April 1, 2025 • 28 mins
In this episode of ShiftShapers, host David A. Saltzman sits down with Vinay Patel, PharmD, founder of MakoRX, to expose why prescription pricing remains so confusing—and what can be done to fix it.
Patel breaks down how pharmacy benefit managers (PBMs), vertical integration, and opaque pricing structures are driving up costs for patients—while limiting access and undermining local pharmacies. From subscription pharmacy programs to cash-pay and compounding models, Patel shares bold, practical solutions for bringing real transparency back into the healthcare system.
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🔑 Key Takeaways from This Episode
- The Truth About Prescription Pricing
Patel explains how PBMs and vertically integrated systems distort drug pricing—making it difficult for patients to know what they’re really paying and why. - The Power of Local Pharmacies
Community pharmacies often serve as the most frequent healthcare touchpoint for patients. Their role in building trust, offering consultations, and providing accessible services is critical to public health. - How MakoRX’s Subscription Pharmacy Program Brings Real Cost Transparency
Patel details a model offering 300 commonly prescribed medications for a flat monthly fee—providing predictable costs and supporting a national network of independent pharmacies. - Breaking Up Healthcare Oligopolies
To fix what’s broken, Patel supports breaking up vertically integrated giants, allowing regional players to compete on quality, service, and fair pricing. - The Role of Compounding and Cash-Pay Pharmacies
With growing demand for affordability, Patel highlights how compounding and cash-pay pharmacies are offering lower-cost alternatives and bypassing insurance constraints. - A Vision for Integrated, Transparent Care
Patel explores a future where technology enables collaboration between pharmacists and medical providers—creating a more coordinated, transparent, and patient-focused care model.
⏱️ In This Episode
00:00 Introduction and Guest Welcome
00:54 Vinay Patel's Career Journey
04:28 Challenges in the Healthcare System
05:49 Political Perspectives on Healthcare Reform
14:17 The Role and Importance of Community Pharmacies
20:02 Subscription Pharmacy Programs
25:30 Future Trends in Pharmacy and Healthcare
27:20 Conclusion and Farewell
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Is the term prescription pricing
transparency an oxymoron?
We'll find out on this episodeof Shift Shapers.
Speaker 2 (00:10):
Change either energizes or paralyzes.
The choice is yours.
This is the Shift Shaperspodcast, bringing the employee
benefits industry interviewswith individuals and companies
who are shaping the industry'sshifts.
And now here's your host, davidSaltzman.
Speaker 1 (00:31):
And joining us to help answer that question is
Vinay Patel.
He's a PharmD and founder atMAKO Rx.
Vinay, welcome to the program.
Speaker 3 (00:40):
David, thank you so much.
It's an honor to be here, anhonor to be in front of your
audience that is helping tochange the healthcare landscape.
Speaker 1 (00:48):
Oh boy, I know they are and we're all working real
hard at it and some days it justit's a higher slope than others
.
That's right.
We always like to ask ourguests what was your path to
being the head googa-mooga atMangoRx?
Because most of us don't havecareers that go in straight
lines.
Speaker 3 (01:07):
So it's always fascinating to ask the question.
That's right.
It's been a fascinating path forme to get here and unlikely for
me who wanted to start offbeing a clinician.
I did a residency out in KaiserPermanente in California,
learned how integrated care issort of efficiently delivered
(01:29):
with minimal patient disruptionand clinicians get to
communicate and collaborate onpatient care and not be worried
about insurance although it'sgotten a lot more complicated
than it used to be, than it usedto be and then taught at a
university as a pharmacist,taught pharmacy students and
(01:50):
medical students and medicalresidents and learned the basis
of not only how to train andeducate other rising pharmacists
and medical professionals butalso set up a clinic inside of a
university medical center thatserved the community, served the
Medicaid community actually inCalifornia, and got to see
firsthand issues and concernsand this was before Obamacare,
(02:13):
before the ACA, where we justhad to figure out how to help
people get access to theirmedications, how to care for
them better.
Patients that were takingmedications that required a lot
of monitoring.
Patients that had diabetes.
Patients that had a specificblood thinner that we don't, we
(02:34):
rarely use today, that had evenmore side effects than the ones
that they have today calledCoumadin and Warfarin, and how
to monitor them and keep them inmind so that they didn't have
adverse events, and so that wasmy.
That was sort of the basis of myclinical training.
I got to learn a lot fromclinicians that worked there.
I was working side by side withphysicians that said hey, we
(02:54):
have a pharmacist on our teamand just go down the hall and
meet with them and they're goingto help straighten out your
medications and help me bettercare for you.
We work as a team together andthat was really powerful and
impactful to me in my trainingand understanding of real
patient issues, real things thatdoctors, offices have to deal
with, and that was the daysbefore there was a ton of health
(03:18):
care, health insuranceoversight but we helped out and
understood that flow process atthe time as well.
And then shift over here toNorth Carolina after a couple of
years of training and being outin the beautiful sunshine.
That's California and thethings that are to do there.
It's a wonderful state butcouldn't afford to live there.
Family grew up in the EastCoast, came out here and worked
(03:40):
at an independent pharmacy witha colleague of mine from
pharmacy school and worked forthe state and worked for doctors
making house calls, anorganization that goes out to
long-term care facilities andhelps care for the elderly.
We were the first here to setup what was called annual
wellness visit insurance billing, and so, as a non-traditional
(04:02):
practitioner, we were able toactually build Medicare under
the umbrella of doctors makinghouse calls, and we were the
first, to the best of ourknowledge, to do so here in
North Carolina as a pharmacist,and it was a wonderful system.
Medicare had just authorizedthat review.
It was like a full system reviewof a patient once a year that
they would reimburse for, andgot to learn again all the
(04:24):
nuances of taking care ofMedicare people and then work
for a home delivery pharmacy andthroughout all of this.
My point here is that the, the,are the insurance system
accelerated after Obamacare, thevertical integration and the
control that they had.
(04:54):
No matter where you practice asa pharmacist, you had this cloud
hanging over you.
That was the pharmacy benefitscompanies that told you what to
do, how much you could, what youcould tell patients at some
point at one point, how much youwould make, so on and so forth.
And so we decided OK, if thereis chocolate and vanilla in the
marketplace, we need to createstrawberry, because that's what
everyone's asking for, butthey're not getting it.
It was a transparent model.
It was cost plus pricing at thetime, the first in the country
to put together a network ofpharmacies that would accept
cost plus pricing on drugs and anew level of transparency where
(05:14):
we weren't telling you a madeup price for medications, we
were telling you what thepharmacies bought the drugs for
and how much you were going topay them to dispense that
medication to patients.
So that's what led me here tothis six years ago, putting this
together and fighting a goodfight.
Speaker 1 (05:29):
Well, and to our friends in North Carolina, and I
know you love it where you are.
Yes, you know there are somedifferences between California
and North Carolina.
It's just like you know,california is tipped on its side
.
It's kind of North Carolina.
You got the ocean on one sideand the mountains on the other.
So you know every place hasgreat stuff, but you know both
great places to be AbsolutelyWell.
(05:49):
Let's level set here.
We're recording this on Friday,january 31st, and a couple of
days ago Robert F Kennedy Jr hadhis second set of hearings as
the nominee for US Department ofHealth and Human Services head
and he said this.
He was talking about PresidentTrump and he said, and I'll read
Trump is absolutely committedto fixing the PBMs.
(06:10):
I think we need to reform thePBMs.
I think we need to get all ofthese vested interests out that
are draining money from thesystem.
Trump wants to get the excessprofits away from the PBMs and
send it back to primary care topatients in this country.
Fair statement 100%.
Speaker 3 (06:31):
I couldn't agree more with RFK Jr and the Trump
administration's talking pointson helping to reform the
healthcare system from theoligopolies that we have today
to a future vision and to afuture path that has yet to be
(06:53):
created, has yet to belegislated to figure out what
that is.
To add to that, david, there wasElizabeth Warren sent, penned,
a letter if we still do thosethings today, in this year, to
the Department of GovernmentEfficiency, doge, run by Elon
(07:13):
Musk, and in that letter one ofthe statements he made was if we
break up UnitedHealthcare andOptumRx, it will save the
government money.
So you should consider that aspart of your efficiency efforts.
And it seems like there's agroundswell of over the last
five to 10 years, not only theleft, not only the right, but
(07:35):
together all around there isthis chorus of voices saying we
need to do something abouthealthcare, we need to do
something about drug prices, andthere's a million different
ways to get there.
And there's the camp of we needto regulate and reform and put
more sort of policies that theycan narrowly do business in
(08:00):
which, in my opinion, I thinkthey've already found ways
around that, they've already gotloopholes sort of factored in
and there's going to be it'llhave little effect, in my
opinion.
The other camp was let's breakthem up, like we did with Ma
Bell so many decades ago.
I think that I'm in the breakupcamp.
I'm saying let's break up theseorganizations into smaller
(08:24):
pieces to allow the regionalplayers in that area to compete
on quality, price and service.
And if we can all have accessto the same pricing because
we're all about the same size,then it's really going to be
focused on who can deliver thebest quality care and who can
deliver the best service tothese patients.
Speaker 1 (08:40):
Yeah, I mean, I think the stumbling block now is not
patients, because I thinkpatients have finally started to
wake up and it's not even youknow, some of my friends in your
end of the pharmacy industrywhere they're trying to do stuff
right and do it the right way.
I think that the challenge isCongress.
I remember back when they werefirst started talking about ACA,
the first person in the frontdoor of the White House was a
(09:03):
guy named Billy Towson and hewas a congressman from Louisiana
, but for a long time he's beenthe head of Big Pharma and
there's tons of money floatingaround and you know the question
is if they break them up.
I guess that just has to go tothe Federal Trade Commission.
It doesn't have to go throughCongress.
So maybe there's a chance.
But you know you're askingpeople to vote against their
(09:23):
vested interests and that's.
You know that's tough andthat's why I think there's been
a lot of talk around this, butthere hasn't been a ton of
action until recently, otherthan Doge and some of the things
that are being talked about.
What are the factors that aredriving this new wave of?
Okay, we're at the corner ofanything goes meets enough
(09:44):
already with pharmacy andpricing.
Speaker 3 (09:51):
It has to do with the experience not only of patients
.
Patients experience thisfrustration every day when you
deal with insurance companies.
But now you also have thetentacles of this vertical
integration going into everysingle area.
(10:11):
Healthcare sector, area,healthcare sector.
Before it was okay.
We had our insurance businessand we would we partner with
plan sponsors, whether that'sgovernment, state agencies or
private companies, to getrevenue from and we sort of ran
it as an insurance business.
It's now grown out of that into.
(10:31):
We're going to find a way to getrevenues from pharmacies.
We're going to find a way toget revenues from pharmacies.
We're going to find a way toget revenue from health care
providers and practitioners inclinics.
We'll find a way to get revenueoutside of through patients,
(10:56):
just patients saying this is areally bad experience for me and
it's only gotten worse.
But you have health careproviders now that are standing
up and saying you've got to payattention to this.
It's disseminating, it'sdecimating excuse me communities
that now we have pharmacydeserts in many parts of rural
parts of America where there areno pharmacies that are there to
serve those members, and nowyou have let everyone going to
(11:18):
their state legislature sayyou've got to do something about
this.
And then the state's tellingfederal okay, we got to figure
out how to do this at a federallevel as well.
There's only so much that thestates can do.
So I think it's gotten into somany parts of the country that
it's just gotten louder andeveryone's paying attention of
the country that it's.
Speaker 1 (11:37):
you know that it's just gotten louder and
everyone's paying attention.
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I wonder do you think thatmaybe some of the slow awakening
on the patient side is due tothings like GoodRx?
Speaker 3 (13:38):
where people are finally realizing that wait, I
can pay less for the drug if Ipay cash and use this goofy card
than I can if I use myinsurance.
Awareness and education werealways key in healthcare.
It was inordinately complex andfor people to understand it
they had to experience itdifferently.
And that was absolutely.
The transparency and awarenessthat CodeRx brought to drug
pricing to a certain extent whenit was first created, allowed
people to see and open theireyes to say, okay, well, it's
not just my insurance company'sprices that are important, it's
(14:00):
also this cash price.
And now I can search for theprice now and I can find there's
a difference.
There's a big difference in theprice I'm getting charged
Absolutely.
Speaker 1 (14:08):
Isn't that amazing, just like everything else that
we buy.
Speaker 3 (14:11):
Yeah, exactly no, the price up front.
Speaker 1 (14:37):
It's a strange world, isn't it?
So you know you mentioned.
Speaker 3 (14:38):
You mentioned local pharmacies.
And I know one of the areas thatyou guys work in a lot, and
maybe listeners aren't quite asaware of as they may soon be, is
the role of what we'll callcommunity pharmacies.
Can you talk a little bit aboutwhat a community pharmacy is,
why it's important to theeco-structure and what we need
to know about them?
Yes, absolutely, they are soimportant, not just speaking as
a pharmacist, but the way thatthey serve communities is
multifaceted, oftentimes.
An interesting statistic apatient will oftentimes visit a
pharmacy 12 times a year, versuson average, seeing their
physician three times a year ortheir medical clinic.
(15:00):
And so the touch, the healthcare touch point in the
community is more oftentimesthan not, a pharmacy.
And community pharmacies arebrick and mortar stores that
exist in communities, incommunities, whether it's big
box pharmacy stores, grocerypharmacy stores or the mom and
pop shops that are in stripmalls and sort of hidden out of
(15:21):
plain, out of the main streetview sees these people knows
their community.
They live and work and havefamilies in this community.
They contribute to thecommunity and they do more than
just care for the patients thatwalk through their doors.
There's more than just there'sconsults that happen, with these
(15:42):
patients saying, hey, my kid,you know, it's the middle of the
night, my kid's sick and I'mgoing to need something to hold
me over until I can go see mydoctor tomorrow morning.
Great, let me help you out.
Let's talk about what's goingon and you on and how's your
grandparents doing, and so onand so forth.
Right, there's this communityeffect and it's so vitally
important.
And also there's other servicesyou can get at a pharmacy.
(16:03):
There's so many more servicesyou can get now, except a bit
outside of just getting yourmedications.
You can get vaccines at apharmacy.
You can get as we learnedthrough the pandemic COVID
testing at pharmacies.
And the access, theaccessibility of a healthcare
practitioner in the communitythrough these pharmacies all
over the country is so vital forthese communities to thrive.
Speaker 1 (16:25):
How do we keep them going?
What a lot of people may notrealize is that the margin on
pharmaceuticals at the pharmacylevel is very, very, very thin.
It's almost, you can almost seethrough it.
That's how thin it is.
How do we help those communitypharmacies that aren't the three
or four biggies?
How do we help them stay inbusiness?
(16:46):
What can we do?
Speaker 3 (16:50):
it's a.
That's a tough question, davidum, and I'll tell you why.
Even if every patient in thecommunity decided they wanted to
use a mom and pop pharmacy, theone of the first bears they're
going to run into is do I takeyour insurance when I walk?
When I walk into the pharmacy,can the pharmacy take your
insurance, and is it going to bea better price for you at the
(17:11):
community pharmacy versus thebig box store, depending on on
what insurance card you have inyour wallet?
It's going to dictate that, andthat's sort of navigating
patients to all these differentpharmacies around the country,
and so I wish there was aneasier answer to say what we can
do to help them.
What you can do is, when youhave medications that you're
(17:34):
filling at a big box store, youcan always ask your local
pharmacy how much thesemedications would be at your
pharmacy without using insurance.
Just how much would the cashprice be for these medicines?
Oftentimes these communitypharmacies can beat the good or
X price without having to runthat card and run that program
at the pharmacy.
It just takes a little bit ofasking and then also talk to
(17:56):
your pharmacist about otheroptions for medication so they
can discuss drugs that can becompounded that may be more
affordable, or a differentformulation that would be more
palatable for them, customizedfor their need.
If it's appropriate, and reallyjust having that relationship
with a community pharmacy, evenif you don't use them for your
(18:17):
medicines to go in and have aconversation, establish that
relationship.
If you can purchase somethingat a small business we talk a
lot about this a lot Shop local,shop small.
If there's a way to work orpatronize a local business, it
would be a local pharmacy.
It just gets a little diceywith the prescriptions alone,
(18:39):
but there's other services thatyou could use there.
Speaker 1 (18:42):
You know I think some people are finding with this
now big discussion aboutsemaglutides that pharmacies
that compound can actually getyou the same medication that you
need at a much lower cost thanthe brand name.
Do you think that's going to bea driver of folks maybe looking
, taking a second look at somelocal pharmacies that do still
do compound?
Speaker 3 (19:02):
Yes, there's been a ton of demand for these
medications and there's been aneed to educate the public
between you know the differencebetween a MediSpa and a licensed
regulated compounding pharmacy,that you know the difference
between a MediSpa and a licensedregulated compounding pharmacy.
That you know that's accreditedby health care bodies.
So, yes, there's been moreinterest and more education and
awareness of compound pharmacies.
(19:22):
There is some FDA statementsthat have come out on the
continued use of these drugs orcompounding pharmacies, on the
continued use of these drugsthrough compounding pharmacies.
The resolution of that has yetto be seen, but for now,
sometime next month, individualpatient prescriptions may not be
able to be filled throughcompounding pharmacies and then,
beyond that, sometime in March,what we call bulk compounders
(19:46):
won't be able to supply thesemedications.
Speaker 1 (19:49):
Gee, he said not being at all cynical.
I wonder how that happened.
Speaker 3 (19:53):
Yeah, I think we can trace the dot, connect the dots?
Yeah, I think we can.
Speaker 1 (19:57):
Even if you've got a really big old fat crayon, it's
not hard to connect those.
One of the things I wanted totalk to you about that I know
that you've been working on arethese things called subscription
pharmacy programs.
What are they?
What's the market for them?
How can they help?
What's the market for them?
How can they help?
We have a unique.
Speaker 3 (20:13):
Patients have been exposed to these subscription
products through services likeyou mentioned, like GoodRx, and
there's certain grocerpharmacies that offer these
subscription programs as well.
The program that we'vedeveloped is really interesting
and really unique.
It provides access to 300 ofthe most commonly used
medications in the country.
(20:34):
We're talking about drugs formental health, cardiovascular
disease, antibiotics, birthcontrol and various other
therapeutic areas, but mostcommonly used prescriptions in
the country these 300medications at no cost, through
our network of preferred costplus pharmacies that are about
22,000 and growing across thecountry, and so for a monthly
(20:59):
fee.
In exchange for a fixed monthlyfee, about $30 a month,
depending on what plan youselect you can get access to
these 300 drugs at no costthrough your local pharmacies.
As the value and this issomething that is really
important, david, when we createproducts, we want to understand
what is the value we'rebringing to patients.
(21:20):
What is the value we'rebringing to the healthcare
market?
Today, it feels like we pay aton for health insurance but
we're not getting any value.
No one's talking about thevalue of healthcare, and so we
really wanted to make sure wehad a good value proposition
that includes access to thesedrugs and then every other drug
that you might want to takethat's not on the list is cost
plus prices you pay directly tothe pharmacy.
(21:40):
That's fair reimbursement tothem and that you know that can
help to accelerate this adoptionand survival of these community
pharmacies.
Speaker 1 (21:48):
And where are you marketing that Is, that large
group, medium sized group, anykind of group?
Speaker 3 (21:53):
Anyone, any employer that wants to offer it, they can
offer it.
Any size employer, whetheryou're fully self-insured.
You don't offer healthcare orhealth insurance like we see in
the hospitality industry, soanyone can offer it.
Anyone can pick it up and offerit and it's a monthly
contribution for those membersthat want to sign up for this
plan and as members come on andoff the plan on a monthly basis,
(22:15):
we are flexible to that andit's not an annual commitment.
You don't have to worry aboutthousands of dollars in health
care costs.
It's very specific and it's avalue add.
That's our bronze program,which is just access to the
drugs, and then we have a silverprogram that does drugs plus
access to telemedicine.
So if you need, you know anytime to chat with a doc via
(22:35):
telemedicine to get access tosome of these drugs.
That gives them access throughthe silver plan that we have as
well.
Speaker 1 (22:41):
You know, kind of taking a little bit of a left
turn.
You know there was with theJohnson Johnson lawsuit a year
ago and changed now, aheightened awareness of the fact
that employers and plansparticularly have a fiduciary
responsibility to ensure thatthey're paying fair prices for
prescription drugs.
What's the role of the PBM inhelping them get there?
(23:02):
How do you see that?
Speaker 3 (23:06):
In getting.
I just want to clarify what'sthe role in the PBM in helping
patients.
Speaker 1 (23:10):
It means helping plans understand and assure
themselves that they are makingwise choices when they use a PBM
.
Speaker 3 (23:20):
So the PBMs, you know if truly an advisor to the plan
to help them understand drugcosts and how to manage those
drug costs effectively.
And PBM can help the plansunderstand that there's many
(23:41):
different ways to access amedication.
And where you go will determinewhat the price is for a drug,
which is what we see every day.
And there's three big bucketsof drugs.
There's generic medications.
These are the least expensivedrugs and the most commonly used
drugs in the country.
Then there's brand medicationsand then there's specialty
medications.
(24:01):
And that's sort of the lens thatwe see the PBM landscape in
terms of these three buckets ofdrugs.
And so if they were advisingtheir clients, they would tell
them we want to maximize as muchas possible utilization of
generic medications becausethey're the least expensive and
there's a lot of brand drugsthat have alternatives that are
generic.
That not only helps the plantsaver but also helps the patient
(24:25):
at the pharmacy.
Today, when you have a brandmedication, the patient has to
pay the full retail price ofthat drug and then the rebate
goes back to the employer interms of savings.
So the patient never getsbenefit of any rebate dollar
savings, just by design of theway the system works.
But if you take a generic, boththe plan and the patient get
the benefit at the pharmacy.
(24:47):
And so just helping to educateand understand and break down
demystify the pharmacy and Ithink that's a great first step
that PBMs can take to help plansponsors just understand
healthcare.
It's extremely complex and justbreaking it down into simple
concepts for them to understandthis would help and benefit
(25:08):
everyone in society, but there'sa lot of barriers to that.
Speaker 1 (25:12):
Yeah, well, certainly .
You know, demystifying PBMs isa heavy lift because there are
so many corners and layers andother pieces that maybe are not
as transparent and others thatare opaque by design, so it's a
big job.
We've got a couple of minutesleft.
What do you see coming in thenext couple of years in your
(25:33):
industry?
What are the trends that you'rewatching?
Speaker 3 (25:36):
We're seeing today as the status quo of the
healthcare market continues,pharmacies finding other ways to
diversify away from theinsurance market to continue to
serve their communities.
Cash pay pharmacies we talkedabout compounding pharmacies.
Cash pay pharmacies we talkedabout compounding pharmacies.
Cash pay pharmacies areparticular pharmacies that don't
take any insurance at all.
(25:57):
They're just going to try toget you the best price for the
drug and transparently show youwhat drugs cost without having
to worry about insurance at allup front.
We're seeing models like MarkCuban's Cost Plus Pharmacy go to
market and say there's a betterway to do this.
There's a way to change themarketplace.
If employers wake up and decidethey want to get engaged in
changing healthcare, they havethe ability to do so with
(26:19):
publishing contracts soon andpublishing these drug prices.
On the care side, I really thinkthere is a model, there is a
vision, there is a push to havethis care team model come into
the community, with yourpharmacy in a separate place in
the community than your doctor'soffice, but then collaborating
(26:40):
through technology, throughefforts that exist in parts and
pieces today, where we can nowinclude that pharmacist onto the
care team and provide theirexpertise and their care outside
of just sort of the specificissues that they find when
prescriptions come in throughtheir doors, but it actually be
involved in that patient's careand collaborate with the medical
(27:00):
providers in the community.
And telemedicine is a greatexample of that sort of greasing
the skids to getting to thisintegrated care model for
patients, and maybe we'll seesomething like the model that
Kaiser put together in morecommunities through technology,
intervening on the care andmaking it more coordinated.
Speaker 1 (27:20):
Well as the solutions evolve.
We hope you'll come back andchat with us some more.
Vinay Patel, founder at MakoRx.
Thank you so much for sharingyour wisdom with us.
Speaker 3 (27:30):
Thanks so much for the time and opportunity, David.
You made it so easy.
Speaker 1 (27:39):
I want to give a quick shout out to our sponsor
and our producer, hatcher Media.
Hey, if you need podcastproduction or professional
graphic design, josh Hatcher isthe expert to contact For more
information.
Visit him at HatcherMedianet.
That's H-A-T-C-H-E-R-Medianet.
Speaker 2 (28:01):
This Shift Shapers podcast is copyrighted content
and may not be reproduced inwhole or in part without the
express written permission ofShift Shapers Solutions LLC.
Copyright 2024.
Is the term prescription pricing
transparency an oxymoron?
We'll find out on this episodeof Shift Shapers.
Speaker 2 (00:10):
Change either energizes or paralyzes.
The choice is yours.
This is the Shift Shaperspodcast, bringing the employee
benefits industry interviewswith individuals and companies
who are shaping the industry'sshifts.
And now here's your host, davidSaltzman.
Speaker 1 (00:31):
And joining us to help answer that question is
Vinay Patel.
He's a PharmD and founder atMAKO Rx.
Vinay, welcome to the program.
Speaker 3 (00:40):
David, thank you so much.
It's an honor to be here, anhonor to be in front of your
audience that is helping tochange the healthcare landscape.
Speaker 1 (00:48):
Oh boy, I know they are and we're all working real
hard at it and some days it justit's a higher slope than others
.
That's right.
We always like to ask ourguests what was your path to
being the head googa-mooga atMangoRx?
Because most of us don't havecareers that go in straight
lines.
Speaker 3 (01:07):
So it's always fascinating to ask the question.
That's right.
It's been a fascinating path forme to get here and unlikely for
me who wanted to start offbeing a clinician.
I did a residency out in KaiserPermanente in California,
learned how integrated care issort of efficiently delivered
(01:29):
with minimal patient disruptionand clinicians get to
communicate and collaborate onpatient care and not be worried
about insurance although it'sgotten a lot more complicated
than it used to be, than it usedto be and then taught at a
university as a pharmacist,taught pharmacy students and
(01:50):
medical students and medicalresidents and learned the basis
of not only how to train andeducate other rising pharmacists
and medical professionals butalso set up a clinic inside of a
university medical center thatserved the community, served the
Medicaid community actually inCalifornia, and got to see
firsthand issues and concernsand this was before Obamacare,
(02:13):
before the ACA, where we justhad to figure out how to help
people get access to theirmedications, how to care for
them better.
Patients that were takingmedications that required a lot
of monitoring.
Patients that had diabetes.
Patients that had a specificblood thinner that we don't, we
(02:34):
rarely use today, that had evenmore side effects than the ones
that they have today calledCoumadin and Warfarin, and how
to monitor them and keep them inmind so that they didn't have
adverse events, and so that wasmy.
That was sort of the basis of myclinical training.
I got to learn a lot fromclinicians that worked there.
I was working side by side withphysicians that said hey, we
(02:54):
have a pharmacist on our teamand just go down the hall and
meet with them and they're goingto help straighten out your
medications and help me bettercare for you.
We work as a team together andthat was really powerful and
impactful to me in my trainingand understanding of real
patient issues, real things thatdoctors, offices have to deal
with, and that was the daysbefore there was a ton of health
(03:18):
care, health insuranceoversight but we helped out and
understood that flow process atthe time as well.
And then shift over here toNorth Carolina after a couple of
years of training and being outin the beautiful sunshine.
That's California and thethings that are to do there.
It's a wonderful state butcouldn't afford to live there.
Family grew up in the EastCoast, came out here and worked
(03:40):
at an independent pharmacy witha colleague of mine from
pharmacy school and worked forthe state and worked for doctors
making house calls, anorganization that goes out to
long-term care facilities andhelps care for the elderly.
We were the first here to setup what was called annual
wellness visit insurance billing, and so, as a non-traditional
(04:02):
practitioner, we were able toactually build Medicare under
the umbrella of doctors makinghouse calls, and we were the
first, to the best of ourknowledge, to do so here in
North Carolina as a pharmacist,and it was a wonderful system.
Medicare had just authorizedthat review.
It was like a full system reviewof a patient once a year that
they would reimburse for, andgot to learn again all the
(04:24):
nuances of taking care ofMedicare people and then work
for a home delivery pharmacy andthroughout all of this.
My point here is that the, the,are the insurance system
accelerated after Obamacare, thevertical integration and the
control that they had.
(04:54):
No matter where you practice asa pharmacist, you had this cloud
hanging over you.
That was the pharmacy benefitscompanies that told you what to
do, how much you could, what youcould tell patients at some
point at one point, how much youwould make, so on and so forth.
And so we decided OK, if thereis chocolate and vanilla in the
marketplace, we need to createstrawberry, because that's what
everyone's asking for, butthey're not getting it.
It was a transparent model.
It was cost plus pricing at thetime, the first in the country
to put together a network ofpharmacies that would accept
cost plus pricing on drugs and anew level of transparency where
(05:14):
we weren't telling you a madeup price for medications, we
were telling you what thepharmacies bought the drugs for
and how much you were going topay them to dispense that
medication to patients.
So that's what led me here tothis six years ago, putting this
together and fighting a goodfight.
Speaker 1 (05:29):
Well, and to our friends in North Carolina, and I
know you love it where you are.
Yes, you know there are somedifferences between California
and North Carolina.
It's just like you know,california is tipped on its side
.
It's kind of North Carolina.
You got the ocean on one sideand the mountains on the other.
So you know every place hasgreat stuff, but you know both
great places to be AbsolutelyWell.
(05:49):
Let's level set here.
We're recording this on Friday,january 31st, and a couple of
days ago Robert F Kennedy Jr hadhis second set of hearings as
the nominee for US Department ofHealth and Human Services head
and he said this.
He was talking about PresidentTrump and he said, and I'll read
Trump is absolutely committedto fixing the PBMs.
(06:10):
I think we need to reform thePBMs.
I think we need to get all ofthese vested interests out that
are draining money from thesystem.
Trump wants to get the excessprofits away from the PBMs and
send it back to primary care topatients in this country.
Fair statement 100%.
Speaker 3 (06:31):
I couldn't agree more with RFK Jr and the Trump
administration's talking pointson helping to reform the
healthcare system from theoligopolies that we have today
to a future vision and to afuture path that has yet to be
(06:53):
created, has yet to belegislated to figure out what
that is.
To add to that, david, there wasElizabeth Warren sent, penned,
a letter if we still do thosethings today, in this year, to
the Department of GovernmentEfficiency, doge, run by Elon
(07:13):
Musk, and in that letter one ofthe statements he made was if we
break up UnitedHealthcare andOptumRx, it will save the
government money.
So you should consider that aspart of your efficiency efforts.
And it seems like there's agroundswell of over the last
five to 10 years, not only theleft, not only the right, but
(07:35):
together all around there isthis chorus of voices saying we
need to do something abouthealthcare, we need to do
something about drug prices, andthere's a million different
ways to get there.
And there's the camp of we needto regulate and reform and put
more sort of policies that theycan narrowly do business in
(08:00):
which, in my opinion, I thinkthey've already found ways
around that, they've already gotloopholes sort of factored in
and there's going to be it'llhave little effect, in my
opinion.
The other camp was let's breakthem up, like we did with Ma
Bell so many decades ago.
I think that I'm in the breakupcamp.
I'm saying let's break up theseorganizations into smaller
(08:24):
pieces to allow the regionalplayers in that area to compete
on quality, price and service.
And if we can all have accessto the same pricing because
we're all about the same size,then it's really going to be
focused on who can deliver thebest quality care and who can
deliver the best service tothese patients.
Speaker 1 (08:40):
Yeah, I mean, I think the stumbling block now is not
patients, because I thinkpatients have finally started to
wake up and it's not even youknow, some of my friends in your
end of the pharmacy industrywhere they're trying to do stuff
right and do it the right way.
I think that the challenge isCongress.
I remember back when they werefirst started talking about ACA,
the first person in the frontdoor of the White House was a
(09:03):
guy named Billy Towson and hewas a congressman from Louisiana
, but for a long time he's beenthe head of Big Pharma and
there's tons of money floatingaround and you know the question
is if they break them up.
I guess that just has to go tothe Federal Trade Commission.
It doesn't have to go throughCongress.
So maybe there's a chance.
But you know you're askingpeople to vote against their
(09:23):
vested interests and that's.
You know that's tough andthat's why I think there's been
a lot of talk around this, butthere hasn't been a ton of
action until recently, otherthan Doge and some of the things
that are being talked about.
What are the factors that aredriving this new wave of?
Okay, we're at the corner ofanything goes meets enough
(09:44):
already with pharmacy andpricing.
Speaker 3 (09:51):
It has to do with the experience not only of patients
.
Patients experience thisfrustration every day when you
deal with insurance companies.
But now you also have thetentacles of this vertical
integration going into everysingle area.
(10:11):
Healthcare sector, area,healthcare sector.
Before it was okay.
We had our insurance businessand we would we partner with
plan sponsors, whether that'sgovernment, state agencies or
private companies, to getrevenue from and we sort of ran
it as an insurance business.
It's now grown out of that into.
(10:31):
We're going to find a way to getrevenues from pharmacies.
We're going to find a way toget revenues from pharmacies.
We're going to find a way toget revenue from health care
providers and practitioners inclinics.
We'll find a way to get revenueoutside of through patients,
(10:56):
just patients saying this is areally bad experience for me and
it's only gotten worse.
But you have health careproviders now that are standing
up and saying you've got to payattention to this.
It's disseminating, it'sdecimating excuse me communities
that now we have pharmacydeserts in many parts of rural
parts of America where there areno pharmacies that are there to
serve those members, and nowyou have let everyone going to
(11:18):
their state legislature sayyou've got to do something about
this.
And then the state's tellingfederal okay, we got to figure
out how to do this at a federallevel as well.
There's only so much that thestates can do.
So I think it's gotten into somany parts of the country that
it's just gotten louder andeveryone's paying attention of
the country that it's.
Speaker 1 (11:37):
you know that it's just gotten louder and
everyone's paying attention.
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I wonder do you think thatmaybe some of the slow awakening
on the patient side is due tothings like GoodRx?
Speaker 3 (13:38):
where people are finally realizing that wait, I
can pay less for the drug if Ipay cash and use this goofy card
than I can if I use myinsurance.
Awareness and education werealways key in healthcare.
It was inordinately complex andfor people to understand it
they had to experience itdifferently.
And that was absolutely.
The transparency and awarenessthat CodeRx brought to drug
pricing to a certain extent whenit was first created, allowed
people to see and open theireyes to say, okay, well, it's
not just my insurance company'sprices that are important, it's
(14:00):
also this cash price.
And now I can search for theprice now and I can find there's
a difference.
There's a big difference in theprice I'm getting charged
Absolutely.
Speaker 1 (14:08):
Isn't that amazing, just like everything else that
we buy.
Speaker 3 (14:11):
Yeah, exactly no, the price up front.
Speaker 1 (14:37):
It's a strange world, isn't it?
So you know you mentioned.
Speaker 3 (14:38):
You mentioned local pharmacies.
And I know one of the areas thatyou guys work in a lot, and
maybe listeners aren't quite asaware of as they may soon be, is
the role of what we'll callcommunity pharmacies.
Can you talk a little bit aboutwhat a community pharmacy is,
why it's important to theeco-structure and what we need
to know about them?
Yes, absolutely, they are soimportant, not just speaking as
a pharmacist, but the way thatthey serve communities is
multifaceted, oftentimes.
An interesting statistic apatient will oftentimes visit a
pharmacy 12 times a year, versuson average, seeing their
physician three times a year ortheir medical clinic.
(15:00):
And so the touch, the healthcare touch point in the
community is more oftentimesthan not, a pharmacy.
And community pharmacies arebrick and mortar stores that
exist in communities, incommunities, whether it's big
box pharmacy stores, grocerypharmacy stores or the mom and
pop shops that are in stripmalls and sort of hidden out of
(15:21):
plain, out of the main streetview sees these people knows
their community.
They live and work and havefamilies in this community.
They contribute to thecommunity and they do more than
just care for the patients thatwalk through their doors.
There's more than just there'sconsults that happen, with these
(15:42):
patients saying, hey, my kid,you know, it's the middle of the
night, my kid's sick and I'mgoing to need something to hold
me over until I can go see mydoctor tomorrow morning.
Great, let me help you out.
Let's talk about what's goingon and you on and how's your
grandparents doing, and so onand so forth.
Right, there's this communityeffect and it's so vitally
important.
And also there's other servicesyou can get at a pharmacy.
(16:03):
There's so many more servicesyou can get now, except a bit
outside of just getting yourmedications.
You can get vaccines at apharmacy.
You can get as we learnedthrough the pandemic COVID
testing at pharmacies.
And the access, theaccessibility of a healthcare
practitioner in the communitythrough these pharmacies all
over the country is so vital forthese communities to thrive.
Speaker 1 (16:25):
How do we keep them going?
What a lot of people may notrealize is that the margin on
pharmaceuticals at the pharmacylevel is very, very, very thin.
It's almost, you can almost seethrough it.
That's how thin it is.
How do we help those communitypharmacies that aren't the three
or four biggies?
How do we help them stay inbusiness?
(16:46):
What can we do?
Speaker 3 (16:50):
it's a.
That's a tough question, davidum, and I'll tell you why.
Even if every patient in thecommunity decided they wanted to
use a mom and pop pharmacy, theone of the first bears they're
going to run into is do I takeyour insurance when I walk?
When I walk into the pharmacy,can the pharmacy take your
insurance, and is it going to bea better price for you at the
(17:11):
community pharmacy versus thebig box store, depending on on
what insurance card you have inyour wallet?
It's going to dictate that, andthat's sort of navigating
patients to all these differentpharmacies around the country,
and so I wish there was aneasier answer to say what we can
do to help them.
What you can do is, when youhave medications that you're
(17:34):
filling at a big box store, youcan always ask your local
pharmacy how much thesemedications would be at your
pharmacy without using insurance.
Just how much would the cashprice be for these medicines?
Oftentimes these communitypharmacies can beat the good or
X price without having to runthat card and run that program
at the pharmacy.
It just takes a little bit ofasking and then also talk to
(17:56):
your pharmacist about otheroptions for medication so they
can discuss drugs that can becompounded that may be more
affordable, or a differentformulation that would be more
palatable for them, customizedfor their need.
If it's appropriate, and reallyjust having that relationship
with a community pharmacy, evenif you don't use them for your
(18:17):
medicines to go in and have aconversation, establish that
relationship.
If you can purchase somethingat a small business we talk a
lot about this a lot Shop local,shop small.
If there's a way to work orpatronize a local business, it
would be a local pharmacy.
It just gets a little diceywith the prescriptions alone,
(18:39):
but there's other services thatyou could use there.
Speaker 1 (18:42):
You know I think some people are finding with this
now big discussion aboutsemaglutides that pharmacies
that compound can actually getyou the same medication that you
need at a much lower cost thanthe brand name.
Do you think that's going to bea driver of folks maybe looking
, taking a second look at somelocal pharmacies that do still
do compound?
Speaker 3 (19:02):
Yes, there's been a ton of demand for these
medications and there's been aneed to educate the public
between you know the differencebetween a MediSpa and a licensed
regulated compounding pharmacy,that you know the difference
between a MediSpa and a licensedregulated compounding pharmacy.
That you know that's accreditedby health care bodies.
So, yes, there's been moreinterest and more education and
awareness of compound pharmacies.
(19:22):
There is some FDA statementsthat have come out on the
continued use of these drugs orcompounding pharmacies, on the
continued use of these drugsthrough compounding pharmacies.
The resolution of that has yetto be seen, but for now,
sometime next month, individualpatient prescriptions may not be
able to be filled throughcompounding pharmacies and then,
beyond that, sometime in March,what we call bulk compounders
(19:46):
won't be able to supply thesemedications.
Speaker 1 (19:49):
Gee, he said not being at all cynical.
I wonder how that happened.
Speaker 3 (19:53):
Yeah, I think we can trace the dot, connect the dots?
Yeah, I think we can.
Speaker 1 (19:57):
Even if you've got a really big old fat crayon, it's
not hard to connect those.
One of the things I wanted totalk to you about that I know
that you've been working on arethese things called subscription
pharmacy programs.
What are they?
What's the market for them?
How can they help?
What's the market for them?
How can they help?
We have a unique.
Speaker 3 (20:13):
Patients have been exposed to these subscription
products through services likeyou mentioned, like GoodRx, and
there's certain grocerpharmacies that offer these
subscription programs as well.
The program that we'vedeveloped is really interesting
and really unique.
It provides access to 300 ofthe most commonly used
medications in the country.
(20:34):
We're talking about drugs formental health, cardiovascular
disease, antibiotics, birthcontrol and various other
therapeutic areas, but mostcommonly used prescriptions in
the country these 300medications at no cost, through
our network of preferred costplus pharmacies that are about
22,000 and growing across thecountry, and so for a monthly
(20:59):
fee.
In exchange for a fixed monthlyfee, about $30 a month,
depending on what plan youselect you can get access to
these 300 drugs at no costthrough your local pharmacies.
As the value and this issomething that is really
important, david, when we createproducts, we want to understand
what is the value we'rebringing to patients.
(21:20):
What is the value we'rebringing to the healthcare
market?
Today, it feels like we pay aton for health insurance but
we're not getting any value.
No one's talking about thevalue of healthcare, and so we
really wanted to make sure wehad a good value proposition
that includes access to thesedrugs and then every other drug
that you might want to takethat's not on the list is cost
plus prices you pay directly tothe pharmacy.
(21:40):
That's fair reimbursement tothem and that you know that can
help to accelerate this adoptionand survival of these community
pharmacies.
Speaker 1 (21:48):
And where are you marketing that Is, that large
group, medium sized group, anykind of group?
Speaker 3 (21:53):
Anyone, any employer that wants to offer it, they can
offer it.
Any size employer, whetheryou're fully self-insured.
You don't offer healthcare orhealth insurance like we see in
the hospitality industry, soanyone can offer it.
Anyone can pick it up and offerit and it's a monthly
contribution for those membersthat want to sign up for this
plan and as members come on andoff the plan on a monthly basis,
(22:15):
we are flexible to that andit's not an annual commitment.
You don't have to worry aboutthousands of dollars in health
care costs.
It's very specific and it's avalue add.
That's our bronze program,which is just access to the
drugs, and then we have a silverprogram that does drugs plus
access to telemedicine.
So if you need, you know anytime to chat with a doc via
(22:35):
telemedicine to get access tosome of these drugs.
That gives them access throughthe silver plan that we have as
well.
Speaker 1 (22:41):
You know, kind of taking a little bit of a left
turn.
You know there was with theJohnson Johnson lawsuit a year
ago and changed now, aheightened awareness of the fact
that employers and plansparticularly have a fiduciary
responsibility to ensure thatthey're paying fair prices for
prescription drugs.
What's the role of the PBM inhelping them get there?
(23:02):
How do you see that?
Speaker 3 (23:06):
In getting.
I just want to clarify what'sthe role in the PBM in helping
patients.
Speaker 1 (23:10):
It means helping plans understand and assure
themselves that they are makingwise choices when they use a PBM
.
Speaker 3 (23:20):
So the PBMs, you know if truly an advisor to the plan
to help them understand drugcosts and how to manage those
drug costs effectively.
And PBM can help the plansunderstand that there's many
(23:41):
different ways to access amedication.
And where you go will determinewhat the price is for a drug,
which is what we see every day.
And there's three big bucketsof drugs.
There's generic medications.
These are the least expensivedrugs and the most commonly used
drugs in the country.
Then there's brand medicationsand then there's specialty
medications.
(24:01):
And that's sort of the lens thatwe see the PBM landscape in
terms of these three buckets ofdrugs.
And so if they were advisingtheir clients, they would tell
them we want to maximize as muchas possible utilization of
generic medications becausethey're the least expensive and
there's a lot of brand drugsthat have alternatives that are
generic.
That not only helps the plantsaver but also helps the patient
(24:25):
at the pharmacy.
Today, when you have a brandmedication, the patient has to
pay the full retail price ofthat drug and then the rebate
goes back to the employer interms of savings.
So the patient never getsbenefit of any rebate dollar
savings, just by design of theway the system works.
But if you take a generic, boththe plan and the patient get
the benefit at the pharmacy.
(24:47):
And so just helping to educateand understand and break down
demystify the pharmacy and Ithink that's a great first step
that PBMs can take to help plansponsors just understand
healthcare.
It's extremely complex and justbreaking it down into simple
concepts for them to understandthis would help and benefit
(25:08):
everyone in society, but there'sa lot of barriers to that.
Speaker 1 (25:12):
Yeah, well, certainly .
You know, demystifying PBMs isa heavy lift because there are
so many corners and layers andother pieces that maybe are not
as transparent and others thatare opaque by design, so it's a
big job.
We've got a couple of minutesleft.
What do you see coming in thenext couple of years in your
(25:33):
industry?
What are the trends that you'rewatching?
Speaker 3 (25:36):
We're seeing today as the status quo of the
healthcare market continues,pharmacies finding other ways to
diversify away from theinsurance market to continue to
serve their communities.
Cash pay pharmacies we talkedabout compounding pharmacies.
Cash pay pharmacies we talkedabout compounding pharmacies.
Cash pay pharmacies areparticular pharmacies that don't
take any insurance at all.
(25:57):
They're just going to try toget you the best price for the
drug and transparently show youwhat drugs cost without having
to worry about insurance at allup front.
We're seeing models like MarkCuban's Cost Plus Pharmacy go to
market and say there's a betterway to do this.
There's a way to change themarketplace.
If employers wake up and decidethey want to get engaged in
changing healthcare, they havethe ability to do so with
(26:19):
publishing contracts soon andpublishing these drug prices.
On the care side, I really thinkthere is a model, there is a
vision, there is a push to havethis care team model come into
the community, with yourpharmacy in a separate place in
the community than your doctor'soffice, but then collaborating
(26:40):
through technology, throughefforts that exist in parts and
pieces today, where we can nowinclude that pharmacist onto the
care team and provide theirexpertise and their care outside
of just sort of the specificissues that they find when
prescriptions come in throughtheir doors, but it actually be
involved in that patient's careand collaborate with the medical
(27:00):
providers in the community.
And telemedicine is a greatexample of that sort of greasing
the skids to getting to thisintegrated care model for
patients, and maybe we'll seesomething like the model that
Kaiser put together in morecommunities through technology,
intervening on the care andmaking it more coordinated.
Speaker 1 (27:20):
Well as the solutions evolve.
We hope you'll come back andchat with us some more.
Vinay Patel, founder at MakoRx.
Thank you so much for sharingyour wisdom with us.
Speaker 3 (27:30):
Thanks so much for the time and opportunity, David.
You made it so easy.
Speaker 1 (27:39):
I want to give a quick shout out to our sponsor
and our producer, hatcher Media.
Hey, if you need podcastproduction or professional
graphic design, josh Hatcher isthe expert to contact For more
information.
Visit him at HatcherMedianet.
That's H-A-T-C-H-E-R-Medianet.
Speaker 2 (28:01):
This Shift Shapers podcast is copyrighted content
and may not be reproduced inwhole or in part without the
express written permission ofShift Shapers Solutions LLC.
Copyright 2024.
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