The Business of Deprescribing | DeLon Canterbury, PharmD, BCGP, GeriatRx

Speech to text:

Mike Koelzer, Host: [00:00:25] DeLon for those that haven't come across you online, introduce yourself and tell our listeners what we're talking about 

DeLon Canterbury, PharmD: today. My name is Dr. DeLon Canterbury. I am a geriatric pharmacist and founder of geriatrics. Our focus is to get any overmedicated adults off of harmful meds while improving quality of life and hopefully saving them some money in the process.

Today, we're going to talk about the business of deep prescribing, how clinicians can actually leverage deep prescribing and grow their practice while improving quality outcomes for their patients. 

Mike Koelzer, Host: Dylan. If somebody came into this and they heard us talking, they would think we were crazy talking about how to make money by prescribing less.

Now our listeners kind of get the idea, but let's say someone was new to pharmacy and they came in here. They would say, what in the world are you talking about deep prescribing 

DeLon Canterbury, PharmD: in our country? We love each other. Our fee for service model. We love to build those copays and get, um, our payment reimbursements from what the patients are getting out of.

D prescribing is literally a movement. It's more than just stopping medication. It's showing our health system how we can minimize costs using cost avoidance. So not just, okay, let's stop some harmful meds, but how are we lowering readmission rates and heart failure patients who are taking too many assets.

Right? For example, how are we quantified? The costs say for the patient, who's paying out of pocket for a myth that they may not really need anymore. As you may know, there's a lot of clinical inertia. There are tons of ways where men are just kept on for years and years. And pharmacists have the perfect opportunity to leverage their skills already as natural D prescribers to really show how they can market this to patients.

For a flat fee or retainer fee and still improve those quality measures that the patients want to begin. 

Mike Koelzer, Host: Well, when I hear about deep prescribing, I think about some old person just getting Gabs and medicine. And for some reason I pictured the elder daughter as the one coming to you and saying, we don't think she needs all this stuff.

We know it's not the son doing it. Because my sons don't care. They're just, you know, but it seems that the older daughter who had. Search you out. Who's looking for you? 

DeLon Canterbury, PharmD: You are spot on. A majority of patients who reach out to me are female and yes, they are the female caregivers. And they usually are the daughters of the loved one who they're worried about.

So most of my patients are generally female caregivers. Yes. So you're spot on. It's exactly how I got my very first patient whose mom. Unfortunately, it was on 36 medications in a nursing home. So they thought she was overmedicated. They literally thought she was a walking zombie. She was just comatose, unresponsive, kind of just drooling in her room and they felt she was wasting away.

And so it was a blessing that they reached out to me and we were able to deeply prescribe them from 36 medications down to eight medications. Get her back to her normal sale when 

Mike Koelzer, Host: they come to you, I'm sure they don't come to you and just spell it out cleanly. It seems like they come to you and they're blaming someone.

I'm not saying the blame is correct, but when they come to you, who gets the brunt of that, are they complaining because there's so many doctors or the nursing homes not listening to them or the one doctor's not listening to them or the nurses are screwing something up who seems to get the brunt of that.

DeLon Canterbury, PharmD: I would say the primary care doctor gets the brunt of the blame. And at times it's undone. They're big beef really comes with the entire healthcare system, right. 

Mike Koelzer, Host: Everybody under the 

DeLon Canterbury, PharmD: bus, right. It's, it's easy to say it's all your doctor's fault. Half of the time they're just catching on or they're carrying on a case that was passed on to them.

And now they're stuck with trying to figure out how to help you. And. When they go about that, I try to reeducate and say, look, it's really a systems wide issue. Okay. Over-medicating over prescribing is in their DNA. It's literally our healthcare model to treat and diagnose. That's how we get paid, but that's also how we know to treat.

But we don't think about whether what we're treating is the heart, or is the causative agent. And that's, again, comes from. Change in our medication mindset, you know, how we respond to meds, how we think about meds in the first place. And my eyes should be a last ditch effort. Uh, but patients are quick to say it's all the doctor's [00:05:25] fault, but really it's the system and their hands are generally tied with 15 minutes to see a patient and then an ongoing list of things to do before you're out the door.

And so it's a very difficult work set. We see. 

Mike Koelzer, Host: I know you're more one-on-one. Have you had luck with the bigger models of telling an insurer you're going to save them this much? And so on. I am still in 

DeLon Canterbury, PharmD: the process of doing that. I'm thinking about working more with these small business insurers, um, and that, that is a goal probably in the next year that I'll be addressing, working more with quality improvement networks.

These are third party agents that work. Under Medicare to say, reduce like opioids in a nursing home, et cetera. And they look for those types of metrics. So there are programs that literally do this. It's not verbalized as the prescribing, but they call it say quality improvement or, you know, there's other ways that you can look for it.

Um, but that is a goal. Um, ultimately I am more focused on getting this into our provider's mind first because. Even though these are big name companies, they may be insurers. They want this, they need this. They're not sure how to look for it. So I want our providers to at least have a foundation. And I'm finding that most people don't even know what the hell deep prescribing is.

Mike Koelzer, Host: The insurance companies want to save money. Are you saying they're already hiring consultants to lower costs and you could somehow maybe. We get in through the backdoor with one of those companies that's already doing that and you'd help them out with the pharmacy side 

DeLon Canterbury, PharmD: of things more. Absolutely. There are companies that do this, they make a living off of this and millions are spent on getting consultants to find ways to reduce costs and improve outcomes.

And so we already have stuff like Hedis measures and metrics. We see thick picks and et cetera. Um, but you can still find ways to do this from a. Down policy with these insurers. So I know I've found that United healthcare tends to be very progressive in giving that more concierge feel to their patients.

And I've been in talks with United healthcare about doing something like that, as well as an added value service. And again, it's doable. If you're showing this level of care, you're reducing X, Y, and Z. If you're reducing, say a set number of pills, Per group of patients you're working with, uh, that all looks good to the insurers.

And when they see that the budget sheet said, Hey, we've actually saved money and their patients are still good. Again, that is the perfect opportunity for pharmacists, especially to, to capitalize on. 

Mike Koelzer, Host: I think there's psychology behind people not wanting to pay money. To save money. They want to save money on something.

They can hold, they don't want it on something that they're not holding, but they would've spent, it's a whole psychology of sunk costs and all those kinds of things. I'm not smart enough to explain all that, even to myself, you know, to understand that, but it's sometimes a hard sell and I think the way you have to sell that is with a lot of.

Data. And you've got to compare year over year and look at, this is truly what you would have spent because why would you not have spent that, you know, and then prove that you're the one that's doing that for that. 

DeLon Canterbury, PharmD: Oh yeah. Uh, and you're right, Mike, it can be a hard sell particularly to patients, but when you are able to convey the value that you're bringing, when you're able to say I have saved, and this is a true story, I, that very same patient on 36.

What I've been forced into a nursing home, had I not interceded and given a full medication D prescribing plan. 

Mike Koelzer, Host: Is it fair to say, this is your first taste in your own business stuff. And then will you replace yourself on this or do you enjoy the mix of it? And so on of being the, the business owner and also the practitioner, 

DeLon Canterbury, PharmD: uh, business is definitely not for the weak.

I was always interested in it. But I definitely didn't feel like I came in knowing everything about business. I was a pharmacy manager with Walgreens for about five, six years. So that does help you understand, like those spreadsheets, what you're moving with metrics, you know how to drive a team. All those soft skills were critical for my growth today.

And I'll tell you, I love being an entrepreneur, man. I, I. The state of freedom. I have, I love being my own boss. Um, I love being a clinician. I do admit there are pieces to the business. I'm like, Ugh, I don't want to do that because that's not what I enjoy doing. For instance, I don't enjoy pubbing stuff all over social media, however, that is integral to my business.

So while I say. Was I ready for this? No, I was not ready. Uh, but I do love the thrill of adventure. I face each day. I love the impact and knowing that I have my own patients, my own clients, my own referrals who come to me and vouch for me, and I could track my [00:10:25] data because they are telling me how much better things are since I've been with them.

So that joy. I feel what was lacking in the world of retail pharmacy. For me, I didn't have that joy. It was just for someone else's metrics, not mine. 

Mike Koelzer, Host: You do a real nice job on social 

DeLon Canterbury, PharmD: media. Well, thank you. Thank you, man. I 

Mike Koelzer, Host: appreciate that. I like your stuff. It's always, I don't know. It might be because you're so handsome, but it's always nice and clean.

Yeah. I don't know how to explain that. Better than that. It's clean. It's very, um, I'm trying to think of the right adjective for. Tight. I think some of it actually goes to the quality of things like photographs and things. I think we don't think about that, but I think your photos are always tight. You must have a photographer.

Is that 

DeLon Canterbury, PharmD: right? I do. Uh, I do. He's a friend of mine. He does a lot of my professional stuff. Of course he I'm actually doing another shoot with him next Sunday. But yeah, I do. And I'm not saying everyone needs that. A lot of it is consistency, Mike and practice. And again, I wasn't the 30 day live challenge guy, but what inspired me was getting coaches who encouraged me to start being more vocal, being more consistent, even if it's a minute, a day, two minutes a day.

And just talk about anything related to. Over prescribing or whatever you're seeing as the problem. And that really was what started it. I was like, okay, I'll do it. I'll try. I don't like doing stuff live, but I did. And this was maybe two years ago and it's been the best thing ever since about two weeks of me doing that, I got so comfortable with just putting it on and talking about issues.

It's growing my brand. And in fact, that's where, that's where most of my clients. 

Mike Koelzer, Host: The 

The benefit of that is twelves. Two-fold you just said that people see you more, but then you get more confident and you actually then start coming up with more ideas, even you're like, oh, I talked, oh yeah, maybe I'll talk about this too.

And it snowballs from so many different angles. Mm Hmm. 

DeLon Canterbury, PharmD: Yeah. I mean, it is so crazy, Mike, because. i Did not envision that me doing these lives would lead to me having a segment on the radio show with the Chicago crusaders or being on PBS for black issues, forum, to talk about COVID or being asked about the Johnson Johnson vaccine pause like this has led to media attention from just the stuff I did on social media.

So it's crazy. I'm actually now in toxic becoming a pharmacist on retainer for a local news station to do like maybe a weekly excerpt on, on over-medicating, on their channel. So all from going live on site on Facebook. Right. So I didn't see this coming at all, but it's been a, it's been a. 

Mike Koelzer, Host: Well, 

talking about making jobs easier, you know, for like these doctors think of how you can make someone's job easier at a local news station.

They know that you are going to do well in front of a camera. You know, you're not going to be stuttering your words. They know you have good lighting, not only good lighting, but they know that you appreciate those kinds of things. And so it makes their job a hell of a lot. Easier to just say, oh, call DeLon. He can do it and not take away your content, but I'm just saying they don't have. Deal with all the other crap. They know that you're going to give them a quality product every 

time. 

DeLon Canterbury, PharmD: Right. It's true. And when you get real close with these anchors and producers, they don't forget. And they're like, okay, we got them for next time.

And you, they, they, they keep you in the circle. And so you get invited for talks and more engagements and all of that. Subsequently I built my brand and I never thought I would be a paid guest speaker, but now that's a part of my business too. I could leverage that as a way to also grow revenue. So it's awesome.

Those are local news places. They are their local news places. I've also done other things. Like I've done COVID panels in Arkansas and other news forum platforms elsewhere across the country. But it's yeah, it's been, it's been everywhere that 

Mike Koelzer, Host: local stuff, when they can get their hands on somebody local that can help them out.

They want the local stuff that is really important to them because there's a ton of people who could do stuff better than I could. Let's say the news calls and wants a story. Well, one, they know they can get to me because they don't have to go through a bunch of red tape with all the corporate stuff.

When they get to the edge of that red tape. Now they're talking to someone instead of talking to a local person in Michigan, they're talking to the headquarters in Chicago. And then by definition, that blows the local news story. 

DeLon Canterbury, PharmD: Yeah. And we forget that these networks are syndicated. So like, if there's something really hot here, like you just said, um, it can go to a mom and mother of the organization in that syndicate and it could be passed onto another higher producer and that can also lead to garnishing national attention.

Um, I haven't [00:15:25] quite gotten there, but, um, I, I've definitely been in the room with those, with those people to have those conversations. And it's cool to see it happen in real life. 

Mike Koelzer, Host: If you're like me and someone has invited you to something and you're lying there at night, then you start dreaming about stuff and you start saying, Hey, I did this for this station and you always go the next step up.

You know, you're always thinking about the next step up. What would be really cool for you? I mean, getting a call from, I don't even know the people's names anymore, but getting a call from NBC news and you're going to be on their morning show. Where does your mind take you with that? And don't tell me 

DeLon Canterbury, PharmD: it has it.

Uh, no, it has . I've had quite a few, my colleagues and coaches be like, you're going to be the next, uh, that correspondent on CNN, the Indian guy. I forgot his name. Yes, yes, yes, yeah, yeah, yeah, yeah. Sanjay Gupta. He was like, do you remember the next time? Because I was talking about COVID with all the time, right?

I was doing COVID, uh, town halls and panel and radio shows and discussions all local for me. Uh, and just so you know, Mike, I actually had, uh, I had a radio show for about. About four or five months last year, it was based out of Chicago. It was with the America's heroes group. And it's a group of veteran caregivers who provide content for their senior seniors and caregivers in Chicago.

So I did it for a month. Uh, show on over prescribing how to leverage pharmacists, et cetera. For me, I want to be the Clark Howard of pharmacists. Okay. I want to be the number one stop for deep prescribing across the entire country. So I want literally a podcast or radio show or TV show that literally talks about.

Over-medicating how to stop it, how to leverage pharmacists, how to use a team-based approach and whether it's NBC, frankly, it'd be my own show. It doesn't have to be a network, but I see it as being on, uh, uh, the NPR. I see this being pretty much on like Dr. Oz hill, even though I don't like his work at all, but you know, I see it being nationally syndicated if need be.

So 

Mike Koelzer, Host: I've been around. It's been a long time and I've heard a lot about MTMs and polypharmacy and all that. And I guess I've heard about deep prescribing, but I can't really put a face to it. Dylan, except for yours. Do you think a lot of people are using that terminology or do you seem to have more of a corner on that?

And I probably have listeners that are going to say you should've seen my stuff, you know, but for some reason, and it might just be because you did a damn good job of keeping in touch with me when you're commenting on the podcasts and stuff like that. And what a great job you've done on social media.

While raising my awareness of you. I mean, I'm a little thing, but I mean, you've raised awareness by touching me somehow. And so maybe that's why you're the face of deep prescribing, but is it a common phrase? 

DeLon Canterbury, PharmD: It's a good question. I feel as if our. Lay members like patients wouldn't really know that term.

You have to kind of re-educate and say that safety providers are well aware of the concept, but they don't really know how. And to say that I'm the face. Flattering trust, but I know there are tons of pharmacists who are D prescribers, but they're not quite using the verbiage. They're just saying they may use it in different ways.

Right? There are so many, uh, consultants, pharmacists who work in like stips and LTCs, um, they have pharmacists who are holistic, like functional medicine, pharmacists, and so in different avenues, they are technically deep prescribing. 

Mike Koelzer, Host: When you think of LinkedIn, Is there anybody that you envy slash you think is in front of you?

Using the deep prescribing niche who's using that word actually. Can you think of, and don't give me the name, but can you think of anybody else that you're like, oh, he's doing it too, or she's doing it too. And I want to, well, in my mind, I would say I want to catch them, but I mean, is there anybody that comes to mind that is focusing on that one verb D prescribing more than.

DeLon Canterbury, PharmD: Um, there are people who discuss it like me. There is no one who discusses it more than me, to your knowledge, to my knowledge, I am the face of D prescribing. Now, again, I don't want to give away credit. I'm a young man. So I feel like there's so many out there who are doing it, but I am constantly talking about D prescribing 

Mike Koelzer, Host: People need the first person.

That's why Neil Armstrong is more popular than the fourth guy on the moon. [00:20:25] They know the first guy on the moon, you either have to be first or you have to be first in people's minds. And so you might not have been the first, but if you're the second and you grew fast. So all of a sudden, you're the first in people's mind, then that's a great spot.

DeLon Canterbury, PharmD: It's actually hilarious that you asked me that because I literally searched within LinkedIn last night, D prescribe and D prescribing, just to see who else is talking about it. So I'm telling you. No one is posting. Like I am about deprescribing There are a couple from my colleagues, but. When I searched deep prescribing, deep prescribing, it's all me.

And then like later on, you may see like some, the deep prescribing network of Canada or the U S but that's it. And Dylan, 

Mike Koelzer, Host: You don't need me telling you this because you've already done it. So I'm just the one coming along and shining a light on you. But you gotta take that word. What you've done that deprescribing just plow it through.

And I think, I think. It's because of the alliteration where your first name starts with it. And it's not like your name starts with it. Just like if your name was Derrick like D E R R you know, it's D E and then Lon is like the capital. So it's like, you're like online, you know what I'm saying?

DeLon Canterbury, PharmD: Yeah. I never saw it that way. It actually works. So you're right. 

Mike Koelzer, Host: You know, think of the companies that have owned words, you own the adjective, just like Coke is the real thing you own deep prescribing. You own it now. And it goes with the Dylon. It's fascinating to allow me to go cool 

DeLon Canterbury, PharmD: with that. I'm going to get a trademark.

Thank you, Mike. I'm gonna do that next. 

Mike Koelzer, Host: All right. So now that you've conquered the world with your deep prescribing, speaking about the world, I saw on your website. I think telehealth. Are you doing some of that? Through the internet what's stopping you, or why don't you say that your nationwide or something like 

DeLon Canterbury, PharmD: that?

Technical. I am nationwide, I guess I haven't been really verbalizing that. Uh, but 

Mike Koelzer, Host: You know, because I saw on your website, it's kind of focused more on. Durham area Raleigh, North Carolina 

DeLon Canterbury, PharmD: area that is more for patients when it comes to the deep prescribing movement. I'm leading, that's more of a national thing.

And, you know, that's only because of licensing. I'm based in North Carolina, but when it comes to teaching the prescription, that is a nationwide mission and I will be known nationwide for that. So maybe I got some tweaking to do on the 

Mike Koelzer, Host: website, as you keep growing nationally, that can be your. Kind of your landing page versus your services page or something like that.

And 

DeLon Canterbury, PharmD: that's the thing I made that website with no idea of the prescribing as an accelerator. With my coaching program in mind, it was simple. What I do for patients one-on-one so it was tailored more to local patients, uh, but I've had that website for what, two years. And so I'm now I'm still, I'm always re-editing it, but ultimately, yes, it will be a landing page for our deep prescribing accelerator and getting more and more clinicians involved, uh, nurses, pharmacists, uh, providers, social workers in this movement.

Mike Koelzer, Host: I think that's too small. Here's what I'm seeing. And again, you've, you've already seen this. I'm just pointing out what you've already seen. There's a hole that's still there for a pharmacist to come in, be on every stinking TV show in the country and saying, I'm the pharmacist. That deep prescription and the whole audience, you know, is pretending like they're in shock, you know?

And then they clap for you and stuff like that. But I don't know of a pharmacist. You're like the pharmacist that's taking on the world, kind of like doing the opposite. Maybe there's a face out there for it. We talked about, is there a face on LinkedIn for it? Is there a national face that comes to mind?

Is there a face that comes to your mind that says I'm the. Uncola pharmacist. I'm the pharmacist that does the opposite. Is there a face of that that comes to your mind that doesn't come to my mind? 

DeLon Canterbury, PharmD: Uh, only my beautiful face comes to mind. Honestly, Mike, see, I told you only mine. I mean, I've, I've already had national reach.

I mean, Build an army, a D prescribers are there with our accelerator. I've got cohort members in South Dakota, Texas, and North Carolina, who are all leading the charge and making their own deep prescribing conferences, their own deep prescribing summits. They're integrating deep prescribing as a value service.

So even with that stuff, And a three, they're going to be touching hundreds of more lives down the road. So [00:25:25] let's imagine how we can, uh, expand upon that. And yes, this can be translated into a national syndication. Uh, podcast. That will be me. That's inevitable for me. I'm not worried about that. I'm more focused on getting this into people's communities now, and notoriety is great.

I love it, but I need it. For our system to change sooner than 

Mike Koelzer, Host: later. See, I'm always looking at the fame side, so, 

DeLon Canterbury, PharmD: Well, I need you on my PR team. I need you in my PR I 

Mike Koelzer, Host: ain't no good at it. I just think it's fascinating. All right. So let me backup a step then. So we talked about. Capital D small E matching up with the deep prescribing and all that.

That'd be a fun thing. And then are people paying you to learn to do what you're doing or is that just a hope of 

DeLon Canterbury, PharmD: yours? Oh yes. They are paying for that. Uh, yes. So that's a part of our three-month program. It's a coaching and training program where it will actually be CE accredited pretty soon for pharmacists and nurses, et cetera.

Mike Koelzer, Host: Was it ever tempting for you to say. I'm Dylan, I've got 50 employees. Let's say one from each state, who's actually doing this work and you're making a cutoff of that. Did you ever think about doing kind of a 

DeLon Canterbury, PharmD: sounds like you're referring to a franchise. Maybe not 

Mike Koelzer, Host: Even a franchise, maybe they're just your employees that you've got 50 people on telemedicine and they're talking to doctors and you're paying the pharmacist to be there, but that's all, you're getting a cut of all this, not a franchise.

Let's say they're your employees, or let's say a franchise kind of thing. What are your thoughts on that? What does a hell of a lot more work? What are your thoughts on that? Instead of just getting paid to teach people. 

DeLon Canterbury, PharmD: Funny enough. One of the benefits of joining the program is that you will be a part of not only my network of deep prescribers, but I'm hoping to have that lead to potential job opportunities when I have other contracts in other states, and I want to be able to refer people who used by a program to get work.

So. It's kind of a mix of a franchise model. So as I keep coaching and coaching and coaching, I'm expanding my reach. I'm going to be able to funnel work to people with my cohort and say, Hey guys, we got deep prescribing opportunities here. Who wants to take this? That's going to be the future added benefit of being a part of our organizations.

Cause you know, not every pharmacist is licensed everywhere. I sure don't. So I'm going to contract that out. Uh, and so yes, that is the goal is to build an army of D prescribers. And so they. I can do something there or vice versa. 

Mike Koelzer, Host: Can you talk to a doctor in a different state if you're not licensed in that state, as long as you're not dispensing, how does that work as far as having to be licensed?

If you're not actually dispensing anything? I mean, could you sit in your room now and serve 50 states? 

DeLon Canterbury, PharmD: Uh, licensed wise, nobody has a clue, uh, when it comes to telehealth, these border pharmacies. Err on the side of caution, meaning anything you do is probably a no-no. If I were to consult outside of the state, because you're 

Mike Koelzer, Host: using your pharmacy services somehow outside of the state.

DeLon Canterbury, PharmD: Right. Because technically, you know, you know, it's outside of the state, right. But again, it's not attached to a pharmacy and as you know, pharmacy boards, right. With pharmacies and mind not tele-health as the advent of the future. And this is actually a pretty good question because it kinda happens a lot in pharmacogenomics where you've got patients across the state or other states, and you're like, can I do a consult?

And you don't know if it falls technically under consulting as a pharmacist or just as a consultant. And you're a pharmacist, you know what I'm saying? I say, I just asked her forgiveness. I just do it at this point. The boards don't even know pharmacists don't even know. And I trust me, I tried doing it the right way.

I've asked if I've reached out. No one has a clue. So I'm just like, whatever, I'm just going to do it. And then if I'm in trouble, you, you see me later. I got, I got liability stuff for that too, if we got to, but I'm, I'm growing a business. Okay. So I tell people not to be afraid. I know, we don't want to get ourselves in trouble.

I'm not going to give you bad advice, but you gotta take the leap. You have to find out and you can always get an answer. So I just do it until someone tells me no. So that's where I'm at. And I talk to the doctors all the time and in other states, I text them. Uh, we have a conversation. You have zoom meetings.

They're not asking me about my licensure. In fact, there are some states that are more progressive and they're used to pharmacists doing this and they're like, oh, well, yeah, just do what you want. Just tell me what you do later. So I'm like, man, this is crazy. Like, come on. We 

Mike Koelzer, Host: had the state inspector come into our pharmacy a couple of weeks ago and some [00:30:25] pharmacist turned me in because this had to do with the transfer and whether initials were needed on it and saw.

She came in and she's like, you did not include the right initials when you sent your prescription to this pharmacy through fax or something like that. I'm like, well, it doesn't say I need to, it says I have to have the initials of the pharmacist that came from and to whom it's going. It didn't say the initials of the pharmacist has just said to whom.

And so she said, well, I've been a pharmacist for a long time. It's just good practice. It just makes sense. Sense. I'm like, is this a lesson in etiquette or is this law? I really could not believe what I was hearing that she said, like, it just made sense to do it. I just couldn't believe it. Just get forgiveness later.

You tried show where you researched it and just do 

DeLon Canterbury, PharmD: it. Yeah, I tried and I didn't know at first, but you asked him, why does it have to take all that nitpicking? Just for what really? Like, what, what did she prove with that? 

Mike Koelzer, Host: I'm not sure how I feel about this, but, and sometimes I go back and forth about things like in our pharmacy.

Do I ever want to mention the competition? There's a debate going back and forth on that in political runoffs, where bashing the competition, then bringing yourself up. It's just human nature, I guess. Do you have an enemy? Like the message you fracture who want over prescribing or, you know, the insurers want over prescribing?

Because that's how they make money as their money enemy in this. Do you feel there's any enemy and are you ever tempted or would you ever use that as the Goliath of what you're up against? 

DeLon Canterbury, PharmD: It's hard to put it all in one category, but there, there are enemies to this movement per se. Um, I think number one is greed and I'm not anti-capitalist, uh, I believe it's important, it's necessary, but we have.

Capitalized our healthcare system to the level, to where it's sick care. Basically the sicker you are, the more money they make. So we, again, need to address that at its core, but. There are players involved like the PBMs and we can't blame it all on big pharma either, but they all have an intrinsic role to make more money.

So it's hard for me to say it's all big pharma and PBMs fault when they're literally just doing what they're supposed to because our country is founded on greed and money and capitalism. And so it's just, healthcare's a different model of making the same money. So who were the bad guys to me? The bad guys are.

Likely, our healthcare system is the entire healthcare system. The lack of care that providers are feeling they can't even give. Cause they're so strapped with PAs and documenting all these issues. It's the lack of reimbursement for pharmacists who were giving life-saving consultations, who can't even be seen as providers.

That's a problem. But even that is a prescription. That's a problem. There's a game of ego. There's clinical inertia. Well, I did this 20 years ago, so I don't care what the new information says. There are people who are in their own silos, so I believe we can truly. Make this happen. If we monetize and reimburse for DMD deep prescribing and they do it in other countries.

And another problem is we are one of the few countries that allows direct to consumer marketing of drugs, period. So now you get patients coming in with that new commercial on what? Oh, I want that one. It doesn't work that way. Healthcare doesn't work that way. It's the evidence that works that way. So yeah, it's a multi-layered issue.

There's a 

Mike Koelzer, Host: A lot of people. On a big scale. Don't like this idea. I mean, you're taking money out of the system, man. I suppose I'm trying to think who really benefits obviously the patient does, but outside of that, and I guess taxpayers may be if, if sick people are put onto the state's cost and things like that, but there's a lot of people that wouldn't.

The thought of less medicine business wise, capitalistic 

DeLon Canterbury, PharmD: wise. Sure. For sure. But to counter that we waste $528 billion a year, just on mismanaged medications that the taxpayers are paying. 

Mike Koelzer, Host: I guess that's what I'm getting here. The taxpayers are paying that. Because why because taxes go up to pay for the sick 

DeLon Canterbury, PharmD: because there's costs spreading.

And when it comes to these insurers, uh, for some of those smaller plans who can't regulate costs for those who are uninsured coming into their system or using their networks, they [00:35:25] spread the cost. To those small business employers who are trying to pay for their people. So that's one way they can do that.

Um, and then some of these systems, some of these safety net systems, uh, they get funding based on certain metrics or the things they keep. And so it affects that too. The truth is it's a system wide issue and yes, they're going to be people there'll be lobbyists. There'll be people who will never want this to ever change because their coffers are full of gold.

And. But at the end of the day, we are still losing money. As a healthcare system, we are still ineffective. We are still lower ranked as a developed country and providing quality healthcare. We can't just keep doing the same thing and expect things to change. It's only getting worse because we have an aging population, more meds, less providers.

We have a shortage of doctors and nurses in COVID and senior care providers. I mean, we're just looking at less. Supply more demand. And now we're going to tack on things to just, well, let's just put it on the meds. Just hope the meds do the trick. Cause I am not going to see you for six months. See you later.

Good luck. Um, but we can do things differently and I mean, it may take a couple mil, get a small clinic. 30 patients and just see what you do with a cash model. Just see what we do when we do things differently and just, just see what happens if we volunteer. There are some people I'm not good at like details, but I can talk about the big picture.

Right. And I just know that from the data I see extrapolating from what I see, that's already being done. It's doable. We just aren't. We just aren't putting the funds and time and, and importance there. Um, and again, it's multifaceted patients, providers, pharmacists, everyone needs to be trained on this. So there's some type of comfortability it's 

Mike Koelzer, Host: multifaceted.

I think if you keep that daughter happy and then on the other spectrum talk about costs for people, about people saving money and saving taxes. It's saving a lot of stuff. When you talk about money , people's ears. 

DeLon Canterbury, PharmD: This is why I'm so passionate, but also why it makes me so angry is we literally have five studies conducted where literally there's just simple.

Hey guys, in our nursing home, we want to reduce the number of opiates. That's it all they did was trained. They have one pharmacist, two or three technicians and an MBA person. All they did was just train the providers and the tests on how to look out for ways to avoid opioid use. So what did they do?

They increased OTC use of like Tylenol and approximate, which is great. Also cheaper. They reduced opioid use by 22%, they reduced opioid related constipation. They reduce falls. So indirectly that's thousands to millions saved just from stopping. You can monetize that. So why not fund all of that for our country and put this in all nursing homes.

So everyone's doing the same damn thing and not throwing it on a consultant pharmacist who sees 50 patients in a LTC, and you expect her to catch everything in one chart review once a month. Once a month. So it's just, it's so mind bogglingly frustrating to see great evidence that says we can do it yet.

Our system sucks. So let's throw it on. Let's blame it on a patient or blame it on non adherence or whatever boogie man you want to put. So I'm just tired of that crap. Right? And I'm just like, we can do this now. Let's do it. And I'm going to show you how. 

Mike Koelzer, Host: Sometimes it's as simple as getting the word out.

Here's an example who would ever think that I would not want someone to fill medicine at my pharmacy cause I'm losing money on it because of, you know, I ours and so on. When I drive by a gas station, I don't know if the owner of that gas station wants me to buy their gas or not. I really don't know. I don't know if that hurts them or if it helps them, because I know they make their money on the hot dogs and the Slurpees and all that stuff.

I really don't know if it helps them or hurts them and it really wouldn't kill any of them to say, We would like you to get your gas field here? I don't know if they want me or not. So the point I'm making here is that as pharmacists, we can say, as simple to doctors as this, it isn't always good to do more medicine and we have a skill in ASA that can show you the benefits of not doing medicine.

And we're the people that you should listen to about that. 

DeLon Canterbury, PharmD: Absolutely a thousand percent agree, a thousand percent. And frankly providers want to hear that providers want the same thing too. They want their patients on less meds too, they have no clinical training on how to do that. They have no inkling on what the [00:40:25] prescribing is, unless they're like a geriatrician or someone in the ER.

And they're like, whoa, polypharmacy is killing this guy. Let's stop some stuff. Maybe. But you're right. Again, this is an ample opportunity for us. And I literally had a colleague who's a, uh, internist, a medical provider. And Kelly texted me yesterday, how she helped to D prescribe like eight medications because they had this patient who was a repeat offender and their ER, and unfortunately, To ER, visits for someone to finally intervene, mind you, that doctor had to argue with other doctors that this was the problem.

So there's still a problem at its core in that we don't see that this is the issue, right. We don't see poly-pharmacy as the issue, but I ask you, Mike, how much were there? ER. How much did that cost to healthcare systems? This patient was uninsured by the way. So how much did that cost? So that's like, that's like 50 K a hundred K I don't know.

And it's in Cali, so it's more so again, had a pharmacist spend an hour or two. Could we have saved all that? I don't know. If you asked me, probably I 

Mike Koelzer, Host: I think the thing is people don't like spending money to save money. They'd rather gamble. We're going to gamble that this person doesn't have a needless trip to the ER.

And when they do we'll pay it, but we all can do better by learning how to pay more, to save more. We 

DeLon Canterbury, PharmD: are forced to pay insurance, but we don't crash the car on purpose. Right. We don't do it on purpose. We do it as a protection. So again, it's risk mitigation here and cost avoidance. And we have a system that, well, we want you to say, so trying to go against that is difficult.

Is it doable? It damn sure is. And, uh, I'm going to keep preaching that till the cows come home 

Mike Koelzer, Host: Well Dylan, I'm going to keep listening to those snazzy pictures of you with all that good lighting. I might have to hire your person. And I got you. I got you 

DeLon Canterbury, PharmD: for sure. For sure. Hey, Dylan. 

Mike Koelzer, Host: Keep doing what you're doing.

Thanks for all you're doing for the profession. 

DeLon Canterbury, PharmD: Thank you so much, Mike. Appreciate 

Mike Koelzer, Host: you. Pleasure meeting you. We'll talk again soon. All right. Take care.