IRA Negotiations Teaser
[00:00:00] Stacey Richter: Episode 401. The most interesting questions about the IRA drug price negotiations. Today I speak with Peter Neumann, SCD.
[00:00:28] Stacey Richter: Somebody wrote on Twitter the other day that he was gonna give a talk on the use of evidence in drug policy, and Barrett Montgomery replied, it'll be a short talk then. So let's talk about the IRA for a moment. The Inflation Reduction Act, specifically the CMS can negotiate for drugs for Medicare patients part of the IRA.
There's one topic I don't hear discussed. What I would consider maybe often enough, will these negotiations result in pricing that is evidence-based, while good drugs that companies developed using less taxpayer money for r and d drugs that positively impact the patient lives or have spillover benefits for society or save downstream medical costs, drugs that have solid comparative evidence data, drugs that are a meaningful therapeutic advancement over competitors.
Will these drugs be priced in line with that value? Everything I just mentioned, by the way, are things that CMS is supposed to take into account during its negotiations. So that's what this show is all about. To have this conversation, I invited Dr. Peter Neumann on the podcast because Dr. Neumann, along with his two co-authors, Joshua Cohen and Daniel Lenor.
Just wrote a book about pharmaceutical pricing entitled The Right Price. I convinced Dr. Neumann to come on the show and talk about what the likely impact the IRA will have on these right drug prices and short version. Dr. Neumann told me that presumably drugs that offer more therapeutic advances will do better under these negotiations.
How CMS Will Negotiate
[00:02:05] Stacey Richter: Here's a really, really top line summary of the negotiation provisions that are in the IRA. CMS will negotiate prices on the highest gross spend. Top 10 part D drugs in 20 26, 15 Part D drugs in 2027 and 15. Drugs from Medicare part B as in boy, and D as in drug for 2028. Small molecule drugs become negotiation contenders after nine years and biologics after 13 years.
Once a generic or biosimilar comes out, IE, the patent is well and truly expired, then this negotiation provision is no longer in play. Now, CMS has given some discretion over how it's going to do things, and they will issue guidance and figure out how to implement the law over the next couple of years.
As with so many things, and Chris Deacon talked about this recently on LinkedIn. It's how that law is operationalized that actually determines if it achieves this right price goal and or, and Dr. Neumann, my guest today makes this point really clearly too. Maybe the point of the law is as much about cost containment, frankly, as it is about achieving value-based, right?
Prices and cost containment and value-based pricing are not the same thing. Gonna do a show on this coming up. So what are the likely effects of the IRA pharma price negotiation provisions and not talking about the whole IRA here And the cadre of other stuff like patient out-of-pocket caps and inflation caps.
The show is complicated enough just talking about the negotiation portion and just talking about its potential to achieve pricing based on value.
Eight Big Impacts
[00:03:42] Stacey Richter: Here's a summary of likely impact of Medicare drugs being negotiated, some of which we talk about today. There's seven-ish main implications. Here we go.
Number one. Some Medicare patients will benefit substantially from negotiations as a reduction in the drug's price will result in lower co-insurance and liability during the deductible phase. Okay, this makes sense. Number two, overall negotiations are projected by the CBO to reduce premiums resulting in lower costs for all Medicare beneficiaries.
By the way, links to references are in the show notes. Okay, so this number two here is kind of thought provoking, especially when it's unclear at this time, whether the negotiated price will refer to the list price, the a WP average wholesale price, or the rebated price, IE, the price after rebates are applied.
There are many, many implications if the negotiated price is before or after rebates, just given how addicted plans are to rebates and use the rebates and cost shifting to patients. In a convoluted and super inefficient way to try to keep premiums down. Listen to the show with Chris Sloan for more on this.
Moving on to number three, potential impact. There's more incentive to go after biologics than small molecule drugs. Obvious due to the nine year versus 13 year thing. There's additionally some incentive for rare disease and orphan drugs, most of which are biologics in other parts of the IRA. Number four, potential impact of IRA Drug negotiations.
More interest in drugs for non-Medicare markets, IE drugs for diseases of younger populations, perhaps number five, possibly less pharma innovation, fewer drug launches. Oh boy. With this one, listen to the show with Mark Miller for many, many nuances here.
Goldilocks Innovation Balance
[00:05:31] Stacey Richter: But lemme give you a few things to think through and I'd start with four words.
We are chasing Goldilocks. There are two ends of the spectrum and neither are good on one end. Pharma charges way too much And the system gets bankrupted while pharma shareholders get rich. On the other side of the spectrum, there's not enough returns for any investors to invest in new drug development.
It's all about moderation. Finding the sweet spot in the middle, something the healthcare industry has a super hard time with. Bottom line, we want to incent meaningful innovation drugs that actually work. If we pay a ton of money for drugs that don't work particularly well, then what's the incentive to find good drugs?
As per my earlier point, if this legislation does as was intended, then good drugs should get rewarded and less comparatively effective drugs should be less rewarded. Let's cross our fingers, shall we? Number five, potential impact. Will pharma raise its launch prices? Because the negotiations center on discounts a higher price times the discount means a higher discounted price after all.
This one could be exacerbated by the part of the IRA that mandates inflation caps. There is some evidence that higher launch prices are already happening. Number six, potential impact Manufacturers wait to launch until they have all their indications ready to go. If you didn't understand this, we explained in more detail during the interview.
Number seven, potential impact. There are incentives for pharma to jack up commercial prices because they're making less money in Medicare. They try to make more money in the commercial market. But as Dr. Neumann says, you'd think that if pharma could do that, they already would have done it. Or let me say that a different way.
You'd think that if pharma could have raised their commercial prices more than they already have been raising their commercial prices, they would have already done it. So I think whether cost shifting actually increases here is a sizable question mark. Numbers eight, potential impact of the IRA's negotiation provisions.
There's also less incentive for pharma to innovate me too kinds of drugs if a drug in the same class for the same disease is being negotiated. Then a new drug coming out in that same category might sort of have to charge a price similar to the negotiated price of the other drug.
Meet Peter Neumann
[00:07:48] Stacey Richter: Dr. Peter Neumann, my guest today has a background in health economics and currently directs a research sensor that's focused on health economic issues.
His group does a lot of work trying to understand the cost effectiveness of drugs and other health interventions, other shows. You should for sure listen to here are the ones with Mark Miller, Anna Coten, bch, Dr. Bruce Rector, Scott Haas, and Chris Sloan. These shows offer context and adjacencies that are extremely relevant right now if you're gonna understand the potential impact of the IRA.
In the show notes, there is a quote from the book, the Right Price, again, written by my guest today, Dr. Peter Neumann and his co-authors, Joshua Cohen and Daniel Lenor that I thought summed up. Some of the issues here very nicely. My name is Stacey Richter. This podcast is sponsored by Aventria Health Group.
Dr. Peter Neumann, welcome to Relentless Health Value.
[00:08:41] Dr. Peter Neumann: Thanks so much for having me.
[00:08:42] Stacey Richter: Well, it is a pleasure to have you here. You wrote a book along with your co-authors, Josh Cohen and Dan Olen Dorf entitled The Right Price, And the main theme of that book is what is a reasonable price for a pharmaceutical product?
You wrote, paraphrasing here. I love this quote. You wrote bookshelves grown under the weight of books, critical of pharma practices, and there's endless talk about how expensive pharma products are, but what is the fair price? So I realize we're gonna have a very short conversation about a very big topic, but this has all become wildly front.
Patents And The Bargain
[00:09:15] Stacey Richter: Burner with the passage of the IRA, but the drugs that are on the docket here for negotiation, these are drugs that are headed toward patent expiry. Correct.
[00:09:25] Dr. Peter Neumann: The idea is that these drugs have been on the market long enough to recoup the often heavy RD costs that go into the development of these drugs.
[00:09:33] Stacey Richter: And as we all know, some of these drugs have had their patents protected for decades. Is that a reason just given the rampant so-called patent thickets, that it becomes an imperative in some people's eyes for Medicare to be able to negotiate?
[00:09:51] Dr. Peter Neumann: Right. Well, that, that's a central idea behind this legislation that we've, we set up a kind of reward system deliberately for, for pharmaceuticals.
Protect patents, we encourage innovation. The drug companies are allowed to reap the rewards if they get approval and they have drugs that can offer advances to patients, and they're allowed to price these drugs at high levels, but then the drugs go generic, or biologics become biosimilars at some point, and prices go down and.
Consumers benefit in perpetuity from lower generic drug prices. At least that's how the system is supposed to work. And as you say, in many cases we've seen delaying tactics that the drugs that are supposed to lose their exclusivity and go generic are on the market for long periods of time. Because companies file new patents, they go after new populations for the drugs, they have incremental advances, sometimes important ones.
The idea is they're supposed to go generic, and often they do not. We need innovation. We want to encourage innovation. On the other hand, we want these drugs to go generic at some point, and what is the right balance is really the question. Now, whether this loss strikes the right balance, I don't know. We will see how this affects both.
The amount And the type of innovation.
Defining Value And Metrics
[00:11:10] Stacey Richter: That last thing that you said there about the type of innovation, if all that we are limiting is the number of Me too drugs that come out, how big an effect is that actually gonna have? There's a really pivotal question that sits behind pretty much everything that we're, we're talking about here.
It's really fundamental. How are we assessing? Is this innovative or is it not so much? How are we assessing the value or the cost effectiveness of the products here? And those are factors which are pivotal to the. Drug negotiation poll process. What is most important for legislators and policymakers to recognize as we're sitting here thinking about what's the value of the drug or what's the cost effectiveness of the drug or the impact or the, in innovativeness of, of a drug?
[00:12:00] Dr. Peter Neumann: We'd like to align drug prices with the value that the drugs deliver. And the reason that's important is. We don't want to, in a way, overprice drugs because there are better uses for resources, but we also don't want to underprice drugs because we do want to send the right signals to the innovators to produce drugs that people in society value.
So. The idea is we'd like to align prices with value. The problem with healthcare markets and, and drug markets in particular is that the markets really don't work very well. They're heavily regulated. Consumers have difficult time judging their need for the drug. We have insurance. We have externalities or spillover effects.
That is to say if the patient is managed on the drug, other people benefit from that. The families, society, the patient may go back to work. The idea is that someone else, an external party needs to help judge the value of these products through, for example, formal cost effectiveness analysis where we try to.
Estimate the costs And the benefits of the drug, and then try to kind of infer a value-based price.
[00:13:14] Stacey Richter: The point you're making is that you can't rely on the market dynamics And the marketplace to determine the cost of a drug just because you've got a whole lot of factors that work against that. IE. You have consumers unable to necessarily calculate how much they really need a product.
You have externalities, as you said. If a patient can go back to work or the family benefits, then how are you factoring in all these things? I'm just basically taking away this. Value equation is fraught with all kinds of variables and probably differences of opinion.
[00:13:52] Dr. Peter Neumann: That's right. And we should also say that even before this legislation, the government is already very heavily involved in prescription drug markets.
The VA negotiates prices. Medicaid has rules around getting the best price in the market. Medicare is already involved in, in a lot of ways. So what we're talking about. Additional government intervention to be sure.
Million Dollar Drugs
[00:14:14] Stacey Richter: Some of these drugs are millions of dollars at this juncture. So what do you think in your mind would qualify for a million dollar drug?
[00:14:20] Dr. Peter Neumann: Well, we have methods and tools to help us understand the benefits of drugs, even million dollar drugs. There are a million dollar drugs that groups such as the Institute for Clinical and Economic Review, ICER have judged to be reasonable value at their price because they offer such large health benefits in terms of future gains in quality of life and life expectancy.
So simply because a drug is very expensive doesn't mean that it's of it's poor value. What we need is, ideally is a metric that gives us a standard, a benchmark, an apples to apples comparison across diverse products. So an an inexpensive drug that doesn't offer benefits may be poor value, even at a lower, relatively low price.
Company Incentives Shift
[00:15:06] Stacey Richter: If you were just gonna think about the likely outcomes of the IRA or the factors that we're watching closely that will drive these potential outcomes, what are you keeping your eye on?
[00:15:16] Dr. Peter Neumann: I think the IRA in terms of the lowering the out of pocket to cabs, providing better access through these kinds of insurance reforms that that's good news.
We should see better affordability for, for patients. The drug companies certainly are looking very closely at all the provisions of the legislation and gearing up doing their scenario analysis, seeing what new incentives they have under the law. For example, there are now going to be incentives to increase your launch prices to the extent you can do that.
Because the launch prices are not regulated, And if you're a drug company, you wanna get as high a launch price as you can, because after that, it'll be subject to the inflation caps and ultimately to a negotiation. I think we can expect drug companies to look very closely at non-Medicare markets to the extent they could bring drugs to the market.
Are not subject at all to these negotiations. I think they will try to do that. There are going to be much stronger incentives to bring biologics to the market rather than small molecule drugs because those biologics, large molecule drugs have 13 years, not, not the nine years. There are going to be incentives to start with the largest indication or population possible.
And in the old days, not too long ago, it was the opposite the the typical. Tactic for many drugs, for example, in oncology, was to start with the smaller populations, get the drug on the market, and then begin to expand from there. There are going to be, in a way, disincentives to continue to go after those incremental populations because the drug price will be tied after nine years to whatever population you, you have.
These are all issues that the companies are looking very closely at. As they think about their portfolios and their development programs,
[00:17:09] Stacey Richter: as we evaluate what the long-term impact or short-term even impact of this might be, you're keeping your eye on how pharma companies are scenario planning, the likely impact, and then their response to it.
One of them that you said is their eyeballing the non-Medicare markets, IE the employer market. And considering if there's any, I'm gonna assume cost shifting that can transpire, right? So if all of a sudden you have drug prices that are considerably higher on the commercial side of the house, coupled with it, the next thing that you said, which is a higher launch price for bigger populations like this could actually wind up smacking commercial.
Populations or employer plan sponsors particularly hard. What do you see happening there?
[00:17:54] Dr. Peter Neumann: There is a question about the extent to which the companies are going to be able to increase their launch prices. Increase their prices in the commercial markets. Certainly they will try, they have, will have stronger incentives to do so.
One could, I think, reasonably ask well. Why haven't they done that already? If the, if there's room to do that, And the insurers have their own policy levers. They, they restrict drugs, they, uh, put drugs on higher cost sharing tiers. Possibly they won't cover a drug outright. So th they have their own tactics and their own constraints.
But, but certainly I think, we'll, we'll be seeing these kinds of things play out over the next years.
Silos And Value Pricing
[00:18:33] Stacey Richter: We've had plenty of guests on the show, and I've been involved in plenty of conversations wherein potentially the high value drug. Gets blackballed in a way because of just the silos in the marketplace.
If the value consists of improving downstream medical costs. But if you have pharmacy costs siloed from medical costs, then somebody on the pharmacy side of the house really doesn't care if you are saving downstream medical costs at all because it's not part of their budget. How does that factor in here?
[00:19:03] Dr. Peter Neumann: You raise many good points, and we've heard this for a long, long time, and I think it's a reality that we may have high value drugs that are not favored because the cost offsets that are real are not captured by the pharmacy budget, and so the cost offsets are downstream and someone else reaps benefits of those savings.
We, we should emphasize that And we do in our book. Value-based pricing doesn't mean necessarily lower spending overall. There are many cases we've talked about some already here, where high price drugs could be high value drugs, And we should encourage the systems to adopt those high value drugs. But some of them offer savings.
Some of them just offer good value for the extra money you'll be spending. We do need to couple information about the value of the drugs, ideally with structural changes in the system, meaning incentives throughout the system to think about the long-term consequences, to think about this potential societal benefits of using these drugs and, and, and capturing those in the system, and giving the decision makers incentives to think about those kinds of things.
Now, that is not easy. And that it requires systemic change, payment changes, delivery system changes.
[00:20:19] Stacey Richter: Is this potentially a path forward for a pharma company that wants to control its own destiny who has a drug that they think actually works, right? And they're trying to figure out how to get paid what they would consider fairly for this drug to, to start leaning in harder into some of these.
More innovative outcomes-based or innovative contract arrangements?
[00:20:37] Dr. Peter Neumann: Well, these discussions are about outcomes-based agreements have been going on for some time, And we will continue, and that's regardless of the inflation reduction Act. I think the companies will lean in because some of these new products have very high prices and it's hard for the plans to pay upfront for.
Drug that's two 3 million or several hundred thousand dollars. So I think we'll see the companies leaning into these. I'm not sure the IRA changes that that much IRA's in.
[00:21:06] Stacey Richter: Not an accelerant in any way. I was just thinking
[00:21:08] Dr. Peter Neumann: maybe the IRA is just intensifying the companies, the strategies around recouping their investments and to the extent that's true.
Still be looking at everything much more intensely, including these arrangements.
[00:21:22] Stacey Richter: So just recapping here, we have going after the broader market, trying to jam as many indications and get as big a patient population as possible, right at the very beginning. And by indications, by the way, I mean getting FDA approval for the drug to be used for as many things as possible, like different tumor types if it's an oncology drug or different kinds of.
Mental illnesses, drug companies have to get all these different uses, IE indications approved in order to promote the drug's use for them. So it's definitely a more laborious FDA process for sure. So I guess pharma would have to weigh the pros and cons there. Then you also said there's an incentive for pharma to go for biologics since they have a 13 year non-negotiable run as opposed to small molecules which have only nine years.
And that could have an impact on whether pharma invests in highly needed small molecule products like new antibiotics, for example. They also could be thinking of ways to cost shift to commercial markets. None of these things are what I would call purely positive results. If thinking about this from a patient or a taxpayer angle, we have pharma less concerned with the spirit of the endeavor and potentially more concerned with maintaining or maximizing their profitability.
Not that anyone shouldn't have anticipated this, but I think your bigger point is that how this law gets operationalized could have a really big impact on whether drugs that are high value are actually the ones to get the most incentives and come out on top in negotiations. Are there any other potential implications?
Pro Orine, if you're thinking about this from a pharma company standpoint.
Me Too Drugs And Competition
[00:22:58] Dr. Peter Neumann: There are some exclusions in the law that of drugs that will be excluded from the inflation reduction action, which we haven't talked about. Rare diseases, companies with drugs for one indication, small, uh, biotech. Me toos. We should also, I think emphasize in a way get a bad name, but some of these products are offering incremental improvements that are very important to patients.
Different dosing, for example, or different tolerability. The law, I think, will create problems for, in a way, fast followers if we call them that. But once a drug in a therapeutic class gets a price negotiated. A drug that has important to incremental advances maybe is going to fare less well in the future, but certainly again, the drug companies are going to be looking very closely at all of this.
[00:23:43] Stacey Richter: I also, sometimes my eyebrows go up when there's Me Too drugs being kind of a hundred percent castigated just just because of the fact that competitive markets are ones in which the drug prices tend to be lower. So sometimes you wonder whether allowing more drugs into a category serves to lower the overall price of the entire category.
[00:24:09] Dr. Peter Neumann: I think we've seen differences in different classes of drugs on that. Certainly we've seen drugs say for in oncology, which seem to be coming out in the same class without any big reduction in price, despite what you might think of as competition, but in other. Product classes, I think we have seen rebated prices come way down.
And so I think that whether or not these, the competition works may be tied more to the types of drugs. And in a way, the, the leverage that the company has to keep their prices high And the leverage the plans have. To negotiate a price down.
PBMs And Plan Sponsors
[00:24:44] Stacey Richter: If we're thinking about this on the, not the plan sponsor side, but the PBM side of the house.
Now I have heard multiple people say, and I have no insight into this at all, but, but I have heard multiple people say that the PBMs have had their. Plan of action war rooms for years probably, and have a full game plan. You already see their revenue mix getting more into administrative charges and tagging less as rebate revenue, which on the face of it makes sense.
It's a pretty obvious move. I've also heard rumblings about PBMs doing things at the portfolio level, IE at the pharma company level and not at the drug level, which is probably another way to skirt observation and probably potential regulation. Do you have any insight into that?
[00:25:31] Dr. Peter Neumann: I think the PBMs and for that matter, the drug companies and perhaps others are.
Going to try to revisit provisions of this law and, and lobby for, uh, changes. And the drug companies are going to be attempting to move the nine years to the 13 years, for example, from for small molecules up to large molecules, the PBMs there, there are some provisions around, uh, how Medicare negotiates and whether it's starts with a, a list price, an average.
Sell price or a, a rebated price that will affect their tactics here. But again, I, I'm going to have to defer to others on the specifics there.
[00:26:05] Stacey Richter: If you were a plan sponsor right now, so you're an employer, let's just say with a self-funded plan and you are kind of a. Given the sideways stare to this bill, wondering if all of a sudden your prices for these drugs are gonna wind up going up as pharma companies eyeball the market for potential avenues to to raise prices, what would you be doing right now?
[00:26:29] Dr. Peter Neumann: Well, I, I think they're going to be doing what they've been doing, but perhaps with evermore scrutiny, that is, they'll be watching these launch prices intensely. They'll, I think, look more closely at restricting. Products. My group has been watching the, the specialty drug restrictions across these commercial plans, and they are increasingly tightening the screws, meaning that you only get access to the drug if you fail other drugs, first step edits.
They are focused increasingly on populations with narrower clinical characteristics. As a way to combat higher prices, I think they'll be looking to do those kinds of things. And again, putting drugs on, on higher tiers, increasing the cost, sharing arrangements for the, for the patients, things like that. I think we need to keep at this and continue to try and, and while it's easy to throw up our hands and complain.
About the system, and there's lots of reasons to do that. We should also be mindful that the science is progressing. There's, there's a lot of very important advances coming. Uh, there's a lot of unmet need that we can address and should be addressing. We need to keep, keep at that. Certainly there's need for systemic kinds of changes, and there's better data systems coming.
There's better infrastructure in terms of. It and artificial intelligence and I, I think we'll be applying. This is going to be hard. Always. We need to keep at it.
Value Without QALYs
[00:27:55] Dr. Peter Neumann: It, and, and finally, I think we need to redouble our efforts to try to measure value. Something we, we've talked a bit about here, but maybe, perhaps not as much as I.
Might have, because I think that to get back to our, our book that I think is, is going to be central to all of this. That for, for, for markets to work well, we need information for those marketplaces and, And we know that these markets don't work well. That's even more reason we need information. The Inflation Reduction Act does have some constraints on Medicare's ability to think about value And we bans against quality adjusted life years and things like that, which I think are unfortunate And we need to keep working at that as well.
[00:28:32] Stacey Richter: So what do you think are the most important value metrics then? Like obviously we can't, Quas are banned, which listen to the show with Anna Carlton Beck for more information on what, what a qualy is, but what's just your sort of in sum thinking relative to what we all should be thinking as we contemplate the value of a product.
[00:28:55] Dr. Peter Neumann: Well, the therapeutic advance, the comparative effectiveness of new products, which will be tied to the clinical benefits. We can't use a standard metric like aqua in the new legislation. So I think in a way it, it ties Medicare's hands. How can you compare? A drug for depression with a drug for cancer, with a drug for Alzheimer's disease, and on and on without a standard metric.
But you can look at the safety and efficacy as we look at the clinical data, which is what they'll presumably be doing. The the law says that they should look at things like unmet need And the nature of the population that it's being treated, and I think they'll be trying to make adjustments based on that.
But there's a lot, again, there's a lot that we haven't heard yet from Medicare about how they will do this. That's just gonna be very important to watch and maybe this will be revisited in in the future.
Wrap Up And Resources
[00:29:43] Stacey Richter: Dr. Peter Neumann, is there anything that I neglected to ask you or that potentially I skimmed over very quickly that you think would be important to mention here?
[00:29:54] Dr. Peter Neumann: You know, we didn't talk a lot about to the work of groups like ICER, which are not in the Inflation Reduction Act, but I think are playing an important role here in. In the value space. The one other thing that I thought we might get to is, should prices be higher for more severe diseases? And I think there's uh, some good reasons to argue that and some interesting theoretical and empirical work to support that.
And I think that's something that's, the Medicare is going to have to really grapple with that. What do you do about. Rare diseases, people with really severe diseases where we have new treatments with very high prices.
[00:30:28] Stacey Richter: Dr. Peter Neumann, if someone is interested in reading your book, where would you direct them?
[00:30:34] Dr. Peter Neumann: And again, I wanna acknowledge my co-authors, Josh Cohen and Dan Lenor. The book is called The Right Price. It's available from Oxford University Press, and of course. All your favorite online stores,
[00:30:44] Stacey Richter: And if someone is interested in learning more about your work at Tufts, where would you direct them?
[00:30:49] Dr. Peter Neumann: They can certainly search for me, Peter Neumann at Tufts, or our center called CEVR, CEVR. We're the center for the Evaluation of Value and Risk and Health at Tufts Medical Center.
[00:31:00] Stacey Richter: Dr. Peter Neumann, thank you so much for being on Relentless Health Value today.
[00:31:03] Dr. Peter Neumann: Thank you. It's been a pleasure.
Subscribe And Show Notes
[00:31:05] Stacey Richter: So let's talk about going over to our website and type in your email address in the box to get the weekly email about the show that has come out.
Sometimes people don't do that because they have subscribed on iTunes or Spotify and or we're friends on LinkedIn. What you get in that email is a full and unredacted unedited version of the whole introduction of the show transcribed. There's also show notes with timestamps. Just uprising you of the options that are available.
Thanks so much for listening.