Navigating Legal Minefields for Independent Pharmacies | Dae Lee, PharmD & Adam Farkas, Attys Buchanan Ingersoll & Rooney PC

Mike: Adam and Dae, introduce yourself to our listeners. 

Dae: my name is Dae Lee I'm a pharmacist attorney assisting pharmacies as well as plant sponsors for their dealings against major pharmacy benefit managers. I recently joined Buchanan, , I believe in the first week of January along with my colleagues to better service my clients with a bigger platform.

Adam Farkas: My name is Adam Farkas. I work at Buchanan Ingersoll Rooney along with Day, handle a lot of pharmacy matters, pharmacy board of pharmacy matters as well as really any kind of action involving PBMs on behalf of plan sponsors, really anything prescription drug, industry or supply chain related as well.

Mike: Day, know you, always spoke highly of your former firm, and I know that you've left there, you said a kind of a wider platform, what do you mean by that, 

Dae: provide any services that, whether it be transaction, FDA support even like, trust and estate issues. So, at FireLevitt, which is a great firm it's limited to healthcare and life sciences, but at Buchanan, while we have a deep bench of healthcare and life science attorneys, we have other experts and attorneys who handle, you know, matters for the client. And we also have a government relations team and professional professionals that could help with, introducing bills or supporting bills and directing the notion of the pharmacy industry as well. 

Mike: I tell you dad, I learned my lesson years ago. had kind of a family lawyer and I was the guy in charge of all the financial stuff, mainly because my dad and I were part of the pharmacy together and I was the eighth child, but I was kind of the financial guy for him. When he passed and we had our family lawyer do all this stuff and all the all that over the years when he passed a couple of my siblings went off the deep end and Contested all this stuff and I believe that there was some background going on. I don't know exactly what they were, but both of these attorneys, these family attorneys, they both folded.

They both walked away and said, you know, it's too much for us. And then we're left getting a new attorney. Here's the lesson. My lesson is Go with a bigger firm. If you can, even for family stuff, at least go with a place that has some litigation experience, courtroom experience, things like that, because you don't want this happening.

You don't want someone folding on you just because it gets a little bit higher than they're used to. They're comfortable. So that was a lesson I pulled from that. It's like if I do family stuff with attorneys now, it's going to be in a big enough firm where I know that if things get Well, I should say anything.

It's going to be a big enough firm where I know it can keep going up the ladder with more, maybe not more power, but different, different parts of the law and things like that. So there's a free one for the listener. 

Dae: and expert expertise nobody can become, experts in everything. So it's good to good supporting system and, and, group of attorneys who can handle different tasks 

Mike: All right. So Adam and day, what's terrible in the world of pharmacy now? Does your business wanna reach our 500 weekly listeners during this 10 seconds? Head on over to B, find out how. 

Dae: diabetes, as well as weight loss or weight management drugs. And these are Ozempic, Manjaro, ZepBound. They are a hot topic, a hot drug in the market. 

struggling due to the low reimbursement rates. Imposed upon by pharmacy benefit managers, so many of them have tried to create another source of revenue, including compounding and GLP ones, they have been a very, very, very hot topic and key revenue source for a number of pharmacies. Now, the FDA has taken it. There's episode as well as off of the shortage and now a lot of 503 compounding pharmacies are, in a some sort of a unique situation where know what to do at the same time, I believe, as early as week or even today, no vote, nor does the manufacturer of semaglutide product started sending out cease and desist letters. to 5 0 3 a compounding pharmacies indicating that, Hey, you should stop, we are ing you to stop compounding or purchasing from 5 0 3 Bs and then dispensing it to the end users who are patients the State Board of Pharmacy regulations, and they can only compound prescriptions pursuant to, patient specific individual prescription 0 3 B. Outsourcing facilities are outsourcing facilities that meet the CGMP standards and, they can mass produce drugs that are on shortage list. Both the Stemaglutide, Teriparatide Zompig, Manjaro and ZepBound products were on the shortage list. FDA has taken off of the shortage list. So. FDA is allowing for terzepatide to continue compounding, well, the date was already passed, but February 18th, or until the district court decision on the OFA versus FDA case, the preliminary injunction is issued, whichever is longer. So right now, the case is still pending. The Outsourcing Facility Association filed a lawsuit against FDA. know and as for preliminary injunction, the case is still pending. So five or three a. can still continue to compound and FDA will not exercise its enforcement authority on them. However, again, that doesn't mean that the 503A compounding pharmacies are off the hook. compounding pharmacies must be cognizant of the state for the pharmacy regulation, but also potential legal action risk from the manufacturers.

Mike: And for 503Bs, You the FDA said they're not going to exercise this enforcement authority until March 19 until the district court's decision on the preliminary injunction motion, whichever is longer. As for the semaglutide, FDA recently, like just recently in the past couple of weeks, took it off of the shortage list. So the FDA said for 503As. you have until April 22nd. For 503Bs, you have until May 22nd. So what does this mean? So there are certain, I guess, potential deadlines for 503Bs, continue their compounding practice for compounds in both compounds that have um, interzeptide. but I'm not sure whether any of them are actually going to stop. compounding pending the O. F. A. versus F. D. A. lawsuit. mean, D. A. has come out and said, Hey, there is no shortage of semaglutide However, that's not what I'm hearing on the street per se, you know, pharmacies are still getting prescriptions of compounded products and patients are having trouble accessing the medication. So there are a couple of reasons why I don't think the shortage has been resolved. Because number one, I don't think the manufacturers are able to, at least at this Right. And also in the event of that prescription, let's say they meet the demands. Then we have to really think about the reimbursement rate because if you receive Mozambique or Manjaro granted medication prescription, you have to go to a pharmacy and that pharmacy must carry that product. And then that pharmacy can dispense it, but many times the pharmacies lose money because the reimbursement rate is below the acquisition cost of the product then if they refuse to fill it or if they don't have the stop, you know, in place, then, the prescription has to go to another pharmacy. And then, of course, the assumption is that the patient, insurance or benefits of the GLP 1. And I believe Lilly recently came out with, like, their step down direct to consumer model, which is about I want to say 499, 499, but, there are much cheaper compounded versions out there. 

All right, Dave. Thanks for your opinion on that. But who cares? I mean, you don't just get to decide what you think is right. Aren't we waiting for law to come out and say this, or does it matter what your opinion on this is?

Mike: service and making sure patients have access to the drug. Decided that, shortage no longer exists and the FDA has given firm deadlines to both 503A compounding pharmacies as well as 503B outsourcing facilities. That is the FDA stance and we'll also have to look into the state board of pharmacy stance on whether a 503A compounding pharmacy or outsourcing facility in that state can continue to compound or, they have to stop per the FDA. And of course, as I mentioned before, These compounders have to be aware of potential legal action risk from the manufacturers. 

If someone says, I'm going to keep doing it because you know, the opinion is stuff like they said about, is it available? How are the copays things like that? But if the FDA goes down and says it's not allowable, it's not like they get to go to the FDA and say, well, here's my opinion on it.

Mike: Right. I mean, isn't the rule just going to come down and they don't really care what anybody thinks.

Dae: come out and said that for 503A compounding pharmacies, has out and said 503A compounding pharmacies may continue to compound until the court renders any decision 

on the pending lawsuit. 

Mike: was your opinion on which way you think the court should go.

Gotcha.

Adam Farkas: Thank you.

Dae: they're not going to, face any legal or the state board of pharmacy may say, Hey, you, in our state, we're not going to allow you to continue compounding terms of the type.

Adam Farkas: right, were several states that signed onto a letter to the FDA. Talking about compounding GLP ones and specifically how it's still relatively new. A lot of unlicensed unregistered facilities are getting involved in it.

And selling these products across state lines. So it's definitely getting the attention of not only the FDA, but also state boards. it's something definitely worthwhile to pay attention to.

Adam, is that something that they're saying, because this is happening, you know, established pharmacies do it? Or does that give credence to just saying, because this is happening, let's just get this back to the manufacturers? 

I don't think it's either. I think it was kind of the state A. G. saying, you know, this is a big problem that we have going on right now that a lot of pharmacies, companies, industries are just involved in compounding these products without a

Adam Farkas: regulation in it,

they were asking for, you know, the FDA. DOJ whoever it may be to kind of crack down on enforcement

but yeah, so that's just another angle another risk I guess, along with any manufacturer actions that you know

Mike: should be paying attention to 

When I was younger and as wise or maybe wiser than I am now. a law would come down and I always thought, well, that's, that's the rule. that's what it is, but I guess that's where all the judges, I mean, you watch TV, the judge kind of sits back and scratches his goatee and makes this wonderful, personal decision.

Mike: It's none of that. I've been in court, you know, when they make a decision there, they're just talking about. Case versus case versus case. You know, then they're, they're saying because of this, we're going to do this. And they mentioned all these, Smith versus Jones and Brown versus Johnson, that kind of thing.

And so laws are there, the interpretation, and then the core precedence. Of the cases often accompanies that. So it's like, well, what did they mean by this event? And until it's tried, sometimes you don't know exactly what something means. 

Adam Farkas: Yeah, I mean I'm trying to process like what was just said there because I know the first thing he said was talking about a judge and how there's no personal nature to it and I mean, I'm not a litigator. I'm not in court all the time,

I know, you know, this is just a personal story, but my mom. Is a litigator and when I went to law school one of like the first lessons that she gave me and I still think of it often today when we're working on whatever matter it may be the first judge that she ever interned for her like you decide what is right based on whatever case is going on and then you find me the law that allows me to do it so know, I,

that story, and I also think it kind of fits in with what you're saying, you know, Smith vs.

Jones, Jane Doe vs. John Doe, whoever it may be, kind of like taking all of those different pieces and just putting it together to what you want to rule,

Mike: see. So in other words, I think there may be cases one, two, three, and four, but they're really saying one, three, five, and seven, I mean, the ones between those, they. Could have just as well quoted those probably for the opposite opinion in the court.

Adam Farkas: right,

I mean Yeah, you can feel free to disagree, but I really think you could probably go find any case or any law to really stand for, like, almost any position that you want, and then another one standing for the exact opposite.

Mike: I should have learned that from my wife. I'll say something. And she's like, you can, you can read anything you want to. And it's like that, the response from her has shot me down so many times. I don't even try anymore. All right. So the weight loss drugs, that's hot. What else is hot going on right now?

Dae: Well, independent pharmacies, as we know, are a cornerstone of the healthcare system. But for the past couple of years, including this year, they have struggled, struggled a lot. Okay. Because of the below water reimbursement rates. And PBMs are the ones actually, major PBMs, the traditional PBMs are the ones who are setting up the reimbursement rates. As they're the middleman, they sit in between the pharmacy and the client sponsor. They manage and administer all those claims. At the same time, everything is happening, they are perfect, they're about to perfect the vertical integration model. Where everything is under one umbrella, whether it be plan, plan sponsor, PBM, rebate aggregator, specialty pharmacy, mail order pharmacy, retail pharmacy, and even physician groups, So, the vertical integration is, is almost done, in my opinion. Because of the power of this vertical integration, now, there's more opaqueness in the system. So, plant sponsors, they don't have visibility into what the pharmacies are getting reimbursed. sponsors don't have any visibility into, or limited visibility into the rebates that are being collected by the rebate aggregators owned by the PBMs. plant sponsors don't have

into the fees paid by the manufacturers to the rebate aggregators or So all these, mushed together allows PBMs to charge plant sponsors with, higher fee pay lower fee to the independent pharmacies, independent pharmacies have been suffering, at the same time. There's a lot of legislator actions or supports, right, to regulate PBMs. I think we're in the thick of it, and PBMs know it. They know they're getting a lot of attention from the Congress level, the state level, or even the grassroots level, or at the plan sponsor level. And Unfortunately, it's backfiring. There's a lot more audit scrutiny by the PVMs upon the pharmacies. More investigations. And , they're terminating pharmacies left and right because they have to, profit. All these PVMs are part of the traded companies.  

All these are backfiring at the pharmacies, but a positive outlook and I think, we will, maybe at the end of this year or next year, there will be more positive changes to the pharmacy industry that will better service or serve independent pharmacies.

Mike: All right. Here's my beef day. Implemented a bunch of laws like the beginning of this year, maybe last year, I forget, and some aren't going into effect for a while. These PBMs don't give a rat's ass about this. And I think it's even a situation in Michigan, not just a law, but I think it's like they get a PBM certificate or something like a permit almost.

But my thought is that they can snub their nose at practically anybody, because how would you like to be the person responsible in Michigan for having, you know, roughly a third. Of the patients overnight, not be able to get their medicine because they're with such and such PBM that have a third of the market and nobody's going to go in and pull that third out. 

Dae: That's kind of my thought on why none of this is being, looked at basically, or, or. Or stopped. 

recent cases where the state agency actually jumped in and then regulated PBMs behavior against independent pharmacies. I don't recall the specific state, but there are, there are a number of states that have cases pending or that have already imposed a restriction on the PBM. So. Thank you. One thing that I want to really emphasize is that pharmacies need to communicate with the state agencies that should regulate PBMs, like, for example, the Department of Insurance and Banking. Most states have those departments and many states have PBM regulation laws. And you have to utilize those state laws against the PBMs and then have the agency actually jump in.

Mike: But I don't think they're going to, it's a third of the market. If they come in and say, you know, shame on this one, you are breaking this law. And the PVM says, so what? And they said, we're going to shut you down. It's like, try it.

You know, you're going to have a third of the residents of Michigan not getting their medicine the next week. I just don't see how they, these laws, how they crack down on them. 

Dae: Adam and I pharmacies, many, many independent pharmacies throughout the country. I mean, independent pharmacies, when they deal with PBMs, where it's literally David and Goliath. In many times, we utilize the state laws, we utilize the federal laws, and then favorable outcomes. in many, many instances, and we've also during that process, we've also, looped in the state agencies or stakeholders which are now investigating the PBMs, regulations and every single PBM, they, they could walk away. Right? So right now there are many smaller, more transparent PBMs in the market, and they are coming up. And so, the field is, I think

I think the field is getting more diverse. so a state doesn't have to rely upon one big PBM. 

Mike: That might be how it happens. So instead of them saying, we don't want to take the brunt of all the constituents saying, why'd you shut down a third of the market? It's like, well, you shut down 10 percent and there's nine other PBMs that you can hop onto fairly easily. So I think that's probably part of that answer.

Adam Farkas: I think as far as enforcing a lot of these state laws, I know like over the summer, I think it was because West Virginia had a few different actions against PBMs. And as far as discipline goes, it's typically not going to be something where they're taking away their 

PBM license or permit or preventing them from being a PBM, it's usually a monetary fine, 

A lot of the time in what Dan and I do, we'll see temporary restraining orders prevent the termination. Granted, that's not from a state agency. 

Adam Farkas: That'll come from like an arbitration board, but a lot of the time it's Not so much shutting down a PBM, a PBM from operating. It's more just some sort of penalty or mandating some action. And then the second the second thing that I was going to mention based off of what Dey said just about how there's so much focus on PBMs and a lot new regulations, you know,

The Senate Finance Committee just released their second interim report.

So Congress is looking into PBMs as well. I was at a conference a few weeks ago, and the focus there was really talking about getting access to insurance data for plan sponsors. But someone on my panel was talking about it more on the medical side where Dan and I really focused on the pharmacy side, but were saying that where we are now in the pharmacy side. It took probably about six, seven years to get there on the medical side with third party administrators who kind of fill the same role as PBMs on the medical side.

and it took like 15 years to get full transparency and regulation on the medical side. And for PBMs, pharmacies were already where they were at like that halfway point only three years in.

So I think that just shows that kind of intense focus there is right now.

Mike: My grandma, God rest her soul, Tilly, but she would say when someone did something to an animal or one of the kids in the neighborhood, she'd say, they ought to string them up by their toes and let everybody take a whack at them. Grandma had some wisdom there, and I think that they've got to put some of these people in jail.

And I'm, I'm not joking about that. I think just like they've done with, back in the days, I don't know, this isn't the same thing, but you know, some of the wall street guys, I think they probably spent a little time. They got to start putting these people in jail because what do I care about? If I'm in the C suite of, of these companies or big stockholders, what do I care if there's some, you know, penalty, I don't.

I don't give a rat's ass about that. You know, I, I can, it's not any shame on me because it's a corporation doing it. There's no embarrassment on me. I think these guys got put in jail. This is kind of a fanciful, kind of a, of a far out question, but would anybody ever serve jail time for, for

any of these laws?

Dae: now, any foreseeable future at the end of the day PBMs, are being regulated pursuant to apolitical federalized state law. And I don't think there's any criminal statute that would actually provide some hook for the government to put any of the executives in jail. The other thing is that,

I'm okay with

money. Everybody got, bills to pay, but there's gotta be some limit to it. on the Sponsors, right, they, you know, self funded employers, they have to themselves. They can't just hand over a blank check to the PBMs. And that's why there are two, you know, lawsuits pending. I mean, one of which was, Johnson and Johnson employee class action case. But that case was dismissed, because of the standing issue, not a lack of merit of the plaintiff's claims. The court allowed the plaintiff to amend the complaint and refile. if that plaintiff's firm files the right plaintiff and it's, they're going to file it again. And there's another copycat case, Wells Fargo case, same thing. A Wells Fargo employee filed a lawsuit against Wells Fargo, alleging that Wells Fargo failed to properly manage the prescription drug benefits. It should be an eye opening case for employers because otherwise, if you don't manage your plan properly, if you don't monitor your PBMs, and if you continue to hand over a blank check, and, and your drug spend goes up, pay beneficiaries, out of pocket, spend goes up, are going to be held accountable. Maybe not definitely civilly. 

Mike: And it brings up the point about Amazon.

I love Amazon and, you know, like everybody here, I even told my wife, when we retire, here's what we're going to do. we're going to move to the cottage. Every morning, I'm going to wake up and think of some gadget I need, you know, something around the house, a new key holder or a new bottle opener or something like that.

That's going to be my morning activity on Amazon. I'm going to be in the hunt and then we're going to have lunch and then happy hour early. I'm not talking about the late happy hour around noon. And then the other excitement of my day is going to be waiting for the Amazon truck to show up.

You know? So that's like, that's all I have to look forward to in my old age anyway. Someone had told me with Amazon, it's like, cause you think about these insurances that PBMs are always talking about, well, you're getting so much off invoice and all this stuff. They don't talk about real numbers. They talk about all this stuff.

But someone told me that Amazon really. Raised the prices of a lot of things because if people sell on Amazon, you can't sell it for less somewhere else. Let's say you sell a 24 pack of pens for $10. Amazon says we're going to sell it for 13 and you can't sell it for 10 anywhere else if it's on our site.

So in theory that's raised up like. All the prices up to 13, they don't tell you that it's come up from 10 where it normally was. I don't know if that's true or not, , it got me thinking about that with the whole discount thing where the brokers go in with a big smile and they say, trust me on this.

And, you know, we're getting a bigger percent off than last year and, and no one does the homework. And that's where some of these. Transparent PBMs are going to come in and hopefully,

that market around a little bit. 

Dae: brokers and it's no secret that they receive incentives from the PBMs that they recommend to the plan sponsor. Some are not. A plan sponsor, I would demand my broker or to sign a conflict disclosure. And I don't think anybody will sign it.

Mike: Alright, so we covered GLP 1s, what the PBMs are up to, what other topics do we need to talk about? 

Dae: I want to talk about ever increasing drug use. And I touched upon it. Yeah, the rebate aggregators,

Caremark owns a rebate aggregator called Zinc, Zinc is in the United States.

define the rebate aggregator, Day. PBM's entire line of business, And the entire line of business will include different plan sponsors. Caremark has Zinc, Optimal Rx has MSR, and Express Script has Accent Health. And it's very interesting to think that, like, these three rebate aggregators actually dominate the market. And smaller PVMs, they can't really negotiate and get rebates directly from the manufacturer without having a contract with these rebate aggregators. And the other thing is, in Ireland, Like, why did they set it up outside of the United States when these claims are all being paid, in the United States for, and dispensed to the U. S. residents. So why are you setting a rebate aggregator outside of the United States? Now, because of the vertical integration, plant sponsors don't have visibility of the total amount of rebates that the PBM actually received. The total amount of rebates that the rebate aggregator actually received, and all the fees and this opaque model, contributes to ever increasing drug spend, higher premium, out of pocket expense. It makes medicines not affordable. To certain group of population, 

Mike: I've said it before, you know, we only do generics at our and have asked me and it's a really pretty simple demonstration. I basically hold up my hand with my five fingers and I say, this is what the brand name costs.

And then one finger is what the generic costs. Everybody who's got their fingers in the pot wants that 500 in there. Instead of just a hundred dollars and with 500, you can make everybody feel good. You know, Hey, here's a hundred dollars back to the plan sponsor. And look what we, you know, we got this back to you.

And then, you know, here's some money here and here's some money there. And the PBN ends up with, you know, 300, something like that. no one's talking about the, you know, the hundred dollar part. So it's crazy, talking about legal stuff in the courts and all that. Where's the FTC right now?

 What's going on with that? I know some of the PBMs got their hands slapped for not giving enough information soon enough and so on.

Adam Farkas: Yeah, so the FTC has been investigating PBMs and their rebate aggregators for, I mean, for the better part of 2024. They released their first interim report over the summer. Their second interim report just came out in January. That second report was really focused more on specialty generics, cost of specialty generics, how those prices are really, really going through the roof right now. 

A lot of what that report focused on was looking at NADAC and acquisition costs for

Looking at their reimbursement rates, and then how much PBMs are charging plans above NADAC. and the difference in reimbursement between independent pharmacies compared to PBM affiliated pharmacies. Patient steering practices to those PBM affiliated pharmacies and really dove into mail order pharmacies, which I think is becoming a bigger issue, for plans and independent pharmacies alike, because. These PBMs are mandating that certain drugs, specifically specialty drugs, which are the most profitable, a lot of the time, to be filled exclusively through their affiliated mail order pharmacies.

This is going to cost patients, pharmacies, and plans. A lot more in the long run all while the PBM is going to be profiting more because PBMs are able to, you know, fluctuate mail

to their own mail order pharmacy interim reports are so important because really just getting knowledge and information out there 

I don't know how many lay people really know what a pharmacy benefits manager is Who their pharmacy benefits manager is but the more that it's in the news the more that it's Spoken about I think the more problems will be solved

Mike: The whole FTC thing, I do like that kind of because ain't no genius of this and I've had a lot smarter people on the show than I, I know about this, but the whole thing when I was a kid of, you know, AT&T breaking up and all that monopoly stuff. I mean, that stuff. Can be done with a stroke of a pen that doesn't take all this You know court tied up at the supreme court all that kind of stuff. 

Dae: Recently the judge dismissed the PBMs motion for preliminary injunction against the FTC. immediately, um, appeal that decision. So, they're fighting, they're fighting FTC and PBNs.

Mike: There's always talk about Trump doing this or that, people can do stuff pretty quickly, but whether they do it or not, it's another 

story. 

Dae: as well as the former administration, is looking into regulating PBMs more, making the drugs affordable, holding PBMs accountable for ever increasing drug spend. 

Mike: Well, the proof's always in the pudding, but unfortunately, there's so many layers and so much power there that if they, I like to say, yeah, just look at what the consumers are paying, but that doesn't help the pharmacies from not being reimbursed underwater and things like that. And I don't think anybody gives too much of a care of. 

Dae: All the ins and outs, as long as the consumers are getting decent prices. So, yeah, it's, there's a lot, but you know, that doesn't mean you stop. They are facing higher premiums, higher out of pocket costs, like, copay, deductible, co insurance, whatsoever. It's all the drug debt. PBMs should take a lot of responsibility for the whole phenomenon, or the trend.

Mike: I've had Kyle McCormick on the show a couple times from, a few times from Blueberry Pharmacy, and we've talked, and it seems like, and I've heard this before, it's like, you don't use car insurance to buy Windshield wiper fluid. Alright, I've gotta confess. You guys just seem to pull this out of me.

winter, I've been driving around with this Michigan crap on my windows. You know, all the salt and all that. I told my wife, I said, Listen, you can press this thing here, the button, and it goes, you know, like a, you know, the pump going, and it's supposed to be coming out the back, supposed to be coming out the front, and I'm like, That stuff must've frozen there. So I wait until it's a little bit warmer. I bought some of this orange Preston windshield wiper fluid. It's supposed to melt this and go down this and not freeze things. And so I'm at home and I'm pouring this stuff into the windshield wiper fluid.

I go to close it and it says antifreeze. And so I was pouring the. wiper fluid into the antifreeze all winter. And it was a cheap fix. I was, I had to go over about three feet and start pouring it into the windshield wiper container and it worked fine. And so on that topic, I don't use the insurance to pay for my Preston, you know, windshield wiper fluid or replace. wiper blades or new tires and things like that. And so Kyle and I were talking, it's like letting people lose their special prescription cards and let them shop the best deal.

If they want to get something cheaper, but maybe not get the service fine. If they want to go someplace, that's. 10, 20 percent more and want to get better service or want to buy an annual membership at a pharmacy, things like that. Whatever the delineation is there, it's like, well, maybe that one finger thing is under this cash prescription card and you're not even thinking about the five fingered one. And so, PBM doesn't want that. they want their nose in about everything though.

Dae: and, many times they even want to see the cash claims on the data. I believe a number of switch companies are also the company that relays a claim submitted by the pharmacy to the PBM or the, to the plant through the PBM. So they see, top to bottom of a prescription drug claim. 

Mike: Adam, how long have you been in the pharmacy venue of law?

Adam Farkas: Since january 2021 

Mike: I don't see much gray hair or anything like that. You still seem pretty much enthused.

Adam Farkas: you just didn't see me before 2021

I got married in October and I've been with my now wife for 10 years, and One of our decorations going up the stairs was a picture of us When we started dating in 2014, and then 15, 16, 17, and so on. I can really just see, like in 2019 when I got to law school, There's a big change in the bags under my eyes.

Mike: Sure. like the presidents. I mean, they talk about presidents being in there and you look at them and I, some of them have been there eight years, but you look at pre-prescriptions and posts, but found out that gray hair is really caused by stress. There's a lot of myths about health and things like that, but they do say gray hair can be related to that.

Something about the, I don't know, steroids in your, yeah. Scalp, I don't know what it was from but yeah stress does its role on it, but the point is I guess you're in a good Part of the field because there's always issues I mean, no one's real happy. And so you might as well be somewhere, in pharmacy rather than Floral design or something like that.

I mean be in a place that a lot of people They're at the end of their rope sort of on things

Adam Farkas: Yeah, I mean, it was definitely not something that I was aware of, before kind of starting to work with day, and getting exposure to it, but it's a really interesting field. It's a really hot topic and I think 1 of the things that I really enjoy about it is, I've noticed that pharmacy is really just kind of the backdrop of it all like the

I mean as far as our day to day goes when we're a PBM audit or a termination we're really just you know it's like contract law a lot of the time you're looking at what the says or It might turn into some form of like litigation where you're looking up

and trying to argue, advocate for a position. So it's nice to get all these different types of exposure, you know, it's just pharmacy as the backdrop.

Mike: Well when push comes to shove, I mean There's the stuff that we've been talking about the higher level stuff when it really comes down to it though it's what's the pharmacy getting paid for this and What are they able to do within the contract or you know? What are they getting in trouble for it all it all comes down really to what you guys are doing there on the day to day level 

Dae: We not only take Our job seriously, but We view ourselves as the protector of our clients, right? Our clients are, many of them are mom and pop independent pharmacy owners. They've been in the business many, many years. Some of them want to hand over their business to their children who may also have become pharmacists. And so we take it very seriously. We want to protect their interest. If we're not successful, if we don't do our job, you know, pharmacies, lose contracts, PBM contracts. And, you know, pharmacies go out of business. So we view, ourselves as, last resort for the pharmacies 

Adam Farkas: it's something that I really do take a lot of pride on, and I try my best to, you know, relay or give this impression to all of our clients, I don't want them to think that I, that I would ever view them as just another client, because I know in the back of my mind, like, this is their livelihood, like,

to them, so yeah, it's a lot of responsibility, but it's something that we do take really seriously and something that we fight really hard to protect.

Mike: So guys in, in closing here, someone's listening to this or pulling up to the pharmacy. What's something they could do in a minute before they go into their pharmacy, whether it's signing up for something online, checking something out, what would be their next step?

Dae: A our firm's website, but on LinkedIn and other social media. So if you want to be, if you want to read any additional materials, feel free to check out our website as well as LinkedIn and other social media profiles, but also feel free to contact us, we pick up our phone, respond to emails, as soon as possible, but no later than 12 hours.

Mike: Adam and Day, golly, nice seeing you guys. Thanks for the update. It's fun talking to the politicians and maybe some of the businesses that have these kinds of visions and things like that. But it's the pharmacists that are in the battle and it's you guys in the daily battle, seeing what they're going through and helping them out at that level.

so keep doing what you're doing a pleasure to meet you, Adam, and to have you on again, day

Adam Farkas: Yep. Thanks for having us, Mike. 

Mike: You've been listening to The Business of Pharmacy Podcast with me, your host, Mike Kelzer. Please subscribe for all future episodes.