EP465: The Not Super Effective Contracting Industry Norm, Where Jumbo Plans and Others Wind Up Paying $10,000 for $50 Drugs, With Chris Crawford

[00:00:00] Episode 465, The Not Super Effective Contracting Industry Norm, Where Jumbo Plans and Others Wind Up Paying $10,000 for $50 Drugs. Today I speak with Chris Crawford.

[00:00:23] Chris Crawford American Healthcare Entrepreneurs and Executives You Want to Know, Talking, Relentlessly Seeking Value. First of all, everybody listening here has probably heard of the lawsuit in which J&J and talking about J&J as a large employer here now, not as a drug company, but J&J is or maybe was there's action afoot being sued by a plan member because here's the short version.

[00:00:52] Chris Crawford American Healthcare Entrepreneurship Program, in the past, was paid for $10,000 a month for a drug that can be purchased for something like 50 bucks on Mark Cuban and other pay cash, get the drug types of places.

[00:01:09] Right? A giant PBM was charging $10,000 a month to the plan sponsor and member and a rando individual with a crumpled Jefferson in their pocket could pick up that same drug for around 50 bucks, $50.

[00:01:25] I don't know. I don't know. For every excess $9,550 a month, I mean, how many members could get prepaid advanced primary care or other high value care or meds assuming that the plan can capture those, in air quotes, wasted dollars?

[00:01:41] And this is just one example with J&J. J&J is not an outlier here. I mean, talk to anybody in pharmacy benefits and you will get a rundown of plan sponsors who are paying way too much for the in air quotes specialty generic drugs in the same exact way. It's word on the street. And when I say word on the street, I don't mean some kind of like wonky street. I mean, Main Street. It is becoming pretty common knowledge how often if you go to a cash pay website, especially for some of these specialty generics,

[00:02:11] it's cheaper than if you go through your insurance. Now might be a great time to bring up the aggregate discount guarantee because the aggregate discount guarantee is the mechanism, the contracting mechanism by which a lot of plan sponsors hope to control spread pricing, which is what jacks up the cost to $10,000 for a drug that can cost 50, right? That's spread. The PBM is taking the balance and putting it in their pocket.

[00:02:39] It's what many consultants recommend, this aggregate discount guarantee to plan sponsors when they do PBM RFPs also. And not sure if it's working out great, obviously, for the plan sponsor and member. But let's talk quickly about why it's not working out great and results in $50 drugs costing $10,000.

[00:02:59] We'll just do this quickly because I'm going to let my guest today, Chris Crawford, do the heavy lifting in terms of digging into the why the aggregate discount guarantee doesn't actually control spread so well. And also what you can do about it, which I don't know, doesn't seem to be all that terribly hard and might be what employees are doing anyway, all by themselves. So here's my dramatic reinterpretation of what Chris Crawford says during the interview about the aggregate discount guarantees.

[00:03:27] Who remembers that kid's book, Briar Rabbit? Briar Rabbit, a rabbit, ate a carrot, I think, out of a field and got caught by the farmer. The farmer wanted to punish Briar Rabbit and was sitting there contemplating the best way to do that when Briar Rabbit started wailing. Whatever you do, farmer, don't throw me in that briar patch. The farmer is obviously not connecting the dots between Briar Rabbit and Briar Patch.

[00:03:56] So yeah, he believes the tricky rabbit and the farmer throws Briar Rabbit into the briar patch as the punishment. And yeah, happy scampering and sues. So here's my reinterpretation of any PBM either suggesting or getting confronted with an aggregate discount guarantee by a plan sponsor looking to control spread pricing on generic meds. Oh no, whatever you do, don't throw me in that aggregate discount guarantee Briar Patch.

[00:04:23] And in the PBMs, I don't know, maybe defense, if plan sponsors or their consultants insist on including aggregate discount guarantees in their RFPs and will select PBMs on their ability to haul in the biggest discount. Yeah, it's just like the selecting PBMs based on rebate yields for branded drugs. Both are great examples of how something that might seem intuitive actually is a perverse incentive.

[00:04:47] Chris Crawford, my guest today and CEO over at RxSaveCard, who is also our sponsor of the show today. Thank you very much to RxSaveCard. RxSaveCard clients are typically seeing about 50% of total retail generic spend being reduced just by having access to cash prices. And generic drugs, by the way, are the most utilized benefit for most employees. 92% of all prescriptions are generic.

[00:05:15] And this matters for not only financial reasons, it also has huge perception consequences. For example, I was talking to someone recently because apparently I am a magnet for people who want to talk about their drug benefits. But this person said, oh, hey, this generic med I've been taking for a long time. Five years ago, my copay was like seven bucks. Then it became $15. It was $25 last year.

[00:05:39] And in January last month, when I went to fill it, they told me that through my employer's insurance, it would be $34 copay. I went on Mark Cuban Cost Plus Drugs because I heard you talk about it. And the total cost was $7. And then this person said, I feel like an idiot, you know, having paid more than $7 for more than five years. And I'm not sure what to make of my employer. You know, are they unaware? Do they not care?

[00:06:05] I mean, we all talk about pharmacy trend going up and then you see stuff like this going on. I do scratch my head and I do think to myself, well, if we got rid of these thousands and millions, maybe billions of dollars across the country in spread, could we actually have a decrease in pharmacy trend? Even as more patients took some of the branded drugs? I don't know.

[00:06:25] But I will say in the wild, the impact of the aggregate discount guarantee, not guaranteeing much, is becoming very obvious to plan members at this time. My name is Stacey Richter. This episode of Relentless Health Value, as I mentioned, is sponsored by RxSaveCard. And thanks so much to them for doing so. I loved this conversation with Chris Crawford and I think that you will too.

[00:06:49] And listen to episode 461, also with Chris Crawford, for more on the GLP-1 goings on and the manufacturer websites where if an individual goes on the manufacturer website, they can access a list price that is less than the price an employer with a big PBM contract will pay. Chris Crawford, welcome to Relentless Health Value. Yeah, I'm excited to be here.

[00:07:12] As has been said over and over and over again in earlier podcasts with Scott Haas and Paul Holmes and Luke Slindy, AJ Luakino, there is a great opportunity for PBMs to take spread. Now we're going to walk into Surprise Valley, Chris, because I kind of thought that the reason for this was just obviously PBMs are for-profit entities. And I'm talking about the big ones, right? I don't necessarily want to throw everybody in the same bucket there.

[00:07:38] But if you're talking to a for-profit entity and no one's stopping them, like why wouldn't they take as much spread as possible? But you introduced another concept here. So let's talk about aggregate discount guarantees. What is an aggregate discount guarantee? Yeah. So when you contract with a PBM, this is mostly spread PBMs, although sometimes a pass-through PBM will do that same thing. And so with an aggregate discount guarantee, and generally it's around all generic drugs.

[00:08:03] So it says if we purchase as a plan sponsor 100,000 drugs, when you throw those drugs into a bucket at the end of the year, we guarantee, we the PBM, an aggregate discount of some percentage off of average wholesale price. And so that is sold as a form of protection to the plan sponsor. Okay, I know I'm going to get at least this discount. The challenge comes in where you aren't getting that discount on every single drug.

[00:08:31] There's some drugs where you might get a greater discount than that, and some drugs where you might get a lower discount than that. And so the lower discount ones are also the ones that end up costing more to the plan sponsor and to the employee. And so when we look at the numbers, essentially it's pretty consistent. 30% to 40% of the scripts that are running through are cheaper if you just don't use insurance and pay cash. Use a discount card or get through cost plus drugs.

[00:08:59] So that is the real issue. That's kind of one of the things I'm not sure if everybody appreciated about the lawsuits. You could audit them and go through it. They met their contract guarantee, I'm guessing. This wasn't a missing guarantee. There's a big bottom tier of drugs that lots of patients take. So there's a big aggregate discount there at the bottom. This then enables the top of the stack, the more expensive specialty generic say, to have far less discount. Right.

[00:09:28] The bottom half pulls the average down. So this was the keys are given to the PBM to say, I'm going to meet this guarantee. And that's where you have these issues coming up of just the overcharging and the extra spread on some of us. Because at the end, when we throw them all in the bucket, we're going to meet that guarantee. And then it gets even better because the how it gets better is that discount is based on something called average wholesale price. So let me just interject it before we go to the next level here.

[00:09:58] Plan sponsors may feel confident. It's almost like the solution to the problem has as many issues as the problem is how I'm taking it. Plan sponsors are kind of, I get what you guys are doing over there. I see you. So we're going to put this average discount guarantee in so that you can't spread to your heart's content. This is going to be me being a smart negotiator. And I'm like, throw them no shade. This is a tangled web that we weave in all circumstances.

[00:10:24] So the PBM walks into the plan sponsor and says, look, you see, we have an incentive to do spread or whatever, but I'm going to make you feel better about it. I'm going to offer you this aggregate discount guarantee. And I solemnly swear that I'm going to honor it. And you're going to get some kind of discount that limits my ability to charge you too much for generic drugs. Like that's how I'm reinterpreting what you're saying. Almost this average discount guarantee is presented as a solution. Yes.

[00:10:54] And it's what is the industry norm when requests for proposals go out from consulting firms. They're evaluating PBMs. You know, the rebate issue and how you guarantee rebates has been discussed at nausea. But this is another one of those. You get aggregate discount guarantees and rebates. And I think that what the lawsuit's really pointed to is the issue of are we really paying attention to this? Do we know what could happen? Because I think there's a thought of, well, generic drugs are just inexpensive. Sometimes that's true. Sometimes that's not true.

[00:11:24] And that's where you kind of see these examples where you're saying, this is a maintenance medication that somebody takes every day. And there's savings of $1,000, $2,000, $5,000 per fill for a generic drug. How can that be? Yet if you were to audit it, you'd say, well, you've met your contract guarantee because you're allowed to do that in the contract. Because in total, you're still meeting your aggregate discount guarantee. So basically, it's like the PBM in this instance.

[00:11:53] If it's A divided by B equals C, and you say C is the aggregate discount guarantee, right? But if I control A divided by B, I can make A whatever I want. I can make B whatever I want in order to maximize my own profits. You absolutely nailed it. And the key headline there is that your aggregate discount guarantee percentage has literally no relation to what you actually pay for the drug. Yeah.

[00:12:19] If I walk into a store and this lip balm costs five bucks and you're like, oh, this is an amazing deal because its list price is $1,000. I'm saving so much money. I can't help but purchase this $1,000 lip balm. Right? Like if you jack up the original costs, then the savings can be amazing. And you have, if we can get into the weeds a little bit, I think it's also, these are the same drugs.

[00:12:47] So from a generic perspective, remember, these drugs are off patent. And so there's multiple manufacturers that can be making one drug. So that average wholesale price, which is what the discount guarantee is based on, that average wholesale price is set by the manufacturer. So if I have 10 different manufacturers making one drug, they can all set a different average wholesale price, even though it's the same drug.

[00:13:13] And so as the discounts play out, you can kind of see how that again doesn't relate to what actually costs less because that's what we care about in our everyday lives. Yeah. So AWP is the list price. Like this is what the price that a generic manufacturer says is like, this is the AWP, also known as Ain't What's Paid. And Luke Slindy gets into this in great detail. So if anyone is really looking for nuance, then go listen to that show. But what Luke says, he has a funny term for it.

[00:13:40] He calls the list price like the nonsense price or the gobbledygook or something. He says something kind of funny because he's just like, to your exact point, like it's the same exact ingredients. It's the same exact formulation. They are following a formula that was set. It used to be patented. Now it's not. There could be six different manufacturers and they're all just making up a price. And they could be wildly different. Like one of them could say, oh, my list price is $9,000. And the other one could say my list price is $40.

[00:14:07] Like, I mean, it just seems like there's wildly divergent prices here. It's not only wildly divergent, but then the manufacturers have a perverse incentive. And I know you've probably talked about this on rebated drugs, like setting a higher wholesale acquisition cost or wrap cost because there's more room to give a rebate. In generic drugs, if I'm a generic manufacturer, I want my drug to be the one that a pharmacy stocks or to be the one that is sold through a formulary for a PBL. Let's just take two examples if we can.

[00:14:36] So let's say drug A, again, same exact generic drug. Drug manufacturer A sets the drug with an AWP of $1,000. But PBM says, we're going to give you a 90% discount on that, right? So that means that drug is now $100. That's what you actually paid for. Drug B, same exact drug again, has an AWP of $100. Let's say the PBM gives you a 50% AWP discount on that one.

[00:15:04] Now I'm paying $50 for that drug. In PBM math, I want to put the $1,000 AWP drug on my formulary and in my math to your earlier question. That's my numerator now. And so if I get a 90% discount, wow, that is a great discount. That spreadsheets really well. Look at these amazing deals. I'm giving you a 90% discount. Even though the lower AWP with a discount of 50% costs literally half as much.

[00:15:33] So that is the issue where even within AWP discounts, that's how they can be manipulated where the PBM still meets the guarantee. But again, it has no relation to what a plan sponsoring employee can end up paying out of their pocket. Just recalling, we started this conversation talking about these aggregate discount guarantees where the PBM, the way that they're going to keep themselves under control is by the plan sponsor forcing a discount guarantee onto the PBM.

[00:16:01] Like that's how this is going to work and that's how PBMs will be held to account. And what you just went through is why that doesn't work so well. Because as you said, drug A and it's the same generic composition, right? Two different manufacturers. The example that you gave was drug A manufacturer sets a list price in AWP and eight ones paid. They just make up a number and it's $1,000 for this particular set of ingredients formulated in the same way.

[00:16:29] And then the PBM like, but you know what? We're so amazing. We're going to give you a 90% discount. So if you do the math, now the plan sponsor is paying $100 for this particular generic. Whereas you could have manufacturer B who's like, it's $100. So I'm going to make this $100, but then the discount is going to be 50%. So now that drug costs $50 as opposed to $100, which is what you said.

[00:16:55] It's like actually half as expensive in absolute terms, but yet the discount is only 50%. So if you look at the aggregate discount spreadsheet, it doesn't look as good. And said another way. So let's also give PBM some credit for, well, this is the contract I've signed. So the PBM would actually be penalized if they have a high aggregate discount guarantee for putting the lower AWP on. It'd be harder for them to meet that guarantee, right?

[00:17:20] Because if I'm guaranteeing an 85% discount, why would I want to fill one at 50%? That makes it harder for me to meet my guarantee. Yeah. And I'm going to underline two common themes that come up over and over and over again on this podcast. The first one is, and Rob Andrews said this very succinctly, so I'm going to quote him. Organizations do what you pay them to do. So what in effect with these aggregate discount guarantees we are paying people to do is to maximize their discounts.

[00:17:48] And which brings up the second thing you hear over and over and over again on this podcast, which is what's the absolute price? What we should be looking at is what is the absolute unit price? Not what are these savings? When you have someone who can set a list price, like they can make the savings whatever they want to suit the people do what you pay them to do. So we get ourselves in a very downward doom loop when both those things are true. And we set contract guarantees that are based on savings or discounts.

[00:18:17] And that is really what Cost Plus Drugs and certainly others have done. But Cost Plus Drugs really is looked at now as a benchmark for the cash price. Where before, these things are buried in an employer's claim file. What did the employee pay? What was billed back to the employer? It changes. You don't know if you're getting a good deal or not if you're an employer. Now, as fiduciary law also really pointed out is you now have a reference. Anybody can check that price. Anybody can look at it.

[00:18:47] And I think that's the thing that I've always told employers is, hey, just look at your claim file. Select generics only and do descending order, highest cost to lowest cost in ingredient costs. And then take those drugs and prepare it to Cost Plus just as an example. And every employer is going to find examples in there, frankly, that are going to make them a little nauseous. So, yes, it matters to the client sponsor. Absolutely.

[00:19:12] But one of the things you said earlier, where it really matters is to the employee when they're in their deductible phase. I mean, so we're just taking over a new client for January 1st with a PPM. And we're just going through and looking at some of these employees. And the benefits center is like, I want to see who we're going to help in this. So, yes, we're going to save money. Let's talk about the employees. And so we looked at somebody on a cancer med for breast cancer. This is a chronic med that she's taken to battle breast cancer.

[00:19:39] The PBM charging $1,200 for that drug. She was in her deductible phase paying $360 out of her pocket. Okay. These are the plan to pay over $800. That drug through Cost Plus drugs costs $43.70. So the PBM, so this is a perfect example of what we're talking about here or another example. I guess it's probably a better way to frame it.

[00:20:03] That, you know, PBM looking to maximize aggregate discount guarantees does the thing where they pick the manufacturer. Oh, we're going to give you this big discount. So patient in deductible phase, why is it paying $360? Like 300, that's a lot of money. $360 a month is a lot of money. That's something that as consultants, and I think I'm certainly guilty of this. You get in, you're negotiating PBMs and the numbers just get so big that sometimes it almost seems funny money.

[00:20:31] Where, well, you're spending $50 million on pharmacy. What's $500,000 here? Or what's a million here in kind of the grand scheme of things? But at the individual level, exactly what you said, these numbers are meaningful. And you're already battling cancer. You're already going through something. Now you've got to spend $360 out of your paycheck. In this example, the employer is like, we're just going to pay 100% of it because we win. Because the employer now saves over $800. The employee gets a drug for free, gets the medication they need.

[00:20:59] Because the other piece of that too, where you really see this play out, we're talking about aggregate discount guarantees. Another way aggregate discount guarantees can be manipulated is if you're with a PBM that owns their own pharmacy. So their male pharmacy and their specialty pharmacy, essentially anytime something's sent to your home with the largest PBMs in this country, it's coming through a pharmacy they also own. So you have no ability to shop. That's why Cost Plus Drugs is really locked out of the traditional market.

[00:21:28] Because filling that drug for $43 through Cost Plus Drugs penalizes the PBM. They lose the discount guarantee. They lose the margin as a PBM. And they lose the revenue of shipping that drug through their own pharmacy. And we have no idea what they actually bought the drugs for from the manufacturer wholesaler at the start of this whole thing. So I just want to interject two points here that go together. And then I want to really understand what RxSafeCard, how RxSafeCard fits in this mix.

[00:21:57] So the first thing is, what is happening right now is that there is some transparency, which is entering the building. And that transparency has come from entities such as Cost Plus Drugs. There's others, you know, Amazon, right?

[00:22:13] There's a bunch of different players right now in the pharmacy space in particular, where a somebody who is health literate at not even the highest level can go and figure out how much the cash price of a drug is or how much that drug costs. You actually can go on Google and you can do a search for what's the cash price for this drug. So it's not like you have to have arcane spreadsheets and proprietary information. It's easy enough to figure this out if you can use the Google.

[00:22:42] And because of that transparency, a couple of things are happening. Number one, lawsuits. Because what is the role of a fiduciary? One of the criteria here is prices paid must be reasonable. Because like we have a fiduciary responsibility to spend plan assets wisely on reasonable costs. And costs have to be reasonable based on information that is available.

[00:23:08] Okay, well, information is available that you can get a drug for $53 and the plan is paying thousands for it with internal plan dollars and then forcing members who choose to use that plan to spend. And not reasonable. Not reasonable. It's not prudent. So like lawsuits are happening. That's kind of thing one as a basis of this transparency. Here's just another point to ponder.

[00:23:30] There was a big conference recently where the head of one of these, literally the CEO of one of these big consolidated entities stood up on stage and said, And this is almost a direct quote, well, you know, everybody knows transparency doesn't lower prices. So you also have comments like that, which are clearly on the pharmacy side, at least incorrect.

[00:23:56] What drives costs lower is competition and the ability to see prices. And so I think that is what has really changed everything with it. So cost plus charge is a great example. Again, there's prices out there. Now you can compare and say, how good is my price? And we'd love to see other pharmacies doing that as well.

[00:24:18] I think the other thing that you mentioned is there's more, you can go on Google, but discount cards and how good are X created a category of people to be able to go to their pharmacy, check prices and potentially pay less than their insurance without having insurance, without paying a subscription fee by just seeing it. And so when you have competition, that is where you actually go. Okay. And I can do unit cost to unit cost. And I know what this is. Why should I overpay?

[00:24:46] And that is really the key point we saw that RX save cards. We saw this environment where I'm locked into only paying my prices that my PBM tells me I'm going to pay. I got to go to the pharmacies they tell me I can go to. And here are the prices I pay. And if I want it to be, I'm air quoting covered, right, by my insurance, these are the rules I have to play by. So how does RX save card fit into this? Yeah. So how are RX save cards? Because we're outside of that system.

[00:25:15] There is an emerging ecosystem of cash pay prices, right? So cost plus drugs is a great example. Discount cards. When I go into my pharmacy and I use a discount card and I don't need insurance to do that. That is an example. We're seeing Eli Lilly going direct and offering cash prices to people without insurance for Zetna on their GLP-1 at a cost that's 70% less than what you pay through the PBM.

[00:25:44] And listen to episode 461, also with Chris Crawford, for more on this, the GLP-1 goings on. The rub on all that is if I'm with a traditional PBM, I can't access those prices. What our solution really does is allow employers to access those cash prices outside of their PBM. They don't have to change PBM. They can still keep their PBM if they want the rebates, if they want coverage for other things.

[00:26:11] You stay with your PBM, but you're not locked into only paying those rates. And so that's really what we've done. So if employers want to have access to cost plus drugs, their PBM won't allow it. We can do that. Do you want to access lower cost through discount cards if they're less expensive and I'm going to my local pharmacy? I always go to my drug. We can do that. So it's this concept of in our everyday lives. I love Amazon, Amazon Prime. I don't buy everything in my life from Amazon Prime when it's shipped here.

[00:26:38] If something's less expensive from Target or Walmart, I'm going to go buy it. Yet in our world, we've said, no, everything has to be purchased through this one entity. And that just, the fiduciary lawsuits are saying, that's a problem. So what you're doing, and I think this is the point that you're making, that competition lowers prices. Which, by the way, is also why GoodRx prices are often lower than a PBM price, just because the GoodRx forces PBMs to compete, right?

[00:27:05] So what we've got going on here is an employer, you have nothing to do with the PBM relationship. Like, great, keep your PBM. You do you. Employer, plan sponsor, as far as the PBM is concerned. But also, give your employees the RxSafe card. Because what you're going to be able to demonstrate is that in any of these cases, or the cash price, or the non-PBM price, or whatever, like, you are the competition here.

[00:27:30] And it is eminently possible for a lot of these drugs, especially the ones that are subject to this aggregate discount guarantee, if that's afoot in anybody's circumstance. There is going to be a plethora of these meds which are cheaper, just using the card and not going through the PBM. And it's meaningful. I mean, we're typically seeing about 50% of a total retail generic spend being reduced just by having access to cash prices.

[00:27:57] Well, wait, so it's 50% less for a plan sponsor to add the card? If you look at all those drugs, the ones I was talking about. So if you take 30% to 40% of the drugs that you are overpaying for, they're the highest spread. They're all those drugs that are well below the aggregate discount guarantee line where a cash price exists that's less, right? Which is where our save card comes in. We access all those prices. You're going to wipe 50% of your total retail generic spend just off the board.

[00:28:26] And more importantly, it's the most utilized benefit by all your employees. 92% of all scripts in this country are generic drugs. This is what people are going to the pharmacy for. This is what they're using. These are where you hear those stories when people show up in January and all of a sudden the pharmacist tells them, well, that drug is now $500. Like, wait a second. I was just paying 20 last year. What happened? Well, formulary changed. It's like you're locked into these prices.

[00:28:51] And you alluded to it, you touched on a little bit in the discount card market where it's like, well, GoodRx is kind of using some different PBM networks. But the way to think about it is discount cards, that's really what they are doing. So our solution, if you're with a PBM and you go in, again, you're locking that price. You're locking that one price that they've negotiated. That's what they're going to tell you.

[00:29:11] What discount cards do, so what ours is, we check the price of 14 different discount cards at that pharmacy for that specific drug at the time when the member goes in to fill it. So what do you think is going to be better? One price or letting all those discount cards underneath the hood compete and the best price always comes up. So it's almost like discounts themselves when you go to a retail pharmacy are getting a little commoditized.

[00:29:39] It's just how you access those. And if you aren't locked into only paying the rates that a PBM tells you and you can open that up, again, competition leads to lower prices. Access leads to lower prices. When you're locked in and you can't change, you have to pay the prices dictated by that one entity. That's where you end up overpaying and you don't have the protection. And is this considered like a carve out? For example, do I have to get my PBM's permission to use RxSaveCard? You do not. No.

[00:30:09] So we, our solution specifically, we're not violating any terms of a PBM contract. The same way a PBM couldn't tell you, Stacey, you can't go to Cost Plus to get your drug. Even if it's on insurance or, hey, Stacey, you can't use a discount card when you show up at your local pharmacy. Same thing here. We are just accessing cash prices where they exist for employers and for their employees. So yeah, we're sitting outside of that PBM relationship.

[00:30:37] And how this would look would be, I would just send all of my employees this card. I mean, and I don't want to minimize what I'm sure is a ton of education and stuff that goes on. But at the end of the day, it kind of looks like all the employees get this card. They can walk into a pharmacy. It's not like this is alien to most people at this time to pull out a discount card and see if it's cheaper. People are doing that now as kind of the course of how they operate a lot of people.

[00:31:05] So you're basically saying just send everybody this card. And when they go into the pharmacy, they can price check. And that is what makes us feel so great about it too, is we aren't denying anybody's drug. We're not telling you have to switch a drug. We exist to save people money. And so when employers are rolling it out, they're rolling it out as, hey, here's a new benefit where you might be able to get a drug for free or you might have an option to spend less than you were spending before. So we really have worked hard to create a everybody wins. Employer saves.

[00:31:35] Employee saves. You don't have to change your PBM. You don't have to go through that migration or anything else. This is just an added benefit that you can put on next to it. And so that's what's so fun is just it's all good news. You know, when we're looking at it, like, yeah, you can save. And getting back to that, the cancer patient or somebody else, a couple hundred bucks, 300 bucks, that's meaningful. And I think also I would say 40 bucks is meaningful. If you're filling it every 30 days going through it, all of a sudden you get a drug for free and everybody spends less.

[00:32:04] Like, why would we not do that? I think that's very well put. When lower costs exist and the cash marketplace is out there and you decide that I want my folks to have access to this, why overpay if you don't have to? There is a market now and there's this emerging market of cash. And I think that's what we're most excited about. Chris, is there anything I neglected to ask you that you want to talk about right now? We could talk about this for hours and go in so many different directions and everything else. So I just think what you are highlighting is really important.

[00:32:32] And in preparation for this discussion, I went back and listed some older episodes that I hadn't listened to. And it was fascinating. G-Buy from almost three years ago now was talking about this emerging cash marketplace. And so many of her predictions came through. But you mentioned the Luke. Luke Slendy. Discussion. That was really fascinating. It's like, why don't all pharmacies just do the cost plus model? Well, they offer cash. And it's like, they're stuck in this position of, well, if I enter into a PBM contract,

[00:32:58] he gets into this usual customary, which is essentially the cash rate and why they can't do it. So I just think, I'd say people go back and listen to those episodes. And it really just gives a nice kind of overlay of the land of, okay, now this is the market. And now what can I do as an informed buyer or an informed benefits leader, knowing the market has exists and there is this whole new area that we can access. And you don't have to only pay the prices dictated by your PBM.

[00:33:27] So Chris Crawford, if someone is interested in learning more about the work that you're doing, about RxSafeCard, where would you direct them to find you? Yeah, RxSafeCard.com. You can reach out to us there. We're very active on LinkedIn, trying to educate as much as we can on the opportunities in the market. So people can feel free to message me there as well. Chris Crawford, thank you so much for being on Relentless Health. You today. I loved it. Thanks, Stacey. Hi, this is Rob Marty. The Relentless Health tribe has had a positive impact on my life since I first started listening two years ago.

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