Transforming Pharmacies into Nonprofit Entities | Edward Ullmann, R.PH., MPA

Speech to text:

Mike Koelzer, Host: [00:00:00] Ed, for those that haven't come across you online, introduce yourself and tell our listeners what we're talking about today.

Ed Ullman, Pharmacist: My name's Ed Ullman and, I am the, c e o and, the managing Pharmacist, for Wellness RX in Taylorsville, New York. the first for-profit community pharmacy pharmacy in America transitioned to a nonprofit community So that's what we're talking about 

Mike Koelzer, Host: ed, Ed, let me cut to the chase with this early question. Is somebody who really should be listening to this a pharmacy owner that's about ready to throw in the towel and what we're gonna talk about today gives them a little bit more life? Or is that too selfish on this topic?

Ed Ullman, Pharmacist: No, Mike, I think it's an excellent question . I watched the closing of pharmacies, all across America. Now, I don't think we could ever have thought it would be this acute, that 25% of communities in America don't have easy access to a pharmacy. But I looked at the pharmacy profession as underperforming and the only reason that it was underperforming, not because we weren't training the students as doctors of pharmacy, or that we couldn't increase the training for more clinical services or provider status or communication skills or so on.

It's just that the reimbursement fulfilling prescriptions, the economics are not there. I'm an entrepreneur. I've developed over 30 different companies and I was stunned coming back into the profession to look at how poor this has become with the consolidation of the third party reimbursements of pharmacy benefit managers and the consolidation of power in the hands of few.

and the impact is quite intense for any industry, when only a handful of companies control policy, they can control innovation and growth. and they could squeeze you, at any given time when they control your reimbursement. So right away, it put the retail pharmacy owners, and it didn't matter how many years you were in the business or if you were even got to the point of filling 250.

300 scripts a day, you might have had some institutional accounts. you're under the same squeeze and the exit options stink. and so if you are looking at the changing drugstores as an exit, I think we're gonna enter into a new era right now where those options of buyout are going to be even less, not more.

 American capitalism is great. I am a capitalist, I'm a business guide, but this is a stack deck that we're working on right now. And so when you have a, as early as six months ago now with CVS announcing the closing of a thousand Brick and Mortar stores in the United States, almost 20% of their inventory, that doesn't look like a growth business to me.

it might be horizontal and vertical, and then they picked up the insurance company and so on. So the answer was, I said, what options do independents have that are being forced to work more hours for less money? And you have your pride, you have your relationship with your patients,and you wanna keep it together for your community, but you can only go so much before you're starting to make 50% of what you could be working for a chain

 Now it's gotten more intense after covid because of so many pharmacists that said enough, and they don't wanna work for a chain drugstore. and even if you get a $40,000 bonus, they're saying, we're not whores here. I don't want to do it. and so that puts more economic pressure on the chain drug stores to increase salaries.

To try to get two year deals, to just get warm bodies to open up the stores, even if they're reducing hours. Now, when you still come and put that much pressure on a pharmacist, errors are gonna happen. poor services gonna happen. and so I kept saying, one is the options for my profession. This is for community pharmacy, and I serve on the President's Advisory Council for Albany College of Pharmacy where I went to school.

And I go, then my next time when I make my presentation to the students and I have a six year student as an intern right now, what am I gonna tell them? Well, I think there's some rich opportunities in industry, especially coming out of Messenger, RNA and all the vaccines. I Think we're gonna see enhanced public health opportunities for pharmacists. I think, at some juncture, HMOs and medical group practices are gonna start to incorporate the clinical services of pharmacists more and embed them. I think we're gonna have an increased growth in the federally qualified community health centers, and I [00:05:00] think that there's gonna be more and more roles in the public sector. But then I looked at and said, well, what about all the retail pharmacy distribution centers that don't live in an urban area where they can at least get around to, to go see, a pharmacy?

And I go, we have to find a better way. Now whenever you're gonna try to plan, you wanna plan for the next generation, where are they at? What do they think? Why should a mom and dad put out 50 to $60,000 a year in tuition to send their kid to pharmacy college?

We have to ask these questions. and, and so I looked at, you know, what is it they have, they have a thirst,for authentic 

behavior. They have a thirst for wellness and prevention. They want the respect of a pharmacist, but they want more than the dispensing of the right drug, for the right person and so on.

So I explored that to say, what does that model look like? What are the people telling me that they want? And the first thing that, that, that came away was obviously public health. And then Covid hit. And, in our little pharmacy we did 1400 covid vaccinations. We had contracts with the local high school.

We did all the covid testing for the students and the administration. and you started to say, wait a minute, the pharmacy came out of nowhere. Or We did 30% of the first round of vaccinations and I believe we've done 70% of the booster shots. Well, the public loved it. The accessibility was there and we stood tall against adverse situations and operated as professionals.

And then I go, well, what else happens? What else should we be talking about? And, at one time, like I was the county mental health director, and, so I've had some really good experie. Working with substance abuse and, and, dealing with psychiatrists and psychologists and social workers and decentralizing,wellness centers for mental health counseling, and also setting up facilities for domestic violence and so on.

and I go, alright. Just because pharmacists have not been trained in, in, in mental health, that doesn't mean that the need of their population is not needing the help and mental health. Now, little did I understand that Covid was gonna put mental health issues over the top and bring in the kids at a very magnified level. And it's now our number one issue that we're all dealing with. Well, when you look at your patient population and any pharmacist can do this, just look at the percentage of your patients that are on a mental health medication in some shape or form, and then you can separate the really high risk mental health,candidates like schizophrenia, manic depression, and so on.

but most are dealing with depression, most are dealing with anxiety, which is only escalated and in a sense of wanting hope. And the community pharmacist is the best person to do that. And so we established our model around the mental health field, believe it or not. And what I realized is that, we set up our own mental health unit, division, mental health professional of staff, And then we started to work on case management of high risk groups of people.

These are the people, your patients that are not gonna go to the county mental health department. They are living a little bit underground. And the notion was, if you build up trust with them and you're authentic, then you have a connection to go deeper and further. And that gives you an opportunity to learn more about who they are, how do they get banged up?

Why are they on narcotics? What is happening in their life? And start to come up with game plans with them. That includes drug therapy, but it also includes food, housing, and other things to try to help guide them. And I go, this is a new pharmacy. This is really a wellness center.

and how do we do it? So we then looked at how important it was to not only connect with seniors, especially doing at home services. But the kids. And so we set up fish tanks for the kids, and if they come in, and say hi to the fish, they get a honey stick. And I went, okay, we're onto something.

Their eyes light up, they're excited to come to the pharmacy. We then brought in art so that the kids would feel comfortable, engaging in art in any way to kind of make them feel that they were important. So when they would come in, I would have them sign for their medications before they leave.

So for many of them, they, the first time they ever saw their signature come out on a receipt,

so it answered to your original question, of, is there an exit strategy that's positive for existing retail pharmacists? Especially in rural America, we are older.

The pharmacists are older, they've been around, they've seen the best of pharmacy, they've seen the ugliness of pharmacy. and so I go, what [00:10:00] strategies do we have? Because this is not a typical industry where you have individuals that have developed health systems for pharmacists that they, in effect, you could call, incorporate into the health

systems. And so it was really limited. And so I said let's think outside the box. And then I brought in my background that I had a non-profit world and and I had my masters in public administration. And my first HMO that I did was non-profit. So I've had that experience and I said, why not for my profession?

and I said, well, let's come up with a strategy of how we get here for two options. One, how do you make the conversion of a for-profit pharmacy into a nonprofit structure that gives a reasonable buyout, and sale of the assets and liabilities to a nonprofit organization with a nonprofit local board of directors.

and this would be in lieu of a cashout to a chain. and then how do we set up new non profit pharmacies ? It's a large learning curve. How do we go through with the Board of Pharmacy to get them to feel comfortable, approving a nonprofit?

How do we go through, with loans in, in early startup on the financial side? How do we help to streamline these startups so we're not reinventing the wheel? How do you operate a, like a hard edge business, but the profits just go back for the public good. And I think over the years we've worked that out.

And so we had the grand opening,two Fridays ago. And Mike,I was brought to tears. I lost my wife during this process,six weeks ago.

Mike Koelzer, Host: Oh, I'm sorry to hear

that, ed. My sympathies. 

Ed Ullman, Pharmacist: we were together for 52 years. my best friend, and she got pancreatic cancer. And as a pharmacist, I thought I knew all about cancer, but let me tell you, pancreatic cancer moves in 30 days.

She was 

Mike Koelzer, Host: I'm sorry. 

Ed Ullman, Pharmacist: Yeah. So I said, all right.

What are we gonna do? Well, I dedicated the first nonprofit community pharmacy in America to the spirit of Patty Oman so we had the event not knowing where to go, but Mike, here's the formula that we came up with that I only will start if I had the town government totally on board.

Now, whether they pass a resolution or not, I know when they're telling me, I want this, I want longevity. I want sustainability for my pharmacy. And I go to them. I said, all right, do you want a wellness center with a pharmacy that will be part of the community, a structural part of the community, the same way that our community library is?

And they go, absolutely. I go, well, that's what we're gonna do. We're gonna get you there. Then I go to the business community, the Chamber of Commerce and the business associations. I go, I don't want you to see this as competition. Right? This is synergy and this is what brings people in. And then I said, from my experience in my pharmacy, now that I've had it for eight and a half years, more people come to the pharmacy than any other depot.

And therefore I get to know the people who migrated in our case from New York City up to the country through Covid. I know the tourists, where they come from. And then I can blend that together with my locals. And now we got something very interesting. And so, I then tell them from the business community I can bring in business, I'll develop a tourist attraction.

Our stores that we do, Mike, 

are really first class. I mean, if you, they really are beautiful, old Aary looks, 

Mike Koelzer, Host: I've seen them online. Yeah, they look beautiful.

Ed Ullman, Pharmacist: Clinical rooms and everything else. So, we got the support of the business community. I went to the churches. I said, I need your support. We went to the schools and then we went to the county government and then to the economic development folks, to the nonprofits in the community.

 And once I knew everybody was on board, then I knew I had to juice in the coalition of strength. and so when we opened this store, a few weeks ago, I didn't know who was gonna come out. Well, 120 people came out

on a Friday morning. Now I didn't know which of the public officials were going to agree to come to this opening in this rural community.

Well, they all.

Mike Koelzer, Host: Wow.

Ed Ullman, Pharmacist: Came, the county executive came and she said, this is the number one thing I wanna back up from my communities and our county. The state senator came, she said, I've been watching Mr. Oman has used this model for years. He said what he was gonna do, he delivered it today. I'm all in now. My job is to find state grants for, to do this.

and it went on and on and everybody threw their speeches away. Mike and everything was from the heart and it was really sensational. And the PR that we got, we had Spectrum TV there, all day. There's a documentary team from [00:15:00] California that was following our progress. I go, we are onto something and then we've got a request from eight other communities without any advertising to do the same thing for them.

 So I had not experienced this magic before. And all it just says to a pharmacist, you gotta think outside the box.

Don't be afraid to get a little dirty here to learn new things, but your community will support you. Right. And the states and the federal government are going to have to create new ways in order to provide grants and low interest loans to communities in order for them to be empowered to bring primary care to their marketplace.

And the pharmacy wellness center gotta be the anchor. We have to look at the people in the communities who are asking us to be leaders. Now, when you already are in that community and you just are not able to keep it going from the economics, you gotta be straight out and tell them that this is the pressure I'm under. But we have some creative ways that we could turn it around.

And what we are now planting is the seed to demonstrate how that was done. Now, Mike, for the new pharmacy, I raised $205,000 in a manner of six weeks.

Mike Koelzer, Host: Wow.

Ed Ullman, Pharmacist: And that was no grant yet. That was just personal individuals that have had, who did well. And again, I'm a capitalist. I have hit big and I've hit bad.

That's the way it goes. And I went to them, I looked them in the eyes and said, I wanna do something special for our community, not my community, our community. And I need your help. Now, one guy made a lot of money from his stock during Covid and he set up his own foundation and he got a tax write off.

He has to give that money away each year. I want to be one of those entities. He gives it away

and,and so the rest will be history.

We had to go and get the IRS to give us a tax exemption as a public charity. First time ever they did this because they don't see dispensing of drugs to be charity. So we had to make an argument that we're daud with all these other services and yeah, then we dispense drugs. That's how we were able to win that argument.

So now we have a president that other pharmacies can follow, but you have to show that you do more for the community than just fill prescriptions and you'll get there. One of the journalists who did an interview with me said, like, you're having so much fun and all the other pharmacists we talked to are angry, frustrated, or dispirited.

And I said, well, let me tell you. It's the stories, it's the people, it's one-on-one. 

Mike Koelzer, Host: Ed, let me play devil's advocate. You go and bring this information to the community and somebody steps up and says, Hey, ed, let the market speak for itself.

You're obviously not needed. and I'm an independent pharmacy owner, you're obviously not needed because the money and the profit is not saying that you're needed. And so, sorry.

Ed Ullman, Pharmacist: Well, I think the first thing I would say is, I respect the courage for you to ask me that question. And I would say, I can assure you that you do not represent. The majority of our community league and so the majority of the people are feeling the same anger and frustration that the community league pharmacists are.

They are fed up with being on hold for 45 minutes for nothing. They're fed up waiting three months to go to a doctor. It's sometimes driving 25 to 40 miles away and getting there for their seven to nine minute visit. They were fed up taking a whole day from work just to get a laboratory test and then come back.

So the issue is that the people are very unhappy with the consolidation of power in this community, whether it's the closing of branches of banks or their healthcare providers. it, this has gotten to that. This is not the America that they signed up for. and so they are looking for leaders that will help bring those I'm talking about healthcare and social services perhaps, for it.

But I'm gonna tell you something, all I say to them is, give me a shot and if I don't earn your trust in your confidence and deliver, then don't support me, but go forward with it. And if we allow this consolidation to continue unabated, we are gonna look like the technology world of our country.

Control controlled by a handful of companies. They'll tell you how much you're gonna spend for a phone. They're gonna tell you how much you're gonna pay for the services. And now with artificial intelligence, they're gonna just tell you what they're gonna do and they're gonna say, good luck, adapt or not.

and so, I would go further that healthcare is too important. If you ask [00:20:00] anybody why they live in a community, what makes a community great. They're gonna tell you infrastructure number one, I wanna make sure my roads are taken care of. I have water sanitation services. I wanna have computer access.

I want some basics done. That's what I want for my government. I want my government to protect me,from law enforcement to allow me to know that things are gonna be okay. I then want education, and I want education both in the form of secondary school and in primary school and elementary school.

And I want my libraries. That's what I want. And then most important to me is healthcare. I wanna know where my kids are gonna go, where I can go, and I wanna make sure that I get quality healthcare, that it's affordable, and those are the pillows of great communities. And that's what people want. And what are we doing now?

We're allowing a regional health system. and just Mike, look, there's not more than three regional health systems that control every region in this country. That's how fast it is consolidated. Do you really think that primary care doctors just wanted to sell their practices and become part of the health system?

No, they got squeezed the same way that the pharmacists are being squeezed, except they have exit strategies from big health systems. The pharmacists have ugly chains. and so the issue is the community wants something more. and that's what I think that they're gonna tell you now.

Provide them, challenge them. I'm telling you, they will support that community wellness center and win-win situation. So that's what I would say to that questionnaire.

Mike Koelzer, Host: If someone that's a peer to you said, ed, I can see through all this, what you are really doing is this. Is there anything that somebody could say, not a customer, but is there anything somebody could say that would shake you on this that would question your motives and things like that? And I'm not saying there is, maybe you've been through it all, but there's a ton of stuff that would bother me if someone questions my motives, just cuz I'm not a hundred percent on them.

Do you have anything that's tender for you on this?

Ed Ullman, Pharmacist: Well, I think that,being older,comes with some wisdom and,I always try to kind of be a moderate, both in political situations as well as, how I see the world. So I don't like the extremes of things. And, I understand that,we are at a time where it's very easy to be cynical that everyone has an angle, everyone has the game,and so on.

so what you have to look at is in your heart,

who you are feeling very comfortable in your skin, and then you have to demonstrate who you are through your actions and. Sometimes when I'm having a long day, the last thing I wanna do is make two deliveries, or give a covid vaccination on my way home.

And I say to myself, ed, this is what your model is and, this, let's just suck it up here. Let's get it done. And that could end up being my best time of the day. So I think it, your actions speak uh, aloud and if individuals at all are going to question their motives or who you are, so be it.

It comes with the turf. Because if you are going to allow yourself to be, where you only will do things that are pleasing to others, and you are afraid to rock the boat or to go into the darkness, where people haven't been before, then you are not really a creative leader. this is part of.

Creativity is, it doesn't matter. I'm also an artist. and, and you start a new picture. I do rock sculptures. I had no idea if anyone's gonna like them 

or not. I'm doing it cuz I like it. and they get knocked down and I'd put 'em up again.

I've taken some pretty heat from my capitalistic friends, my corporate friends. When I said to them, they said, why do you spend years in corporate America? You were CEO, you were the founder of a company,and you had a lot of money. Why are you not doing that? Why are you doing this, community pharmacy stuff, and they can comprehend it.

And I said, because I'm bored stiff doing what you're doing. 

That's why. You can't buy me. I'm just gonna end my career just hanging out, doing corporate stuff. I've been there, I understand it. I go, if it worked for you, God bless you. If you were playing for the retirement ring, God bless you.

But understand that many of us desire something more, to be a service to others,and to leave behind something,stronger, a stronger America than what we inherited. So I respect what you're doing. Just please respect what I'm 

Mike Koelzer, Host: ed, I've got five brothers, one deceased, and I keep in touch with three of them. And these guys tease me like there's no tomorrow. Just brother teasing.[00:25:00] 

I know that if they got word of me doing something like this, they'd say, Mikey, must be nice. The store was so bad that you couldn't even pay yourself a salary. So you decided to do this, a nonprofit thing to get a guaranteed salary and have the nonprofit do this and that.

And I would sit there and feel a little bit,maybe. Angry or something. But I would feel that way because they would be right. it's like, I probably wouldn't think about this road unless I was in that situation. And you've already explained it, you've already said that is the reason, because this is like a, oh, maybe the public transportation or a school or a library that, it's not a business, but it's so important for the community that it becomes a nonprofit.

And so I love the idea, but I can just see my brothers laying into this and I would kind of walk out feeling like a failure. How would I pass through something like that and I would be representative of other pharmacists in this situation.

Ed Ullman, Pharmacist: I think that,I would say to them, as you remember, I went back to create this model, because I wanted to capitalize it and do 50.

 and the capital to do that, is readily available as, maybe it's gonna wane now a little bit. But we went through very aggressive venture capital equity firms, Wall Street.

it invests in health centers, in healthcare in general. So we went through there and I had to make the decision, from my background, to say that once you go down that road, if you can deliver the economics that are anticipated, then you're going to be very embarrassed when they kick you out and take over and close everything down because they can't exit it to someone else.

So I looked at that as a model. The second thing I looked at is to say, okay, let me be rational. pharmacy accounts somewhere between 10 to 12 and a half percent of healthcare dollars. And we now, coming into the most of the healthcare professionals. We have a shortage of a million nurses in this country. We have a shortage of at least 40,000 primary care doctors in the last medical school graduates. And they have to determine which residency they're gonna go into, coming outta Covid. Everybody's watching. Where are they gonna go? Number one was anesthesiology, probably the least patient contact.

and then the second was plastic surgery and then orthopedic surgery. And the worst was primary care, medicine and emergency 

medicine. All right, so, so we got things really sideways here. On where the needs are and really where the economics are and so on. And so you turn around and you say to your brothers, so here we go.

We are having the students come out as doctors of pharmacy. That's what we wanted. And they come out with some pretty hefty debt and we now still have 54% of all pharmacists in the retail setting. and we are giving them these options to come out as an entrepreneur or to do your own business and make it almost like a death spiral.

A death trap. That's the best we can do for them. And therefore we are saying to them, grab the hot early salary, you'll be good cuz they just want your license and you'll make some good money, working for a chain and, you'll become dispirited within about a year. And, that's the best we can do for you.

Well, what's gonna happen right now, there's about an equilibrium of supply and demand. For pharmacists in this country. And, depending on the new outlets that we have for them,it's gonna be interesting to see. Even though we have an aging population, seniors now are 18% of Americans,that still doesn't guarantee that going into retail makes economic sense.

Or if you do that, it's rewarding emotionally, or intellectually. So we gotta come up with new types of things. But to your brothers, you would say to them, okay, so I can sell to a chain drug store. One of them would wanna take me out and basically all they want is my patient base.

All right. So, yeah, we can, we could do that. I can liquidate, maybe make myself whole depending on how much debt we have and call it a day. Anti-climatic. And, and then where do I want to go next? And then what do I still wanna stay in this 

profession? All right. So you then turn around and,if you were to look at a nonprofit option, the reason the month [00:30:00] to me was it was the best option for sustainability and permanence for a community because it puts the community into partnership with you.

, and let's assume, I use this model when I go out. Let's assume for the first three years, the community has to raise a hundred grand to make it happen between grants and donations. That's not heavy lifting for a community. If you can demonstrate to them, 

 the value you bring into the table and, and let's challenge our government then to provide grants to, to help sustain these models.

That's leadership and,when I spoke to one of the legislators the other day, I said, when I entered into the HMO business, as a young pharmacist, our country provided, at the national level, state, national grants and National Lowers loans to help communities set up nonprofit HMOs.

And then, president Reagan, cut all that out and sent over the development of HMOs to Wall Street.but we were headed in the right direction. I think that states are gonna have to do the same,now, but if you are to say, I will make equal or more of a salary, with more predictability in a nonprofit, well, what's wrong with that?

And I'll have left pressure on me,to have to go and get deeper into debt in order to keep the goddamn thing going. What's wrong with that?

and then what's wrong? If you could come and look at my pharmacy that I've done and say the guy's having so much fun and the people love him.

What's wrong with that? 

So

I got the win-win down and if I can liquidate by the sale of my assets and get something out of it, it's probably not gonna be much less than I would get from the chain

drugstore. So I would say to them, when I went into retail pharmacy, I didn't sign in, being controlled by pharmacy benefit managers that do nothing but be faceless intermediaries that are unregulated.

I didn't know that was gonna happen, but it happened. And that's the economics that they drove for their agenda, not for the community's agenda. And then finally, I would say to them, once in a while, in one's career, you get to do something really important.

and that's my legacy to my community. That's why I'm doing it.

Mike Koelzer, Host: The other thing I could just say is mind your own damn business and why don't you lose a few pounds? something like that. Right back at 'em. It's sad, because in my pharmacy, any of the kids that showed any interest in pharmacy, I've got a handful of kids. I've told them, you better damn well love every aspect of pharmacy. Pretty much. In other words, I'm getting at them, it's like the odds of us being here are pretty low, so you better like retail chains and hospitals and all this other stuff.

I know there's a lot of other options, but you better like that. And it's sad to me that I know that the future doesn't really include this three generation legacy. And that's so cool. thing to think about generationally.

And, boy, that, that seems like, a real possibility for people that could be in a situation like mine.

Ed Ullman, Pharmacist: Well, that's a powerful question observation, Mike. Are you talking about coming from the gut? living in New York, for so long,I don't know if your listers no. New York is the real national home of independent pharmacies. And, even today on a percentage basis, there's more independent pharmacies in New York than any other state.

There was great pride in independent pharmacies. And when I graduated, everyone just 70% went into, 

community pharmacies and very similar to what you just said, a chain of family owned pharmacies. So there is an emotional component that is really tough to take.

and if we don't come up with new creative ways, repurpose basically what we do and to save it, then I think that's where it's going. And, and you can't blame your kids, because basically we need to have the romance of pharmacy. That's really where the action happens.

And I still am stunned that they don't teach much about natural medicine or history, our history of pharmacy. I call it world medicine. Mike. I traveled the world. I had the privilege of really experimenting. And, and remember when I went to China as part of an American study tour.

And I was in Beijing and then I was in Shanghai, and we went to the Shanghai Medical Center, the largest in the city. And you get there and if one sign said traditional medicine this way, and the other sign said alternative medicine, this way, their alternative medicine was our western

medicine.I, I went, whoa, 1.4 billion people.

And this is their healthcare system for 30,000 years. And here we are, 330 7 million of a population [00:35:00] and we think we are exceptional. So I wanted to know more about this. I wanted to know more about their diet in India. Why do they have 30% more dementia cases than Americans do?

and why are we so obese? and when you look at it in an overall bigger pitcher, you go, Hey, we got some work to do. And what better role than for myself to be part, the quarterback, they helped with that. So, when do we look at careers? And, Ionly say that basically, you gotta be happy with what you do.

You got pride. And if you didn't enter pharmacy to be of service to others and for your community, then you shouldn't have gone into it. And so, I basically say to young pharmacists, One way or the other, you're going to do okay, you're gonna make a decent living.

and, and the choices will become more on the institutional side, the public side, the public health side, and industry with the thing is nothing richer than to be the quarterback for your community. Where they look to you, as a leader all the way down to the little league, the chamber and so on,and so you live a very rich life in addition to economics.

It's socialization. And so it really, if you wanna be a leader at a quarterback for your community, then independent pharmacy is very sweet. Now let's work together to make it more profitable, to make it more sustainable. but it's still a great way to go. If that is not something that is of interest to you, then stay away from it.

just go work for someone. Put in your hours, go home. Call it a date. Everyone makes their decision of what their values are,what is important to them. but we have got to, especially as older pharmacists, we've gotta create new models. I don't know what the last model for independent pharmacy that's been created in this country, Mike.

All right? So gotta create new models for these young folks to be inspired by it. I basically, I had to go into my moment of truth of going, I knew it was bad. I didn't know it was this bad. All right? and so what do you do about it? One year I was the entrepreneur of the year in healthcare for eight magazines, and had a company we grew by 30%, the HMO for 10 years straight.

so I know growth, I know how it could be done. We had the first capitated pharmacy program in the United States. And, it worked extremely well only with community pharmacies. And then what happened? We allowed for public advertising of drugs. Now no other country, but New Zealand allows for the public advertising of prescription drugs and utilization with up 38% in one year.

And therefore it broke all the actuarial tables. and now is a great time to introduce that again. because, we're at 83% low cost generics. So, there's other ways that we can be creative, but it has to be a partnership with our government, Mike, this access to primary care in the urban areas for rapport and in the rural areas for us that wanna live here.

This is serious and it has to be a partnership with the government to help provide pharmacists their ability to do these things. That's where I think we're working. This is where it's going. and it can spread very fast. If you looked at the recent anger of the United States Senators for ppms in this country, when's the last time you've seen that level of anger?

I mean, they have come, ran out and said these worthless organizations control is powered. And what is it behind the scenes? They really don't. I think that was Senator Roesler from Montana. I mean, this is pretty powerful stuff. So we gotta come on this. Push off this N C P A, uh, and Doug hok, he, he has done a remarkable job trying to spearhead the leadership, for in.

Don't get dispirited. We can move it along, itch by inch and get policy to help save this profession. This is an old profession and it's a beautiful profession. Don't allow these outside forces to destroy and break our spirit or destroy what the beauty and power of pharmacy can be.

Mike Koelzer, Host: From 2015 to 2020, I was spending a lot of time at home. Our staff was too big. We were losing money. The i r fees were starting up, and I just wanted to ignore the whole thing. , and in the midst of that, I also felt irrelevant because I was at home and I'm thinking, we must be irrelevant because we're worth 12 cents or 18 cents.

And, I'm kind of having my own little pity party. Covid comes along, one reason leads to another. I'm back in the pharmacy full-time, right when Covid started, and I'm like, how in the hell would these people, I'm not talking about Covid eating, I'm just saying, how in the hell would these people survive without.

Our pharmacy, the delivery customers and figuring out this question and helping the daughter help their invalid parent and things like that. And I got [00:40:00] reinvigorated with the relevancy. But then you look and somebody's telling me I'm worth 17 cents on this. And that's where the breakdown is. And it seems that the new life comes in with what you're talking about, because yes, they can say something's worth 17 cents, but that's skewed because it's a monopoly.

And so this idea brings a lot of really cool light into the current and the future pharmacy.

Ed Ullman, Pharmacist: Well, Mike, here's what I think. Covid was a great opportunity, cuz the spotlight went on pharmacy and in all pharmacists, that the chains turned around and sent to the investment community. Hey, I'm gonna get a $40 reimbursement fee from Medicare for these, covid vaccinations, and I don't have to increase our labor costs.

We are gonna add a heck of a good quarter. And what does that do? It goes to that pharmacist that's been filling 300 prescriptions a day, standing on his or her feet, QQ in scripts, and then you ask them to do sometimes, Shots, covid shots of a day. What in the world are you thinking about?

It's, and so if the stupidity at the leadership level didn't even think that one through all right and agreed that the profit increase was that strong, it should let you know who's making the power decisions that impacts our profession. Cuz then they're not even smart enough to prevent their own backlash from their own labor sources.

Now they're gonna be dealing with unions and they're gonna be dealing with a whole bunch of stuff. So all that's pathetic, but that's what we're dealing with. and, and so, coming outta covid with this spotlight that we were there for the people, was a convenience sometimes. Oh, we have a law, long days.

Long hours and everything. And we were, and the community thanked us in whatever way that they could. But they're coming out of being stunned. a new America is being formed all over now with every way we live. and, and so why not in our small communities to create new wellness centers that work and, and that people want to see.

And if it's built around the existing pharmacy that is there, I would just say, retool You. Look, make it, make it much more interesting and attractive. Don't look like a mini chain. Get rid of the metal shelves. Make it powerful and inspire yourself. Go create an environment that allows you to do your best work and bring in art.

Bring in fish tanks, we have couches for people to sit. So if I have them meet with a family that has cancer, or an open heart surgery or something, or hey, or somebody's, oh, I've taken too many narcotics that I can sit with them and say, Hey buddy, come on. Let's get it together here.

I'll help you. But man, you gotta help yourself here. This is going nowhere. You're gonna be dead pretty soon. and, so that's how we have to look at it. because if you don't, it gets too dispirited, because you don't understand how in the world did I get into this mess and everything else.

And we have got to pull the curtain away from this. Now where's I'll, I'll be away from this Now. Where's it gonna start, Mike? The logical one is the public sector, and that's Medicaid. Medicaid,you can get to them, they're slow moving, but the legislators no legislator unless you've been bought off with the lobbyists for PBMs are in love with PBMs.

So, your legislators are where you begin and you get them to understand that this is gonna get uglier for their communities that they represent. If they continue to lose pharmacy, that's now in a death spiral of more closings than openings. and then, New York, broke away. April 1st, Medicaid took back all reimbursement for pharmacy.

And I estimate we're gonna make about $3,200 a month in increased revenue, from that switch. Now, whoever thought that Medicaid reimbursement would be a godsend, that's how bad this thing has gotten. All right. Well, that's a big number. and I think you're gonna see other states.

Oklahoma is looking at it, Ohio's looking at it. you're gonna see other states moving in that direction. Now that gets the attention. Those are big purchasing units, all right? Right. But then they gotta go further and, Medicare has got to create, through their innovation center, new ways to look at how they reimburse.

and, and when you start getting some muscle, then on the public reimbursement side, you can then get two employers. but at the pharmacist side, we also have to have coalitions of strength. We have to have spokes, peaks representing hundreds and hundreds of stores with a loud voice.

 Are we starting at a grassroot level? Yeah. are we, did we wait too long to take it? Get punched out? Yeah, we did. But reality is it's where we are and I came back to the profession to be one of those fighters. And, I'm not quitting it till I see action. And, I believe in the communities we serve, I believe that's the best source of revenue coming in to help sustain the pharmacy and the welder centers.

 and I believe that communities are only gonna support it more and more. As the community sees you through your [00:45:00] actions, but you gotta do more than just dispense 

medications. 

Mike Koelzer, Host: tell me what's on your plaque for your new pharmacy. I know it's a first of some sort. And I'm not gonna ruin it here. Tell me what the wording is on your new.

Ed Ullman, Pharmacist: Well, it just does a little history on nonprofit pharmacy and we did quite a search on it. There are several pharmacy colleges that have student, nonprofit, training facilities at Albany College of Pharmacy. We have two that are embedded with federally qualified community health centers.

you then have, the federally qualified community health centers that have their own in-house nonprofit pharmacies. and so we have examples of,clinic setting. For it. And then we do have this organization of nonprofit pharmacies only for the medically uninsured. And what they do is they partner up with the manufacturers that can move drugs before they expire, take tax write off, and then these entities have warehouses and they can move that product and they can move it fast to individuals for free that qualify, with no, medically uninsured.

And in many of the states, like in the south that didn't expandMedicaid eligibility, there's still a substantial, we're still talking about 10% of the American population that is medically uninsured. So, that has worked, but nowhere has a nonprofit community pharmacy that's open to the public and everything else ever been formed.

And certainly no existing, for-profit community pharmacy is ever transitioned to a non-profit structure. So that's what we're talking about now. I love that challenge. and well, when I had my H m O, my first big national, first, we were the first to enroll Medicaid recipients into our H M O and, and oh my God, what I had to go through to do that.

I don't, can't tell you how many people said, what are you talking about? They're poor people. What the heck do you care about them? And I said to the commissioner of Social services that we were both county legislators at one ton. And I was elected at 24 as a young pharmacist. And I said to him, I go, Tom, how come the poor, the Medicaid population, don't have the same health insurance as you and I?

And he goes, well, they should. I go, well, let's do it. But we had to help write the legislation. And we ended up winning the National Public-Private Sector Partnership Award in Washington DC before 5,000 people. So I saw how it can be done to think big. Now in many states, every home, every Medicaid recipient has to choose an HMO that's their provider of care, or they call it now managed care.

but so I saw how you can do something on a local level that can morph into a national story, and we're gonna do this now with this. But,you gotta think big outside the box. And I'm thinking about what happens when you are on your feet and your AC store, let's assume, somewhere between 45 to 60 hours a week, that you don't have time to think and you're angry.

You, you're internally angry at the reimbursement and someone embarrassed that you're hanging out there

and. and you just don't know how to get out of that darkness, to see some light. and it's a human condition. I went through it for a period of time myself when I said I came back to this at Fort.

But, you gotta get beyond that. And, so this is one model. Now this model has many different configurations, and you gotta get an independent appraisal on your pharmacy, what it's worth, right? And then you gotta work out what you can do to sell the acids. It might be that you've gotta take half price and you take the other half as a tax right off, and then you won't have to pay taxes for the next 10 years.

All right? So there's different ways that you can structure this. but I can tell you the creation of that. When you do that for your community, you'll be proud of yourself. you're gonna look back and you, wow. Now, If that doesn't attract young pharmacists who think differently and want a different way as a profession, then I don't know what is right now.

We're not giving them those options. and so you build off that, look at the new generation. Every single young person that comes into our store, I ask them, where are you from? and we're a Taurus area. And so they come from all over the world. They're all the same. and, they are coming with different values.

Mike,the male and female balance, is extremely rich. and dads are taking care of their kids and doing half the work. This is new. They're not homophobic. They don't care about religion. or they care about the environment that we are leaving behind to them. So, they have a lot of really good values.

That we can build off of. and they have community spirit, and they wanna see wellness, services more than just dispensing drugs. and they want to eat good food. They, this generation's eating better than any other generation of Americans. All right? So why don't we build off that and talk to them, bring them into this discussion.

And I, I think that's how we have to look at this. And, if I wasn't in so many [00:50:00] businesses in my career, I might not see things as clearly as I do now, but I, this is what I can bring to the table. This is what I'm doing.

Mike Koelzer, Host: Ed, if I may ask, what legacy do you carry onward from Patty?

Ed Ullman, Pharmacist: Woo. Is, wow. I, uh, you know, I said we named the, uh, the, the, the new no profit pharmacy in dedication to her spirit. Uh, with the hours that I've had up and down through my. Pharmacy and, and, and, uh, and HMOs and, and other projects. She was always with me, always behind me, backing up all the way. And we were best friends and one of my friends, we never had a major argument in years.

And so she was a very special human being. her legacy was always there for people. And, and and I think she kind of overlooked the line of my faults because she knew I had a good heart and that together we were gonna make a difference.

And she wasn't afraid to jump on the train, so to speak, when we didn't know where we were going. And, we took a lot of risks when some didn't. But, I want her to know, That she helped me with this story and we're gonna carry it on. 

Mike Koelzer, Host: Well, on behalf of all of our listeners, I think it's safe to say we're very sorry for your loss and wish you the best.

Ed Ullman, Pharmacist: Thank you, Mike. And I, I really, thank you so much for allowing me to be on your podcast. And,one of the biggest things that I have learned at my age is you don't take anyone for granted and you don't take anything for granted in, in, in life. and that,with openness and with carry and with love, we all can do great magical things.

And, and so I think, for our profession, let's see what we can do.

Mike Koelzer, Host: Well, ed, boy, cool stuff. Thanks for bringing that to me and the listeners. 

 It's a whole new direction and it's gonna take a little bit of time for it to sink in to realize that something like this is even out there.

 Thanks for your leadership. Thanks for being here. We'll be following closely and I look forward to keeping in touch.

Ed Ullman, Pharmacist: Okay. Thank you, Mike.

Mike Koelzer, Host: Thanks, ed.