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Jonathan Ogurchak, PharmD, CEO of Zeal Specialty Pharmacy and STACK, shares his innovative journey of transforming specialty pharmacy through smarter technology. Learn how he’s empowering pharmacists, improving patient outcomes, and disrupting the industry with his dual focus on pharmacy operations and groundbreaking tech solutions. A must-listen for pharmacy innovators!
This transcript was generated automatically. Its accuracy may vary.
Mike Koelzer: Jonathan, introduce yourself to our listeners.
Jonathan Ogurchak: I'm Jonathan Ogurchak. I'm the founder and CEO at Stack, a pharmacy software technology firm, also the co founder and CEO at Zeal Specialty Pharmacy, both based in Pittsburgh,
Mike Koelzer: There's two areas in the country that I sort of called the Liverpool of pharmacy. And that's Ohio, I think. And also Pitt, I've had Gordon Vanscoy on the show and I know that, Pitt has brought back a lot of successful pharmacy business people back into the program, Jonathan, I know you've got associations with Pitt. I know that you teach or have taught there. And I know that, Panther RX is the logo, the mascot of Pitt being a Panther, I know you spent some time there. So you're part of that Liverpool crowd. I call it Pitt.
Jonathan Ogurchak: specialty really got a lot of its originations here in the Western Pennsylvania, Pittsburgh area. I was fortunate to spend some time at Panther. Even though I'm not a grad myself, I went to Duquesne up the street. So go Dukes. Um, you know, I've actually been on faculty and I've been teaching through the University of Pittsburgh for a number of years.
I helped to build a specialty pharmacy track as part of their master's in business administration degree curriculum and, yeah, they both hold a near and dear spot to me, but you know, it is, it's neat. You refer to it as Liverpool. There's so much in this area as it relates to not just pharmacy, but specialty pharmacy in particular.
Where I'm sitting right now, if you kind of draw a circle around it, you go an hour and a half, hour and 45 minutes in any direction and see, presence from about 20, 25 different specialty pharmacies. And it's not just, you know, because people were here and they stuck around and they didn't want to move, things like that.
There's just a lot of richness and talent. in this area, and it really affords opportunities to continue to grow the basis for what goes on in this pharmacy sector. The reason why I never left you, is because there's so much opportunity here that you don't tend to see in a lot of other locations around the country.
Mike Koelzer: All right, Jonathan. I run an independent pharmacy in Grand Rapids and, whenever I talk about specialty now, anything that I know the PBMs touch. I can't help but, uh, uh, Lambasting them and including them in all my griping and bitching about stuff. I know it's not fair to the specialty, profession, and I'm always thinking about the opaque PBMs I, when I say this, I'm always saying, specialty just means that, they're treating themselves specially by the drugs that get the profit and giving us pharmacists all the crumbs and things like that. I've had some people on the show and we've talked about specialty and the reasons why manufacturers might want to have their products only in four pharmacies in the nation, then try to have. 20, 000 pharmacies, making sure they keep the temperature correct and all that kind of stuff. So when you hear someone like me griping about that, I imagine you can see both sides being in the specialty profession. You can see a lot of good, but being sort of a, uh, independent person, I mean, not wearing the hat of one of the big three PBMs. I think you could probably understand where thisDarkness in my comments come from. imagine you see both sides of that from specialty.
Jonathan Ogurchak: Oh, I do, and a lot of times when people say specialty, it's just another S word that, gets a bad rap,
Mike Koelzer: That's right.
Jonathan Ogurchak: I think it's just a function of how it's been steered for so many years. When you look at dispensing in the specialty sector, about 70, 75 percent of all specialty fills go through one of those big three PBMs.
And it's a function of how the industry grew and evolved. But really, if you do it the right way and you do it the way that specialty is intended to be, it's not intended to be a glorified mail order, unfortunately, because of a large volume going that direction, that's, Another wrap that it gets, when you look at even specialty at its core, it was started back here in Pittsburgh, almost going on 40 years ago.
It was designed to help manufacturers have the best outcomes for their patients, whether it was through new HIV drugs coming to the market and making sure there was a supply chain to roll patients into the mix, or whether it was, you know, new solid organ transplant drugs getting them to the right patients at the right times for the right doses, helping with adherence.
Those are the things at the core of what specialty is intended to be that tends to get lost when you start to think of the S word side of specialty. Honestly, as an independent specialty owner, you know, we don't have that affiliation with a PBM. And oftentimes I feel like we're fighting a pill, absolutely,
way that somebody would be in the traditional community sense saying, well, here's a patient that's come to my front door.
They have a need. It's something that I know that I can fulfill. Why can't I do that? It's a similar argument that we tend to see often ourselves. we've gone through the paces, we've done all the boxes that needed to be checked. And you're still not saying that we're up to snuff for what it needs to be.
You know, it makes it a little bit of a frustrating sort of, uh, piece.
I was listening to one of your shows recently talking about pharmacy education, a specialty that tends to not be included in that. It's the nature of Standards work and trying to grow curricula geared towards helping students to pass the naplex.
while there are some of those more specialty, quote unquote, disease states on the boards, that's not as much as what you'd see in a community setting or hospital setting or things like that. So you don't, you don't teach it. And think that all of those things kind of mush together, it makes this whole area of specialty, like a very gray area.
Even when you look at things like CMS guidance, there's not anything specific. That tends to be like the gospel truth of how a lot of other plans align. You don't see CMS saying, this is what is specialty and this is what is not. It's up for a lot of interpretation.
because there's that lack of specificity, it allows some people to go to one extreme and say, Everything specialty allows some other people to go to the other and say, Nope, we think it should be open. really, I think what it comes down to and what it should come down to is the quality of care that you can provide your patients.
And how can you do that in a way that empowers the pharmacist behind the counter to speak to those patients in a way that they need to have information provided to them? If I knew that there was one patient that was going to be coming to the counter for that one drug that I only dispensed to them once a month, would I have as much familiarity with it as I would my Lasix or my ACE inhibitor or whatever that might be?
you always feel more compelled, like you're Googling it under the desk just so that when they come to the front, if there's a question you can answer. My specialty is really helping to guide. dedicated resources for the ability to provide patient care or counseling to physicians on how to write for drugs, not necessarily something exclusionary from a reimbursement perspective.
I feel like it allows for the pharmacists to be prepared and taught the same way that they would, you know, if, if you were in the community setting and you were asked to step into an ICU and be able to dose appropriately, it's a little bit out of like the day to day practice.
But when you start to, align what practice settings can look like. there is some benefit from, you know, a pharmacist practitioner to be taught and, and trained to function in those ways., it helps to align those resources where they need to be. It allows for those. conversations to be happening as they should.
Jonathan Ogurchak: it doesn't always get that wrapped up, because when you start to see some of those other things that are out there in terms of, patient steering to a certain effect, going to a PBM going towards an entity that doesn't necessarily provide the same quality of care that an independent can,
where it tends to solidify that a little bit more,
Okay.
Mike Koelzer: People that are trying hard anytime they can make it gray, it's better for them because then they can say, well, we meant this kind of specialty as far as the pricing goes and not that kind. So I'm going to throw it all back on the PBMs, Jonathan. whenever we have a chance, we're going to beat on the PBMs again.
Jonathan Ogurchak: Well, I think it's right there with you, to be honest with you. We'll see how many PBMs are listening to this recording to see what kind of blowback that is. But, you know, it's, I just look at it case in point, you know, the pharmacy that we opened here in Pittsburgh, we've been open for about 18 months now.
And in that time, we've gone the whole gamut of how to, you know, credential and, uh, and license and get payer contracts, et cetera. And, you know, we've been trying to do things the right way. In terms of, we know that, you know, while we might have built some things under a retail agreement, because that's how we functioned when we started, we now know that as our scope continues to broaden, let's go get that mail contract.
Let's go get that specialty contract. Let's get the reimbursement. Like as, as is dictated to us so that way we could do it the right way. There's one payer in particular who I won't choose to name here, but I've been trying since February of this year to get the right contract because I know that that's what we should be doing in terms of playing by the rules, etc.
And it's been just round and round and round and, oh, you need to go talk to this person and talk to that person and, oh, talk to this first person again. almost as though they're deliberately trying to make it difficult so that way I just throw my hands up and walk away and say, forget about it. And at the end of the day, is that really that, is that what it should be?
I mean, we all got into this profession because we want to take care of patients . We want to do it the right way. You know, even, you know, the traditional PBM market, all we want to do is to save money, etc. We can do those things, but it doesn't all have to be. done by one party for it to be done well.
There's other people that, like you and I, that in that independent setting could probably do as good a job, if not a better job, than what you know is deemed to be, to be correct out there. But yeah, when you don't have a seat at the table, even it makes it difficult to, to have your voice heard
Mike Koelzer: In that area, the specialty area, much of it, for example, in independent pharmacy, it's like, I sure as hell don't have the PBM sending people my way. I'm talking about the general community, not the specialty. I don't have the PBM sending anybody my way. maybe some physicians,
Jonathan Ogurchak: sorry. I'm sorry.
Mike Koelzer: You could have a hospital, you could have a specialist, you could have a manufacturer, you could have a PBM. Where does most of your stuff filter in from? Is it just basic, like an independent community pharmacy would be? Or you have connections, do you have connections? And if not, where does it come from?
Jonathan Ogurchak: Yeah. I think initially a little bit of it was the connecting piece of things. I always get that spine crawling sort of feeling when I think back to the olden days, Oh, pharmacy is a small world. And like, Oh, it just makes it such like a
trite sort of saying, but I mean, there's, there's so many people that I've been fortunate enough to meet over the years that have been looking for different solutions when it comes to providing that type of care.
put a post on LinkedIn, send a press release and people see, Hey, Gorchak doing a pharmacy again. Maybe we should reach out and see what that's all about. I've been fortunate. as word gets out and we put out a release an accreditor puts out a release saying, Hey, here's zeal.
They're now accredited as a rare disease pharmacy. it gives us more credibility to the things that we're trying to do. I think the bigger part and where we started to see more of our opportunities has been due to some of the things that we've done from a technology perspective.
So, I have zeal as my pharmacy, I have a separate company. a software company. that does Some different things as it relates to driving patient outcomes and driving data capture and all the things that really, especially pharmacies can do a really good job at if it was built to scale and there were solutions available to, quantify those things, because we've been able to do some of those activities, it's allowed for some perpetuation of the name out there.
We have a program we did as a pilot where using the software, we were able to drop ship smart scales into patients homes. for weight titrated drugs, it's easier for me to say, Hey Mike, go step on a scale. I'm going to click a button.
have this weight hit a cell tower and it's going to show up in your profile in real time than to say, Hey Mike, how much do you weigh?
And in a lot of cases, it's like, I'm going to tell you what I want to weigh and not what I actually weigh.
Mike Koelzer: Absolutely.
Jonathan Ogurchak: going to get underdosed most of the time.
And it really doesn't afford you any solutions. And so, you know, because we've been able to do things like that, where we may have started in one particular therapeutic area. And it works. Then word gets out there and it's like, Hey, have you seen what they can do? Can you try something like this?
Or, Hey, you know, we see that we could do really customized bi directional conversations with the patients and we can really extend what we asked or did during the clinical trial, but now we could, Take that out to the masses. We could get real world data on what
is happening with our drugs or what's happening with the actual patient experience.
Now that it's outside of that sterilized clinical trial setting, capability to do those things has really allowed itself to grow opportunities. And that's where we started to see more of that word of mouth, not necessarily from prescriber to prescriber, but from partner to partner.
Hey, have you seen what zeal can do? They can take this data and identify it and publish it. there's things that can be done that really put that special part back into what specialties intended to be. I think that's where we've had as much opportunity to grow is the fact that we've been able to differentiate ourselves in terms of how we deliver those types of services.
as opposed to some of the others out there.
Mike Koelzer: Jonathan, your patient base, is it nationwide? Is it mainly through the mail? Is it local? How do you describe that?
Jonathan Ogurchak: So it's a little bit of everything, to be honest with you. We have our local patient base, a retail counter. folks can come and pick up scripts if they want to But we're licensed to dispense in all 50 states.
Mike Koelzer: All right. So Jonathan, you have some of these cool things you've done for your pharmacy. through some of the companies like stack and so on that you have, you. Somewhat market to other pharmacies, I think. Is it other specialty pharmacies or other pharmacies in general?
What's your problem with that? They are two separate companies, we have a zeal side that's just, you know, it kind of serves a little bit of a test kitchen for the software side, we can try things out. We can build the cases. We can say this is how it needs to actually deploy. market to pharmacies as well.
Jonathan Ogurchak: We have 2 products today on the software side. One's namesake, which is stack. it focuses on. All things back of the house. So licensing, accreditation, payer contracting, regulatory, compliance, like all this stuff that usually you hand a blank spreadsheet and say, Hey, Mike, figure out how to keep track of this for the whole company.
And if you screw it up, there's going to be a problem. We've built a curated framework. So that way pharmacies can benefit from that. And that's across the board, whether it's retail, hospital, community, Specialty, we've even worked into the association space so we can do growth and development of professional associations in terms of programs deployed educational offerings that are there.
builds an ecosystem where there's a little bit more from information sharing. perspective. The second product is a product we call OnCue, and that's designed to sit right next to the dispensing system in a pharmacy. It can take data from the claim and build that patient experience to make it more holistic.
instead of training a new team member to say, don't forget if it's a seromark patient on this drug, ask these questions. We have a work engine that runs behind the scenes that says, we know this about these patients. Let's ask the right questions at the right times and create different tasking to make sure that we're doing the things that we need to be doing.
Yeah. It's always been crazy to me that There's so much robust data that we could get in pharmacy, but we're relying on systems that are. 40, 45 years old to do things with them. If we can see technology that's being used in other ways, let's find ways that we can apply it to take better care of our patients.
effectively, that's what we're trying to do with these offerings it doesn't matter what type of pharmacy you are, we've now scaled it. So it's not just touching pharmacies, it's being used as a standalone EMR in certain cases for different types of clinics, because the, Cause and effect type of, you know, relationship that you can have with the data transcends just what you do in a pharmacy.
And if we can find ways that, you know, if this happens, then this is the cascade of events that happens thereafter, there's ways we could get much more standardized, much more robust data and try to do it in a way that It's overcoming that end of one you see a lot of pharmacies that say, this is not the way that it should be.
I'm going to go build my own solution, you know, own little, end of one type of scenario where it doesn't play nice across the board. And so you're only valuable as the data that can be shared.
In terms of helping to scale and grow these things. You know, you look at other initiatives that are out there that people have been trying for a long time to say, well, let's prove the value of a pharmacist in the community setting.
Let's show the clinical things that they could do above and beyond the transaction. But when you're talking apples to elephants and how people capture that data and there's no parity, it makes it hard to demonstrate to scale. And so that's what we're really trying to accomplish is take the tech that's out there, find ways to scale it and grow it.
it's just trying to find ways to take what healthcare data should be and make it actionable.
Mike Koelzer: All right. So Jonathan, a three layer question for you. How much time are you spending percentage wise between the different things? then secondly, How much time would be good for the company for you to be spending among the different things? And then thirdly, would you like to spend the time if you had that option? So, you know, where are you and what do you like to do though?
Jonathan Ogurchak: you figure when I left my prior pharmacy ownership role, it was to go start the company. that's kind of where my heart lives and breathes
Mike Koelzer: And what kind of pharmacy was that?
Jonathan Ogurchak: It was, it was Panther. I was one of the co owners at Panther, um, here in Pittsburgh so when I left Panther, it was kind of multifaceted at the time, you know, my, my wife and I were expecting our, our third and I had seen like how much I had missed because of just spending hours upon hours in the pharmacy to grow the business.
I'm like, I don't want to be that dad that's absent. So I want to make sure that I'm there and I'm present for all of these milestones that you don't get back. I was fortunate enough to divest my equity and do those things. But at the same time, it was like, well, I have this itch to do something with technology.
So let's figure out how we can build something to scale and scratch that itch. And hopefully more pharmacies can benefit.
Mike Koelzer: Jonathan, when you talk about Panther, were you part of the group that when Gordon tells me this group of students came and talked to him, were you one of those few people?
Jonathan Ogurchak: So I was not one of the original, uh, Panther guys. I had worked with one of the other gentlemen, In my early days, we worked at a credo, which is express scripts,
especially pharmacy. And so, I kind of grew up in the credo world and I was going to take another position at another specialty pharmacy.
they convinced me in the meantime, like, Hey, you've built the operations here why don't you come do that for us at Panther? So I was higher. Number 1, really, as a pharmacist that came in and helped to build and And then, you know, Over time, I was afforded the opportunity to buy into the ownership group, part of me thinks it's why they had me teach at Pitt, just so they could say, hey, he has a Pitt connection, if he's going to be a part of the Panther side of things, I wasn't one of the original few, but
I came into the fold, after we kind of grew from the garage into our actual facility, I was able to join and be a part of that.
Mike Koelzer: You kind of moved away from there into the computer world on purpose.
Jonathan Ogurchak: Yeah, and it was one of the things I even swore at the time, like, oh man, I'm never going to open a pharmacy. It's crazy how life throws curveballs at you. And here we are today with another pharmacy, but, you know, at the time it seemed like there was, and there still is a huge opportunity as far as what can be done with technology as it relates to outpatient care.
and the care that pharmacists can deliver. when you see case studies that look at the value of care, you're looking at, real world outcomes A lot of times you don't see pharmacists as part of that conversation because, there's a lot of disconnection between how that data can be quantified, as opposed to, let me look at something transactionally.
you know, a patient had a hip replacement where they didn't, they were back in the hospital where they weren't. When you then start to scale it out and say, well, here's Mike's pharmacy and here's Jonathan's pharmacy, and here's how they're capturing what they did to keep that patient on Lovenox, to keep them out of the hospital.
there's not a real standard way of doing that. Or there's not the same, you know, the same standard that we use to bill NCPDP claims. You're not seeing that when it comes to delivery of care and delivery of service. So it's hard to quantify those things. And, to me, I think that's where that next threshold is going to be for pharmacy to prove some value; it's more than just the transactional piece.
Sure. It's a necessary part of what we do, but What can we actually prove in terms of how there's an outcome, related to those interventions that we make? And is there a way that we can start to standardize those things, leveraging technology just to show that there's a value to including us as part of that care conversation?
We know that there is as pharmacists, but , that's where I feel like as pharmacists, we put our heads down, we get the job done, but we're not out there tooting our own horn for the things that we can and should be doing
Mike Koelzer: So you leave there, and then you find yourself. Pharmacy again. if I'm in your shoes, I want to keep doing the computer stuff. I like that kind of stuff. Where do you sit then? So when you open the pharmacy your heart is still looking. Computer stuff.
Jonathan Ogurchak: You can't serve both masters. You know, there's enough there to grow each one of these opportunities that realistically, you know, should you be focused on one or the other? And really they're, they're synergistic and help each other to grow enough.
Somebody, used the analogy. I had to laugh. It referred to me as the George Lucas of pharmacy. I said, what the hell are you talking about? Like that? And they said, well, no, if you think back to the, you know, when he was innovating and trying to build these new opportunities to direct movies, the technology didn't exist for George Lucas to make a Star Wars, but then he went out and he built the tool.
He made it work. And now you have however many other movie studios that are using industrial light and magic
to scale. It was because of that synergy between the two. I would have conversations with pharmacies about putting smart scales in the patient's home, their eyes would just kind of glaze over, they'd give me that look like, what are you talking about?
How is that something that we can actually do? Whereas now because we're able to do these things, we can, we can deliver a program like that. We can show how it's built and intended to work because we have the ability to do so through the pharmacy.
Mike Koelzer: What led you back into the pharmacy? You left because of technology. why did you end up back then
Jonathan Ogurchak: a couple of reasons. I think first was the technology piece because it afforded me an opportunity to show how the technology can actually work and scale. And
if we can build some programs, But I think part of it was just because of some changing dynamics in the industry. Um, you know, I kept in touch with a lot of folks from all walks of my career.
I would often be asked by folks on the pharma side who should we go work with? What would be a good fit for us in terms of a pharmacy that we're looking for a network of pharmacies, or should this go community? Should this go to a specialty? I answered a lot of those sorts of questions.
I think because I've done this for a while, but also because of that educator part of me, I try to keep an agnostic sort of mind when it comes to, what the industry should be, what are some best practices, that sort of thing. And finally, somebody said to me well, you built the technology.
Why don't you just build the dispensing part to go with it? And that way we can work together again. And it was like that aha kind of moment where I was like, yeah, Maybe, maybe there's something to it. And, took an opportunity to put a business plan together and we saw where some of the directions could be.
A lot of those referrals that I was making to go elsewhere were things that could be done a heck of a lot easier, especially if we use the technology at the core of what we built at the pharmacy. So we can scale, we could show those efficiencies that were intended to be there from the technology perspective.
And we were doing it from the jump. We weren't doing it as an afterthought or a solution that was coming in later on. it's allowed us to grow much more quickly .
even on the pharmacy side too, I think where we are today, We weren't anticipating being at this point until year four of a business plan, it's largely because we've been able to scale and replicate programs using the technology you're kind of that validating sort of feeling like, okay, well, here's where we thought that something as simple as looking at a call center and Sending text messages to patients to initiate refills instead of me paying somebody to sit and leave voicemails all day long.
it's that kind of hunch, that hypothesis, you know that it's going to work, but we can show now it actually worked. So when the sales team on the software side needs to go and make a case as to why, of hiring that next call center representative, look at what you can save in terms of cost savings, because there's efficiencies you can gain.
And there's not just Operational efficiencies, but you could build a better rapport with your patients because of
meeting them where they're at from an expectation perspective. I always use the example. Um, you know, I was on a flight this time last year. I was going to speak at an open conference, you know, the little lady beside me, got her bag down from overhead.
I left my AirPods and realized that after that point of no return where you're not allowed to go back or else they're going to haul you out in handcuffs type of thing. It was easier for me to log onto Amazon. Order a new pair of AirPods, have them shipped to my hotel.
Demand is for most patients to get started on medications these days, especially when it comes to these higher touch, higher cost sorts of therapies.
Why should it be that way? it really shouldn't. If anything, you would think it would be the other way around. It would be easier for people to get the care that they need when they need it. for whatever reason, it never seems to line up like that. So, it's become a little bit more personal for me, I think, to try to find ways to deliver that care and allow others to deliver that same scalable sort of care.
if we can do it and improve it at the same time, then. It's a win-win for everybody.
Mike Koelzer: I talked about percentages and now the question changes to it's very much intertwined. Are you comfortable with that?
Are you itching to grow one side more than the other? Or is that symbiosis okay now?
Jonathan Ogurchak: I'm being very deliberate in keeping those two companies separated. I think that's maybe just a business decision on my end, but I truly feel as though in order for more organizations to benefit from those solutions, it is better to keep them separate because if it's zeal software, And you're going to use zeal software to go and get better pharma data.
It kind of has a stigma associated with it.
Mike Koelzer: Sure,
Jonathan Ogurchak: Though it's separate, you know, it's, it's a stack process. I'm still the common thread, but it allows for those things to operate independently. You know, I can have opportunities when a pharma company wants to leverage the technology side to, to actually administer a limited network.
Zill doesn't have to be a part of that. I mean, I'd love for it to be, but it doesn't necessarily have to be a part of that in order for that software opportunity to grow and thrive. It's allowing for the solution to scale and more patients to be impacted by the ability for that technology to grow.
On the flip side, maybe there's something that we can do on the pharmacy side. Let's scale it and find ways that we can grow that and make an offering that's just good for us. there's, A number of different ways to look at it. you're talking about percentages right now.
I try to keep it 50-50 as much as I can, but there's times where it may look to shift up or down based on the needs of what's going on. If we have a need on the pharmacy side, right now we're getting ready to launch a type of drug, probably shifting more towards the pharmacy side.
But I also know that I have folks on the software side, they're able to allow it to run and grow effectively where I can focus some of those efforts and vice versa, if there's something that needs to happen, you know, we're getting ready for a release of a new product or service on the software side.
I know that I have a team in place at the pharmacy. That's going to allow the pharmacy to not crumble if I have to focus my efforts there differently. So yeah, I try to keep it even keel, but At the same time, I have teams in place on both sides that I trust implicitly with keeping things running if and when my focus is diverted a little bit just based on the needs of that particular point in time.
Mike Koelzer: What's your worst quality you bring to your organization? probably my worst quality would be sometimes not relaxing in my mind as much as I should be, , I tell my team when they go for the weekend, they'll say, do you need anything else?
And I'll say the best thing you can do. This weekend is to forget about us. Cause I want you coming back Monday fresh and ideas and that kind of stuff. And I don't do the same thing sometimes. I wish I would, and I don't pull out or anything. It's just kind of spinning up there and it's not good for the business. And I'm getting better, probably in your case, what's your worst quality you bring as a leader to your groups?
Jonathan Ogurchak: It's that inability to say no. And because there's so many opportunities that are out there, I always find myself always spinning in that same sort of way to say, can't, we do it. I know we can do it. It's just, at some point there has to be an opportunity cost with one of those options.
And I think that I'm trying to get better at that. but I know that there's so much opportunity that there's almost this opportunity to say, well, we know you do this and we could do it a lot better. So let's figure out how to make it happen. We can scale, we can source, we can do this, but at the same time, there's also something to be said about having a little bit more focus and the ability to say no, you're not going to be everything to everybody all the time.
And I think that's where, I've tried personally to see, well, how can I find ways to balance when to say no, because there's ways to fix everything, but, you're not always going to be, Mr. Wolf from Pulp Fiction, where they bring you in to fix things
Mike Koelzer: I got to
see the movie still. I also have to see six cents, you know, with Bruce Willis and
Jonathan Ogurchak: Yeah.
Mike Koelzer: And the nerve of some people to spoil the ending for me. I know it's been probably 30 years, but you think people could be a little
Jonathan Ogurchak: You would think that, oh, yeah, absolutely.
Mike Koelzer: they would realize not everybody has seen it.
Jonathan Ogurchak: But yeah, I know. I think that, you know, it's kind of a long way of saying, I think as, as an entrepreneur and as a business owner, you could always find ways to find your solution to make it fit. And
just knowing when the right time is to say, yeah, maybe this isn't a good fit. Let's find ways to do that.
And I've become much Better, especially over the most recent months where I've been having to split more time. Maybe I'm not the solution, but let me find somebody who is, and make a referral so that we can still meet the needs of what that other stakeholder has, but I don't have to be the one to always do it all the time.
Mike Koelzer: I've never been one much on mission statements and vision and stuff. And it's hard when you're a community pharmacy because when you're serving everybody from an infant to a 99 year old person for every product, it's kind of hard to narrow that. But for the podcast here, I said, all right, I'm going to kind of vision this out. because sometimes you're enamored by the Tik Tok videos and the quick things.
Jonathan Ogurchak: a slide to slide a slide
Mike Koelzer: And.
lo and behold, just by spending an hour on that, writing this out and using chat GPT to help me with the vision statement, not that I had a weight on me.
Cause this is just fun. It's just a fun hobby. When you spend that time, you don't realize how many things are vying for your attention out there when you find the purpose. It really alleviates a lot of stress, doesn't it? know what direction you're going with things.
Jonathan Ogurchak: Absolutely. And especially knowing that there can be so many multiple competing priorities at the same time. somebody told me once it's okay to have a lot of balls in the air, but you need to know which ones are made of rubber and which ones are made of glass
I've always kind of had that mentality because especially when you have so many competing priorities, you know, that there are some that you just can't mess up, and there's other ones that, maybe you can let slip a little bit, you know, at the end of the day, it, just comes back to your own integrity and what you want to be known for in a marketplace or, personally, professionally, whatever that is.
And I think that that, uh, that always kind of comes full circle to drive me forward. Do I really want to be known as the guy that lets things slip and gets it done well, but it's not always a priority or is it something where it makes more sense to be able to say no and focus on doing a lot of things really well.
I don't know, it's kind of interesting that you say that cause there's so many ways and you read any number of business books on what the right thing to do is. I think it really just comes down to what's the right thing for you at that point in time.
You make decisions, you make them the right decisions. Should I have gone and started a software company? Who knows? should I have opened the pharmacy? you can always have that moment of self doubt and wonder if it's the right thing to do, but in the moment, you're going to make it the right thing.
knowing the information that you have, you're going to continue to push forward until you have new sets of information. And then you make a better decision based on that. it allows for people to pivot and be more deliberate with how they're working in the day to day with those sorts of things
Mike Koelzer: I think back to business decisions and things I've done, and sometimes I have to just say, well, it was probably better that I was there than not there. But a lot of times you think back and you're like, I should have done this or that. It's like, yeah. Those were both crap positions. Those were both, negative decisions. You had pressures. It's not like you're deciding between, an obvious good and obvious bad. You had two bad and there was a bunch of bad ways they could have gone. you make a decision and it's there sometime that I say, Was it better I was there or not?
I probably made as good a decision as anybody else is going to make,
Jonathan Ogurchak: Making decisions based on the information you're given, let's pick a best of the worst type of decision as long as it's still. It's still a decision, it's something that you can act upon and start to move forward from it.
I think oftentimes people get that deer in the headlights type of approach when they need to make some of those decisions that are important, even if you don't make a decision, that's still a decision not to act.
It's still something that's going to guide the next steps of whatever that path may be. And I think sometimes people become too paralyzed in the analysis of that situation to know what they should do. But, it's some advice I always give to my pharmacy students too, I have so many students that I, I been taking happy students,
the pharmacy before we've done a virtual thing all through COVID. So I think I have like 26, 27 schools that send students my way virtually just to see entrepreneurship, see the specialties, see whatever. around this time of year where you're starting to get into the residency fellowship type of conversations.
And you have so many people, these students that are, just getting visibly stressed about this. It's a, it's a life event, you know, it's a life event. It's going to have a beginning. It's going to have an end, what I'm doing right now probably isn't going to be the same thing that I'm doing when I retire someday, it's knowing that each of those decisions along the way, whether they're a better of two bad decisions, if one's a good one, if one's not, It all becomes incremental in the process to get you to where you're going to be someday.
I know I've made a lot of bad decisions in my lifetime, but, you know, if I can use that as an opportunity to learn from it and take a step in another direction, then wasn't that bad of a decision? A decision overall, you know, and I kind of use that as my framing of mind, and I try to encourage students to do that, too.
At some point in time, you're going to need to make that decision, but what can you learn from it? And trying to get you to where it is that eventually you're going to go. Maybe a student doesn't want to be a staff pharmacist in a hospital for the 1st job, and if that's the only thing that's available to them, learn from it, take something from it and kind of parlay that into whatever that next is.
it's just making those best decisions for yourself at that point in time. And I think that's the case for anybody, but especially for business owners, you have people that are doing these things where you're making decisions for the livelihood of your business and the livelihood of your family and the livelihood of other people's families that are counting on you for salaries and jobs.
You can put a lot of undue pressure on yourself, but, those decisions that help advance to the next step, you can always pivot. Learning from the things you do wrong sometimes is more beneficial than the things you do right.
Mike Koelzer: My best friend and I will be sitting around and I'll say, Dave , damn it, I should have done this to someone. So I should have fired him and given him a what for back then and this and that, then we'll be talking to him, we'll say, all right. All right. Well, I'm. Mike, let's run back the clock tomorrow's going to be that day. Go ahead and do that. Now go ahead
Jonathan Ogurchak: Um, Um, Um, Um,
Mike Koelzer: I forgot now
Jonathan Ogurchak: Um, Um,
Um, Um,
Mike Koelzer: you play the hand you're dealt at that time. it's a crap decision sometimes.
Jonathan Ogurchak: Yeah,
Mike Koelzer: it and you, you learn and you keep going.
Jonathan Ogurchak: yeah, it's the old Marty McFly syndrome, like, if you could go back and change something, would you do it? You never know what that downstream impact's going to be
30 years later, it's hard to predict that future, but making the best decision at that point in time, you gotta trust your gut.
And I feel like I've made a lot of decisions in my career where I didn't really have a sounding board to bounce things off of, but your gut tells you one thing. And usually when you trust your gut, there's a reason for that. it kind of steers you in the ways that you should be making decisions.
Mike Koelzer: It's your gut at that time. It's not even fair to go back 10 minutes later or the next day, because it's a river. Things go by you so fast. You can't hold onto a part of it and say, this decision should have been that.
Everything changes each moment to each moment. So it's at the moment where your gut is.
Jonathan Ogurchak: Yeah, absolutely. I didn't think we'd be waxing this philosophical when we were talking here today, but I, I
kind of like it. This is fantastic.
Mike Koelzer: This is what we
do, Jonathan!
Jonathan Ogurchak: Now, having the time to reflect on these things is important because so many times the needs of the day.
Are the most important thing at the time. That's where we see it happening so often with some of our software customers, they'll say, Hey, we're going to get accredited and we're going to do this. We're going to kind of let it go.
And then we're going to forget about everything that's out there because we have 30 more scripts that need to get out the door and we need to call back.
Mr. Smith, we need to do this and do that. And you know, the needs of the day tend to take priority over all of these other things that you might've committed to. And it's hard sometimes to just take that step back and refocus and know what is the right direction that I need to be doing?
Not just here, but more broadly than that, because you're just so entrenched in the mentality that you said, go and not think about this place for a little bit. That's what's best for everybody. If you don't think about work, for the weekend. It allows people to reset and calibrate and make better decisions at that point in time too, as opposed to just always being on.
Mike Koelzer: I talked earlier about the PBMs with all the greatness of it. Now, here's a problem in pharmacy with the DIR fees, which are supposed to be gone now I'm sure all of our listeners know that, but basically in pharmacy, you would sell something to a patient and then like three or four months later, because of some screwy, you know, Medicare law, these pharmacy benefit managers could basically take money out of your back pocket and say, you owe us this from three months earlier when this happened. My thought
Jonathan Ogurchak: the caption? Sorry. Yeah, I think so. It's fine. It's fine. Oh, there
Mike Koelzer: one's wants to build
Jonathan Ogurchak: So first of all. Uh, third,
Mike Koelzer: spend time with
Jonathan Ogurchak: Mr. President, and members of the public for being here this evening. If you have a question, please let me know. So, uh, I have a question in Um,
Mike Koelzer: back, the pharmacist is still running Reagan and still filling the same amount of prescriptions and
Jonathan Ogurchak: Silence.
Mike Koelzer: once they gained their composure to look at where they wanted to go.
Jonathan Ogurchak: Yeah. And even to kind of play off that, that analogy, as you're talking about building a house, you know, if you're putting a roof on house and the rain's coming, you're going to be making sure that you're making that decision, whatever, you know, right, wrong and different, going to put an extra nail here, an extra screw here just to make it happen and that's what, pharmacy owners are faced with.
You have a patient on the other end of that phone, the other end of that counter that needs something at that point in time. And you're making the Best decision at that point in time to take care of the problem that's in front of you. But in reality, it's, you know, months where they're coming back and, you know, they're saying, Oh, well, you've got to pay for, for 10 extra boxes of screws that we think maybe you used, but maybe you didn't, and I think as clinicians, many of us are trained to do that assessment, to see what the problem is in front of us, to see how we can look to address and how we can look to make sure that there's an outcome associated with that you're not always thinking about what the repercussions are and the way that some of these D.
You're not thinking of what the downstream repercussions are later on. I think to your point, it's a wish and a knock on wood that, you know, these things are kind of coming away. But if it's not that, there's going to be something else, you know, and it's when you look at where pharmacy has grown.
It's not getting any easier. You're not seeing regulations go away. You're seeing more of that being put on. You're not seeing fewer terms and conditions going into a PBM contract. You're seeing more of that stuff. And so, I think that it's, for those of us that want to keep doing what we're doing, we're going to continue to find ways to overcome that.
But I think you're right. I think it's a way to start to create these exclusionary pools where, you know, is the juice even worth the squeeze anymore for me to continue doing this? Or should I just say, you know what, let this be somebody else's problem. it's created a weird sort of dynamic
Mike Koelzer: in my pharmacy, if I'm losing money on Mrs. Smith, I'm still going out and listening to her about her grandson. And I'm letting her talk to me for 10 minutes, even though I'm losing money, but we don't do
Jonathan Ogurchak: Um, Louis. In the state of Louisiana the great city of okay
Mike Koelzer: to go down, for whatever reason. You realize that, and it goes down a little bit. And then maybe someone else sees that they couldn't get their tree cut down. And so they start a tree cutting business and they rise up while some other company's going down.
And it's just A balance, but in pharmacy, you've got this fictitious high level of service that has no infrastructure under it. And all of a sudden it drops off.
Jonathan Ogurchak: And I think that's part of the reason why I always come back to the technology piece of this, because how many of the things that are being done on a day to day basis in a pharmacy, whether it's specialty, whether it's community, whether it's hospital, yeah,there's so many processes that are repeatable processes.
There's so many processes that are things like that. You know, could we have a better, more meaningful conversation with Mrs. Smith if we knew about her grandkids and we had all this information, and it wasn't just in Mike's head that he was the only one that she wanted to talk to? If you could build those sorts of things, allows for The function of the pharmacy to scale and still provide that same level of service if it's done in a thoughtful sort of way,
, I'm calling the cable company and, you feel like you're just talking to a call center
They don't know you from Adam. That's totally the opposite of what it comes to when you're looking at customer service from a pharmacy. knowing that you could take what, you know, and what it means to take the best care of a patient, we could find a way to put some technology behind that.
You know, it's a win-win for everybody. Could we take Mrs. Smith, who wants to talk to you for 10 minutes and take that same level of information that we know and have learned about her, but put it behind a conversational AI tool. So it sounds like she's talking to a pharmacist, but she feels like she's being heard.
We're getting that information behind it, but it's allowed. the pharmacy piece of things to be more functional, And I think that there's so many people that have said here's all these solutions that are out here, but maybe there's something in it that actually makes it make sense.
You know, there was a program that we tried to launch going into COVID. It was a program where we were going to deploy it in a community pharmacy. it was based on, data that a pharma company wanted to get about a brand product that was largely dispensed to community as soon as we saw that NDC that was being billed, you would get an email and said, Mikey, it's time to, ask these 5 questions, whenever Mrs.
Smith comes to the counter, you're going to get reimbursed. However many dollars for doing this type of activity, but if you don't ask those five questions or if something happens, we now know enough about Mike's pharmacy so that way it can route back to a call center and I can still have that same sort of conversation with Mrs.
Smith. Oh, you know, Mike from down the corner wanted me to give you a call
and he wasn't able to talk through this and it still was allowing that same level of knowledge of what would happen in the community to scale, but that way you were. Taking the little bits and pieces that you knew and could actually prompt people to, to try to grow that, you know, it's taking that corner drug sort of mentality, but put it in a call center and not make it feel like a call center.
For whatever reason, we as pharmacists and we as healthcare are so stuck in our ways like that'd be this way because it's always been done this way when in reality maybe something's worked better in another type of industry that we can apply that to what we're trying to do in healthcare leveraging technology at the background and we can now scale our Our deliverables exponentially and actually scale patient satisfaction.
And, you know, there's things that can be done, but oftentimes, again, we're so entrenched in the day to day of what we need to do to get that next script out the door, get that PA approved, or, make sure that the copay cards apply. Then to take a step back and say, what is it that we really can be doing to make sure that the next time there's a copay card, we have five patients that could benefit from the things that we learned just now.
Or maybe there's a question we ask about a side effect in the patient. Maybe it's something we didn't know about or maybe it was something that was less than 2 percent in the clinical trial. So it didn't show up on the PI, but if we have another patient reporting it, let's.
Find ways that we can kind of scale that backwards. You don't do that with just one pharmacy or N of one pharmacist adheres to that one case report. It's finding ways to use the information you have to pull it together and help empower other people to make better decisions.
Mike Koelzer: is not a language that We are it bye.
Bye bye.
was getting talked to by one of those cousins, if I went in with, my wife or, you know, someone goes in with someone they're dating or something, they want the owner to come up, and make some, you know, Condescending joke about you, but butter up the lady, you know, all the ways that you can do things to make people feel special. the problem is, these guys were there till like, two in the morning, real late restaurant
So, uh, Um, ki Mil Mo ke ke ke ke ke ke, Bye bye. Bye bye.
is when social media was coming up And that's like, Hey, I'm going to post some stuff from personal. And when people come into the pharmacy, they may not see me, but they're going to see some of that social stuff people still want? I don't know that.
I really couldn't replace it. Didn't replace it very well, but how do you give what they want?
On scale, a win win for both of them.
Jonathan Ogurchak: Yeah, and nobody's quite figured out that true solution yet, but I think that there's, there's a little bit of a better opportunity to find that solution when you have the, the folks like you and I who are in the trenches taking grenades that know what's going on to help drive some of the solutions, as opposed to, I can't tell you how many vendors, I'm sure you see this too, vendors come through the door.
Hey, here's the latest, greatest, whatever. Well, have you ever set foot in a pharmacy before? No. How's this going to work in my day to day? Well, I don't know. We just had some money from Silicon Valley. Somebody said pharmacy was cool and we should invest in it. And I'm going to throw some money towards that. Well, it's only good if it, if it's something that actually can be usable. It's something that could be applied day to day. And I feel like too often that's what's being missed when it comes to some new opportunities. It's a really great, technically savvy idea. And I would, usually
I'd entertain those vendors when they come in or entertain them on a zoom call or something like that. And I say, well, tell me how this is designed to work in my pharmacy. And as soon as I get the, the no, I'm like, well, then what, what good is it going to do? I said, no, you know, no offense. But if it's not going to work, it's not going to work.
And, you know, until you find ways that you can align some of the technology with what a workflow should be in that healthcare setting, it's just another thing to forget. As an outlier, you know, and that's where, you know, if you could find those sorts of ways to integrate and build and do things to, to support the day to day, it becomes a much more usable offering.
Mike Koelzer: when I looked at some of these, uh, delivery app things, that came out four or five years ago and they raised a billion dollars or something like that. And I'm thinking, do they talk to pharmacies? Do they know the intricacies of this?
Jonathan Ogurchak: No, it drives me nuts sometimes because I'm thinking, I actually have a solution that I know works,
and I've done this before, I'm seeing this guy over here raise a Series B, and I could poke holes, left and right through this solution. Like, why am I not having that Series B?
How much further along would I be if I had that type of capital? And, You know, it just, it makes you wonder sometimes, you know, it's one thing you're talking about like, Hey, is this something I want to keep doing anymore? Well, there's like a down type of decision points. Like, sure. If you're seeing, you know, the opportunities out there that are being funded as opposed to, you know, tried and true solutions, it just kind of can be one of those factors.
It's like, holy crap, am I really doing the right thing, or is it something where I'm just, it's all falling on deaf ears because I don't know how to go and raise the money that would make it sound sexy to somebody else. I mean, pharmacy complies, not sexy by any means. I'm the first to admit it, but it's a necessary evil.
It's something that, most people would probably put Two or three FTEs behind if you could find ways to offset some of the spend in putting a tech solution in place, why wouldn't you do that?
It's always something that you don't necessarily think of the spend because you're in the day to day, it's just getting done.
wouldn't it make more sense to have something like that, that would allow it to scale and grow, and he could take the personnel resources that you have and put them towards more patient facing activities. that's not as sexy when you're talking about trying to go and raise capital, but it's a necessary sort of evil,
Mike Koelzer: There's a huge value in a company like yours that's able to solve the problems that you have the stumbling blocks and pharmacy along with someone like you who's Forward thinking, along with being intertwined with technology. That's a good combination of somebody because some of these companies, I don't reply to all the people that reach out to be a guest on the show. But
I had a guy last week and he looked very interesting. He wanted to come on because he marketed for Caterpillar and John Deere, he worked with that company, promoting them. So I thought. I'm going to respond and I'm going to tell them why it probably wouldn't work for us. I wrote something back, like, know, pharmacy marketing is unique because it needs to market to people, but half the people that come in from that marketing, we don't want to sell because we're going to lose money Okay.
Thanks. they moved on. It's just a challenge. And so, you know, your stuff and the,
Jonathan Ogurchak: Okay. Okay.
Mike Koelzer: them
day in
Jonathan Ogurchak: Well, we're done. I think we're done. Let's go to the next one. Okay, so, uh, Yeah, I always use the example. It's like the old hair club for men commercials. Like, not only am I the president, but I'm a client type of thing. it's one thing if you're selling, you know,
hair plugs, but it's another thing when you're actually trying to sell things that you need to run a business.
if it's something that we can't find value in and now we can prove that we, you know, it's sell. Yeah. It's great. You had that gut feeling, that hypothesis that maybe this is going to work. But if you look at it and say, yeah, there's a reason why like, yeah, it may be validated, but now you can validate it the other way too.
my gut was telling me the right thing. There is some value in what we're trying to derive here. It's just getting others to appreciate that value so they could benefit from it as well.
Mike Koelzer: That's where the rubber hits the road with your stuff, because you know, the problems you can come up with solutions. Like you say, you can test some things, they don't all work, but you're dealing with reality. I know I've got this medicine I need to take at night and a lot of times I don't take it. It's not because I don't remember my app goes off. It's like. I'm home after work. My mind says, I just want to be done with any to do list, any alarms. The thing goes off at 9 PM. I'm like, screw it. I don't have the energy to get up and walk over to my backpack and take the tablet out and take it, even though it's going to extend my life and keep me from having DVTs and all that stuff. The point is you can think you've got. All these answers with your technology and so on, but unless it's coming from somebody who's lived it and then sees it and then knows that the simple, maybe logical answer is not always the answer. You're not going to make it.
Jonathan Ogurchak: No, I think back to, early in my career, we were trying to put a new solution in place Oh, this is great. We're going to put a web portal out there and everybody wants a web portal and this is the way it's going to be. And then, next thing you know, we're primarily dispensing MedD, Oncology patients.
at the time the older populations weren't as tech savvy. so we put all of these efforts into putting the solution in place only to find that nobody was doing it. We're like, why isn't nobody doing it? Well, because, on their little flip phone with the T9 texting, they can't get access to a web portal.
And so we said, okay, great. we'll move it into another patient population. And we're all going to go with younger people and we're going to focus on HIV and adherence. Well, it was Ryan White 340b program that was, you know, financially underserved. They may not have had access to those sorts of tools.
Just because it's the solution doesn't mean it's always going to be the best solution. oftentimes that's how these things are being sold. You're going to put this in your pharmacy, Mike, and it's going to change the face of adherence.
And you're going to get refills and auto refills But if it's not meeting the patients where they need to be, it's just another fancy, shiny thing that you're going to
have out there that nobody uses. That's part of the reason why I've refused, you know, to build any sort of app. So many people are like, Oh, do you have an app?
Well, who cares if I have an app on the app store? If it's something that people have to download, you know, nobody's going to use it. It's cool to say, Hey, I have an app on the app store, but is it really something that's functional then? No, I'd rather spend money and effort and energy on something functional.
Mike Koelzer: exactly. And you'll know what that function is when you're breathing it. and I'm sure Jonathan, you get,, not so much cause you're coming from the product side, not so much, maybe a receiver of a salesperson, but then you always get the, you know, we figure there's. 300 million people in the U S and if you just get 1 percent of 1 percent of 1%, you know, it's going to be three people a day who are going to do this. And then it's like, nah, that math doesn't work out Either it's helping or it's not helping
Well, golly, Jonathan, thanks for joining us. Nice talking to you.
Jonathan Ogurchak: Yeah. Appreciate you having me.
Mike Koelzer: As we said, it's that combination and you saw it, you went.
To technology. And saw that bringing in the pharmacy too, was going to improve both symbiotically. So very cool. What's the best way for a pharmacist to dabble in what you're doing? Is it to visit you online? What's the best way for them to get in touch?
Jonathan Ogurchak: LinkedIn is probably the best way for me, you know, I encourage people to reach out to me directly on there. You have to type the whole long name to find me. It's part of the challenge. If you actually spell my last name, then you've earned the ability to chat.
But no, we have, we have pages there for stack, uh, we have pages for zeal, you know, if there's questions that people have or things I've talked with so many pharmacists that are interested in that side of the world, they just don't know where to begin.
And, you know, I'm happy to try to point people in any direction because I've probably learned more from what I did wrong than what I've done right. I really want to help support people so they don't make the same sorts of mistakes. It's one of those things in healthcare.
I think we see it all too often, especially when it comes to patient activities. We don't want you to do any better over here, pharmacy, because you are independent, if you do better than it makes the chain look bad or vice versa, there's enough to go around for everybody. the more that we as individuals and professionals can help to empower other people to do well, it's only a benefit to all of us.
Mike Koelzer: Well, Jonathan, I appreciate you joining us. You had a lot going on. a busy guy. I appreciate it. The listeners appreciate it. And we thank you for dropping by.
Jonathan Ogurchak: appreciate you having me. Thanks so much, Mike.
You've been listening to the Business of Pharmacy podcast with me, your host, Mike Kelser. Please subscribe for all future episodes.
