The Business of Pharmacy Podcast™
April 24, 2023

Navigating the Complexities of Pharmacy Benefits | Wendy Barnes, CEO of RxBenefits

Navigating the Complexities of Pharmacy Benefits | Wendy Barnes, CEO of RxBenefits

In this episode, we sit down with Wendy Barnes, CEO of RxBenefits, to discuss the challenges faced by self-insured employers in managing pharmacy benefits. Barnes shares her insights on the difference between PBOs and PBMs, the complexities of managing pharmacy benefits, and the importance of pharmacists in the healthcare system.

Here are 10 points covered in this episode:

  1. Pharmacy benefit optimizers (PBOs) help smaller to mid-sized self-insured employers manage their pharmacy benefits.
  2. PBOs and pharmacy benefit managers (PBMs) have different roles and responsibilities.
  3. Self-insured employers face financial pressures and the complexity of managing pharmacy benefits.
  4. The big three PBMs extract high rates year over year, but the industry is moving towards a cost-plus environment.
  5. RX Benefits offers a one-year contract model to account for market changes.
  6. Misinformation is a challenge in the industry, and transparency is critical in negotiations.
  7. A small team of decision-makers engages with PBMs directly, emphasizing the need for accountability on both sides.
  8. Providing a comprehensive approach to managing pharmacy benefits and a single member service center can simplify the process for employees.
  9. A supplemental stop-loss product can help smaller employers cover specialty medication costs.
  10. Pharmacists are essential in the healthcare system and have become increasingly relevant during the COVID-19 pandemic.

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Speech to text: 

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

Wendy Barnes: I'm Wendy Barnes, I'm the CEO of RxBenefits. We, brand ourselves as the first and leading pharmacy benefits optimizer

Our conversation is gonna be focused on not only that difference between PBO and pbm, but just the pharmacy benefit landscape in general, Mike, and all of the forces that are pressuring the self-funded employers.

Mike Koelzer, Host: I guess the one thing, Wendy, that everybody has in common is you talked about the pressure. It seems like everybody's got pressure, and I guess if you didn't have pressure in the market, there would no longer be a market, I suppose.

Wendy Barnes: Well, I think that's probably an accurate observation.

Clearly all companies have financial pressures, Mike, but when you think about that smaller employer, so you know, 500 employees or a thousand or 1500, I mean, they're not only grappling with, their own pressures around their p and l, but typically just from an expertise standpoint, the notion that someone, leading benefits, say you're head of hr.

Would have a deep understanding of pharmacy benefits on top of all of the other support services they're looking to provide for their employees and family members. I think it's just a bit unfair. This is a really complicated space and so we step in, in partnership with brokers, consultants that have a myriad of names, that we work with to really help with that decision making.

Mike Koelzer, Host: We as pharmacists, there's a lot of independent pharmacists that listen to this, and when we talk about small business, we're talking about like, Myself and maybe my top dog who came with me in the morning. Now you're saying small businesses are still under 1500, but you yourself are in charge of what, 900 people?

Wendy Barnes: That's about right. Yeah. As we continue to grow, I think certainly.

the definition, depending upon who you ask of what small the mid-size self-insured employer is, probably varies Mike, depending upon who you ask, but in general, we think about it in terms of the smaller to mid-size end of the market that the largest PBMs typically don't serve well, and or perhaps said differently the size of an employer that on the whole is not going to get a dedicated account management team, for example, and the size of employer that given, the amount of pharmacy spend they would have doesn't command the volume and therefore the leverage to be able to engage directly with a large PBM and get the type of, financial outcome that we can provide for them when we aggregate everything.

Mike Koelzer, Host: Wendy. Now I'm gonna say this as, PC as I can and as nicely as I can. we, pharmacists, especially independent pharmacists, hate PBMs with a vengeance. We just can't stand them. And a lot of it comes from just the oligopoly. The big three just pressed down.

And if you wanna do something outside of that, you've lost a third of your business.

But, I'm always reminded of that. It is business. There are three of 'em. I can't say there's just one. I like to think they're all in cahoots with each other, but I suppose the largeness of the PBMs still has some value of, you know, there's still enough competition there and they're bringing prices down.

 With their size probably there are certain reasons why you still wanna work with them. And frankly, it's the reason why

Wendy Barnes: we

Mike Koelzer, Host: pharmacies still work with them.

Wendy Barnes: Sure. I mean, there's no question, Mike, it's a conundrum, right? And it's the question that I think not only pharmacies have been asking, but if we're being transparent here, so are the big PBMs, at some point, a hundred percent off of a w.

It's nothing, right? we're going to run out of runway when it comes to the year over year, discount, merry-go-round that we've been on. And the beauty of the RX benefits model is, yes, you're right. The big three continue to extract that rate year over year. I do think we're probably gonna end up in a cost plus environment at some point.

And at that point, and granted there are some contracts now it's becoming more prolific. It's just not quite as pervasive across the whole industry. But as we interact with the big three are exp benefits on behalf of our smaller clients. Truly the billable equals the payable. So at that, There is no spread being taken and any pharmacies that are in the network that we partner with, the big three that our clients and brokers take advantage of, we are passing through.

The rate that we're getting is in fact the same thing that the client's getting and the [00:05:00] billable is equaling the payable. And so, when I think about the regulatory environment and what could be,the end of spread in general, and I know we've been talking about this for years, but I think for the first time, well, I think the government's getting a little more serious about this. We as a company feel pretty comfortable about where we're sitting cuz we have not had our hand in this cookie jar, for the last however long. And so, as a result of that, we are positioned to keep functioning in a very similar model, which is a good side of the equation to be on.

Mike Koelzer, Host: Yeah, it was kind of like years ago in the independent pharmacy. It's kind of like when, I think it was President Clinton came out with HIPAA, basically, and they had all these damn rules about privacy and things like that, and we would kind of be amused by that. It's like, they're not talking to us.

we weren't dumb enough to shout out things across a store or mail stuff to people that their spouse is gonna find out and stuff. It was a different part of the industry and we kind of just sat back and kind of were glad that we weren't a part of it, even though we had to do all the rules and stuff with it.

But you can tell when they're going after certain parts of the industry and there is some peace in just being able to sit back and say, well, we're in pretty good shape.

Wendy Barnes: And I think just in general, as you think about. Pharmacy across the us. I mean, there's no question, Mike, that you know with, gosh, at this point, what are we at, like 76, 70 7,000 pharmacies in the US in general.

I mean, people do appreciate choice. and I think that's just balanced, however, with how many do you really need in your network for solid access in my view, having sat. Frankly, all three sides of this equation. Not only driving the network contract, now supporting clients on the other side through RX benefits and some time ago leading managed care for Rite Aid.

I have an appreciation for what the pharmacy is delivering in that counter to counter, contact that the pharmacist delivers. And I do believe that as more organizations press towards all in trend management, and I actually think that's where we're going over time, the pharmacies that are providing more value at the counter and getting better outcomes, it's going to start surfacing over time.

I just think we've got to run out of the AWP off game before we get there, unfortunately. 

Mike Koelzer, Host: Pharmacists have been crappy at that because, we go to oil change places and they come out with their clipboard, you know, and we've done this and they check all this stuff they've done. I think they're fibbing half the time. It's like, I'm not gonna go down there and check but they check all this stuff off and we as pharmacists, I don't think we've done a good job on that because we do so much.

But we haven't really recorded it. We haven't communicated to the payers well enough to the rest of the medical profession to Medicare. We haven't done that enough and, we probably should have been doing that years back and learning from the oil change shop, but I don't think we did a good job of that.

Wendy Barnes: Well, I mean, I, look, I, it's complicated and being,if I'm being honest about my observation, having been on multiple sides of this throughout the years, I think we've actually asked too much of pharmacists.

You are being asked to not only provide stellar service in dispensing the medication and if the patient elects to have consultation, but then you're also in the crosshairs of any patient who has a question about their benefit. And oftentimes it has nothing to do with what's happening with that particular fill at the counter.

it has to do with why is my company this, why is it so high? Um, Truly, It's all of us who have to contribute, to make it more understandable.

And I think a more broad observation, if there was any silver lining to come out of Covid, I think that patients were more in tune with, how am I going to get my medication for the first time? Because they really had to think through what channel am I going to obtain it through? And suddenly education kind of expanded on the consumer side, meaning people started asking questions, where is my medication coming from?

What is the cost? and right, wrong or otherwise goods and other cash programs. and we could probably debate that at nauseum, but it pushed the consumer for the first time to say, is this a fair price and is this where I should be actually getting my medication? Which I think is actually a positive thing.

Mike Koelzer, Host: Pre covid for a number of years, I wasn't at the pharmacy very much. We had too much staff and were selling too many things below cost. And, it just wasn't a good situation. [00:10:00] So I was kind of, what do you call it when you sit at home a lot? What's that? one disease.

Yeah, Gora phobia. It was kind of like that. I just sat home, and I did stuff, but I worked from home and I just didn't like going in. And part of the reason for it was I was feeling unneeded. I was feeling like a pharmacist in a community pharmacy, I felt like We weren't relevant. And when I went back after Covid, because I lost staff, I said to myself, how the hell would these people function without us?

I still felt crappy with reimbursements and business structure, but my relevancy. Shot up and it remained up. Cuz every day I look at people and I say, how would they not receive medicine? Everybody can get some medicine, but how would they really understand this? getting the medicines, one thing, it's talking to the daughter who lives over there and the mom it's a whole soap opera of that stuff that, 

is just not being handled across the board.

Wendy Barnes: Well, I think so, you're absolutely right.

I think the other thing it did is for all of the years through,ncp, DP and a CDs that pharmacists were pushing to be able to practice at the top of their license, it suddenly expedited that overnight, the number of states who opened up permissions to provide vaccinations, and to your point, I don't think we would have progressed through the percentage of, the population that got vaccinated.

But for community pharmacy, there's no way, cuz clearly we were trying to keep patients out of settings where there were too many sick individuals. So , you're spot on. and I think the key is how does pharmacy hang on to that? 

Mike Koelzer, Host: From the pharmacy side, we always 

Wendy Barnes: obviously

Mike Koelzer, Host: bitch about the PBMs. And here's what I like to bitch about too. I hate the nurses that call up and they're kind of top dogmatic, like they say, we did this, and it's like, You mean There's no room for saying we thought we did this for Mrs.

Smith, but can you check this? It's always top dogmatic and I think it comes from the top dogmatic physicians. I think the physicians treat the front staff badge sometimes and they take it out on us. Alright. Enough about 


 When RX benefits from talking to different people, is there anybody that you guys don't like?

You know what I mean? Just how, like, we don't like PBMs. Like do you guys talk about the damn, physicians or the damn, HR people from a company who's the thorn in your guys' side?

Wendy Barnes: Oh, boy. I don't think there's any good way to answer that. Here's what I will say. Look, negotiations are always tenuous, right? When you're working with three players that have as much leverage as they do, the beauty of aggregating the lives on our side though is that we command, kind of that top tier of, focus.

Are those conversations always pleasant? Well, not always, right? Negotiations can be difficult, but the beauty of it is we renegotiate every year. 

 So unlike your typical arrangement, which will be a three year deal, and that's the standard arrangement for most clients, we actually aren't as supportive of that model. We think a one year contract is more appropriate. Why? Well, it's really difficult to think forward to years two and three of any contract.

Wendy Barnes: Look, we all try to read our crystal ball and anticipate when brands are gonna go generic, when Biosim is gonna launch all of the things that heavily influence the economics for any pharmacy benefit, and frankly, the economics for all of the players in this value chain. But if you are off by a few months, or you completely get something wrong in a given year, largely those agreements for your smaller employer, if they're engaged directly with one of the big players, are going to fall in favor of the pbm.

So if things don't launch according to plan, typically the economic benefit. We'll convey, to the larger partner. And so we really think about it in terms of one year at a time. We keep extracting that rate and we just automatically pass it through to all of our clients. And I, you know, I I wanna make sure I address your question as who's in our crosshairs, who the 

Mike Koelzer, Host: I'm not gonna let you off of

Wendy Barnes: The really lovely thing about this company is I've worked a lot of places. The culture we have is truly one of kindness. And I just, I mean it with all

Mike Koelzer, Host: Wendy, I know that 

about your 

fellow employees, you have to have some competitors out there. people That are just making your life a little bit more difficult as the leader. 

Wendy Barnes: Well, I think to be fair,over the last. Few years ago there was a [00:15:00] number of competitors entering this same market, right? Going after the self-insured employer and trying to deploy a very similar model. And I think for me,, I don't know that it's an organization specifically, but if I were to characterize,some of the more difficult people in the business that we come across, it's players who either sit in front of a broker or that smaller employer and suggest that they're getting a transparent deal, when they're not.

And look, the word transparent is thrown around so frequently. I almost hate to use

  1. It's just, 

Mike Koelzer, Host: it's kind of like invoice cost on a used car, 

Wendy Barnes: It is. I mean, we can all define it 10 ways and say we're all right. Um,it's true. Misrepresentation that can happen to that smaller employer. And you just, you see it over and over when we come in to provide a new quote, and on average you're showing a 30% savings from the arrangement that they were currently in.

While that feels good from being able to convey that value, honestly, Mike, it kind of makes me sick if I'm being candid. it's just, when you think through how those dollars could have been deployed inside that employer, sometimes it's the difference between making payroll and not, or being able to enter a new line of business and so on and so forth.

And that's where we tend to get frustrated is the misinformation. Look, I'm all for,a real competitor and going head to head and duking it out for business. I actually think that's good. I think it's good to give people a choice and to have to compete. Cuz if one person's service is better than another, then you know what?

You should have the ability to move your business. and it's something that we pride ourselves on as our service model. But nonetheless, that's really, if you're gonna push me into a corner and make me answer the question where both myself and our leadership team get a bit frustrated is when you really come across just a one-sided agreement that someone has been in, and then thinking that it was a good deal.

It's kind of sickening,

Mike Koelzer, Host: And it doesn't always make you guys look good. Cause somebody gives this quote of X and they say, we're transparent and all that stuff. And then you guys come in and can do it for 0.7 x it makes you look bad, like at 0.7 X. It's like, well, what corners are you cutting? and , there must be some underhand things going on because, you're so much lower than somebody 

Wendy Barnes: some. Sure. And I, I chalk it up to the years and years of unfortunately, agreements that just weren't typically in the employer's favor.

And there's just generally I think, always going to be a distrust and it is on us to earn that back from the employers and brokers that we work with, interests.

Look, all we can do is continue to educate and push a service model that we believe is fair. There are always going to be actors that are less than scrupulous, unfortunately. Cause there are a lot of dollars at play in pharmacy benefits. So it attracts all kinds. . 


Mike Koelzer, Host: Wendy, how many people, I'm not talking like office staff, but how many decision makers is your company working with the PBMs? Is this one person, is it 20 people? Is it a hundred people? how many of you are going back and forth with the decision makers at the PBM and you guys,

Wendy Barnes: We have a pretty small team who engages with the pbm, directly. really two individuals 

Mike Koelzer, Host: 

Wendy Barnes: and how about their it's pretty small, 

 I tend to find, the fewer touchpoints the better in making sure that you've got two individuals who know they're both accountable, on both sides. And so we've got one senior VP who engages strictly for the contractual terms with all three of the largest PBMs.

And on the other side of that, they primarily engage with one person as well. Now, clearly there are larger teams behind each of these individuals, but for the primary decision maker between the two, it's one and one. that does change when there are. For example,larger market forces at play.

So, if we've got a situation with a particular brand launch, or generic launch, rather that's negatively influencing our client guarantees, or we're trying to get a read on how is Express Scripts Caremark, Optum going to approach handling biosimilars or GLP one s, I will engage with the head of pbm, or sometimes the head of supply chain just depends on what the issue is.

Mike Koelzer, Host: Now, Wendy, I know all of your clients are wonderful. You just have a great relationship with them. Picture a 

Wendy Barnes: a company 

Mike Koelzer, Host: yours, what would be a really difficult customer for 



Wendy Barnes: I think one of the scenarios where it can be a little more [00:20:00] difficult, to partner as well as we'd like to,with some of our brokers and clients is when you know you're. Obviously we're all focused on our specialty.

Nothing new. That's, at, I think any of us in this industry have been talking about this for

Mike Koelzer, Host: keeping those costs under control.

Wendy Barnes: Absolutely. but doing so in a predictable manner such that you can still manage the global benefit. And what becomes difficult are partners who've determined one to completely carve it out.

which sometimes is a decent decision, but working with some clients will go back and say, oh my gosh, but here's the trade-off in rebate and here's actually the percentage of your patients. By carving it out and perhaps taking advantage just of a patient assistance program actually didn't get coverage and either needed to go back on benefit or truly were left stranded with no opportunity and specialty is something that just needs to be managed holistically.

There isn't. A point solution that's really going to provide clinical oversight coupled with appropriate use of these really expensive medications. And you know, this far better than I do as a clinical pharmacist, but having been on the business side of this for so many years, it's frustrating to see, some clients run two point solutions that are more of a bandaid as opposed to thinking long term on how you truly should be managing, this very expensive component of your pharmacy spend.

Mike Koelzer, Host: So 

that would mean like a company might say, we're gonna supply 


patients with

Wendy Barnes: with 

Mike Koelzer, Host: various medicines, but we're gonna stop short of covering the ones that are 20 x of that price. And then sometimes it's just difficult. But sometimes it might cost a company more than they realize if they lose that employee and 


like that.

Is that kind of the 

Wendy Barnes: the whole.

Absolutely. I mean it's the, there are I think many instances where taking advantage of a patient assistance program makes sense. it's just from our vantage point, doing so with eyes wide open and understanding the full picture of it.

Mike Koelzer, Host: 

that's patient assistance, as in the insurance isn't gonna cover it, so we're going to use the copay card or some, the discount card from the 

Wendy Barnes: manufacturer.

slight nuance. So that would be a manufacturer copay assistance program. I'm specifically talking about the entities that step in when you say it's not going to be covered at all and in turn you qualify based upon income and or not having insurance for said specialty medication.

Mike Koelzer, Host: It's income based a lot of times. 

Gotcha. The copay card that's not so much that, 

Wendy Barnes: it can be both. you're right. the mcap, but oftentimes Pap is squarely of course, based upon,eligibility for income. And unfortunately, some of the programs in the space were selling themselves squarely on, look, we can save you, fill in the blank number.

And they were, speaking directly to employers to say, here's how we're going to help you mitigate that cost. One without showing them, well, and here's what's going to happen to your rebate guarantee as a result, right, wrong or otherwise, if there were dollars that the client was depending upon, they at least need to understand that.

And part two would be, look, there's no guarantee that patients are going to qualify under these programs. I roughly think it's between 20 and 40%. And so then you're left with a whole swath of your employees who are really left with no option at all. And so, Our view at RX benefits is it's a component, and it may be right for some clients, but you really have to look at the math and the mix and who you're servicing to make that decision appropriately.

And it's best coupled with clinical oversight in general, around step therapy, all of those components that go together to provide better clinical care. And your comment on the outlandish, expenditures kind of points you back to a stop loss scenario, let's say. And we've also taken the long view there, understanding that as a small employer, many, of course, when you're self-insured, you're going to have stop-loss insurance, which can be incredibly expensive.

And we have designed a product around that, which is a supplemental stop-loss opportunity to kind of come over the top, at an attachment point. To really cover the spectrum. So it allows the smaller employer to really approach specialty holistically and to understand that their spend likely will be contained at a certain amount in any given year.

And the objective is not to have people not get their therapy . The objective is just to make sure it's appropriate and truly if there's a less expensive alternative in partnership with the physician that makes sense, then we'll do that.

[00:25:00] And stop loss policies can be quite expensive. And unfortunately, in many instances than when you actually have a claim as an employer. Oftentimes then that employee slash patient will get what they call lasered out of the actual coverage such that in a subsequent year then they can no longer participate in the plan.

And so where we come in is, again, a supplemental stop-loss product. This is a separate entity that we've set up as a captive to, once again with a similar thinking of pooling lives. Then we can provide a supplemental policy on top of where your stop loss actually ceases. And so from there, you then have the opportunity to know that your employees will be covered on the upper end of specialty spend.

And this is across. All therapies, not just a particular group of therapies. It's all a specialty. and it just really provides a bit of peace of mind, frankly.

Mike Koelzer, Host: My son just got his mechanical engineering degree. So he joined a company and it's 

probably not gonna change his mind a ton, like what PBM they are, And he doesn't really care like how many pharmacies are available and what the formulary is. He's just happy to have a job. He knows they're gonna take care of 'em. 

And so,

something might not be quite right, but he doesn't know the difference anyways.

And then a word gets back to her. And finally HR calls you guys and there's a little bit of 


 There's so many levels that a cost pruning or decision is like a pbm. It gets down to the worker eventually, but I don't think they really know. What target they're supposed to fire back at because there's just so many pieces to blame? And if there was, there's really no one 

Wendy Barnes: really no to 

Mike Koelzer, Host: everybody just 

Wendy Barnes: kinda, 

Mike Koelzer, Host: along.

Wendy Barnes: Well, I mean, I think this is pointing to. the complexity of what we've created. And look, and I think all of us should raise a hand as having contributed to the complexity. It's pharmacies, it's PBMs, we've all made this more complex than it needs to be.

And so, my view is the easiest way as an employee if we're trying to make this simpler, is to truly have at least one stop for service. So when you have a question, it's a member service center. And I think we've also pointed ourselves to death in this space and, just coming in over the top to employers to say, now look over here for this solution and this app, and look over here for this solution and this app.

I'm not a big proponent of all of that. I think it makes a lot more sense to comprehensively manage. Someone's pharmacy benefit and look, I'm all for some of these point solutions are great, but they should be available to the employer and employee through one conduit. So a marketplace, if you will, an app and one member service center.

And it's, there are things that we don't do ourselves or haven't historically at RX benefits. We have a diabetic solution in partnership with tria cuz they do it so well, but it's our member service center who chats with the patient. Cuz look, we've all been on that side of the equation and there's nothing worse than contemplating,needing help with something and you're just, you don't even know who to call.

You're looking at the back of your pharmacy card. You're not sure if that's who you're supposed to call. You get redirected somewhere else. So it's always been our goal to have it be a single member service center.

Mike Koelzer, Host: I think AI is gonna help this too. think somewhere we can 

load up like our employee manual and then people can ask questions off of that instead of looking up the index and finding what category something is, and finding it.

They can just look it up that way. And I think the personal touch is great, but, I think all that stuff's gonna help give better customer service. I would hope.

Wendy Barnes: Gosh. I'd love to think so I think there are basic questions that chatbots can help respond to and just online chat in general. But we've always been pretty cautious as a company about using. that type of channel to communicate with our patients. And again, it's slightly different from our competitors.

I'm okay with spending more in our member service center,to have folks in Birmingham, Alabama be on the phone, with the majority of our clients. I fully understand the financial motivation to try and digitize more. And clearly you need to provide an option for digital answers when it makes sense.

But at the end of the day, most of what we're talking about is pretty darn complicated outside of, what's my company? Or, is my drug in transit? Or is this pharmacy and network? There's some basic things you can handle that way, but on the whole, when someone has reached a point where they need to call our member service center, it's usually a little more complicated 

Wendy Barnes: then that and they actually wanna hear a human voice.

Mike Koelzer, Host: At our pharmacy, my [00:30:00] dad would roll over in his grave, but you know, you have an IVR pickup and say hello and push this in. 


the calls that get through are not as easy as the calls that came through years ago because years ago you're answering yes or no about something, and you're talking to somebody who didn't use the computer to talk to you, but 

they could have, 

And now , it's not that person. 


Mike Koelzer, Host: Wendy, now you're the cEO in different companies, you were way up there, but not the ceo. How is that different for you 


Wendy Barnes: 

In my previous role, which was pretty comprehensive, it felt like running my own business in many ways because it was such a large team and so integral to the company that I was a part of.

Mike Koelzer, Host: I think the biggest difference, from having a very senior leadership role compared to. Being the CEO is primarily everything that hits your desk as a CEO is something that well skilled, seasoned leaders on your team largely couldn't solve. taking on the most difficult issues that really smart people know, are having difficulty navigating.

And not to suggest that you're coming in with a solution I, 99% of the I don't. It's applying all of those years of leadership and people skills to really navigate, okay, what's on the table? What are our options, in making the best choice that you can. beyond that, I think it is, and frankly I've felt this is true of any leadership role, but.

Certainly more so when you're in the CEO seat. Just leadership by example is incredibly important. You can talk about culture, you can talk,highly effective habits. You can quote any business on the planet. 

But if that is not what your company or team are seeing you ESPs and actually do, you should really pack your bag.

 The eyes are always on you. and it's continually keeping that in mind. But I, gosh, Mike, I would be remiss without saying it's an incredible honor to be able to lead a group of individuals and to know that they're putting their trust in you. I mean, at the end of each day, I always remind myself that there are families depending upon me in this leadership team.

to steer this company forward in a meaningful and positive way. and that's how they're paying their bills. So it's personal,not just the clients we serve, but I feel like I'm also in this job too, to serve the people who work in the company. 



Now let, I 

honest with me here. 

Wendy Barnes: me here.

Mike Koelzer, Host: was having 

c e o behind your name, something that you aspire to. Now, don't get me baloney here. yeah. 

is that

something that 

looks nice to you? name? you may find this to, to be interesting and you can poke me on it if you want, but honest to God, Mike, I have never cared about titles 


Wendy Barnes: No, I never have. 

Mike Koelzer, Host: Alright, but how about the top top dog? 

Wendy Barnes: Well, certainly again, it's an amazing honor, but I would respond by saying, for me, any role I've had is always about is it challenging?

 Am I doing something meaningful and in service to something and is it aligned with my personal values? It's something I've asked myself Every year, I take the personal inventory with those very simple questions. I usually do it in November of every year. And if the answer to one of the three is no, it usually requires a little thinking on how I can regroup to get that to a yes in the next year.

If two of the three are a no, then I ask myself, do I need to be in a completely different role or do I need to contemplate maybe something outside of the current company I'm a part of? And if all three are no, I know I've got some major misalignment. And then at that point you kind of have to open yourself up to, well, what else might there be to get the three of these things back to Yes.

And there's no question that I think anyone's career that ends up landing in a CEO chair, there's also a component of luck and timing. no question. clearly you have to put in the work. but I would like to think that it's largely because those that I've worked with historically, I still work with.

I pride myself on really not burning those bridges. This isn't a very big industry despite the days that it feels like it

I think that the overwhelming majority of people in our industry, Mike, are aiming to service clients in the best way possible. And that truly coming at it from a positive intent, despite perhaps being a part of a business model that may not be as well aligned, [00:35:00] I just don't think you're attracted to work in this very difficult industry.

If you don't, at the end of the day, have a hope to take the cost out on behalf of employers.

Mike Koelzer, Host: Wendy, what could a pharmacist do who's listening to this in a minute or two when they roll in from 



get into work it's reaching out to your big partner PBMs that you're contracted with. If you believe you're bringing more value to the table as it relates to a client a, fill in the blank. There are all sorts of creative arrangements that pharmacies are important to mutual clients.

Wendy Barnes: Can then strike with the pbm, cuz there are other things you may want to do that would be of benefit to that particular client. And it's not just the big chains that do this. I've seen plenty of smaller pharmacies do this cuz they're 

really important in the communities in

which they serve. 

Mike Koelzer, Host: Wendy, boy, thanks for coming on and opening up,

I appreciate you letting me spout off a little bit. anybody that helps clear up this opaqueness is a friend of pharmacy. 

So thanks for what you do and, look forward to following what 

RX benefits continues.

Wendy Barnes: Thank you, Mike. It was my pleasure to be on. I appreciated all of your questions and thank you for what you do, in pharmacy. I know it's not easy to be an independent pharmacist. Having said that, you are integral to how our mutual patients get the care they need.

So Thank you. 

Mike Koelzer, Host: Wendy, we'll 

talk again soon. Thank you.