Crafting a Lasting Legacy in Pharmacy | Gordon Vanscoy, PharmD, MBA Vanscoy Rare, RareMed Solutions

This transcript was generated automatically. Its accuracy may vary.

Mike Koelzer, Host: Gordon, for those that may not have come across you online, introduce yourself to our listeners.

Gordon Vanscoy | Vanscoy Rare: My name is Gordon Vanscoy. I am chairman and CEO of Vanscoy Rare Pharmacy. I am also chairman and CEO of RareMed Solutions. 

Mike Koelzer, Host: All right, Gordon. Last time we talked, had just retired Panther, I believe. And if I recall, when you went down to Florida you realized that everybody down there was old farts because they were all the retired ones. Do I have that right? I think I remember that. 

Gordon Vanscoy | Vanscoy Rare: Yeah, [00:02:00] it interestingly, I have been in Florida since 2007,

Kind of coming back and forth. But, you're right, I did retire for three months and found that it was quite boring

and, Got back into things because I found what my passion is

and my passion is putting teams together that deliver products and services in the healthcare industry.

Mike Koelzer, Host: And I recall, You had sold out of Panther and then you this new one, Rare Meds. Then I saw recently that you started the Vanscoy Rare. And I thought, Oh, here he goes again. He's supposed to be retired this time. And I was looking almost at a sellout from the rare meds, but I'm seeing that you're quite involved in both of them.

So. It seems like there has to be a difference between the two. And what is that difference?

Gordon Vanscoy | Vanscoy Rare: Yeah. [00:03:00] And it goes back to Panther. Divested a Panther. It went to an entity called Centene. And the intent was, Centene was a Fortune 20 company, and they were supposed to continue to foster the development of Panther. But their chairman and CEO was replaced. Their objective changed. So in 18 months , they divested a Panther again.

And in fact, that divestiture ended up benefiting them financially. We delivered on all of our promises, but it went to private equity. And so the sale to Centene and then the sale to private equity, and then when private equity acquired it, it's a different animal, than when it was, Handled by a strategic. So in that transition I saw our baby change in character [00:04:00] and my commitment was when we started RareMed and we continued to develop it, it wasn't to build it to sell it and that was even further, supported when we launched Vanscoy Rare

because it carries my name. I have no intention of selling that.

It's going to be a legacy company.

Mike Koelzer, Host: Okay. So is there something that Vanscoy is doing , Is there something maybe deeper 

Gordon Vanscoy | Vanscoy Rare: Yes, 

Mike Koelzer, Host: on this one or

Gordon Vanscoy | Vanscoy Rare: there is. And there's two things. One, when we put our name on Vance Goy Rare there's a couple things that transpired. One, I'm blessed to be able to be joined by both of my sons who work in the

company. 

Mike Koelzer, Host: right. 

Gordon Vanscoy | Vanscoy Rare: All of the original partners except one are part of Vance Goy Rare. Many of them are also part of RareMed, but it's this group of people that I just enjoy working with and enjoy [00:05:00] seeing success. So it does put on a different face on the organization. And in fact, it does change the character of. What we intend to do and our intent is to innovate. Our intent is to continually reinvest. Honestly, our intent is just to have a good time servicing patients.

Mike Koelzer, Host: But the difference is this another company just like, somebody might put out Coke and cherry Coke or is there a difference? 

Gordon Vanscoy | Vanscoy Rare: there's a difference. First of all, the difference is that RareMed is not a rare pharmacy. RareMed is a hub. It's called a patient services hub.

Mike Koelzer, Host: Yes.

Gordon Vanscoy | Vanscoy Rare: Now think about this. If a manufacturer has a relatively small population of patients that they want to limit distribution to, let's say, two to four specialty pharmacies.

[00:06:00] Well, they will contract with the patient services provider like RareMed that basically takes all the scripts in, triages them, qualifies patients financially, makes sure that they get on the product, and then transfers the product in a round robin style to the pharmacies.

Okay. 

And we, at RareMed, we provide free drugs, patient assistance programs, all of these ancillary services. that surround a specialty or rare pharmacy. Now Panskoi Rare is in fact a pure rare pharmacy.

 It primarily works on exclusive relationships with biotech companies that have orphan products. Sometimes it's with, we're one of two or one of three, you But it's fundamentally where we can provide most value. So it is very possible that a manufacturer, [00:07:00] if we're in a small network, will work with RareMed and Vanscoy Rare.

 And then what's the difference between Panther and Vanskoy Rare? 

Gordon Vanscoy | Vanscoy Rare: The difference between Panther and Vanscoy Rare is Panther right now is private equity owned,

Vanscoy Rare is independent and I can't speak for Panther, I love the Panther. The ladies and gentlemen over there do a wonderful job and there's plenty of opportunity for everybody. But Vanscoy Rare, we have been investing tons of money into technology and, we're going to have two locations, both Pittsburgh, as well as Orlando and we have the support of the folks who were part of the original organization who are now part of Rarement

And part of Pittsburgh.

Mike Koelzer, Host: Did rare med fill a hole that Panther didn't have what we're talking about? It was that kind of clearing house more. So that was quite a bit different from Panther. And now Panther [00:08:00] is not similar, but in the same category as Vanskoi.

Gordon Vanscoy | Vanscoy Rare: Correct.

Mike Koelzer, Host: Gotcha.

Gordon Vanscoy | Vanscoy Rare: Panther and Vanscoy are in similar categories. RareMed there were no rare patient hub entities. So that was a unique entity. And it was an interesting story because one of our partners at Panther who I just got off the phone with literally an hour ago basically we were one of the three rare pharmacies in the network and the CEO called me and he said, the weakest link in servicing our patients is our hub provider. And he said, if you would build something that had the same quality and technology, we would send all of our patients there. And in fact, that's how rare med was born.

Mike Koelzer, Host: Gotcha. All right. So when did it dawn on you to do this Vanscoy, Gordon? I know we talked [00:09:00] about your son's last time. Has this always sort of been in your back pocket or did something tickle you to do it?

Gordon Vanscoy | Vanscoy Rare: No. And if you think about it, Mike because I was under a non compete with Centene,

Okay, 

Now a second transaction to private equity we ended up negotiating our release from a non compete, thus opening the window, the opportunity. And then, it was our partners for RareMed who basically said, the market is changing dramatically. Rare Pharmacy just isn't like when you started Panther. And there's a couple things that they said were changing. One, these entities that have, this big financial backing, their intent is to get a 3x or 5x times their money in three to five

years. So, It's not goodwill.

[00:10:00] all about making money. And their intent would be, they put window dressing in, they put financial controls, They load up the pipeline with a bunch of work and then basically flip the company again. But it changes the character of the company. It changes the focus of the company many times from that being focused to the patient and employee to that of the bottom line. And a lot of people don't care for that. And the culture gets really significantly affected. As a matter of fact, there was an article published last year in Harvard Business Review of the impact of private equity on healthcare companies and the mission changes.

We have at least six entities out there now that call themselves independent, which are really private equity backed independents.

Some of them do a really good job. Some of them You know, are really focusing on the financials. But if you look at this cadre, there's room for somebody who's not [00:11:00] interested in just making money. That's what Vanscoy Rare is all about.

Mike Koelzer, Host: If you had to, Gordon, let's say you now versus, and we'll leave Panther out of the picture, but let's say that right now somebody figuratively held a gun to you and said, you've got to either now or in a year or two, whatever, you got to go up three times or five times versus if you were private equity coming into Vanscoy.

 What kind of things would you absolutely not do owning Vanscoy that a private equity coming in might do and do any of those overlap if you had to increase that fast or are some of them are like oh we didn't plan that but I guess we'll do it versus no you would never do that in an active company that you planned on holding on to

Gordon Vanscoy | Vanscoy Rare: Two things. One, I would never unleash uncontrolled [00:12:00] growth. The number one killer of culture, the number one

killer Of relationships. Because what happens is you end up with so many partnerships, that the quality goes down, and your reputation is lost. Because you end up with not enough employees, not enough qualified employees, and not enough People doing the work.

So, that's number one. And number two is, remember, the money is going to the bottom line. So in private equity, so your goal here, my goal in independence is quite frankly, innovation. So, we've got over 30 programmers on staff. Constantly creating code to differentiate our product, make it easier for patients, make it easier for physicians offices and nurses and really to try to link all these entities together so that patients get on and stay on drugs that [00:13:00] can save their lives.

Mike Koelzer, Host: You talked about the non compete. Is it common for a non compete to get renegotiated when a second or a different investor comes in or is that all across the board? I mean, I imagine your non-compete is not only there with the original investor. How does that work out in your case where you had other people come into Panther to buy them and so on?

Gordon Vanscoy | Vanscoy Rare: Yeah, some of this I'm not at liberty

to discuss, but it, But I'll tell you in general in the market, it's all over the

board. 

 Sometimes it's part of an interwoven agreement.

Sometimes company A doesn't care company B does

because it was just part of the deal,

But fundamentally, I know we were, we had a really good relationship with Centene and we exceeded their expectations on a sale, that company sold for well over double of what they paid for it when we sold it to them. [00:14:00] So they were happy and we had a good relationship. So they were very integritous and allowed us to do what we do.

Mike Koelzer, Host: Have you ever heard stories, not in your case, have you ever heard stories of non-competes that somebody didn't plan well enough? Like they thought they were protected, but the man or woman got out and did something that they just didn't cover it in the contract.

Gordon Vanscoy | Vanscoy Rare: Yeah it's one where we firmly believe in honoring whatever we sign and two, ensuring. that the lawyers that we get to write that legalese , it is as black and white that you are released, that you will possibly

find. There is no discretion whatsoever. And, it's interesting because time transpires also, and, it's [00:15:00] been a while.

I think we, we sold the company, four years

ago now. So, time would have been ticking anyway. But it's a circumstance where, as you're aware, the FTC is now looking at non-competes.

Mike Koelzer, Host: to ask you that. Yeah. Gotcha.

Gordon Vanscoy | Vanscoy Rare: Yeah. And non competes, our understanding, this is all taking place, I believe it's in August or September, still can be, held up for the senior most executives or somebody that has a stake in the

game, but it's just been abused before when the rank and file sign these intimidating documents. They're threatened and in fact now they may be unenforceable.

Mike Koelzer, Host: Yeah, and let's see, the non compete would, I'm trying to think. Well, most of those are signed at the time of gaining employment for some people. And 

Gordon Vanscoy | Vanscoy Rare: Right, 

Mike Koelzer, Host: holding a signing bonus and someone's future in front of them, and they think [00:16:00] everything is copacetic and this and that they're not reading that as closely as they could or should when the time comes in 

Gordon Vanscoy | Vanscoy Rare: right, right. And I think what the courts are looking at right now is the value of it. Because for you to be excluded from an opportunity like that, you've got to receive value back from a company.

Okay, so, it's not just a threat, it's got to be, oh, we're going to give you options or stock or a significant role, and it's got to be a senior enough role in the company in order to be enforceable.

So, again, there's going to be a lot of people that have found independence. We believe that's going to occur this fall.

Mike Koelzer, Host: a lot of times companies. Probably just do it customary when people just get a job, like 

Gordon Vanscoy | Vanscoy Rare: Right,

Mike Koelzer, Host: in, and in those cases, no benefit to the person they haven't gotten anything in, [00:17:00] of that or higher than 

Gordon Vanscoy | Vanscoy Rare: right. it's something that kind of got out of control that I think they're trying to reel back in.

Mike Koelzer, Host: And a non compete that has nothing to do with corporate secrets. I mean, that's a whole different beast. 

Gordon Vanscoy | Vanscoy Rare: Yes, yeah, that's non disclosure. typically you'll see non compete, non solicit non disclosure. So, the intent is, you're not going to disclose any secrets. Basically, you shouldn't be doing that, period. Non solicit, there's two parts to that. Officially going in and trying to raid employees. Then there's the integrity of having relationships with people and coexisting with other entities. So, we've been in this business for a long time. And if somebody wants to come and work with us we would love to have you.

But I'm not going to go for something that's going to get everybody in trouble. 

Mike Koelzer, Host: Gordon, Vanscoy Rare, how long has that been in business?

Gordon Vanscoy | Vanscoy Rare: Yeah, 2023, end of [00:18:00] 23, it launched. We are licensed in Pennsylvania. We will be 50 states licensed within the next 45 days.

Mike, I think I may have mentioned this the last time I was on. With Panther, we were dual accredited. We will be dual accredited also in that same time period. In fact, we, myself and many of the members of my team worked with URAC and ACHC and wrote those rare pharmacy accreditation standards for them.

Mike Koelzer, Host: Refresh me 

on that. What, 

What's dual accredited again? 

Gordon Vanscoy | Vanscoy Rare: There's two entities, primarily URAC and ACHC. that set standards

for your policies, your procedures, your operating processes. And in fact, they sought us out probably six years ago to write them in Rare Pharmacy. So that somebody could have that distinction of being in an accredited rare pharmacy. And we will have that also. So the three [00:19:00] things you need are licensure, you need accreditation because many of the PDMs require accreditation now, in order for you to get reimbursed. And the third thing is, payers. You need payer contracts . And so, once you have those components going, then you basically can say you're open for business.

Mike Koelzer, Host: And what does getting licensing in all the States entail? I know this sounds too simple, but a pharmacist in your organization has to pass the boards there, or is it your company that gets licensed?

What is that?

Gordon Vanscoy | Vanscoy Rare: Yeah, one of your pharmacists has to. Every state's very different, but some states you have to literally fly there and take aboard.

Mike Koelzer, Host: somebody that works for your company. And absolutely. a, not one of the owners or anything.

Gordon Vanscoy | Vanscoy Rare: No it can be any pharmacist, but for that state, they're the PIP. the

pharmacist in charge. So they would be the entity. And, we always have [00:20:00] redundancy. So let's say that employee. Or that owner or whatever, something happens, then you always have to have somebody else to step in just in case something happens. 

Mike Koelzer, Host: So how many pharmacists do you spread that out over? 

Gordon Vanscoy | Vanscoy Rare: Typically about 12.

We try to have half of them being owners and half being Just pharmacist employees.

It's always good to have owners because they have skin in the game.

They're typically not going anywhere. And, you want pharmacists, people who aren't owners to keep an eye on the shop too. Because sometimes they're

a little more, I hate to say it, even diligent. More diligent.

Mike Koelzer, Host: Yeah. Right. Right. And sometimes Not that you need it at all, but if you've got to present yourself, I imagine to a board or something like that, there's 

Gordon Vanscoy | Vanscoy Rare: Yeah. 

Mike Koelzer, Host: To say, look, this person is part owner and they really care, but it's also good to say, look, we've got eyes that couldn't care less. They're not going to 

Gordon Vanscoy | Vanscoy Rare: [00:21:00] Yep. 

Mike Koelzer, Host: along with something just to go along with it.

And so it's probably good to show both of those.

Gordon Vanscoy | Vanscoy Rare: Yes, absolutely.

Mike Koelzer, Host: All right. So Gordon What's the size about how many employees and how roughly are they divided? We have so many pharmacists, so many programmers and so on. Oh,

Gordon Vanscoy | Vanscoy Rare: actually in a separate company called Rare Path. And Rare Path is a company that started that supports both Rare Med and Vanscoy Rare. So we've got this technology entity that supports both, they're just shy right now of 30 employees in Vanscoy.

Rare, we're right at 12 pharmacists. The rest are our technical or administrative support people on the pharma, on the rare side. And if you contrast that entity that's growing, we already have two signed exclusive agreements that'll launch at the very beginning of [00:22:00] 2025, end of 24. So those are inked. So, that will begin the process from now until then, we'll be recruiting and adding people. But if you contrast that organization to RareMed right now, RareMed has almost 800 employees right now.

Mike Koelzer, Host: wow. And The real person in charge of that? I'm 

Gordon Vanscoy | Vanscoy Rare: that yeah, no, that, 

Mike Koelzer, Host: sons and so on, and sometimes there's, names and 

Gordon Vanscoy | Vanscoy Rare: no, It's Doug Gephardt Doug, he used to be a student of mine. All these guys 

Mike Koelzer, Host: was Doug the one that came to you and encouraged you to. I think a group of your students they had done well on a project with you and they're like, 

Gordon Vanscoy | Vanscoy Rare: Yeah, yeah,

Mike Koelzer, Host: this. 

Gordon Vanscoy | Vanscoy Rare: yeah. Doug was not part of that original group. That original group was Tim Davis, Rob Snyder, and Patrick Pugliese.

So those three entities, they were students and they wanted me to get back into specialty pharmacy, which ultimately led [00:23:00] into the launch of Panther Rare. But then Doug was a classmate of Rob

Snyder's. 

Doug went to work for CVS in Woonsocket. And he went to work with Larry Merlot and that group. And I was trying for years to get him to come back. Doug ultimately came back and started at Panther Rare for a while, ran operations, and then I never had a president of any of my organizations.

I always served in that capacity also, but Doug so impressed me that I actually offered him the opportunity to be the president of RareMed and that's what he is now, so he's running that organization.

Yeah I'm the one who's leading Vanscoy right now but also Justin Smarker. Justin came over from, again, a former student who went Panther, used to be a fellow, actually a Master's student, Master's of Pharmacy Business Administration at Pitt. Then he went to Panther, [00:24:00] then he went to RareMed, and now he's the lead person at Vanscoy Rare.

Mike Koelzer, Host: That's really remarkable that your students, I mean, I've talked to a lot of people now and I've never, either it hasn't come up or we've never talked a lot about it of students or mentees, I guess you would call them, that have been that involved in the of, in being active in businesses and something like that.

That's a really remarkable story.

Gordon Vanscoy | Vanscoy Rare: Yeah, I started at Pitt in 1986 And was with him a very long time. And they, it's kind of like the secret sauce, Mike, quite honestly, you get to see, a hundred to 120 of these students every year,

There's going to be a handful, a few, who are going to be these rare birds who are entrepreneurs. And, they're the ones who will work their tail off. They're going to be successful no matter what. And honestly, that's what I surrounded myself with [00:25:00] by these talented individuals who just needed somebody to support them and work with them. And that's what happened with my organization.

And, many of them are still with me today.

Mike Koelzer, Host: Because what was your role at Pitt again?

Gordon Vanscoy | Vanscoy Rare: I was associate dean for business innovation towards the end, probably the last. I ran their Masters of Pharmacy Business Administration. It was a joint program between the business school and the pharmacy school.

Mike Koelzer, Host: What is your take Gordon on because once in a while, see people complaining on LinkedIn about pharmacies not having enough business training. Sometimes they 

Gordon Vanscoy | Vanscoy Rare: Mm hmm.

Mike Koelzer, Host: world to show what sometimes the unfortunate demise is of some people that go 

Gordon Vanscoy | Vanscoy Rare: Right. 

Mike Koelzer, Host: stores or Areas and they haven't been taught the reality of what's out there, but also I think business [00:26:00] as in administration, entrepreneurship and things like that.

And I'm always sort of interested in saying, Oh, well, boy, the podcast, I'd like to get in front of a lot of these and stuff. And even some interaction with these students and things like that would be fun. But hearing your stuff about 

the business 

interaction at Pitt, would you guys put yourself above the rest, far above the rest, or are you one in the same? I think that's a little bit of an from what I've heard with other schools.

Gordon Vanscoy | Vanscoy Rare: Yeah, it's, the one thing about this program, it's not only the combination of the skills of the business school and the pharmacy school, but it's quite frankly the successful alumni have graduated from the school that are out in the world Business and practice, folks like Larry Merlot, who was CEO of CVS.

He was part of this program. [00:27:00] Cronus Manolis, who is at UPMC. I could go on and on Rich Krasinski. There are probably a dozen or two dozen nationally or internationally recognized business people that have come through the program. And here, that, that's the crown jewel, is when you can get talent like that, that is willing to give back to the students willing to enrich, that's the secret sauce.

It's not the academics. Academics you can get online. The accounting et cetera. And which we're still suffering in, okay? The next level is making connections and having relationships with people that can help your career. And that's what we created. 

Mike Koelzer, Host: What's the chicken and the egg on that? I mean, we're the first of the Pitt schools to have these successful business people. Was that by dumb chance that some of these skilled people went through Pitt and then got to be in this position? Was [00:28:00] the leader of the early program that taught some of these people these skills? What was the genesis of that? If there was no mentors to look back at

Gordon Vanscoy | Vanscoy Rare: Yeah, the mentors came on their own, quite frankly. These were self made business and entrepreneur people

Mike Koelzer, Host: out of pit, who looked back at it? I 

Gordon Vanscoy | Vanscoy Rare: And unfortunately, the schools and universities look at them for, financial donations

only. And that, it's just short sighted because their talent is really inspiring the next generation.

Mike Koelzer, Host: And then would you say that let's say some of the students that came up through you or with you, not with you, but kind of under you, whatever. Did some of them go there because they knew that 

Gordon Vanscoy | Vanscoy Rare: Yes. 

Mike Koelzer, Host: That, and if they had an entrepreneurial spirit, maybe among all the pharmacy schools, they said, this place has some shining stars.

And so let's go through their 

Gordon Vanscoy | Vanscoy Rare: Yeah, it's [00:29:00] not like a Harvard MBA where it's the sheepskin that you're going to put up on the wall. It's all about making connections and developing relationships. And that's why they would come to Pitt.

Because they knew that they had the opportunity to interact with these people. And in fact, that's how Doug Gephardt ended up at CVS. I had brought in Larry to teach a class. Larry met Doug, gave Doug an opportunity to interview at CVS, and he ended up at home office.

Mike Koelzer, Host: All right. Now, I'm not saying this doesn't happen, but when I think about it. 18 year old kid, 20 year old kid. So they're looking at different pharmacy schools. There's something inside of them, or maybe it's marketed this Like, Hey, we can give you one more step or our kids that age, do they have the wherewithal to look and think they want to go to a school with successful business people afterwards?

It never crossed my mind when I chose a [00:30:00] school. 

Gordon Vanscoy | Vanscoy Rare: I don't think they enter pharmacy school. With the intent of going into business, I think they enter and then they're searching for what they want to do.

Okay. And, we do give them tracks within the school. One of them is a business track

And that's where they can explore. Whether they want to do this stuff. I mean, I can't, my original career when I first started, I was a clinician. I did residency training 

 But, my dad was an entrepreneur, really just worked in the mill his entire life, but ran a business on the side, little business. And it takes people like that who are inspired by wanting to do something different. And that's what we look for in these types of people.

 If you were in charge of the United States college curriculum and so on I kind of always say what I think should happen in colleges as far as timing of [00:31:00] years and things like that. Would you change anything? Would you force anything in colleges?

Mike Koelzer, Host: Or do you think it's, people, some might want to be more clinical and this and that. And so don't force business, what do you want to call it? Exposure.

Gordon Vanscoy | Vanscoy Rare: Yeah. I agree with you. And that's what we're calling in education, personalized education. Now, you gotta be able to pass the board. That's just your first threshold, but not everyone's going to be a business person. Not everyone's going to be a clinician, not everyone's going to be a researcher. You want to give people the opportunity to do What they will accelerate at

and I do think that there is a basic understanding like for example any Pharmacist should understand personal finance Regardless, I mean you should understand You know how to look at an insurance plan a final, 401k, retirement planning, a balance sheet, these things should just be common knowledge [00:32:00] and we're still missing even those things. 

Mike Koelzer, Host: Gordon, what's your thought on, not so much the curriculum, but what's your thought on the pharmacy colleges as far as you hear about Some of them not requiring a test.

I think that's maybe to let more people in. And what did I see? I saw something that said back in my day, like 20 percent of the enrollees got in and now it's like 80 or 90 or something like 

Gordon Vanscoy | Vanscoy Rare: Yeah. 

Mike Koelzer, Host: on all that? 

Gordon Vanscoy | Vanscoy Rare: Unfortunately what we have in pharmacy is the exact same thing that's happened in many disciplines,

Including law, et cetera.

 Had a proliferation. of pharmacy schools to the point where supply exceeds demand. And all of these pharmacy schools are pumping out countless pharmacists and the pharmacists I, many times I believe that their experience [00:33:00] is diluted from what it was. But at the same time, pharmacies change. If you think

About it, Many of our colleagues used to go into community pharmacy and were like the local PCP at one time and had to take care of an entire family or families. Now, the majority are employees. Just like in medicine, right? So, you go in and you do your job and you've seen people just getting hammered with in terms of productivity and efficiency and getting burnt out and suing the companies. So I think what we've got is too many pharmacists. It's really held down the pay scale. It's their ability to expand their roles because there's not only so many of them, but their educational base is much more diluted. And then you end up today where people. You know, there are pharmacists out of work or have to relocate to find a [00:34:00] job. The stagnation in salary has been tremendous over the last 10 to 15 years. It hasn't grown at all. And it's just a function of supply and demand. Yeah.

Mike Koelzer, Host: I go to some of these Colleges now with some of my kids as they're picking colleges and so on and they usually start in town and community college for a Couple years, but afterwards we go to them and One of the first things they do is bring you through their new field house and you see all these new buildings and so on What is your?

Especially after we went through COVID with all of the online stuff. And now you're hearing about things like. Google having six month degrees, in certain things. What is your take on that? And I have no idea about this stuff, but you know, the, all the big brick buildings you see at all these colleges and, just building after building and my dad used to always he would go by churches and he would say, you don't need to build a [00:35:00] church.

To use it one hour every Sunday. My dad 

was like, 

put it in the community center or do this or that. I don't know why that was his beef, but what do you think about it? Physical college versus what's going to happen with all the online stuff. And you hear about, like a lot of things, but college, you look at the graphs and you look at income versus college costs.

And it's like four times inflation or something like that. Where's that all going to go?

Gordon Vanscoy | Vanscoy Rare: Yeah. I think educational will, will still be one of the most valued attributes for somebody to attain. The question is the manner. And I think COVID has taught us that it can be done virtually.

And, we've seen it in our secondary education. However, there is value in personal, one on one and interacting with people. Healthcare, even though we have telemedicine, you still, to get, receive healthcare, it has to be [00:36:00] from, with somebody. So there's gotta be a component of that. And I think it's interesting, even office buildings, And universities, I think, will change as they're redesigned. For example, we just moved into our new office building. God, when was it? Probably seven months ago. And we're able to host, you know, 800 people in an area that probably we could only host 100 people or 125 people before because no one really has a permanent office anymore. It's all hotel space. It's all working between virtual and coming in and having more conference space and so the whole dynamic of how that is, is changing. I think the same thing is to be said for education. I think buildings will change. I know Pitt just opened up their new school pharmacy. Again, about a year ago, it was being built during COVID and it's a different organization. It's not [00:37:00] as office based. It's not 100 percent you have to be in this type of situation. So I think as time goes on, you're going to see a hybrid. And I think that, when the pendulum stops swinging in the other direction, there's got to be personal interaction because healthcare has to be personal.

Mike Koelzer, Host: Yeah, that's true. Whenever you talk about telemedicine and all that stuff, I'm a big advocate of that. I think

Gordon Vanscoy | Vanscoy Rare: yeah, sit with someone online in private for 10 minutes, whether it be a doctor or a pharmacist, then be in a, Potential store with someone screaming at somebody and all the stuff you get in person.

Mike Koelzer, Host: I think there's a big value in that. But with that said, healthcare is one of the fields, unlike maybe selling books or records or tools, healthcare is still a place that needs a lot of humans, touching humans and seeing what their gate is and all that kind of stuff, which a lot of that you just don't get as easily online.

Gordon Vanscoy | Vanscoy Rare: Hey Mike you had mentioned something earlier [00:38:00] about what, and I don't want to digress, but I

I don't want you to miss this because it just went out on social media today. You were asking what makes Vanscoy Rare different. And, this is something that hits home very hard. In February of this year I was diagnosed with a rare disorder that really kind of not only shocked me, but shocked my family. It was a circumstance, actually a carryover from COVID some nine months prior to that. And in fact, if it wasn't probably for the manifestation after COVID there could have been very serious consequences because things would have gone undiagnosed, but it was February 14th.

I'll remember today that I was diagnosed. And fast forward June 15th I went back to Pittsburgh for a procedure which completed my treatment. And in fact, I'm, [00:39:00] delighted to say that today I sit here disease free as healthy as can be, and with a renewed lease on life. But what it did do is it caused me to go through everything my patients go through.

From symptomatology, looking for a diagnosis, going to centers of excellence, being misdiagnosed, being appropriately diagnosed going through Batteries of testing and genetic testing and getting insurance claims denied and having to get prior authorizations for medications and going to treatment centers and going to going to surgery and dealing with that circumstance and being discharged and dealing with case managers . Nothing sensitizes you to your patient's plate. Like being one of them. And

in fact, Fortunately [00:40:00] I came out the other end, but keep in mind, this is all during the building of Vanskoye Rare

and it was all about turning a serious health situation into a blessing.

And, like I said today,

I'm, I couldn't be happier than I am and healthier.

Thank you. 

Mike Koelzer, Host: Gordon, where would you have been 10 years ago with this same diagnosis?

Gordon Vanscoy | Vanscoy Rare: It would have been very challenging,

Healthcare has changed so much. genetic testing, targeting genetic markers the, half of the drugs that are in the FDA pipeline are targeted towards orphan conditions, rare conditions, and it's all because of financial support for these small companies to do this research. But remember, It wasn't until really 2015, 10 years ago, that we started seeing the [00:41:00] onslaught of these newer, more advanced products.

They're not cheap. It's funny. I go in and I speak as a patient, I'm talking to a counselor and they're telling me the price of these drugs.

And, as a patient, you're like, I know it on the provider's side, but as a patient, you're like, it's just amazing. But on the other hand they do have financial support situations if your insurance doesn't pay for it. And, fortunately, it all worked out. And that's, that's one of the things today that changed Vanscoy Rare

is where we lived it.

Mike Koelzer, Host: Well, congratulations. I'm glad everything went well. Did you ever feel disrespected through that process when. Maybe people didn't know who you were, or they didn't know what insurance you had, or they thought, well, like me, they just thought, oh, Mike's an old guy kind of thing.

Did you ever get disrespected in that time when you thought that you were sort of a cow in the, [00:42:00] herd?

Gordon Vanscoy | Vanscoy Rare: No question.

Mike Koelzer, Host: You 

Gordon Vanscoy | Vanscoy Rare: Absolutely no question. Oh, absolutely.

 I experienced it. I will say this, I sought out an institution that really prioritized my health. But it took a lot of effort. And in fact, I went to one treatment center. I swear to God, Mike, it was like going into a beauty salon or a nail center where people were lined up. There were like 30 people in this tiny little room and there was absolutely no respect for privacy. There was absolutely, you weren't allowed to have a loved one with you. So it was. dehumanizing,

And very disrespectful and just some of the craziness aside from that situation when it comes to insurance. The night before I had surgery, the night before, I got a call from my insurance company [00:43:00] telling me that instead of going to the institution that I was going to have surgery where I was going to have a PET CT that if I went across town. I could get it done for less money and I said, you, you don't understand I'm having surgery in the morning. And I said, unless I'm in a hospital gown to save a hundred dollars, I'm not, or whatever was I said, this call makes no sense. But it, it they take these financial situations, they make them processes, and they take the human out of it they don't think and it's absolutely frustrating, and when you get denials for things that just don't make any sense And the effort you have to go to try to get it reversed is just amazing.

And you know, the healthcare world, I know [00:44:00] the healthcare world a bit. Imagine the poor people who really don't know and don't know how or where

or when to persevere. 

They

go bankrupt.

Mike Koelzer, Host: oh, I had to get some medicine, I think for a migraine or something I had years ago. I used to get headaches more and I got a rejection back. It said, denied. I thought, well, okay, I guess I don't get this headache medicine. Like a month later, I go to the doctor's office and they're like, well, Did you start this?

No, it was denied. I'm in the business. They're like,

Gordon Vanscoy | Vanscoy Rare: Yeah.

Mike Koelzer, Host: But did you get a second and a third denial? That's what you have to get. I Didn't know that and I'm in the 

Gordon Vanscoy | Vanscoy Rare: Yeah.

Yeah.

Mike Koelzer, Host: Gordon what was the most difficult emotion to deal with while you had this challenge?

Was it anxiety, depression, anger? What was the most difficult emotion?

Gordon Vanscoy | Vanscoy Rare: It was related to the unknown [00:45:00] dealing with the unknown. I'm the type of person that if I, regardless of what it is, if I understand what my options are, I can manage that a little better. These Patients are dealing with this black box in front of them without understanding, what is my future?

What are my choices? How is this going to impact my family? And I agree that it creates a cadre of emotions. Including anything from anxiety to feeling like you're, you lack control of your life . I would say it's the fear of the unknown, because as time progressed and things became clearer as you got more and more information regardless of whether it was good or bad, because I'm telling you that probably the 70 percent of that journey I got bad news around every [00:46:00] corner. At least it allowed me to figure out what my next step would be in order to try to address it. When people go to the hospital, and this is what I really empathize with, and they can't get a CT for three months, or you can't get in to see a specialist for six months or a year, that is living hell.

Mike Koelzer, Host: Absolutely. Absolutely. have a lot of things going on. You have the unknown, you have a clock ticking, you got a lot of stuff 

Gordon Vanscoy | Vanscoy Rare: Yep, Absolutely.

Mike Koelzer, Host: And here's the part I hate about all this, Gordon, and it's the same, I guess, with going to a funeral home after your loved one died to figure stuff out. It's like, hard enough to deal with insurance companies and things when you're at the top of your game you're pissed about something and that's all that you're dealing with is just being pissed at the insurance company whatever.

But to go through that [00:47:00] at your lowest, And have to make sense out of it. You're dealing with emotions you maybe had never felt before at that level. And now you have to deal with someone. And it's like, every time you turn around their simple no might feel like a sentence to somebody. And it's.

Well, back to the company , glad you went through this, but what a gift, as you're saying to your company, what specific things did you learn from this besides just being empathetic? Are there any specific things you learned from this that you might change at your company or think, let's do this?

Institute this because of what you went through.

Gordon Vanscoy | Vanscoy Rare: Yeah, it's all about when you make decisions it's gotta be for the patient. Involve the family, because the family [00:48:00] becomes you know, the person the person is just one victim. in this scenario because the whole family is devastated.

Mike Koelzer, Host: sometimes it's even harder for the person looking in as you and I know, you'd almost rather 

Gordon Vanscoy | Vanscoy Rare: absolutely. 

Mike Koelzer, Host: Then watch your child have a broken arm.

Gordon Vanscoy | Vanscoy Rare: Absolutely. So, I think the things that we will reinforce and continue to focus on is, one, ensuring that every patient has the opportunity, if we're the one providing the drug or the care, that there are no barriers between us and that patient. And that includes going to organizations to find financial support for them. Because it's not just the drug company or the insurance company. You have these foundations that you can tap.

We will do everything possible in order to do that. And I'm proud to say that to date, we've never had a situation where a patient [00:49:00] wasn't served, but we. We're fully aware of patients that they hear the price, they quit calling back or we can't reach them. We will be diligent to make sure that we are doing everything possible to get them on drug and to keep them on drug. Because the second thing that happened that I learned about this is You know, all these wonderful drugs, they all cause side effects. And even these incredible

genetic, you know, I ended up with one that was a real circumstance, but it was a choice of either continuing on it or dealing with a nasty side effect.

And I decided to do the latter, where some people may not have done that and the outcome may not have been the same. So none of them come without risk.

Mike Koelzer, Host: And especially if you have a side effect and you don't know what's going to be for the rest of your life, or it's going to be for a week, those are important conversations to know how long you have to put up with something.

Gordon Vanscoy | Vanscoy Rare: [00:50:00] And that's where pharmacists can come into play, because you go on the internet, you'll find every answer possible.

but even I, at that time, had a natural reaction. You go online,

 You just start searching,

 You'll go to a, you But how many of our patients go to sites and get dissuaded or are misinformed and that's one of the commitments that need to make is not only get them on and keep them on, but keep them informed appropriately.

Mike Koelzer, Host: I had a couple times with my own family. I don't say who it was, but Person was like over there for like a tear in their eye. I'm like, what's going on? They said, I think I'm dying. It's like, what do you mean you're 

Gordon Vanscoy | Vanscoy Rare: Yeah. 

Mike Koelzer, Host: Well, I read these four symptoms. I'm like, you're not dying. I see that every day,

of course they're not going to ask me cause I'm just an old dad.

I don't know what's Yeah,

Gordon Vanscoy | Vanscoy Rare: yeah.

Mike Koelzer, Host: Boy that's really something. That's really something. Going for you to go through that like that and have that as your company all right, I got to ask you now that we're [00:51:00] talking about Nasty diseases and stuff it'd be a good time to bring up the PBM topic again So, 

Gordon Vanscoy | Vanscoy Rare: yeah. 

Mike Koelzer, Host: me, Gordon.

What's your relationship with the PBMs? Do you deal with them? Are they a pain in the ass? Is it easier? Is it harder than average? What's your relationship with them? 

Gordon Vanscoy | Vanscoy Rare: They're unfortunately a necessary evil for us to deal with.

They're a business.

They aren't necessarily a transparent business.

They really honestly and truly do not have the patient's best interest in mind in most of the circumstances that we deal with. However, I will say this, there hasn't been a single circumstance where we haven't been able to work with them in these rare conditions to get a patient on drugs. I think the risk to them is too high. Would be too much of a public [00:52:00] scenario if they denied somebody appropriate care. So, we've been able to coexist. We are clients of theirs, because they reimburse us. I will tell you this, it's that segment of our business that continues to get more and more challenging.

Yeah.

Yeah, 

Mike Koelzer, Host: Believe it or not, even though I've worked with these guys for PBM since the early eighties and deal with it here. It seems like I'm just starting to realize who pays whom, you know what I mean? It's so damn cloudy, really no sweat off their back because if they cover something, it's really the plan sponsor or the corporation that is hiring the PBM they're buying it.

The PBM is not paying for it. So it seems like. As long as they get the go ahead from the corporation, I'm just going to Nike or something like that, that they're okay with, am I missing in that equation and maybe it's a reimbursement thing. What am I [00:53:00] missing in that equation where the PBM is a rat's ass about giving it or not.

And in other words, they'd give it no problem because someone else is paying for it.

Gordon Vanscoy | Vanscoy Rare: it depends on how the risk is set up, how much it goes to the employer or the insurance company. So when it comes to drugs even though we have to negotiate with the PBM a rate PBM, the one thing that they don't disclose is they make a margin on every drug. We dispense a significant margin. It's margin that they keep, it's not margin that goes back to the insurance company or to whomever. Their goal is to keep prices, to keep providers like us in check in terms of what we get paid, but still maintain.

Mike Koelzer, Host: So it's not so much. The PBMs care how many of these really expensive drugs [00:54:00] go out. It's more about, are they making the right margin on it? So it's not like the PBM is going to say, no, this dying child can't have this rare medicine because they're going to get paid somewhat either way.

It seems more like. company that might have to be the bad guy in this, but the PBMs aren't really the ones that say yes or no. Is that right? 

Gordon Vanscoy | Vanscoy Rare: Yeah, almost all situations require prior authorization.

So they're going to make us go through hoops and justify why we're doing, why we're putting this patient on drugs. But beyond that You have to be within the network. You have to accept their rates sometimes their rates, if you're not significant enough, they'll just like brand product at a retail store, you're

going to lose money every time you dispense

something. And that's what kind of their situation is for some [00:55:00] entities . But, their whole. to the rest of the world PBM saved the world money by negotiating contracts for you. But when you look at what they reimburse and what they charge the insurance company, there's a difference between the two. And you just have to be aware of that and aware of the fact that You know what? My goal here is to try to get the best I can. You have to know what the industry standards are and you're unlikely to get more. If you're not careful, you'll get less. So you just have to stay in business in order to survive for tomorrow.

Mike Koelzer, Host: It seems like once a company has, I don't know a better way to say it, stock or an outside ownership or something like that, it seems like some of the internal moral Decisions go away.

Like I've heard it said, everybody in the company is good. It's just that it's hard [00:56:00] to change, hard to turn the Titanic and things like that. And people have said, if you talk to the average PBM person, they all are good people. And it's just the corporation that's going in a certain direction, and they're not going to agree they're bad anyways, but if you had a company that was a bad company.

You can't always say everybody's in it good, but it's going the wrong direction. Someone, it seems, has to take responsibility for that. But I know what they mean. I mean, in my company, I feel like it's easier for me to go down three levels and tell, I try not to do it too much, but tell this person to tell this person, to tell this person, to tell the customer this than me going out myself and 

Gordon Vanscoy | Vanscoy Rare: uh,

Mike Koelzer, Host: it's just a further thing, but it just seems like.

It seems like there's a divide between what an individual might feel in a company versus the corporation. And it seems like a cop out a lot of times.

Gordon Vanscoy | Vanscoy Rare: yeah, and it's why I've never been part personally of [00:57:00] a larger corporation. Some people thrive, they enjoy managing the bureaucracy, let's put it that way. It's kind of like functioning in academia, quite frankly, because very little gets done. It's kind of amazing. But in my company 

Mike Koelzer, Host: Things don't get done at colleges. Is that what you're saying?

Gordon Vanscoy | Vanscoy Rare: yeah.

I mean, everything's done by committee. Um, It's just a very bureaucratic environment. But in my company my friends call me a benevolent dictator at times because I try to make decisions . That's the one thing I will do is make decisions. But I make decisions that are. In the best interest of the company, and not just the company, but of the workforce, of our patients, of our partners. [00:58:00] And I don't think big companies are used to the nimbleness that occurs from entities like Vanscoy Rare

 I mean, we can turn on a dime. it's not a function of excuses. Accountability stops. One place and it stops with me if one of my employees do something I remember once when I was a panther and there was a product that was hundreds of thousands of dollars inadvertently thrown out

One box

 it was in short supply to Made it even more stickier, I'm the one on the phone with the manufacturer apologizing, explaining what

happened, explaining why it wouldn't happen again, and I'm the one who basically said, this is going to come out of

the owners and That's it. Did we fire the person? Absolutely not. The

person, It was the first mistake they had made.

But when people realized that this little box or this, whatever

[00:59:00] they had such a magnitude, suddenly they became aware again and we never had it happen again. 

Mike Koelzer, Host: think back to my dad, this is when the I guess when we even saw salespeople, either of the wholesaler or of

Gordon Vanscoy | Vanscoy Rare: Yeah.

Well, 

Mike Koelzer, Host: that would tell me things and I think part of them were jokes, but had a bottle of let's say brand name augmentin or something like that they mixed by mistake And now it's you know, 18 days old and he would say the sales guy came in He would say yeah The customer returned this.

They said they saw a spider leg in it, and the guy would jump over the counter to grab it out of his hands, before he did it. And I don't know if that was true or not. Gordon, what in your company now, don't give me solid numbers and don't give me mission statements. What metrics are good for you?

Is it getting new, Manufacturers who choose you to do this or what kind of things are your sales people promoting [01:00:00] your business and what means success for you? Who's the customer I guess 

Gordon Vanscoy | Vanscoy Rare: our motive is if you have happy patients , that is promoted by great employees. And to have great employees in a great culture, you need to have a robust enough business to keep them motivated and engaged. engaged through good partnerships. Okay, so that's it. So, think about it on Vanscoy Rare, our partner, our client is twofold. One is the biopharma who gives us the opportunity for exclusive or semi exclusive relationships. So where we can get the drug and the other partner is going to be, the other customer will be. The insurance company who pays us ,

So the patient is indirect in all this But paramount,

Mike Koelzer, Host: [01:01:00] Gotcha, that's on the Vanscoy Rare.

Gordon Vanscoy | Vanscoy Rare: Okay 

so a measure of success to the private equity entity It would be number of contracts and financials

It is all about having clients. Having these biopharma partners who are thrilled with how we're taking care of their patients Okay, and If you have that going on, think about this market. We have these small biotech companies emerging and you end up with these. within these companies who are there typically five to seven years. They're successful. They get promoted. They go to another company. Their reputation then follows them. We then work with that company. They then go to the next company. And in each one of these companies, They now launch more than one product.

They'll launch two products, three products, four products, five products . So it just proliferates based upon reputation and your ability to deliver. [01:02:00] Our one metric that we stand on all the time is an external measurement of patient satisfaction . And they use patient satisfaction scores, and it's done by Zitter MMIT. We used to dominate on the Panther side. At the end of 2023, we reclaimed that number one position at RareMed. Our patient satisfaction was at 98%, and again, this is external measure, and they do these, how likely would you recommend

Entity to a

loved one or whatever. And my goal with Vanscoy Rare, as we ramp up, will be to be number one in that market again. Because if the biopharma sees patients love you they're going to want to work with you. And, that dynamic just requires having a team on board who can deliver on your promises .

Mike Koelzer, Host: Yeah, that makes sense. [01:03:00] they know the customer You Loves you. It makes everybody's job a hell of a lot easier

Gordon Vanscoy | Vanscoy Rare: Oh, yeah. 

Mike Koelzer, Host: problem spread and that kind of 

Gordon Vanscoy | Vanscoy Rare: Yep. 

Mike Koelzer, Host: Well, golly, Gordon, fun talking to you again. I enjoy our conversations because you give a great answer. It doesn't draw on. And it keeps me on my toes . And it's a fascinating conversation. I know you're a busy guy, Gordon. Thanks for your time. It was such a pleasure talking to you again.

Gordon Vanscoy | Vanscoy Rare: Mike, it was an absolute pleasure again. The world's changed so much since the last time I talked to you. But, now we're out of COVID and things are looking bright for everybody. And circumstance today where pharmacy continues to evolve

and you continue to have your finger on the pulse of it.

As a listener, I appreciate everything you do out there.

Thank you so much for your podcast

Mike Koelzer, Host: all 

right, Gordon, look forward to talking again soon.

Gordon Vanscoy | Vanscoy Rare: Take care,

man. See you.

Bye. 

You've been listening to the Business of Pharmacy podcast [01:04:00] with me, your host, Mike Kelser. Please subscribe for all future episodes.