Finish the Fight for Fair Pharmacy Reimbursement | Doug Hoey, CEO of NCPA

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Mike: Doug, introduce yourself to our listeners,

Douglas Hoey: I'm Doug Hoey. I'm the CEO for the National Community Pharmacists Association. We represent all the independently owned pharmacies in the U. S.

Mike: Doug, I'm looking at some of the stuff that the NCPA is doing. And one of them is finish the fight campaign. And the one complaint I have against groups that. March or have sit ins or have protests, things like that is I've never done it, but I feel if I went up to him and I said, what's your endgame, what would make you not do this, you know, anymore?

I don't know if they'd come up with something. In fact, I think it ruined it. If they came up with an answer, then they don't get to do that stuff anymore. Looking to finish the fight. So what are we fighting against and can we define finish?

Douglas Hoey: Yeah, so it's a great question. So finish the fight campaign. That's the campaign we rolled out in June, and it really underscores what we're trying to do with this. Changing the pharmacy payment model. Everything in CPA goes back to changing the pharmacy payment model, whether it be some of the more clinically oriented programs that we have available to members or just getting paid fairly for dispensing the product.

Mike: All of that goes back to changing the pharmacy payment model. To finish, the fight is tied to a couple of key pieces of legislation. One of them would reform Medicaid payments to a cost plus model, which 14 states have passed. 130 million people in the United States live in states where it's cost plus in Medicaid already. And what this would do is it would make it across the entire country where Medicaid, including managed Medicaid, would be cost plus. So that's it. One component of the finish is the fight. The other is Medicare reform which would require reasonable and relevant contracts in Medicare, which makes up 37 percent of the average independent pharmacies business. So to what end? Well, on the Medicaid side, that bill has already passed the house of representatives. Overwhelmingly, like 320 to 71. Doug, when they're talking about like 90, 96, I'm hearing people say, yeah, but there's 50 other bills, and that kind of flabbergasted me. What does that mean? 50 other bills going on?

Is it true? A ton of bills going on?

Douglas Hoey: tons

Mike: Really?

Douglas Hoey: PBM bills have been introduced. Most of them are going nowhere. And that's why we've been so committed to this Medicaid reform because it's actually passed the House of Representatives. Then, of course, if you remember back to your schoolhouse rock what happens then?

Well, it goes to the Senate. it then has to go through the Senate committee, the finance committee in this case. gone through the finance committee. So what a lot of people forget is that there's a process, I mean even though Washington DC seems like it's anarchy all of the time which I can certainly understand that perspective. There is a process by which bills move and bills get scored, which means that a price tag is put on them. A price tag has been put on this Medicaid bill and it would save the government a billion dollars, which makes it even more attractive for legislators to put in bills where they want to spend money, which is just about everything they do.

Mike: Sure.

Douglas Hoey: So to finish the fight, the end game would be that this Medicaid reform gets passed by the Senate, Senate.Senate. What we need there is for the Senate to take it up for a vote and [00:05:00] hopefully it would pass in the Senate. We think it would because it saves a billion dollars and it passed in the house. So overwhelmingly bipartisan passed in the house. The second thing to finish the fight would be this Medicare reform, which would put reasonable and relevant conditions in contracts, so that would be, those would be markers. Does it really finish the fight? I mean, honestly, it finishes that fight. But then the fight is going to continue because once we have reasonable and relevant Medicare contracts, we're going to be fighting over what is reasonable and relevant, but at least we'll have a toehold.

Cause right now, CMS, Centers for Medicaid and Medicare Services, they say we're not going to get involved in contracts. We wash our hands, non interference. So if they had something in statute that said contracts have to be reasonable and relevant, We at least have a marker down to say what reasonable and relevant is. And, and my, one thing that people ask is, well, why didn't you put cost plus or put cost plus something else in Medicare? Which is a great question. And of course we did that. Um, Flabbergasts me sometimes when folks think, well, why wouldn't NCPA think about that? Well,

we did

Douglas Hoey: And when the committee of jurisdiction. back and said, Hey, if you put cost plus in Medicare, going to cost some money. So how about if we change it to just NADAC? How about we just pay independents NADAC and no plus. And we, we said, no, please no favors like that, because can you imagine if our members were just being paid NADAC and no

Mike: Great.

Douglas Hoey: So that's what they came back when we tried the cost plus on the Medicare side. So we pivoted and went to reasonable and relevant and that has gotten some traction with this congress, but you know, there's a reason Why we didn't do cost plus in medicare because we did and it would have been a horrible Outcome for our members.

So we quickly pivoted and asked for something different that would still move the ball forward.

Mike: So Doug I've been hearing a lot about this big Medicare bill. That's the second one you're talking about, Medicaid and Medicare. I think Medicare is 9096. And when you're talking Medicare, is that the bill you're talking about?

Douglas Hoey: No,

No,

Mike: Explain that to me.

Douglas Hoey: the 90 96, we support it. How could we not? I mean, it's got things that our members would want. But that's what I refer to, of course, we tried the components in that bill and it went nowhere. 

Mike: that one, if I'm correct, I've heard it scaring the PBMs because it hasn't even done anything yet and everybody's like fighting against it, but compared to the Medicaid bill and the Medicare bill you're talking about, those are a lot further along, than this nine zero nine six bill, which is in its infancy.

Pretty much.

Douglas Hoey: That's right. And it may be a good for next Congress, but

Mike: Hmm.

Douglas Hoey: hasn't passed any committees. The lead sponsor is in the minority party. He's got a, co sponsor with Diana Harsh Barger, who's obviously a

Mike: Hmm.

Douglas Hoey: great pharmacy champion. But yeah, as far as the provisions, it looks great on paper, like I said, just the Medicare piece that landed on its face.

but just trying to reform Medicare, just that part of it on its face. did a big face plant, which again is why we pivoted to reasonable and relevant to get something that's actually attainable this Congress moving forward in Medicare. But if there's a, again, the provisions in 9096 are great. they'll have to go through multiple committees of jurisdiction. I think at four or five different committees of jurisdiction, they'll have to get scored, which means again, the government puts a price tag on them. And the price tag if there is a positive price tag, it means it costs something Then you know, that's it's a harder fight when they cost something but certainly a fight I know we would be willing to take on but we're really focused on getting something Realistic and done in this congress 

Mike: 

Douglas Hoey: and to finish the fight just to I want to make sure listeners

Mike: Sure.

Douglas Hoey: Because they may not know finish the fight, but hopefully they've seen You The video titled PBM Career Day which is One of my favorite short videos, it's a humorous video about a PBM standing in front of a, probably a 5th or 6th grade class explaining exactly what PBMs do and it's, it's a good 60 second

PBM career day, the other PBM leeches. that's part of the finish the fight campaign again. Another [00:10:00] short spot on a patient that comes to a doctor and he's got just the worst case that the doctor has seen of PBM leeches that are attacking this guy. So, both make the point. Really reaching out to consumers asking consumers to go to Congress and say, we've got to pass PBM reform, got to do it this Congress. Because we've had pharmacists, NCPA has been asking pharmacists to contact members of Congress and the response has been phenomenal. Just tip my hat to our out there, over 20, 000 messages into Congress just in the first quarter of 2024. At the finish of the fight, again, focused on consumers, we had over 40, 000 marching well on our way to 50, 000 consumers. Going out to their members of Congress saying you've got to get PBM reform over the finish line. We've had ads on MSNBC, Fox News, CNN with those PBM career day and the PBM leeches to try to get consumers attention. So our board went into our reserves for this finish the fight campaign because, heaven forbid that it doesn't pass. We didn't want to look back in the rear view mirror and say, Oh gosh, if we had just done one more thing, if we had just done this, we wanted to really leave it all out on the field. And so that's the finish of the fight campaign.

Mike: So, Doug, that's even more specific than I thought specific would mean, because I wasn't clear on the bills, the 90 96 and so on, but we're talking about two specific bills that are kind of precursors 

you know, you hit the next notch and maybe we settle there for a bit and then maybe bills pile on top of that. But these are two specific bills that are what we're talking about finishing.

Douglas Hoey: Absolutely. That's right. It's not some general, oh, PBM reform. This is payment for pharmacies. The two biggest programs that they have, which are Medicaid and Medicare for the average pharmacy, just those two programs alone make 55 percent of the average pharmacy's business, NCPA doesn't negotiate contracts.

 Well, we don't negotiate contracts, period. commercial contracts are done through PSAOs as are Medicare contracts. So where we can have the most impact, not that we're not trying to work with legislators on the commercial side too. where we can have the most impact are Medicare and Medicaid as far as payment for services, payment for prescription dispensing and services. And that's where the Finish the Fight campaign is really focused. So hopefully we've got all kinds of stuff on our website. codes. For our members to put them at their, at their counter or on their doors for patients then to take a picture with their cameras. It'll take them right to the website, personalize their story.

That's one thing that's really important is for a couple of sentences to personalize it. They don't personalize it. The bots will just weed it out. So just a couple of sentences on why PBM reform is important and why that consumer cares about lower drug costs that's what we've really angled it towards lower drug costs rather than try to explain what a PBM is to

Yeah. Really encourage, your listeners if they haven't been to, you can just Google finish the fight in CPA,

Just all the ads and all the information. And, as far as specific bill numbers, when the consumer clicks on the site, it takes them right to a place where they can put in their zip code.

 Customize their message, and it'll send a message to their two senators and their representative. 

Mike: I don't know a damn thing about this stuff. We had sucky Political science in our high school. I mean, it was just terrible. Doug, you and I were about the same age. Back in the day in high school, we had these. They were like ticker tape cards, you know, they were three inches wide and eight inches long. You'd feed them into a computer score thing.

Douglas Hoey: Yeah.

Mike: We were one of the first generations to have a computerized grading kind of thing.

So our political science teacher, he would hand these out to the class after they computer graded them for some reason. And then we had to go up and show him our grade. And he would then pencil the grade in, in his grading book of what we showed to him. So what we would do with these is, We would turn them over on the side that wasn't used, and we would take our pencil erasers, you know, the old pink pencil erasers, we would take those and write the mirror image of our score that we wanted onto these pencil erasers, in blue ink, and then we would just.

Push it onto the top of the blank scorecard with whatever score we wanted, and we'd go up and show it to them. I wouldn't do that. Now that [00:15:00] was the basis of our political education back then. All right. So. Doug, what is the year of this? Does it go like with the school year?

When does this have to be voted on to say if it was successful or not? What is the timeframe?

Douglas Hoey: Yeah, point well taken as far as how deep our political science knowledge goes. And, I don't consider myself a DC native, but I've been up here a while. And so I've learned the hard way. I've kind of learned through the school of hard knocks and having a lot of smart people around me.

NCPA has five full time registered lobbyists on our staff. We have outsourced. lobbyists as well. So I've learned a lot through them. The Congress goes in two year cycles and it's tied to the elections. So this Congress ends, at the end of the year.

Mike: Hmm.

Douglas Hoey: and there are very few days remaining this session.

So, during an election year, they're especially going to a presidential election year. The members of Congress go back home to campaign.

Mike: Gotcha.

Douglas Hoey: the whole house of representatives, they're up every two years and about a third of the Senate is up every two years. And then of course, the presidential campaign.

So they're gonna be back home. And even if they're not up for reelection, trying to raise money because they're raising money for their next election or to

the machine.

There's very few, uh, days left on the calendar. Congress will actually be in session especially before the election and even after the election. There's only maybe a few weeks. 

Mike: Yeah.

Douglas Hoey: they're trying to pass a funding resolution that would fund the government through December 20th. And if that happens, then you can pretty much bet that the congressional world stops on December 20th. Unless they haven't passed something to continue funding the government after December 20th. So, as far as vehicles to pass legislation, there's not a lot of vehicles left.

Mike: Hmm.

Douglas Hoey: If whatever doesn't pass, which most bills that are introduced, the vast majority don't pass,

Mike: Hmm.

Douglas Hoey: whether it's pharmacy or agriculture or diamond mining or whatever, very few

Mike: Sure.

Douglas Hoey: pass everything starts over. With the new congress when it comes in in mid january So you gotta start over on everything and that means going through the committee processes again the score if your bill got scored, I think that may that may carry over to the next congress I'm, not I think so, but i'm not sure but everything else the reintroduction of bills going through the committees all that starts over which is makes it even more urgent that we get medicaid reform done this year You And we'd love to have the Medicare reform done as well.

Understanding that the job is just beginning, especially on Medicare, because reasonable and relevant, good, good starting point, better than what we have now, which is nothing, take it or leave it contracts and basically no way to fight back. That gives us at least a little bit of weaponry to use to defend ourselves.

Mike: Was the goal to get these in at the very beginning of the two years to let them slosh around for a while? Is that kind of the goal of someone trying to get a bill out? You know, or if there's a new bill or something, you're going to try to get it like the first of 2025 to give it a couple years to ferment versus hitting it with a month to go.

Douglas Hoey: Absolutely. Yeah. I mean, time is not on your side. When it comes to getting bills passed federally, not that it's easy in the states, in no way. I mean, passing in states is, is not

Mike: Sure.

Douglas Hoey: but it's a completely different ballgame trying to get things passed federally versus state wise.

I mean, the state legislatures, a lot of them, they're in session for 8, 12, 16 weeks. A lot of them, not all. But it's a very finite window and they clear the deck and start over. every two years. And yes, so like this Medicaid bill. That was introduced in 23 and Medicare, that bill it went through, its committee early this year, I believe, and it went through that committee 26 to 1 out of the Senate Finance Committee. So, some good momentum. But yeah, early in the year is highly preferred, and especially in an election year, because the election year calendar is super, a presidential election year is even a shorter calendar than a midterm election year calendar. So, at the bill numbers, by the way, I'm just looking up Medicare, the Medicare bill is Senate [00:20:00] 2973. And the House bill is 5378, 5 3 7 8. And that one's lower cost, more transparency. That's the one that has already passed out of the House. 320 to 71. 71. Again a bipartisan bill.

Mike: Doug in general, I'm not going to talk about these bills because we're going to claim victory already, but in general let's say there's a generic bill, is it? A feather in the cap to almost get it, but not get it and then say, well, we have momentum, so it's going to be easier the next two years. Or is it the opposite?

Like we tried it, it didn't go, no sense doing it again because people are sick of it. Not so much in the mind of the fighters, but in terms of the Congress people, do they want to latch on again? I'm already claiming victory on this, but in a generic sense, do they want to latch on again to a bill that didn't pass?

Or do they say that it's like a loser mentality, let's go for something else because we didn't get to the finish point 

Douglas Hoey: I think it just depends on the bill. This may not be a good analogy, but I'll give you, I'm a baseball fan and the Baseball Hall of Fame. So the Baseball Hall of Fame, you can get in, you have to wait five years after you've retired that you can go on the ballot. Then there are people who have been inducted who are first ballot hall of famers, like, uh, Aaron Judge, the way he's, he's going right now, he'll be a first ballot hall of famer when he, when he comes up. Otani, the way he's going will be a first, as an example . But then there's other players who fall short, I think 75 percent they have to hit to get in. And the first year they're at 43%, the next year 47%, next year 51%, and so I, I bring that up and eventually they get in, eventually they, after 10 years they, they hit the magic, the magic number. Some of that goes on with congressional bills where they know they're not going to pass the first year but they maybe are heard by the committee.

And they get through a committee. Or maybe it's the next year, they actually get heard by the committee or the next congressional cycle. And so most people have to take the long view with federal bills. So depending on what the topic is, a bill sponsor is going to feel defeated if something doesn't go through that first time. as long as it is picking up momentum. One different thing, though, than the baseball analogy, though, is that members of Congress turn over pretty frequently. And

Mike: Mm hmm.

Douglas Hoey: depending on who's in power, they control the committees.

Mike: Sure,

Douglas Hoey: in the House of Representatives, the Republicans have the majority, so all of the committee chairs are Republicans. In the Senate, it's the opposite. The Democrats have the majority, so all the committee chairs are controlled by Democrats. So if you have this long year plan, one thing you don't know is who will be in power, also if you're a sponsor, will you be on the committee of jurisdiction? Because if you're not on the committee of jurisdiction, it's just harder. It's just a lot harder if you're not on the committee of jurisdiction and a lot of our stuff, a lot of our pharmacy bills in the house go through energy and commerce. so we always liked, like Buddy Carter uh, Diana, they're on the energy and commerce committee, which we love to see. And of course it makes total sense for them to be on that as pharmacists. Because the Energy and Commerce Committee has a sub committee on health. And so, so who better than, people like them to be on it. but it is a long term view a lot of times. Which is frustrating for us as NCPA. It's frustrating, I know, for our members because it just, just takes such a long time and then you have all these shifting sands of the political shifting sands that have nothing to do with pharmacy But impact us.

Mike: So Doug. It seems like. You're never going to get everything, but there's some steps that are taken that possibly might help. When you come back in the future. 

Douglas Hoey: reasonable and relevant, at least we'd have, to your point, as far as a stepping stone, Cause then you could define it later.

 We're working with members of Congress and they're trying to be helpful. That would at least move the ball forward,

Mike: Move it forward. Debate on that later. Figured out later.

Douglas Hoey: there's actually some provisions on who decides what reasonable and relevant is, and

Mike: Okay.

Douglas Hoey: so there is a referee in

Mike: gotcha.

Douglas Hoey: and relevant, and again, right now, CMS just says oh, [00:25:00] Congress passed non interference, a bill, The Medicare Modernization Act of 2003 has language that says non interference in it. it relates to pharmaceutical manufacturers and rebates, and it relates to something different how it's applied today. But CMS refuses to get involved with virtually any aspect of pharmacy contracting in Medicare because they say, well, Congress said non interference, so we're not allowed to get involved. We have shown them that it is not correct, that they do have authority to get much more involved than what they are. They continue to use that as a reason why they won't get involved. So if reasonable and relevant was passed by Congress, we'd have a chance to say, What do you mean non interference? These contracts have to be reasonable and relevant. You can't just say interference. We have to dust our hands from it.

Mike: Right.

Douglas Hoey: it would move the ball forward. Is it the end all be all? No, we never thought it was, but it at least would move the ball forward. And at least it's something that's realistic in this Congress. Plus the Medicaid reform would again pay pharmacies cost plus a dispensing fee determined by their state, the 14 states that have passed it. That dispensing fee is between about 9. 50 and 11. 50, 12 is most of the states that have implemented it in their state, which our members, they're not gonna get rich on that. But for the most part, when I talk with people in those states, , guys okay on Medicaid?

They're usually 90 percent of the time, 95 percent of the time, they say, yeah, yeah. I mean, I don't like it on specialty drugs. It's a 3,000 drug and I'm getting paid 10 bucks. But at least they're getting paid positive and,

and of course on the lisinopril and the atorvastatins and the metoprololis and the levothyroxine 10 bucks on those plus their costs are pretty happy about that.

Mike: Sure.

Douglas Hoey: half their

Mike: Sure.

Douglas Hoey: There were 90 percent of their prescriptions are those low cost generics

Mike: So, Doug, despite inking up my pencil eraser one of the things I think , I've learned about politics is that, I don't know if this is true or not, I want to get your take on it, is they said that politics on purpose was meant to move slowly because it has a lot of checks and balances and this and that.

Do you agree with that statement? Or do you say, yeah, Mike, it was maybe meant that way, but now we have to deal with X and Y and Z?

Douglas Hoey: Yeah, that's a great question it frustrates me how slow everything federally moves On the other hand, if it was something that was detrimental to our members, glad we've been able to block those things and stop those things

So it's sort of a

sword, die by the sword. I do think, this is just me personally as uh, patriotic citizen of the USA, is like we've gotten a little too big we can't get out of our own way at times.

And so it does feel like some, me, common sense, legislation that should pass.

 As obviously someone very pro small business, I do worry about the oversized influence of corporations. our government and the too big to fail, which was started with the banking industry, but it seems like that's stretching into health care.

Mike: Yep.

Douglas Hoey: It really concerns me that we're allowing these healthcare institutions to get so big that insurance companies, et cetera, get so big that they're too big to fail. And that the

Instead of the government being able to work with them on terms, government is, kind of bowing down to them

Mike: Right. 

Douglas Hoey: need them. And that worries me as both an advocate for pharmacy and advocate for small businesses and a citizen, probably as much as anything in our government. Other people run for office, that's probably the first or second biggest thing that concerns me as well.

Mike: Yeah. I had Greg Reibold on the show last week and talking about different stuff and he was talking about, you know, calling the legislators and things like that. And I got the conversation switched around to saying, well, we could tag people and you know, that kind of stuff.

But Doug, you'd have been so proud of me last week. I'm sitting in my office there at work. And I said, ah, what the hell? I picked up the phone

Douglas Hoey: Good.

Mike: called the Congressperson.

Douglas Hoey: That's

Mike: And I didn't die. You know, everything was fine. The guy on the phone was friendly, you know, he said, well, let me take this down and, you know, this and that.

I think afterwards, though, I heard the paper crumpling up and

off the basket. No, I mean, I didn't die from it. And I, and I'd [00:30:00] recommend, you know, here's the question I want to ask a marching order for us then??

Douglas Hoey: So the marching orders between now and then are to get your consumers involved, get them to help us finish the fight, help them oppose high drug prices caused by PBMs. And it's especially important if you live in the state of New York. And why is that? Well, because Senator Schumer the House Majority Leader.

He controls what comes up for a vote or not. And when the pharmacy bills that would have paid pharmacies Cost Plus and Medicaid and Reasonable and Relevant came up in March, they were in the bills and because it wasn't just a pharmacy bill that was attached to something else. There was other stuff mixed into it. And according to our sources, the other stuff, Senator Schumer didn't want to vote on, so he cut it out and out with the baby went out with the bathwater. And so, we need Senator Schumer to agree to bring the pharmacy issues up for vote again, or to bring them up for vote in the Senate. But before the end of this Congress, so all over the country, we need consumers. So, other senators know Senator Schumer and they can whisper a good word. And we need consumers to just like you picked up a phone, Mike, and that's important because that call got logged. And so that office, okay, called, he called about a pharmacy issue, said something about PBMs. So maybe that's if that office got one call that week, That gets lost in a sea of the other 500 other topics they got calls about that week. They get 50 calls that week on it. It's like Casey Kasem's top 40. It moves up to the top of the charts.

Mike: Can non constituents call them? could pharmacists across the country put in a call to his office in New York or whatever?

Douglas Hoey: they could, but I wouldn't because.

Mike: You wouldn't. You'd go through your own, senators and so on.

Douglas Hoey: When you go outside I mean, they can't elect him. I mean, I guess

Mike: Yeah. He's not afraid of them.

Douglas Hoey: right? What are

Vote me out of office. You don't have a vote in New York. it's just like, your representative, if you're working on people outside of your district, I mean, some offices when they have people come to see them and they find out they're not from their district, Some of them get kind of, kind of nasty about it.

Like you're wasting my time.

Right. so yeah, I think for someone from, Michigan

Mike: Calling your own 

Douglas Hoey: New York, they probably not going to be that impactful,

Mike: Not a thing.

Douglas Hoey: in Michigan, as an example, or any state contact your own senators, especially if they're Democrats.

Mike: Doug, you say talk to your consumers and I'm thinking, well, We have customers and I'm thinking sometimes those conversations are in the midst of being busy and so on. Does NCPA have any kind of artwork or anything or PDFs that people can print off, you know, 30 sheets and put them on their counter at least to start that conversation?

Douglas Hoey: We've got all kinds of materials on the finish the fight website. We've got some associated, stop PBM fat cats. And we've got, now, they originally showed that to me and the cat wasn't fat enough. 

Mike: I saw that. You got a big fat one now. That's a big cat.

Douglas Hoey: huh. Yeah. That's more what I was talking about when I said a fat cat and they

Mike: Yes.

Douglas Hoey: The PBM leeches Mike, if we had, we don't need, I mean, of course, we'd love to have 200 patients, patients, customers, consumers from every pharmacy. But if we just had five, if a pharmacy was able to recruit five patients from their pharmacy times 18, 000 plus pharmacies, that's 90, 000 into Congress. So, someone listening to this, it's not like you have to recruit your entire patient base, get, get your, recruit. Five or 10 most active pharmacy patients ask them again, customize the correspondence. So it's not just the same because we've got pre written. I mean, it's pre written for folks, but they have the chance to customize it with their own story, and personalize it for their own story. then it has the bill numbers and, and, and all the, the guts of it, that a legislative aid would need. Oh, okay. Here's another one talking about PBMs and, but this one's talking about how they couldn't afford their heating bill or whatever their story is, to make it personal.

Mike: So Doug, we got the finish line for that. Talking about fighting though, what's going on with the FTC now in terms of, I know the letter came out, but I know there's opposition to that. What's the update on that?

Douglas Hoey: Yeah. So FTC, just for folks who've been looking at FTC over the last 40 years, they were not pharmacy's friends. Not that they're, they're not meant to be anyone's friend. They're meant to be a consumer's friend, over the last two or three years, they've really had an awakening, on the problems that [00:35:00] PBMs cause for consumers and how anti-competitive they are.

And in fact, they just filed a lawsuit recently against the big three PBMs for how. PBMs have manipulated insulin prices, which as pharmacists, we've all seen. We've all seen how insulin prices have skyrocketed over the last 30 years. happen in other countries. The U. S. is the only country in the world with PBMs.

We pay the highest drug prices in the world. Insulin is the biggest example. However, I mean, to me, it's a, I mean, no case is shut and dry, but if

Mike: Sure.

Douglas Hoey: that shows how PBMs drive up costs, it's insulin. Well, you've got, of all places, the Wall Street Journal editorial board wrote an editorial against the FTC supporting the PBMs. And I mentioned that, Mike, just to underscore how powerful these insurer PBMs are. They have friends in very high places. so we've got to, also have friends in high places, but also out, outman them, outnumber them. I mean, Governor Newsom from California, Just vetoed a bill that was unanimously or almost unanimously passed by his Democrat controlled legislature, his own party, that protected the insurance companies. So again, they've got friends in high places. It's all the more reason why none of us can be on the sidelines. We've all got to, just like you did, Mike, you picked up the phone and you made a call, make those calls, set aside five minutes a week to do

that, and we all need to be doing that.

Mike: I shared this with the listeners, I think last week, but I was at the pharmacy and I'm looking at some article from some Michigan legislator, you know, statewide, and he's talking about how PBMs do all these good things. And I told my guy, I said, look up and see who his donors are. He goes in, comes out a minute later, emails me, you know, he's like, sure enough, thousand dollars from them and them and them.

And it's like small potatoes, but I mean, it can get pretty dirty.

Douglas Hoey: It does. And pharmacy is a $500 billion industry and independent pharmacy is about a $90 billion industry. And so there's gonna be people coming after us, to the first question about finishing the fight, the fight's never done. 

Mike: Sure. All

Douglas Hoey: or $500 billion, there's always gonna be, know, people coming at us and. We're going to be fighting them off forever, we have to fight and we have to fight hard and strong 

Mike: Now, Doug, now to the fun stuff. So I remember during COVID, you said how eager you were to get back to the convention. So here it comes again in another couple of weeks when the show's coming. Tell us about the convention. I know there's some programs you guys are still offering, not at the convention, but in general, the core program and the fellowship program.

So. Twisting this conversation around to some positive stuff. What's exciting in the NCPA world?

Douglas Hoey: payment model And at some point in my career people are going to get so sick of hearing me say that everything that we do is tied to changing the pharmacy payment model, again, whether it be on getting paid fairly for dispensing the prescription or for the services that we provide, the conventions, a mix of both, we're going to have programs one of the things that I really like about our programs at the convention is Almost all done by peers, successful pharmacy owners who are implementing like a cost plus program or a cash only pharmacy So, cash only pharmacies. I know a lot of pharmacists are thinking about doing that and they want to know the pros and the cons. And so we'll have people who've done it. And here's the mistakes I made. Here's where it's worked, know, tactical, practical kind of things like how many people did I have to hire and how did I train them to do cash only?

 Did I have to do something different contractually, I mean, just real nuts and bolts kind of things, other things that we're doing are helping pharmacists who want to carve out a niche, like for example, acting injectables, there's a pretty big need for someone to administer long acting injectables. And there's even a network of pharmacists who do that. That's not everyone's cup of tea, but for those whose it is, that can be a fairly profitable niche that pharmacies can get into.

And of course an amazing service that they provide to their community because these patients often are doing without long acting injectables and they're probably the last patients who should be doing without long acting just, I think the innovation for people who are innovative and are looking to grow their [00:40:00] practice, not instead of, in addition to the dispensing of prescriptions, there's just. It's like a buffet. I mean, there's something for everyone, and they can heap as much as they want on their plate. One thing that we do recommend, Mike, is that we, if you're able, and I know it's hard to do this, to free up a staff member, but if you're able to bring a pharmacy member with you, We think that's a really good idea.

So if you're the owner, you come back and you're like sharing all this stuff you want to do, your team's looking at you like know, like you have three heads,

Are we going to do all that? And to have our day job too,

Mike: right.

Douglas Hoey: bring an advocate with you, one of your lieutenants with you, not just you that's, drunk the Kool Aid, it's

Mike: Great idea. 

Douglas Hoey: it's usually a lead technician or a lead pharmacist or, when my folks my dad and my mom would go because she was the, even though she was a school teacher, she was also the bookkeeper and kind of the, the chief thought partner with, with my dad. So, we do recommend that, but the first time we've been in Ohio since 1941, so it's been a few years, been a day or two, and it's the first time we've ever been in Columbus. so we're excited to check out Columbus. I've been there a few times, but we've not hosted a meeting there.

So, we're excited about it. I mean, I think it's going to be a great program. we're going to have some fun stuff there too. Like you mentioned the fun stuff. entertainment. And keynote speakers. one goal of mine with the keynote speakers is if at lunch right after, if I overhear people talking about a point that that speaker made,

Mike: Hmm.

Douglas Hoey: liked that point.

I really hated that point.

Mike: Yes.

Douglas Hoey: thought provoking,

Mike: Yeah,

Douglas Hoey: I'm making the touchdown signal. 

Mike: sure.

Douglas Hoey: what I want. And I think people will leave these sessions, both entertained. And having their thoughts provoked. I mean, I think it'll be thought provoking.

Very cool. Mike, one thing to mention is that it ties into the convention. When PDS exited a few years ago, Pharmacy Development Services, they had some good programs and we felt like when they left that there were some gaps in the marketplace. And so we rolled out the core program. this summer to help kind of fill some of those gaps from a business operations, leadership marketing we have, a couple of the speaker used to do some PDS speaking and so it's not exclusively that, but we thought there's just a need in the marketplace that PDS really did a great job filling that we thought was needed.

So that's the core program. It's rolling out this year. You'll see some reflection of some of the content from the core program, a little bit of that in the convention programming. Again, leadership, marketing, operational issues, financial issues, personnel management, those kinds of things.

You'll see a lot of them. In our convention programming, it's tied together and bundled together in the core program. So if a Listener is like hey, how do I take my to the next level? How do I get out of a rut? That core program is something that might be a good fit for them

Mike: Well, golly, Doug, thanks for your time. I know a lot of the future success of pharmacy, I think goes through DC. So thanks for being there. And I know you're busy.

I know you have a lot going on, so I appreciate it. and our listeners appreciate you joining us.

Douglas Hoey: Yeah, Mike, it's a pleasure. You're right. Uncle Sam is pharmacy's biggest business partner, whether we want them or not. Over 65 percent of our businesses are tied to federal programming. So yeah a lot of pharmacies run through DC and uh, NCPA. There is no place I'd rather be than representing independent pharmacies.

And so, happy to be out there fighting for our members every day.

Mike: Very cool. Thanks, Doug.

Douglas Hoey: Thanks, Mike. 

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