On Being the CEO of APhA | Scott Knoer, PharmD, CEO, American Pharmacists Assoc.

Transcript Disclaimer: This transcript is generated using speech-to-text technology and is intended to capture the essence of the conversation. However, please note that it may contain multiple spelling errors and inaccuracies. It should not be relied upon as an exact or comprehensive record of the discussion.

Mike Koelzer, Host: [00:00:00] Well, hello, Scott, how you 

Scott Knoer, PharmD: doing? Good. Good. Doing well, doing well for those 

Mike Koelzer, Host: That hasn't come across you yet tell our listeners who you are. And why are we 

Scott Knoer, PharmD: talking today? I'm Scott Knoer and I'm, uh, for the last two and a half months, I'm the CEO of the American Pharmacist Association. Do you still feel like you're a newbie?

Yeah. You know, and it's interesting Mike that you ask because, uh, I've always been incredibly active in professional organizations, but because. Uh, before I was here, I was, uh, the chief pharmacy officer at Cleveland clinic. And, my whole world has been in the hospital world. I always paid my dues to a PHA cuz I thought that was important as an umbrella organization.

But, uh, this was not my professional home. You only get so much volunteer time and, and other organizations where I spent the majority of my time. So I'm learning a lot, you know, I'm learning about a PHA, uh, and uh, I've learned a lot in the last two and a half months, but there's a lot more to learn when I 

Mike Koelzer, Host: talked to Michael ho the other.

Day. He was talking about a three year term of the presidency, basically, maybe the vice presidency and the year after. Do you get anything like that or, or do you just come in and they say, 

Scott Knoer, PharmD: here you go, Scott. . Yeah. Well, it's more like, here you go. And, and I guess Mike, the good news is the, you know, the, the fire hose water still tastes good, but no, you know, so that's like, so you have employed folks like me.

Okay. I'm paid full time. This is my day job. And Michael's a volunteer and the president's and that's pretty standard through your term, your president elect. President immediate past president, kinda like the military, right? C one do one teach one, but me it's like, here you go. I did have some overlaps.

So Tom GaN, uh, I'm the 13th, uh, CEO, uh, of a PHA. We're gonna make that lucky 13. Yeah. Uh, you know, but Tom was here for, uh, you know, roughly a decade. I don't know exactly how long and we had some overlap, you know, we had a month together, uh, where, you know, it's gonna be warm handoffs where Tom would connect me with all of his, uh, contacts he's developed over the years.

I, I'd call him Luke warm handoffs, you know? Cause, uh, they're more like this, everything through zoom, meaning so a month and you know, Tom's great if I need, if I have questions he can call, um, I can call him and, and you know, he's a, he's a good guy, but no, it's pretty much, uh, here you go. And, you know, throw a pandemic on top of it.

Mike Koelzer, Host: What does your day look like now? What time do you get up? And how much time are you in front of the computer screen versus talking to people and things like that. 

Scott Knoer, PharmD: Yeah. Uh, Uh, in front of the computer screen too much, but I, I, you know, uh, Mike, I work a lot and you know, when you start a new job, you expect and you gotta put in your time.

I hope in a year, certainly in two years, I'm not working the kind of hours I am now. Uh, but you know, I have to this morning. I got up at five and, uh, Fortunately, we got a small fitness center at a PHA headquarters and I got a little shower there. So I was up and probably by five 30, I was in and worked out till about 5 45, took a shower till probably six 15.

And, uh, you know, Mike, I don't think you've ever been to a PHA headquarters. I was there 

Mike Koelzer, Host: probably 20 years ago for a one day marketing 

Scott Knoer, PharmD: thing. The original sort of Mar marble building, you know, was designed by the same architect, uh, Pope that designed the. The Jefferson Memorial and the national archives.

Uh, yeah, so it's super cool. And you walk in there's all marble and statues and, uh, and you know, just really, uh, speaks to the, the history of the profession, the new building, which again, don't they had a building there before, you know, it got torn down, they built new and John GS, who was, uh, three CEOs, uh, ago, uh, you know, got that bill, which you can imagine is the only privately owned building on the national ball and the red tape.

He had to go through to get it built, but it's, you know, so you got the, the dichotomy there, you got the old building, which is fantastic. Uh, and then you got the new building, which is pretty modern and, you know, it's got, it's very open and natural light, but I tell you what, I'm the luckiest guy in the world for my view.

So from my office and we have a big patio, it's. There's a setback. The building's actually six stories, but there was a rule that you couldn't see the six story. So this, the five stories are then my floor is setback, so you can't see it from the street. But because of that, we got a ginormous patio and we actually rented out for weddings and we rented out the chamber of commerce for the 4th of July for the fireworks, but it, so I'm, I'm, I'm, I've got this beautiful patio and I swear to God, I look directly at the Lincoln Memorial, straight out.

I turn my head left and I look at the Washington monument and I can see the capital. So every day, unless it's raining and I haven't had a winter here yet, I go out, I have a cup of coffee for five minutes, and I just appreciate, uh, you know, the, the incredible opportunity I've got to do. Good. And I'm gonna leverage this platform to my last breath and do absolutely everything I can to advance pharmacy.

And, you know, Mike, when I. When I start thinking I'm having a bad day or I feel sorry for myself, cuz I started a new job, uh, during COVID I look at the Lincoln Memorial and I'm like, you know what? Lincoln has a civil war. That was a lot worse. I look over [00:05:00] there at the Washington monument. I'm like, okay, independence, war for independence.

And you know, it is not a good thing to have a pandemic, but it could be a lot worse. It really puts things in perspective. So I appreciate that of you every day. Uh, Joe Janelle, the CFO and I, uh, go, we have a cup of coffee, we get energized and, and we hit it hard. 

Mike Koelzer, Host: I'm gonna cut the day down. I'm sure there's more than this.

Let's say that you have three options. You've got a computer, you've got individual meetings and then you've got meetings with more than. One person. Are there a lot of different parts of the day too? Or are those your main 

Scott Knoer, PharmD: three things? Yeah, it's almost all meetings. I mean, almost, almost all I do. Every half hour of my life is scheduled.

I've got fortunately a full time administrative assistant, Kathy, who is a very good babysitter. Uh, she keeps me on track. She's the one that scheduled this interview. I could not, and I, she won't let me touch my calendar. She's like for God's sake, you'll just screw it up. So anyone wants me, I'm like, okay, I CC Kathy, cuz I will just, I will mess it up.

Uh, yeah, but I live my life in half hour increments and most of 'em now are zoom meetings or zoom or Skype with one person or usually more than one. Boy today I met with, so all the, the folks I mess with the acronym, uh, but the, the federal forces, you know, we have army Navy. So I met with all the chiefs of those, uh, for a half hour.

I met today with the entire board of BPS, our, uh, board certification group, uh, you know, folks from all over the country. Uh, you know, a lot of it's with advocacy groups. We have a coalition of people. I do have one on ones, you know, I met with, uh, uh, some executives from, uh, uh, one of the buying groups. Uh, yesterday I had a meeting with one of them. I was really excited cuz it was the, I thought it was the commissioner for the federal trade commission, turns out there's six, but I got one of them, you know?

So one of the commissioners and we talked, we, you know, so, you know, advocacy's a big part. We talked about the problems with vertical integration because you know, now the insurance companies own the PBMs, own the pharmacies and now they're starting their own buying groups and that crushes competitions.

It should be competitions, competition, singular, uh, you know, absolutely a PBM should not be able to own pharmacies. Uh, you know, and we talked about all those issues. So I'm constantly, I would love nothing more than to break up the oligopolies, but Carter is the only pharmacist in Congress and, you know, and, and, uh, had a pack meeting with him, you know?

So I, I know there's some one on ones, a lot of groups. How would 

Mike Koelzer, Host: Have you done all this without zooming? Would you be bopping around to all these buildings or would some of them be coming to you? It sounds like you're able to probably put in about an extra 30% of meetings that you couldn't without. COVID 

Scott Knoer, PharmD: almost, you know, that there's some truth to that.

Uh, you know, and, and obviously there's a, there's a balance because I'm a relationship guy, Mike, and you build relationships better when you have in person means, but we can't do that. Uh, you know, so it just takes it longer to do, but, you know, I. I tell you the one thing I've really been able to focus on the job.

I would've been, not only that, Mike, the travel would've been crazy. Okay. Cuz there are a lot of meetings and, and right now I'm new. So I'm really trying to get me. I mean, I would've had, I don't know how many meetings out of town travel, uh, and for instance, all the states, you know, have state meetings.

Yeah. I've already given the keynote, which is great. They, they're interested in what they have to say right away. I did tri-state Washington and Montana. Uh, they did it together and then I did Tennessee with myco and then, uh, I've got on deck. I've got not in this order. I've got Iowa, Oregon.

Minnesota. And they have a combined meeting for, uh, Missouri and Illinois. I've got a talk I'm given in Abu Dhabi, uh, uh, it'll be broadcast in Abu Dhabi. I'm not given an Abu Dhabi. Uh, you know, so I mean, there's a tremendous amount of, of meetings and see I've recorded. Countless, um, podcasts, uh, you know, with our students, I've done webinars, you know, so the communications part of it is absolutely huge.

And I hate to say no, you know, we got an audience that is interested in what a PHA is doing. Right. Um, I'm gonna try real hard to take advantage of that. So thank you for what we're doing today. 

Mike Koelzer, Host: Do you have a bunch of stuff at night? Like at 7:00 PM, they're gonna have this function. Are they meeting still or are they like award banquet stuff 

Scott Knoer, PharmD: or whatever, you know, usually, absolutely.

Now tonight, it's 7 : 26. And we started at seven and we'll go to eight 30 and I had another recording. I did yesterday. I, I, God, I swear to God, I can't remember what I had for breakfast this morning, Mike, but, uh, oh yeah. It was an interview with one of our past student national presidents and, you know, interviewed me to go to the pharmacy today and, and online about leadership for students.

So there's almost never a week when there's not something in the evenings. At least I'm not getting fat. Cuz a lot of times there'd usually be meals, you know? So I'm, I'm cutting down on calories. They would have something almost every night. I don't know about it. Some weeks there'd be something every night.

But usually I'd say there's probably something at least once, once a week, you know where, where you gotta do something, Mike, it's kind of funny. Cuz the same thing happened at Cleveland clinic. I talk a lot about leadership. I mannered a lot of people and [00:10:00] invariably now millennials, uh, one of the first things they always want to ask is about work life balance, you know?

Yeah. And I tell 'em well, um, I prefer to call it work life integration. Yeah. Cause I call it balance. You say, oh my God, this my God. Sure. No balance, but I'm sure I have a couple friends who aren't Pharmac. Not many, you know, but, but, but I got relationships around the world, you know, very close. So my job, I was the chief pharmacy officer at Cleveland clinic for nine years.

That was my identity, my life revolved around that. Fortunately, those friendships transfer. I am the CEO of a PhD. I cannot separate myself from that. And I don't wanna, I mean, it's, it's who IM no, if you 

enjoy 

Mike Koelzer, Host: You don't, yeah. You, the head of the Cleveland, you're gonna be to hundreds of thousands of people this year, you know, talking to classes and schools and this kind of stuff.

How many people? Heard your voice back at the 

Scott Knoer, PharmD: Cleveland clinic? Well, that's an interesting question. You meant this, but you know, for listeners, I'm sure they understand. I was the head of pharmacy at the Cleveland clinic. I wasn't the head of Cleveland clinic. I like that we made a lot more money, you know, but you know, so this is interesting. Mike, you know, I wasn't looking for a job.

I wasn't looking for a job in the clinic called I wasn't looking for a job when a PHA called, but one of the things I enjoyed most, and I think, you know, I, I think I did better than most is I leveraged, you know, Cleveland clinic they're internationally recognized and they have us news and world reports.

The worst we were ever is number four, we were number two, a couple years ago. They just got their ratings a month ago. And they're number two. I think Mayo is number one. The, you know, Mayo has kind of been one and. They're a pretty big gap. And then two, three, and four and five, they changed mass generals in their hop and they all bounced around.

So Toby Cosgrove was the CEO. A man I tremendously admire, uh, he retired about two years ago at Cleveland clinic is a physician leader and oh my God, I learned, but he's probably the best known CEO and health systems in the last 20 years. And to. You know, he was in the media all the time. Cuz everyone, again, people wanna know what the Cleveland clinic thought and you couldn't turn on a Sunday talk show without him talking about one time I've turned on Toby, Karos talking about Ebola.

I'm looking like, did we have any Ebola cases? Like, no. I'm like, but he is still talking about Ebola. I'm talking about it. Yeah. So Toby used to call me because someone would wanna talk about drug prices. So he'd call me, I'd prep him. And then at some point he's like just Scott, take it. I got too much going on.

So Toby let me and most people can't, I mean, it takes an act to God to speak for your organization. Yeah. You know, so I was given that, I mean, not a right, but that, uh, I don't know what the right word is that privilege, you know, uh, knowing that if I overstep my bones, it would be taken away and, and, and Mike is kind of an interesting story.

Egregious drug prices have been around for a while. And the, the first real real example, I got a lot of media attention before pharma bro with Derem and 5000%. Yeah. Right, right. Nitropress side and ISO Perol. Uh, drugs that were generic, they've been around literally as long as dirt. I mean, they're just, I mean, they've been, you know, a hundred years, these things been around and what happened is when, when a drug is new, you know, it's brand name and they have a patent, which is good because manufacturers, you know, they, they know they make money and then they have the first generic is the six month exclusivity.

So prices come down a little bit and then they open it up and everybody starts making and prices just drop. So generics have been one of the best things to bring drug costs down. But what happens is you got some predatory, uh, manufacturers who they're, they're looking around, they're going, you know, what.

There's only one company making this. So while technically anyone can make it, no, one's got idle manufacturing capacity, right? They're they're making everything. So they'd have to stop making something, get an NDA, you know, go through, you know, spend money ahead of time and, and ramp. It would take a couple years to make it.

So they're basically saying we have a monopoly temporarily, so they would buy that drug and Jack the price up. And here it was, I don't, I think don't quote me. I'm not really good at quotes, but directionally I'm 800% accurate. And, uh, so, so I got a call from ed Silverman who was at the wall street journal at the time.

And, uh, you know, it used to be media relations. They'd want, like I got Frank on the call here. Just make sure I don't say something stupid. usually he'd be in the office. You could step on my toe, you know, but he's just virtually, so it used to be communications that sit on that make, but then, then I earned again, the privilege to talk and, and he called, he said, Scott, have you seen.

Prices have increased in these hospitals and Cleveland clinics for the last 26 years, 27 maybe has been the number one heart hospital in the US news and world report. So it was in their cardiac drugs. So we used, we had, you know, the main hospital is 1300, some beds, big hospital, number one, heart ho. So we used probably more than any other hospital, but, and again, don't quote me.

I, I said, ed, I did the math and Jeff Rosner. My purchasing guy got me all the numbers. He was my peripheral brain and we said something like ed, [00:15:00] if we use the exact same amount of Nitropress and Arian. This year, as we did last year, it would cost us one hospital, grant a big hospital, six and a half million dollars, multiply that, you know, by all the hospitals and, oh my God, that, that, and those guys were, they were good writers.

They were actually runners up for a pure prize and explanatory writing. Yeah. You know, so it was really good and it got a lot of traction. And so Mike, when I talk about leadership to, to, to students and all, I talk about some. Universal TRUS and my residents get, you know, they gimme a hard time. They call Scott isms but two of those are, have a bias free us cuz before me and all my other CPO chief Pharmacy officer buddies, we were bitching to each other.

It's like, can you believe that we're getting screwed? We felt helpless. We couldn't do anything. Reporter calls. I'm like, oh, you know, do I wanna talk to him? My communications person said, do you wanna talk to him? I'm like, yeah. You know, let's get the story out. And uh, and then the second part of the Scott ism has a bias for yes.

And then success breeds success. So after that, oh my God reporters saw in the wall street journal, Washington post New York time, every major periodical. And now my friend Aaron Fox, who, uh, if you've never talked to at university of Utah is, is a genius. She's the best in the world, drug shortages. She was, uh, quoted in there too.

We didn't know each other since then when we came to the tag team. So when you asked about my reach, I actually had. With Aaron and myself and, and, and, maybe Antonio Chacha at the Ohio Pharmacy association, cuz the data, you know, he gets, and now he's more of a drug price expert by far than I am. I was one of the primary voices in the media all over the 

Mike Koelzer, Host: country because you were in 

Scott Knoer, PharmD: the news then.

Yeah. And then, you know, it's interesting. Because one of my mentors, I don't know if you know who Bill Zelmer is. He was a longtime chief editor for the American journal of health system pharmacy. One of the best pharmacy writers and a historian, still a close friend. I remember Bill called me after that and he said, Scott, and this is where it kind of sank.

And he said, Scott. This is the first time I can remember. And Bill's been around, he's retired, he's been retired for it's one of those guys that does more in retirement than most people do. And he said, this is the first time I can remember where there's a major issue about medications. And it was a pharmacist instead of a physician that talked about it.

So you want, you know, he said, I wanna commend you because you brought pharmacy to the forefront on Medi, which we're the medication experts, you know, we should be doing it. So back to the question about reach, I had a pretty big reach and, and I learned Mike, and it's still the same. No one cares what Scott Canor thinks.

You know, I'm not full of myself. Everyone cared what the chief pharmacy officer at the Cleveland clinic thought because it was a nationally recognized organization. Same thing at a PHA. No one gives a rat's butt about what Scott, but people wanna. What the chief executive officer, the American pharmacist association thinks.

So I, with my background and my ability to sort of amplify my voice and media, I mean, we're just gonna blow it outta water here. Right? I'm gonna use this pulpit to the best of my ability for the good of our patients. And, uh, that's why I don't turn down a podcast or a student or a media outlet, getting your 

Mike Koelzer, Host: voice out.

Did that get you this 

Scott Knoer, PharmD: job? Oh yeah, no doubt about it. Again. I was, I was content. I didn't realize that Mike was kind of bored. Yeah. I got about a 10 year shelf life. I was at the University of Minnesota medical center and you know, it was a, it was a fixer upper. I mean, I was the fifth director in six years.

We got going and ran like a top nationally recognized clinic. I'm like, oh, you and clinic calls, you answer the phone. And, uh, they recruited me and you know, when I got there, the pharmacy department was a decent pharmacy department, but when I left the pharmacy department was as internationally recognized and appreciated universally as the rest of the clinic.

And that was my goal. But, you know, I mean, I went from having 11 resident to 64. I went from having 300, 285, you know, one month Appe rotations with college pharmacy. 1200 rotations with 27 colleges, as far as we were leaders in IB robotics. And you know, and yet we opened a beautiful specialty pharmacy, but, you know, and I could have done more.

I could open a five, but it's the same stuff, different day, you know? Right. And I got bored and I didn't even realize it was bored when the clinic called, but here's the thing. Well, another one of my, my Scott ism when I'm talking to folks is don't forget where your paycheck comes from. Right? Because a lot of people, the fun stuff is the professional organizations getting beaten down by the man and having budgets and having tried to cut your FTS every year.

That sucks. That's the thing that kills pharmacy chiefs more than anything, because it's just the, you build it and they try to take it away. You know, with that, you know, I tell people, don't forget where your paycheck comes from, because it's great to be in the media. It's great to be given talks all over it.

You know, it's great too, I got invited to the national academies of science, to talk about drug shortages and that's cool, but you know what, if patients didn't get their medications safely and effectively in the clinic, I'd lose my job. So when the clinic called, I. Don't forget your pay. Well, what if my paycheck came from what I enjoy most in the world.

Yeah. And that's driving the profession for it and advocating and not having anyone sort of pull the leash back, you know? [00:20:00] Right. Um, so, and, and so this is what it came down to. Honestly, there were two things I had to meet the board and, uh, and I thought this is a PHA now. Yes. Now they're recruiting me.

They're and it starts, a recruiter calls just gauges your interest. I'm like, well, you know, I'm not looking, but I hadn't thought about that, but you know, we'll talk and, you know, and they're like, oh, damn. You know? And so they, then they had, uh, it was a top secret search committee. Who's who of important people in, in, uh, in, uh, but they, they intentionally didn't wanna know who that was, but, um, you, I got there, I'm like, damn, you know, these are some, some heavy hitters and then you, you get past them.

And then it's the board of directors. Okay. And so the board of directors hired me. And when I met 'em. You know, and you know, every organization needs some change. If everything was going perfect with a PHA and pharmacy, don't hire me. Right. Because I'm not gonna Polish the, the, the windows and that's not me.

It blows it up and fixes it. I mean, if you want a major overhaul drive change, push hard, I'm your guy. So I wanna make sure that my skill set was what they wanted. So I met them and they're like, we want fundamental change. We, we want what you got. It's kind of funny with some personality. You know, you go online and take, and I'm very honest with that stuff.

I'm like, if they, they gotta know what they're getting. Right. Because they're my bosses. If they don't like it. But it's funny cuz Brad Tyson, who is the president, then Michael's the president. Now he showed me the scale when I first went to the PHA headquarters. So here's the chart of, you know, my strengths, you know?

Yeah. There's a line. And he said, and here's what we told because the board all took it. What they wanted. I swear to God, you could have told that lie. That graph right over top of it. It was just, it was exactly. And, but it just happened to be, I'm what they needed. You're the right person at the right time, at the right time for the job.

Right. I would not be the right person in other times. So, is the board gonna be, because I'm gonna mix stuff up, I'm gonna change things and I don't want a board. That's like, oh, that's too much. So meeting them. That's what they wanna do. The other thing I swear to God, this sounds corny Mike, but, but I said, where can I do the most good?

Okay. What platform can I use? That's all. It's about patient care. Okay. I'm a pharmacist. My lens, my getting that done is through pharmacy and pharmacy technicians. So where I was doing, I think a lot of good for society and for patients and advancing practice and you know, expanding pharmacists all over the place in different countries.

And, but I thought, you know what? After I met that board, I said, there's no doubt that if I am driving full time, I can do more here than anywhere else in the world. I'm like, sign me up. And then I'm like, oh, you guys are gonna actually pay me for this. How 

Mike Koelzer, Host: cool is that? So talking about leashes, I was attracted to your message right away.

When I saw something on social media and I said, this doesn't sound like what I've maybe been used to for the last 20 years now, granted, you know, we needed a stronger voice and that's why things have changed and that's why they hired you and so on. But. I was attracted to that. I said, oh, this, this is good.

And it was something where it just didn't sound like something that a president would say in terms of is 

Scott Knoer, PharmD: that when I challenged Larry Merlo to a cage match, Mer, most CVS CVS making 28 and a half million. Yeah, I think it was that 

Mike Koelzer, Host: I don't remember if it was that scenario, but it was something where you were going after him, Scott.

That's why you and I are talking tonight. Cause I'm like, whoa, I gotta talk to this guy, but here's the question you got Frank over there. Who's got this leash on you still. Yeah. Yeah. How far can you go with this stuff? What could you say on social media? That would be too far that would get your hand 

Scott Knoer, PharmD: SLAPP?

Well, that's a great question. And Frank is, yeah, I tease Frank. Frank's my, oh, we like to tease Frank. Yeah. And Frank reports to me. So Frank, you know, doesn't really, I like to exaggerate for effect, but I have 15 bosses. Right. I have the board of directors that hires me and can also fire me. Um, so I have to make sure I'm in line with what they're thinking.

What kinda people are those made up? Oh my God. They're good. You know? I've really come to appreciate a lot of 'em because of the nature here, we got some entrepreneurs, you know, so Brad's done startups, pharmaco, genomics companies, kinda like the, and also like the Uber of MTM, uh, Sandra, uh, you know, works, uh, down in Arizona for symphony RX.

So we got entrepreneurs, uh, there's a toll on pharmacy owners. Uh, Randy McDonough is a pharmacy owner. Alex Vay is a health system executive, uh, in Houston, probably the most like me from my former role, you know, uh, Michael is a Dean and a former pharmacy owner, but I tell you. Wow, smart people, you know, do they run for that position?

They do. It's elected and you know, it's a process. You gotta be involved. You gotta run some committees, then you gotta be on the board or the speaker, the speakers on the board, and then you do a good job. And, you run for president Michael. I swear to God I was born at a [00:25:00] PHA. I mean, he's got a love for it.

Amazing. I talked to him today at a meeting and he was like, I don't even know who was , oh yeah. I knew I, you know, was in a college room maybe. I mean, my God who doesn't, you know, you know, he knows everybody, but they're good and they want change and they're supported now, you got a board, anytime you got a boss, you never want your boss to be blindsided.

Right. So I got 15 of them. I work primarily through my current president, but I have a call every couple weeks with all the presidential officers. Uh, and I have broader meetings with the board. The, um, treasurer is important, you know, because of the money and uh, Greg's a great guy. Uh, but it's relationships, Mike, you know, it's just like with your significant other kids or anyone, you just gotta, it's just relationships.

And I had, you know, interestingly. I had some mentors and I, I called around and I'm like, you know, talking about jobs. Yeah. Now I'm gonna do whatever the heck I want, but I want people's advice. And, and one of the great guys who's been, uh, my mentor, especially whenever I looked at job jobs, you know, he told me Scott, if it was me, him, I would not take that.

And he'd been done. The health system thing he'd been in industry actually ran some PBMs, big ones. And in a smart company, he said, I, I would not wanna report to a board, you know, cause uh, you know, lots of people get sideways with their board. And, and I thought about that cause I really value his opinion and he had great points and I'm glad I thought about it, but I'm like, it's a relationship.

It's all relationships. Just like anything else? You know, I got a couple of 'em that got little worked out. You know, after that, uh, I got a little worked up on Twitter and I, I had something like Larry Lucifer Merlo and, you know, and I think I'm like, well, should I said Baalzebub you know, uh, maybe, maybe that would've been, 

Mike Koelzer, Host: did you 

physically type this in with your own thumb or did Cathy, 

Scott Knoer, PharmD: Cathy would not let me type Larry Lucifer.

So you tapped this in and hit the sun button. Oh, I totally, yeah. Yeah. I mean, my God, the guy is crushing competition and you know, and so in retrospect, I mean, it's fun to be passionate and pushing the envelope, but you know, you delete your message if you're calling people names. Right. You know, so, and, and, and, you know, so, so, but, you know, so I'm out there, there are probably limits to what I should do.

I haven't quite found them yet. Uh, you know, 

Mike Koelzer, Host: That's good to hear. 

Scott Knoer, PharmD: I'm gonna test them cause God knows it's fun to push, you know, here's the deal. Einstein's definition, Sandy, you know what that is? Mike, you do the same thing over 

Mike Koelzer, Host: expecting different 

Scott Knoer, PharmD: results, right? That's what we've been doing in the pharmacy. We don't have provider stats.

We're not getting paid. So the board's like, you know what? We used to be pretty nice folks around here. You know, it's like, uh, Minnesota. Nice. You know, and where did that get us? Right? Where did that get us? So, you know, and the AMA I, I took on the AMA publicly because we find out, uh, from, from, uh, our, our representatives in the pack meeting that they're lobbying against provider status for COVID for God's sakes, we're in a pandemic pharmacists, 90% of population lives within five miles of pharmacy, put us in code, pay us, cuz we can't go broke.

You know, we're not looking to make a bunch of money, pay us to do COVID testing and then immunizations, let us kick C's butt for you and the AMAs behind the scenes lobbying against it. So I like to call 'em out. I'm like guys, how can you, how can physicians say we should not. So guess what now? I don't know if it's because of me.

I like to think so. Probably not. Um, they went neutral, at least they say they do. And our representatives say, yeah, their lobbyists, you don't need them to support it. You need them, because they got a lot more lobbying dollars than we do. Having said that everyone here needs to join a PHA so I can out lobby the AMA.

Mike Koelzer, Host: They don't need to support it. They just have to 

Scott Knoer, PharmD: not, not against it. So I'll give you an example where I learned everything I've learned from being in Ohio with Antonio Chacha, I've seen states can do stuff. So OSMA, which is Ohio. I don't know the same thing. The local AMA version you live in Ohio.

Well, I've got a house in Ohio. But now you're living in Washington, I'm living. I've got an apartment here in DC. My daughter's remind me where we're at. Cause I'll lose my train of thought. So let me come back to where we're talking about. I have a house in Medina, which is just south of Cleveland.

Uh, my daughter is, uh, gonna start her junior year at Ohio state. My son is in his last year of pharmacy school at ni me in Ohio. And yeah, so my wife's there and, uh, you know, I get home, uh, she'll come out here and, and, but this is not a, this is a full-time plus job, you know, so for now, and again, I don't wanna be working this kind hours, but till my daughter, till my daughter gets out, uh, I'll probably plus I, I, I, I like toys, Mike, and, uh, I have a special garage outside for the extra toys and there's nowhere to put 'em here, you know, uh, in, in, in Virginia, you know, I'd have to go pretty far out to get a pole barn, you know?

Yeah. 

Mike Koelzer, Host: All right, Scott. So back in Ohio, so that's where, that's where you, you've got 

Scott Knoer, PharmD: some real mentors back there. Yeah. And I saw what they could do. So back to the O S. So, I don't know. I wrote an article with Antonio and some other people on how to pass a good collaborative practice. I'm a writer. I didn't even know it, but, uh, that reminds me to come back to writing.

Remind me. Cause that's a good story too. Yeah. All right. But, uh, [00:30:00] so OS A was adamantly opposing this expansion. It was collaborative practice. It's just that, uh, we could do things. Uh, it used to be, we had a collabora law, but it was very restrictive. You have you're the patient, I'm the pharmacist and Frank's the doctor.

Okay. Yeah, for me to do anything for your patients. I forgot who's the doctor, but you know, I had to have the patient left, Frank, the doctor, you, me and Frank, all I had to sign, that was just for that one patient. Right? So we wanted to open it up. We wanna say, you know what I got, well, I had 15 hundreds, probably 700 more pharmacists.

I want all of my pharmacists to be able to work with all the Cleveland clinic physicians under one PR act. So I can see all their patients and the patient, you know, doctor doesn't have to sign 800. Uh, so they were because why is that? I mean, so, you know, they're, they're a trade organization. They primarily represent.

Uh, independent physicians, which is a die in model, right? Because the Cleveland clinic owns how many physicians. My little brother is an internal medicine doc in Luddington, Michigan. He sold his practice because the bureaucracy it's just the market. It's so difficult. You know? So O SMA was Adam and AMA has been opposed to expansion practice.

They, they, they don't want all the executive orders for states where they say nurses can do this during COVID. PAs can just, they're like, okay, when COVID is over, we need to go back to the way we're just, it's very territorial. Uh, you know, but the thing is, Mike, keep me back Ram me back in, cause I'm going off on a tangent.

No, you're perfect. There are not, and we'll not there. There was a study and I'll get the numbers wrong. But between 40 and 140,000 primary care physicians, we're gonna be short by the year 2030. Absolutely. So even if they wanted. Okay to take care of everything they can't, you know, they can't, and it's interdisciplinary my God.

I love our physicians, the Cleveland clinic, we work together in interdisciplinary camp. The, the, the physicians, the quarterback, you know, and they need a dietician and a PA, a nurse practitioner, and they need a pharmacist. Uh, so the, the, the way of thinking is a small group, but a very influential lobbying group.

So O SME was opposed to it. So what did I do? I go to the Cleveland clinic every year. There's a bunch of state laws. So in Ohio, they're up. And you gotta say where we're gonna put our resources, Toby Cosgrove. Again, my superhero CEO physician said. I convinced him. I gave him a PowerPoint. The advantage of pharmacists, I said, is that we'll be able to improve quality, lower overall costs.

He said, yes, this is the number one. I don't know what year it was four or five years ago, number one, lobby. So we put a lobbyist almost full time on it. And what we found when we found out that OSAMA was, you know, being a barrier, what I do well, I, I had a couple of our physicians that worked with pharmacists that were OSA members.

One, it was their pack chair, work it from the inside. Okay. We had physicians go to companies before. We had a bunch of pharmacists say, pharmacists should do this. It looks self-serving when physicians go and say, pharmacists should do it. So we leveraged our physician champions, right. To say, yeah, right.

You know, this is bass backwards. You can't be, you know, we have to do interdisciplinary team care. That's where patients better serve and OSM went neutral. Boom. We passed it. All they had to do was go neutral. They didn't have to split. Just had to go neutral, just have to go neutral just when, because they got so much lobbying dollars, right.

With their, with their lobbyists, high dollar K street, you know, all that. Um, and we got good lobbyists, but uh, at least Carrie, she, I mean, she's outgunned, you know, I mean, there's, there's all kinds of, uh, so again, everyone listening to this needs to join and contribute to our pack. Uh, so we can, you know, work with our legislators and yeah, we're a nonprofit, but I come from the nonprofit hospital world.

Where we like to say no margin, no mission. Right, right. We've gotta make money so we can invest in, uh, advocacy in practice and all that you were talking 

Mike Koelzer, Host: about the relationships with your other. Leaders and so on how much did your psychology degree at Creighton help you? Or did you go into that at first?

Because you had this desire to affect people or the desire to know how people 

Scott Knoer, PharmD: work? Yeah, no, that's a great question. And I'm totally playing mind games with you right now, Mike, just kidding. Um , that? That's a long story. I dunno how time ago, but, but so interesting. Okay. I'll give you a little bit of my I'll try to abbreviate it because most people knew they wanted to be pharmacist when they were like six years old or at least when they're in their eyes.

I didn't, I, you know, honestly, I'll be honest. I still don't know what I wanna do when I grow up. You know, if I grow up, God only knows, you know, so I fell into this and you know, it was that bias for us success, breed success. But I was at Creighton. I wanted to be an army officer. Okay. Army army officer. I was an ROTC and I'd earned a scholarship.

I hadn't signed the paperwork for it yet. And, uh, I wanted to be a general somewhere. I thought that would be super cool. And my fiance at the time, my wife, now, she got a full ride scholarship from the [00:35:00] military. She didn't wanna be an army officer full time. She wanted to do that, you know, weekend a month, two weeks, a year, kind of reserve things.

So we figured I'd go active duty. She'd be reserved. And you know, we'd do all that actually ROTC was that that's a side gig, which is important, but first of all, I was pre-med okay. I, I, uh, you know, my, my dad was a truck driver. Uh, my mom was a stay-at-home mom . She went after we all went, she was a, uh, went and got her nursing degree and they were super supportive.

You know, my dad paid a lot of money at Creighton university for four boys, but they weren't really good at guiding me, you know what I mean? Because they didn't know my son was a pharmacist. I'm like, what do I do, dad do this and this and this. He was like, okay. And he does it, you know, so I didn't know what I wanted to do.

And uh, I took the second semester of organic chemistry. And it was kind of funny cuz me and two of my best friends, we that's back when they actually had chalkboards instead of dry race and stuff, they got all the scores up there, you know, nineties and stuff. There's three scores like a 43, a 42 and a 38.

We're like, I wonder who those idiots are. It was me and Clark and Jeff, you know, that first we had the threes, we all walked down together and dropped it. You couldn't do it online. Then we dropped and I'm like, I'm like, screw that. I can't do chemistry. I don't wanna do that. And, and I was interested in the psychology of work behavior, you know?

So I, it wasn't straight psychology. I got a psychology, well rounded degree, but I was interested in, you know, you know, uh, the Hawthorne effect, right. I went to, you know, a factory. Just because they know you're studying I'm productive, they turn lights up, productivity increases. They turned the lights down pro just because you're, you know, so, so you know how to manage people and, and all that.

So I thought I toyed with getting a PhD in industrial organizational psychology, but I didn't. So my, I, I managed, I had a glorious job, uh, great mentor, uh, serial entrepreneur, uh, mark, Reever still a close friend of mine. He was a serial, he owned restaurants and I lived, you know, went to Omaha at, uh, farm school.

Nebraska Valenti's is a local pizza place and started in Lincoln, Nebraska. And he had a Valenti's pizza place. I had to do something for a year till my fiance graduated. So I in Nebraska city population seven. The home of Arbor day and the famous appleJack festival, uh, you know, I managed a pizza place for a year.

Uh, you know, so I've done tough jobs. I mean that, I think I made like $18,000 a year in 1989 running a pizza place. Uh, but then, then, you know, my, uh, wife got active duty, so I'm like, well, crap, what do we do? I'm like, we don't have any kids, you know, let's put in for Europe. So we put in for Germany. And it was like a three year vacation.

Uh, you know, we traveled all over, but I didn't speak any German. Right. So I'm like, what am I gonna do? And I don't know if you have any military, you know, every military base has their own supermarket and like little, and it's not a Walmart BX or PX dependent army or, or air force base. Uh, and they sold China, you know, millennials don't know what China is.

You're, you're at the demographic. You probably registered for China when you're at your wedding, your wife. Yeah. And, uh, fine, but super expensive hand painted and British China. And we had individual China shops on us, military bases, and I got a job. Uh, you know, through again, relationships, a buddy I'd known since kindergarten, his wife worked, you know, she was a, I was, I was a military dependent.

I, you know, that's a little emasculating. I had to know my wife's social security number. I wasn't a human, you know, I was, I was like, you know, yeah. You know, but that's okay. I mean, you know, um, but I got a job managing the warehouse, you know, which basically was glorified. I took big boxes from China. I put 'em in little boxes, put up labels, and sent 'em all over Germany, Italy, SERS.

But I got a field promotion, you know, in the military. You're in BML. I wasn't in B, I've never been in the military. I tried to kick myself up cuz my lungs. But uh, um, the Colonel gets shot. Guess what? You're the Colonel right? So it's a field promotion. So after the first Gulf war, no one could leave during the Gulf war.

Right? Yeah. Because everyone's locked down on their bases and their husband's mostly their husbands. It could be their wives, everyone that worked there except for the gal who was the CFO, she was Swiss, married to a German guy. She was there. Full-time everyone else was. Officer, uh, military wives. And so I was one of the military spouses and all their husbands got sent home.

So I'm like in charge, you know, so I'm 23 years old and I'm running, you know, it sounded like a lot of money. I think we had 20 million in sales in 1990. I had a $1.2 billion drug budget, clean claim, but it sounded like about a lot of money at the time. So I'm, I'm 23 and I'm in charge of, you know, 32 shops. I'm traveling all over this.

It was so funny, you know, and I had, I had, I had a cell phone, I had a big cord in my car, guess it was some cell phone. And I thought it was so cool. The one year Mike, we, we had a good year of sales. We flew all of the managers to Paris and we had a mayor's meeting and I'm, I'm in Paris. I'm 23. I gotta call London, you know, in Frankfurt, you know, I'm like, oh, I'm so damn cool.

You know? Yeah. So it's a great, great experience. So, so then. The thing was, they started the glass nose para Rica. A lot of our younger audiences don't know what that was, but the fall of the Soviet union, the military presence we had in Europe was ridiculous. It's still pretty big. But the last thing I was doing was close.

We were closing the military base. So I was closing shops in China. [00:40:00] I needed to change careers. Wedgewood, you know, they sold Wedgewood here, but they don't have individual stores. I could have been a sales rep to department stores or something that doesn't sound very sexy. So my little brother was a pharmacist.

He got his bachelor's at CRA and he's a physician now. And. He came over to see me four times in three years, I'm like, oh, I ain't bad. You know, maybe I should be a pharmacist. I got a lot of the prerequisites outta the way. So I applied to the pharmacist school from Germany really before the internet, it kind of technically existed.

It's hard. Now you just be online and do everything. Oh, it wasn't easy. no, it wasn't. Yeah. I like trying to get references. I'm like, I would call my brother and he would walk down and talk to someone. I had six years ago for class, but anyway, I got accepted contingent on me passing second semester, organic chemistry.

dude. It has been six years since I had my first semester. I didn't do very well. I walked in, I had summer class. It was short. I walked on the first day. I swear to God and it's like they were speaking Martian. I mean, the guy's riding on the board. I'm like, what am I gonna do here? And so I followed him. I mean, he left, I'm like right behind him.

I'm like, I. First semester organic six years ago, I don't understand a word you're saying. So he takes this huge textbook, my textbook. He says, "Have you seen this textbook? I'm like, yeah. I said, we're covering the second half of this textbook. I strongly recommend that you're familiar as yourself with the first half

Oh my gosh. But dude, I was in the library for 12 hours a day, teaching myself organic chemistry once. Wow. That first test, I got a C. I was never so happy to get a C on a test. I am getting to be in the class, you know? Uh, I, I went to bed, I know I was doing organic chemistry. I wake up and I'm like, my God, I was, you know, but, but you can do anything.

I was younger before. I didn't have the focus when you gotta do it, or it wasn't even that tough. You know, you never know what's gonna happen Mike in life. So now my kids, my daughter, she's a great kid. Oh my God, she's accounting major, but she's changed her major three or four seven was physical therapy.

That was a pharmacy for a while. I got excited, you know, but, and, and people are like, well, what's she gonna do? I'm like, I figured as long as you're not. Whatever smoking crack and getting arrested, you know, she's going to school, she'll figure it out. And interestingly enough, I got three brothers and we were all the same thing.

We're the first generation to go to college, my older brother, um, you know, he got a mark. Well, he went, started going to law school at Creighton hated super smart guy, way smarter. Right. Just hated it. So he quit, he got a marketing degree. Uh, he went back to engineering school. He's successful. My youngest brother, uh, drank a lot of beer in college.

You know, he's one of these super smart people who didn't apply himself. Yeah. And he graduated, he passed, you know, and I think he got a, or a poli sci degree. It's like my psych degree, you know, what do you do with that? You know, it is actually helpful, but then he took it. L set that that's law school, he scored the 95th percentile and went to Georgetown for law school.

He went, he joined the army just to go to the defense language Institute and learned Russian, you know, but he's extremely successful. You know, it used to be when I was in the clinic, we had the calves suite, you know, so I, I'm giving up brothers, I'm texting. Well, I'm watching LeBron from the suite. I'd send pictures, you know, once in a while to get a course.

And then he's like, oh yeah, you know, baseball is like, oh yeah, I'm in the pole. The pole ads are the owners of the twins. I'm in the pole ads box. And, and then he's down the foot, he's on the 50, all in the 50 yard. Like not like the seats, you know? Yeah. And then my little brother, Zane, he was, he worked, uh, at Walgreens for chain Walgreens.

That's where the story is. So remember that. And, uh, and he was, uh, frustrated, like a lot of our chain pharmacists are the Ellen Gaver article, you know, chaos and chain pharmacies. Right. And he went back to, uh, medical school and he's an internal medicine physician, but. Long story short. I planned on it, I knew I wanted to do leadership.

I had an amazing, uh, career, uh, in, in, you know, I was 23 years old and had a great business opportunity. So I figured I'd go to pharmacy school and I'd manage a hundred Walgreens, you know, cuz retail management. I knew I'd combine it with pharmacy. I worked at a chain, uh, for a couple weeks and said, oh, I don't like this.

So I, I talked to, uh, Jim Dubey was the, we didn't call him pharmacy. He was the director of pharmacy in Nebraska at the time. I'm like, oh, big academic medical center, Jim, how do you do that? He's the one that told me about two year combined residencies and master's degrees. So I did that in Kansas. Texas Minnesota Cleveland clinic.

So, you know, for those nurses that don't know what they're doing, or maybe they're not where they wanna be. It's okay. Right. Just keep working and keep moving, keep moving. Right. I was a wrestler in high school. I was pretty good. I grew up in the Iowa wrestling capital world, and I could wrestle at some small school.

I would've never wrestled at, you know, Iowa or Iowa state, but, uh, my, after my junior year, I had my first pneumothorax. I, I couldn't wrestle, you know, I hit a wall. I'm like, okay, well that sucks. I can't do that. Had Nene had another pneumothorax when I was gonna be an army officer physically disqualified I can't do that.

You know, so I got my psych degree, went to Germany, you know, just keep moving. It's an obstacle, don't sweat it. You know, just, just keep going and, and don't get down on stuff or have a little pay party for yourself and yeah, you gotta keep going. Yep. Scott 

Mike Koelzer, Host: you're in Washington and I say to you, Scott, you've got one year to make the biggest impact on pharmacy.

Now you can have any position you want. You can be the P. You can be the head of health and human services. You can be the head of the DEA. You can be the head of the [00:45:00] FDA, or you can be any Senator. You can be any governor you want, you can be the head of a PHA. You can do whatever you want. You got one year, you gotta pick one job.

And you also have to do other things with that job too. You can't fail, you can't take part of the job and just focus on pharmacy, which one would you pick? Which would you pick first? And then if you couldn't do that, which would you pick second? Which would you pick third, go all the 

Scott Knoer, PharmD: way down. I tell you right now, after my meeting, uh, with the FTC, I would push 'em to break up the oligopolies.

I think I'd be the head of the FTC. Now, you know, if the administration doesn't want you to, you probably can't right. I mean, so, but because of the oligopolies, we have three major PBMs that control 80, whatever percent of the market. We have the vertical integration of the health plans, owning the PBMs, and owning the pharmacies.

And now they're owning, uh, purchasing groups. I think having competition, breaking up monopolies, getting rid of DIR fees, which are part of that problem, and allowing community pharmacists to be successful. Are the D would you 

Mike Koelzer, Host: say that's part of the FTC, is that kind of a 

Scott Knoer, PharmD: monopoly thing? I believe it is related to vertical integration because the PBMs own the pharmacies and yeah.

So I think, I think, you know, and that could be wrong. I'm just throwing stuff out there just for fun. The president. Oh my God. I'd be writing executive orders. Right. But now the problem with writing executive orders just like Obama did Trump overturned all up and he is writing his own executive orders, but, but you could make an impact in the short term pretty 

Mike Koelzer, Host: quick.

I'm gonna make you nail these in as we're going here, at least for now head of FTC or 

Scott Knoer, PharmD: president. Ah, I'd have to be present just, I mean, just F because you could then direct, you could have influence over the FTC, 

Mike Koelzer, Host: right? Tell the FTC to do this. Number one, president number two, FTC what's number 

Scott Knoer, PharmD: three. Well, you know, I, I start looking at Congress and, oh my God.

If you had one party in control, that'd be fun. You get a lot done. But right now, I mean, you know, being Pelosi and fighting with the Senate, uh, I don't know, they, they can't get anything done. So I don't know if I'd wanna be in charge of the house or Senate. Quite honestly, if it was one party. Yeah. Like the first two years of Trump or the first couple years of Obama.

Oh yeah. It'd clearly be present then. And then it'd probably be. House or Senate, I mean, flip a coin. What do they call that? The majority leader or something? Yeah. Yeah, yeah. Majority leader, Nancy Pelosi. And uh, what do we even call the head of the Senate? What's um, sorry. I'm in DC. I gotta know all this, but uh, 

Mike Koelzer, Host: the head of the Senate, president FTC, Congress, head of that.

What's next? 

Scott Knoer, PharmD: Oh God. You know, I don't think the FDA's got the authority they need to. I think that'd just. Tough job. That would just be hard 

Mike Koelzer, Host: that you just gotta, like, you just gotta do stuff for them 

Scott Knoer, PharmD: and no one's gonna be happy, right? No, one's gonna be happy. You're Dan, if you do, you're trying to inspect you too much.

They said you can't, you know, you're not allowing people to make things, at least Bernstein, my head of government affairs. She retired. I was 30 years old and the FDA did a great job, but I think that'd be tough. I don't think I'd wanna be running the FDA. That's a no win. Everyone's gonna be pissed off at yet.

Where does 

Mike Koelzer, Host: the DEA fit into 

Scott Knoer, PharmD: that then? Well, the day is just enforcement. You know, they don't write laws. That's not even close 

Mike Koelzer, Host: to be on the list then. 

Scott Knoer, PharmD: No, no, no. Cause they're they enforce it, right? I mean, Okay. You can't, you know, you're selling crack cocaine, they'll arrest you or you got morphine, but that's just, that's just, you know, uh, more law enforcement, really 

Mike Koelzer, Host: president FTC Houser, Senate FDA.

What's next? 

Scott Knoer, PharmD: Well, if it wasn't for pharmacy, I think it'd be coolest. Heck to be the secretary of state. But I wouldn't choose that cuz I don't know how I could advocate for patients, but that would just be a fun job. Secretary 

Mike Koelzer, Host: of state is the one that makes all the different countries. 

Scott Knoer, PharmD: Yeah. So you'd be traveling all over the world, but that'd be fun.

I wouldn't choose that because that isn't patient focused. But if I wanted a fun government job, you know, that's not for pharmacy. No, that's not for pharmacy. 

Mike Koelzer, Host: What's next in line after the FDA for 

Scott Knoer, PharmD: pharmacy. Oh man. I know I've never thought of this before. There's nothing. Mike, I hate Morton bureaucracy.

I would slit my wrist before I took almost any government job, because you wanna talk about bureaucracy and God love those poor people who do it. I mean, you know, but you can't get anything done. I mean, if you're, if you're elected, oh my God. You know, you're taking polls every day. You know, I, I, you could not make me take a government position, a PHA.

That's not a government position. No, no, we're independent. We're a professional association. We have nothing to do with the United States government. We lobby the government, you know, because we try to change laws. So 

Mike Koelzer, Host: to make the most impact in Washington, Would 

Scott Knoer, PharmD: dude, I think what I'm doing 

Mike Koelzer, Host: right now, that's what I'm getting at, what 

Scott Knoer, PharmD: you're doing right now.

Yeah. There's nothing I would rather be doing than what I'm doing right now. What 

Mike Koelzer, Host: you're doing right now, you can make more impact as Scott for a year than the president. Could. 

Scott Knoer, PharmD: I believe they've done appropriately that, not as Scott, but as the CEO of a PHA. Yeah. Cuz no one cares what Scott thinks it is.

It's what you do with it. I, I honestly, Mike, I, I swear to God, wake up every morning. Am I dreaming, you know, and I look out, I got, you know, I got an apartment here. I can see, uh, the Washington Memorial and the capital from my bedroom window. And I'm like, wow. I am really here in this role to [00:50:00] impact patient care.

Listen, you 

Mike Koelzer, Host: only got one year though. So you can't sit around to drink coffee all day and think about how 

Scott Knoer, PharmD: lucky you are. I don't drink coffee all day, drink for five minutes. Then I got my bud in my chair just for the record. And then I'm there. So it's, it's 8, 8, 11 PM. Mike. And I'm talking you 

Mike Koelzer, Host: Frank us back and listen to parts.

No, I know it was just five minutes. You've only got a year. You've got a year. I know you don't, but you've got a year as CEO of this and then you're done. You've got 10 and a half months left or what have you been for two and a half months? Two and a half. Yep. You've got nine and a half months left. This is your only nine and a half months ever for pharmacy.

If you only had. These nine months left and you did not have to answer to the board, then come 10 months from now because you're already out. Yep. And you didn't have to answer to anybody because you're already out. And so maybe you get a little bit of a loose lip on social media and maybe you ruffle a few more feathers.

So what would you do in the nine and a half month to make Scott's biggest impact in the best job for pharmacy 

Scott Knoer, PharmD: in the world? Okay. Now for the record, I know that you've listened to me on and followed me on social media. So, you know, I ruffle some feathers and I don't have a lot of filters, you know, that's why I don't really drink because, cause I got very few inhibitions when I'm sober, Mike, I probably need to keep the couple I've got, you know, so wait, you said really 

Mike Koelzer, Host: drink.

You didn't say drink. You said you really drink. 

Scott Knoer, PharmD: that's a pretty loose interpretation. Like I said, I have very few filters, stone sober, so I probably need to keep this as my. I would, it's all about payment reform. Okay. I would hammer, you know, what, what do I wanna do long term, I need to get a data ADLINK center.

I need what Antonio's doing so I can show the shenanigans to the FTC and everything, but it would be, it would be leveraging the data where pharmacists are doing good stuff, running crunching numbers, hammering Congress, but not only Congress cuz oh my God, it's hardship payers. Just show what pharmacists do.

Everyone would be paying pharmacists to do what we're trained to do. And that's not count by fives as fast as we can and managing to drive through the window. It's managing your mom. You got nine months. How are you gonna do that? I would do it. I would do it. I would, I would, I would, I would. Okay. We got a little money in the bank.

Right? We got a little slush fund. Yeah. I mean, uh, I, if the board I'd spend it, I'd I'd yeah. I wouldn't build a data company cuz I'd take long, I'd buy it, you know, and I'd say run this and I would work with United health and I would work with everyone's paying pharmacists and I would show that. You pay a pharmacist, whatever, $120,000, they save 500,000 quality improvements, you know, and I would, I would get every player in the United States in nine and a half.

To pay pharmacists to do what we're trained to do United health. Are they 

Mike Koelzer, Host: part of the three monopoly? 

Scott Knoer, PharmD: They're well, yeah, they, they do actually, they own PBM and, and uh, specialty pharmacies. So they're part of the problem there, you know, and they get a lot of bad press. So I think one of the reasons they're paying pharmacists is they wanna say, Hey, see, we aren't doing some good stuff and it's good stuff.

So they start in Ohio with two pharmacies and they're good pharmacies, but I mean, they aren't, you know, these super genius, young folks who, I mean, they're regular pharmacists and they're just doing what pharmacists do. They're saying you're on too many drugs and you know, you, you this, and, and they, they, and they pay them to do that.

And guess what? Their cost per member per month, which is how insurance companies care, is going down, are they paying pharmacists more? Yes. Their total costs are going down, which is what we saw at the Cleveland clinic with, when we have our pharmacists engaged our costs go down as we hire more pharmacists.

All right, Scott. So you've got 

Mike Koelzer, Host: These nine months left and now. In the morning, you're writing this stuff about the big three and you're calling them out and saying, you're gonna have a rumble in the jungle and all this kind of stuff. And now you're telling me in these nine months that you're gonna sit down with them and talk about what pharmacists do.

And so on, those two don't jive together. You gotta pick one. How would you sit down with a guy you just told me that you are having all this fun on social media about 

Scott Knoer, PharmD: yep. And it's not a rumble and juggle. I would have the thriller and Manila. you know, for the record, for the record, that was Ali.

Ali. Yeah. I think it's definitely Ali. And they had a 

Mike Koelzer, Host: couple different 

Scott Knoer, PharmD: ones. Right? Rumbles, just a little dude. My dad watched that religiously. So we were back. Yeah, we were, yeah, the same age. All right. How do those two line 

Mike Koelzer, Host: up, you just said you're gonna attack them. And now how are you 

Scott Knoer, PharmD: gonna sit down with them?

You know, what if I got something in common with my enemy that can help pharmacies and patients, I'm gonna work on that. Okay. I'll I'm calling balls and strikes. Okay. If someone's doing something bad, I'm gonna call that. We're gonna talk about it in the media, if someone's doing good. So Walgreens, right. I had over a hundred thousand views on LinkedIn.

When I posted that Walgreens has given a half hour LUS pharmacist. That's a pretty low bar. Right? I mean, their pharmacist actually gets it eaten and they can pee rather than not drink any coffee, you know, but okay. C isn't doing it, you know? Right. So, I'm like, thank you, [00:55:00] Walgreens. You're you're, you know, I have a lot of pharmacists in chain pharmacies, you know, I don't like what Larry Merlo does now.

You know, he's my God record profits. He's a business genius. You know, like I said, that probably he's unfortunately an evil genius, but if he's gonna pay a pharmacist to manage your mom's diabetes, Then I love it. You know, if he would change his behavior and do things that are good for patients, I don't care about the past.

Right. I'm looking forward to it. I don't care what happened. And that's another thing here. I'm coming in with a clean slate. I don't, you know, someone at a PHA, they know no one says, well, Scott, that's the way I've done it. Oh, right. Oh, there's the door buddy. You know, we don't talk like that. Right. Right. Where are we going?

And people are like, well, you know, we got it all, I have no baggage. I don't care if we're doing things that help patients, I'm gonna support that. You know, I'm gonna call balls and strikes and you could 

Mike Koelzer, Host: even have things where you're not only not looking at the past, but you could have somebody who the count is a ball and a strike.

In other words, you like something they're doing. Yep. You hate something they're doing. Yep. But let's move 

Scott Knoer, PharmD: forward on what we like doing exactly. You know, what helps patients, Mike? You know, it's not about me. And the other thing Mike, I used to hold grudges. I did, I was uptight. You know what I found out, I was grumpy.

You know, you let the crap go. If you can't control this over. How do we move forward? I don't care about yesterday and I don't. I just, I, I have no time to worry about the past. I only look for it in 

Mike Koelzer, Host: nine months. You'd sit down with these guys. Now you call up and you say, Hey, is Larry there? This is Scott.

Can we sit down? Is this gonna happen in this theoretical nine 

Scott Knoer, PharmD: months? What am I gonna do? And, and it's probably United health more. I'm gonna get the data. I'm gonna crunch the data. And I'm gonna say, we're gonna put in the media, we're gonna say, look at all the money you're saving. They're doing it already.

Antonio is doing this. I'm gonna, I'm gonna. I'm gonna spread the good work. That's what I can do. I can empower people. I can expand. I can explode and help folks. He's getting paid. We're gonna get a national lawyer. I'm gonna do this anyway. I'm not gonna get done in nine months. Antonio's feeding me people from Centine.

And we're gonna say, let's roll this out nationally and I'm gonna tell 'em what a great job they're doing, cuz they're doing a good job. Not because I'm lying. Not because I'm making it up because they're paying pharmacists for the right things United. He. Yeah. Yeah. It, and United does a lot of bad things, right?

I mean, they steer to their own specialty pharmacies and, but this is good. Right. So we're gonna, we're gonna talk about it. So I already posted, you know, the things they've, we're gonna blow it up on social media. We're gonna put in the media when they're, when they're really paying pharmacist for the, is Antonio 

Mike Koelzer, Host: 46 

Scott Knoer, PharmD: Brooklyn.

He's got a couple things. So he's, uh, employed by, uh, the Ohio Pharmacy association. Uh, he's their lobbyist. He created 46 Brooklyn, uh, 46. Brooklyn is a nonprofit data company they've got. And then he has got, you know, some really smart data analysts he created. It's a for-profit company, three access advisors, uh, to kind of pay the bills and pay everybody.

But, they're doing God's work. You know, I'm not a particular religious man, but the stuff they're doing is the real deal. I've never met a pharmacy Patriot in my life than Antonio. He's. He's a superhero. He's my eye. I've heard great things 

Mike Koelzer, Host: about him. Yep. All right. So you work with, you work with United health, someone that's.

Probably gonna listen or probably meet with you in your theoretical nine months, you're still gonna hammer social media. What else are you gonna do in those nine months? Yeah, 

Scott Knoer, PharmD: I mean, I, I'm gonna be working, you know, the government part of that as well, and I'm gonna use that same data. Right. And, and I'm gonna, when they're paying pharmacists to, to, to participate in Medicaid in Ohio, I'm gonna use Antonio and other people's data companies, and I'm gonna hammer the hill with it, showing the success.

Is this out there, Mike? No, one's told the story and when they get the story there, aren't good storytellers. Okay. I am the chief marketing officer, as well as the CEO. If nobody knows about it, it didn't happen. We're gonna brag about pharmacists' successes. We're gonna spread the word that's. That's what I did at the Cleveland clinic.

If the CEO didn't know how great my team was doing, I wouldn't get any more resources. I wouldn't get more FTS. They know how good my team is. We got more resources. It's the same universal truth. 

Mike Koelzer, Host: How do they physically get that data? Are you gonna be walking around with a 

Scott Knoer, PharmD: sandwich billboard or what, you know, well, getting the data, you know what a lot of, uh, the data that, that Antonio's group's gotten is publicly, uh, it's Medicaid data, but the insurers own their data and they care right.

Everyone before COVID you couldn't pick up any trade journal or electronically, I guess, you know, pick up journals, everyone. What were they talking about? Big data, AI, you know, maybe robotics that isn't going away. Okay. It got sidelined because we're all trying to work online and COVID yeah. Right. It's not gonna go away.

They're crunched in the numbers. Right. It's all insurance companies. They're just actuaries. Right. They're trying to say, what do we need to do? Where are we gonna save money? Where are we gonna make money? They want their data. You know, if they can't do it, work with them, mind their data show. 'em what we know.

You know what I'm saying? So the data is there. And they're looking at their data. Why are they gonna expand in Ohio? Because they're looking at their data and they're saying, [01:00:00] well, crap, we do save money when we pay pharmacists. So 

Mike Koelzer, Host: It's kind of like someone coming up to me and saying, Hey, Mike, you didn't really ask for this, but I'm gonna show you exactly how you can gain 10 pounds of muscle and lose 20 pounds of fat.

And I'm like, oh, well show me. Yeah. You're not going against them 

Scott Knoer, PharmD: if you, no, I'm not. If 

Mike Koelzer, Host: we do this correctly, everybody's, everybody's winning, including the three 

Scott Knoer, PharmD: evil, they make money and I don't care. I want people, I'm actually a capitalist. Okay. Is unbridled. Oligopoly monopoly when capitalism goes bad is when there's no competition.

And what they've done is they crush competition comp prices go down when people have to compete, right. Prices go up when you eliminate competition. So no, and PBMs should make money. They shouldn't make the hundreds of billions of dollars and suck it outta the healthcare without providing any value. You know, people don't have insurance, but you know, Larry and his group are, you know, making huge millions of dollars and shareholders.

I mean, I don't directly own any stock. I probably own it cuz I have an S and P index fund and that's got all kinds of stuff, you know? So I guess it benefits me. Uh, but I don't actually buy CVS stocks. You know what I mean? Scott, what 

Mike Koelzer, Host: other either by name or by category, what other monopolies are there in pharmacy that you would break up if you were the head of the FTC?

You 

Scott Knoer, PharmD: Now, I think really the only things I've got are the vertically integrated, you know, oligopolies. Yep. Uh, and they're the, the big three, the, you know, the breakup, the PBMs break it up horizontally. Right? Uh, you can only get so big because the PBMs all buy each other. And now we 're some little ones, there's three of them that own it all.

Yeah. And then break it up vertically. And that's where the insurance company owns a PBM. Don't let em, they, you cannot have em, integrate the whole supply chain cuz they just screw the public in the taxpayers. Take 

away 

Mike Koelzer, Host: these nine months. Now you've got as long as you want to assuming you keep the board happy.

How long realistically can you? And I know, you know, the answer is like, well, every day we can make big success, but how long do some of these things take? Do you think this takes a while to kind of butter 

Scott Knoer, PharmD: up people and from my experience start new jobs. It takes three years to really hit your stride.

Okay. Gotcha. When I took it. Minnesota again, good people there, lots of turnover, all kinds of problems took three years to get your team up to speed, to hire people, to get people in the right seats. And then you go to Cleveland clinic took three years and again, getting the right people on the bus. Yeah.

Right. Three years. We're going, you know, I'm driving like crazy. My team, I feel sort of poor Frank and the rest of 'em. They're like, oh my God. There's no downtime. You know what I mean? The pace, I mean, they've always worked hard, but we've taken it to a new level, but you get, I just hired a chief of staff.

We've got the right people in the right spots and we're doing crazy good stuff now. But you know, in three years we're gonna be just hammering. And I got shelf life, Mike, I'm a 10 year guy. I'm gonna do everything I can. And after that, it just starts to be the same thing over and over. They need some fresh blood.

They're like, you know, Cano. I never wanna be the guy who's arrested on his laurels. Right. So right. I was 10 years old in Minnesota. I was nine years at Cleveland clinic. I got three years of building seven years of just kicking, but we're gonna be kicking, but these three years, but we're really gonna be kicking.

But for seven years in 

Mike Koelzer, Host: 10 years, you're 64. Yep. Is that the last of your 10 years or are you gonna have another 10 year run in some other 

Scott Knoer, PharmD: position or industry? You know, I never say never. And like people ask me when I was in Cleveland clinic, what are you gonna do? And I'm like, I don't know. I mean, at the right thing, it'll find me, you know, it's, it's like.

If the right thing is gonna come it's and I got the Cleveland clinic, I said that, I said, I honestly believe what I did. I had the best job CPO at a major, internationally respected place, drive and practice. I loved it. I said, if I do something that's gonna happen, because I worked at the Cleveland clinic and some opportunity that I hadn't even thought about is gonna come and that's what happened.

So I couldn't even now, I don't know, you know, I don't, I'm not geared to retirement. I'm really not. You know, and I like some days like, oh, I'll just fish. I could fish for like three days and I went nuts. Oh, I see that fish behind you. Is that one of yours? Oh yeah. He's bigger than he looks, but that's a sailfish soap.

Dang. You know, it started had hospital in Florida. I'm not stupid. Right. I went there in January or February from Ohio and I took a little, this is a big darn fish in the picture. I don't think it looks that big. What do they call that? I wanna call it a swordfish or a Marlon. That's a sailfish. Oh, this is my, I got, I, I got a Tarpon.

I got a sword. I got a 270 pound, uh, swordfish, but that's a different story. Dang. But, um, Uh, I was going somewhere and you got me all sidetracked. I'm easy to sidetrack. Well, we were 

Mike Koelzer, Host: talking about not retiring in case 

Scott Knoer, PharmD: something comes up. Oh yeah. Yeah. So I think more of what I'll do is I have a couple pharmacy heroes.

One of 'em is David Zills and he's the health system. Uh, he was a resident at the University of Wisconsin. And then, uh, he wound up being the director and that's before chief pharmacy, he retired there, he's 80 and he does more for pharmacy. He mentors students and residents more than he ever did. He's kind of, I loved it when he said this, Mike, I'll never forget it.

He said to him and, and Sarah White, who's another retired person, uh, in the hospital world. Who's done a lot. He said, you know, Sarah, and they do this visiting leader thing. They'll, [01:05:00] they'll come and they'll talk to all your residents. Yeah. And try to inspire 'em and stuff. And he said, Sarah and I were talking one time and we agreed.

We, we said, Aspire to inspire until we expire. That's good. That's good. That's what I wanna do. And, it may not be in a paid role. It may be volunteer work. It may be something, but I just can't shut it off, Mike. If it's, it's probably a problem. When did that 

Mike Koelzer, Host: kick in for you to inspire your years at Cleveland?

Or had you always from the start kind of wanted to kinda get people 

Scott Knoer, PharmD: going. So have you ever taken strength, finders, Mike? No. Common leadership. It's a, it's a book it's part of by Gallup who does the, and, and they said that, you know, a lot of times people try to minimize their weaknesses and I've had to do that cuz otherwise my weaknesses kill me.

But, these ones say you take it personally back to psychology. You take a valid test and it breaks. I don't know how many strengths, I'll say 30. I made that number up. There's 30 and everybody probably has a little bit of everything, but you got some primary strengths, right? Yeah. And your top five is what really drives you.

And they're like maximizing your strengths. I tell you, one of mine is significant, right? Yeah. And. And when I first read that the definition sounds kind of icky, you know, like, Ooh, I wanna be whatever, but what dude, I wanna be part of something bigger. I wanna make an impact on the world. I am driven to make the world a better place.

And I'm just wired that way. I mean, so, so that, and the rest of 'em are all very chief pharmacy officer stuff, you know, strategic and vision and, and related. I'm a relationship guy, you know? Yeah. Life is about relationships. Scott, give 

Mike Koelzer, Host: our listeners a message. We've got a pharmacist who's maybe driving to work in the morning or someone coming home in the evening.

What do you wanna leave? The pharmacists 

Scott Knoer, PharmD: a lot of pharmacists have felt that they aren't represented by the national organizations, right? Independent pharmacists. They still got D fees. There's 5,000 less of 'em than there were 10 years ago. Chain pharmacists, Ellen Gaber you know who called me? Uh, Sunday when I was at Walmart, cuz she's doing some stuff.

I can't talk about what, but uh, you know, I, you know, we're here for you and I, I tell you what, after that podcast heard around the world, I've had people join and said, oh my God, I didn't think that that a PHA cared about me as a chain pharmacist, independent pharmacist. I got a guy in Florida who, who sent me a really nice email, said I haven't been a PHA member for 20 years.

I heard your podcast. I joined, we got like three membership chairs, whatever our engaged member. And I wrote a $500 pack check to your pack. I can't do it alone. Like, okay, no margin, no mission. I can't lobby. I can't put people in practice unless we make money. You know, money makes the world go around.

Yeah. I'm not making, you know, trying to make money for myself. The organization has to take in more revenue than it has expenses so that we can invest. So if you are not part of a PHA, you are part of the problem. And you know, a lot of people like, oh, a PHA, doesn't do it. You know, we actually do a lot. I'm just now letting everybody know what we're doing.

And we're aggressively doing it a lot faster and harder. Right. So my message to that, that community pharmacist, I think that community pharmacists already heard the message and they probably join. But if. you're part of the problem. Join up, fight the fight with us. We can't do it alone. You can't do it alone.

I can't do it alone. Let's join forces. Yeah. And, and so with that, you talked about the one year, all that. So I, I told my team when I got here, I said, guys, flip a coin either. I'm gonna be outta here in six months, or we are going to be successful beyond your wildest dreams. The jury's still out on how that's gonna go, Mike, but I'm having fun no matter what.

Well, 

Mike Koelzer, Host: Scott, it's been an absolute pleasure having you here. Thank you for your time. Thank you for all you're doing and 

Scott Knoer, PharmD: let's get this done. Thank you brother. And thanks for what you do. All right. Thanks, Scott.