Empowered Pharmacy Selection Post-Visit | Otto Sipe, Photon Health

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Otto Sipe

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

Otto Sipe: I'm Otto Sipe, co founder and CEO of Photon Health. We're a startup based here in Brooklyn, New York. So we're investing heavily in technology that really helps patients navigate the pharmacy landscape. Obviously, it's a pretty complex decision when someone gets a prescription filled at a pharmacy, helping patients figure out what things cost, where they can get them filled especially as time of day matters, and really kind of helping modernize the prescription fulfillment process for a patient who's making sometimes a very complex and expensive decision.

Mike Koelzer: Otto, to give our listeners a little bit of a scope [00:02:00] of what that means, if you had a little TV commercial , what would you be showing? a phone, someone in an app at a pharmacy kind of thing? Is that kind of the setting we have?

Otto Sipe: Totally. So, there's a cool way of demoing Photon that I've adopted, is if you go to our website. You can punch in your phone number and Photon will send you a fake prescription. Our website is photon. health. But what happens is we'll send you a fake prescription

via text. 

so walking through that experience. With Photon, a patient gets a prescription with a secure link sent to them via text message. Of course, it could go via email or any other mechanism of transferring information to a patient. But what that means is a patient takes ownership of a prescription before a pharmacy is selected.

As we step through this process, that gives patients kind of the resurrection of paper in a digital format. So when things went electronic, patients kind of got cut out of the conversation. Quite literally between how a prescription is fulfilled and in the 90s, we joke [00:03:00] that, when you went to a pharmacy, you had your prescription in your hand

You knew when it might be ready after you dropped it off. You actually knew which pharmacy it was at, which is

a Phenomenon in the e prescribing world, like patients being confused

where their prescription even is.

 It was an interesting phenomenon

That didn't exist before. And further, you know when something will be ready.

So we digitized that experience. And make it feel like DoorDash. And the other thing you'll hear me say a lot, is you can track a pizza as it moves across New York City on a map. And know what it Cost before you ordered it, when it's gonna be there, with like really high promise. And that's like a 17 transaction. Well, I don't know if you can get a pizza for 17 in New York anymore. But

The transaction value's low compared to maybe the urgency and cost, really, of a lot of pharmacy transactions.

Mike Koelzer: When you went through the beginnings of this thought process, did you find any parallel industries that were close to this or was this [00:04:00] rather unique on that it's out of your hands from the doctor's office and you don't see it again and they kind of own you basically.

Otto Sipe: So, yes, there's a ton of parallels. First off we talk frequently about business models and patient facing or customer, consumer facing

experiences, Like Uber, like Airbnb, like DoorDash. There's bits and pieces. We operate a lot on the idea of there not being really many new ideas for a startup.

 We're borrowing heavily adopting and testing, and I think, The thing that we're doing as a startup, which, there's one thing we do well at Photon, it's this like notion of using product discovery or a product process to build software. So, there's some, famous ways of thinking about innovation, but basically Steve Blank has this. Advice, and he's like a big product nerd, but his advice is like, there's no facts within the four walls of a startup. Of course, there's not many four walls in a lot of startups now. A lot of people start remote, etc. But we spent a lot of time in the last two years that we've been around with [00:05:00] customers, with patients, with doctors, with all the different stakeholders involved in prescription fulfillment.

And we also started from scratch. We didn't start with any existing abstractions. There's a lot of knowledge here, too, that predates what we're building, where we've seen things in production, we'd seen things at scale, we'd spent some time understanding how e prescribing works, etc. But the point is, yes, we borrow very heavily and we're testing things.

We invest in things that work well and stop doing the things that don't work like we hypothesize. And we're wrong hypotheses from a product perspective.

Mike Koelzer: I don't, a listener to this might. See your company and say, good luck with that because you don't understand the HMO is in the size and these health organizations and you've got to sell your soul to be a part of this and this kind of stuff. But there's [00:06:00] some companies that say that's why we're doing it.

We know this behemoth of things and that's exactly why we're doing this because there's a hole to fill.

Otto Sipe: I

Mike Koelzer: What side do you guys come down on?

Otto Sipe: I think a lot about healthcare at the infrastructure level or the specific like tech level all

the way up to the highest abstractions of healthcare, which is large, you've got pharmacies, PBM, pharma companies, payers, etc. I'm not convinced this is intentional, but this industry is so complex that I fundamentally don't believe that anyone understands it

, some of the abstractions were designed well, and some of them were not designed well.

 We don't take any of it as like a necessity or something that was built by design. And I think when you start a company Or a project from that stance. You know, it's kind of disarming for the way that things are, and it really lowered the barrier to entry for us to say, well what if we just tried this working differently? [00:07:00] And yes, there are absolutely gotchas along the way where we're like, wow, we didn't even think about that. But truthfully, we've been sort of set free by removing the need to understand what all this complex healthcare stuff is. And the last thing I'll say is we listen really well.

As a leader, someone who's only been a CEO for two years, I'm just working like super intently to listen all the time because I

don't understand how value based care works, but I have a hunch that our tech might help. And I don't really understand how a PBM works truly under the hood, but I have a mental model that's been informed of, five to 10 years now of understanding the impacts on the market.

Mike Koelzer: If I had known how little you really need to know about the inner workings of healthcare earlier, I would have started Photon two years earlier. You never know enough to run a business or to try to innovate in any space. me see if I got this right let me just throw this back at you

Otto Sipe: Sure.

Mike Koelzer: You thought you had to know more and there is a lot to know but you're doing things fresh and you want to really solve [00:08:00] problems you don't necessarily have to know all the problems you have to be open to innovation is that even close to what 

Otto Sipe: Yeah, no, you're honestly spot on. It's simply, you never really know what you don't know when you

get into this thing. And the things you do know, you're probably wrong on a lot.

And being able to approach this with a mindset of, well, we're just following out what we've learned empirically.

Doesn't, it means you don't really need to understand the whole thing. There was no blueprint for Photon or anything that really looked exactly like

it

two years ago.

It

is really just we have a really big, hairy hypothesis that prescriptions could work differently. And here we are two years later it.

And now we round around 25, 000 scripts a month. That number is growing pretty rapidly. And we are proving quite a lot of other things as a corollary to that original hypothesis. 

Mike Koelzer: I picture, and I think it's from pharmacy too, because every time a pharmacy thinks they want to get [00:09:00] into a part of the business, let's say as simple as a 

Mike Koelzer, Host: wanting to fill prescriptions for a 

Mike Koelzer: certain nursing home or something, they're like, no, corporate does this. They're in Ohio, a few States away, and you can't even get a foot in the door.

I alluded to it earlier about the big and vertical integration and things like that. Is that a pain in the ass? I mean, do you guys even think of that? Because I'm sure, well, at least I'm imagining you get a lot of figurative doors shut in your face because you're not already tied into the API, of this and that, and they just slough you off.

How does that affect you? And where do you go from there? And maybe it's not even a problem. Yeah.

Otto Sipe: not to be too abstract, but that's the art of starting a company. You get a lot of doors slammed in your face, and I think the thing

It's like in some investors, you explain it, some investor might say, ah, that ain't gonna [00:10:00] work. You didn't think about this. And whatever it is, obviously a large company sometimes look at what we're doing, saying, Oh no. You guys don't understand this, this, this, this, this, and this. And yeah, we probably don't to be clear. this, and this. 

But what we do understand and what we have proven empirically is where we draw our momentum. And there's something interesting about that like first few years of a company where you kind of clear that product market fit is a lot of what enables this.

But

we

have a product that our customers pay for that helps them and helps their patients navigate pharmacy. Unequivocally, that is valuable and novel, aka no one's done it before. And it doesn't really matter how the long-term care facility model plays in, or how the PBM model plays in.

We have enough momentum now that we get to prove this and get to continue to take next hypothesis. But we're doing it in a way where we're super open to input and the number of times, like a sales call or someone who's given me advice that's changed. How I think about the value we could build [00:11:00] in the future has been pretty profound.

So. eyes wide open, focused on what we know and what we don't know has given us this interesting power to innovate. It's also what makes this thing so hard. Because the majority of the last two years as a company has spent just beating your head against all the things you're doing wrong.

And lots of people saying, no, you can never take on SureScripts. There will never be another prescription network. if I had a dollar for every time I heard that maybe we wouldn't need to fundraise. 

Mike Koelzer: between saying Sissy paid me a dollar to take her prescription and to send it here or there versus having actual customers. on this show have idea startups, I like to have a startup that's a year because have you gotten paid for anything yet?

That's the big divide. And of course you guys have. And so that's the path you take at that point.

Otto Sipe: I mean, we have by no means gotten to a mode where what we're doing is default alive, is how

you hear a lot about in the startup space. We're fighting every day for

this thing to [00:12:00] exist and the story I'll share, which is kind of related to what we're building, we send prescriptions to patients via text. What's cool is they can text us back. There's some upsides and downsides to that as a company, but we just did some stats over the weekend. Almost a third of our patients over time thank us a text message, in a text thread that is predominantly automated.

I don't think many people, I doubt DoorDash has a third of their users sending a thank you text back to the DoorDash

driver.

So I think this shows just how valuable the space we're operating in is. we're really drawing on concepts that work in other industries. Patients want it to work like this. We hear it all the time. And also, it works like this in every other industry. whether it be from Amazon to DoorDash to Airbnb, a patient could see the price of something and when they're going to get it, when they make a buying decision, and it's not like that in pharmacy. And obviously there's some impacts of that being true and we're figuring them out as we go, but that's, what's been so [00:13:00] neat about this inflection point for us as a company we're starting to play with, bigger names and bigger bets. And it's just been cool to see really largely how many folks are incentivized for things to change.

 And I've honestly been surprised how. Once you prove something, folks really want to work with that. We've proven something novel and cool and fun, and also massively impactful for a patient. So, we're figuring out where we go next.

Mike Koelzer: Otto, contrast that. You said texting. Are you saying that the other companies, it's too app heavy or are you saying there's not even that personal communication to the phone at all?

Otto Sipe: Text is an example of a modality that is obviously open doesn't cost anything or hardly cost anything to send something to a patient via text or email, The idea is that it feels modern, or that it feels like the patient has true agency. We talk a lot about the idea of agency. The issue, whether it be an app or, [00:14:00] cloud native this and that it doesn't matter. The point is, does the consumer have agency? And I would argue there's been a reduction in agency from the world of paper. And we frequently meet companies where the doctor says, I still give these prescriptions on paper

They're so likely to be either out of stock, Or, there's a pharmacy closure issue, where if a prescription is routed to a pharmacy that's closed,

And if it's 10 o'clock at night, and you've got a kid that's sick, and you hear doctors telling us that they still put amoxicillin scripts on paper because of that you start to question whether or not the existing abstractions truly solve the consumer problem.

prescriptions were just like a little widget that you could carry around,

 Existed in your wallet or something like that, and for many people they still work like this because of some of the, complexities, or a lot of concierge docs still just

use paper. Obviously there's major downsides there, and the thing that drove the adoption of e prescribing was security. It was the idea that this prescription really came from a doctor. And obviously the context of an opioid crisis and [00:15:00] abuse for certain medications drove legislation to drive e prescribing. But we didn't really fully solve the problem. If you look at this from like a patient perspective, everyone else in this industry, including the folks we talked about, who are like up in the clouds per se in terms of levels of abstraction, they really aren't looking at the patient experience as a driver for Economic value, the same way I think we are.

Mike Koelzer: Otto, when I would market our pharmacy or when I do market the pharmacy, always show a contrast between pharmacy and the chain pharmacy. So 

Mike Koelzer: If I think, okay, the chain pharmacy, they're not locally owned. Okay. So I can say.

We're locally owned and we support the baseball team or something like that. 

If you had to make the same kind of marketing piece

Look at some of these bigger companies that are doing it, whether this is true or not, what are a few opposing things [00:16:00] like this company is this.

Yeah. But we're this and they're that. And we're this, what are a few things that you would at least put forward in a marketing piece, let's say

Otto Sipe: The way I think about this is that in order for us to make a patient more happy, we need to take on, and happy is obviously a difficult to quantify thing, but for us to improve the patient experience. And when patients and providers over to our way of thinking, I think we need to be 10x better.

And I think this is a, what's super hard

about service oriented businesses is it's it's really hard for a car wash to be 10x better than

the other car wash. And in reality, you can keep loyalty by being better. But for us to like truly create a wave of change in an industry, you need to be 10x better.

so I'm going to give you this pitch from the stance of being totally 10x

better. We are building

a product that takes on more responsibility

Pain and confusion of getting a prescription filled. And quite importantly, we are [00:17:00] not a pharmacy, so we don't

actually fill Prescriptions. We work closely With a lot of pharmacies, big and small, chain and retail, all the way down to, single pharmacist to get prescriptions filled. But we are taking on an enormous amount of the Product oriented confusion,

that Exists with routing a prescription. And we think a lot about this as a team of technologists. To solve a problem truly for a customer, whether it be a patient or a doctor, you have to take on a bit of their pain. You have to offset their pain and to

offset pain is extremely difficult.

I'll give you an example that's not photon. Like Uber enabled you to book a cab,

just being on your phone.

The customer 

pain was like standing on the sidewalk thinking, gosh, what's going on? Why are there no cabs tonight? That type of thing

is really hard to offset. You got to get an app and you got to build a whole ecosystem of drivers that are standing by and

willing to get

there fast enough.

And

like The actual operational requirement to offset [00:18:00] that pain well enough. And when you do it and it feels like a 10x experience, it's like magic.

The pitch is, we are solving prescriptions, solving the confusion around prescriptions or the lack of transparency around prescriptions with a product that is literally 10 times better than the way it works now.

I tell that to, some of my team They'll say how come those people aren't coming to our pharmacy? Think of all the things you have to conquer. Don't want to admit they're leaving someplace.

Mike Koelzer: They have to then talk to this person and it's been good enough. people aren't going to come to our pharmacy as you say. For one or two times, to really shake them up, it's got to be 10 times. So, well, I tell you at 10 times, one at 10 times, one is they can't get their medicine somewhere else, so that's like a 

Otto Sipe: Yeah. 

Mike Koelzer: times one, but you got to find something in there because just a smile and a name and this kind of stuff, it's not enough to wake people up and to change. Because they're already getting something, it might not be perfect, but they're already getting it. 

Otto Sipe: think this is true [00:19:00] in a lot of businesses doctors probably struggle with this too,

How do I keep patients

there's a human element to to pharmacy and to providing medicine that like we don't really focus on. We're a software company. We want our experience to feel like it's offsetting pain and confusion for

folks, And feels like a great experience, but it's not a human experience. 

I do Think there's like a human element that is keeping independent pharmacies ahead of, and will always be ahead of some of the retailers where they really can't compete on that front. We don't think about our business in that terms, but we do think about how we enable that phenomenon to help patients too. An example of this is we tried this experiment where we put Google ratings in the experience where a patient could pick a pharmacy, and we saw an increase in adoption of patients going with higher ratings. I don't remember the numbers, but still, the idea of helping patients discover the pharmacies that do provide that human edge in an otherwise commodity market, I think is pretty profound. It also increases the likelihood that a patient's going to get their prescription, that they're going to get their [00:20:00] questions answered. And if you look at the problem we're trying to solve as a software company, we do want to leverage quality at the pharmacy level as a vector to help introduce better outcomes, et cetera, et cetera.

Mike Koelzer: I tell you though, Otto, it's a beast. I mean, just commenting on the 10 X, right? I joked about the a hundred X about getting somebody to our pharmacy because the medicine's not out there from anybody else, but they found it here 

Otto Sipe: Yeah. 

Mike Koelzer: they live a mile away they've. Waited in your store a tenth of the time that they're going to wait somewhere else.

And you gave them every good bit of loving you could. And they'll even say I'm coming back. This is my new place now. And you never see him again. 

 That's why you need that 10 X again.

Otto Sipe: Yeah. I mean, I have a lot of perspective on this just as a human. I grew up waiting tables

working as a mechanic, and

like all these different odd jobs when I was in high school.

My mom owned a little restaurant growing up. And the thing I learned from [00:21:00] that is A there were people that come in those doors that treat your business as a commodity, they take 

for granted that a business might be open

To serve lunch.

And I don't think there's nothing you can do

about Those guests, do your

best. 

But I do remember a huge portion of our customers who came back. Who love the restaurant, who

love what we stood for, and it's really hard to differentiate when your product is a commodity

But I do think there are platforms that have fundamentally helped those businesses compete in a world full of cheesecake factories,

And otherwise, commodity landscapes.

Mike Koelzer: I think before our listeners start, yelling at their phone. Tell me if I'm right here. When you talk about commodity, you're not saying every pharmacy service is a commodity. Every pharmacist is a commodity. We're saying that a hundred red pills with a yellow stripe is the same, whatever pharmacy you go to.

So the medicine itself is a commodity, 

Otto Sipe: Correct. 

Mike Koelzer: companies like yours and some independent, small or [00:22:00] whatever finding ways to turn The non commodity part into not being a commodity.

Otto Sipe: Correct. I mean, When I speak of the commodity, I speak of the commodity that is the medication. we're Lucky to live in a world where medication is a commodity. The

fact that I can walk a

hundred yards in Brooklyn and get amoxicillin

is a beautiful And so, that's the whole supply chain reality of modern America.

And going further, the fact that when Photon is done with what we're doing, you're gonna be able to know which pharmacies have stock, or at least you can tell which pharmacies are gonna tell you when it will be there by,

Not all pharmacies keep stock, what it's gonna cost, and when you can go pick it up, and they might even say, we'll deliver it to you, right?

A lot of pharmacies offer delivery in our book. But I do like the idea of If things are going to be a commodity, you kind of have to embrace that and then differentiate on, the vector that, that you have. And I would love to have that conversation as we grow about how pharmacy becomes [00:23:00] more than just a margins based business.

 The dream is to push the industry past just a percentage of the cost of medication. But I do think there's lots of ways to do that and ways that we can help support that with our partners. The independent pharmacies that we spend time with are extremely excited about what we're doing. Austin is sort of our test market just because we have a lot of local business there. And we frequently spend time in Austin, in pharmacies, talking to folks, talking to the owners and telling them what we think we can do, what we think we can build and sort of how our business can eventually impact pharmacy. And a lot of this is about just understanding the viewpoint of a pharmacist. But also this idea that if it was a more level playing field beyond just what's the closest pharmacy it might help the indie stand out. 

Mike Koelzer: Otto, You seem like a nice enough guy. Someone said that to me one time they were walking by. I was outside. They say, you seem like a smart enough fella.

I don't know what it was. So it's like an old guy phrase. 

Otto Sipe: Yeah. 

Mike Koelzer: You look like a nice enough guy, but if you put your [00:24:00] evil hat on, 

Otto Sipe: Yeah. 

Mike Koelzer: point, you guys said, we're going to find a way to exploit this and. necessarily nefarious ways, but maybe just not quite As transparent. If you were not so transparent, could the company like you be tempted in anything? Are there some things out there that might be hidden that you could get into if you were an evil fellow?

Otto Sipe: Totally. I mean, I don't want to criticize other than broadly, but without a doubt the PBMs have fallen into this predicament. And I think sort of the core issue is that the lack of transparency creates this phenomenon of folks looking at the thing saying, there's gotta be foul play here.

I happen to know a lot about how PVMs work.

I'm no expert, but I've spent some time

reading some great blog posts

from

folks I follow. [00:25:00] Our view is that if you take the Google approach, and imagine a scenario where we're really right, and we do great over the next

5 10 years.

If you take The Google approach of being like, eminently transparent,

Focused on one vector as your mechanism of providing value.

Our vector

is the patient. We want to obsess. over what makes patients happy,

Gives them a better experience. I mean, no one's happy, truthfully, to go to the pharmacy.

I think

that's the tough

part about this is, by definition, you're sick.

If you can make that experience better, less painful, more transparent for a patient, and we can be really clear and really transparent to the market about how we get paid, I don't think there's as much of an opportunity for us to be painted as a bad player. I think also, going a step further, a lot of venture backed companies are met with a, an immediate oh, here come the people that live in New York with their fancy software also, the fact that Venture is looking for natural monopolistic marketplaces that is the world's best [00:26:00] investment. If you think of like the DoorDash and the Airbnbs and they are trying to invest in things that can get to a scale where it's really hard to compete with them. If you look at the market now, we have a more monopolized prescription network than really any other industry. Find another market where there's only one player.

So, I do think there is sort of a David and Goliath thing that is in our direction now. But absolutely at scale, the question is why don't you become the same bad thing? Whether it be, a PBM or like a large group that's

taken advantage Of

consumers.

And I think the way to do this is to be eminently transparent and eminently clear about how we make money with our customers and our partners. And beyond that, I think it's really about making sure that our intentions are to do the thing that's best for patients.

Mike Koelzer: All right, now, Otto, you told me about your transparency. That's just the very first part of this question. 

Otto Sipe: Mm hmm.

Mike Koelzer: your evil hat.

Mike Koelzer: What could a company like yours [00:27:00] do? Is there anything there that you could take advantage of this system?

 Don't get me wrong. This is the opposite of you. This is the evil Otto. what could you do? you could get with the PBM to do stuff and this and that. What could you do that maybe is not illegal, not criminal, not cheating per se, but just not as transparent

Otto Sipe: think you see this all over American business. And there are businesses that are like really close to crossing lines of anti competitive tactics.

and generally speaking, I would say anything that's anti competitive and removes patient choice is a problem.

Otto Sipe: For example, and this is something I'm happy to criticize publicly, a PBM owning a pharmacy.

Where they then Can compete at a lower rate than,

say, a, A retail partner or an indie partner, for that matter. Does create some questionable economics

for folks who are also forced to contract with a PBM, so aka a pharmacy.

I do think there are mechanisms where it is impossible to compete with a large [00:28:00] organization that are unfair to players in that business.

I'm not one who goes around pushing for regulations, etc. But I do have an opinion that if an organization gets big enough and this is true in any industry, you have the opportunity to do stuff that isn't necessarily in the best interest of your customers. And you see this time and time again, you see marketplaces driving spread pricing like behavior.

is not just true with PVMs, this is also true in shipping industries, this is also true in lots of other places where, you know, you can effectively turn into a rent seeking organization. In most markets, those businesses do not last long. imagine if Google

decided tomorrow that it would cost 10 for every Google search.

I bet you a lot Of people would pay it, 

Otto Sipe: reality is that there is always going to be a business that sees the opportunity of providing value in a way that is more aligned with your customer.

you can build a good business by making money from your customers

Amazon is an interesting case. Their NPS and, customer [00:29:00] satisfaction is

absolutely through the roof beating any brick and mortar retailer by a mile.

Also really good at this too, long story, but I worked at Walmart before as well. And it's just about obsessing and being really clear about how to provide value to your customers and focusing on that and having that be the vector by which you make decisions.

If you do that, I think it's pretty unlikely that even if you're at massive scale that you create too much consternation. That said, any big business in America is gonna, either throw its weight around intentionally or kinda, create tension. And that's something, I don't run a big business in America, but something that I don't know if I'm going to be any better at it at scale than the other guys unless I have a set of core values to stick to.

Mike Koelzer: Listened to a psychiatrist online and he talks about Nazis, you know, the regular policemen and people were brought up and they knew it, one thing led to the other and they're out there You know, shooting people and killing people, not in a war, just in the [00:30:00] Nazi sense.

And you never think you'd be there, but you never know the temptations in that, but you'd hope to have the values not to fall into that.

Otto Sipe: Yeah, I mean I think, this is what's so difficult about, it's tough to shift gears from Nazism to like American corporations. I'm not going to draw that parallel, but I'm going to make the shift because I think American corporations can do egregious harm to

But it is not working in the same mechanism where like, individuals who work there

I doubt you could find a single nefarious person

PBM. They think they're doing good, and the reality is the shape of the thing got ahead of where its values were. And I'd like to think just like gravity pulls these things apart naturally as innovators like us are coming for them.

And like we're, we don't understand how PBMs work and we're not trying to build a business that just disrupts PBMs. But

we are trying to sort of build a business that puts pressure on things to work ways that are better for a patient. [00:31:00] And I'd love to, in five years, be back on this podcast saying. Gosh, we are totally right that giving patients agency over prescriptions and helping them see prices before they pick a pharmacy is a really good way to add pressure for the PBMs to be more transparent.

But, we'll see. That's a hypothesis right now.

Mike Koelzer: I always talk to my team about that at, my pharmacy about how, individuals in companies, the PBMs in particular, I hate to say it, but They're 

usually people and,

They're probably friendly people their soul is not identical with the PBM soul.

Otto Sipe: Here's how I think it happens. If a business is not responding to constant consumer pressure, they can do bad things.

I think of this in terms of the environment.

With no consumer pressure not to pollute,

pollute like crazy. So the way I think about it.

I take a lot of faith in that mechanism being true. We would like to build a business that is responding very heavily to consumer pressure for something to exist. Mostly because we're trying to coalesce that 

There is no [00:32:00] pressure from a customer that's really pushing on the PBMs to change. And that doesn't mean they're bad. There's a lot of what they do that I would get on this podcast happily and say is actually good for the market.

same Thing goes for pharma. There's more consumer pressure on a pharma company in a lot of ways than there is on a PBM. Same thing goes for payers. Not as much consumer pressure, but certainly more than on the PBM side. The question is like, how do you expose businesses to consumer pressures and use that as a mechanism to change the industry? And I'm just a kid with an engineering degree that's been focused on building software in digital health for a while with a hypothesis, but we are starting to see some traction in that if you can coalesce a lot of patients using experience that changes the way they think about what a prescription could work like, it can start to get profound about how it impacts bigger businesses. .

where I net out across all this is how do you change a model?

Like how do you actually innovate in a space where? It's so difficult to get foothold that's really the [00:33:00] focus of our company 

we're focused on proving that this could all work a lot differently. And we have, we're doing our homework. Doing our best to prove this works and figure out what comes next.

Mike Koelzer: You look at a lot of these pharmacies and, Some people would say I'm lazy, in fact most people would say I'm lazy, but there's a lot of stuff I haven't done in my pharmacy because I'm like, we haven't perfected Stuff yet, even in our 77th year, we haven't perfected the customer experience 

Prescription.

And so before I start taking on, I sound like an old fart who's got his head in the ground, but before I take on vaccinations and having people standing in line and pissed about this and, going up to someone and say, have you signed up for our new Weight loss, this and that. While at the same time, somebody has been waiting for five minutes and nobody said hello to them yet at the counter, because you're so focused on this and that stuff, but there's a crap load of stuff that pharmacies could just be doing a better job to improve the experience, but it's like they say, yeah we're [00:34:00] 53 percent there.

Let's move on to the next thing.

Otto Sipe: Yeah. I mean, I think there's a couple problems here. One, obviously, is the fact that there are not many people innovating in this space. And my co founders and I were talking about the square card reader the other day. I don't know if you remember.

like 10 years ago now. They were like, what if we built a credit card reader into a headphone jack?

And turned every iPad into a POS.

No one's doing that level of innovation in pharmacy. And I

should be really careful because I know a lot of really amazing founders building really incredible software for pharmacies. But there is not this ecosystem of innovation where things are getting better and technology's driving the experience forward and these tools are all available for pharmacists to try, a lot of times it's salespeople, it's, these old pieces of software that haven't changed since, I was in high school. And I think the reason is a couple of things. One, there's not a culture of technology adoption and using [00:35:00] technology to drive experience change. Pharmacy is behind the curve, might be the last customer or consumer focused industry. That has not really adopted this. I think independent pharmacies have to move forward in that department. To stay alive, And to continue to compete. 

Mike Koelzer: break that one down. Give me an example of that.

Otto Sipe: I think the biggest thing is, and we've seen this recently, is like things like delivery or things like giving patients insight into when something's going to get fulfilled. Those are clear. I'm not saying the pharmacist should do this for free necessarily, but these are clear services that patients absolutely want. it's hard for a pharmacist to figure out how to do that because there isn't enough innovation in this space. There aren't enough entrepreneurs. There's only a few. And there's a lot of good ones, but there's only a few who are really driving innovation. And the reason is, is so much of the market is locked up by the three big players who control the three big experiences. And if you're not offering something from the three big guys, it's very hard to go out and invest in the tech to sell [00:36:00] to only a few thousand potential customers.

Mike Koelzer: repeat that back, Otto. pharmacies are doing delivery but. lot of people

don't enter the market because of the big three. it's a minor market and you're only going to put so much money into building a delivery Uber ish thing because there's not enough market there and therefore the pharmacies suffer through notepad and the old, paper through a pin sticking up kind of thing.

Otto Sipe: Yeah. And that's only. a hypothesis, you also have Regulatory, to even wake up and play pharmacy,

 as a startup, like you've got a mountain of regulatory complexity

to mantle. And I would bet you our legal bills are 10x what, a similar company in different non regulated spaces is focusing on. So like the barrier to entry for an entrepreneur,

Smart software folks to go

build for pharmacies

is too high. So it just makes it really hard for. I think independent pharmacies to have tools that they can grab off the shelf

because [00:37:00] There is no experience. That's as elegant as square in pharmacy

I think if there were you'd see like this groundswell of pharmacists saying you know what we're done with this.

Here's a better way And i'm not just saying, the pms software needs to change It might not

even be that

the pms has changed at all But I do think there's so much opportunity for innovation in this space. It's just really hard to get to

And we've seen this for a while. I think this is also true a lot on the other side of the fence where we operate, which is like helping doctors prescribe medications. All of our competitors, there's a stat I heard that like some huge percentage of integrations with Surescripts were done before the year 2014. So 10 years ago, the majority of integrations were done. So that means, for the last 10 years, most prescriptions have gone through tech that hasn't changed in 10 years.

And obviously there's been iterations and such, but this is a space that doesn't have natural competition where the next best product can step forward and win. And we need to get to that type of an ecosystem in [00:38:00] pharmacy for independent pharmacists and for retail pharmacies to be able to innovate on the experience.

Mike Koelzer: Yeah. There's some Parcel Health and they have this fill box, which is a cardboard accordion thing. You pull this and that out. And I was just talking to her and that's something there that hasn't changed who knows what should happen, but you know, it's been the same orange bottle for 70 years and I've seen some places try to do flat this and that, but basically I don't disagree. And in fact, I agree. There's things that who's going to be the leader in that? It's a small market, and it's a big market.

Otto Sipe: I think you're getting at the sense of it, which is My view is like, old tech doesn't mean it's bad. I'm a funny bird in that I'm a technologist. I happen to run a complex, fancy startup. Well, not that fancy. But I drive a car that was built in 1988.

Right? 

And, It has power windows and that's it.

And tape deck. It works for what I need.

 I do [00:39:00] think that mentality of like simplicity being more important that said, you've got to have an, you've got to have iteration.

I'm driving a car that was iterated on for 50 years or however long BMW has been building cars and that mentality of building better products, making them better every day. Most people take an update for their PMS like quarterly. Or yearly,

if at all, if they even pay for it. And like, they don't even get to get the new update unless they pay for it. That way of shipping software is 1990s. We need to push the industry, especially in pharmacy and really across healthcare, toward of like, the best products are winning because they're providing the most value to businesses. And the most value to consumers.

Mike Koelzer: So like in this case, let's say a company like yours comes in the market and hopefully you get a ton of market share, but if you don't get enough market share or the market's not even there to support you now, not only are you going to suffer, but [00:40:00] nobody's going to come in to try to beat you because now they're going to get, of what you get 

Otto Sipe: yeah, I mean, I think there's a lot of white space also around

what we're building, where other folks working with us benefit.

Seen this unequivocally where a lot of health platforms are psyched to work with us. Because it turns out building prescribing, that's our core product. We sell a product where you can embed prescribing into a clinical workflow with a couple lines of code. That's how all of our prescription volume gets to us, That Innovation, let's say enables a whole bunch more innovation with our partners. we're not building, a lot of the complexity that they're building around clinical workflows and patient messaging and, CRM like features to allow a patient to update a doctor with condition changes, et cetera.

 There's so much complexity there, but just by being an awesome partner, we invite innovation. The same thing can happen on the pharmacy side. And that's really what we're starting to figure out. We're so excited to work with some upstart PMS companies. Especially some folks who are focused on mail order use [00:41:00] cases, where there really hasn't been much innovation on the pharmacy side. We're psyched about working with folks who are trying to figure out delivery use cases for independent pharmacies. We really want to partner, and modality about innovation is that it gets a lot of people excited, Even some big companies and big names in this space have seen what we're doing. And been excited. And that's super cool for us.

Mike Koelzer: One 

concern I would have if I'm an investor I guess that's why I'm not in the VC area because I know pharmacy, but if somebody came and invented something like a, I don't know, for grocery or hardware stores or whatever, I better have done my homework because it's easy for a company. To come in and say, we've got the answer and throw some VC at us, but they don't have the answer. Sometimes I'll flip through, let's say I need a software in my company to do X help with deliveries or this or [00:42:00] that. . I'll look at my phone and I'll see a company that like a billion dollars or something.

And I'll find What I think is a relatively big error or a gap in not understanding the market in 

Otto Sipe: Yeah,

Mike Koelzer: seconds. And I'm like, how did they get capital for this versus someone like you, who's saying that you've already have pharmacists wanting to invest. That's a divide 

Otto Sipe: yeah, there's this funny thing about venture, and I don't pretend to be an expert. 

raised some money, but I've been an

engineer for the past ten years. So don't have experience raising venture capital until Photon, really.

But, The funny thing about raising a lot of venture money is you can afford to be wrong for a really long time.

And then you go away. Gravity does what it does, there's sort of an ecosystem thing there. But if you're going to be big and good over a long period of time, you have no other way other than to like really go solve the true problem.

And

Into the deepest meat of what does and doesn't work for folks.

In our world though, I also want to be [00:43:00] transparent. We're focused on the patient, there are trade offs between what's best for the pharmacy and what's best for the patient,

in our experience, that have come up before from indie pharmacies especially and also retailers too.

And I'll give you an example. If a pharmacy is out of stock, we allow the patient to

Then reroute that prescription without a transfer. And, we're doing this with authorization from the provider and obviously work directly with clinicians across the country. There is a way of thinking around owning a prescription at a pharmacy that I completely understand. Prescription volume, how many prescriptions are being refilled this notion of owning the patient relationship is sacred to pharmacies. And I understand why these businesses cling to this. But at the same point losing a patient because of a transfer is also a really expensive process for a pharmacy.

They're on the phone, they're faxing stuff all over the place so there's kind of this world where, obviously the transfer standard hasn't been implemented for a lot of different

complex reasons. We just think, look, it's clear that this is what patients want. [00:44:00] At some point, someone's going to build this and the market's going to move this direction.

So we might as well do this by involving the pharmacies in this conversation and truly understanding where this nets. And I would encourage anyone who's listening to this, who has some thoughts on literally a pharmacy marketplace that doesn't have a notion of transfers anymore,

to

send me an email.

I'm auto at photon dot health. Happy to have a chat with this, but we really think there's. Trade offs here that we are making as a business to do what's better for patients to improve the patient experience that directly change the economics for some of our partners and we take that really seriously and want to make sure we really understand that.

Mike Koelzer: There's so many things that I'm used to in pharmacy.

seemed normal to me, but they're not. And I'm glad you brought that up. The transfer thing. There's probably a million things like that, but I'm just like, ah, that's just part of the game but it shouldn't be.

Otto Sipe: Yeah, I mean, to your point earlier to connect this to the VCs and like outside innovators, there is data that shows that. [00:45:00] Some of the biggest software companies, whether they're tech companies in general, are often started by Outsiders. Folks with zero experience in the

industry.

And we're not totally outsiders.

 We've spent a lot of time kind of in the bowels of digital health companies,

Building with different components that we now sort of are trying to replace.

So we're sort of wise, but we're absolutely still outsiders and always forcing ourselves to look at this from the objective perspective,

of, how it works in different industries is usually the framing of

things. And transfers do not make sense.

They don't make sense. They shouldn't exist. And, it's something I've kind of screamed into the void plenty of times in my career well before starting Photon. But there's abstractions and ways of doing things that everyone's just used to that we take for granted because they've always been here and there's no line of sight for them going away. But I still wonder if there's even bigger abstractions that we could get rid of next. And I don't know what that is, but I do think if you have this outsider's perspective and you're building something that's new [00:46:00] and not built on top of existing abstractions,

you get to say, That whole thing, what if that went away?

And we'll

find that actually a lot of pharmacies are really excited by this, because

they're sick of sitting on the phone. It's honestly the larger retail pharmacies. They're understandably very short staffed and the phone calls take forever.

Blamelessly looking at that

transfers don't make sense. So rather than wait for everyone to slowly do all the implementations to make this happen, we just do it.

And the patient experience allows you to do this. And it's obviously in a very closely guarded way. So the patient can't just pepper prescriptions all over the place,

but It's a cool experience when a patient gets a prescription for amoxicillin. It's out of stock at the first pharmacy. They get a text that says, Hey, it's out of stock, pick another pharmacy. We help them pick another pharmacy and often can help them find pharmacies nearby that we know might have it. Cause we're pretty good at supply chain at this point. It's a magical experience.

If it's 10 o'clock at night and you're just trying to get amoxicillin for your kid. And that's what's driving our growth.

Mike Koelzer: I was saying that same thing. get calls all the time. Do you [00:47:00] have this medicine, I'm on the phone, so there's gotta be a better damn way to do that without spreading to the world , that you've got this certain controlled medicine or something when I think of the people having.

This in their hand now, the one piece of technology that comes to my mind, but everybody who I've spoken to on this said, we don't need it yet because we're doing fine without it. So why bring this in if we don't need it, but would be like blockchain slash NFT kind of thing. And it kind of gets me thinking that, you can just take this around, there's gotta be some way not to have a half dozen of these prescriptions somewhere.

Otto Sipe: I remember reading the white paper on blockchain before blockchain was alive.

And obviously there's a lot of mystery around how this tech came about and funny stuff like that. Blockchain is a piece of technology. It's a tool.

Think of it like a hammer, for

the sake of discussion. It is a tool that also has gotten a lot of hype around it, because it's [00:48:00] novel. But, you know the whole saying about a hammer? Like, when you're a hammer, everything looks like a nail?

The mentality of blockchain and NFT and all this stuff has really been to like look at every problem and say there's an adoption of blockchain.

Mike Koelzer: Sure. 

Otto Sipe: reality there's much simpler tools, and I picked a simple enough tool here. But the simplest tool that solves the problem should be used. Blockchain is really good at distributed ownership of something. Or distributed transparency, currency is a perfect use case. It makes a ton of sense. Prescriptions are an anti example, and I don't want to say you're wrong, because I think the idea of why isn't this tech kind of making it about, because it seems new and great but the reality is, you don't want anyone else to see your prescription transactions, and you don't want public information out there, and the only way to get to a place where only certain people can access something is by having centralized control.

And blockchain 

Nerds who come after me on this,

What a lot of folks have done is if you want to keep information that isn't [00:49:00] publicly available on the whole chain,

it needs to be in some central database somewhere,

and access control becomes a nightmare, and then you end up just building something that's sort of, it's possible, but it's an absolute rat trap compared to just a database that's run by a private organization that has a lot of investment in smart people working who are incentivized to operate and facilitate a marketplace. And maybe there's many of them, right? It's the same idea where we're not averse to the blockchain use case. And I do think there's actually some interesting

security oriented

 plays that

are related to blockchain.

But it'll

actually probably end up looking a little bit more like just a basic distributed database.

than a blockchain. Because other thing is blockchains are wildly expensive to run

and like it's just an inefficient way of saying like we're gonna store data on a blockchain when the only reason it makes sense for currency is because the huge likelihood that someone's gonna try to steal Anyway, I could nerd out about that for a while, but it's something that what's been funny.

I think Raising money in the last year versus [00:50:00] it was about August of 2022 versus end of No one asked us if Photon was going to be on blockchain.

The VC hype on blockchain had hit zero

basically. But yeah our view to put it simply is to use the best tools for the job

and nothing more complex than it

needs to be. 

Mike Koelzer: That's what I'm getting from a lot of people. It's like, we don't need it. 

Otto Sipe: Yeah, 

Mike Koelzer: it. 

Otto Sipe: but

to ask the spirit of the question. Like, how aren't these new innovations coming into pharmacy is the right question it might not be blockchain, but there new AI is the

next question to be

asked. Like, why aren't there AI use cases in pharmacy? What if it's not a pharmacist doing the transfer?

it's an AI.

Honestly, that's a bad use case, because we think we should get rid of transfers in the first

place. But, Why can't the why can't an AI 

pick up the phone at your pharmacy and be able to provide 90 percent of the examples and then patch you over to a human only when necessary. There's a lot of cool stuff that I think AI is going to absolutely revolutionize pharmacy and help pharmacists get away from some of the more mundane operations oriented stuff

into patient care. And look, I'd love to say that like AI might be [00:51:00] the angle that helps pharmacists and indie pharmacies succeed and survive in an otherwise, you know.

Mike Koelzer: Otto, I know from your website, that you do not do controlled drugs. 

What's your biggest hurdle there actual situational problems or strictly like DEA? 

Otto Sipe: So this answer is complicated, as you might have expected. We try to be really smart about understanding the pain points with the DEA. And I've attended a few meetings even where representatives from the DEA are talking about the rules changing. The issue for us with controls, is a couple things.

 For us to do controls, we would need to get certified all of our integrations with all these different pharmacies. Not to mention our customers also have to go through a controlled substance. Approval process, and we're really trying to figure out how to do that and make that process built into the product, but it's a lot of stuff to build, The core requirements are that, you gotta ID verify the provider, verify that they are who they say they [00:52:00] are, and then set them up with a two factor authentication so that I couldn't just grab your computer and start writing controlled substances. We take a security problem very seriously. So that's part one of why we don't support controls. Part two is really the fact that we sell predominantly to digital health organizations who skew very heavily towards telehealth visits and the rules are changing in telehealth about who can fill a prescription and

we regularly talk to customers. Or hear in the marketplace from folks we don't work with who have done bad things

sometimes, like there's a cerebral thing, and I'm not going to pass value judgment

necessarily

on what went wrong there, but there's the cerebral thing, and there's even just distrust of telehealth across the board because of even a little bit of misbehavior, and I think that's really the problem we need to solve.

Versus

just supporting controls. So, it's been cool, even some of the bigger pharmacies have been excited about working with us to verify prescriptions at a deeper level. This person wrote this prescription, here is a verification of [00:53:00] that. That you can, access and verify publicly.

And that's super important, It's not technology that exists today. Secondly, Helping a provider who wrote a prescription with a patient disambiguate from a telehealth prescription because if the rules start to change for how pharmacies enforce that, you just put a bunch more work on pharmacies for them to say well, did this come from a telehealth

a lot of related issues here around like license verification that I'm sure as a pharmacist are painful for you and we hear it from both indies and retailers.

So as a network, we actually want to take on the ownership. of automating a lot of this problem,

And helping folks understand this is a telehealth prescription, it needs to have an in person verification, etc.

So, if anyone from the DEA is listening we technologists over here at Photon, who are now growing pretty rapidly in telehealth prescription volumes, are eager to solve that problem in a thoughtful way. With technology, not just with, a word document.

Mike Koelzer: The DEA though, it's some of the stuff you jump through to get your CSAWs, your [00:54:00] DEA license, I mean,

Otto Sipe: It's hard.

Mike Koelzer: there's people that have millions and billions in Vanguard , and you need your Thumbprint, and the DEA, you gotta match up this to that. I think it's just a puzzle 

they don't want idiots to have these licenses, so they give you about 19 steps to see if you can figure it out.

Otto Sipe: Yeah, this is true on both sides of the fence for prescribers as well, but there's sort of this walled garden problem where, once you're in the walled garden, you kind of have a lot of free reign.

Because of that, you got to like really police the edges.

And we're trying to build a paradigm that's not a walled garden, where it's like

you hear in

security world, they say zero trust, where like, even if someone's one of our customers, we by default don't have trust for anyone and have developed systems to prevent fraud. That's a huge undertaking and like very much a different problem than we're trying to solve. But you see this in other industries. Stripe said, we're going to make it easy for anyone to put a credit card button on the internet. Well, you know what? That creates a lot of problems,

right?

We are at this place where we [00:55:00] predominantly work with groups that have chief medical officers.

That

have, Someone who runs Clinic. Someone who's like signing a contract with us and almost all of our groups are sort of like enterprise deals where we're

working with a group of 300 or more doctors.

Otto Sipe: so, we're a little bit less worried about solving that problem now, but at one point, very soon, we want to get to a place where any provider on the internet can just sign up and use Photon. And no pharmacist is worried about a prescription coming from Photon

being from

a real provider.

 And that's like again to the problem of like really solving the whole problem and building trust on our network.

Otto Sipe: these are

cool things where code can solve this problem.

Mike Koelzer: in your business, I don't need numbers, but. How is the whole pricing set up? traditionally PBM's are the ones that at the end, they try to not only screw us with prices, but also throw in some wild fees, just.

Because they can no longer do rebates and stuff like that. But what is that process set up of the [00:56:00] funding of this? Cause you mentioned some doctor groups and then other pharmacies and so on. And I assume the person who enjoys it the most, or is getting the most out of it would pay, but how does that work out overall?

Otto Sipe: Totally. So, the thing that we do differently, really, than I think a lot of software that focuses this much on pharmacy or the pharmacy experience, is we only charge the provider. Or the

 Or the platform of the prescribing doctor who for Photon. And a lot of the reason we do that is we can save the process of what we're doing as a service to the physician or the clinician who's writing a prescription. The advantage of a prescription being texted to a patient where they can choose their own pharmacy, obviously saves some time for providers immediately. They're not sitting on Google trying to figure out which pharmacy you meant. In the digital health use case, this is pronounced because a doctor will commonly hear, Oh, just send it to CVS on Flatbush. Sitting on Google, doctor's not in New York, and they're trying to figure out where Flatbush is, and

there's four CVSs down Flatbush, doesn't make sense. So there's a lot [00:57:00] of inaccurate information, or not quite specific enough information that doctors are using to find pharmacies.

That's a huge time sink in digital health, or especially a scenario where the physician isn't co located with the patient. The other thing is, if the prescription just goes to the default pharmacy on file in the EHR, And it's closed. That's a callback to the doctor 99 percent of the time.

I mentioned that earlier, but the issue is if Photon can help the patient navigate that, we're saving time for the provider.

And we're saving time for the group that they work for. Because you might call it front desk or an ops team or whatever it is. And further, a lot of doctors are doing like patient price navigation. And they're doing real time benefit check and digging through prices. And it's obviously creating a lot of extra work for doctors to effectively navigate insurance for a patient.

So our

view is like a next step is help the patient do this on their own and take that work away from doctors. They're willing to pay for because it removes work from them. And it also incentivizes us to make this product really great for providers, too.

They've been our sort of core use case really since we got started [00:58:00] and in a lot of ways we're sort of Extending their value prop through the patient experience of selecting a pharmacy.

Mike Koelzer: the whole thing on pharmacies is a little bit backwards think about the agency, I mean think about if Someone came up and said your mufflers not sounding good. I've already sent an order over to Joe's muffler shop. And you go in and Joe's got his, shirt buttoned down.

Past his chest and gold. I mean, and then think of going into Joe and saying, Joe, I don't really want it here. It was like, why the hell did you send it to Joe in the first place? 

Otto Sipe: Totally. 

Mike Koelzer: Those things.

like they should be done before you get to Joe's.

Otto Sipe: this is actually an experience I just had myself. I don't take many prescriptions. I've obviously had acute scenarios where I've taken prescriptions, but I don't have any chronic prescriptions. And I was at the doctor. The doctor said, Oh, let me just send this to the pharmacy that's near your house.

Is this an okay pharmacy? And one I hadn't heard of.

And I get there and I'm like, oh, whoa, [00:59:00] there's like bulletproof glass, like I live in Brooklyn, so it's kind of the vibe sometimes, but

I do feel like the sort of the ability to shop across the network, even if you're not comparing prices,

but just to understand like, Who's open now?

Who's closest? Or

who's like

in the area of my work? The thing we see a ton actually is really neat. We work with a bunch of pediatrics groups and on spring break, all of a sudden we see a bunch of scripts going to Florida

Groups that are in Texas all of a sudden have, scripts going to California

and it's super cool to see how like just giving patients this agency every one of those scripts would have been a call back to the doctor saying, Oh, actually I'm on spring break.

Can you send this to this weird pharmacy near me? And actually I don't know where there's CVS's in Sarasota kind of question. And fact that doctors are doing that is wild. So that's

something that we've found that's like really profound and absolutely driving explosive growth for Photon.

We save time

for doctors. We, extend their value prop by allowing them to give a branded patient experience. Again, you can check out this demo on our site. Go to photon. health, punch in your phone number and you can experience what it'd be like to get a script [01:00:00] from a doctor. So, extending that though, we want to do even more to do the same thing for pharmacies.

If we can also work closely with like helping patients navigate price decisions. can actually go even further. And again, this is something we want to do with a lot of thought and trust, but the thing that's also very different about Photon is that we are not charging pharmacies to receive a prescription.

And here you have me on the radio saying this, but my view having spent a lot of time at a pharmacy They're margins based business. They're transactional and they're, in a position where it doesn't make sense to take additional cut away from their model when in reality we're not yet even adding value.

sending

a script to the place a patient would have brought it on paper anyway isn't adding value. So we really want to get to a place where we're proving that we're adding value before we start charging pharmacies.

Mike Koelzer: And ten times.

Otto Sipe: Ten times the value. Yeah, you

hear me on the radio saying it

but it's something we take seriously.

For us to win we need to be ten times better than the status quo.

Mike Koelzer: [01:01:00] Boy, it sounds like you're doing your homework. You've got the customer as your main objective. You're spending time in the pharmacy, spending time with the doctor. That three legged stool all adds up. So very cool.

I'm looking forward to watching your guys success as you move along here. And thanks for your time today. I appreciate it.

Otto Sipe: Thanks so much Mike. I appreciate you kind of asking the questions that get at the core of what we're doing and also asking a couple that are critical. Like we're constantly trying to think through, what we're doing and what it means and I encourage anyone who's listening to this. A, if you're interested in working with us, shoot me a note, auto at photon dot health. We're also growing, the team's growing, so if folks are intrigued to work on a technical problem like this, shoot me a note, I'd love to chat.

Mike Koelzer: All right, Otto, in touch. Thank you.

Otto Sipe: Thanks Mike.

You've been listening to the Business of Pharmacy podcast with me, your [01:02:00] host, Mike Kelser. Please subscribe for all future episodes.