Pharmacist Prescribing Simplified | James Lott, PharmD, MPP, Scripted Founder

Speech to text:

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

James Lott, PharmD, MPP: So my name is James Lott. I'm a pharmacist and also the founder and CEO of Scripted.co by ScriptHealth. Uh, today we're gonna be talking about, uh, the future of pharmacy and how scripting aims to take a very large role in that future.

Mike Koelzer, Host: I was on your site script. That's a nice looking website focused on pharmacist prescribing. Now the average person listening will say, Well, pharmacists can't prescribe. In general, I'll tell 

James Lott, PharmD, MPP: you about the first transaction that ever happened using our platform. Scripted. Yeah. So we partner with the pharmacy on the west coast.

This pharmacy is in a rural area. Um, a patient went to their local doctor's. And that patient knew she had a urinary tract infection, very common in women. So she didn't have an appointment, went, walked in and the doctor said, I'm sorry, but I can't see you for three weeks. Hmm. Um, the patient was a little bit, you know, frustrated, but went to her local pharmacist like lots of, uh, patients would, and she grabbed some azo and overcount medication to kind of relieve the bladder pain and, um, took it to the pharmacist and was like, Hey, does this.

Um, the pharmacist says, Ah, well, it's, it's okay. But actually we just started this new program, um, called scripted. Why don't you scan this QR code here, answer some questions about your health and, um, if you're eligible, I can actually write you a prescription for an effective antibiotic. The patient completed the questionnaire.

The pharmacist logged in, and used a scripted platform. She was able to comfortably and easily assess that this patient was in fact, eligible under a. To get an antibiotic for her uti, the patient paid a cash price to the pharmacist for the visit, which is different from normal. And then the pharmacist was able to charge, um, the patient or build a patient's, uh, pharmacy insurance for the medication.

Now, obviously this patient was relieved, but also the pharmacist made money and it's like this transaction was seamless and. Hmm. Our question is, with something so obvious and so win-win for patients and pharmacists, how can we scale this kind of experience to every zip code in the United States? 

Mike Koelzer, Host: The pharmacist there, he or she already knew that they were going to be able to prescribe.

They already had that association with the doctor. Outside of your program is that. 

James Lott, PharmD, MPP: In this particular case, the pharmacist didn't actually need a doctor because this was actually in Idaho. But in many states they do. Gotcha. That's a great question because so many pharmacists, so many, uh, everybody has that question.

Who's a doctor? Well, we are going a step further. We're actually removing that. If you need a doctor to help you, uh, with the protocol or a collaborative practice agreement, we even help with. All of the barriers that are in the way from getting our futures, our pharmacists to the future of pharmacy. We're taking them one by one and removing those barriers and that friction so that pharmacists can do this at scale, and that is so absolutely important.

What 

Mike Koelzer, Host: was the thing that was the biggest disappointment as you got this going? 

James Lott, PharmD, MPP: Sometimes your biggest failures are let downs are your greatest. Um, I'm a pharmacist. I do not have a business background. Um, I literally, um, remember, um, I was very fortunate. I got to go to a great, uh, school. So after pharmacy school, I went back to policy school.

Um, but when I was in policy school, uh, at the University of Chicago, um, at the time there was, uh, the business school there, the Boost School of Business. And I remember entering a competition there and I told the professors about my idea and there were some questions I. And one of those, uh, professors when I asked a question was so stupid.

The professor literally kind of laughed at me and rolled her eyes and then answered it. And I will never forget how that felt. So like everybody else, I'm not a business person. But at the time my idea was to try to solve the opioid crisis. Hmm. And um, I launched this platform from Naloxone Exchange where people could go online, buy Naloxone, and get it shipped to them.

Um, the business idea was, um, for a business, for a few people, it was great, but to scale, to be a national brand, that wasn't really happening. But it was timing. Timing was right. Um, one time we had the White House actually call us. The White House called us. They wanted to know more. We told 'em all of our challenges.

You know, we thought they were gonna help us, the biggest issue and the opioid crisis. And we have this thing where we could ship medication to all 50 states. You know, the government's gonna help us. Absolutely not. . That never happened. Uh, that never happened. And, um, when I realized that, You know, no one's going to save you when you're tackling a problem.

No one's going to save you. You have to solve your own problems. Yeah, that was [00:05:00] a big wake up call and it challenged me to form a better business model. And we got connected to some, to some of the right people, some, you know, some decision makers at the large chains and they kind of, you know, said, Hey, you know, there's this other problem where you guys could, uh, probably, you know, figure out how to solve this.

And it would create a lot of economic value for everybody if you could figure it out. You know, put pharmacists more into the, you know, And to the, to the hierarchy of the care system. 

Mike Koelzer, Host: Is this mainly you that's running things or do you have another, We as part of this that's trying to push this forward, 

James Lott, PharmD, MPP: I'm lucky.

I'm not at the point where I'm the CTO and the CMO anymore. . Wow. That's great. That was, that was, Thanks. That was back in the Naloxone Exchange days. Uh, you know, But today? Today, no. We're a completely different company. We have a team. Um, we are funded, um, we've raised, uh, money from investors. Um, some of them, we've finished accelerated programs.

Uh, some of these investors are some of the same investors from Uber and PillPack. So we do have a team. We are funded. Um, and luckily this team is wonderful. They're, you know, these are physicians. These are, um, , these are, uh, product owners who, who, uh, study human centered design. So they kind of take the problems from the pharmacist.

So, you know, when we first started developing this, I told them, Hey guys, look. Pharmacists are busy and they don't want to hear if they, if you tell them to do one more thing, they're gonna take a pill bottle and throw it at you. Uh, they don't want to do anything else. So, you know, we need to develop something that they're gonna be proud to use and proud to help their patients.

Because let's, let's also be honest, you know, it's not that pharmacists don't want to help people. They really do, but they want to help themselves too, and sometimes their employer. Are not always stepping up and doing their part. You know, one big part of this future of pharmacy, cuz there's so many question marks, is how are we gonna get to the future of pharmacy when we're just trying to get through today?

And today is hard. We're understaffed, our business model is not working for us. There's so many things to figure out. James, 

Mike Koelzer, Host: you mentioned accelerator companies, which is a cool concept. I've talked to some other startups about what accelerator program was that? What company was 

James Lott, PharmD, MPP: that? Sure. We actually did, uh, two, uh, two more, uh, I would say higher end accelerator programs.

First we did, uh, SoftBank, uh, which is an extremely competitive program. SoftBank is, if I'm not mistaken, it might be the largest investors in the. Um, I might be, I might be wrong, but I'm pretty sure they, they are, um, they, they write typically checks of about $1 billion. I think their minimum used to be a hundred million dollars.

Uh, but we got lucky in, um, when they were trying to diversify into early stage companies. We were one of the first ones on their radar. So we got lucky to be in our Celebr Pro program. And then also, uh, we were in tech stars, uh, which is a very, Well known and established, um, accelerator program. PillPack was, um, was one of their first healthcare deals.

Mike Koelzer, Host: Your site in app is really cool. A lot of thought, a lot of time, a lot of money went into it, but nowadays some of this stuff can start pretty easily. But it looks like you and your team. Fully committed to this. Yeah, 

James Lott, PharmD, MPP: that's actually, that's absolutely right. And you know, it's funny because you say it, you say it looks easy, but what you're looking at is you're looking at the consumer 

Mike Koelzer, Host: side.

Yes. And it's supposed to look easy. If they've done a good job, they've built it 

James Lott, PharmD, MPP: around the consumer. Exactly. Now where the magic, and for us, the nightmare comes. It's a side benefit for the pharmacist , because essentially the way it works is someone can go onto scripted.com, enter their zip code and select a treatment that they want.

And again, these are things that are like. You know, low risk for pharmacists or the healthcare system to undertake, but high touch, you know, uti, erectile dysfunction, asthma refills, um, you know, covid tests, et cetera. Um, but you know, the patient just wants to, you know, get started and save time so they can go online, you know, um, start filling out the form, um, select an appointment time, and then go to their local pharmacy and execute the service.

Now, um, the pharmacist is that, you know, What they need is completely different. They want to be able to see the form. They want to be able to, um, you know, to document this. They want to bill for the service. Uh, it needs to fit into their workflow. They might need to report all these services to the government or to insurance, or to the county or whatever the case may be.

Um, there's a lot . Yeah. Right? And, so we actually spend a ton of time working. Um, in my opinion, are some of the most motivated and best, you know, [00:10:00] pharmacists, um, in, in the country too, to develop this out, and it's really, really exciting. How do you 

Mike Koelzer, Host: get input from the pharmacists at this point? Are these pharmacists slash customers already on it?

Are these people that have taken a look at betas and are giving their opinion? How do you get that input from the pharmacist that's valuable to you? 

James Lott, PharmD, MPP: A couple of things. Number one, I always tell my team, you have to be customer obsessed. Mm-hmm. , when you're customer obsessed, you're solving problems for them and they inherently give value for it.

Mm-hmm. . So our first customer, you know, we didn't charge very much. We're still not charging very much, but all of these are paying customers. Hmm. And these are customers that are very serious. They're very serious about being successful and keeping their lights on. Okay. Um, right now these are mostly independent, although some chains have, uh, contacted us, um, for sure because they, you know, they are interested in what we're doing.

Um, but right now we focus on these high performing visionary pharmacists, um, you know, who are leaders in their communities and the pharmacy. To leverage the platform and provide what the future is. You know, I've heard things like, you know, you guys are deifying this for, for, for other pharmacists. You're making this seamless, you know, you're, you're creating, you know, something that, you know, in 10 years when the pharmacy completely does transition, this is gonna be the main tool that we're going to be using.

You know, they get to develop, uh, what they would need to be successful, and then we get to, you know, bring that to life for them. 

Mike Koelzer, Host: There's probably no one better to get an opinion from than someone who's actually paying for it already. You know, they, yeah, they're gonna give you some good opinions if they're putting money out for it.

James Lott, PharmD, MPP: I, and I do agree, but I don't think we're charging, uh, much at all. And that's kind of the goal. We, we want, you know, we want to be the solution of choice for all of these pharmacists and. Um, you know, I, I, I have to read a lot of data. You know, pharmacists, the average independent pharmacist makes about three and a half million dollars in revenue a year.

Um, now how much profit that, that's a different story, but revenue, that's, that's pretty substantial. So, you know, at the prices we're looking at this is, uh, we, we make the decision super easy for them. 

Mike Koelzer, Host: If you could cut your desires down into percentages, how much of a percent was this goal scripted?

How much of it was helping the patient versus you doing something that was really cool versus you loving technology versus you wanting to make money from it versus you wanting to leave a legacy. All these kinds of things go into these new businesses. How much of. Percent were some of those things or are some of those things?

James Lott, PharmD, MPP: Man, that's a very good question. It's a hard one to answer. Um, you know, when LeBron James picked up a basketball, and I'm not saying I'm LeBron James, I can't even dunk, Okay. , so I'm not LeBron James, but when he picked up a basketball, um, you know, things just seemed to make sense for him. Probably he was really good at it, Okay.

Mm-hmm. . Um, and if it, with probably his value a. I would say the same thing happened to me. I did not pick a pharmacy. Pharmacy picked me, and I'm really fortunate to find it. I remember when I was a pharmacy student, um, I did a rotation, um, at a h p, um, and it was a really competitive rotation to get. Um, and I remember one of my last meetings with the outgoing president of asp, uh, he was a wonderful man.

And we sat in a room with him for an hour and a half, me and three other pharmacy students, and at the end of the meeting, he pulled me aside and said, Hey James, I don't know what it is about you, but I think you're gonna save our profession. Hmm. I don't know why he said that to me. I don't know if I believe that I'm not. That's not my goal to try to save the profession, but everything that's ever happened to me in the pharmacy setting has been noted.

And interesting, and it's been a calling and I've always answered the call and it's always made me feel good. . I used to call myself a social entrepreneur, um, which is somebody who's mission oriented. I stopped calling myself that because investors think that you don't know anything about business and you're gonna lose all their money

Um, which is fair. Which is fair. Sure. Uh, but I've had to, I've had to learn a lot. I've had to take the social part off because I validated that there's a social, um, there's a social. Um, benefit here. There's an economic value. There's the savings, there's access, there's all these things. And I feel so lucky that our team has been able to put together a product and a business model that solves so many problems all at once.

Mike Koelzer, Host: If you come across any roadblocks of not just like things [00:15:00] you have to do, is anybody trying to stop 

James Lott, PharmD, MPP: this? I think at a high level, uh, there probably are people who. Probably don't want this to, to be, um, you know, a reality. And that's why, that's why intention matters so much. Um, and I, you know, I have a lot of questions as to why this may never come into fruition in the first place.

Future of pharmacy has become such a buzzword. And Mike, I know because I've been paying attention. But, um, you know, here's the bigger question. What's the plan to get there? Who has the answer of how we're going to get to the future pharmacy? What does that even look like? Better? Who is advocating for this?

Who is the leader in implementing these things? You know, we've, you know, I don't think anybody's figured that out, and that's the problem. Um, another thing, it's like when you're trying to shift an industry, Fragmentation is your biggest adversary, but coordination is your biggest weapon. And if we're gonna go to the future of pharmacy, we all have to go there in the same direction.

Um, it's, you know, the reason that Covid was such a big win for pharmacists was because we, we did get to, we did 229 million vaccines delivered by pharmacists. That's according to the CDC, over a hundred million tests. . Um, and an express script study says that 91% of people feel confident pharmacists can give vaccines.

And then 74% of people, this is the general, uh, public feels pharmacists are capable of prescribing. So with that, you know, we, everything is there. The one question is, how are we going to get there? How are we gonna get to the future of pharmacy? And that's what scripted has been. We've been busting our butts trying to figure 

Mike Koelzer, Host: out.

Sometimes when you've got more of those buzzwords, like the future of pharmacy, it's because. , somebody doesn't know the future. You know, the current stuff is hard to do. Yeah. It's like people giving an arousing speech and saying there's a brighter light and a brighter future. It's like you have, that's because things are pretty dark right now, , you know?

So if there was a clear road, you might be talking more about, All right, here's what we're doing. You know, here's what we're gonna do tomorrow. You know, here's what we're gonna do next year, and sometimes the future is kind of nebulous out there, so it's easy to talk about. I 

James Lott, PharmD, MPP: completely. Hmm. Yeah. And we're, um, I mean, again, we're working with customers who are, who, I mean, if I'm being honest, a lot of these people, they're so smart and motivated, you know, they can figure this out for themselves.

And I, honestly, I wish that there was more of a spotlight in our profession on these pharmacists that I'm talking with, because the naysayers of the profession, they might feel really. Um, you know, for complaining when they see these people and how. Their lights are about the profession. Now granted, there are different, completely different scenarios.

You know, these are independently owned pharmacists who set up their own, you know, they set up their own, um, culture. They set up their schedules, et cetera. They're not in control. I mean, they're in complete control of these versus our, our community friends who, you know, are, you know, they're just trying, They're really just trying to make it through the day sometimes, which is super unfortunate.

Um, yeah. These folks are still, they're still really, really, really doing great work in their communities. These independent pharmacy owners, some of them that we're working with, um, and just extremely inspiring. They're so inspir. 

Mike Koelzer, Host: A master in public policy. Do I have that right? Yeah. How did that come, You went to pharmacy school and then decided you're gonna go back for a master's 

James Lott, PharmD, MPP: in this?

Yes. I've never told this story before, but, um, Okay. So when I was a pharmacist, I legitimately loved my job and I had a, um, there was a stat where, you know, I had a mentor who was my. And she was amazing, and she decided to leave the company at a large chain. Um, she said she didn't like the way, she didn't like what the future held.

This was like 20 15, 20 16 maybe. And I got this new boss and, um, you know, this was a non pharmacist, um, you know, someone who was just stepping into the, you know, stepping into the role and probably didn't know what to do with somebody like me. Uh, somebody who's extremely ambitious and assertive and this, and.

Probably felt intimidated. I got, um, long story short, uh, we had some disagreements. I was disciplined and I didn't, I didn't like the way that felt because I knew I was just doing what was best for my patients and my team members. So I was like, I don't know if I wanna be a part of something like this.

What does a 

Mike Koelzer, Host: discipline means in that regard? 

James Lott, PharmD, MPP: This, again, just kind of back to the opioid crisis. In [00:20:00] our area, we were getting a lot of fake prescriptions. Mm-hmm. I called all the pharmacists, pharmacy managers at the stores near me to figure out if they were having the same issues as us. And they said, yeah.

And I asked them what they did and they were like, Oh, well we check IDs, we have signs put up that we check ID, and it deters a lot of it. And I was like, Oh, okay. Great idea. So I did the same thing. My boss told me to remove the sign. We couldn't check IDs. And I was like, Well, you know, If somebody filled that script, you know, illegally, I'm pretty sure you wanna fire me.

So what , what am I supposed to do here? Uh, . But long story short, I called the company to clarify to see if it was okay. And I think that she might have gotten an alarm that I had called the company. I wasn't trying to, you know, go after her. I just wanted to validate so I can keep everybody safe. But, uh, she retaliated, uh, my boss retaliated and.

and, and, uh, I got demoted from my store and manager and sent it to the float pool. And, um, Really? Yeah, that didn't 

Mike Koelzer, Host: make me feel good. That was your discipline. They, they yank you out of there and put you in the 

James Lott, PharmD, MPP: float. But also at the same time, I was looking to do something different. I actually, um, I went to midyear.

I tried to do the fellowship interviews. I got pretty far, uh, Um, didn't quite make it. And then I saw, you know, I, I was like there was only two options for me to go into industry potentially, or to go back to school and, and figure things out. Um, but I knew if I was gonna go back to school, it needed to be, you know, a school that, um, You know, the name spoke for itself.

You were gonna be around some of the smartest, most ambitious people in the world. Um, and I found that at University of Chicago, you know, at University of Chicago is kind of funny. It's so elite that only the elite people know about it. , they say, they say the smartest people in the world don't go to Harvard or Stanford.

They go to the University of Chicago. Is that. Yeah, which is a better question cuz I don't know why they let me in . But, um, , but it, it, it, it really is a really amazing school. Um, uh, it, it, it kind of fits my personality in some ways because it's kind of low profile, but, you know, but packs its weight for sure.

And, um, very rigorous for sure. 

Mike Koelzer, Host: Now, James, you weren't disciplined to the point where you weren't employable as a community pharmacist, right? You pulled yourself out of that market then? 

James Lott, PharmD, MPP: Yeah. Yeah, kind of. And I mean, I guess not entirely. I still worked, uh, for a couple more years. I worked as a manager at another company.

I kind of had this reputation for being a turnaround pharmacy. You send me to your worst store and I'll fix it up and get it right. I'll put the policies and compliance and I'll get people motivated. That was nice. They paid me a lot of money to do that. Actually. 

Mike Koelzer, Host: the Masters in public policy. Interesting.

Good choice. Would you have chosen something else in retrospect, or was it the right place to spend? A couple what? A couple years later. 

James Lott, PharmD, MPP: University of Chicago was the right school for me. I'm not sure if the Masters of Public Policy program was. Um, I'm not sure. For me personally, I had a ton of value. Actually, while I was at UChicago, I spent a ton of time at the business.

Hmm. Um, and if I hadn't thought that, you know, if I hadn't been, uh, completely incorrect in thinking that businesses are immoral and wrong and capitalistic society is terrible, I probably would've pursued a business degree and not a policy degree. But luckily, you, Chicago, are versatile enough to allow, uh, people to get, um, you know, a multitude of experiences.

So you could say I took like four classes at the business school and kind of made my, I kind of created my own degree. So yes, it was public policy. Also, um, integrated with a lot of, uh, foundational business, um, perspective as well. So, So you've kind 

Mike Koelzer, Host: of changed the mission of your endeavor to take the word social out of it.

You said that your view on business kept you out of the MBA program, and here you are now a business person that's like a triple whammy. So where did the strength come from? against business. And where was that turning point for you to say that you 

James Lott, PharmD, MPP: were wrong? I love that question. Um, well, I was wrong because of my own experiences.

If you, if you bust your butt and your job demos, you and your community loves you, and your employees love you, you know, you just feel like, Oh, and, and you're like, That's just how the world works. . Uh, but the problem is that man created that world. Man created that, that opportunity for that to happen like that, that's a man-made, uh, structure That is a big flaw.

Uh, but the thing is, PE people make businesses. So because people make businesses, um, you could create your own business in your own culture where you treat people well, you make them feel special [00:25:00] every single day. You celebrate them when they come and work for. This is one of the biggest reasons right now in pharmacy.

The perspective is so bleak because people are not being celebrated. Um, shout out to bled to. No, she, um, she just took on one of the most important fights of our professions in the last a hundred years. . Um, I am so thrilled to be able to, you know, we're, we're forming a relationship. She's really wonderful, but I'm embarrassed by our profession that one person has to take on that much burden and speak out for everybody.

But luckily, more people are stepping up and the impact that she and others are making is starting to definitely show 

Mike Koelzer, Host: up. When I spoke with Blood on the show, we were joking about how. that I, when I've made some more minor decisions in my career. Some people will say to you, it's like, Oh, you must get a lot of support from that, and bled and I left.

It's like, well, she hasn't gotten like a ton of job offers coming your way. Some people might say, Hey, wait a go, You know, But it's risky and yeah, the offers might. Come for people in that situation. But a company's not gonna throw a bunch of money at you just because they support the cause or the social cause.

They need to make sure there's dollar signs behind hiring you. And it's risky to step out like that and you know, way to go 

James Lott, PharmD, MPP: bled, way to go bled. And, um, here's what I will also say. because I was a social entrepreneur and I saw all of the challenges behind that. I never got away from that core of wanting to do better just to structure and the business economics of it had to look different at the end of the way.

And that's what I would challenge anyone to do. If you have that pure heart, that bleeding heart for change, um, you can definitely make a lot of noise doing it. Social entrepreneurship. But if you want it to be sustainable and scalable everywhere, you have to think about the business aspect.

You have to for sure. It's the only way to make sure it li li lives on forever. Um, and that's what I have had to condition myself to figure out over the last several years. And now I'm, I'm really proud of what, what we've been able to do. You even 

Mike Koelzer, Host: see it with things. Let's say that you have sprinkling at your house, you know, underground sprinkling, let's say.

And the one company you get every year to, let's say, winterize your sprinkling cost X, you know, And you can find another company who's kind of a, you know, a younger company, maybe it's a guy with a couple helpers and they started this up and so on, and maybe you can hire them every fall to do your sprinkler blowout.

And it. Point six x or something like that, you know, So the company's making money. It's not a social cause of blowing out sprinklers, but you know, they're lower cost and things like that. And then like a year or two goes by and you call 'em up. There's no one on the other line. You know, they didn't charge enough money.

Even to be a sprinkler blowout company, and it's like, all right, I guess I have to pay X because X is what it's gonna cost to keep a company in business so that they're there year after year after year. The companies have to make a profit to be sustainable. Exactly. 

James Lott, PharmD, MPP: Again, I know pharmacists are versatile and we're smart, but not all of us

I would say the majority of us, we don't have business acumen. Um, and it is not our fault. But it's definitely our responsibility to figure that out. Um, the pharmacists that complain a lot about the current state, uh, you know, I, again, I empathize with you so much. I was, I'm, I'm, I'm a community pharmacist first before anything else but the business, it, it's not sustainable.

I was looking at a, um, I was looking at a, a recent study that shows healthcare costs in the top 10, spending expenditures in he. And of the 10 expenditures, all of the healthcare costs rose except one. You wanna guess what that was? Medicine, Prescription Drug services. Yep. The only one of the top 10 expenditures in healthcare that was going down is prescription drugs.

Uh, CVS is closing down 900 stores. Walgreens is closing down a substantial amount of stores. Um, there's proof everywhere that the business is. working. Um, and again, I understand, I understand completely what it feels like, but the only savior that I see are, you know, clinical services because that margin that is, uh, potentially predictable and, and, and mostly profit.[00:30:00] 

you can't really compete with that versus drugs. You know, you might make $2 here, negative three 50 there, $6 there. That's two. That's not, that's, that's not, Nobody's winning from that. We haven't even factored in the competition, online competition, which is about to become enormous. So we already have declining profitability and Amazon and Mark Cuban haven't even.

They haven't even put their foot on the gas yet. So the trends are not in our favor. They're not in our favor. Now, am I completely, um, am I going with the doom and gloom perspective? No, but only because I'm optimistic. But there is a case for that if pharmacists don't shift quickly to this new business opportunity of providing care for common conditions.

At scale then Yeah, the future could look very, very bleak. And a lot of pharmacy folks are gonna be jobless,and a lot of communities are not gonna be very healthy. So we gotta get a hold on this quickly. And again, the whole buzzword of the future of pharmacy, we need to be on the same path together. We don't have 

Mike Koelzer, Host: time to waste.

It does come quickly. I mean, all of us can remember. well Old farts. Maybe we can all remember. Seems like yesterday when you were going to Blockbuster and looking around for videos and so on, it's quick. It happens quickly. 

James Lott, PharmD, MPP: Absolutely. 

Mike Koelzer, Host: Talking about businesses and how you got a bad taste in your mouth, you know, because of this one manager and boy, it makes me think too, kind of the opposite way of how I'll sit to bitch about the PBMs and I think as a whole, I think.

PBMs are evil, what they're doing, You know, opaque PBMs, what they're doing to pharmacists and patients and things like that. But in general, when you look at individual employees, it's kind of the opposite of what you were saying. In my mind, I've got this evil business, but each individual person you pull out of there.

Kind of a nice person and they don't, as an individual, they don't set up all these policies. It comes from groupthink and a board and investors and all that stuff that really makes that whole industry evil. But it's interesting how you can come at it from so many different angles because in your side, you know, the one person made this maybe our.

Benign industry seems evil and in, and in my case, in looking at the pbm, it's like there's this evil industry and one person could kind of make it look good on an individual level. So boy, there's so much there about our perceptions because of what we're dealing with on a local level. 

James Lott, PharmD, MPP: Absolutely. No, I, I completely agree.

And you know, I know folks in the PBO space and. These folks are bright . That, that, that machine, that machine is, um, it, it's, it, it attracts some bright people probably because the business model is absolutely genius. However, that business model is extremely toxic in what it does to industries and, and, and pharmacists and sometimes even patients.

Um, it, it's. . Yeah. I, I, I don't even know. I have so many emotions and thoughts on that. 

Mike Koelzer, Host: Sometimes part of my staff and I will connive about how we can screw the PBMs back, you know, by these little tricks. We have everything legal, but if we can find a loophole and things like that. But I joke with my staff, I'm like, We think we're conniving.

The PBM hires the best damn can. IRS you could think. So when you say someone's bright, do you mean they're bright at being shifty? Is that what you're getting at? They're bright at knowing how to screw people, or do you see a brighter talent other than just Yeah. Screwing people? 

James Lott, PharmD, MPP: I think, I think that's, well, I think that's well taken.

Um, I think that these people are bright for business. Um, if you put these people in a room to solve problems, they're going to come up with an. Um, they're gonna come up with an answer. And I also know these people and when they're, when they're doing their job, they're not thinking about how it's going to impact, you know, um, small town USA Pharmacy, they're just thinking about how to make more profit because that's the problem that they were given to solve.

Mike Koelzer, Host: My nephew, he's, uh, like a freshman in college. We were sitting around with our family camping a couple years ago, and I think he likes to rile the [00:35:00] uncles up and stuff, but he said that he was smarter than Einstein was. And we're like, Danny, you're not smarter than Einstein. He's like, Yeah, I am. You know?

Because he said, I can pull up my phone and I can do all this stuff. And he said, Einstein didn't know all that. I'm like, Yeah, but Einstein can think better than you can Dan. And he's like, No. IQs go up, you know, 10 points every generation and this and that. So I'm smarter than S ninth. You're not smarter than Einstein.

But here's what I was thinking though a couple weeks ago. I've got this narcissistic attitude that I think I'm smarter than a lot of people, and I have no way to prove that. And if someone seems to be smarter than me, I always shrug it off as saying, Well, they're smart in that field, you know? How do you tell when someone is smart?

How do you know that when you say a business person is smart, how would you make that? Yeah. Judgment. Why do you say that? Because I'm trying to bring myself down a few notches with some humility and maybe I can learn from you. No, that's 

James Lott, PharmD, MPP: a good question. Um, I think that from my own perspective, when someone is.

at business. And I think that you can be smart at different things. You can be smart at basketball, you can be smart at, you know, um, gardening. But when you're smart at business especially, um, when it comes to these things, you're able to take large amounts of, you know, inputs, data systems, uh, thinking and be able to digest that, understand it, and come out with solutions that will focus on sustainability.

What I think needs to happen is that we need some of these smart people to work with independent pharmacies so that we could figure out ways to move them forward and, you know, kind of take some of the things that they're doing. Um, that is working, double down on it and then kind of scale that across the board.

So we need some of that smartness to come back in our industry. And there's another really big problem in our industry. Um, our industry is mostly led by large chain pharmacies whose business model is completely different from everybody else's. Yeah. Their business model is to bring patients in the store at any cost and just get them to spend money.

It doesn't matter where they spend money. Just spend money because we're gonna make margins on all of them. If the pharmacy is the ration for them to come into the store, then they have succeeded. Part of 

Mike Koelzer, Host: Their game plan is to say, you know, we're smart chain people and over the next five years we predict that we're going to get an extra, you know, 300% foot traffic.

In order to do that, we have to do B and c. And D is finding ways to lower the reimbursement of. Our prescriptions, we're gonna lower it on purpose because that's gonna help that 300% foot traffic to come in. So they don't care. They see the big picture. They don't care what the pharmacy reimbursement is.

I mean, I don't know the ins and outs of course, but in general, they can say if they're gonna make it on, you know, helium balloons or on, you know, greeting cards or something like that. If all of a sudden that's a big market. They'll sell out pharmacies. They don't care. 

James Lott, PharmD, MPP: Unfortunately, you're probably correct.

I'm back on 

Mike Koelzer, Host: the smart people here. All right, so it might be a situation where you've heard the same input they do, and all of a sudden they say to you, James, here's how you look at it. Blah, blah, blah. And then you. Oh yeah, I didn't think about it that way. Right. You're kind of comparing apples to apples and they might come up with something that you don't even think 

James Lott, PharmD, MPP: about.

That's, that's absolutely correct. In fact, you know, some of my ambitions have been to understand, um, how a company like GoodRx works, a very common question amongst people who have time to think or just kind of care about these systems. It's like Goodrx, how do they make money? And if you kind of go on the back, A lot of 'em is kind of all of this finding and all of these are kind of complex, um, you know, and strategic, uh, connecting, uh, with PBMs and contracts and loopholes.

Um, and that's how they're, they're able to make money without. A very sophisticated product. It's just something that is a loophole and connecting contracts that have, uh, that and, and extracting the margin from it to, to make profit for themselves. Um, and so again, like this is something I ask my PBM friends, um, but they teach me a lot more than that.

Um, for sure. Um, I am, I am, [00:40:00] um, and, and maybe this is where my, me being naive sometimes comes in. But I think I am cautiously optimistic that we'll eventually get some type of handle, um, on, you know, what PBMs are doing to independent pharmacies, um, over the next decade. But I guess a better question would be, do we even have a decade to, to battle that's them, You know, do we have a decade to battle with, with PBMs?

Uh, a lot of people would probably, you know, be mad at me for saying that, and I think that's fair too. But I, I'm, I just believe in people who are passionate. And serious about solving problems, uh, when they all kind of come together collectively to, to solve the problems that they have 

Mike Koelzer, Host: in Michigan, they just passed a PBM law like two days ago, and it's not going into effect to like 2024 and 2025, and that just seems

It's not a decade, it's like a year and a half. He was too far away even. Here's what sucks about these Smart PBM people if you said it yourself. They're these smart PBM folks and they can break stuff down and make it look easy. They use that skill to make it opaque. They use their brains. To understand how to make it smoke in mirrors and make it more complicated, because that's their key to all this.

You know, they can take something easy, make it complicated, and then sell it as a complicated thing too. Politicians, and you know, when you're selling it to corporation owners to buy insurance and so on, their goal is to make it as confusing as they can. And so the smart minds who can break down anything, have used that skill and talent to make it the most confusing market in the 

James Lott, PharmD, MPP: world.

And defensible. 

Mike Koelzer, Host: And defensible because it's so confusing. No judge can pick it apart, right? 

James Lott, PharmD, MPP: Absolutely. It's so complex. That it requires an enormous amount of expertise to even understand what's actually 

Mike Koelzer, Host: happening. I was talking to one of the guys on our team, and I was saying that they're like, Well, is this Michigan law gonna solve everything?

I'm like, I don't know, we might even get the same reimbursement. But I said, I think what it does is it starts to chip away at that confusion. You know? So instead of a DIR fee, you know, it's like they have to get that up front, you know, And instead of this and that fee, they can't do it, then they gotta do it here.

So it's one step maybe, and clearing at least making things transparent, at least letting people see you getting screwed by them, and they know what's happening. . James, what's your biggest weakness in all of this? 

James Lott, PharmD, MPP: That's a great question. So, um, Mike, I'm gonna be honest, this is, this is hard. This is really, really hard.

Every time you think you figure something out, they throw another curve ball at you. Um, you know, you would think that you just put some software together. You say, Here you go. Use it and you know, you've, you know, you've done your job as a founder, you've done your job as a ceo. That's not what's happening.

You know, pharmacy is the most regulated profession in one of the most regulated industries. Mm-hmm. , and you have 50 states and 50 different laws. Every pharmacy needs a solution that works for them, but also works for other pharmacies that look completely different. And it's just like the amount of grit that it takes to kind of, you know, again, go into this future that we're trying to provide.

Uh, sometimes I wonder if, if, if the, the cost is more than I actually have in the tank. You know, ? Mm-hmm. . Um, so you have to love it. I. , but it doesn't make it any more challenging. You know, there's definitely, this is definitely challenging. How would that 

Mike Koelzer, Host: present itself in you? Would you get burned out? Would you get depressed?

Would you get anxious because you can't handle it all? Does it bring you down at all because of those challenges? 

James Lott, PharmD, MPP: I've definitely, I've definitely, um, I've taken my licks from this, that's for sure. Um, this has taught me a lot about. And, um, about the importance of like, you know, drawing lines in the sand for my personal life so that I can, you know, keep this going and be the leader that my team needs me to be.

Because this takes a unique leader. You can't just [00:45:00] throw any CEO and in this, in. Dragon fights and expect them to come out, you know, winning. So I have had to learn how to be able to take care of myself and, and, um, and also like this company, , uh, at the same time, because we're not just, it's not a, it's not even a company.

This is a movement. This is something that we need. We need the entire community to adapt, adopt this approach. Um, and once that happens, then we know that we're on the right path. Uh, but having customers here, customers there, like, you know, this is some, you know, uh, product, like a laundry detergent product, and no, no, that's not what you need.

We need the entire community to get behind this, for this to work. Otherwise, you know, it's not going to, so, What's attempting 

Mike Koelzer, Host: barrier? When you talk about a boundary, what's an attempted barrier for you that you're like, Oh, I, I know I would maybe feel good momentarily if I could do this. If I could go beyond this barrier, I'd set for myself this boundary.

But you say Every time I cross the damn boundary though I get hurt. You know, I get less of me. What boundary is that Temptation that. Feel like you want to give more sometimes, but you know, you have to stop yourself. 

James Lott, PharmD, MPP: So I, I see myself as a disciplined person and a lot of, a lot of the wins that I've had in life is because, become, because of my discipline.

When you work at a startup, a lot of things change, and this is a beast that you. ever seen before, you're creating something in the world that's never existed and the world's first responses to reject it. But you have to convince the world otherwise. And so that's hard. Um, and when you're doing that, you gotta take time for yourself, so that you can rest up, recharge and you know, go back.

But. you have. I'm a non-technical founder, which means I don't know how to code, but I have to convince, you know, these expensive developers to develop my vision for the world, and how are you gonna do that without working hundred hours a week? So I worked hundreds of hours a week for years. Now that takes a toll on you, for sure.

um, to try to make this thing come to life and try to change people's minds. And we're getting traction now, but definitely at a cost of, of me and all of my early employees. Uh, but you know, that's just again, why I try to push for such a healthy culture in our company. And I have a great team that helps me do it as well.

We care about each other. We try to take care of each other. Do you ever feel lonely? Being a founder is incredibly lonely. Um, for sure. There's no doubt about it. I'm okay , but it's incredibly lonely. It's just there's not that many people in the world who understand what you do. And when people see you, they just see you for what you put out in the world.

They're not, you know, they don't check up on you, which is, which is, luckily I have friends that do, they care about me, Um, they check up on me. Um, but yeah, being a, being a founder is, is incredibly difficult and hard. Um, that's why most founders have co-founders. They have, you know, two or other three people that they have tried to, um, that they've, they've come up with the idea with.

And even none. They're still, they're still lonely, but less , less so than being like a sole founder. 

Mike Koelzer, Host: So, it's interesting you say that. Do you have that? Do you consider yourself a soul? I'm a sole 

James Lott, PharmD, MPP: founder. 

Mike Koelzer, Host: Correct. I was talking to a, i, I think it was FLA view from Troy Medicare. I was talking to him and I, and I was telling him how, I would hate to have a co-founder in terms of I just want to be my own guy and just do my thing.

And he was saying exactly what you said. It's really interesting you brought that up because he said it's lonely with those kinds of hours. And a, a co-founder, if you're the person that would respond well to this as someone to walk through some of that loneliness with you, James. What would be your message to a graduating class of pharmacists?

James Lott, PharmD, MPP: My message to them would be, it's gonna be a combination of reality and hope. The reality is that our profession is struggling because of the decisions people that are not pharmacists have made about our profession, [00:50:00] and we allowed them. . to The hope is because the hope is that we can fix this by being innovative and being valuable and helpful to our communities.

Doing things that are not counting pills, but helping patients in their own journeys to achieve health. And we're perfectly in line to do this for the simple.

and I want pharmacists to start taking a more active role in deciding what the future of their profession looks like. 

Mike Koelzer, Host: Are they giving up any security? Any dollars? Are we asking them not to be lazy? I mean, what are they giving up to carry this mission 

out 

James Lott, PharmD, MPP: in the current world today, if you asked them to do.

I think that you'd have more people leave the profession, to be honest with you. Hmm. They're tired. Tired. They're tired of these enormous expectations put on them without the tools to be successful. They need investment. They need investment into their future. Um, and they need divestment from things that don't, that, that have never worked.

Pharmacists should have always been helping out in the community and doing clinical stuff. They should have always been doing that. I don't know whose idea was that filling more prescriptions was gonna be the answer. That was a bad idea. Now, out again, we've done a lot of research and spent a lot of time working with pharmacists so that when.

They're asked to do more. They know that they're going to be supported with the right tools because again, I mean, I was just going back on social media a couple, uh, maybe last week, and whenever I hear anybody ranting about the expectations and they, and, and find the, the solutions, they often bring up clinical services, but then they immediately.

but they're asking us to do it without giving us tools. That's 

Mike Koelzer, Host: the thing. Everybody can help, but it's like, And wants to help and wants to help. It's just this nebulous, like where do we start? It feels like everybody has to invent the wheel 

James Lott, PharmD, MPP: That, and that's exactly why scripted by Script Health exists today.

We, we have the will here you go. Have fun using it. I think you're gonna get a lot of enjoyment from it. You're gonna on the other side of this is gonna be a better version of yourself as a pharmacist. That's the, That's what we're going for. Well, James, 

Mike Koelzer, Host: golly, you're putting out hope at scale. I'm eager to see what you come up with.

It's a great looking site, and I can tell there's a lot of expertise that went into it to make it look simple from this end, which it's certainly not in reality. Great meeting you. Thanks for all you do. 

James Lott, PharmD, MPP: Thank you so much for the 

Mike Koelzer, Host: opportunity here, Mike. Fun talking to you and we'll talk again. We'll be following closely.

We'll see your friend.