Healthcare Conversations: The $84,000 Pill

Healthcare Conversations: The $84,000 Pill

About this episode:

When it comes to talking about healthcare costs, pricey treatments, such as an $84,000 treatment for Hepatitis C, usually take a big chunk of the blame. But when weighing drugs that cost less but have to be taken throughout a patient’s life verses drugs that cost more but have to be taken only once—the Hepatitis C treatment has a cure rate over 90 percent—and the R&D costs to develop those drugs, the situation becomes a little complicated. In a special episode of UB Insider, Utah Business’ Pat Parkinson discusses. Subscribe or download this episode on iTunes or Stitcher.


Pat Parkinson: Hey, greetings everyone. Pat Parkinson here, podcasting today for Utah Business magazine from the beautiful Grand America Hotel in downtown Salt Lake City, Utah. Awesome setting, beautiful day. I’m staring out at the lovely city county building in Salt Lake City. I’m looking at the impressive Wasatch range, a bit U on the mountain for the Utes that I believe are number five in the country in college football this week. And we can see that U from here.

I’m here with three extremely impressive guests today. I’m here at a conference at the hotel that Utah Business magazine is putting on today that’s about the future of healthcare. And as you can imagine, there’s a whole list, a whole slew of interesting guests speaking about all kinds of innovative, cutting edge healthcare topics. This conversation is going to be no exception as we speak about the rising costs of prescriptions and drugs as it relates to healthcare and individuals and employers. We’re going to tackle it in a pretty broad way based on the lineup of guests we have here. So let me just go down the line here and I’ll let you know who we have. We have three guests here. The first is Alex Bidding, and Alex is the pharmacy services manager at VRx Pharmacy Services. Our next guest is Cash Yellepeddi, and Cash is an assistant professor at the Roseman University of Health Sciences. That’s in South Jordan you said, Cash?

Cash Yellepeddi: Yes.

Pat Parkinson: Excellent. South Jordan, Utah is where that school is located. And I’m also here with Doug Burgoyne, who I believe is Alex’s boss over at VRx Pharmacy Services. Doug is the president over there. And I’m sure Doug is going to have a lot of interesting knowledge to drop on us today about this situation. This topic that I think a lot of people can understand. I was kind of chatting with Doug here before we started recording. And I was just speaking from my personal experience with insurance and such and how important insurance is when you need prescriptions and when you need to use a pharmacy. Doug kind of said right away that it’s what people do first when they get insurance. Is that how you put it Doug?

Doug Burgoyne: Yeah. That’s exactly right.

Pat Parkinson: What does that mean? Can you elaborate on that a little bit?

Doug Burgoyne: Absolutely. You know, it’s interesting. As folks receive an insurance card for the very first time, or their benefits renew on an annual basis, nearly the first thing that they do is go into the pharmacy to fill their prescriptions. Whether it’s a chronic medication that they need, which is usually the case, or it’s a brand new prescription for a new diagnosis that they’ve kind of been waiting to see the doctor about. The number one reason that folks go into the pharmacy, obviously, is to fill prescriptions. And they really can’t do that unless they have their prescription card, especially as costs for these drugs have gone up over the last few years.

Pat Parkinson: Very interesting. Can you speak a little bit about…I don’t know if I said the name of the panel you guys were on today – the panel was called “The $84,000 Pill”. Can you speak to those rising costs, Doug? Maybe, can you put a few numbers and a few stats to that?

Doug Burgoyne: Yeah, certainly. And thankfully there’s not actually one pill that’s $84,000. But there is…

Pat Parkinson: You can speak to that title as well, and what that means.

Doug Burgoyne: There’s a course of therapy for Hepatitis that is about $84,000 for the treatment. Now the nice thing about that, right, huge cost isn’t it? The nice thing about that is it cures the illness. So depending on the genotype or the type of Hepatitis that you have, you can take this medication for, these guys will correct me if I’m wrong, for 12 weeks and receive a cure if you’re Hepatitis C.

Pat Parkinson: Pay $84,000 and you’re cured of the disease?

Doug Burgoyne: But it’s $84,000. So somebody’s got to carry that. And here’s the staggering statistic that goes along with that. If you look at Baby Boomers, they’re now saying, the CDC, the Centers for Disease Control and Prevention has come out and said everybody who was born between 1945 and 1965 should be tested for Hepatitis C. Well if we did that, and all those people required treatment, there’s no way that we could afford all of the drugs that would be necessary.

Pat Parkinson: So we can’t afford to optimize that situation that you’re describing. We don’t want to know, basically.

Alex Bidding: Well the challenge with this disease is…

Pat Parkinson: This is Alex. Alex, thanks man.

Alex Bidding: No problem. Well the challenge with this disease is that a lot of people will go through life asymptomatic, meaning they won’t have any symptoms of their disease, of their infection with Hepatitis. And so, what that really translates to is, they may never develop liver cirrhosis, or require a liver transplantation. So we may be identifying patients, who in reality aren’t sick enough to receive treatment. So they don’t really have any symptoms. They don’t have any issues. They aren’t talking to their doctor about it. And yet the CDC is, you know, kind of pushing this and saying, if you have Hepatitis C, you should go get treatment and get this cure because it’s available. But if we did that, there would be an economic collapse in the healthcare industry.

Pat Parkinson: That is a crazy scenario that you guys describe. It seems very cataclysmic.

Doug Burgoyne: Yeah. It certainly could be cataclysmic as Alex said, if everybody that technically qualified for treatment was treated even though they are asymptomatic.

Pat Parkinson: But they’re all sick. These people are all sick, you’re saying?

Doug Burgoyne: Well there’s a difference between sick, feeling sick and actually being sick. Most people that have Hepatitis C go throughout their life never knowing that they actually have the disease, and they die of some other condition in their 70s or 80s. So it’s not really something that should be on the top of mind for everybody unless you develop symptoms of Hepatitis.

Pat Parkinson: Which is what you just explained pretty well, I guess?

Alex Bidding: Exactly.

Doug Burgoyne: I think the staggering thing, and Cash can probably speak to this is the cost of development. Drug manufacturers say that new drugs cost a lot to develop, and so they should have the right to charge a high amount for a prescription. On the other hand, somebody still has to pay for that prescription. Whether it’s the employee who’s paying out of pocket, or the employer who’s contributing to it, or the insurance company which is still made up of dollars coming from employees and employers. So, the real question that we’re going to be tackling on the panel today, as well, is, is there justification in such high prices for prescription drugs?

Pat Parkinson: We saw a very high profile situation in the news recently, concerning that, obviously.

Cash Yellepeddi: I was about to talk to…

Pat Parkinson: Would you like to reply to a little bit of that Cash?

Cash Yellepeddi: Yes. So, I’m a researcher in the field of drug development. I develop new formulations. And, so here is the statistic about…Doug rightly mentioned. So the cost of drug development. The cost of taking a drug from scientist’s inception to pharmacist’s shelf is on average, $1.4 billion.

Pat Parkinson: That’s billion with a B.

Cash Yellepeddi: With a B. $1.4 billion. With that, you can buy two football fields and pay all NFL players. So, that’s the statistic.

Pat Parkinson: Stupid question I guess, what is that so expensive?

Cash Yellepeddi: So the cost of research and development is inherently very expensive. The equipment involved to test medications or the personnel you hire to perform research are very expensive: technicians or scientists or professors or…

Pat Parkinson: Is that most of the cost? Paying people?

Cash Yellepeddi: That’s part of it. But then reagents and, you know, the kits, the diagnostic kits you use to test those medications. And the majority of the costs comes from clinical trials. So each trial, you are $100 million into each trial. So if you start a clinical trial to check whether your drug is working or not, whether it be a patient, whether it be a healthy volunteer, you’re looking for somewhere around $50 to $100 million for each one. And if it fails? The whole $100 million is gone. That’s just an example. So anyway, but, you know, it’s unfortunately, the R&D spending is reflecting on rising prices. However, with the recent brouhaha over data, where it was raised from $18 to $750, that’s completely unnecessary.

Pat Parkinson: It is?

Cash Yellepeddi: Yes. Because that drug was discovered or developed in 1953. And the person who developed that drug, developed it mainly to treat tuberculosis and malaria. And it was developed in 1953…

Pat Parkinson: It worked for those diseases?

Cash Yellepeddi: Yes. So basically, in the United States it’s basically indicated for toxoplasmosis. So it’s a kind of disease which is most common in HIV patients, a very small population. Unfortunately, there is no competition for that drug because there is such a small population of patients, and there are no generics available.

Pat Parkinson: That’s a big part of this situation.

Cash Yellepeddi: Yes. And this drug, Dataprim, was with GlaxoSmithKline until 2010 and then in 2012 another company called CorePharma, they got the marketing rights. In 2015, it is with Turing Pharmaceuticals. So they got the marketing rights and they immediately increased the price, just, without anything. Now if you compare that with what Doug mentioned about the Hepatitis C treatment, there are two new drugs which are very effective in treatment of Hepatitis C. I would say that their price, even though, you know, might not be justified in terms of economic, present economic conditions, but their high price is basically backed by a lot of research.

The company, which doubled up this Hepatitis C treatment, they spent money in bringing those two groundbreaking treatments for Hepatitis C which will basically save a lot of money down the road for liver transplants. However, in comparison, Dataprim, it’s just them taking advantage of free market trade in the United States. There is no price control, let’s jack the prices up.

Pat Parkinson: Doug, as president of VRx Pharmacy Services, you’re obviously an expert in what we’re talking about here. When you learn about a new product, or you learn about the research and the process that goes into bringing these drugs to market, can you understand the costs? Does it make sense to you? I know a lot of people get concerned because we see so much marketing and so much advertising from drug companies, and it’s a very complex topic. It’s hard for someone who’s not in the industry, probably to understand, or care to understand. Can you speak to that maybe a little bit?

Doug Burgoyne: Yeah, absolutely, and I think Alex can weigh in as well. As we present these products to our clients, whether employers or health plans, we review them first as a pharmacy and therapeutics committee. Our panel of physicians and pharmacists get together every other month to review new medications. We recognize that there is significant cost that goes into the development of the products. There’s no doubt about it.

We know that human clinical trials are expensive. It’s the best way to test a drug and we certainly want to have good and safe and effective drugs on the market. However, we really have to look at it and say, and ask ourselves if a manufacturer is taking advantage of the situation. In the example that Cash gave, that’s a pure economic decision where the manufacturer or now the marketing rights company says we’re just going to jack the price from $18 to $750 because we can, because nobody else is out there to check our price.

Pat Parkinson: Should that upset people?

Doug Burgoyne: Absolutely.

Pat Parkinson: You guys speak very freely about it. It’s, you’re very comfortable talking about it in a very candid way.

Doug Burgoyne: We live in it every day.

Pat Parkinson: That kind of stuff, I don’t want to oversimplify, but that kind of stuff impacts you.

Doug Burgoyne: Well, it makes the whole pharmaceutical industry look a little bit bad. There’s a black eye on the industry when we start to gouge, when manufacturers start to gouge folks simply because they can. On the other side of that, what we try to do as a pharmacy benefit management company and the way that the wise employers work to reduce costs is to engage patients to make sure that the right patient gets on the right medication at the right time in their course of treatment, so they can have the best outcome.

Certainly, if somebody is symptomatic and needs treatment in our Hepatitis example, we want that person to receive the drug. And usually the employer is very happy to pay for it. The situation is just the opposite in someone where there’s lack of will on the patient’s side. Let’s say they start a medication, they take it for two or three weeks and then decide, I don’t want to take it anymore. Well if a pill is $1,000 each, that person has just wasted $15,000 or $20,000. That’s horrible. So our job as pharmacy benefits managers and case managers is to work with the employee, the patient that’s taking that prescription to make sure that if they’re ready to start, they continue on it and get the best benefit of the medication. And if they’re not ready, in this case, hold off a bit. Let’s use a rational approach to treatment.

Alex Bidding: And I think, just to add to that, we look at a lot of new treatments that have significant costs. Hepatitis is an example, but we have Multiple Sclerosis, we have inflammatory conditions like Rheumatoid Arthritis and all of these diseases come at a significant cost in treatment. The therapies can range anywhere from $2,000 to $5,000 per month for treatment. These are chronic diseases. But we have high rates of discontinuation because, you know, they are specialty. They are biologic in nature, meaning they are made from human cell lines. Therefore, they have potential risks associated with them. So patients, a large proportion of patients can’t tolerate these therapies. And so, it’s our job to make sure that we work with the patients to help them understand what expectations are. Because typically, you know, when they get that drug prescribed by their provider, they have 10-15 minutes with them. And it’s not a sufficient amount of time to outline, here are all of the things you need to consider with this new treatment. These are the costs associated with it. And oftentimes the patients don’t even know the costs of their drug. And the doctors don’t either.

Manufacturers do a very good job with their market reps to hide that fact. They don’t share the cost information with the providers. All they share is the clinical data and we’re not here to dispute that. We know that these therapies, there are a lot that come to market that are innovative and they provide lifesaving treatment options for our patients. But what is the true value? And I think that’s another discussion we’re going to have as a part of this panel is: how do we define value for these new therapies? $84,000, we can cure the disease. I think there’s legitimate value to that. But I think there’s a lot of disparity in the market, even amongst our group of industry experts. We don’t know how to define that.

Pat Parkinson: What kind of disparity, do you mean?

Alex Bidding: Meaning the definition of value. We’re trying to work that out. You know, we work with pharmaceutical companies and they’re trying to figure that out too. And they’re asking us every single day that they come in.

Pat Parkinson: Somebody just has to make up rules right?

Alex Bidding: As a pharmacist, I understand the clinical value of a drug, but translating that to cost value and the outcomes that we derive from that new therapy, and how it compares to the therapies that we already have. And I think one thing I do want to make a point on is, I think patients oftentimes have a misunderstanding of a new therapy means that it’s new and it’s better. That’s not always the case. It’s not like new cell phone technology where, you know, it’s new, it’s updated, it’s got new hardware. That’s not what we’re talking about. We can’t think of drugs in that way.

Pat Parkinson: Drugs don’t evolve that way.

Alex Bidding: I wouldn’t say that’s always the case. There’s definitely great therapies and innovative therapies that do come out. But I don’t think it’s always the case 100% of the time.

Pat Parkinson: Go ahead, Cash.

Cash Yellepeddi: Just to add on to what Alex was talking about, whether this innovation is beneficial or not. So one thing which the field of pharmaceutical industry has been seeing since past two or three decades in terms of therapy is, as Alex rightly mentioned, is the introduction of biological therapies. So, biological molecules. What I mean by biological molecules is that, usually, previously, all drugs were chemical compounds that were synthesized in the lab as new synthetic chemical compounds or extracted from some herbal medications or extracted from microorganisms. But now, the new therapies, which are biological therapies, are mostly, they mimic your human body’s biological molecules.

One such example is monoclonal antibodies. So these monoclonal antibodies, they basically, they mimic your own antibodies, and then they will, you know act accordingly. So they are highly targeted therapies. So, for example, rheumatoid arthritis. You know, there are a lot of monoclonal antibodies which are widely used, and highly prescribed and very effective. So, they kind of, they’re slowly replacing these traditional drugs which are chemical, small chemical molecules which are not targeted towards the site. So let’s take, for example, rheumatoid arthritis. These small chemical molecules are not targeted to that particular tissue. However, these monoclonal antibodies are more targeted. They act only on that tissue and are more effective.

Pat Parkinson: So why do you tell us that? As far as why it’s important for what we’re talking about today, I’m interested in that. What’s your point?

Cash Yellepeddi: So now, the process of synthetically manufacturing a drug is much easier than developing a biological molecule. Because biological molecules are very complex. It is protein in nature, and it’s a collection of amino acids, there are a lot of linkages. And any small, and the production of that particular molecule throughout the process is very difficult. So all of these things will add up to manufacturing costs of those molecules. So they are very complex.

Pat Parkinson: Oh yeah, you’re a professor aren’t you? You speak about it very academically, Cash.

Cash Yellepeddi: Yeah. My professor is coming out.

Pat Parkinson: And again, you’re a professor at the Roseman University of Health Sciences in South Jordan, Utah?

Cash Yellepeddi: Yes.

Pat Parkinson: Alex, it’s pretty interesting listening to you. I kind of got from what you’re saying, that you’re a pharmacist. You’re a trained pharmacist.

Alex Bidding: Correct.

Pat Parkinson: Correct me if I’m wrong, but I’m thinking that you’re not exactly a pharmacist in your job at VRx Pharmacy.

Alex Bidding: Actually, I am. So that’s actually an interesting point.

Pat Parkinson: You can talk about that. I don’t mean to interrupt you. But I’d also like you or Doug, whomever wants to, we haven’t really gotten…You guys have been referring to it all along, but if you want to give us a real, kind of, elevator pitch about VRx Pharmacy Services, I think I’d…You were telling me about your relationships with the insurance providers and all kinds of stuff, so I think we’d like to hear more about those dynamics as well. But let’s go to you, Alex, if you still remember the original question.

Alex Bidding: Yeah, so, I think it’s really important that people understand that from an insurance company standpoint that cover drugs, it’s not just on a whim that we decide, oh we’re going to put this drug on this tier, and this is going to be your copay. That’s not how the process works. It’s very clinical in nature, and so it requires clinical expertise to make that evaluation. Doug mentioned that we have a panel of physicians and pharmacists who meet every other month, it’s a P and T committee or a Pharmacy and Therapeutics Committee.

As a pharmacist, it’s my job to evaluate all these new drugs in development. And when they hit the market, I have to do comparative research. I have to see, how does this clinical outcome that was demonstrated in the clinical trial compare to what I already have on therapy. You know, we have a lot of generics in a lot of different disease states and they’re very effective. And so, he mentioned Dataprim, made in 1953, it’s still effective for those conditions today.

Pat Parkinson: Would something become not effective? Like, a disease or condition would evolve beyond a drug, so to speak?

Cash Yellepeddi: Resistance.

Alex Bidding: I mean you have some resistance mainly in bacterial type infections or viral infections. But in traditional chronic disease it’s not a huge factor. So it’s very clinical in nature how we approach these new therapies. And we make…But it’s important to not only look at the clinical aspect of it, but the overall cost implications to that. Because at the end of the day, we’re managing benefits and dollars for the employer and we want to make sure that we’re doing that in a responsible manner, in a clinical, respectful manner, and that we’re responsible in that.

Pat Parkinson: So, you’re the pharmacist, I mean, you probably have others, but you’re the pharmacist for VRx Pharmacy Services, so to speak.

Alex Bidding: We have about seven pharmacists. Doug is actually a pharmacist as well.

Pat Parkinson: Cool. And it’s not like, it’s a different type of pharmacist job than what we’re used to seeing in a grocery store or something, obviously. It’s very interesting hearing you describe it. I think people probably don’t think about that. Maybe this is a good opportunity for you, Doug, to maybe elaborate on that a little bit if you’d like to. Or even speak a little bit more about the company and some of the relationships that you were telling me about earlier today.

Doug Burgoyne: Yeah, happily. Thank you. Alex was exactly right. And you’ve nailed it. This is a different type of pharmacy. The training that pharmacists go through that is different from the grocery store or the drug store pharmacist. Different from the hospital pharmacist. Where the skill is to do comparative effectiveness research to evaluate medications based on their value. Which is the question we were talking about before. What is value in terms of medication? How much is it worth to pay for a prescription in order to get the clinical benefit that you’re looking for? Which is really what VRx does every day.

VRx is a pharmacy benefit management company. We’re based here in Salt Lake. We’re a little bit different from the standard PBM. The big PBMs are our friends at Express Scripts and Caremark and some of the really monster companies. We’re tiny in comparison to them. The difference is that we’re completely transparent and pass through. What that means for employers, is that when we contract with a pharmacy for a certain rate on a prescription, our employer groups pay that same rate. We don’t mark up a prescription ever. That’s important for our customers because it means that they save on every prescription.

Pat Parkinson: That’s a big part of the transparency, obviously.

Doug Burgoyne: Yeah. Right. It’s completely transparent to the employer. We talk a lot about transparency in the healthcare industry today. Our president, nationally, President Obama talks about transparency and what that means to him. To us, it really means what we think it means to everyone else in the world. You can see through the systems. You know exactly how much revenue we make off of the service that we provide. And an employer or a health plan can make a real evaluation if what we’re providing to them is valuable and has value for that price.

Pat Parkinson: Does that word, transparency, don’t let me get you on a tangent because you’re doing great here. Does that word, transparency, mean as much to people, to the general public as it does sometimes to guys like you and journalists and people like that? Is that kind of a wonky word for the public? Or do they really, genuinely appreciate that and understand that? Is that valuable to them?

Doug Burgoyne: Boy, great question. I think everybody thinks they know what transparency is. But the person saying the word transparency might sometimes have a different opinion or a different meaning. For us, it’s the common man understanding of transparent, where we don’t play games, and we don’t hide dollars. And we’re honest in our transaction. The V in our name stands for veriticus. A mouthful to say and spell. So veriticus means speaking truth.

Pat Parkinson: Yeah. In wine there is truth, right? The Latin phrase that has a version of that? In vino veritas. In wine there is truth.

Doug Burgoyne: So, we want to bring that same truth to the pharmacy benefit management group. And we’ve done a nice job of it. Our employer groups and health plans that use our services save money. We also provide an outstanding level of service. So most of the folks that work on our staff, with the exception of IT and finance, are pharmacy technicians, or nurses, or pharmacists or social workers. So we employ folks that have a really good understanding of the healthcare system and can answer question or employees.

Pat Parkinson: Sounds like a pretty inspiring staff to work around, too.

Alex Bidding: I wasn’t lying earlier. It really is a great place to work.

Pat Parkinson: You all three speak very well to the topic. You obviously care a lot about it and, of course, it’s an extremely important topic. Is it not?

Cash Yellepeddi: I would like to add on from a scientific point of view, what these gentlemen are doing is really, really great actually. You know, that’s what we as scientists look for in terms of comparison of outcomes and finding a cheaper alternative. So there are a lot of examples, I don’t want to name brand names because I don’t want to get in trouble.

For example, because of research by companies like VRx, who basically take outcomes of treatment and them compare different outcomes, there is one example for, I think it is for heart failure. There is a compound which is biological in nature, which costs $3,000. But the outcome research showed that the same effect can be achieved with another biological compound that costs only $200. So that’s basically, when we as a scientist, we just thought that when this new molecule which is $3,000 came out, that it’s much better. But eventually when you see the big picture, when you see the overall outcomes…

Pat Parkinson: These guys are hired to see the big picture for these organizations.

Cash Yellepeddi: Exactly. So when you see that overall big picture, what’s the use you know? It’s like driving your Ferrari into a big pile of mud. And there’s another example. This is for a treatment of choroidal neovascularization in the eye. Basically, it may cause blindness. For this, there was a new drug which is probably 20-30 times as expensive as the existing drug. But later they found that if you reduce the dose of the existing drug, it will give the same effect as the new drug. So, these are certain things which these companies, pharmacy benefit management or companies involved in healthcare outcomes research, they bring out the data and basically, after five or ten years they will say, there you go, you just wasted $1.3 billion.

Pat Parkinson: So if these folks at VRx Pharmacy Services are doing their job well, which I’m sure they do, you think that their customers, being I want to think about the businesses on the other end and even ultimately trickling down to the individuals, of course, are pretty appreciative of these services.

Cash Yellepeddi: Definitely. Not only customers, but the overall healthcare field will be benefitted from these things. Because it’s irrefutable evidence, right? I mean, nobody can say anything. There is x number of patients, this much percentage of reduction in this particular treatment, done. I’m in. Everybody just has to agree with it.

Pat Parkinson: So this kind of stuff fascinates me and this has been one of our longer recordings today. Maybe partly because of that, and also because these guests were very well spoken about it. We have a few minutes left here. I think you guys kind of want to get along, but I don’t want to rush off though. If there’s anything that we haven’t discussed that you expect to be really interesting on the panel, please chime in. Otherwise, I want to kind of end, I’d like to kind of sum up here and end with one question for each of you. It’s kind of a more practical, actionable question.

I’m wondering if each of you could offer, obviously, a topic that most anyone can relate to for the most part, can you offer any kind of actionable advice or tips, again, don’t get stuck on that word. But again, I want you to speak to the person out there, whether it’s the employer who’s struggling with the problem, or the individual who’s struggling with the problem that keeps coming across your desk or keeps showing up on your radar. Is there something you can tell that person? Again, it can be anything. I just would like to hear, kind of, what’s top of mind for you, Doug, when you’re trying to kind of comfort somebody, or, you know, even speak about your industry or be an ambassador for your industry. Can you speak to that?

Doug Burgoyne: Yeah, happily. Thank you. I think the thing that employers need to understand is that there are alternatives that can help them save money. There are innovative companies, not just VRx, although I think we’re leading, that can help them reduce the cost of prescription drugs for their employees. That results in real savings for their members. And then for their membership, I would say, in patients people are using prescriptions need to learn to ask their doctors a question. And the question is pretty simple. Doctor, is there an affordable alternative to that prescription? Or gee, that sounds expensive. Is there something else that I can use that would save some money.

Pat Parkinson: And you shouldn’t feel awkward about asking your doc that.

Doug Burgoyne: No. And we all do, unfortunately. We all go to the doctor. And I’m smiling because I do that myself. I go in, even though I know my doctor really well. And he’s a great guy and I like him. I go in, and if I have a problem, I just want to leave. I just want to go in, get my prescription and walk out. And if we just spent 30 more seconds saying, doctor is this the right medication for me? Or is there a lower cost alternative? Then that would be helpful. And our company tries to teach patients to ask that type of question.

Pat Parkinson: Your doc might even think you’re kind of cool if you do that.

Doug Burgoyne: They might be grateful.

Pat Parkinson: How about you Cash?

Cash Yellepeddi: So Doug is right on. That’s my opinion too. Patients should be given options. That’s something that companies like VRx or any other pharmacy benefit management company should start the dialogue between the manufacturers and the payer. Whoever it is. It might be an insurance company, it might be the government in terms of Medicare and Medicaid. So they have to come together. And then they have to discuss and come up with a scheme where patients are given options. So depending on what they can afford, they should be given options. That way, if patients cannot afford it, they will have economical options.

Pat Parkinson: For Doug and Cash it’s about options. Do you have anything to add to that Alex? Any actionable advice from behind the pharmacy counter?

Alex Bidding: Behind the pharmacy counter, my desk. I think it’s really important that we provide increased education to the general public. You know, I think we could do a better job working as a PBM and work with our employer groups and provide more education to their members to ask those questions because they are vitally important. As I mentioned earlier, physicians are often shielded from the fact, what the cost of drugs are. So it’s really important that they do their due diligence, that they shop around. You know, another thing that would be great is, not all pharmacies are one in the same. One pharmacy might be way more expensive than another for the same drug even though they have the same copay structure or the same insurance. So it’s very important that consumers become more, I guess, more engaged in their selection process and asking those critical questions.

Doug Burgoyne: You know, Alex, that’s a great point. We now have this term: consumer directed healthcare. We’ve tried to make healthcare a consumer product. But we’re not giving the patients or the consumers any tools to use to evaluate the medications that they should be using.

Pat Parkinson: It’s not fair man. Get on that Doug!

Doug Burgoyne: So we need to do a better job of that. And I think that the same goes for employer groups. Teaching employer groups that they should be asking their brokers the right types of questions to save money.

Pat Parkinson: Guys, what a pleasure to be with you here today. You’ve given me a lot of time, and I’ve learned a lot. It’s a fascinating conversation. I’m sure the audience enjoyed it as well. Let me go through who we’ve been chatting with today, for everyone just to refresh. We have Doug Burgoyne. Doug is the president of VRx Pharmacy Services which is based in Salt Lake City, Utah. We had Cash Yellepeddi. Cash is an assistant professor at the Roseman University of Health Sciences in South Jordan, Utah. And we had Alex Bidding. Alex works with Doug over at VRx Pharmacy Services. Alex is the pharmacy services manager there. Again, awesome interviews guys. Thanks for bringing it today and enjoy the rest of the day.