Revolutionizing Direct-to-Consumer Healthcare | Peter Ax, JD, MBA, UpScript Health, CEO

This transcript was generated automatically. Its accuracy may vary.

Mike Koelzer: Peter, for those that may not have come across you online. Introduce yourself to our listeners.

Peter Ax: I'm Peter Axe, the founder and CEO of Upscript Health. We partner with pharma companies. That wants to bring medications and therapies directly to consumers. And they do that by creating a digital flow from their branded medication website to our Upscript Health platform where the patient can see [00:01:00] a healthcare provider online, have a telemedicine visit, can determine their insurance benefits, can get patient support, and can receive their medication shipped to them directly. And they can see those providers. quickly, they can have an efficient visit with an expert on their disease state and their therapy that they're considering purchasing and get what we believe is absolutely world class treatment. 

Mike Koelzer: Peter, well, first of all, I got to start here. I know that you're from Arizona. You don't live there year round, but I went down there with my brother in law years ago and they made me go up Camelback mountain with them. Have you been to Camelback?

Peter Ax: have many times.

Mike Koelzer: I got about, probably a hundred yards in there.

And then they had this. Pull that you have to hold on to. And I'm used to marching around Lake Michigan by its name. It's flat, there's seashores.

Peter Ax: Yeah.

Mike Koelzer: saw that and I turned around and bugged out. [00:02:00] I think I made it up like maybe later in that week I went up there but that freaked me out.

So, I stay on the little one. What do they call them? Bunny hills. Now, when I go down there,

Peter Ax: Yeah. Well, if you really want to challenge yourself, try doing that in June or July when it's 120 degrees outside. There are deaths on Camelback mountain pretty regularly.

Mike Koelzer: Well, there was one last year 

Peter Ax: Yeah. 

Mike Koelzer: the guy was with his new girlfriend or something and just let her go down the mountain by herself. She ended up marching around someone's backyard, probably delirious, and then she dropped dead of heat exhaustion or 

Peter Ax: Yeah, heat exhaustion will get to you. And look, the climb is challenging,

but it's not a technical climb. You'll

grab the sides of poles. Like you say, they put poles in the ground

to help people grip. But what happens, so my children and I, of course, I raised my children growing up climbing camelback Mountain pretty regularly. Well,

My daughter, when she finished college, decided to take me on a hike up Kilimanjaro.

Mike Koelzer: Oh, wow. 

Peter Ax: And I'm not a lover of hikes

but it was quite an adventure. 

Mike Koelzer: Kilimanjaro, is [00:03:00] that you're roping yourself in with the hooks and all that kind of 

Peter Ax: You're not, it's not a technical climb, but it's a brutal climb. It's 10, 12 hours a day of non stop climbing uphill. you get above the tree line eventually in very thin oxygen and you end

up in a shale area where there's a lot of sort of dust and not great footing around you.

And it's a really challenging climb,

Mike Koelzer: All right, Peter, here's a problem though. When I'm going up Camelback, I see these benches with like dedication things on them. And I do the math, this person 1960 to 1992. Now, wait a minute. That person didn't die of cancer up here, 

Peter Ax: Exactly.

Mike Koelzer: went 

Peter Ax: Yeah. 

Mike Koelzer: edge there's more benches up there than I'm comfortable with with all those plaques on there. 

So Peter, do I have that right? that you founded the company, but you didn't always run the company. 

Peter Ax: So I left Wall Street. In the late nineties, 1999, I believe it was maybe 2000, and I decided I would invest in a [00:04:00] number of different companies. I'd had a pretty solid career on Wall Street. I'd been a tech investment banker. I'd done some venture capital things. I'd had some successes, and I thought, I'm going to relocate from New York to Arizona, raise my children in Arizona and. I was then going to invest in various businesses. So in 2000, I started to invest in a number of different companies. One of those investments was in an online pharmacy. In those days, it was called QuickMed, K W I K M E D.

And we still operate the QuickMed website. It sells lifestyle medications, but it's not really our core business.

It's a small fragment of our business.

And so I purchased that online pharmacy and I wasn't really too involved for a long time. I was very much involved in the regulations and the legal aspects of it and making sure it was a legitimate business and that the cornerstone of everything we did was around proper regulatory policy

because we knew we were creating new ground in a lot of ways.

And so, I was a secondary figure in terms of [00:05:00] running it, operating it in those days, but then about 10 plus years ago or so, the business really started to take shape. It took a while, but it took shape and I really need to be much more involved. So about 10 plus years ago, I became full time CEO of the

company and have been operating it since.

Mike Koelzer: You guys were maybe kind of a target when you're one of the first ones, you've got people looking at you and making sure everything's straight and narrow, but then as time went on though, then you had to take a bigger role because it was growing so fast.

Peter Ax: Right, right. And it was really becoming a very substantial company with a real possibility of being an earth shattering company. And I really do think we're going to fall in the category of earth shattering company. We're on that

track. But there is no doubt in 2001 when we acquired the online pharmacy, we were absolutely a target.

We were a target of every regulatory

agency you could think of. The AMA was after us. 

Mike Koelzer: Probably chain pharmacies. I didn't stuff it in the mail. That kind of stuff.

Peter Ax: Well, yeah. And one of the real [00:06:00] challenges, if you think about pharmacy boards on a state basis,

who sits on their boards, pharmacy operators,

Mike Koelzer: Absolutely.

Peter Ax: and the last thing they wanted was an internet pharmacy

or potentially displacing their business. So we were oftentimes dealing with regulators that had something at stake against us.

So it's very hard to win battles, but we ultimately buy evidence based medicine. We won by explaining that we're going to be here for good. So you're gonna

have to learn to work with us,

period. And that's how we approach things. And fortunately in 2002, a year after owning the business, we received a license from the state of Utah to write a prescription online.

And then that allowed us to take that sort of methodology into other states and gain permission to write a prescription online.

But we had a lot of battles. 

Mike Koelzer: You could write a prescription from someone remotely.

Peter Ax: Exactly. so the model that's used today, right, you have synchronous and asynchronous office visits For HCPs. Back [00:07:00] then, we literally created that notion that you could actually write a valid prescription on the internet.

We received the first License to do so by the state of Utah.

Mike Koelzer: Interesting.

Peter Ax: And the reason why it was the state of Utah is because when we acquired the company, they were effectively based in Utah . We moved them to Arizona, but they were

based in Utah at that time.

Mike Koelzer: well, back in the day and I come from an independent pharmacy background and back in the day, we wanted to attack mail order and Canada 

Peter Ax: Yeah. 

Mike Koelzer: Another place you could think of, we wanted to attack. And now with the vertical integration of the chains and God bless colleagues in the chain pharmacies, but they're overworked and they don't have time for much.

And they've got this overbearing corporation putting more work on them and things like that. Now the question is, especially since COVID with what we're doing here, talking face to face over the internetIf someone gave me the chance to either go [00:08:00] talk to a chain pharmacist, again, they're overworked, not 

Peter Ax: Right. 

Mike Koelzer AI: They're overworked by the pressure on them. If they gave me a chance to do that or sit face to face with a pharmacist online with No other abstractions and nobody behind me waiting. And I'm afraid to say something because of HIPAA and 

Peter Ax: Yeah. Yeah.

Mike Koelzer: or embarrassed. it's a more level playing field. And you can argue either one. You can now argue, well, which one's better

In different cases, different things are better.

Peter Ax: absolutely. In every case is unique, but think about this irony when we started the argument consistently against online pharmacies and consistently against my business was that we were not as safe. As traditional medicine,

Physicians weren't that informed. How could you get, how could you be informed when you are simply writing a prescription on the internet, where you're simply collecting an answer to question sets and reviewing a file, or maybe you're having an audio conversation or a video conversation, how can that be as good as a face to face visit? [00:09:00] Well, if you really look at the evidence. The contrary is actually true, and that's what's being proven today, is that the visit that we can have with you on the internet is much more significant and much more profound than many visits that are taking place in face to face settings. That doesn't mean we can cure every disorder and treat

every disease through telemedicine, but we can certainly treat the vast majority of disorders where you really don't need a physical examination.

You might need lab tests. You might need to see the person, understand who they are. You might need to have a phone call with them. You might need to just ask them a series of questions. But what happens when patients come to our platform, they're generally coming from one of our pharma partners, from a pharmaceutical manufacturer that has a specific medication, and they're interested in that medication. They come to our platform, they're speaking to a healthcare provider that's fully informed about that medication, [00:10:00] fully up to date on all their information about that disease state, about other treatments available,

and that physician can make a selection of what the best solution is for that patient. And that is something that really doesn't take place very easily in traditional medicine, because there's so many different ailments. There's so many different medications. You go to a primary care physician for a migraine headache. You might also go to them for diabetes, but they're not an expert in either one.

They've had a lot of experience, but we can actually put you in touch with experts on a daily basis. We put our patients in touch with experts who've been trained in that disorder, in that disease state. 

In many ways, our quality of care is superior on the internet. That it would be in a face to face setting.

Mike Koelzer: It's a bell curve. Obviously there's outliers. There's outliers that they're going to say, Hey, look, Peter, we do everything you just said, but we hold their hand during it. There's always going to be an outlier there, but in general, it's every person for themselves now, if it was a free [00:11:00] market, if you didn't have all the PBMs and stuff, well then let the free market win. And let. People decide and that's how it should be, people like it better.

Some people don't like it better.

Peter Ax: we're not the answer for everything and everyone. But certainly that patient might have tried to reach their provider and they can't get in for six weeks. Or, they don't know whether or not insurance is really going to cover their drug, and they're

going to be put on an expensive therapy. They can go to our platform and basically be provided with all that information. They can find out, is the medication going to be covered by their insurance? If so, what's going to be their out of pocket cost? Then they can talk to a healthcare provider. Does it make sense for me to be on this medication?

And that provider might say yes or no, or wait, I have another option for you. You suffer from migraine headaches. Maybe you should try this other medication first. And so we could do all that and we can do all that right away. You can get on the internet through our platform and talk to a provider, generally speaking, certainly within [00:12:00] 24 hours.

And we're even now working on some solutions where you'll be able to talk to providers within 15 minutes, almost all the time.

Mike Koelzer: Some arguments. A fictional listener would say, yeah, but look, you're calling this company that has this one drug.

How much freedom do you think you have? yeah, but the same person saying that might've just been on the. Fishing boat of the sales rep for this drug in town or was just taking out to golf or whatever. No, I'm not sure how much of that happens anymore. I know we as a pharmacy don't see it because we just bow down, I guess, to the formulary of these insurances.

So we don't make decisions on that anymore, but I think there's still a little bit of that, greasing the palm, maybe not. Money wise, but I think that's out there still. And I think that's a fair argument to say, all right, , there's no black and white. It's like, let the best person win .

Peter Ax: It's valid. [00:13:00] concern that physicians might somehow be steered toward a type of therapy. and we would be naive to not think that is going to be a concern. The way we deal with that is we create no incentive whatsoever for that physician or healthcare clinician to write a prescription, get paid whether they write a prescription or not.

We do not create an incentive for them to write a particular prescription. We don't give them any kind of incentives for volume prescribing or anything. We give them incentives for quality care. That's what we do. So for example, all of our clinicians, all the visits that we have, and we have millions of visits, there's a certain percentage of them that every quarter we go through and we pull files and patient records and we determine whether or not our clinicians are providing good healthcare.

We have it vetted by an independent provider. Who works with us so that's part of our quality control program. We have a much more extensive quality control program, but at least the foundation of it is a review of files and patient records to be [00:14:00] sure that the clinician has done the right thing by that patient. And the only way a clinician can be penalized is if they don't have good care, if they're

not creating enough notes in the file, if they're not really interacting with the patient where they should, and so on. And so that's the kind of quality control that we want in healthcare. I'm not concerned about writing more scripts.

I'm not concerned about writing scripts for a particular type of drug. We just want great healthcare. And that's the culture of our entire organization. That is a fundamental tenet of everything we do at our company.

Mike Koelzer: Peter walked through that with me. Let's say somebody calls and they're calling the company that has the main product for disease X. If a person were to be talking to that doctor and. your drug is not the top choice, but it's going to be some other drug, because it does something else, some other quality that this main drug doesn't have.

What happens at [00:15:00] that point? Does the doctor write for something and then say, here it is, go someplace else. How does that work out in cases where it's not the best choice?

Peter Ax: So thinking about this, prescribing is so simple. a clinician listening to you and deciding that the drug you've come to me to talk about, not the drug I should put you on.

They could simply push a button, send a different drug to a different pharmacy

anywhere 

for fulfillment. So that happens all the time.

So let me make sure that I, Mike, I should probably run through our model

so you understand how it works. 

Mike Koelzer: hmm. Mm 

Peter Ax: So what happens today is drug manufacturers spend a lot of money on advertising medications. And heretofore, before Upscript Health, there really was no way to immediately. Get that therapy or talk to a physician about whether or not you want that therapy. So you might see an advertisement for a migraine headache drug.

You might see an advertisement for Inhaled insulin a new [00:16:00] concept that people have

used insulin 

that's injected into your body. But now you can inhale it and whatever the case may be you see an advertisement you go to that brand website and on that website will be a button that says something like Would you like to speak to a clinician?

Would you like to see if this drug is right for you? Patients will click on that button and they'll end up on the Upscript Health platform. And on that platform, they'll have a telemedicine visit. They'll have a patient support group that sort of rallies around them, if you will, collects their insurance information, determines whether or not there's insurance coverage for the medication, and will send that information to the clinician. The clinician will see the patient. The clinician will decide. This drug makes sense for you. Or by the way, maybe there's a generic for this drug. Maybe we should be prescribing you a generic. or if there's not a generic, maybe there's another option for you. The patient is coming to that clinician to discuss a [00:17:00] specific therapy. And that clinician is there to answer questions about that therapy. So that clinician has been trained on that therapy. They've been trained on that disease state. They've been trained on all the various options available in the marketplace for that disease state. And the clinician makes a decision whether or not to prescribe. By the way, the clinician might say, I need you to get lab tests, send you out for a lab test, and you'll come back. And those lab tests were automatically uploaded into our system. And we have a relationship with lab providers. And so the physician may have a followup visit. And so what we're finding is we're finding that we are being used in all sorts of use cases that we never expected. So, for example, we might have a patient that comes to us through a branded website about an infusion drug, a drug that needs to be infused, a drug that needs to be injected into your body. And we will literally have the patient speak with the clinician, decide whether or not that's right for them, and then if it's right for them, send them [00:18:00] to an infusion center. It might have otherwise taken weeks and weeks to get to

see a clinician, but they can get an answer very quickly, get an appointment at an infusion center right away. We have other drugs where something has to be implanted in the patient. We'll send you to a location to have that medication implanted. We can streamline the patient experience, make it relatively quick give them excellent care because the provider has been informed about that medication and that

therapy. And then, by the way, if the drug is in short supply, we can probably tell you if it's in short supply and our patient support team will call 10 different pharmacies if they have to determine where they can find a supply of that medication. So that's another thing that's coming up today quite a bit with drug

shortages. 

ultimately what we've done. It's sort of taking some of the noise out of the system, the friction, we've gotten rid of some steps. We literally, in my view, are redefining the patient experience in a really positive [00:19:00] way for great care.

Mike Koelzer: It sounds to me like that when this doctor is talking to the patient because that was sponsored by the brand. Initially it sounds to me like I want to make sure that brand is part of the possible solutions. We don't want it to be forgotten about.

We at least want it to be 20 percent of the solutions or something. it keeps it in the conversation, but not necessarily the end of the conversation.

Peter Ax: We call it the conversation starter. that, how the conversation starts.

The conversation can go on a lot of different paths

And the clinician and our commentary to the clinician is we want the best care for that patient, you take that conversation wherever it needs to go. And that's really important.

Because we're laying a lot of new groundwork here, so

we're defining the sector. And if we stumble, if we misprescribed, if we make mistakes, if we have our incentives misaligned the industry won't happen. It

literally won't happen. We'll shut it down.[00:20:00] 

Mike Koelzer: Well, and I think that's an part to be because really, it could be argued that, and I know this isn't the case, it could be argued people say, I'm calling this up and if the doctor just takes my word for it, I might be calling up with a fungal infection and it could be, other skin cancer or something, but I'm diagnosing myself because it got advertised on the fungal infection page or poison Ivy page or something.

And so. They're already all going down the wrong road, but that's why it's so important that the doctor has that freedom because the person may have made the wrong call to begin with.

Peter Ax: Yeah. Look, a good clinician will know if there's a risk to them having a misdiagnosis, the clinician has to use judgment and say, Is this the appropriate format to diagnose you?

Is it not? If not, let me send you to a primary care physician. Let me send you to a specialist,

but I can't prescribe online. There's too

much risk in what it [00:21:00] might be that you don't think it is. Now, the context is, if you think about what physicians learn in medical school, the mantra is 90 percent of the time, the patient will tell you what's wrong with them, 

listen to the patient.

It isn't something you do physically. You don't touch their knee or their heart or

whatever. They're telling you what's wrong with them

and you just have to listen.

But even in that context, you have to listen very carefully online and be sure that you're doing the right thing. And if there's any ambiguity, any doubt, any issue, that our clinicians will send you to your primary care physician.

And we do that all the time.

right back to the primary care saying go talk to them. You need this feeling. They need to feel the surface of this or whatever.

Right, right. Or maybe it's a dermatologist whoever the clinician might be, we'll send you back there. And by the way, we can oftentimes help you get a faster appointment with that clinician because our clinician can speak the language and say, this is a little more urgent 

Mike Koelzer: cut to the chase more.

Peter Ax: In the end, we want great care. It's

[00:22:00] what our model is all about and that's what we're delivering to our patients.

I'm doing it as a really economic model. 

Mike Koelzer: I don't have a phrase for it. I should, but it's basically, don't let the old lady sit down and give them a place to put their purse while they're sitting down. I don't really have an office that works.

I do now, but no one really knows. But if I'm going to talk to one of my sweet old ladies, I don't let them sit down and drop their purse down once they do that. It's seven minutes talking hello and five minutes about the problem and a Midwest goodbye for another, five minutes people say, that's what you lose. It's like, you don't lose that. The doctors right now don't allow for that. The system doesn't allow for that anymore. That's old school.

Peter Ax: old school. It's a myth, it's one of the urban myths. There used to be a metric, and I never checked this for a primary source, so I don't know how accurate this is, but there

used to be a metric I always heard in the days when I was fighting with regulators about

getting a license to prescribe online, and the metric I heard is that [00:23:00] in an HMO environment, a physician speaks to a patient for 18 seconds.

18 seconds of real substantive conversation.

And that is not a care bottle that made any sense at all.

So, by the way, the foundations of our company were really one of the reasons why I bought the online pharmacy in 2001. Is I read the National Institute of Health put out a book called Crossing the Quality Chasm and it predicted what was going to happen with care and some of the fundamental tenets were about bringing care to the patient,

making it accessible, making it

affordable, making it focused and so this, that book became almost like a Bible for us deciding to purchase this online pharmacy and try and drive a business that would deliver care online.

Mike Koelzer: Just told me recently, like they were at their doctor's office and they brought up, because you would think that in person and the old thought of, the doctors know all [00:24:00] your conditions and they see the interactions of those and they know your hips, not bad.

It's because your neck is bad and that's thrown out your back and that's thrown off your hip, that kind of stuff. Nowadays, you go there and it's like, you've got your one thing and you'll say, Hey doc, as you're running out the door, I've got this going on too. The anecdote this person told me, they're like, well, set up an appointment for it.

It's like, well, 

Peter Ax: Right.

Mike Koelzer: Here right now. And I guess maybe in the yearly physical, that doesn't happen. But typically now you're going to the doctor even in person for one issue, 

Peter Ax: For an incident. And by the way, 

a number Of the elements we treat. If you suffer from migraine headaches, you know you suffer from migraine headaches. You've been treated for migraine headaches. You just want to try a new drug that's out. You just want to know if U Barelvi is right for you.

You just want to know if Nertec is right for you. i want to know if Amavig Amgen's injectable is right for you.

And so you can have that dialogue with a clinician [00:25:00] really easily. It's transaction focused and that's okay. We're not saying your entire healthcare plan should be revolving around

that model, but that can help you.

 So for example, we treat sickle cell anemia. How can we possibly treat sickle cell anemia? Well, sickle cell anemia, a patient understands they have sickle cell anemia.

There's a drug on the market by a company called Emmaus. And it's a sickle cell anemia drug. And a patient wants to talk to a clinician. They can't get into their clinician for 6, 8, 10 weeks.

And they want to talk to a clinician and say, I've heard about Emmaus, I saw an advertisement. I want to try this drug. Does this make sense to me? And

they can have an intelligent, informed dialogue with a clinician.

That's the essence of our model.

Mike Koelzer: And I picked about the most difficult one in my example about the skin, but in general, you go through most of those on there, most of them are pretty, pretty straight about, like a migraine 

it's not as abstract as just something's happening to my skin. And by the way, Those dermatologists make a hell of a lot of [00:26:00] money, Peter.

Peter Ax: Yeah.

Mike Koelzer: Those guys make a crap load of money, almost more than any other specialty. It must be tough.

Peter Ax: And it's hotly demanded and there's a reason why you need to see your dermatologist.

However, there's a lot of skin ailments we can treat.

We really can. and technology with imaging is getting better and better. You can take a photo with your iPhone, it's going to be as good as an image used five, ten years ago in the dermatology world. you can get a really crisp image and see whether or not some mole is cancerous. You can

definitely get that view. 

 so I do think you'll see more and more use cases for our model. We're

also, testing for esophageal cancer. Well, how can we test for esophageal cancer? You'll go on and talk to a clinician if you're at high risk for esophageal cancer. For example, if you were a fighter fighter for more than 10 years, you have a pretty high level of probability. You may have esophageal cancer someday. We can give you a test. we will send you to a testing center. It takes about two minutes. They put something down your throat, they take it out, we'll give you a report [00:27:00] online,

And it's been seamless, and we find out if you're high risk by asking you some questions. If you're high risk, we have that test done. 

Mike Koelzer: Peter, my listeners still, mainly pharmacists or pharmacy industry, they're saying, All right we're listening, but we haven't touched the pharmacist part of this yet.

Where do the pharmacists fit into this? And what would your best argument be to say how pharmacists are being used in a really good way?

Peter Ax: So it's important to recognize that today, nine times out of ten, when we have a patient support phone call and the patient needs information, they don't want to talk to the HCP, they want to talk to the pharmacist. Because they want to talk about how the medication is impacting them, or they have questions about side effects, or they have questions about dosage, or they have questions about when they should refill, if they should extend out most of the time, our pharmacists are front and center with our patients having conversations about care. And that's a really new [00:28:00] phenomenon. But I think it's consistent with the phenomenon that pharmacological solutions have really become the focus of healthcare today. If you think about what's happening, people are not on just one or two meds these days.

People are on three, four, and five meds. As you

age, you might be on 10 and 15

So there's really pharmacology going on these days and people have to understand side effects. They have to understand drug interactions. So there's a big role for our pharmacists. And it's a very important part of our offering.

In our model, most of the time we don't fulfill the drug because branded drugs require insurance adjudication. Our pharmacy does not work with branded adjudicated drugs. We are a cash pay pharmacy solely.

So we usually team up. Whether it's Amazon or 20 other hub companies or specialty pharmacy companies, whoever the manufacturer wants us to work with, we work with. but what we find is the questions that are [00:29:00] always being asked are really related to pharmacy and pharmacies playing a bigger and bigger role in everything we do.

Mike Koelzer: Interesting where we match up, Peter, is our little pharmacy about three years ago, I don't think there's a whole lot like us in the nation, but we 

stopped doing brand name medicines because we're ordering 10, 000 a night in brand name medicine and we're getting paid 9, 000, a month later.

Peter Ax: Right. 

Mike Koelzer: Maybe someday they'll call me a wise man. And I'll humbly get up there and say, well, I'm not that wise. We were going to go out of business if I continued down this path. So in essence, it wasn't a choice for us. It was a choice to either lock the door or have a different model. And I wish it wasn't that way, but we're still around at least to bitch about it, where maybe 

Peter Ax: Yeah. 

Mike Koelzer: have before if I had to do that.

Peter Ax: Well, you've done a number of podcasts on PBMs,

 And we know it's just a, it's [00:30:00] a broken model.

Peter Ax: It's a misaligned model with healthcare and it needs to be readjusted.

But you think about it. PBMs control reimbursement.

Absolutely control it. They have no incentive to provide good reimbursement to a mail order pharmacy, for example. Because they would compete directly with the PBM.

Then add to it the independent pharmacies. What's their real incentive to give you good reimbursement?

None.

So they're going to squeeze everything they possibly can. And if you don't want to handle branded drugs, the next guy will have to

handle branded drugs. 

They don't care. So, the PBM model is a problem and it needs to be fixed. And there's a lot of scrutiny on it now and A lot of eyes looking at what's been happening in the PBM world. I

don't know that it will change so quickly,

but because these are very powerful companies.

But there was a Harvard business school case written last year about Upscript Health, about our

business. And it really [00:31:00] extends through our whole entire history, regulatory history. It talks about a pivot that I made in the business, which I'll talk to you about in a minute.

But it talks about ultimately, if you think about Upscript Health and where we could go eventually, we could disintermediate the PBMs. We can work directly with manufacturers, get pricing directly from manufacturers at a very good price, negotiate with payers, assuming payers are independent of PBMs, which they're not

today, but assuming they were, and you don't need a PBM world,

you can get a best possible price from the manufacturer, which is probably 50 percent off of their

WAC price

and have a cash pay component and a payer component.

 I've oversimplified things, obviously but the Harvard Business School case goes through this entire model of what could potentially happen if UpScript Health, you know, goes, is as successful as we think it'll be.

so let me talk a little bit about

the pivot we made.

So about six years ago, we had the original online business that I bought in [00:32:00] 2001. The online pharmacy. And that was basically focused on selling largely generic medications at a profit and good business, solid business. But about six years ago or so, companies like HIMS and Roman and others got lots of venture capital funding and were willing to generate tens, if not hundreds of millions of dollars in losses and acquire customers. And we thought to ourselves, the generics business is a business that's a race to a zero gross

margin. So we said, let's pivot from that business. And let's really focus on our farmer partnerships, which we know we're working on, but it was on a very small scale in those days, six years ago. We only had a few partnerships.

They were working for sure. But they were small, and so we said, let's really focus our efforts on these pharma partnerships. Well, lo and behold, it's really worked, there's a

a lot of demand from pharma. We did seven partnerships in 2022. We did 17 in 23, we're going to finish 24 in over 30 partnerships, and we're [00:33:00] probably gonna do 60 partnerships next year.

So we're

doubling in size every single year

with our pharma partnerships. The business is exploding. It was the right decision. And by the way, we have a good relationship with our pharma clients. And they really won't leave us as long as we're providing great service and great care to their patients. Pharma companies get to be closer to their patients, which is a big win for them and for the patient. And we get to report on things like shortages. We get to report on things like adverse events. We can provide a lot of good solid information to our partners as well. so we pivoted the business about six years ago.

That's what the Harvard Business School case was written about. And then the secondary piece of that is what could happen to the PBM world if we continue to succeed.

Mike Koelzer: ones you mentioned, the hymns and things like that, they don't really associate themselves with a brand, they're more like generic different odds and ends, but 

Peter Ax: Correct. 

Mike Koelzer: really selling a big brand.

Peter Ax: So I give them credit. They're developing their own brands

a sort of super brand for all these generic medications. Their model has worked [00:34:00] better than I thought it would,

particularly HIMS. But having said that, how do they maintain their position? They constantly have to invest In client relationships and in acquiring new customers, because there's going to be the guy down the street that sells the same drug for less money.

And maybe it's Mark Cuban at cost plus

selling that same pill of Viagra or that same finasteride or any other pill at that much of a lower price. And so how does HIMSS maintain that customer relationship? They've got to invest a lot in that customer. And again, we just believe that was a business that ultimately would go to a zero gross margin.

It hasn't yet, which is a bit surprising to me. But so I give them credit having said that, that's not a business we really wanted to be in. To me, that's not a healthcare business. They're creating a brand out of some medications in order to sell to consumers and consumers like it.

And that's a good thing, but that's not the business we wanted to be in.

Mike Koelzer: And Peter, let me think that through. So I'm contrasting that because they have to keep getting [00:35:00] new customers because people are undercutting them with maybe not their branded generic, their house brand, but they're still undercutting them and people aren't stupid. They can maybe look through the house brand in your guy's case.

 Would that differ? That you're more exclusive with some of these brand names, I'm trying to picture 

Peter Ax: No, No. So, the difference is we're dealing with a branded medication. Yeah. That the pharma company sells to the patient. We're not involved 

in the drug much at all.

Mike Koelzer: That's right.

Peter Ax: it's It's really, we're providing the healthcare,

we're providing the patient support,

but we're not necessarily providing the medication and that medication is a branded medication that will not have a competing medication.

It might have a competing therapy,

but a different drug, but it won't have the same medication that's available in generic, because it's branded.

So, whereas, HIMSS and Roman are dealing with generic medications that are, [00:36:00] widely available.

And then it's just a question of how much margin you put on the drug to sell to consumers. Now HIMSS is combating that a bit by creating some of their own formulations with those branded medications. They're creating a different form factor. For example, they have a Viagra pill that's sort of almost like a piece of gum and you put

it in your mouth, and it's different from a pill.

Mike Koelzer: I bet there's a lot of jokes to go along with that if we stopped and thought about it.

Peter Ax: Viagra, boy, oh boy, did I have was the butt of a lot of those

jokes. 

Mike Koelzer: I bet. I'd have to put this into the explicit category then. Contrast what you're doing. So let's say that I see a brand name drug in a magazine or something. And I know now that I can go there and, or press a button online or scan a QR code or something like that. And I might be taken to your company.

else might I be going to? What other brand, not by name, but what other things are some of the brand [00:37:00] name companies doing? Are some of them. Actually partnering with a pharmacy and so on, what other business models are there for a brand that I see in a magazine, for example?

Peter Ax: So there's really been a sea change taking place in pharma. Pharma, in the last, Three, four or five years has started to really think about digital. How do they provide a digital experience for their consumer? And what that has typically meant is not just creating a branded website that gives you lots of different information that's static, they've had that, but how do they elevate that experience for the consumer and how do they remain close to the consumer? So what we've seen is a lot of manufacturers have gone out and done requests for proposals for. Telemedicine support. How do you plug and play a telemedicine company? And if you follow the news for Lily Direct, they did it at a very grand scale. They announced that they're going to partner with several telemedicine companies and go direct to [00:38:00] consumers, which has also really instigated a lot of adoption in the industry. so this digital experience has transformed into a telemedicine experience. But what we found is these requests for proposals that go out to market, there's usually 30, 40 companies that might answer. and be a part of the proposal. It always comes down to us and maybe one or two other possible solutions. But frankly, no one has the fully integrated solution that we have. And what I mean by that is that patients can go online. We create an electronic medical record. We have a healthcare provider providing information to the consumer. We have a patient support team checking on coverage, benefits, analysis for the patient and helping the patient through the consumer flow, and then we're fully integrated from a technology standpoint into many different hubs and many different pharmacy operations. So we have a full closed loop solution for pharmaceutical companies that really, I don't believe anyone else has today. There are different pieces of it. People have. So what [00:39:00] we find is we win nine out of ten requests for proposals, at least, if not more than that. And out of all the partnerships that launch this year, we'll launch over 30 in 2024. There may be another three or four that are going to get launched by some other methodology. And usually that methodology is partnering with a marketing firm that's going to do a lot of customer acquisition on behalf of the pharma company in addition to then teaming up with a telemedicine service to plug and play. 

Mike Koelzer: All right. So let's say I'm a short sighted CEO of a startup manufacturer or something like that, and I want it all, want all the profit from this. It seems that I would. Set up my own, and I know all the reasons why I wouldn't do this. Cause I believe in specialization and I believe in what you do well and all that kind of stuff.

it seems that I would want to set something up to do what you do. then I want you closely associated with [00:40:00] my brand more closely associated, and I want my hand in the. Kitty, when I sell that drug, I kind of want to own that too. So I want it to be more closely associated. Are there companies that try to do that?

For example, let's say there's a name brand company that is trying to sell it out of there, maybe figuratively, but sell it out of their warehouse instead of getting all these secondary and tertiary markets involved?

Peter Ax: They can't. If what you're describing is a pharmaceutical company going direct to consumer, creating their own healthcare practitioners, for example,

owning the entire suite 

 From a regulatory standpoint, Pharma companies cannot be

involved in the practice of medicine at all.

And there's even an infrastructure that we have to establish as a third party supplier or vendor to pharma. There's a whole complicated infrastructure that we have to maintain to be able to provide that service to pharma companies, but pharma companies legally are [00:41:00] not able to provide those services directly.

Mike Koelzer: they can't do either the medical part, meaning the prescribing, and they can't do a true direct to consumer from their back warehouse

Peter Ax: Correct. Correct.

yeah. so first of all, they can't go direct to consumer with healthcare practitioners because they are not allowed to practice medicine, they're

manufacturing a drug. They'd be, it'd be a strange set of incentives if they were

then had a bunch of

physicians prescribing their

drugs, which is why in effect, the Chinese walls for us are so significant. Because we have to be sure that our clinicians are not incentivized in any way by what pharma companies pay us to support their programs, so that's very carefully managed. By our organization and by our lawyers. on the pharma side, pharmaceutical companies can't really go direct to consumer because they'd have to get 50 state licenses

and they'd have to have a pharmacy operation and they'd have to have pharmacists in charge. These are things they would never want to do. I'm not even sure [00:42:00] they could do it 

purely from a regulatory standpoint. At 

what I'm aware of that 

Mike Koelzer: I know you're not a history person necessarily, but was there ever a catch up to that where some of these companies tried to do it and then the laws get stricter or do you think none of them really tried because the laws have always kind of been there?

Peter Ax: companies have never really been able to do that. 

You've had durable equipment manufacturers try and go direct to consumers and they've gotten involved in a lot of regulatory problems. So that's a complex relationship. And that's been shut down very quickly by regulators.

Mike Koelzer: That'd be like some heart monitor or something like that, that they're trying to have the sales team and the product team and all that kind of wrapped up into one, something like that.

Peter Ax: well, I'll give you a really recent example,

and this is where you've seen the justice department come out with some anti

fraud suits

You would have a healthcare company create a health fair, invite a bunch of geriatric patients [00:43:00] to this health fair, they would do Genetic testing

For these geriatric patients.

And the geriatric patients don't really know what they're

signing up for. They just, sure. Would you want to give me a free test for me to learn about my genetics and whether or not

my children will be influenced or my grandchildren will be influenced by

something in my genetic composition? I'll take that test. Well, the issue is number one, those companies were then applying for Medicare funds to pay for the test. Number two, the patient wasn't having to come out of pocket at all, which is

another red flag. And three, these were really unnecessary tests.

And so you've seen investigations. I think you've probably seen indictments of companies that started doing genetic testing of groups of people in health fairs.

Mike Koelzer: I shouldn't have had to look for this example because in my life, I've had a couple of DVTs in my leg and I go to this local group of doctors [00:44:00] who their claim to fame is we don't amputate, not for my thing, but I mean for diabetes, we don't amputate. We like to save stuff.

I just got a letter. In fact, I just got the packet today of my record because they were basically shut down because they were both. Diagnosing and then doing too much testing with Medicare, which wasn't needed. And I think they might've even, I don't know for sure, but they might've even had like their own products or something that they were using for this or something, and just not enough oversight on that.

And they closed down. Like I say, I just got my transfer packet today. 

Peter Ax: Yeah, look, this is an area that's fraught with all sorts of regulatory issues.

You've got 50 state laws to deal with. You've got federal laws to deal with. You've got Medicare. You've got anti kickback. You've got a corporate practice of medicine.

You've got pharmacy laws. You've got physician laws. The amount of investment we made it legal to basically launch our compliant platform.

I mean, it may not go into the tens of millions, but it's certainly in [00:45:00] the upper millions of dollars to set this up properly and do it right and maintain it for that matter,

because laws are always changing. 

Mike Koelzer: Now, Peter, none of your staff put me up to this and it always comes out wrong when I ask this, but what do you do all day? 

Peter Ax: yeah, 

Mike Koelzer: But as a CEO, I know all days are different, but give me an example of what a day might look like for you.

Peter Ax: So Mike, one of the interesting things, I spoke a little bit about our corporate culture and we're really focused on the patient. But because we've created this organization, it's just pure integrity, really doing the right thing, leading from the heart, as much as we do from the pocket.

literally we have signs all over our offices with these various slogans, but there are six senior members of management that really run the day to day operations of the company. Five of them. Have been there 20 plus years,

incredibly loyal, incredibly dedicated,

incredibly successful at building a really important platform.

And the last one was our chief operating officer we hired three years ago, [00:46:00] who is just outstanding. George jones and he's made my life a lot easier these days, by the way The last three years i've been able to vacation more than I have in the previous

20 years 

so that's been quite nice. But look, I woke up in the morning.

First of all, I read the press. I spend a lot of time reading various newspapers, like the Wall Street Journal and the New York times. I try and read the economist I try and get some articles in the new yorker as well but I spend time reading in the morning and then I

answer emails 

Mike Koelzer: on your phone or?

Peter Ax: Uh, iPad, iPad,

Mike Koelzer: IPad. Yep. 

Peter Ax: iPad. And then I head over to my laptop computer and I answer emails. And I always have some emails that are important. Sometimes they're from pharma companies wanting to talk about things going on in the platform. Frankly, most of those go to the other members of our management team these days, and not so much to me.

I might get an inquiry from one of our physicians that says, Hey, I want to talk to you about something. I have a concern about this, or I have a concern about that. But most of my day is really spent on legal, regulatory matters. It's on our financial matters. Are we going to [00:47:00] go public someday?

Are we going to sell to a strategic partner someday? I'm always talking to bankers. I'm always talking to private equity firms. So that's how a lot of my time is spent and really thinking strategically, where is this business going? I'd say the final hour of my day is always about what we are going to do next?

What do we

need? Where's the risk in the business? What do we need to improve? How's our user interface? Maybe we need to do a study on that. What's happening with our NPS ratings? What's happening with our TrustPilot ratings? Are we doing well? And frankly, I try to have a, Holistic vision of the business and a strategic vision as best I can, which is really, these days, so many CEOs are caught up in the day to day.

It's really difficult to do that, but I've got such an awesome management team.

I get to do the good stuff. 

Mike Koelzer: And then are you on the phone for these conversations? Are you on face to face or video? What are you doing for 

Peter Ax: That, 

Mike Koelzer: you mentioned?

Peter Ax: So that's a really interesting question. [00:48:00] I really dislike the phone. I can be so much more efficient in emails

and I can be so much more efficient in texting and. And I can set things straight and be factual. I love the zoom calls. I mean, I like the personal

interaction, but my day would be unproductive if I was on zoom calls all day.

Because every once in a while, I am on zoom calls all day.

So with our pharma partners, after we launch their site, we have regular meetings. They'll generally start out every single week. They'll move to a cadence of about once a month, and they rarely move to a cadence of anything extended more than once a month, but we get on the phone with them.

 Every once in a while, I'll sit on some of those calls, but I can't spend my day on those calls. I need to be responsive. And so, I find email is highly effective for me.

Mike Koelzer: So your conversations with them are typically email conversations.

Peter Ax: Correct.

And then every once in a while, there'll be a zoom call. That's rare.

Mike Koelzer: I love email. I sound antiquated, like it just [00:49:00] got invented yesterday, but it's a track record. You can go back and check it out. Look at your conversation, get caught up on it.

Peter Ax: Yeah.

Mike Koelzer: It's passive interruptions. You can read it at six at night. Someone else can read it on the other side of the world, six at night, their time.

I mean, it's a really good way to go. And when people say they want to talk to me, I'm like, I don't want to talk to you and I typically don't

Peter Ax: Yeah. And look, I find that email on a personal level, sometimes it's hard to have the right intonation about something, but on a professional level, you're right. You create a permanent record. I can go back and look and say, Oh yeah, this is the conversation I had last time. Let's be sure I'm sympathetic to what was said then.

Mike Koelzer: And let's take the conversation another step further. and It kind of avoids like The old lady purse There's a lot of old lady purse stuff That is done by 40 year old corporate guys. It's just in a different style. 

Peter Ax: yeah, 

Mike Koelzer: minutes shooting the breeze on the sports and it's fine, but it doesn't make for a real [00:50:00] tight day.

Then you can break off of that and spend time with your family and 

so on. 

Peter Ax: And Mike, I'm not a chit chat guy.

I probably spent too many years on Wall Street for that.

I really just want to get to the heart of the matter.

And if I want to chitchat, I'll chit chat with friends, relatives, and my wife. I

I really don't want to chitchat. I just want to get the business done.

Mike Koelzer: I once heard that I guess I practiced this. They said, don't put up a bunch of pictures around your office at work of your family and that kind of stuff. It's just get in there, get it done and go spend time with them.

Peter Ax: Yeah,

Mike Koelzer: you have pictures of them there you're not with them enough.

You're spending too much time at the office.

Peter Ax: right. Although I'm guilty of having lots of pictures of my kids all the

way, all around, but 

Mike Koelzer: Well, I just don't do it because I'm lazy. we're in our house now. We've been here for 20 years and I'm still thinking about putting a picture up in the bathroom someday or something like that, don't take me as a guide for that. Peter, what's the worst hour or two of your week [00:51:00] is there such a thing? 

Peter Ax: In the early days of this business, we faced existential risk every day, we were worried about a regulatory silver bullet. So when a regulator sent me an email, oh my gosh, my heart would pound. If a regulator ever called, one time, I won't name the state, but you can probably guess who it is, but a state sends me a fine for a hundred million dollars by fax.

Mike Koelzer: By fax for 

Peter Ax: By fax. They said, we think you've done this many prescriptions in our state. We don't agree with the way you've done your prescriptions, blah, blah, blah. 100 million fine. And this was one of many crazy regulatory incidents. We, of course, negotiated out of it and it was nonsensical and they didn't

understand something. But

I think we gave them 5, 000 to go away.

So it's moments like that over the years that were really hard. Today? If I get a bad call or a bad email, it's going to be patient [00:52:00] related.

It's going to be, I've had an unsatisfactory experience. Your customer service person was, or your patient support person was abrupt with me. My doctor didn't show up on time. We're not perfect. So sometimes our

doctors don't make

their appointments online or,

We missed something. Those are the moments I hate because I just want everyone to have a phenomenal experience with our platform. 

Mike Koelzer: Boy, there's some stuff you read the books about, offloading this or that and there's some stuff I just kind of like to do like at my house. I've got a riding lawn mower and that was a time where I would just kind of do it because I enjoyed the noise and the peacefulness of it and so on and the hum of the engine and that and But no longer, Peter, I've got a cottage 40 minutes away, in this spring, I said, I'm never going to cut this damn lawn again.

And so I looked into riding mowers and things like that. And I ended up getting a lawn robot. 

Roomba 

Peter Ax: I've

seen those things. Yeah. 

Mike Koelzer: Today, it's the first day of 90 degree weather in Grand Rapids. [00:53:00] we're gonna have a stretch of that. So I was at work and I started this thing up remotely.

And there was such pleasure knowing that something was getting done, but I wasn't sweating to do it.

Peter Ax: Right. Dread. How beautiful is that? So does that Roomba really work?

Mike Koelzer: It works great. 

Peter Ax: Oh, that's fabulous. That's beautiful.

Mike Koelzer: I wanted to wait till there was GPS on it. Cause I didn't want to put down the lines and all that kind of stuff. It's fascinating. it knows exactly where it's going. And so it knows if it missed this spot over here, it goes back and gets it and things like that. 

Peter Ax: It's

great when technology takes over tasks. You don't want to do 

Mike Koelzer: And then we have geese at the lake. And so I bought a decoy coyote. I'm kind of a big deal on the lake this year with my fake coyote and my Roomba, I've got people stopping and stuff like that.

And you don't need a big boat to do that or a nice new 

Peter Ax: Right, 

Mike Koelzer: It's just a little yard Roomba the

coyote. 

Peter Ax: This is up in michigan upper michigan

Mike Koelzer: yeah, we're [00:54:00] in Michigan if you put your left hand up Grand Rapids is about a halfway up your hand kind of in about an inch in and 

Peter Ax: Okay, 

Mike Koelzer: That's about where we are.

Narcotta is just a little bit north of there.

 Now Peter you were saying that You've spent a lot of time in New York, but now you're in Arizona, What's the difference? Is it just heat related or is it still business related to why you do some of these things?

Peter Ax: It's largely business related in the sense that if we have a number of meetings that are going to happen in New Jersey with our pharma partners or in New York City, I'm going to be here for an extended period. I kind of try and push them together as much as I can.

It's not so much weather related, honestly, but it's also sort of family related

because my children are here in New York City. And so I sometimes want to be around for Father's Day. It was great to be here this past weekend.

I'm in New York now But I probably won't head back to Arizona for a few months just because it's so hot there right now until

it cools off a little [00:55:00] bit 

But you know, our offices in Scottsdale, that's corporate headquarters We are largely a virtual company in the sense that we have

30, 40 tech people that almost never come into the office.

We have people that live in Washington, we have people that live in Montana, we have people that live in Ohio, on and on. So they're almost never around. Our patient support people are around, they show up to the office, the executives show up to the office, most of them, not all of them, some of them kind of work, for example, our chief operating officer lives in New Jersey.

He commutes to the office every third week, he's in the office for a week.

I try and time it so I'm in the office when he's there, if I can

But I've got a complicated schedule because I travel quite a bit. I'm always sort of going to some other meeting somewhere.

Mike Koelzer: Are you ever going to those meetings as just the face of the business to show how important an account or something is? because like you said, you've got so much support that's doing such a good job. I can't imagine you're, 

Peter Ax: Yeah. 

Mike Koelzer: careful how I say this. I can't imagine you're [00:56:00] needed there, 

Peter Ax: Right. 

Mike Koelzer: I can see your face needing to be there sometimes.

Peter Ax: That's right. I don't have to be involved from the standpoint of supporting our partners. They really don't need me at all. I have to be involved if our partner needs to feel that we're supporting them.

so every once in a while I'll have to show up for that purpose. And I'm delighted to, and I like knowing our partners and what they're thinking and saying, so it's a good opportunity for me too. But our team is so crackerjack. they don't need me. I know they don't need me.

But I want to be there when I need to be there and I always will be when I need to be there. So, I'll get on a plane in a minute if I have to.

Mike Koelzer: Peter I know you mentioned something private versus public and so on. Is that in the works? Are you guys happy where you are? What's the future as far as ownership and so on?

Peter Ax: so, we are so fortunate in that, I was able to fund the company initially and we really have not taken in much capital at all. Over the last 20 years, stock is only 5 percent owned by outside third parties. [00:57:00] And so the management team and I own the rest of the company and we will decide what to do.

We all are energetic and want to keep going and want to keep growing it. The business is literally exploding the demand for our services. And so we want to keep that going and do it as long as we can. And we'll probably look to bring in a partner. If we think that partners can really help us in growing, we'll look to bring in partners , perhaps some strategic partners in the next year or so. We might look at a public offering. There's some banks that want to talk to us about a public offering next year. I don't know that we really do that or not,

but we feel really good about where we are at the moment. And we just

want to keep growing, keep doing better and better at what we are good at, which is

running the business and

stay focused. but I meet with private equity firms and bankers all the time.

Mike Koelzer: What would be the reason to, let's say you don't need the influx of capital. Would there ever be a reason to bring in a partner to [00:58:00] grow or something that you just couldn't hire? you need to actually bring them in because that's the only way they can do their thing.

 Or could you hire that stuff too?

Peter Ax: I think there's different reasons why you bring in different types of capital into a company.

And one of the reasons is sometimes you want some discipline, you want financial discipline, or another is you want some strategic value. So, we don't feel like we need financial discipline.

We're pretty good at running the company and maintaining the finances. Wherewithal.

We do believe that partners that are potentially really knowledgeable of pharma and opportunities to not circumvent PBMs, but kind of evolve the model for healthcare, evolve the model for online medicine to the extent there's partners that can play a role with that.

Perhaps they provide some hub services that we don't offer. So it might make sense to bring in a hub partner. It might make sense. To bring in some financial [00:59:00] partners who just could help us decide what to do in terms of our major financing that'll come up in the next year or so . But really it's knowledge focused, it's expertise. And can you hire that? You can hire some of them. Sometimes not, sometimes you get it from a board of directors. It just depends on who you have, who you surround yourself with and what you're doing.

Uh, we've not ever focused on creating a real significant board of directors.

I think I know some people I would add.

When we do decide to do that.

But I don't wanna do that until we really are taking in more outside capital and

have more responsibility as shareholders.

Mike Koelzer: In my little operation, my grandpa first and then my dad my dad always said we run best as a benevolent dictatorship. So with both of them passed on, I'm the benevolent dictator now. 

Peter Ax: That's a family of entrepreneurs. 

Mike Koelzer: I have a bunch of siblings, but that wouldn't have worked.

did work just best with one of us. 

Peter Ax: the decisions. 

Mike Koelzer: I wouldn't have gone that route. So you gotta be real careful about [01:00:00] who you bring in and why, 

and what 

power you want to give away and all that.

Peter Ax: are easy right now. They're really easy. I just made the decision. My team will give me all sorts of options and ideas and thoughts.

And we'll say, here's what we're going to do guys. That's where we head.

Mike Koelzer: I spent a few years on this parochial school board. We'd be talking about something for three meetings in a row, three months in a row. And then priests show up to the board meeting and say this and they'd say, no.

And I learned real quickly that we were just a recommending board and that's all we were. 

Peter Ax: That's beautiful. beautiful.

yeah,

Mike Koelzer: My dad, I would have ideas and usually things would go my way. Pete passed on 20 years ago. We've worked together for about 10 years. things would go my way, but it was just like, it's probably good practice and setting up my arguments and stuff that I now can use in my head by myself.

But the things were just drawn out because you knew what, something was a good idea, but you had to articulate it. And that just [01:01:00] took a long time. 

Peter Ax: yeah. 

Mike Koelzer: it was probably good for the business overall, but it just seemed to take a long time instead of just a streamlined approach. 

Peter Ax: So, you know, it's interesting. I'm a, uh, a leader that I really look for the input from everyone around me. I really do. And I want to hear what they have to say. I want to hear the way they're thinking about

something. And then I want to tell them guys, here's what I think we do. And then I want to hear the criticisms of it.

 What am I missing? What am I not

seeing? I constantly ask that question, what am I not seeing? help me to understand your view. And I want

you have a different view. We recently had a strategic meeting of our 15 leaders in the company, and we're sitting around the boardroom table and someone needed my view on something.

And I said, well, let's go around this table. I want everyone else to give their view and then I'll give you my view. it's a great exercise because first of all, you're engaging everyone in your organization to have an opinion

and encouraging to have an opinion and have a view and think about [01:02:00] things. And then besides just encouraging them to do that, they may have a great idea that you haven't really thought about.

then it also adds this culture of we are a team. We're all in this together. And so I mentioned that our senior team has been with me 20 plus years. The

The average longevity of our everyday employees is probably more than a decade.

We don't lose people because they quit. We lose people because They haven't kept up with us where

They didn't rise to the occasion. That's even, that's rare because we give people a lot of chances to really shine.

When I became an entrepreneur from becoming a wall street investment banker, I really wanted to create a unique business environment that focused on people first. that people, meaning our clients, our patients, our healthcare providers, Our pharmacists, our tech team, our patient support team, our executive I wanted to focus on all these other constituencies. Besides just bottom line dollars, besides [01:03:00] just creating another valuable enterprise. I really wanted to do something unique.

And I think we've been really successful at it. And a part of it's been by engaging with our employees and asking them to play a role actively in the organization.

Mike Koelzer: stealing a couple of things from Bezos, I think, the part about listening and I think on purpose, I don't forget if it was their company or not, Amazon or not, but they said that they always have the new people speak first because typically they're just going to nod especially if the leader says something and then he speaks last. I think Bezos was saying that he'll come out and say, I don't agree with you. I don't think that's going to work, but I want to do it. You have my full support.

Peter Ax: Yeah. And if you treat somebody around that table, if you say to them, bad idea, we're not doing that and shut them off that quickly,

no one else at that table is going to respect them and be able to work with them properly. You

have to show them all respect. 

Mike Koelzer: That's interesting you're saying they won't have respect for that person 

either, because they're kind of following you.

Peter Ax: right, [01:04:00] exactly. I've got to set a tone that respects everyone's opinion. And

It's listed in our conference room as one of the things we do is we respect each other's opinions. So when I was young, say what a strange little kid I was. I read a book by Mortimer Adler, who at the time was the editor in chief of the dictionary.

I think it was a Meriwether dictionary.

I remember I'm probably getting that name wrong, but Mortimer Adler wrote a book called how to think, how to listen.

 And I was a young boy when I read this, but it talked about how in school you learn all about writing. You learn all about math.

You don't learn how to listen.

You don't learn how to just shut up and listen. That book has served me well throughout my life. Just don't say anything. Just

listen. 

Mike Koelzer: this goes along with the board stuff. One of my teenage daughters and they only have two teenage daughters left, but She was giving advice to my wife. My wife was saying, I gotta stop eating this and I've got to, do this and exercise this and [01:05:00] that.

And she said, mom, she said, I don't like that negative talk that you're giving to yourself. And so later that night she gives this 

list to my wife.

Mike Koelzer: and it's got 10 things of like self, what would like self appreciation, I forget the term 

 I'm good enough. I'm strong enough, 

Peter Ax: reinforcement, positive

affirmations. Yeah. 

Mike Koelzer: she's got this list one through 10, I'm a good person. do take care of myself. I love myself and all this kind of stuff. So Margaret showed me that later and I turned it over and I'm like, where the hell was 11 to 20 where it says you're the worst mom in the world.

You never listened to me. None of my friends moms do this, 

Peter Ax: That's beautiful. Peter, tell our listeners again how they're going to find your company, find you and so on.

So Upscript Health is the name of the company. You can go to upscript health. com. And if you went to upscript. com, you would see the various medications that we provide. for our manufacturing partners. It's a subset of them. Or the way you'll really find us more often than not is you'll see [01:06:00] an advertisement for a medication.

You'll go online to that website to do some research about that medication. And there'll be a button that says, would you like to speak to a health provider right now? And you'll click on that button and you'll be on our pro platform,

Mike Koelzer: Well, golly, Peter, thanks for joining us. That was delightful. It was fun talking to you and just seeing all the ins and outs of that. Really cool. I know you're a busy guy, you got a lot going on, so I appreciate you spending time with 

Peter Ax: Mike. And I appreciate you taking time and having me on your broadcast. Thank you very much. I'm really honored.

Mike Koelzer: Thank you, Peter. We'll be in touch.

Peter Ax: Great. Thanks, Mike. 

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