The "Specialty" Drug Lockout | Vinay Eapen, PharmD, UTMB Specialty Pharmacy

Speech to text:

Mike Koelzer, Host: [00:00:00] Vinay For those who haven't come across you online, introduce yourself and tell our listeners what we're talking 

Vinay Eapen, PharmD: about today. My name is Vinay Eapen. I'm the specialty pharmacy supervisor at the University of Texas Medical Branch, and I'm here today to talk about specialty pharmacy and how I've been able to help an institution start a specialty pharmacy program in the midst of PBM network exclusions and all the different hurdles.

Mike Koelzer, Host: PBMs, they don't even want you guys as a hospital to break into the specialty 

Vinay Eapen, PharmD: market. Of course not Mike, you know how PBMs are. Um, it's, you know, when whenever there's profit margins to be made, PBMs try to exclude pharmacies, uh, such as ourselves, as, as a small player in this huge market from filling prescriptions for these patients.

So it is definitely one of the major pain points in having a specialty pharmacy program. So they say 

Mike Koelzer, Host: specialty and they never come out and just say, We want all the expensive medicines where there's profit still. Instead, they call it specialty. I know there's reasons, but that part right there irks me that they're not even calling it what it is.

Vinay Eapen, PharmD: That's actually an interesting point in a discussion that a lot of people have, right? There's no universal definition for specialty pharmacy. Every pbm, every entity has their own list of medications that they deem special. For the most part, there's a comprehensive list, but every pbm, if they make money on it, they'll, you know, it'll be a specialty.

Mike Koelzer, Host: When you talk to the specialty people, they don't wanna admit price, they wanna admit that all of this stuff needs a lot more hand holding. And unfortunately, it's kind of the chicken and the egg. It's like pharmacies probably don't do as much hand holding for the drug, these expensive ones, but it's kind of.

The PBM and insurances have taken the time away from the pharmacies to be doing this. Now granted, some pharmacies were not maybe doing it at all, and it's kind of the chicken and the egg, how the specialty kind of got away from the little. . 

Vinay Eapen, PharmD: No, that's very true, Mike. Um, and you're right. You know, most pharmacies these days, they're, you know, they're overwhelmed with the, the volume they have to complete just to make the small margins that they do that they don't have some of the time, um, that it takes to get a, you know, a prescription specialty, prescription filled for a patient.

And I really identify that you, you kind of have to know the workflow for a specialty script, right? We call it the patient specialty journey. When a patient is seen by a specialist and prescribed to me. That's deemed a specialty medication. There's multiple pain points prior to that medication getting to the patient, right?

PBMs will have cost control measures like a prior authorization where bef, you know that prescription is sent to the pharmacy. The pharmacy will adjudicate the claim and realize there's a. The prior authorization that's involved, they'll then fax that back to the doctor's office and then the doctor will have to get started on the prior authorization.

And there's a huge coordination of care that's involved. Right. And that's where when I came into this health system, I realized, you know, that's kind of what we have. That's our unique position that we have. That's an advantage. Over some of the PBMs and, and independent pharmacies, right? We have the resources.

We have a shared electronic medical record that, and that's just one of the pain points, right after you have a patient who's approved for therapy. Guess what? Specialty medications are not cheap for, for customers or patients, right? They're, they're usually really expensive. So patient copay assistance and financial assistance is important in our health system.

We have resources. We have a team. Pharmacy technicians who are there to look for different resources and grants and fund money that's available to help bring that patient copay down 

Mike Koelzer, Host: What you're saying to me, Vinay, it sounds noble, but here's the problem. The PBMs obfuscate that stuff on purpose with the smoke and mirrors, but the PBM makes money by selling these drugs.

They have to make it look difficult. Here's the problem, the PBMs. Own these specialty pharmacies. You gotta follow the money. Yeah. 

Vinay Eapen, PharmD: If you look at 70 to 85% of the prescription claims that are processed in this country, they're done through three of the major PBMs, you know, Optum, esi, and CVS Caremark. So they control a huge part of the market.

And like you were saying, yes, these are hurdles that were placed by these PB. To kinda get the little guy out of there and make it as difficult as possible and to weed out, you know, regular pharmacies from filling these prescriptions, but 

Mike Koelzer, Host: They weed them into their pharmacy because they own it. Do I have that right?

They own specialty pharmacies. Yes. 

Vinay Eapen, PharmD: There's been a whole lot of consolidation and vertical integration that's occurred in the last 10 years. Where you have CVS, Caremark, and Aetna merger, and they have their own specialty pharmacy, guess what? CVS Caremark processes 30 to 40% of the prescription claims in [00:05:00] America.

Right? So, of course, they want their patients to go through their specialty pharmacy so they can profit, you know, from the dispensation of that prescription, and also help control their cost on their end. 

Mike Koelzer, Host: It doesn't seem right when they can stop the, what's a fancy word for that? Not letting a pharmacy do it.

Vinay Eapen, PharmD: We call it payer lockouts, or you can call it network exclusions, where you know a patient is mandated to use the pharmacy chosen by the pbm. It, it really doesn't sound lawful or ethical, but it, it's, it's the current state that we're in. The 

Mike Koelzer, Host: The only hope of a pharmacist working with these more deluxe medicines is to be in a situation like you, because the average.

The average independent pharmacy doesn't have 'em, but the average chain pharmacist isn't dealing with these either. 

Vinay Eapen, PharmD: For the most part, most of these major chains have their own specialty pharmacy, you know, Walgreen, CVS, they, So most of those prescriptions go to an external specialty pharmacy in another state, still under the Walgreen CVS umbrella.

But you know, it's not handled at the brick and mortar stores for the most part. 

Mike Koelzer, Host: Vinay, if you were in charge of this, if you were in charge of these actual medicines you were paying for them, in your opinion, are these not gonna be done correctly in the average community setting? 

Vinay Eapen, PharmD: No, I would not say that there's a lot of good retail pharmacies, a lot of good clinical pharmacists to a retail pharmacist that could manage these patients.

I will say there are a lot of hurdles that exist in that specialty pharmacy journey that I kind of alluded to in the beginning, which makes it. Extremely hard for these regular pharmacies to kind of fulfill that prescription for the patient. The other thing is a lot of these drugs can't just be bought on any wholesaler account, Right.

They're restricted, you know, you have to get accredited as a specialty pharmacy to have access to a third of the specialty medications that are available these days, or as another extra layer of, um, obstacles that are, that are out there. Oh. So 

Mike Koelzer, Host: even if you wanted to. Take the chance of billing something or whatever.

A lot of the pharmacies, you can't even get ahold of these drugs. They're not even open to you with thesal. 

Vinay Eapen, PharmD: Exactly, exactly. They're called limited distribution drugs. And if you look at oncology, you have a lot of new medications that are coming out that are oral medications to treat oncology. You know, before they were infused with drugs.

Now, you know, with patient convenience and treatment outcomes, a lot of the drug companies are making oral medications available for the patient in that, you know, not every pharmacy has access to order that medication for them. They're called limited distribution drugs, and the manufacturer intentionally limits which pharmacies can dispense these medications 

Mike Koelzer, Host: Vinay.

But you're telling me that an oral medicine is also a specialty 

Vinay Eapen, PharmD: drug. Yes, Correct. We have a lot of oral medications. You know, those are specialty drugs. Uh, the hepatitis C space. How was that special ? Yeah, that's, that's, that's very true. So for hepatitis C, you know, in 2014 we saw the, you know, revolution of how patients with hepatitis C were treated previous to the newer drugs.

They came out, they were able to cure these patients of Hep C. We had infusion medications, right? A lot of side effects. Um, you know, expensive and not very effective. In 2014, we had newer oral meds come out that completely eradicated the virus from your body. Um, and these are oral medications, right? These were, they cost patients, you know, not patients, but you know, just in general.

They were $80,000 a regimen. Right. These are oral specialty drugs that patients took for eight weeks and that virus were cleared from their system. So, you know, you have a huge shift in oral and a lot of biologic medications that are specialty. But 

Mike Koelzer, Host: alls I'm hearing from you is as an expensive medicine that they wanna make profit on.

It sounds like there's nothing to it. I mean, not that there's nothing in the pharmacy, but it sounds like an oral medicine. Why is that special? Why is that taken away from the regular? We are regular folk if it's not just financial. That sounds just financial. 

Vinay Eapen, PharmD: Yeah. Yeah, Mike, that, that's a great question. And that's, you know, so the integrated care model I was alluding to at the beginning of the call, so you, you know, you have the first pain point, which is prior authorizations and financial assistance.

Yeah. And that's getting the patients started on therapy, you know? Sure. So once you've got the patient started on therapy, You need more follow up care, right? So we're talking more touch points, adherence checks, a lot of these new specialty drugs, especially in the oncology space, patients have a lot of side effects where they need a pharmacist who, you know, with us, we have clinic pharmacist embedded in clinics who reach out to these patients and see how they're doing on their medication.

Especially to someone. Who started a new medication, right? And needs to know, Hey, I'm having this side effect. Is this normal? You know, we have 24 /7 access to a clinical [00:10:00] pharmacist who can answer those questions for that patient, right? These are, these are drugs that have a lot of, that have a huge side effect profile that need to be managed more closely than regular medicine Devil's 

Mike Koelzer, Host: advocate, those side effects show up with medicines that are also 50 cents a tablet.

But because this is so damn expensive, they wanna follow up with those side effects. So one of these doesn't just end up in the trash or put down the toilet. Are there a lot more side effects or do you think It's what I said, because it's financial. They don't want someone to give up so easily. 

Vinay Eapen, PharmD: I think that there's a little bit of both.

You're right. Since they're financially lucrative, you know, they want to obviously limit who dispenses these medications. Secondly, these are medications that, you know, narrow therapeutic windows treat a very complex condition. These are disease states that really drive up the health spend for a plan, right?

So they want these patients followed very carefully on a month to month basis. Yeah. 

Mike Koelzer, Host: There's no chance in hell of an independent pharmacy doing a specialty. I mean, have that been pulled from every independent pharmacy, do you think? 

Vinay Eapen, PharmD: I think for the most part, with these drugs being so expensive and DIR fees, who'd wanna.

Yep. Specialty drugs. Get a guess. You know, guess what? PBMs, you know, once you start dispensing specialty drugs, you're on their radar. So guess what? The clawback starts happening, you know, the audits start happening, right? My pharmacy in general, you know, we get more audits now that we've dispensed more specialty drugs, DIR fees, you know, things that we have to be aware of, you know, because, you know, in order for us to be successful and take care of our patients, we do have to be financially viable.

And that's, you know, one of the pain points. 

Mike Koelzer, Host: One of my guests, we were talking about selling a pharmacy and boy, you sell a pharmacy. Six years later with the cost of these medicines, you could have an audit that could rip into your profit from that. I can't imagine some of these specialty prices with the audits and things like that.

Oh no, 

Vinay Eapen, PharmD: definitely. You know, we get audits. Weekly, you know, on simple things, right? They just, you know, PBMs wanting to know how you've dispensed medication. If you, if you put in, you know, the dispensed quantity correctly, if you build correctly, they try to catch you on every little thing, you know, So it's, it's very important to have a staff that is trained in processing prescriptions and being compliant.

That's definitely a plus. 

Mike Koelzer, Host: Vinay do they want you as a pharmacy or are they trying to get rid of 

you? 

Vinay Eapen, PharmD: You know, Mike, I sometimes wonder if they even want us existing, but for us at least, you know, we, we feel like we have a higher calling, right? We have patients to take care of. We know our model is, is, is better than, than the PBMs model.

Mike Koelzer, Host: Right. So, you know, this is a, it's a struggle every day to stay open and, you know, and to take care of our patients. But I, I believe it's a battle that's worth it. 

Put yourself in their shoes though. Why don't they just get rid of you guys? I mean, they got rid of the independents. Why don't they get rid of you guys so they can take that profit?

I wonder what's in it for them to even allow you in a health system too. Be specialty, What do you think's in it for them, for you to do it and not just say, screw all the little people and not, not that you're as little as you know, the independence, but why do they even allow you in it, do you 

Vinay Eapen, PharmD: think? Yeah, so 

I think it goes back to that integrated care model.

So if you look at a health plan and them trying to control their cost, And the patients that they manage. If you have a pharmacy model or a model where that literally looks at value based care and taking care of patients on a month to month basis, making sure patients are adherent to therapy, making sure copays are, you know, are, are affordable and patients staying compliant on medicine, I think that's a huge part of what we can do.

Mike Koelzer, Host: You might help keep their costs down. 

Vinay Eapen, PharmD: Correct. Correct. 

Mike Koelzer, Host: They might see some value in having you local with the local people. 

Vinay Eapen, PharmD: Exactly. 

Exactly. Hmm. 

Mike Koelzer, Host: All right, so Vinay, you came from a retail world, and as I understand it, you then joined this health system and one of the first things your manager did is give.

Pile of crap and said, Fne, figure this out. How we can. Get into specialty? Was that his 

Vinay Eapen, PharmD: question? Yeah, as you were saying, You know, I started off as a retail pharmacist, you know, four or five years in, Loved it. Loved the customer base, loved I, you know, I joined pharmacy when the model was really shifting to more clinical services, giving vaccines, doing MTMs, you know, and then five years in, you know, had that itch.

I wanted to see what else was out there. And I saw the writing on the wall with the pharmacy reimbursement model. You know how pharmacists were having to struggle with that? Were you doing 

Mike Koelzer, Host: the MTMs 

Vinay Eapen, PharmD: in that? Oh yeah, definitely. You know, MTMs [00:15:00] vaccinations, doing everything, wearing multiple hats, right? Every retail pharmacist can at least relate to that.

You wear multiple hats, you manage a team, you have metrics that you have to meet, you know, So, you know, at one point I was like, you know, I, I wanna change, right? And, you know, this opportunity happened. monotony. Um, you know, I think it's important to grow to see what you can do because we do have a valuable skill set, right?

So the one thing a health system, a major academic health system doesn't have is they don't know people who understand retail pharmacy. Mm-hmm. and understand how to process prescriptions, how to grow a business. I think that's something that, you know, retail pharmacists inherently know, they know how to grow a customer base.

They know how to make patients satisfied. They know the pharmacy reconciliation part, the DIR fees, you know, we're experts in, in, in that. So I was able to bring that piece of expertise into this new landscape with the health system. When you say 

Mike Koelzer, Host: health system, I'm picturing a big hospital campus, like one square mile or something.

Is that right? Or is your health system like across? State or city or something? 

Vinay Eapen, PharmD: No. Well, we have clinics all across the state of Texas, Mike, but you're right, it's, it's a health system that has multiple campuses. We have a main hospital in Galveston, Texas, and then we have, you know, satellite locations, you know, spread throughout Houston.

It's a 635 bed hospital, you know, huge patient population. A lot of ambulatory clinics where a lot of the specialty scripts originate from 

Mike Koelzer, Host: is a health system. Is that like a new Fal name for what used to be called just a hospital and all the little things that go along with a hospital. 

Vinay Eapen, PharmD: Yeah, it's a, it's a fancy word for hospital, I guess you could say.

It's 

Mike Koelzer, Host: not like a fancy word for like an HMO system. It's more like a fancy word for a hospital. 

Vinay Eapen, PharmD: Hospital. Exactly, exactly. 

Mike Koelzer, Host: And just like a hospital would then branch out to other things. So does the health system correct it. So Vinay, you were brought in as the pharmac. In there. Outpatient pharmacy, Correct?

Vinay Eapen, PharmD: Correct. Specialty pharmacy supervisor where, you know, the whole, the whole goal for the health system was to grow their outpatient program, retail pharmacy, right. We call it outpatient pharmacy. Retail pharmacy, healthcare system. But they wanted to grow that customer base. So if you look at a hospital, you have patients who are admitted into the hospital and leave the hospital.

So we have a meds to beds program where that patient, you know, is seen by our doctors and our clinicians once they leave the. We get their prescriptions ready in our pharmacy delivered to that patient. That's one of the services we offer, um, along with specialty pharmaceuticals, right? We have a lot of our but m b special.

Who prescribes a lot of specialty drugs. A lot of that care prior to us being in existence was fragmented. You had external pharmacies filling it, doctors not knowing if their patients picked up their medications. A lot of back and forth, a lot of insurance, haggles, you know. So with us coming in, Our strategy was to help this health system build a specialty pharmacy, coordinate doctors into understanding all the services we offer, what we can do for the patient, and really building a patient-centered specialty pharmacy was, was really our ultimate end goal 

Mike Koelzer, Host: as your outpatient pharmacy in not counting the specialty, but just the regular medicine.

Were there some people then that came back for refills or did most of the refills go to the retail pharmacies? 

Vinay Eapen, PharmD: A lot of our patients, you know, come into the hospitals. They have existing pharmacies, so you know, most of the time when you're in a hospital you get a 30 day fill, and then after that 30 days, the expectation is you go see your primary care provider or your specialist that was referred to for follow-up care.

So you get the 30 days in our Meds to beds program with our specialty drugs, you know, we take care of patients on a continuous basis or there's that continuity of care. 

Mike Koelzer, Host: They're longer customers. Yes, it's a profit game. . 

Vinay Eapen, PharmD: Yeah. I mean, they're, they're longer customers, right? Yeah, exactly. It's, And no, no problem with that.

Yeah, definitely. It's definitely a way of us advertising our services and, and building brand loyalty. If you look at, you know, these are patients who come to our hospital floors, why not engage them and tell them what we can do? You know, 

Mike Koelzer, Host: How many different pharmacies are there in the health system? 

Vinay Eapen, PharmD: Yeah.

We have three outpatient pharmacies currently, and we're looking to build a fourth one, you know, in this new. 

Mike Koelzer, Host: Is one of them, like the, um, mothership kind of, or are they all like equal size and things 

Vinay Eapen, PharmD: like that? You could say that one of them is a specialty pharmacy and that's the one that I manage.

Gotcha. The ones are, you know, take care of the meds to bed patients and clinic patients who come into our floors. Yeah. Yeah. We're a fairly young program, so you know, that's the kind of nice part, Right. We're organically growing this retail pharmacy program and, you know, coming from retail space, I know the pros and cons.

Right. So I, I. What I valued in a retail setting and hoping to build off of that here in the outpatient pharmacy world. [00:20:00] 

Mike Koelzer, Host: Who owns a health system like that? Are those nonprofits? 

Vinay Eapen, PharmD: Yes, they are nonprofits owned by the state of Texas, actually 

Mike Koelzer, Host: owned by the state of Texas. 

Vinay Eapen, PharmD: Yes. Our health system is an academic health center that you know is technically owned by the state of Texas and taxpayers.

Mike Koelzer, Host: So the money part of it, it helps the whole system. I guess you could argue it helps everybody with the taxes and if you can keep the profit away from the PBMs. 

Vinay Eapen, PharmD: Yes, exactly. , that's always a plus. Do you have to deal 

Mike Koelzer, Host: with the PBMs at all? 

Vinay Eapen, PharmD: Oh, of course. Of course. You know, 

Mike Koelzer, Host: When you set this up, I mean, did you have to kiss their ring or anything like that to get permission for this?

Or was it like it was your right sort of. 

Vinay Eapen, PharmD: You know, for, for the most part, what we've done, you know, we've been open for about a year and a half and we, we've gone after open distribution drugs. These are drugs that are available to any pharmacy. Gotcha. The other layer that, that our specialty pharmacy, um, program is worth three 40 B entities.

Right. So we get drugs at a discounted rate. So, you know, we're at an advantage. It's from. From a purchasing standpoint for these drugs where most independent pharmacies would have to buy this drug, you know, at at a higher price than 

Mike Koelzer, Host: us, is a specialty drug in the three 40 B also, Correct? Correct. It is.

I'd love to have that. 

Vinay Eapen, PharmD: Yeah. Me coming from the retail space and seeing some of the prices for these drugs, it was, it was definitely. You know, eye opening to see how cheap some of these drugs are. But if you look at, you know, the institution we're at, you know, three 40 B covered entities, you know, they take care of an indigent patient population.

So you know, you have patients who are unfunded or Medicaid, you know, or you know, lower income that you're able to really help out. 

Mike Koelzer, Host: I've decided that we are not gonna buy a lot better at the pharmacy, so I'm gonna try to save money on my wages. I'm trying to hire a bunch of Catholic nuns.

Vinay Eapen, PharmD: Yeah, that may be your secret sauce. We went 

Mike Koelzer, Host: to Catholic schools and back in the day you never paid them. You know, they worked for like a penny a week or something like that. And, and, uh, it wasn't fair, but it was done nonetheless. So I'm trying to find some nuns. They're hard to find though. All right.

Now you broach this subject, the three 40 B. I've got some people that own like a three 40 B consulting. Yeah. Firm or something. And I'm like, I'm not bringing you on because one of my goals is always to have the guest show in a good light, and that's why I can't have a PBM person on and I don't think I can have a PSO person on, and I don't think I'm doing very well with the big wholesalers either, although someone was on a couple weeks ago from one of the wholesalers.

But you're a good one to talk to because you're not pushing it, you're just part of it. Do I have this right? The three 40 b, I kind of understand it. It gets the medicine out maybe from the, you know, the inpatient bed stuff, all that, you know, where it's happening in the hospital, gets it out into the community.

And some of these pharmacies are in the community where the government. I Want to make them less expensive. Medicines. I'm not sure if I have that right. And also what I don't know is how is this system, why does it have such a bad name? How is it being abused? That's 

Vinay Eapen, PharmD: a good question. And you're right, there's, there's a lot of, um, smoking mirrors around the whole three 40 b um, space right now.

You know, initially the intention of the three 40 B drug program in 1992 was to. Stretch scarce resources to help covered entities that take care of an indigent patient population and get them access to drugs. But if you look at how many contract pharmacies that every pharmacy has, it's Walgreen, CVS with 3000, 4,000, they're taking care of a patient population that they never really manage.

They're just dispensing the medication to that patient and they're not even close to where that patient lives. So it's a mail order type deal. I 

Mike Koelzer, Host: gotcha. So, Part of the three 40 B is you're supposed to be giving the medicine out and also the person should be in your area because you're seeing how they're doing.

Maybe take their blood pressure, say hi and all this kind of stuff. They're getting all the profit, but they're just like mailing it 

Vinay Eapen, PharmD: in. Exactly. There's no continuity of care. There's no checkpoints. There's not that white glove service that you have when you see a patient on a month to month basis. It's just, you know, mailing that patient the medication and saying, Hey, you're providing access to care.

Mike Koelzer, Host: Yeah. Interesting. I was home for 3, 4, 5 years before Covid. I wasn't in the pharmacy all that much and we had some staffing changes then a couple years ago, and it happened to line up with Covid. But boy, for a while there I was starting to question what value we give as a community pharmacy. And [00:25:00] I'm not saying we get paid for that value, but going back into the pharmacy and.

Seeing the people that were seeing the people that needed our care, especially during Covid. And a lot of it is the poor and the elderly, and those are the people that can't hop on their phone as easily and their computer to order things from these places far away. And there's a huge benefit to that local touch, I think.

Vinay Eapen, PharmD: Exactly. No, I agree. You know, that intimate phone call you have with a pharmacist or pharmacy staff member, you know, the rapport that you build with your customer base is important. You don't, you don't really see that, you know, when you have a huge mail order pharmacy in another state where you can follow a patient, uh, you know, on a month to month basis and see how they're doing.

That touchpoint is really important. And I think that, you know, carries over in, in their care As I think 

Mike Koelzer, Host: about. Dominance by the PBMs and all this. It's especially the vertical integration, it's sad because the people that buy the insurance, a local company, let's say there's a 500 employee company in your town, they're in Texas.

They don't know how the PBM. Is treating this whole specialty thing. They have no idea. I mean, they're not asking those questions between the three or four different insurances. They're just not asking, let's say it's a car salesman or something. They're just, we're just buying insurance and they're going along with what the PBM has set up as far as specialty and all that.

And it kind of makes me question, who's watching these people? And maybe it's not. A bunch of people die and it's on the news before somebody says, Oh, we're with that company. Maybe we should switch. And it's not Scouts Honor because you know damn well the PBMs are way past scouts. Honor, I mean, that's, that's not gonna work.

You just wonder who's watching all this. 

Vinay Eapen, PharmD: Yeah, there, there, there's definitely no watchdogs in that market. You know, they're, you know, if you look at some of the major PBMs, they're Fortune 500 companies. They know what they're doing. But you're right, that local health plan, the local employer has no idea, right?

The true intention of a PBM and its inception was to drive down costs. And to ultimately bring down patient cost. And you know, we both know it. We have pharmacies, we operate and manage that, that hasn't been the case. So there's definitely been, you know, a lot of litigation and, you know, you know, pbm, you know, PBMs, um, exploitation of this, you know, in the news.

You know, I, I think we as pharmacists in pharmacy have kind of put them at the forefront and, you know, you're starting to see more notoriety around that. 

Mike Koelzer, Host: As I'm talking to you here, I've talking to a lot of, a lot of leaders. You're a leader. You're either gonna be an administrator somewhere or you're gonna own your own business.

Which one is it gonna be? 

Vinay Eapen, PharmD: You know what, Mike? I, I think I wanna start a podcast with you. You know, I, I

You know, there's some interesting topics out there. I think, you know, we need to do that. But, you know, um, if I had to choose between the two, you know, I, I think there's. There's something to be said of being a leader. Yeah. Um, a lot of times you, you're put in positions to be a leader, but you don't know what you're doing.

That defines 

Mike Koelzer, Host: me. I'm in a leadership position. I don't know what the hell I'm doing. 

Vinay Eapen, PharmD: You know, sometimes you don't, you, you kind of psych yourself out. You don't think you're ready. But, you know, it's just, it, you know, Leadership is, is learning about managing people over time. The new experiences, you learn more.

It's not something that you're born with. I don't believe in that. I believe it's something that you invest in yourself. You invest in your people. You sh you know, you provide them mission driven work and, you know, and, and that's the true calling of a leader. 

Mike Koelzer, Host: All right, so Vinay, what are you actually gonna be doing in 10 years, maybe 15 years?

Are you gonna be where you are now? Are you gonna be up the ranks of the hospital slash health system? Are you gonna be the president of your business doing something? 

Vinay Eapen, PharmD: You know, in a perfect world, I'd be CEO of a healthcare company. Are we gonna do 

Mike Koelzer, Host: this? Are you gonna go through these different ranks and move around the country?

And pretty soon you're the CEO of one of 'em. 

Vinay Eapen, PharmD: Exactly. You nailed it. You know that That's the ultimate plan. That is the ultimate plan, you know? Yeah, definitely. Like being a CEO of a healthcare company that's really trying to change the patient delivery model. I think there's a lot of innovation in healthcare right now, so, Yeah.

You know, if I had to pick where I see myself in 10 years, I, I think it's, it's that you. Let's 

Mike Koelzer, Host: Say you're sitting in a CEO role, let's say 20 years from now as you look back from 2042, looking back. What big break would be needed to have you in the CEO seat, if anything? Or is it just a straight slope up to [00:30:00] the leadership position?

You know, 

Vinay Eapen, PharmD: There's definitely detours, Mike, but I would say there's three buckets for your experiences. What have you done previously, right on your resume? Secondly, it's a networking tool. Who have you worked with? Who have you made an impression on that can say, Hey, That guy can really do some stuff for our healthcare system or our company.

And the third thing is advanced degrees. They definitely help. You know, for us, we're, we're all clinicians, we're pharmacists. We definitely know the clinical side of pharmacy. Now, do you know the business side? How do you increase the bottom line of an institution over an organization that's important, right?

For us to be financially viable. You know, clinical stuff is important along with the business side and understanding that and kind of bridging that gap is equally as important. Well, 

Mike Koelzer, Host: I was trying. Let you down gently by not saying you needed a business degree, but I'll ask it now since you brought it up.

You don't have a business degree. I don't. I don't. Are 

Vinay Eapen, PharmD: you gonna get one? It is something definitely in my pursuit. I definitely do want an mba. Just, you know, to have a different lens and to, you know, work with other people. In an MBA program you're working with nurses, engineers, doctors, you know, it's not just healthcare providers.

So I think it's important to see problems from a different set of. Is 

Mike Koelzer, Host: Is that practical? I mean, in your lifestyle right now, would that be practical to, to do 

Vinay Eapen, PharmD: this? You know, you'd have to ask my wife, Mike. You know, I'm married and have two little kids, so, you know, there's not a lot of free time, you know. Yeah.

But you know, I think anytime you have your mindset on something, you'll, you'll find ways. If it's really important to you, you'll find time to do it, you know? So we shall see . 

Mike Koelzer, Host: All right. So you've thought of this. 

Vinay Eapen, PharmD: Definitely, definitely have thought of an mba. Yep. I think it is something that, you know, if you're looking to advance your career and move up in an administration, I think it is something that is looked upon favorably that, you know, I would definitely recommend.

I bet it's 

Mike Koelzer, Host: easier though now with video and, And there's always been like night classes and stuff, but now you can probably. Do it in your pajamas at home. Right. There's probably more video stuff for those programs. 

Vinay Eapen, PharmD: Exactly. There there's a lot of online programs available, I think, you know, to make it readily accessible and easier for someone who's working nine to five and you 

Mike Koelzer, Host: get the hospital to pay for it.

Exactly. What career path would you have made if you were not allowed to go into it? I think 

Vinay Eapen, PharmD: I would've been a doctor. You know, I grew up with a lot of family members who became doctors, and I, you know, I see the lifestyle and the care and the knowledge base that they have. And I, you know, if I wasn't a pharmacist, I would've been a clinician.

But, you know, I didn't think I had what it took to be a doctor. So, you know, I said, Hey, you know what, pharmacy, there's no blood. There's, you know, very limited. Patient contact, like touching wise, you know, it's more, you know, managing it, it's making an impact in a different way. Managing a patient's drug therapy and you know, still having that patient interaction, just not as intimate, I guess.

Mike Koelzer, Host: When I was in college, I remember talking to some people and they said, uh, I may have asked the same question. Well, I asked it more specifically. I'm like, Well, why didn't you, why didn't you go to med school? And they would say, , Ah, we don't like them, you know, we don't like the blood and stuff like that.

And inside of me I'm thinking, ah, poke crap. You weren't smart enough. That's what I'm thinking. That's what I'm thinking 

Vinay Eapen, PharmD: inside of me. But that sounds better. You know, the blood, 

Mike Koelzer, Host: You know. Well that's, that's just me. That's what I'm thinking about them, you know? Cause I'm thinking that the most negative thing I can do to this person who says they would, you know, they would've, should have gone to med school.

But when I think about dentistry, Like if someone asked me, How come you didn't go to be a dentist? And if I said, I don't like the sound of the teeth cracking with players and things like that, it's like, Yeah, that's true. Yeah. And I'm not smart enough to do these things. . As I think back, I guess all of them weren't full of crap.

I guess maybe they didn't like the blood and stuff, but Yeah, cuz if I had to do teeth stuff, it's like, No way, 

Vinay Eapen, PharmD: you're, you're right. You know, me and my friends always talk about how dentistry pays really well. It's really lucrative. But the, the, the downside to that is, you know, you're seeing a patient's mouth all day and I, I don't know if I could, you know, solve that.

Right. Like, that's, that's, that's a lot. . 

Mike Koelzer, Host: It's the highest. Suicide profession. Exactly. Do you know that too? That's true. Have you heard 

Vinay Eapen, PharmD: that? Yep. I knew that. Yep, I've seen that. I'm like, Hmm, go figure. 

Mike Koelzer, Host: Oh, they get like bad necks and they're in someone's mouth all the time. You're positioned all the time. We're in a position.

Can you imagine going in some people's mouth, you know? Yeah. 

Vinay Eapen, PharmD: For eight hours. Yeah. It's not very appealing, right? No. And then, and the dentistry dentist school is, is not very, you know, it's very expensive too. So there's that. Yeah. You know, you only really see your return on investment after you've paid off those student loans.

Right. So , but, 

Mike Koelzer, Host: You know, medicine's the same way. Right. But I don't know, I'm not sure why exactly. I've heard that before. Alright, so Vinayt, what if it wasn't medical though, then what road would you have taken? 

Vinay Eapen, PharmD: You [00:35:00] know, I, I, I probably would've done something. I like growing a business. I like, look, you know, the one thing that my job has allowed me to do now is look at p and l statements.

Look at our cash flow. You know, are we getting, you know, learning accounting principles, which I would've never seen, you know, at my previous job or anything, but kind of learning behind the scenes. So the business side is really important. I think looking, you know, growing a company. From scratch organically, you know, and seeing the return on your investment after, you know, making different additions.

I think that's just really appealing to me. So I could see, really see myself going into a business degree or pursuing a business degree. 

Mike Koelzer, Host: You got a lot of leadership things there because like I say, I've talked to a lot of 'em and I see a lot of that in you. So someday I'll swing down to Texas and you can invite me up to your corner office and we'll have tea or something, whatever they do in Texas there.

Of 

Vinay Eapen, PharmD: course, Mike, I'm, I'm a, I'm a huge coffee cono, so definitely will enjoy a good cup of coffee and have some good talk. But this has been great. Thanks for the opportunity, you know, to have some really good conversation. You know, I, I've kind of introduced all my friends to your podcast too, so, you know, hopefully you, you've definitely changed.

I feel like a pharmacy for a lot of people, you know, opening our eyes and, you know, just keeping us engaged. That's important. What I love 

Mike Koelzer, Host: About the podcast, the whole setup is a lot of times in pharmacy we're either reading the negative stuff or you've got a few upper percent of people who have done something pretty cool and.

Talking about the positive, but it's really cool in the long form just to talk about the negative and the positive together. And you know, it's like some of this, some of that, and not paint it too rosy, but still show some hope, you know? So it's a cool way to take time with people and, and get the full scoop on things.

Yep. 

Vinay Eapen, PharmD: Realistic outlook. Mike, do, do you go to any of these conferences where, you know, pre pandemic, where you, you know, are you pretty plugged in with, Cause you know the guests you have on, you know, you have a very extensive network of people, so you know, like you're an independent pharmacy owner, but you don't just have independent pharmacy guests on, you have people from the whole.

Spectrum, which I like, that's what I like. You know, like one week it's, Hey, cash basis accounting, or one week it's PBMs. One week it's talking to Gordon Vasco from Panther Rx. Like, you know, it is crazy. It's an eclectic group. 

Mike Koelzer, Host: I don't go to many of those just running the store. And I used to go more, but my family's just getting to the age where, yeah, I can get away more now.

So I think it'd be cool to go to some of them. I think the guests, when you do send someone an invite, it kind of snowballs, you know, Because I'm assuming that most people I invite then look back at the role of people that you've had, You know? And then if you start building that, I think people look back and they say, Well, you know, if he's on there, you know, then, then maybe I can be on there.

So I think it kinda snowballs up in a pretty cool way. I agree. Now you're one of 'em. Now people are gonna look back and say, Ah, hell Vena's on there. I better get on there too, just to keep up with him. Yeah, I know, right? ? 

Vinay Eapen, PharmD: Absolutely. Yeah. I put it on my to-do list. You wouldn't believe this, Mike. I told myself, you know, I was gonna, you know, get a position within my organization and all I, I wanted to be on your podcast.

I put it on my radar. Oh, that's awesome. You for sure. You made it happen, so you. 

Mike Koelzer, Host: Years ago, I was thinking of expanding my pharmacies. I'm always balanced between am I gonna sell or am I gonna buy some more? Yeah. And someone told me, they said, Mike, go around to the three or four pharmacies you're interested in and tell 'em you're interested.

And I was like, Ah, hell no. That's embarrassing. Yeah, they're gonna, Even though I know 'em, they're gonna say, Why are you asking me? And who do you think you are for this or that? Yeah. And I said, I'm not gonna ask them. And I wasn't on the brink of asking them, but I thought, Oh, I could. I tell you, within like three to five years, they were all sold.

Yep. You know, someone else did that and, and things change, you know, But the point of that story is there's so many things that you can do by just asking. 

Vinay Eapen, PharmD: I, I think put your pride away and just say, Hey, you know, I love your podcast. I love the listeners. Like, I wanna be part of it, you know? And I think I have a good story to tell.

Mike Koelzer, Host: There was one guy, I forget who it was. Some podcaster, he was trying to work on his assertiVinayss and he was gonna do a hundred things where he was told no, he needed to be told no a hundred days in a row in order to learn. Rejection. And one of his first ones was, uh, I think he won McDonald's. And, and he went up and he asked if he could have a refill on his hamburger.

you got a better chance coming on this show than, uh, than a refill on a hamburger. And now I know an a, I know that I've got. Two listeners now. I know I've got you in my black [00:40:00] lab. Yeah, . 

Vinay Eapen, PharmD: I think you have more than that, Mike. So I'm on 

Mike Koelzer, Host: cloud nine tonight with that knowledge. . Well, Vinay great to have you on.

We'll be 

Vinay Eapen, PharmD: following Mike. Thank you so much. Thanks for the opportunity to come on your show and really, you know, tell my story with specialty pharmacy. All right, thanks. When Renee, take care. Perfect, Mike. Thank you so much. Take care. Okay, talk to you soon. Bye.