a 90 day supply. Somebody came out with bupropion, hydrobromide, it costs $13,000 for the same 90 day supply.

There is no clinical difference between those two drugs. Yeah. And in the last six years, 75% of the drugs that have come out in the marketplace have had no clinical, uh, benefit improvement over the drugs that already exist. That cost a lot less. 

[00:47:57] Mike Koelzer, Host: Yeah. And I'm, I'm part of the problem. I'm sitting here with, uh, like I say, too many bowls of cereal under my belt, and I'm working on that with different plant based whole food diets and so on, but it's gotta come down.

It seems that we've gotta narrow that gap between heart disease, obesity, you know, cancer and, and these high costs of the, and I'm, I'm a business owner. I have, I have nothing against profit, but these guys pulling in millions of millions when N nothing has nothing has changed in the community. 

[00:48:31] Adam King, CPhT, RPhT, PRS: Well, you know what, Mike, in the business of pharmacy, we could make just as much profit in helping patients make the lifestyle changes to get rid of the modifiable risks for disease as we can.

And we can make more money doing that. Then we can, by selling prescriptions. 

[00:48:49] Mike Koelzer, Host: I, I, I think you're right, Adam. I always tell my pharmacy that it's like, guys, things might look different. K pharmacy, any pharmacy might look different, but the whole, the holes are still there when you've got, when were the most healthcare agents and a lot of that's because we're the dumbest maybe, and have too much access.

But when you've got the, the life expectancy going down, obesity going up, you know, cancer's going up because of obesity, heart disease, all those kinds of things. It's like the problem's still 

[00:49:23] Adam King, CPhT, RPhT, PRS: there. We need to become the profession of lifestyle modification. Um, teaching lifestyle modification. I'm actually going through the training.

Um, the CDC offers what's called prevent T2, which is preventing type two diabetes. I'm actually going through the training. To deliver the prevent T2 course. It is a one year course. That's scientifically proven to lower the risk for diabetes it's insured or its insurance reimbursable. It can be delivered inside a pharmacy.

It can be delivered inside a doctor's office. It can be delivered inside a clinic. It can be delivered at your local community nonprofit. Um, I'm getting ready hopefully in January to deliver it for the first time at a food bank. Hmm. Here in grand rapids as part of my internship. Wow. So we have a lot of power to reverse the modifiable.

Risks for chronic disease and hypertension, obesity, uh, cardiovascular disease, diabetes, uh, with the exception of type one, we can't do much about that. I don't 

[00:50:33] Mike Koelzer, Host: have many complaints of where the, of where the pharmacy reimbursement has gone because when I bought this from my dad, 25 years ago, the pharmacy, and now the profit's just about gone.

It seems to be the reverse. Um, I knew where it was. I knew where it was going and I, I, I knew what wave I was on and I just decided to ride the wave, you know? So I'm, I'm to blame for all this stuff. I saw the waves. I knew the wave was happening. I didn't know, finally, when the wave would crash, like it is now, but now that the wave, it seems the community pharmacy has kind of crashed, uh, you know, the next, maybe me still, maybe I still have some.

Energy left. And maybe this is my contribution to this next wave coming through with the podcast and so on. But, but nobody's gonna jump, be able to jump that wave or, or to be on that wave again, it's gonna take a different wave of people saying no that, well, that's not working. We're not gonna be able to make one.

We're not gonna make an impact, but even maybe more important for, for, for people in the, in the free market of the us. We're not gonna be able to make money on this. So now what now, what problem can we solve to make money 

[00:51:53] Adam King, CPhT, RPhT, PRS: on it? The pharmacy business is going to have to change in this United States to adapt to that reality.

And if not, 

[00:52:03] Mike Koelzer, Host: they're not gonna be. 

[00:52:04] Adam King, CPhT, RPhT, PRS: Right. It independent pharmacies fail for one reason only they do not adapt to the business climate that they're currently 

[00:52:11] Mike Koelzer, Host: in. Yeah. That's, that's true. And sometimes they, they haven't adapted on purpose, you know, like in my case, like, I mean, we've, we've done some things, but not things that on purpose 20 years ago, that would extend things for a hundred years.

I basically knew my. Lifespan took the risk that the wave was gonna be there long enough. And it seems to be about lasting to that. But if you want to be around a long time, you've gotta adapt better than most 

[00:52:41] Adam King, CPhT, RPhT, PRS: people have. Well, and the case in point is I'm sure the pharmacist that sold the formula for Coca-Cola is still kicking himself.

If he were still alive today, over how much money he could have got off that patent. So, 

[00:52:53] Mike Koelzer, Host: So he could, he could have gone that route. You mean? 

[00:52:55] Adam King, CPhT, RPhT, PRS: Oh yeah. I mean, you, you consider, um, Pepsi Coca-Cola and Dr. Pepper were all made by pharmacists. Those were all formulations that were done by pharmacists in its history, back in the 1800s.

We really need to reinvent ourselves again, to adapt to this current climate. Current climate being in 10 years, it is predicted one in three adults in the United States will have type two diabetes that road's coming down the pike. And also the other pike that's coming down the road is that one in every six adults will have cardiovascular disease.

Some of those as a result of having type two diabetes. And if we can start turning the tide for that now as a pharmacy profession and bill for that. Then we have a whole heck of a lot more impact on public health than say a doctor does because we can pack 20 people in a room and build them each $20 for a class.

[00:53:51] Mike Koelzer, Host: Yeah. And I agree with that. And here's what I think has to happen for guys, for guys like me that have maybe, and I know a lot of listeners are gonna say I'm wrong and that's, and that's, and they might be right. But heck I'm probably wrong. I think 

[00:54:06] Adam King, CPhT, RPhT, PRS: there's 

[00:54:06] Mike Koelzer, Host: But you know, no, I, I, I think there's gonna, no, I don't think so.

I think there's gonna be a lot of, um, I think somebody who has run a pharmacy for like five years, I, I think that the, the bitter taste of the PBMs and the pharmacy of how it is now that takes so much energy and so much fortitude to stand against that, that I almost think that. You need somebody who's fresh and who, and who's not dealing with an audit day after day and legal things and, and, you know, having to work through all the smoke and mirrors of the wholesalers and all that, I think it's gonna be what I've been seeing while I, the short time I've been doing this show is people coming in through the backside and using, using the things that are available to them, like the microphone we're talking in and the video screen and the Venmo and all these things to start their businesses from the backside while they have energy, instead of trying to do it from the front end while their energy is depleted, dealing with all the malarkey that's gone on with the PBMs and so on.

Many people are not as jaded and as depleted of energy as I am to see it change. But personally, like I know right now, if I, and I may still, if I am going to do something like this to get reinvigorated and come in and help the healthcare system again, I think it's gonna be by leaving the pharmacy and, and coming in through the back door.

Of some other way, because I don't, I don't have energy for both community 

[00:55:54] Adam King, CPhT, RPhT, PRS: pharmacy is, uh, I, I had to get out of it too, because it was, it was, I was drained every day, coming home from work even only having been a 10 year veteran of the job. 

[00:56:06] Mike Koelzer, Host: Right. And, and, and am I correct in saying that you were more drained than maybe if you had to dig ditches all day?

It wasn't a physical drain per se. It was more of a tension, uh, bad attitude for whoever attitude it was, but, but it wasn't a, a, it wasn't a real good physical you're 

[00:56:24] Adam King, CPhT, RPhT, PRS: tired, right? No, it was a mentally you're tired. You're, you're mentally done at the end of the day to the point of, um, please don't make me answer my cell phone at the end of my day.

If people called me after six o'clock at night, I didn't answer my phone. Um, text me. Yeah. but yeah. Um, I mean, the reality was I was so sick of talking on the phone. I was so sick of, you know, just. Day to day life that it was just like, there's gotta be another way to do this. And we are going to have to get out of our, if we're going to prevent burnout, we're going to have to get out of our, our, our boxes.

Yeah. And, reinvent this practice. And, I look at public health, public health. There are so many things you can do in public health, um, that are pharmacy related that are, I mean, you think about public health news and public health really is pick random health news of the day. And you'll, you'll see it probably when you turn on the six 30 news tonight, the national news tonight.

Yeah. You know, you'll get some random, oh, by the way, studies have proven that eating, eating a bar of chocolate a day, will reduce your cardiovascular risk within the practice of pharmacy. There are so many of those pieces of random news bites that we can actually work with the public on. And actually, yeah, I, I would argue that there is a fourth practice of pharmacy outside of hospital, long term care and, and retail.

There needs to be a, um, public health pharmacy. Aspects of our careers. And I don't know what that looks like. What does that look like? And I don't know what that looks like yet, but it helps with things like trying to figure out the opioid crisis, the obesity epidemic that we currently have VA vaccinations, um, getting the truth out about vaccinations and actually administering them.

I mean, the health, our, our health department here in Kent county does a pretty kick by job in administering vaccines. But the reality is, we don't have the same immunity, uh, herd immunity that we used to, or even so much as vaccine development. Yeah. Community health education, improving health literacy, getting rid of the health inequities because as the cost of healthcare goes up, people are taking less of their medications.

I'm hearing, you know, reading new stories about how my son died because he was rationing his insulin and it was just like, okay, that's, that's a solvable problem in this country. We're living in 

[00:59:04] Mike Koelzer, Host: the greatest time ever when it comes to getting the word out, like you were talking about one. We can educate ourselves.

We can keep up on things too. There's no one in our, there's no producers in our way that say you can't, I can't do this. I mean, I've got YouTube, I've got a microphone I've we both do. And, and no, one's in our way saying, no, we're not gonna open the newspaper up to you, or we're not gonna open up the radio to you.

And so on because of this program and, uh, I was offered a monthly spot on the local TV station. Because of this, I didn't have to go through a producer to get this podcast out. They know you're hungry and then tomorrow I'm gonna be on a morning radio show. And I think part of that's, they know I'm hungry.

They see the podcast episode come out and so on. I'm not trying to pat myself in the back. What I am trying to say is somebody listening to this right now, unlike 10 years ago, has everything right now at their disposal to, by tomorrow to counsel somebody. Online across the country and help someone doing it and, and, and make a buck doing it.

I 

[01:00:17] Adam King, CPhT, RPhT, PRS: had, I have a YouTube channel where I actually, it just surprised me the other day. I once produced a series of four videos on pharmacology and my YouTube channel is affectionately described as drug school, but it teaches pharmacy technicians what they wanna know about what it takes to pass the PTCB exam.

Hmm. You know, so it's a, it's a lot easier to, to watch somebody kinda guide you through it. Rather than read a textbook. It shocked me the other day when I was looking at my YouTube statistics and I actually started seeing sources coming from like Blackboard, which is the learning management systems that colleges and universities use.

So my YouTube videos are now like starting to reach college students, their instructor assigned one of my 

[01:01:01] Mike Koelzer, Host: videos. That's awesome, 

[01:01:04] Adam King, CPhT, RPhT, PRS: Adam, congratulations. Good to have that done. So it's, we, we are in the era of information and the more information we get out, the better health outcomes we achieve. 

[01:01:15] Mike Koelzer, Host: Yeah. I, I think I, I think you're right.

And then, and then I think people need, you know, obviously people need, um, they still need someone they can depend on to see if that information is worthy of, you know, is worthy of, uh, seeing it. Absolutely. Hey Adam, what, um, so what does life hold for you? Like where do you see yourself? Like in five years, do you have any, is this a, is this a perfect setting for you or do you think that you'll be doing something else?

And if so, what would that be? Well, 

[01:01:48] Adam King, CPhT, RPhT, PRS: with the, with the, um, prospect of having $47,000 worth of student loans come crashing, Donna, we come August of next year, um, because of your graduate school masters, I'm working on starting a non-profit called compassion RX. The first projects that that organization will be doing will primarily be dealing with educating the public in reversing modifiable risk factors for chronic disease in Kent county.

We are one of the healthiest, I mean, Kent county 

[01:02:19] Mike Koelzer, Host: don't don't put my picture on the front of the brochure as a before picture if you've ever snapped something at one of our association meetings, as I've been shoving, uh, potatoes, potato bloated potatoes in my mouth. Don't don't put, you don't have, you don't have express written permission from me.

Um, 

[01:02:41] Adam King, CPhT, RPhT, PRS: and, and you don't have express written permission for you to rush down on all the mozzarella sticks we had in those meetings either. So um, so I, I only have yet to look at the, uh, my own self in the mirror. Um, yeah, but, but in all reality, we have modifiable risk factors for chronic disease, for cardiovascular disease, hypertension, diabetes, I'm picking on diabetes first because it's, it's the worst problem.

And I'm actually gonna pick on two counties in the same breath I'm gonna pick on Muskegon county and Kent county. At the same time I live in Sparta. It's like, Right where the two of the meat Muskegon county has pretty much the worst health statistics of pretty much any county in west Michigan. If you take into account their population, they are the highest in poverty.

One of the highest in poverty, one of the highest in non-insured people, they have the highest comorbidities of chronic disease. Kent county is almost the exact polar opposite, but even then the prevalence of disease is getting greater. But the cost of care in Kent county is higher than that at Muskegon county, almost by twofold.

I'm gonna take the nonprofit. One of its first projects is going to be doing lifestyle modification classes. I'm taking the CDC, uh, certification courses to prevent T2. And I hope to have that done real soon. Um, I'll actually be done. In the middle of October with that. And I'm going to probably give it out as my, one of my, uh, graduate projects to, uh, a food bank here in Kent county, uh, the clients of their food bank, because the most food insecure people actually carry the highest risk of developing type two diabetes.

[01:04:20] Mike Koelzer, Host: Yeah. Right. Because a lot of it, because of the makeup of the food and the right, the low, the low fiber and low veggies and that kinda stuff. Yeah. So they, 

[01:04:29] Adam King, CPhT, RPhT, PRS: they don't have the world's greatest diet getting into the places in the community that need the most help. And I am going to be working on getting, uh, some grants for that and get that going here real soon.

Are you passionate about that? 

[01:04:43] Mike Koelzer, Host: I am. I gotta get some passion back. I've been in the business side for so long in pharmacy and I've been so. Tied up with this negative business flow. And I think that there's probably a change coming in my somewhat near future. And I gotta get some passion back. I got a lot of passion in other things, but in health, in, in pharmacy, in the health business, no, not the business in the health of pharmacy.

I don't have a lot of passion. 

[01:05:08] Adam King, CPhT, RPhT, PRS: I'm getting a lot more passionate about the fact that education is gonna be the way to get us out of this mess. Every phone call I take on a daily basis from one of my groups is the labor union on the Southeast side of the state. and I'll get at least one phone call a week if I'm in the hospital for diabetic ketoacidosis.

My doctor's putting me on insulin. What the heck am I gonna do? Mm-hmm and my job is to help walk them through the process of getting them arranged to get their insulin at little to no cost. Yeah. Right. Getting diabetes testing supplies, cuz they've never tested their blood sugar ever. Yeah. And it, they didn't realize they were in trouble until they started experiencing these ungodly muscle pains or they just flat out went into a diabetic coma.

[01:05:53] Mike Koelzer, Host: When I hear you talking about education, it's like, I'm a damn pharmacist. I mean, for me, education's not the thing. It's the, it's the stuff after that, it's a willpower and the, and all that kind of stuff. But a lot of these people that you're talking about probably never. Heard of diabetes or, or know what it's caused from and so on.

[01:06:10] Adam King, CPhT, RPhT, PRS: Right. And, and the whole goal of, of, of preventing T2, um, from the CDC, if they actually go through that whole year of that class, 71% of the people that make and stick to the lifestyle choices that they, they, they go out with. So. One of the things in type two diabetes that they tell you not to do is, uh, don't tell people they have to get down to their goal weight.

If you told me today I needed to lose 57 pounds. Do you think I'm gonna lose 57 pounds in the next four days, 12 weeks? Heck no. One of the things they tell you is just to baby, step yourself into these lifestyle goals. So in the first. Months of the program. Your goal is to lose 7% of your body weight.

Okay. I'm 210 pounds right now. So I'd have to lose 7% of that. Setting yourself up for goals, getting lifestyle changes, getting moving. So teaching people how to incorporate activity into their daily lives and their activity. Mike might be you going over and doing the dishes yourself instead of having your dishwasher do it.

wait, is a dishwasher, not your wife. Is it okay? Sorry. 

[01:07:19] Mike Koelzer, Host: I gotta, I gotta ask that. I wanted to clarify. I wanted to clarify that. So the, the, the dishwasher with a, a small D yes. . Yeah. You know, so, Adam, it almost sounds like at a certain level. Yes. It's education. And like I say, I know it, but I'm, I'm in the business, but then for, but then I think it goes into such a, such a close education that it's almost coaching.

It is coaching 

[01:07:49] Adam King, CPhT, RPhT, PRS: and that needs to become our business. Yeah. So, the training that you go to, to go through to certify your, your prevent T2 program is lifestyle coaching. So you actually take a lifestyle coaching class. It's a four week class and you're teaching people how to do things that change their lifestyle.

And some of the advice that they give you in this prevention program, I need to take myself, but it's coming from, it says the guy who actually just bought a 90 pack of Totino's pizza rolls at the grocery store this afternoon. um, but, um, 

[01:08:32] Mike Koelzer, Host: my wife and I had a big argument cuz I told her that, on uh, one of the Popsicle boxes, a serving is three popsicles and, and, and a lot of the Popsicle boxes don't say that, but the one I got a serving is three popsicles.

So it's, it's all in the, it's all in the smoking mirrors. Cause that could be out of 90 that's That's like two servings. 

[01:08:56] Adam King, CPhT, RPhT, PRS: It is. Yeah. And, and, um, there's like Gatorade is a Gatorade or even any one of the 20-ounce Cola bottles pick, pick your manufacturer. Those 20-ounce Cola bottles are actually two and a half servings.

Yeah. So you actually have to multiply every. Number on that bottle by two and a half. In order to tell you what your nutrients are from that particular bottle 

[01:09:19] Mike Koelzer, Host: you ever go to Michigan's Adventure 

[01:09:21] Adam King, CPhT, RPhT, PRS: Uh, I haven't been in ages. 

[01:09:23] Mike Koelzer, Host: They've 

got this kettle corn thing. It's gotta be the size of a, not a 40-gallon trash can, but like a, it's like the half the size of one of those white bags you put in your kitchen, trash bag.

[01:09:33] Adam King, CPhT, RPhT, PRS: Okay. 

[01:09:34] Mike Koelzer, Host: And it's, 

and it's kettle corn and it, and it says like 390 calories and I'm like, that's just smelling. It would be that, that amount. I don't know how they're. I dunno why that sign is there. Maybe there's no small print or anything. It must be per serving or some, there's gotta be like a hundred servings in 

there.

[01:09:52] Adam King, CPhT, RPhT, PRS: Oh, I'm sure there are. But, uh, but of all the snacks you could possibly have, that's actually one of the better ones at Michigan's Adventure 

[01:09:58] Mike Koelzer, Host: I suppose. 

So. Yeah, but that coaching, yeah, that coaching, I, I need like, you know, I mean, I don't know, like I, like at night I need like half. Half servant half coach. So when I say, go get me cereal, they know to get the almond milk and the, you know, go lean versus the corn flakes and the milk.

And so 

[01:10:24] Adam King, CPhT, RPhT, PRS: on. Try try this at night, I actually started doing this to get myself off of eating, like, you know, smashing down three kit cats at the end of the day. I 

[01:10:33] Mike Koelzer, Host: Actually, we're assuming that's a goal. You, we don't want to have, 

[01:10:35] Adam King, CPhT, RPhT, PRS: that's a goal you don't wanna have. I took a half a cup of frozen bees, frozen mixed bees.

So it's strawberries, blueberries, blackberries, and raspberries in a mix that I bought as a frozen medley out of the freezer section at the grocery store. And I mix it with eight ounces of milk. and I whizz that up in a, in a personal blender and it kind of makes like a smoothie. It's a sweet treat that you can have at the end of the day.

It feels like you had something guilty. Yeah. That's the thing. 

[01:11:02] Mike Koelzer, Host: But it 

[01:11:03] Adam King, CPhT, RPhT, PRS: was it's it's by far better for you than going and having the frosted flakes with a half a gallon and a whole milk in them, or I think it's fun 

[01:11:14] Mike Koelzer, Host: to feel a little guilty. If you gotta feel a little bit like, uh, a little bit like a Glu afterwards or else you don't feel like you've, you know, done 

[01:11:21] Adam King, CPhT, RPhT, PRS: anything.

Yeah. The glass is a pain in the neck to wash the next day, but 

[01:11:26] Mike Koelzer, Host: so, so Adam, would you, as you look at the masters of public health, do you always see yourself? Like, I don't know, maybe I'm lazy and I've maybe I've taught too many new employees and so on, but if I had an interest in that and I guess the good Lord gives everybody different.

Talents and desires. If I did something like that, I think mine would be more on the administration side where I'm like, where I'm like setting up, you know, setting up the schedule and, and, and marketing and things like that. Do you like the actual patient? Do you actually like talking to, to 

[01:12:00] Adam King, CPhT, RPhT, PRS: people? Here's, here's the fun about the public health program?

You can do anything with that degree. You can think of. So when we graduate, we graduate with five competencies. So one of them is, we use evidence based decision making. So we take a look at data, or we take a look at an epidemiological study or whatever, have you? Yeah, we look at the data, determine the need.

Then we plan for a program we implement and educate. And then we use systems based thinking, which means we actually take a look at what is going on in the community as a whole mm-hmm where does my particular piece of that public health system fit within that overall system? You can do a lot. Um, one of the jobs that is available for a pub master of public health is a sanitary at the public health department.

I learned what a sanitary does, not my style of work. Sanitaries go into restaurants. They do restaurant inspections to make sure that the food eaten in a restaurant is safe. They go out and do septic. Certifications. Yeah. Um, that's the part of the job that got me, that I was not prepared to do. 

[01:13:16] Mike Koelzer, Host: well, part of the, part of the whole thing, as, as you've mentioned, a couple times is keeping the whole damn thing together with, with, uh, communication and that's, uh, you know, just looking at the whole piece and keeping people on the same page has gotta be a big part of it, too.

You 

[01:13:30] Adam King, CPhT, RPhT, PRS: learn very quickly in this program, in, in the, in a master of pelvic health program, you learn very quickly how broken the system 

[01:13:36] Mike Koelzer, Host: is on that question. Adam, do you think that you'd, do you see yourself working, being with patients for another. For, for another five, 10 years, or do you see yourself in 

[01:13:45] Adam King, CPhT, RPhT, PRS: administration?

Um, I see myself doing a little bit of both. I see my, I see myself probably keeping the job I have and I'm probably gonna be tackling the educational component and, and doing the prevent T2 classes on the side. I'll have my main pharmacy job, but as a side hustle, I'll be doing health education.

Yeah. That's 

[01:14:06] Mike Koelzer, Host: cool. How was your, um, More than a dabble, but in, in the state association from a few years ago, when you did some work with the state association, as far as presenting or trying to put forward motions and so on, was that. Good for you, or did you sour on any of that with the state? Are you still involved with the state in that regard through the Kent county association and then into the Michigan pharmacy association?

I'm just asking, because those who are listening, you know, there's not enough involvement there. And so what was your take on 

[01:14:44] Adam King, CPhT, RPhT, PRS: all of that with local association? I was becoming a bit jaded, but we've had a leadership change since then. So. Yeah, I saw some new ones. Uh I'm still serving on two boards.

I'm actually the technician liaison for the consultants and specialty pharmacists of Michigan. Hmm. Uh, which is as Larry wa act of, the Michigan pharmacist association calls it that's the island misfit pharmacist. So that's a compound that deals with compounding and consulting and nuclear and managed care, which is where I work now, the outskirts of pharmacy or, or the, not your average pharmacist land.

Sure. And then I'm also a voting member of the Michigan society of pharmacy technicians. I'm actually my term's next year. And I'll probably be president of that board. 

[01:15:30] Mike Koelzer, Host: Well, congratulations. How, how often are you making the, what hour and 15 minute trip down to Lansing when you're 

[01:15:36] Adam King, CPhT, RPhT, PRS: on an MPA board, each meeting quarterly.

So once every three months, generally speaking, you can do 'em by phone. Michigan's not exactly a small state geographically. Yeah, I 

[01:15:44] Mike Koelzer, Host: was gonna say by phone or video or something like that now. So 

[01:15:47] Adam King, CPhT, RPhT, PRS: like one of the CS P M members is in the upper peninsula. So I do a lot of 'em, uh, by phone or video chat, just like we're having this, this conversation here's yeah.

Right. We have that same ability at the Michigan pharmacist association to join our meetings that way. So, oh, that's good. If I have a board meeting frequently, what I'll do is I'll just drag my laptop into work and log onto the wifi at work and have my meeting over the video conference. 

[01:16:12] Mike Koelzer, Host: And, and some people are there in person and some 

[01:16:14] Adam King, CPhT, RPhT, PRS: people are there in person and then you're representative being on the walls.

Yeah. And then I get to be the voice of God on the speaker system, in the, in the room too. Oh yeah, because when I'm, when I'm speaking, uh, on my mic, they there's speakers in their conference room that you 

[01:16:29] Mike Koelzer, Host: should dress up funny, like the guy on the, uh, what was at heaven's gate or something. Remember that thing.

Do you remember that years ago? That crazy guy that would get up there. He had, like, that was the one where like, I don't know what 39 people took their life or something and, and we're gonna go join the UFO or something. Oh yes, yes, yes. He was always on the video conference like that, so, oh yeah. But he always had a Rob on or something.

Well, I'm glad they're using that because I, I, I enjoyed my year. So going down to when I was in marketing. The state's got just a ton of stuff that you can lend to, and it's great to meet people and so on. And, but I would go down for a year or so, but then it just got to be, or maybe a couple years then it got to be a lot.

But now with video, that would be a good way to do it. It is, 

[01:17:11] Adam King, CPhT, RPhT, PRS: it, it, it, it does reduce that time commitment, especially with the Michigan society of pharmacy technicians. Our board meetings are not in Lansing. Our board meetings are in Flint and I will help you if I'm driving to Flint four times a year.

Yeah, no kidding. That's a and a half. Um, yeah. And it's, it's gonna be fun enough that I have to drive to Flint in a couple weeks, but, um, I'm presenting, uh, a continuing education for the Michigan, uh, pharmacy. We do, uh, five live events for pharmacy technicians every year. Why do they do, 

[01:17:42] Mike Koelzer, Host: why do they do Flint for the phar, for the techs 

[01:17:44] Adam King, CPhT, RPhT, PRS: at the time when I joined the board four out of the seven.

Board members, uh, either worked for diplomat mock community college or, or Genesis or, or McLaren. And so they were already in that particular neighborhood. So that was just where the meetings were held. 

[01:18:04] Mike Koelzer, Host: Uh, yeah. I don't know anything about Flint, but I do know that UMTS is there. Right. That's their headquarters now 

[01:18:09] Adam King, CPhT, RPhT, PRS: diplomat has their headquarters there.

Um, 

[01:18:11] Mike Koelzer, Host: gotta, I will be careful of their suspensions mixing up though with the water. Oh, hopefully they're using, hopefully they're purified. 

[01:18:20] Adam King, CPhT, RPhT, PRS: Uh, yeah, they have, they have their own system, their water system. So their facilities are absolutely huge. 

[01:18:28] Mike Koelzer, Host: I forget why they chose Flint again. Was that because of tax 

[01:18:30] Adam King, CPhT, RPhT, PRS: things they got or were they from a tax cut?

They took over an old GM. Oh, that's good. Good for them. They consolidated all of their pharmacy operations out of that one facility. Oh, that's good. Phil and Jen Hagerman are from that area, so. Gotcha. So that's why Flint got chosen, but, um, they, they essentially have three quarters of an old GM plant that they operate.

They lease the other quarter of that to McLaren health, uh, who operates their laboratory services out of that. That's interesting. Huh. That's cool. Um, so they have quite a, uh, quite the operation over there. Yeah. 

[01:19:11] Mike Koelzer, Host: You've probably got the tour over there and that stuff when you've been there to Flint.

Yeah. I 

[01:19:15] Adam King, CPhT, RPhT, PRS: got the tour of their facility. It's absolutely Gargan. And there is a whole subset of technicians there that do essentially half of what my job is currently in managed care where they do the prior authorizations and oh 

[01:19:31] Mike Koelzer, Host: yeah. For they're the specialty pharmacy. 

[01:19:32] Adam King, CPhT, RPhT, PRS: So the specialty pharmacy. So they do the copay assistance and signing patients up for copay assistance and, and all that fun stuff.

They have an entire department of technicians that does that. So they also have an entire department of nurses too. I'd never even realized that in specialty pharmacy, they have nurses working there that do clinic phone calls, 

[01:19:51] Mike Koelzer, Host: so, Hmm. Big operations. So it's a huge operation. My daughter got married in North Carolina a few weeks ago and we were driving home and I think I was going through Columbus maybe, but I think that's where, and then there's this huge building to cover my meds.

Mm-hmm which, for those not familiar, it's a. I think the business is just based on getting prior authorizations for, you know, pharmacy people, but they got this humongous building and it's like, damn, that's a talk about red tape. There's so much red tape. They, you were able to tape stories together to get this huge building 

[01:20:23] Adam King, CPhT, RPhT, PRS: for that.

Well, in two years time, um, Medicare is actually going to require all prior authorizations, uh, for Medicare part D to become electronic cover. My meds are essentially your one stop shop for doing that. You send an electronic prior authorization off to the doctor's office and they fill out, um, their electronic PA and then they send that electronically to the insurance company with the entire goal of reducing the amount of time it takes to do a PA from 72 hours to 24.

[01:20:53] Mike Koelzer, Host: You know, I, um, here I was in the business a couple years ago and I was trying to get this medicine and we. It was for me, I think it might have been for one of my kids, but we sent a PA in and it was denied. And so I called the doctor up and I'm like, look, it's, it's denied. Uh, we gotta change it to something else.

She said, no, we just need a double PA or something. I'm like, what, what, what are you talking about? She's like, oh, that's. The first one, they always deny. And the second one, that's what, that's where you, that's where you, that's where you have to go. You have to get a second deny and I'm like, are you kidding me?

I've been in this business, you know, and now it's gone from, you know, not only, uh, it's like there's the, there's a PA, but then there's really the PA you know, and it. What a mess. If you get 

[01:21:45] Adam King, CPhT, RPhT, PRS: a letter of denial though, and if you make less than 500% of the federal poverty level in 90% of those cases, the drug company will just ship you the drug.

If it's a brand name drug, 

[01:21:56] Mike Koelzer, Host: if you make 

[01:21:56] Adam King, CPhT, RPhT, PRS: less than 500% of the federal poverty level. Now Mike likes 500% percent. Given the fact that I know how many kids, you have 500% of the federal poverty level for you is probably like 300, some odd thousand dollars. 

[01:22:10] Mike Koelzer, Host: oh, is the poverty level switching between how many kids you have?

Yes. Maybe I'm impoverished. Yes. I've got 10 children. So maybe I'm impoverished

and I decided I'm not gonna have anymore. I think, I think Tanette, 

[01:22:27] Adam King, CPhT, RPhT, PRS: I don't think your wife would let you have any more. 

[01:22:30] Mike Koelzer, Host: I don't think so. Our youngest is eight. I think so we're, we're actually getting a dog tomorrow in Lansing, uh, a new puppy and, and she says, well, are you, are you ready for it? And I'm like, I'm I'm, I'm not doing that night thing.

She's like, no, I'm SI this is mine. This is mine. So we switched from humans to, um, animals 

[01:22:51] Adam King, CPhT, RPhT, PRS: at least. Yeah. I mine have always been animals, so 

[01:22:55] Mike Koelzer, Host: yeah, that's, that's probably, uh, that might be a better, um, that might be a, no, I I'll. Yeah, I don't have to bring both through college. yeah. That's that for sure.

that's for sure. Yeah. We've got, um, three done with college and three in college and then another four more coming up. Geez. That's another, that's a whole nother story of the college bubble and stuff. So thankfully we have a great, you know, community college in town 

[01:23:23] Adam King, CPhT, RPhT, PRS: here. Yeah. And I actually got my start in community 

[01:23:26] Mike Koelzer, Host: college, so it's a great, it's a, it's a great way to go.

And, and, and not being a research college, you get people there that are there that want to teach. Yeah, exactly. You know, versus versus, um, having their head in the research and having the, uh, student teachers doing the thing or whatever. What, 

[01:23:43] Adam King, CPhT, RPhT, PRS: what struck me? What struck me was the relationship going through grad school now, um, is the relationship I have with my grad school professors versus what I, the relationship I had with my undergrad professors is significantly different when I'm going through my master of public health.

First off with the exception of, I think maybe two or three of them in the program, there's six professors that teach the program with the exception of three or four of them. So about half of them make you use their doctor salutation. The other half are like, just call me Amy. Yeah, right. Yeah. And they're like, right.

So I have like Amy Vivian, Dr. McMorrow, Dr. Vamos 

[01:24:21] Mike Koelzer, Host: point out the difference between that and the community college. Because, because some of 'em, some of them, you, you have a closer relationship with demonstrated by calling them by their first name and so on as more of a friendly, they 

[01:24:33] Adam King, CPhT, RPhT, PRS: see you as becoming professional equals.

Yeah. Right, right. Rather than I, I lured over you with my six degrees higher than you have. Yeah. That, and you're not one of, and, and I know this because, um, at postsecondary level I actually teach for a community college and I also teach for a university. Oh, okay. I teach freshman level classes because they don't require my masters.

If I have my full teaching load at both colleges at any one, given time I have 150 students. 

[01:25:06] Mike Koelzer, Host: Oh yeah. So just the pure numbers. 

[01:25:07] Adam King, CPhT, RPhT, PRS: So just sheer volume alone of the number of students I'm working with. It is pure insanity. Yeah. Just the numbers 

[01:25:18] Mike Koelzer, Host: are, 

[01:25:18] Adam King, CPhT, RPhT, PRS: are too high. Yeah. And when you're a grad student, you're one of, I think in my grade, my, my cohort, we have 19.

Gotcha. So in my particular master's program, there are 19 students rolling through the, what will it become the second year? Um, and I haven't met the, the new first year cohort 

[01:25:38] Mike Koelzer, Host: yet. And the teachers know you're more interested too. You're not taking it just out of duty. And so on a lot of the 

[01:25:44] Adam King, CPhT, RPhT, PRS: projects that you get to work on are projects, which you actually have a vested interest in.

Yeah. Right. Our projects kind of take on and morph into what we plan on doing after graduation. Yeah. Right. But you have a lot more leeway too, so for example, I just had done writing, uh, doing a grant writing class. That was my second half of my second half of my semester, summer semester. Was grant writing.

And I wrote a grant for a nonprofit pharmacy in grand rapids. We got done to the end of the project. And she said, if you make a couple, a few tweaks to this, you actually probably have a grant that actually has a chance of getting funded. Hmm. If you work on a project that you're passionate about when you're, when you're writing it.

Yeah. Writing is a lot easier when you're writing in undergrad school. I took women in developing countries. I couldn't have given two craps about what anything I wrote in that class was about. 

[01:26:38] Mike Koelzer, Host: Yeah. I remember one time. I didn't, I can't say I necessarily ever cheated in college, but I had one time where I had to write about a concert.

I guess it was cheating. I had to write about a concert I went to and I didn't go. And so I had to, you know, make it up and I said, how the guy in front of me kept moving back and forth. So I couldn't get a good view of the stage and all that kind of stuff. Um, but it was. No, I, yeah, I shouldn't have, I shouldn't have done it, but that's water over the dam.

I, I, Hey, I'm gonna stick with ster and you stick with your $70,000 story. All right. Sounds good. So I'll leave. Hey Adam, great talking to 

[01:27:16] Adam King, CPhT, RPhT, PRS: you. Yeah. Talking to you, Mike. I 

[01:27:17] Mike Koelzer, Host: appreciate you have, yeah, my pleasure. Best wishes to you. I know people are gonna be inspired by what they hear. If they wanna reach out to you, what's the best way for them to get ahold of 

[01:27:26] Adam King, CPhT, RPhT, PRS: you.

So I have a website called my drug school.com, MYDRUMSCHOOl.com. Contact me. They can get ahold of me, goes to my personal email. That would be the easiest way to get ahold of me. If anyone's in an employer group and they want me. Lower their drug spend. Um, yeah. Health plan, advocate.com is where I work.

[01:27:46] Mike Koelzer, Host: So nice. Hey, save some, um, save some potato skins for me and I'll get down to the meeting one of these months. 

[01:27:53] Adam King, CPhT, RPhT, PRS: Absolutely. September 11th. They're having diabetes. Oh, all 

[01:27:56] Mike Koelzer, Host: right. September 11th. All right. I will write that down. Wait, is that one where you have to learn? No, I just want one where we're going to eat and eat and go over agendas that are like 10 years old that we don't change.

I don't that's the one I want to 

[01:28:12] Adam King, CPhT, RPhT, PRS: go with Lisa as board president. I don't know if there are going to be too many more of those, so, oh, geez. 

[01:28:18] Mike Koelzer, Host: Well I'm out then. all right, 

[01:28:20] Adam King, CPhT, RPhT, PRS: Adam, take care. Do thanks Mike.