Integrative Care Impact and the Expanding Role of the Pharmacist | TWIRx

July 10th, 2026. This is twerks. Hey, hey, hey, and welcome to This Week in Pharmacy. I'm excited to be here July 10th. Holy smokies. 2026, what is going on? If you could just take a break, pull over on the side of the road and take a break. It's going too fast, people. Hey, we're headed to Orlando, Thought Spot 2026. If you're going, please reach out to me. Reach out to the Pharmacy Podcast Network. Let's see you there. I love to collaborate in person. I love getting in front of pharmacists and pharmacy owners and really understanding what's happening in your markets. Your markets are so different from one side of the nation to the next. You do share some similarities and some pressures of what you're going through, but the camaraderie and the lessons learned from one pharmacy owner to the next is huge. And we want to be a part of spreading that word. If you have success stories, if you have something that's working in your pharmacy, if something is working in your community, let's talk about it on This Week in Pharmacy. Join me on twerks. Reach out to me. Let's talk. Hey, up on twerks news. First of all, a shout out to Orsini. Orsini Specialty Pharmacy. Thank you for posting about chronic disease day. This is honoring chronic disease day today, July 10th. Orsini posts something on LinkedIn, recognizing the stresses, recognizing what people go through, what families go through that are supporting those with rare diseases. And the specialty pharmacy sector is probably one of the fastest, if not the fastest growing sector of our pharmacy markets and in what's happening. And I'm so proud to be a small part, a tiny part of the communication side and PR side of specialty pharmacy. we will be headed to the NASP in Washington, D.C. to celebrate the National Association of Specialty Pharmacy's annual event. We're going to have more news coming up on that. We'd also like to talk about it on an episode of TWERX and dig in and really preface what is the future of specialty pharmacy look like. Hey, on TWERX News from Specialty Pharmacy Continuum, thank you for flagging this information. headline is Beyond Symptom Relief Yoga in the Biology of Chronic Lower Back Pain. You have to read this. Readers, this is really interesting. Lower back pain continues to be one of the most challenging conditions in clinical medicine, even with the progress of pharmacologic rehabilitative and intervention methods. Significant portions of patients report persistent symptoms in lower back pain. And among the approaches that are finding a lot of relief for people throughout the world, throughout the nation is yoga and relating mind-body interventions. This kind of plays into what we're going to be talking about today in integrative pharmacy and holistic pharmacy when we welcome Rob Kress back, the godfather of functional pharmacy, and Dr. Bianca Bradshaw. So you're not going to want to miss that. That's coming up on twerks on our first feature. Shout out to Pharmacy Practice News. Thank you for submitting and giving us a heads up. Headline, PBM, Pharmacy Collaboration Improves Medicaid Outcomes. Oh, my goodness. With the pillaging of the traditional three big PBMs and attacking systems of funding, 340B, for example, and where our tax dollar goes, getting sucked up into that almighty stock price. It's nice to hear that there are pharmacy benefit managers out there like Carelon RX, a subsidiary of Evalence Health, who is working on Medicaid reimbursement solutions in the PBM space. They started this project way back in 2021 and concentrated in Iowa and in Arkansas. And it's called the CPTC program, which promotes the use of community pharmacy-centered care to simplify prescription management, increase medication adherence, improving quality of care delivered, enhancing the number of satisfaction and minimized health disparities. The program focuses on Medicaid members with chronic conditions, those who need extensive coordinated care by pharmacists, and gives them the personalized support they need. This was explained by Nirelli Parath, the Clinical Strategy and Outcome Director for the CPTC program. And she goes on and being quoted, she says, participating pharmacists adhere to providing standard services such as free medication delivery, multi-dose packaging for members who are on multiple chronic medications, and medication synchronization and medication reconciliation services. None of that is new to us. We know that independent community pharmacies throughout the nation have perfected all of that multi chronic management of your medications, the synchronization and definitely the packaging. When I hear the word free within this, free medication delivery, as long as the pharmacy is getting something for that in order to support that infrastructure, I'm great. I'm good with that. There has to be a baseline in Medicaid patient reimbursement for that prescription. But I'm going to keep my eyes on this. A shout out to Gina Shaw for writing a great article from Pharmacy Practice News. Hey, a shout out to the MMM Online, the publication that comes from Haymarket Marketing Communications. And if you want a tongue twister, say, hey, market marketing communications fast three times, and I will give you $1 million if you say it without stumbling. I don't have a million dollars. But you can still try to tongue tie that. All right. The article comes from the online news, mmm-online.com. The title is Five Things for Pharma Marketers to Know for Friday, July 10th, 2026. The main one I want to bring to your attention is the top contenders to lead the Food and Drug Administration. And they've been sent to the White House for final review and decisions. The finalists include Heidi Overton. She's a White House advisor. Dr. Jeffrey Vakareca, Vakareca. I don't know how to say his last name. Jeffrey, we'll just call him Jeffrey. Dr. Jeffrey, an oncologist and health system executive, and Stephen Ferrara, a health affairs official at the Defense Department. You know, the styles of our political leadership, especially at the top there at the White House the styles of them of those individuals and then the trickle-down effect of how that impacts public health is mind-blowing and there's good good and bad about so much of what's happened with the Trump administration and there was very little in my opinion that was being done aggressively and proactively to really change drastically change something of the diet and of the education of the American public. And as we listen, every single one of you that's listening right now, I really think you're highly educated. And I think that your education and your understanding of things go far beyond the lay person, far beyond me, for example, not being a pharmacist, not being educated like you are and you physicians out there. So I'm hoping that the FDA chooses someone that has a background in healthcare and in medicine and in patient, direct patient care. So I'm voting for Dr. Jeffrey, the oncologist and health system executive. I don't know of Jeffrey. Maybe you guys do. The reason is because we have to come back to selecting people at such high levels that immediately have credibility based on their credentials, based on their experiences, based on their education, and stop putting people that lean heavier to the political side instead of the baseline. There's nothing wrong with political opinion. Our culture, here I go on my soapbox, our culture has been taught to become hateful and to become combative when you start talking about politics, which makes things hard to ever come to any kind of middle ground. And when you select the sensitivity around medication management, food disparities, things that are really affecting the health and the well-being of our public, and you don't have people that have credentials, it just loses credibility. credibility. Just as lying loses credibility when you find out that our highest of political leaders have lied in the past for narratives and for pushing agendas and the whole debacle with the pandemic and everything we went through. So I'm hoping, and I'm voting for Jeffrey Vakarika. I'm not going to say his name anymore. I need a pharmacist to read that. V-A-C-I-R-C-A. I'm going to have it in the show notes, but look that person up. Send me a tweet. Send me a LinkedIn post. Tell me what you think of these selections. And if you know anything about Dr. Jeffrey, that'd be great. Hey, last up, closing twerks news with some good news because I'm so tired of the bad news that's out there. Good news coming out of Oregon. hillsborough pharmacy opens with a familiar look and new familiar feel and a new look and this organization this pharmacy out of hillsborough oregon is now setting up resetting up the hillsborough pharmacy in in fountain officially reopened just this week in pharmacy after they had a horrible commercial fire. And the owner, Jasmine Nguyen, I'm going to have to reach out to Jasmine because I love this model, this pharmacy, what she's doing for the community. And they're going to be partnered with other pharmacies to do some of the procurement of their medications. But the special side of this that brings the community in is their fountain development, their pancakes, their coffee, their sandwich counter, really to get the community involved in bringing them in in an untraditional pharmacy setting. And rather than filling prescriptions on site, medications are prepared at Nguyen's Portland Pharmacy and delivered to secure pickup lockers inside the Hillsborough store. And customers can still receive assistance from staff in person or connect with a pharmacist by video telehealth all righty if they have questions before taking their medication absolutely love this uh new inn has really been aggressive in battling how the pbms have ruined um independent community pharmacies throughout the nation this hillsborough pharmacy is the oldest operating business in Hillsborough. The pharmacy was founded in 1873. Holy smokies. I love this story. Look this up. This comes from Hillsborough News Times. Just put in Hillsborough Pharmacy and look up the news section to find this good news, news that we needed, news that is happy, happy stuff. You know, I can't see crap. If you're driving and you're listening to this podcast. You don't see me with my obnoxious sunglasses on. These lights are super bright and I can't find my other sunglasses that don't look as shady as the shades do, but I can't see anything. Oh, there, there you are. Now I can see you. Hey, we have two amazing interviews I want to share with you. Rob Kress and Dr. Bianca Bradshaw coming up next on this, on This Week in Pharmacy. What do you say? This episode is sponsored by Independent Pharmacy Cooperative, widely known as IPC. Established in 1983, IPC is the nation's largest group purchasing organization owned by Independent Pharmacy. With a mission of maximizing the success of community pharmacists, IPC works to provide members with access to effective programs and services designed to enhance profitability for independent pharmacy. Read more about our mission by checking out our website at IPCRX.com. That's IPCRX.com. hey returning back to this week in pharmacy my friend who i nicknamed the godfather of functional pharmacy but he's actually getting bigger than just focusing on just the pharmacy aspect rob kress is back on the show it's so good to see you great to see you ted thanks for having Yeah, I have talked with you for years now, and it is changing. It's funny to watch how we dig into very specific things that are impacting our lives, our careers, the people that we're working with, in your case, patients that you serve, and you've now tripped into, and I think it was purposely, I shouldn't say trip, because you don't trip when you're walking down the trail. in the woods when you're doing some of your presentations. You're very directed and very focused, but it become bigger for you and what your mission is and being a pharmacist that involved in what is total health Just share with our listeners some of the stuff you been working on lately Yeah, and actually, I think trip is a good word, because there's a saying in mythology that says, where you trip up, therein lies the treasure. And I think we got to recognize that in life. And that's exactly something that's happened. You know, I've created kind of a lens of medicine called orientation-based medicine. And it's something that actually complements functional medicine, allopathic medicine, integrated medicine. And what we've been putting together is a way to assess a patient's orientation, literally where they are when they come to us, not just based off lab values, but most importantly, what their capacity is to make change. You know, in our clinical practice over the years, we've seen time and time again, where if you primarily just practice off of what the labs say, even if they're functional labs, getting into adrenals, getting into hormones, getting into GI, sometimes it might be mistimed, it might be misdosed, and it doesn't give that true patient specificity, if that's the word I'm looking for, that we say that functional medicine has that personalized approach. So this has kind of taken it to that level to dial into who really is sitting in front of you. And it's been an exciting process. I love what podcasting has done for my career, my network, and bringing people in to really accentuate some of these topics. Introduce us to our special guest today on Twerks. Absolutely. We got Bianca Bradshaw here, who is, she's part of my programs, and she's truly a rock star practitioner, pharmacist, human being, and coach. Bianca is the owner of the longest, oldest continuing operating pharmacy in the state of California. She is an author of a book on anti-inflammatory eating. She's an incredible entrepreneur. And when you asked me, do I have someone to bring on here? Bianca immediately came to mind. And even before you came on, I was complimenting her on how her coaching ability has just skyrocketed to the point where on our calls, I sit back and she just takes over. And for me not to talk, it's a big thing, but I don't have to. Bianca, welcome. Welcome, Bianca. Thank you so much. I have been in pharmacy for 22 years, primarily an independent pharmacy, owner operator for the past 12, almost 13 years. And about five years ago, I started really getting interested in what I was calling what I gave a name to a functional medicine. I didn't know the name when I started. I just thought everybody needs magnesium. So it's been a great experience and I love the opportunity to join you here and excited to be a part of this. Well, I like this conversation, Rob, for selfish reasons, where I try to take a subject that's empowered by and fortified by the guest who then has reaches and prongs into other subjects that we're very dear to on the Pharmacy Podcast Network. To me, independent community pharmacy is one of my most favorite subjects. It really pulls everything in. And I want to confess to the listeners and obviously to the both of you, as a talking head of the pharmacy profession, probably the longest talking, the oldest of the talking heads in the form of podcasting in pharmacy, as a cheerleader, I'm always a half glass fool kind of guy. I can't help it. It's my personality. I always want to talk about, you know, the good of what's happening. And then I've learned as someone that's not completely naive that there is the bad side of things and there are the negative side of things or the challenges. And I've really been excited about encouraging pharmacists, more particularly our pharmacy owners, our independent pharmacy owners, to take the time to build revenues that aren't just about the prescription, not just about the dispensing fee, but slowing things down at the counter and inviting the patient to go into the counseling room and sit down and really hammer out a very specific, very personalized, very precision-based plan that is all about that individual, what's happening at individual's life. And so I've been talking about that concept for freaking 12 years and bringing pharmacogenomics into it and bringing labs and bringing the vitamin therapy at the right time. And not me, but trying to bring in content for people that do that. And that's glass half full. But you as an owner, Bianca, when would you have time with you got to get out 300, 600 prescriptions a day, you have all this happening and your two techs, one's on vacation, one quit suddenly, and your wholesaler isn't getting you the supply and something else is coming up and insurance is due and blah. And I'm this happy podcaster guy that wants you to just go make money in counseling and, but then the real world hits. And so how do you transition from where, you know, pharmacy should be going and pharmacy care should be going and there is money in it, but how do you take the realm of the dispensing fee that keeps the life blood and the light lights on and transform into this next gen, you know, pharmacy that's doing things that could bring money, but it's just like, and it's better for the patient holistically. And, but boy, that's, that, that's a whole podcast in itself. And I said, we only had 20 minutes and I've, I've thrown you into a trap. Just a little bit. That's okay. Um, in about 2021, I realized that juggling everything you just said was becoming a challenge to my health, not to mention my sanity. And I decided to close the pharmacy for lunch every day. Novel concept. Suddenly I have a 40 hour a week pharmacy. In addition, I personally have an hour lunch every day that I can either meet with clients on a functional medicine perspective or take a meeting that I need to as an owner. It has created an opportunity for me. There were some challenges at first because I was always concerned about the overlap of the retail and the functional medicine. But what I found is that it's actually exciting and it wakes me up for the afternoon and gets me going to think about the moments that I've helped somebody a little bit on a higher level. And really that made all the difference for me. That's wild. Rob, when you think of, you know, we expect our patients, you expect the members of your consultation and your coaching to kind of follow the blueprint that you're helping them to build, to live better, to live healthier. But then people like me, a biggest hypocrite on the show today is like, Hey, do this, do this. But then my workout plan falls to the side or I'm not weightlifting every day, like I'm supposed to be. And so the rubber meets the road, like I need help. You're one of my favorite people in, in pharmacy. And I'm not even using, I'm not even your client yet. And I should be. Can I, can I pop in there? He's got the mystical man. true so yeah to speak to that and the the dangers of where we're at today because i can't wait to talk about direct to consumer and and how that's thrown a monkey a monkey wrench and into things good and bad yeah well i think what you just what you just described within yourself is endemic in our society and what it comes down to is nervous system adaptation which essentially identifies what our capacity is to make change in life. So for instance, Bianca's example, I closed the pharmacy for an hour. So she created space. She created an avenue to build capacity and to step into something new. Whether it's a patient, whether it's us as practitioners, we're all experiencing things like this. And I know sometimes it sounds like it's easier said than done, but I think sometimes it takes a proper evaluation of where we are and the changes that need to be made. And when you were saying the direct-to-consumer, you know, I think this in itself, we speak about patient care, and it's not to say, you know, direct-to-consumer offers patients some autonomy, some authorship, which I think is really important. That's something we've always asked for, and that's what the realm of functional medicine kind of grew off of. It was basically the female patient saying, you know what, I want to change. I don't like what's happening. I'm demanding more. And functional medicine and before that, integrative medicine was there to answer it. So when we see that, an example direct to consumer, right? So we know it has its benefits, autonomy, authorship for the patient, but I think sometimes it can fall into a lack of care. And And the example we used before we went on here is the reducing the black box warnings on estrogen. Now, estrogen has gone through the roof, but has patient care followed it? And I've got to say many times it has not. And I think that's where the opportunity is for us as practitioners to help guide our patients the right way, because we're going from, as you said, kind of a fast food type of medicine. And we know fast food doesn't solve problems. So it's actually reorienting that direction of medicine on how we can overlay the patient care and find the opportunity for us as practitioners in doing so. Because they're not finding it through the conventional, my practitioner's paid to see me for seven minutes. So, you know, we were using me as an example before we started recording, and I can fill out six questions for a prescription medication, and I could answer that any way I wanted to answer it in order to just get access to the medication. it may not even be true what I'm doing. And that online mechanism of collecting that data has no way to read my facial expressions, take my blood pressure at the time, dig into deeper consultation of it. So where, like you said, where's the good and bad balance? I know you can't answer that question per se, but is there a lane where we are transactional that makes sense? Or should 100%, you know, should we not go direct to consumer at the mass scale that seems like we're moving towards? It's a juggernaut that I don't think anybody's going to slow down. No, I agree. And, you know, to speak to that, say if someone was to fill out a questionnaire online just to get a medication, because you can do that. You can lie. Right. I mean, easily. Do you have any health conditions? Nah. Are you on any other medications? Nah. Right. Just give me the med. And that's a slippery slope right there. I'm not one that is ever one to ask for more regulations. Actually, I think that gets us into another jargon of issues. but on the other side of things the example that I used it was actually one of my pharmacist members reached out to me on something she didn't know how to operate or navigate and it was basically someone filled out a 10 symptom questionnaire a 10 questionnaire and got hormones basically had an estrogen progesterone and a DHEA sent to them I looked at the doses the doses were horrendous. They were giving them a female who's still cycling, still in perimenopause, right? Excessive doses of estrogen, excessive doses of progesterone, and the DHEA was a man's dose. So this individual felt very agitated, was having suicidal thoughts, and was actually wanting to get a divorce within a realm of two weeks from her husband. So that's not good medicine. And I know that women need, men need proper hormonal balance, but sometimes it doesn't come right from the hormone itself. Like balance has to start first. Does that answer? Yeah, please. Oh, I was gonna say, I would add to that, that in pharmacy, so many things are a pendulum. And I think that right now we are on the upswing of this and there will end up, we will see problems and patients will realize that they want to talk to a practitioner, but I live in a very rural area. And sometimes getting into a provider is difficult and scary. If people are going to lie and try to just get what they want, I think they're going to do that anyway. That's been pharmacy hopping and doctor hopping shopping for years. But I think there is a positive potential to this concept. It's just we need to find a balance where patients are getting the follow-up care. And there's an expectation that they will continue with the provider on some level. Bianca, is there a lane here, my glass always half full and not empty, to get community pharmacy, to get independent pharmacy quicker to revenue so that we can eventually hire maybe a staff pharmacist or a shift pharmacist that does 100% consults instead of having anything to do with prescription processing, which is our core. But do you have a pathway as a pharmacy owner to get that done? Are you familiar with scripted? Yeah, I have heard of that. Okay. I've been working with them for several years. Unfortunately, I've been in the position where I didn't have a full-time staff pharmacists to really grow this program. I have met some resistance from providers because they feel like I'm operating outside my lane in scripted. But as I said, being in a rural area, I know there are situations where I've helped women with UTIs that get them twice a year and know that that's what it is, following a protocol, talking to the patient, having them in front of me, taking their temperature, making sure there's nothing crazy going on. And they were able to get a prescription for UTI that day within two hours versus after the weekend, sometime next week when the doctor can get them in. And they didn't stress the resources of our emergency room, which is extremely overused in this area. Three times as expensive too. Mm hmm. Yep. I love that. You know, if I can speak to that, I think what that really says a lot of is I think this is almost in the self image of a lot of pharmacists. It's almost like the archetype. We always just wait for permission. And I'm not saying to step out of the lines or the boundaries of what's legal. But I'm just saying we constantly, you know, it's, you know, we wait for permission to do something. And I mean, Bianca, on our call the other day, we were speaking with a pharmacist who, you know, my drive was I think you just need to take the you need to take the leadership here and you need to make it happen. Nothing's holding you back from it except identity and self-image. And I think there a lot of opportunity for the independent pharmacy owners the staff to really say what they can do to really speak of their expertise and it there So I think that plays a role as well All right, mapping and blueprints. And this is a good wrap up question, Rob. Is there a model where a pharmacy owner who says, I really wanna build a men's health clinic out of my independent community pharmacy, So it becomes a marketable, repeatable mode of not only marketing, but services provided that you'd have to go get a coach or you'd have to like a way to get what you're doing plugged into independence in order to make it a program that is repeatable and could even become a revenue program. Oh, absolutely. I mean, and whether it's a men's program, I think it's great to niche something and to do something that you're passionate about. But this would fall in line with women's health, whether it's perimenopause, whether it's menopause. Yeah, the mapping is there. I caution it not to fall into the practice in a box, you know, things that are often sold. Just do this test, this test and this test. But very simply, yeah, I mean, whether it's from marketing or whether it's from how that patient journey works, because we can see people from one off, but turning things into actually a coaching program allows better patient care, better, I think, value to the patient and also supports the practitioner, one in sustainability, but also time spent, which is anemic for most practitioners. Yeah. I mean, that's what we do. So, you know, we give them the ways to do that to make it easier to cut down on the time and all that. So it's something, though, that can be implemented and can be turned into a program. I come back to Bianca, I'm thinking, you know, we just came back from covering Podcast Press as the McKesson IdeaShare. Ideashare, I met up with a team that has a program through a company called Fullscript. And it is like a deep dive into the supplements industry, but it's tied directly into pharmacy care and pharmacy counseling. And it's not just, hey, take this magnesium. It's, no, we're not only going to pre-test, but then when you take, we're going to take some, you know, tests later to see how you're interacting. And we're really going to like dive into what our goal is. And it's just like, it's so refreshing because the supplement industry is almost like the wild west in a lot of ways. And I just read an article where a six month old started having kidney issues because their stupid ass parents, I'm allowed to say stupid ass because it's my show. And the FCC is not going to bleep me out. But the parents were giving them protein powder every damn day in their in their formula. And it was like, what the hell? Like, people do things that they interpret because of either Dr. Google or hallucinations from AI or they you feed something enough, you're just going to justify why you think this is necessary to do. Like, it's just like, hold up and settle down. Like, let's, let's bring in your physician. Let's get your pharmacist involved. Who's, who's really dialed in. And we want to know what your goals are for either your infant or yourself or your, your loved one or your, your, your mother who has dementia, but let's slow down and let's get a pharmacist oversight of this. But Bianca, you have last words since you're our special guest today. I think that we are inundated with social media, with every sort of commercial that's out there. And unfortunately, our customers are easily distracted by that. That being said, in a small independent community pharmacy where I have relationships, I know that I'm getting the phone calls asking if this is a good idea before they buy. Maybe not 100% of the time, but it is so refreshing and so nice to pick up the phone and they say, I wanted to talk to you before I did this. So I think that the base role that pharmacists have always played with being accessible and being relatable, being a known part of the community is what makes us unique in this. We don't want people substituting a prescription medication for a supplement. We want them substituting a prescription medication or a supplement for common sense. And that's our biggest role, especially in the realm of functional medicine, but also as an independent pharmacist. Can I steal the last word? Yeah, absolutely, Rob. Because it really speaks to what both of you just said, especially to add the protein thing. I mean, we've become such a biohacking culture. People are looking for the quick fix. So the fact that people are checking with Bianca, that's the gold right there. And I think this biohacking, you know, and it is another reason I think Bianca and I work so well together. We recognize that we need to bring things back to more of a simplistic nature, more of the lifestyle, more of just getting out in nature and getting some sunshine. Like it's this quick drive that people have. And I think that sends us awry i'm not saying all biohacking is bad but i'm saying we kind of lose our uh innateness i think of what's going on in our own body as well as like this first ever standing on and how nature really created us you know yeah we're losing our instincts we're losing our instincts our intuition all of that yeah damn it i took the last word from you again but we did I love this. You both have to promise to come back to twerks. We have to unravel some of these issues. I want to dive deeper into scripted. I love the thought of that organization and how they're empowering the pharmacist. Rob, I really appreciate you. You always give me really good guidance and our listeners really good content to think through and think about. Bianca, we'll have a link to your LinkedIn inside the podcast show notes. Shout out to our pharmacists, our technicians out there doing some amazing, innovative things. Please bring your story to This Week in Pharmacy. we would love to help tell the story of what you're doing to innovate and to push our profession further and change it it's got to change it can't stay where it is it's been hijacked by the big insurance corporations which is another episode of twerks that we can talk about later but hey i hope you guys have a great weekend um thanks for being on twerks thank you Hey, today's episode is supported by SweetRx. This organization has been empowering independent community pharmacies, long-term care pharmacies for more than 15 years. They've been innovative in the technologies that they push out and support, concentrating on retail long-term care combo specialty pharmacies and 340B independent pharmacies throughout the United States. once again SweetRx check them out at SweetRx.com if you're looking for a different pharmacy management system that really customizes especially the consulting side of the world and we're going to be talking with organizations that work with SweetRx specifically for long-term care pharmacy consulting I can't wait for you to hear that and that's going to probably be this week in pharmacy over the next couple of weeks. And I'll make sure that you're all aware. You have to listen to this next interview with my special guest, Bonnie Callahan from Judy Health, which has a subsidiary Capital RX, which is one of the PBMs that are changing the game, destroying the old models and ushering in solutions that are really patient centric driven by our pharmacist um up next on this week in pharmacy hey welcome back to twerks this week in pharmacy it's friday and i'm excited to be here i need a weekend i feel like after the fourth of july holiday we're coming up it's july 10th what are you going to be doing this weekend bonnie oh i am going so i'm from southern california and i am going on a little staycation to San Diego to celebrate a neighbor's birthday. So I am very excited to wrap up this work week. I love it. I love it. All right. Well, this is your first time on This Week in Pharmacy, not your first time on the Pharmacy Podcast Network back in the crazy pandemic era. We and I hooked up through LinkedIn July of 2021. So it's our five-year anniversary. Happy anniversary, Bonnie. Amazing. Exactly. And we had you on a show called Transforming the Nation, which was really about what sociological issues are impacting healthcare specifically. Are there pharmacists within those subjects that are becoming empowered and becoming champions of something that we're really missing? And we do miss little pockets of care throughout everything. In your case, we were talking about how is demographic hatred or how is minority hate, like how is that impacting someone going for care? And then LGBTQ, we were like really diving down into, so we rush ahead five years now where our lives are slightly different, but we all have the same missions and it's so good to have you back. You're part of Judy Health. This is a rock star organization. Our listeners might know it better as the subsidiary or one of the components of Judy Health, which is the mothership. And it was capital RX. And you guys are heroes because you're transforming pharmacy benefit management care. And I'm all for that for sure. And I just wanted to welcome you to TORX. It's good to have you here. Thank you, Todd. Always a pleasure. Such a privilege to be able to speak with you today. So thanks for having me. All right. So the reason why I wanted to have you in, Bonnie, is tell our listeners a little bit about your career track, being a pharmacist. And now you've transformed your clinical passion into the world of pharmacy benefit management and how that's becoming what I consider. I'm a half glass full guy. So I'm always seeing the future of the positivity of being a pharmacist. And I see pharmacists going from transactional, you know, the script gets paid, and then that's kind of like the end. And I'm like, ah, the future is disease state management and specialty understanding and expertise where the board of specialties start in coming out with other standards and certifications, you know. And so you're a rock star that you have proven that a pharmacist moving much deeper into the business of pharmacy care is so necessary. So give our listeners a little overview on your background. Yes, absolutely. So I actually started my career, gosh, more than 15 years ago now in the community pharmacy space, did my residency with Kroger Pharmacy and University of Cincinnati in Ohio. And really what drew me to that program and what I loved so much about it was not only was I able to get experience in what it was like to be on the bench and obviously doing the community pharmacist thing that we all know about, right? But in addition to that, what I wanted to really get into was pharmacist role in chronic condition management at the retail pharmacy. So I saw patients come to Kroger pharmacies. There would be, you know, a consultation room next to it. We would do, you know, diabetes, cholesterol, hypertension kind of checks and make referrals to physicians and things like that. We were able to do that in the community pharmacy space. And this was over 15 years ago. And I thought that was the coolest thing. And that's how I started my career. And that really has been a through line through my career because I've always been interested in how pharmacists, the value of pharmacists in chronic condition management. And the beauty of me being able to get into now the PBM world is seeing how the payment side of this works, how we can incorporate chronic condition management and other types of medication related services in integrating that into the benefit structure of our clients. And I'm able to do that through Judy Health. I started with CapRx back, gosh, in 2021. And since that time, fast forward the five years here, I am now VP of clinical programs here at Judy Health and able to have an amazing team of pharmacists and technicians. And together we really own and operate the different types of clinical programs that our clients can elect. And we have pharmacists embedded, pharmacists and technicians embedded within many of these programs to help ensure the best outcome for the member. I love it. I love the fact that you are so persistent in growing in your career and bolting on the next thing to come out of the knowledge that you have. That's a shout out to pharmacists listening to this. And I kind of like want to start giving you questions to dig into that. And here's something I'm thinking of. So I learned about pharmacogenomics in 2018. It was from an administrative point of view. It had nothing to do with clinical. We were taking ICD-9 codes at the time because there were no such thing as ICD-10s back then. And we were taking CPT codes and we were building this database thinking, how can we help the PBM and how can we help the insurance company find where this test should be paid for based on the necessity, based on the code? and then we gave that information to UPMC at the time. This is years ago. And when that opened my mind up to PGX labs, so much data that's coming in that gets lost in the EHR because it's overwhelming that poor, overworked, overstimulated physician, primary care, who's like, all right, your labs came back. Here's what's going on. Now I got to kick you off to a specialist. And I'm thinking, hold on before you get to the specialist or before, how about you give some of that data to the pharmacist over there who's hungry for it to really dig into this stuff. The, the remember, I don't know if you've ever seen a PGX results test, but it was like 15 pages of yellow, green, and orange and red. And it's like, the red is like, you're not going to metabolize and you're going to die and blah, blah. So it's like, so when I think of that, when I think of everything that's coming, that's going to demand more of the reason that pharmacists became pharmacists and the experts in pharmacology, the experts in medication management. So there's PBM decisions. You need to be informed by the labs, the A1C, the LDC, renal function, all that stuff. So this makes prior authorization and that step therapy and medication optimization It needs to be more precise because of the decisions that are there based on patient specific needs based on evidence evidence So talk to us about that and how people might not realize holy cow that what PBM should be doing They should be grabbing a Dr. Bonnie and saying, hey, get to the bottom of this. Yes, I love that question. And I love the topic of pharmacogenomics. And I would love to kind of give a relevant example that where our pharmacists today on our clinical program team here at Judy Health are actively working with PGX test results and connecting. Well, first of all, to your point about it being 30 pages and red, yellow, green, whatever it is, helping to interpret that for the member. So breaking it down for the member because it is so confusing. And also at the same time, looking at the report and saying, okay, prescribed, outreaching the prescriber and saying, hey, based on these results, here are some recommendations, right? A lot of the times, you know, you can get a PGX test ordered, it gets sent, you know, to you in the mail, you get the results and that you kind of sit on it or it's up to the member to do something. And that's what I love about the RX Helix, we call it program where, you know, we have in-house pharmacists, they review the reports after the member does the cheek swab thing. And then they hop on a call with the member and say, hey, look, this is what this means. And we're also going to talk to the doctor about, you know, specific changes to your drug regimen. And it's funny because as far as talking about the pharmacist and the clinician's role in this, not only can they have a clinical impact, but we also did an analysis that we presented at Pharmacy Quality Alliance actually this year, where we looked at really the impact of a clinician reaching out to the member and the impact of that on the uptake of even doing the PGX test. because as we know, it's kind of scary to say, well, I'll do this cheek swab, but like, what am I doing? Am I sending my DNA in? I don't, you know, so we're seeing resistance there. And so we kind of looked at our, we did an experiment and we found that, you know, by having one of our clinicians, pharmacists or technicians make a telephonic outreach to the member, this increased the adoption rate of, you know, doing the test itself significantly. So we're talking like 10% versus a 2% uptake compared to not doing some type of telephonic outreach. So not only is the pharmacist, you know, friend and center to help with digesting the clinical results, they're also really helpful from a proactive standpoint of consulting the member even before the test to say, this is why it's important. And that goes back to the expertise, right, that pharmacists bring about PGX. There's not a lot of, you know, you know, other clinicians out there who are feel comfortable in doing this and making these kind of consultations with the members and the prescribers. And I think pharmacists are really at the forefront of being able to do these types of interventions. Amen. The most trusted health care provider at that level, the pharmacist, the access, the clarity, the demystifying, describing to somebody what's going on. it just helps to put that patient at ease because it's driven by education and it's driven by understanding. That kind of leads me to my next question for you, and that's collaboration directly with that treating physician or that treating specialist or even the team of people, especially when you start getting into really complex rare diseases. And the pharmacist is there to clarify uh, therapy goals, confirm diagnosis, ask a lot of questions, review the previous treatment failures, where things there might've been gaps, especially when you're talking about titrating from one medication to another. Um, and then improving those turnaround times and then being able to select therapies based on all that information, all that tracking and data. So talk to me about how you as a pharmacist who is plugged into such a powerful PBM, how you guys are managing that. Yes. So as far as, you know, different opportunities to collaborate with a treating physician, I mean, there's, you listed out a number of different opportunities. One of them is, you know, suggesting alternative therapy and as an even further example, a low cost alternative to a therapy that, you know, maybe the prescriber wrote for a new product that's brand only, but there's other therapeutic equivalents out there that are, you know, 10x cheaper, right? So on that note, we do have a low cost alternative program. We call it RX Smart Save. This is where our in-house pharmacists, specifically in our high touch offering for this program, they outreach to the physician directly when Judy, which is our adjudication platform, identifies potentially lower cost alternatives for the member. And these low cost alternatives are aligned to the member's formulary and benefit design because Judy's able to run a test claim to make sure that truly it is lower cost for the member and the plan. And they make outreach to the prescriber and say, hey, this is available. And would you like to send a new prescription? If they say yes, they go ahead and send it. And then our pharmacist called a pharmacy, the dispensing pharmacy to make sure that they're feeling, you know, the lower cost alternative and not the brand, right? Just to kind of close that circle for the member. And so this process and program we set up to really reduce unnecessary denials because you don't want to, you know, call them and say, hey, this low cost alternative, wait, it's actually not covered. And you don't want to have that experience for the member either. Right. It also, you know, improves turnaround time for to make sure the member has access to the medication and then helps the physician select the right therapy that aligns with the member's plan design. So just an example of ways that pharmacists at the PBM can collaborate directly with the physician. All right. So I also want to talk about the patient touch and the connection. The first time I witnessed how a complex disease state and the realm of specialty pharmacy, I got to understand and listen to training recording calls that were de-identified and the questions that were being asked, they didn't sound intrusive. intrusive. They sounded like it was just a natural conversation. And the person that was gathering the information was a pharmacy technician that was dedicated to that disease state management team. And then the pharmacist after the call completed one stage, either a pharmacist would plug in, or they would follow up maybe the next day or a couple days later, especially if it was like something that they got to get them started on a specific treatment, if there's a timetable. it really opened my eyes up to being like, holy cow, patients with these serious diseases, number one, they're so scared, they're nervous, there's a financial issue for it. If you had a pharmacist that could hold the financial description of what's happening with the clinical description of what's happening in the best interest as the advocate of that patient's care, I would feel so much more cared about because it would start, the mysteries of the care itself and the disease itself is one thing, but the mysteries of me not knowing what this is going to do to my financial situation, that's a whole nother thing. So that's where a pharmacist that's implanted in a highly intelligent AI infused, you know, data kings and queens of pharmacy care through Judy Health. So talk to me about that situation of how you've really built that trust with the patient directly. Yes, I think there's multiple examples that come to mind. If I were to kind of hone in on one, you know, many, many of us, probably all pharmacists at this point know about medication therapy management, right? This is a program where, you know, it's pharmacist-led service that optimizes medication use through comprehensive medication reviews, making sure adherence is right, making sure what disease states are you on. Let's take a look at the whole regimen. And I think, you know, here at Judy Health, we have a program like that. And I think being able to have a pharmacist look at the whole person, bring in all the disease states, bring in all the medications, look at, you know, other alternatives if it's from a financial perspective, bringing all of that together and combining it with an identification engine, right, that can kind of look at claims history and kind of, you know, say, hey, here are some alternatives. And to your point, leverage AI as well to help make that a more scalable solution. I think that's an example of where pharmacists who, you know, are involved with that type of program can really continue to make an impact for members to make sure they're on the right medication, right dose at the right time. And, you know, I will say at Judy Health, we have pharmacists who do this type of service. We looked at 2025 data from one of our large health plans and saw that the MTM program interventions was able to save a plan, an estimated cost avoidance of about $1.83 per member per month, which is, you know, significant savings or cost avoidance. And when we talk about cost avoidance, I'm referring to, you know, what is, you know, if a member were adherent to their statin medication or their hypertension medication, that would have prevented, you know, additional doctor's visit or an additional ER visit. So that's what I kind of refer to when I talk about cost avoidance. But really that speaks to the fact that, you know, MTM and pharmacist involvement allows us to proactively prevent these issues and these unnecessary doctor's visits. Because at the end of the day, we're looking at total cost of care, right? adherence is going to increase your pharmacy costs because we're saying take the medication, but we got to also see balance that out with well now we're reducing the need to, you know, go to the ER or the need to do other things on the medical side. So I think it's important to look at the full picture with total cost of care when it comes to medication adherence in particular. Bonnie, when you think of the graduating pharmacist, the P4 that's listening in, or even the new pharmacist that's two years out, they're taking that position because obviously those student loans are coming in and they're going to work in fast-paced retail or they're going to work in one of the chains, which is a wonderful place to start, in my opinion, because you should really understand transaction, transaction, transaction, and then situation, situation and communication. And I think it's like the boot camp for, for a lot of pharmacists to start. But when they're listening to today's interview, they're listening to you. What can you give a shout out to that pharmacist who is very interested in the business side, and the reimbursement side and the benefit management side. And that's kind of where their brain kind of leans towards much more than maybe a bedside pharmacist or maybe a community pharmacist. Maybe they're like, hey, I really want to get into the business side of pharmacy. What do you say to them? How do you communicate and get them excited about the future of pharmacy care and where we're going with the next gen PBMs? Yes, yes. I would say don't lose sight of that dream and aspiration. I think that I agree with you that starting probably in retail and community, there's so much benefit to that because you really understand what what that transaction looks like, what that face to face member interaction looks like, all of that. And so, you know, I I would I usually tell, you know, my students or aspiring pharmacists, you know, every experience is a good experience. bring that with you to the next step. And also that you don't need to know where you're going to be in 10 years. Just know what the next step is. Because from my pharmacy career path, it wasn't straight. I started, like I said, in community. Then I went into PBM, different PBM. And then I went into academia. And then now I'm back at PBM, right? So it's not linear. And that's okay. And don't get bogged down and thinking, well, I'm now quote unquote stuck in retail. That's not the case. as long as you take your experiences and your expertise to that next position. And I would say meet the people along the way. We hear it all the time, pharmacy is a small world, and really make that effort to network and learn from others because you never know if you're going to be working with them next. That has happened to me multiple times in my career. So take those opportunities to learn more and do know that there is life outside of community pharmacy and hospital pharmacy. I wasn't like I said, I was a student in my past. I also worked in academia with students, and I think that a lot of times is the mindset. There's it's a binary path and pharmacy is not. I think we are so lucky to be in a profession where there are so many opportunities. And I think the managed care world, even within the managed care world, there are so many opportunities. At Unity Health, we have pharmacists embedded across all teams. And I'm talking not just our clinical organization within formulary and prior authorization and clinical programs. I'm talking also in the product space and in client services. There are so many opportunities where the pharmacist really is the trusted person. And so don't limit your own vision for yourself and seek those opportunities as they come up. Bonnie, thank you so much for this. This is such a pleasure and joy to get you back on the show. We have to promise that it's not going to be five years that we wait for our next five-year franniversary to get together. I promise. I pinky promise. I would love to reconnect sooner than that. All right. I will put Bonnie's LinkedIn profile in the show notes for people that are interested in connecting with Bonnie active on on LinkedIn, which is great. And a shout out to the Judy health team. You guys are just you're on fire. You're doing the good work and transforming. And and I trust the organization. I've been following you for over 10 years. Like we both said, when we started back when it was just capital Rx and now it's much bigger than that. So excited for where this is going. And it's a it's it's training our benefit coordinators at the at the employer level to think differently. Stop accepting the old crusty PBM contracts that are that are nothing but ways of of pushing revenue to the entity and really start getting into the clinical and start getting into the word. what did the word benefit mean when at first, you know, when whoever came up with pharmacy benefit manager, like when they said that there was supposed to be a benefit and the patient, the employer, they're feeling less and less and less of the benefit part of it. And it's like, you guys are bringing that back. So I'm excited to see where this is going to go. Thank you, Todd. Always a pleasure. Thank you so much for having me. Thank you. you