Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
And welcome to Kentucky Focus. I'm Scot Fitzgerald and we've
got a pack show for you today. We've got stories
there well affect your health, your wallet, and your community
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Need to know about, so stay tuned. This is Kentucky Focus.
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Speaker 2 (02:08):
Welcome back to Kentucky.
Speaker 1 (02:09):
Focus now, whether you're filling prescriptions for yourself, your kids,
or your parents, the price of medicine affects us all.
Speaker 3 (02:16):
Well.
Speaker 1 (02:16):
Now we're diving into a topic that hits right in
our wallets. Prescription drug pricing and joining us to break
that down as Antonio Chachap, president of forty six Brooklyn
Research and a leading expert on the complicated world of
pharmacy benefit managers and drug costs. Antonio, thanks for taking
time to join us.
Speaker 2 (02:32):
Great to be with you.
Speaker 1 (02:33):
All right, Well, you spent year studying how prescription drug
prices are set. Can you explain for the benefit of
those listening and plain terms, really what a pharmacy benefit
manager does and why the role matters so much.
Speaker 8 (02:44):
Yeah. So, in the United States, it should come as
no surprise to anyone that we suffer from some of
the most bloated, inflated prescription drug prices in the world.
And largely that has a lot to do with government
programs and perverse incentives that permeate the drug channel that
I could bore you.
Speaker 2 (03:03):
To death with.
Speaker 8 (03:04):
But let's just take it as a given that the
prices are irrationally high. It's ultimately a failure of incentives
to get manufacturers to compete by lowering prices and instead
often compete by raising prices because essentially you have a
significant amount of discounts that roll off the top of
(03:27):
those prices. So regardless of how it works. We know
that the prices are inflated. So the question then is
how do we achieve reasonableness in a world of inflated prices. Well,
that's where Pharmacy benefit managers come in, or PBMs. Think
of them as the insurance company for your medicines, and
in fact they work with large health insurance companies to
(03:51):
act as a counterweight in an environment of grossly overinflated prices.
So it might sound as though that makes sense, right,
If drug companies set high prices, why not bring somebody
else in to negotiate and get lower prices. The challenge
becomes is that PBMs, like every other member of the
(04:12):
drug supply chain, also can take advantage of their role
in a complicated and opaque transaction to oftentimes make matters
even worse, since they don't have necessarily a pure set
of incentives to solely work to lower the costs of
those drugs.
Speaker 1 (04:31):
All right on, Anthony Chacha joining us now he is
president of forty six Brooklyn Research, saying, leading expert on
the complicated world of pharmacy benefit managers and drug costs.
And now, Anthony, we're hearing that some PBMs are now
launching their own drug companies. How does that affect the prices? Hey,
folks here in Kentucky pay at the pharmacy counter.
Speaker 8 (04:50):
Yeah. So if you think of this as two heavyweights
clashing in an arena, again, you would think that drug
companies want higher prices, and then the insurance companies and
the PBMs would want lower prices. We've shown many, many
times that they both want high prices. But let's just
use this as a perfect way to demonstrate the conflicts
(05:13):
of interest and the perverse incentives. If PBMs truly wanted
to lower the prices of medicines, it becomes the old Hey,
if you can't do if you can't, if you want
something done right, you better do it yourself. Well, now
PBMs are saying, look, we want lower prices, so we're
going to launch our own drug companies and we'll start
(05:34):
setting the prices of those medicines and then sell them
into the marketplace. Well, we did a study about a
month ago where we examined one of the companies who
is owned by one of the largest PBMs in the country.
The company is Qualit Pharmaceuticals and is owned by express
Scripts in the Signa corporation. Express Scripts and Signa being
(05:55):
what two of the largest PBMs in health insurance in
the United States. We looked at the list prices that
they were setting for all the medicines in their generic
portfolio and compared it to all the other prices that
were set by other manufacturers out in the open marketplace.
When you examine those prices and compare them an aggregate,
(06:16):
what you can see is that the PBM owned pharmaceutical
company is only achieving savings of about thirteen fifteen percent
relative to the highest prices available in the marketplace. However,
when you look at the lowest prices in the market,
the PBM owned drug company sets prices that are thirty
(06:37):
three times higher than the lowest prices available in the marketplace.
This results in employers and patients and government programs paying
more because of the inflated prices that are being set
by the companies they thought were working to lower them.
Speaker 2 (06:54):
So long story short is, yeah, you've got basically.
Speaker 1 (06:56):
A PBM or what we call PBMs, is mostly trying
to lower the prices, but they're just going to up
their own number to stay somewhat reasonable. But give you
the impression they're lowering the prices for you is that
what I'm getting here?
Speaker 2 (07:07):
You got it exactly right.
Speaker 8 (07:08):
And the proverbial diluting of your dad's liquor cabinets and water.
Speaker 2 (07:15):
That's a great way to be.
Speaker 8 (07:16):
And the thing that and look, it's not just because
they're trying to give you an illusion of a discount.
They have skin in the game. Remember that PBMs and
insurance companies don't live in isolation. They own their own
mail order pharmacies and specialty pharmacies. So when they can
overcharge someone on a medicine, well, more often than not,
especially for the drugs that they own and set the
(07:38):
prices for, they're being distributed through the pharmacies that they own,
which means that the excess cost paid by plans and
patients translate into profits for the pharmacies owned by those
same companies.
Speaker 2 (07:52):
Right on, Anthony Chacha joining us.
Speaker 1 (07:53):
He's president of forty six Brooklyn Research, and he's leading
expert on the complicated world of pharmacy benefit managers and
drug costs, something I think we all are dealing with
as we sometimes go to pick up a prescription or
something blown away really at the price when they tell you, hey,
by the way, that and you're like I thought this
was the cheap one.
Speaker 2 (08:09):
That is the cheap one.
Speaker 1 (08:11):
Hey, And for Kentuckians trying to save money, what are
some practical steps or maybe questions they should be asking
their pharmacists or insurance providers.
Speaker 8 (08:20):
Well, it was about it. It was about a year
or two ago. I was out in Washington, d C.
For a meeting with the Federal Trade Commission, and your
governor was there along with Mark Cuban, and they were
talking about some of the problems in the drug channel,
specifically some of the inflated costs of these medicines. And
most interestingly is that your governor had essentially a lot
(08:44):
of advice in that forum, essentially saying, look, the prices
of medicines are too high, and the problems with PBMs
often make matters worse. We know a lot more transparency
and a lot more realignment of incentives in order to
cure some of these problems. Now, Kentucky, both through their
legislature and their governor, has done a lot to try
(09:06):
and rain some of these issues in but unfortunately public
policy can only take us so far, especially when you're
trying to grapple with Fortune fifty companies whose fiduciary obligation
is to make more money today than they made yesterday.
So when it comes to just you, the patient, right,
what can you do? The most valuable thing that you
(09:29):
can do with your time if you are cash strapped
for a medicine is to shop around. There are so
in a world of inflated prices. That means that your
risk exposure to overpaying is significant, but it also means
that there might be great room for savings. There are
independent pharmacies, there are chain pharmacies, there are discount card programs.
(09:51):
There's folks like Mark cuban cost plus drug company, all
of which can provide solutions when you are trying to
navigate a complicated pricing system. It sucks that it's that
way because most sick patients just want to get their
medicines in feel better and don't have the time and
energy to go through a labyrinth and a maze of
prescription drug pricing mess But if you are in a
(10:14):
position where you're trying to choose between something that is
really important and your medicine, it is imperative that you
go online or talk to your pharmacists to see if
you might be able to have the cheaper, a cheaper
alternative available to you in a world of inflated prices.
Speaker 1 (10:29):
Right on, spending some good quality time with Antonio and
Chancia again. He's president of forty six Brooklyn Research, and
we're talking about, of course, what they call PBMs or
pharmacy benefit managers and why are drug costs are so high?
And Anthony, looking ahead, do you see trends that could
help lower prescription costs here in Kentucky and elsewhere for
that matter. Is the system just always going to be
stacked against the consumer?
Speaker 8 (10:50):
And there's no question, I think, to just dig into
the last thing you said, Yes, the system is designed
to soak more money out of patients and employers and
government programs. We're dealing with a convoluted drug supply chain,
drug companies, drug wholesalers, pharmacies, PBMs, health insurance companies, and
(11:13):
a litany of other intermediaries that we don't have time
to discuss. But you can trust that every single hand
in the cookie jar wants to grab as many cookies
as humanly possible, and at some point the bill comes due. Unfortunately,
we need a lot more simplicity and a lot more
transparency in this system. Because it shouldn't be people like
(11:36):
me having to do long research reports that most people
won't have the time and energy to read to help
teach how this system works. This is like any other
retail transaction, or at least it should be. If you
walk into the grocery store and see that the gallon
of milk is twenty dollars, you know you're getting ripped off.
But when you walk up to the pharmacy counter and
(11:57):
the price of a torvous stat is five dollars or
seventy dollars, you're not necessarily equipped with adequate information to
assess whether or not that is a reasonable price. And
so as long as the system maintains its complexity, and
so long as the people that we rely upon to
lower the cost of medicines, so long as they make
(12:18):
more money when costs go up, I think will forever
be kind of chasing our tail, because we have to
realign those incentives to ensure that competition in the marketplace
lowers prices rather than raises them.
Speaker 1 (12:31):
Last question for you, Antonio, if you could change one
thing about the way drug prices are set in the US,
what would it be and why?
Speaker 8 (12:37):
I love that question. During the first Trump administration. President
Trump put forth a proposal that was an elimination of
the safe harbor for kickbacks in the drug supply chain.
And what I mean by that is is years ago,
as we were trying to get a better grasp on
(12:57):
lowering drug COSTSBA and drug companies got exemptions to federal
anti kickback laws that allow drug companies to pay PBMs
in exchange for preferring that drug company's medicines on their formulay,
which is the fancy term for the covered medicines under
your benefit plan. Now, it was sold as a way
(13:18):
to get discounts from drug companies. Who doesn't want a discount.
But when the people that you hire to control the
cost of medicines all of a sudden are allowed to
start getting legalized kickbacks from drug companies, well then you
run into an environment where the prices continue to go
up and the kickbacks increase, but those kickbacks don't necessarily
make their way to the end payer, be it the
(13:40):
patient or the employer. If I could change one thing
in this system, it would be dialing all that back
and putting drug companies in a position not to compete
on rebates and kickbacks, but instead to compete by actually
lowering the real prices of those medicines.
Speaker 1 (13:57):
Right on, Anthony Chanca. He is the president of forty
six Brooklyn Research. He's a leading expert on the complicated
world of pharmacy, benefit managers and drug costs. And as
you heard him speak with us today, he knows the
thing or two about what he's talking about.
Speaker 2 (14:11):
Anthony.
Speaker 1 (14:11):
If folks want to know more, they want to dive
deeper into this, where can they go, my man.
Speaker 8 (14:15):
If you want to become a drug pricing nerd, you
can go visit us at forty six brooklyn dot com.
We track the prices of medicines that are set by
the manufacturers, Medicaid and Medicare, expenditures, and a whole lot more.
Speaker 2 (14:29):
Anthony, you're the best, buddy. I'm gonna put you my rollodecks.
You better believe I'm gonna call you again at some point.
This has been an eye opening conversation. Thank you, my friend.
Speaker 8 (14:36):
Hey, thanks for having me up.
Speaker 1 (14:38):
Next, we're turning our attention to another hell story. It's
top of the mind this time of year. You'll want
to stay tuned. I'm Scott Fitzgerald.
Speaker 2 (14:45):
This is Kentucky Focus.
Speaker 5 (14:50):
Talking about guns with others. Might not always feel comfortable,
but it could save a life. Here's a way to
start a conversation. Your family is going over to your
neighbor's home for dinner for the first time. How would
you ask if there are any unlocked guns in the home.
Speaker 9 (15:06):
Hey, hey, we're so excited for it tonight. Before we
come over, ask a few questions. Yeah, of course. Do
you have any pets, Yes, we have a dog.
Speaker 3 (15:18):
Great.
Speaker 9 (15:19):
Do you have a pool outside? Nope, just a big
old backyard. Nice. Another question, are there any unlocked guns
in the home?
Speaker 4 (15:29):
Are guns restored securely locked in a safe that the
kids can't access?
Speaker 9 (15:34):
Oh awesome? Yeah, Now let's just talk about what we
can bring for dessert.
Speaker 5 (15:42):
Learn how to have the conversation at agree to Agree
dot org. A public service announcement brought to you by
the AD Council.
Speaker 10 (15:50):
Hey, I'm your mountain bike. Been a minute since we
hit the trail. Why not roll me over to Goodwill?
Donating me helps Goodwill's mission to provide career training and
support services right here in the community, and that keeps
us all moving. Donate today on your left to find
your nearest Goodwill locations and to learn more about our mission,
(16:13):
please visit Goodwill dot org Goodwill where your things start
New lives.
Speaker 2 (16:19):
Welcome back to Kentucky FOLKUS. So I'm Scott Fitzgerald.
Speaker 1 (16:22):
Well, the holidays are here and that means family gatherings, parties,
and unfortunately the flu season. Today we're talking about how
we can all protect ourselves here in the Commonwealth and
our loved ones from serious illness this winter. Joining us
is of course, doctor Sandra or fry Hoffer. She joins
us to explain why getting a flu shot now can
make all the difference. Doctor Fryhoffer, or as you said,
(16:43):
I can call you doctor Sandy.
Speaker 2 (16:45):
Thanks so much for joining us. As someone who gets
my flu.
Speaker 1 (16:48):
Shot every year, I'm so glad that you are creating
awareness around this.
Speaker 2 (16:51):
How are you today?
Speaker 11 (16:52):
I am great, Scott, and thank you so much for
having me. And I'm glad you're a believer, and I'm
glad you've already started your protection. That is such a
gift not only for you, but for everyone around you, because,
as you know, once you got that flu shot two
weeks later, you had protective antibodies built up. So you
are just giving the gift of protection and health to
(17:14):
your family, friends, and of course you're at the same time,
you're protecting.
Speaker 1 (17:17):
Yourself right on. Doctor Sandra Freinhoffer joining us. Now we're
talking about protecting yourself this holiday season as we're all
going to start gathering soon for the holidays. Doctor Sandy,
can you explain why flu season tends to spike during
the holidays, especially here in Kentucky.
Speaker 11 (17:31):
Well, it just does. This is we're entering flu season.
This year's flu season is getting a little bit of
a slow start, so it's not too late to get
your flu shot if you haven't already done so. And
everyone six months and older needs to get a dose
of flu vaccine every single year. And we're going to
talk about a lot of things today, but if there's
something you missed or something you want to brush up on,
(17:53):
we have a fabulous website that the American and Medical
Association and the ad Council have put together. It's called
get Myflu Shot dot Org and great resources answers questions,
and it also can tell you where you can go
to get a flu shot if you haven't already gotten one.
Speaker 1 (18:10):
Outstanding Doctor Sandy, Sandra Freihoffer joining us. As she mentioned
she is from the American Medical Association and doctor Sandy
last year's flu season was one of the most severe
in fifteen years. What lessons should we take here in
Kentucky from that experience.
Speaker 11 (18:25):
Well, I think the most important lesson is to get
your vaccine this year, because only about fifty percent of
people got their flu shot last year, and as you said,
it was one of the worst flu seasons we've had
in this decade, in this century, as the worst in
several decades. We had more hospitalizations, more deaths. We had
(18:45):
two hundred and eighty children that died. Now, of those
children that died, fifty percent did not have any underlying
medical conditions. Fifty percent of those children were healthy, but
ninety percent of those children who died had not gotten
a do of flu vaccine. So that to me is
just an important message stay protected. This year. Everyone needs
(19:06):
to get a flu shot. Everyone six months and older
needs to get a flu shot. If I will tell
you Scott, this year's flu season and getting a flu
shot is especially important to me. My husband's getting over
a chemotherapy and so I got my flu shot to
protect him. Also, my boy girl twins had little babies
right before Thanksgiving, and these little babies are too young
(19:28):
to get their vaccine. Yet you can't get the flu
shot until you turn six months old. So me getting
a flu shot, everybody who was around those babies getting
a flu shot protects them and just another little heads
up while there. When their moms were pregnant, they got
a dose of covid RSV and their flu vaccine, so
(19:49):
the antibodies from mom were passed on to babies. So
that gives that that gave their baby a little extra
protection during these first few months while they're still so vulnerable.
Speaker 1 (20:00):
Right on, Doctor Sander Freihoffer's joining us now with the
American Medical Association, and we're talking, of course about flu awareness.
And if you're someone who thinks, oh not another flu
awareness story, you can never stress the importance of getting
a flu shot. I get one every single year, and
is someone who just went through the flu that went
through our house. It certainly was a big peace of
(20:20):
mind for me, that is to know that I had
had the flu shot. And doctor Fryhoffer, as you said,
you recommend everyone get the flu shot. How effective is
the flu vaccine in preventing hospitalizations or even more serious complications, Well,
it's very effective.
Speaker 11 (20:36):
At preventing hospitalizations and severe illness. But nothing is one
hundred percent, but it's your best bet to get a
little edge on getting that protection and staying well and
protecting those around you. Now, if you do, even if
you get a flu shot, if you happen to get
the flu, there are anti virals available, and you should
(20:58):
let your doctor know, and especially if you're older have
some medical conditions, because as antivirals in addition to getting
the flu shot can help you pull through and help
you stay healthy and well and live to see next season.
Speaker 1 (21:11):
I think that's the important thing doctor Frenh offered to
let folks know. Now, just getting the flu shot isn't
going to prevent you from getting the flu. It'll go
a long way, mind you, but it also will help
kind of minimize the symptoms should you come down with
the flu.
Speaker 2 (21:24):
Is that correct?
Speaker 11 (21:25):
Well, it can help prevent you from getting the flu,
but it can also but more importantly, it keeps you
from being hospitalized. It keeps you from dying from the flu.
And you know, if you're young and healthy and have
a robust immune system, you're going to respond so well
to that flu vaccine. The very young and the very old,
(21:46):
I have a little more trouble getting through the fluvac
the flu season, and so that's why healthy people need
to get vaccinated. To protect the younger and the older,
and also people with medical conditions. Another group of physicians
that are really in favor of getting a flu vaccine
or cardiologist because cardiologists know that if you get the flu,
(22:08):
you're three to four times more likely to have a
heart attack in the next month after having the flu.
So another reason to get your flu shot. We want
everyone to stay healthy, We want everyone to enjoy the
holiday season and not miss out on being with family
and friends. And we want to give gifts and you know,
thanks to others, but we don't want to give the
(22:28):
flu to other people. So get your flu shot. Remember
that website is get myflu shot dot org. It has
some great resources, some public service announcements, answers a lot
of questions with details. It can also tell you where
to go to get a flu shot if you haven't
done so already.
Speaker 1 (22:47):
That was my next question for you, Doctor fry Hoffer Again,
doctor Sandra Fryhoffer joining us with the American Medical Association
all part of the No Time for Flu campaign and
someone's listening right now, doctor Frye Hoffer, because we do
go statewide and they're saying, listen, I just don't have
a doctor. I don't know where I can go for
a flu shot. How do I even get started with this?
What advice do you have for Well.
Speaker 11 (23:07):
All the pharmacies have flu vaccine, and I would recommend
going there if your own doctors doesn't have one. You
don't need a prescription to get a flu shot. The
pharmacist can give them to you, and doctors and every
specialty recommend that you get a flu shot. Everyone is clear.
All physicians are clear about this. Everyone six months and
(23:30):
older needs a flu shot every year because the flu
changes from year to year, and we update the flu
vaccine each season, and so last year's flu vaccine was
a little different than this year's flu vaccine, and they
try to match it so it'll work better for what
we anticipate will be circulating.
Speaker 1 (23:47):
And doctor Sandy, what are some of the common misconceptions
about the flu vaccine that you hear and how do
you respond to when people present those.
Speaker 11 (23:56):
Well, one of the biggest misconceptions is I don't want
a flu shot because I don't want to get the flu. Well,
you can't get the flu from the flu shot. That's impossible.
It's made from killed or weakened virus. That can't happen.
Speaker 8 (24:10):
Now.
Speaker 11 (24:10):
Your arm can get a little bit sore, and you
may have a teeny little bit of a fever, but
for like a day, or some muscle eggs, but that
is nothing like the symptoms you have if you get
the flu. I've had the flu twice in my life.
I had it when I was a senior in college.
I missed all my exams I had to take incomplete.
(24:30):
And then I got it when I was an intern
in my medical training, and it's the sickest I have
ever been. I have gotten a flu shot every year
since then, and I have not gotten the flu. I
am a true believer. I encourage every all my patients
to get a flu shot. My family has been vaccinated,
so I really practice what I preached.
Speaker 1 (24:50):
Yeah, I fought it for a long time too, Doctor Sandy,
And mostly because that reason that people would tell me,
And that was my mistake was I listened to other
people instead of talking to my doctor, and they, oh.
Speaker 2 (25:01):
Yeah, I got the flu. I feels horrible.
Speaker 1 (25:03):
And then suddenly when I went to my doctor, goes Scott,
let me give you the flu shot, and he did,
and I've never looked back since then. So I welcome
everybody at the AMA and you are, of course no
time for flu campaign. This is amazing. I recommend everybody
get it done.
Speaker 2 (25:19):
And doctor fry Hoffer one more time.
Speaker 1 (25:20):
If folks want to know more about just the flu
in general and the flu shot, where can they go?
Speaker 11 (25:26):
Go to get my flu shot dot org for more
information and some great resources.
Speaker 1 (25:32):
Well, doctor Sandra Fryhoffer, she is with, of course, the
American Medical Association. I think she knows a thing or
two about what she's talking about. So doctor Sandy, thank
thanks so much for your time and thanks for helping
promote awareness for this.
Speaker 2 (25:48):
You have yourself a wonderful holiday season.
Speaker 11 (25:50):
You too, Scott, have a great day.
Speaker 1 (25:52):
And again, you can never underscore the importance of flu
awareness this time of year. I'm Scott Fitzgerald. You're listening
to Kentucky Focus. We're back to wrap things up with
a follow up to a story we told you about
earlier back after this on Kentucky Focus.
Speaker 12 (26:10):
How can you measure the value of education based athletics, Well,
the value is in What makes it invaluable. That's because
school sports aren't just about winning, They're about learning and growing.
School sports aren't just about gaining trophies and accolades. They're
about learning life lessons, bringing a whole community together, developing
(26:31):
character and integrity, having coaches who mentor you, and teammates
who become lifelong friends. And you can't put a price
on any of that. That's what makes education based athletics invaluable.
Of course, when you participate in school sports, you want
to win and become a better athlete, but the purpose
is so much greater becoming a better person. Support your
(26:55):
local school sports programs and if you have a student,
encourage them to get involved.
Speaker 5 (27:01):
Brought to you by the Kentucky High School Athletic Association
and the Kentucky Athletic Administrators Association.
Speaker 1 (27:09):
Welcome back to Kentucky Folkus, signs Scott Fitzgerald.
Speaker 2 (27:12):
Well, as we closed things out and we wanted to
update you on a store we've brought you a few
weeks ago.
Speaker 1 (27:16):
In Kentucky Housing News, the Bluegrass Institute is praising the
Kentucky Housing Task Force for embracing key housing reforms aimed
at making homes more affordable across our state. Task force
final report closely mirrors recommendations from the Institute earlier this year,
focusing on cutting red tape, expanding housing supply, and protecting
property rights. Among the reforms highlighted our streamline permitting with
(27:38):
strict deadlines.
Speaker 2 (27:39):
Stronger protections for property owners, and.
Speaker 1 (27:42):
Changes to zoning it density rules to allow smaller lots
and multifamily housing. Other proposals include cost cutting, building code adjustments,
reduced parking requirements, and support for faith based and charitable
housing initiatives. Institute says these reforms are designed to improve
housing access without adding taxpayer subsidies, emphaside has property rights
and efficiency, with Grass Institute scholar m no And Gray.
Speaker 2 (28:04):
Saying, quote, if we're going to make room for.
Speaker 1 (28:06):
The next generation of Kentuckians, the state has to scale
up housing production.
Speaker 2 (28:11):
As package of best practices.
Speaker 1 (28:12):
We'll do just that unquote, whilemaker's wow the chance to
act on these recommendations during the twenty twenty six regular
session with the goal of ensuring housing remains abundant and
affordable for future generations. And that's gonna put the reps.
In this week's edition of Kentucky Focus, we cover just
about everything, from breaking down prescription drug prices, to sharing
important guidance on the flu season and to house it it.
(28:36):
Hopefully we'll be improving here in the Commonwealth. And to
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