June 17, 2025
Welcome to Perspectives, a signature podcast series from The Leerink Center for Pharmacoeconomics. Hosted by Dr. Mel Whittington, a health economist and Head of the Center for Pharmacoeconomics, we will be hearing from individuals across the industry to better understand and appreciate the societal impact of healthcare innovations.
Mel Whittington: Hi everyone. Today we’re going to discuss concepts in pharmacy. As of lately in the news, we’ve been hearing a lot about the pharmaceutical supply chain or pharmacy benefit managers, specialty drugs, compounded versions of drugs, and even 340B. So, the intent of this podcast is to provide a primer on these different pharmacy concepts. So, when you all hear about them, you have a foundational understanding as to what they are, what they aren’t. So, you’re aware of the intentions of each and the areas for improvement. We have a great guest on the show today. He’s the only person who can make this topic fun and engaging. He’s a frequent commentator on all of these he is a frequent commentator on all of these pharmacy topics, is extremely skilled at breaking down and articulating these complex topics and is someone who just always provides a balanced and honest assessment. Today’s guest is none other than Dr. Joey Mattingly, Vice Chair of Research for the College Pharmacy at the University of Utah. Joey, thanks for being here.
Dr. Joey Mattingly: Yeah, excited to be a part of it.
Mel Whittington: You have a really unique background which is partially explained by all of your credentials. You have a PharmD, MBA, PhD. You probably have a bachelor’s degree in there somewhere. But can you tell us about your background and let us know what you do now?
Dr. Joey Mattingly: Yeah. Well, actually first, thanks for letting me join. I’ve heard some of your podcasts and really excited to be part of this distinguished set of guests. Honestly, like I didn’t know health economics was a career when I was a kid.
Mel Whittington: Same!
Dr. Joey Mattingly: Yeah. Like I legit, to be a little bit more personal. Like my grandmother really struggled with some medications when she, when I was in high school and I was very close to her, and she struggled to pay for some of her medications and it really had an impact on our family. And so, I articulated this early on as like 18, 19 years old. was like, “I want to fix drug pricing in the US.” Literally the nerd in me was literally saying these things. But you know, my dad was a farmer. The pharmacist was actually really great with my grandmother. So that helped a little bit. I had an uncle who was a pharmacist that did very well. And so, I was like, “all right, well, let me check out this pharmacy thing.” I got to the University of Kentucky. I take some business classes because I was interested in my MBA as well. And my econ classes were amazing. And I was like, “oh this would be so cool if I could tie these two together.” But all the economists at my alma mater were like labor economists and everything. They didn’t say, “hey, you should pursue health economics.” So, I say that, you know, because my job as a faculty member today is to try to help identify the, the young people who are articulating some of these other things as they’re in pharmacy school, because maybe they didn’t know that, hey, there’s this whole field, there’s this whole area. And so that’s sort of why I’ve got all the credentials. If someone had caught me a little bit earlier, if I had met a John Campbell or a Peter Newman, or if I’d met one of these folks earlier in my life, I probably would have pursued it much earlier.
Mel Whittington: I know, I understand that too. It took me until I think my first semester of my PhD to be exposed to health economics. And when I was, it was like, “oh this is awesome. This is my calling.” But, I probably wouldn’t have got a bachelor’s in biology if I would have known this was a thing. Well, I’m so glad you’re kind of training the next generation and identifying people who would have a helpful and enjoyable career in our space. Because I think we are an important field, and we need more talent. But you also have a PharmD and you’re a health economist and you have an MBA. So, I think you are perfectly suited for this conversation. And I want to get into some of these pharmacy concepts and start off with a little challenge if you’re up for it. I know you’re a competitor. We often talk sports and so I think you’re up for this. But I want to challenge you to explaining the pharmaceutical supply chain in 90 seconds or less. You okay with this? Okay. I’m starting the clock now.
Dr. Joey Mattingly: Alright, let’s start the clock. Great. So, the pharmaceutical supply chain is just a complex way of explaining something simple. It’s how do we get medications from the discovery and identifying what they are and manufacturing them and then distributing them across the US to 350 million people. We fill 4 billion prescriptions annually in the US and it takes a lot of players to get it there. So, we have wholesalers and pharmacies and then we’ll get into some other things and how we pay for them and that complicates things a little bit more. But at the end of the day, it’s just how do we get medications to the right people?
Mel Whittington: I think we can end this podcast here.
Dr. Joey Mattingly: Did I do okay? I practiced it a bit.
Mel Whittington: Well, that was great. That was only 37 seconds. But I don’t think it needed to be longer. You’ve perfectly captured all of it. And then I think we can kind of dig into some of these specific concepts. So, supply chains aren’t unique to pharmaceuticals, right? They’re supply chains for other things. And I think the concept of a supply chain is confusing in general. And the majority of people don’t often think too much about it. My husband works in supply chain, not in pharmaceuticals, but in supply chain, and I still really have no idea what he does. He probably says the same thing about my job. But the supply chain for pharmaceuticals, as in other industries as well, it’s really important. It’s also complicated. So why do you think the pharmaceutical supply chain is so complicated? Why are there all of these players, wholesalers, pharmacy benefit managers? What makes the pharmaceutical supply chain different?
Dr. Joey Mattingly: Yeah, I mean, you know, I’m glad that you’ve prefaced it with like, we’re not unique. I mean, there’s a reason why In-N-Out Burger only exists in certain parts of the country. Like they try to maintain a very consistent supply of fresh vegetables and meats and cheeses for their delicious burgers. Shout out to In-N-Out Burger. We’re talking about medications that are not, like they’re not benign, they can hurt you. And it’s really important that the product that you get is what you expect it to be. It’s really important that the product says what it is, what it is that’s on the label, is inside the bottle. It’s important that you’re given the correct thing. So, we want to make sure that when a physician or nurse practitioner prescribes you a medication for your ailment, that you get exactly what is needed, right? So, there’s these, all these other components and making sure that you get the right medication because at the end of the day the most expensive medication is you know often the one not taken or if you’re taking the wrong one like those can be very expensive, very costly mistakes, it’s really important that we get it right. You know the pharmaceutical supply chains under a lot of scrutiny for a lot of various reasons but when you step back and think about that’s why I was like to talk about the four billion, there’s a lot of medications consumed in the US and the fact that we’re not talking about deaths every other day from mistakes is actually something we should applaud.
Mel Whittington: Fascinating. I had no idea the magnitude of that number was as large as it was. So, qualities’ important. Getting the right drug to the right patient at the right time is really important. There’s something called a wholesaler. So, I guess what I’m trying to ask is, I also have memories of my childhood of going to the local pharmacy with my grandmother. And we would go on Tuesdays because, this retail pharmacy had this, you know, the pharmacy in the back half and the front half there was a little cafe, and we would get chicken noodle soup and milkshakes on Tuesdays. And it was like, you know, a dollar. And so, like my childhood experience of getting a medicine was, you know, going to this small pharmacy, eating with my grandmother, picking up the, you know, prescription in the back and then like going home. I never thought about how that drug got to there. So, who are some other people that touch the drug besides the pharmacist who lived five doors down from me growing up?
Dr. Joey Mattingly: Yeah, no, I mean, well, you know, it often starts with just the chemistry and the ingredients that form the pills that we take. Like, you know, we see this little pill, but we don’t realize that, like, there’s not just the drug that you see on the label that’s often like, you know, here’s this exact medication I’m taking. Like if I have a blood pressure medication called Lisinopril and I want to take that 10 milligram tablet, there’s also these other fillers and components of the medication too. So, the process of getting that tablet dosed perfectly every single time, millions of doses, right? So, there’s this complex manufacturing process. Then because these products, like imagine just the complexity of just like getting strawberries year-round where you live, you know, we have a complex supply chain for food as well, right? Well, imagine when strawberries are out too long and get moldy and get bad. It can happen for drugs too. So, we have to make sure that the temperature, the humidity, all of these things are within range that the drugs have been tested in so that when they reach you, you finally get to the point where you’re taking them, again, they’re not something that can harm you. We think about the different manufacturers or manufacturing their drugs, it wouldn’t be as efficient. for say a company like, I always pick on Pfizer I don’t know why, but Pfizer is always the first drug company that comes to mind. So, they have, you know, they don’t make all the drugs. They have a set of drugs in their research pipeline, different diseases that they treat, but they have very specific drugs that they make. It’s not as efficient for them to invest in the logistics to get their pills and tablets to all 70,000 pharmacies or outpatient pharmacies in the U S. and that’s not when you count hospitals and stuff to you, got another 20 or so thousand probably locations. So, we’ve got these large wholesalers. There’s about three that we call like the big three wholesalers that make up most of the market there. They are the group that are sourcing at a large scale from the Pfizer’s and Mercs and whatever, and then all your generic companies. And then they work with each of the, you know, whether you’re a mom and pop, a single pharmacy, or if you’re a large chain like Walgreens with 8,000 locations, you’re working with wholesalers to help distribute products. And then the bigger you get, so like when I was with the Kroger company, we had our own internal wholesaler, if you will. So, we would manage some of it ourselves. And so, we would buy enough for our 2,000 pharmacies to have like our own warehouse. And then we would have a backup we would use Cardinal or AmerisourceBergen and one of the other wholesalers as sort of a backup, right? So, if we could source it ourselves and do all the logistics ourselves, we could save a little bit of money. But if we needed it next day and say we couldn’t get it from our own warehouse, we would have a secondary wholesaler.
Mel Whittington: Got it. Okay, so I appreciate the importance of the quality and getting a drug through this complex supply chain and to the patient. And I still think it’s a very confusing process, but a process that I sure am glad is in place. And I think it’s a process that we can often take for granted. I want to pivot a little bit to talking about pharmacy benefit managers, because we hear a lot about them in the news. I’ve read a lot of your really balanced assessments of the intended role for PBMs and some of the areas for potential improvement. But as I understand it, pharmacy benefit managers are intermediaries in the supply chain. They are one person in the supply chain. Can you dig deeper into their intended role?
Dr. Joey Mattingly: Yeah, pharmacy benefit managers have been around since the 1960s. I think the first one was formed in Canada in 1959 and made its way in the US by 1960. Basically, they were just pharmacists that were like, hey, because remember at the time, like most patients just, if you needed a drug, the doctor would write you a prescription, which was still kind of a new thing because you know, I’m a big history nerd.
Mel Whittington: Oh yeah.
Dr. Joey Mattingly: You know, go a little bit further back, the doctor, you know, would not write a prescription at all, just till you go to the pharmacy and ask for this, right? But then they had to put it on a little piece of paper, a little prescription. And you go to the pharmacy, and you just pay for it out of your own pocket. Like you are not using insurance for this care. And in the 40s and 50s, we started developing health insurance benefits, became more common in the United States. And we started thinking, well, would it be helpful if patients and actually prepaid, you know, rather than having like all their cost upfront, what if they prepaid at the beginning of the year or had a way to kind of budget, if you will, their pharmacy expenses for the year? Imagine kind of like your own flex spending kind of thing. And they sort of started as these processors and prepayment plans. But then they got more complex. They started, the demand was to, you know, hey, if there’s 10 different drugs in a class, do we need to pay for all 10 of them? You know, could we just pay for two? And so, you create this list or this formulary list that’s now kind of a real powerful component of the pharmacy benefit manager.
Mel Whittington: If you don’t mind, can I ask you what are some reasons why PBM reform is so frequently talked about today, what’s kind of driving some of that?
Dr. Joey Mattingly: So, one of the challenges as, as pharmacy has grown, while it still only remains a small percentage of the total healthcare spend, it’s, you know, we spend a lot of money in healthcare and there’s a lot of money in this space. So, if you think about it, back to that supply chain, I always love kind of showing the flow of the drug from the manufacturer to the wholesaler, to the pharmacy, to the patient. Along that chain, everyone like, everyone makes money off of the flow of that product, you know? And the pharmacy benefit manager is like, “well, who’s this person? Why are they getting in the way?” Well, the issue is because the patient is not going to the pharmacy paying cash for their medication. They literally are coming with a negotiated group, a population that’s based on, in the U.S., it’s based on our employer. People act like well, they don’t have these, you know, we don’t have pharmacy benefit managers in Canada. Yeah, you do. It’s called the government. It’s called it’s called the you know, the I’ve worked I work for the British Columbia Ministry of Health for a four-week rotation I was in pharmacy school. I was like man. This is just like a PBM. Yeah, it’s just the tax taxpayer dollars pay for it. So yeah, I mean like you ultimately have someone that’s making rules about what drugs patients can and can’t take if you want to use, if you want the insurance benefit. And so, with that. you have pharmaceutical manufacturers who make the drug, and they would like to you know maximize their profit. They would like to sell as many units as the highest price they can. Right?
Mel Whittington: I would add that they’re really the ones coming up with the drug, investing in it. So, we certainly do want to reward them for this innovation.
Dr. Joey Mattingly: Yes, yes. Yeah. Totally. Yeah, yeah, yeah. So, like they yeah, so they they’re looking to sell product. Pharmacy looks to sell product, right? And then the pharmacy benefit manager is in a spot where well, who do they represent? Well, they’re representing employers in the US, right? If I you know, really if I my passions really like coffee, if I could just start a coffee shop and compete with Starbucks and build my own little coffee shop chain and say I get up to 100 employees and I want to offer them pharmacy benefits. If my expertise is making a really good espresso, should I also have the expertise in creating a formulary for my employees? You know, like that’s crazy. So, like in a way, they fulfill a role for employers who are willing to offer these benefits to their employees. And now we’ve created some crazy incentives. We can certainly get into some of those in bit in terms of like drug pharmaceutical rebates and whatnot. But so, the PBMs have filled a role, and they capture value as well. So, like for every, I don’t know, I tried to estimate a little bit like the estimate I did using Medicare Part D plans, I was estimating that the manufacturer may get around 30% of the actual total dollar that’s spent. Whereas you start seeing like the chunks of that dollar coming out along the supply chain. The wholesaler doesn’t get a lot, maybe five to seven percent, pharmacy probably in that same thing. And the PBM and manufacturer kind of split the rest like in that 30, 40 percent of that dollar goes to those two big entities. So, guess what? The reform is very important. It’s very important politically. And there’s a lot of people with money on both sides that can argue this point. It’s a hot topic. It’s really hard to find anyone talking about the that isn’t on a side, right? So typically, you’re gonna see someone representing the manufacturers, representing pharmacies, representing PBMs. Wholesalers seem to stay quiet, but there’s rarely people that just talk about it in more general sense.
Mel Whittington: Absolutely. And our last podcast episode was with Dr. John Campbell. And, you know, he had talked about all of the different kinds of mouths to feed in the pharmaceutical supply chain. And you the estimate varies, but, you know, there are multiple estimates that suggest around, you know, 50 ish percent is going to the innovator and then other people, you know, there are these other mouths to feed. And, you know, so I think when we are this system, this health system that needs to find efficiencies, are there ways we can find efficiency without reducing the incentives for innovation, without reducing the money that’s going to the innovator and making sure we have ongoing innovation and paying back for their investment, but are there ways to still find efficiencies? Transitioning to another pharmacy concept, in one of President Trump’s recent executive orders, it discussed direct to consumer purchasing programs, which I do consider you a pharmacy historian and you talked about in the 50s or 60s where it was kind of direct to consumer prescriptions. How does this change the supply chain or how does this change the role of PBMs?
Dr. Joey Mattingly: Yeah, so no one’s stopping anyone from direct to consumer now, right? There’s nothing preventing a manufacturer working through that process. The issue is, okay, tell a Hepatitis C patient in 2014 to go direct purchase Harvoni for $30,000, right? That’s the issue.
Mel Whittington: That’s why I find this kind of direct to consumer for pharmaceuticals just odd because I think we have insurance for a reason for pharmaceuticals and for health care goods and that we do want to spread out the cost among a large pool of people. We don’t want to just have those who need it be the one who are paying for the innovation. And so, I kind of find that direct to consumer for pharmaceuticals, a little odd. Transitioning to another pharmacy concept, you are certainly vocal about this on social media and other places. What is compounding?
Dr. Joey Mattingly: Yeah, so again, been around since the form, you know, pharmacy was built around compounding because we didn’t have manufacturers produce, producing products that were ready to go. It was like you’d get powders and tinctures and, you know, so most of the time you got a little, you whipped it together in the pharmacy. It’s rooted in pharmacy practice. Compounding is incredibly effective for what it’s meant to be. It’s really personalized medicine in its most real form. If a physician and the patient decide, here use an example, a real common one, like a patient is struggling to swallow a certain pill and it’s only available in a pill and the pill is large or large enough to give them problems. The pharmacist pursuant to the prescription from the physician, so I am very specific by that language, meaning that there’s a physician, a patient and a pharmacist relationship going on. The physician writes the prescription, this drug, you know, once a day, can you, you know, compound as a liquid would be a very straightforward process. The pharmacist would work on the chemistry to make sure that, you know, we’re putting it in the right diluent or in the right suspending agent so that it doesn’t, you know, because again, these are chemicals and anyone who loves to cook would know like if you mix certain things with oil versus water, like you have challenges and stuff. So, it’s really important to figure out how it should be made. And we don’t want to just eyeball it, so this has to be exact. So, there’s a science to it. So compounding is a very important part of our supply chain. What’s coming up right now is a mass compounding or a compounding at a scale that’s not individualized.
Mel Whittington: One question is still related to compounding is there’s something with compounding related to drugs being on a drug shortage list. Can you explain what that is?
Dr. Joey Mattingly: Yeah. So, what’s kind of cool about the drug shortage list is or what it with compounding can fulfill this awesome role during a shortage. So, say you’re used to getting a certain, and we’ll use the GLP-1. So say you’re used to getting this little device where you auto inject and it, and you set it and real easy gives you the dose that you want. And it, it has a certain look to it, right? During a shortage, compounders can make what’s called a copy or an exact like I think the FDA may refer to as like an exact copy. Meaning that when I go to compound it, I’m going to make it almost to spec exactly like the manufacturer. The benefit is, is that it causes less disruption for the patient when they can’t get their manufactured product. In the short term, while it’s on shortage and you have to use this compounding avenue, you’re essentially getting a product that looks the same, has all the same kind of features, right? When the drug’s not on shortage, well, if you create exact copies, that’s literally like, that’s kind of, that’s a perfect direct competitor to that drug.
Mel Whittington: Got it, interesting. Okay, transitioning to another pharmacy concept. 340B. 340B is something that, you know, it’s been around for a long time. But now it’s kind of hitting like mainstream media, 340B. So, what is 340B?
Dr. Joey Mattingly: Yeah, Mel, you’re just trying to get me in all sorts of trouble.
Mel Whittington: No, no, no, I’m not. just want like, you know, what is 340B? Why was it developed? And why is it on the news?
Dr. Joey Mattingly: Yeah. So OBRA 90 came along in 1990 and Medicaid got these amazing drug price deals under the first Bush administration. The VA, other groups were like, “hey, what’s going on? Like we want some of the sweet drug pricing opportunities too.” 1992, I think it was the Veterans Healthcare Act or VHCA or something like that was passed that added 340B. Anyway, that’s sort of the backstory. Basically, it enabled the, the goal was for entities or a hospital, a critical access hospital, certain qualifying entities that are covering a lot of patients that maybe aren’t able to pay for their medications or providing more charitable care. We wanted to stretch their federal resource dollars as far as we could. And the way that the lawmakers came up with this program back in the day was that the manufacturer, the drug manufacturer would have to offer their drug at this lower price and the covered entity, so I’m gonna use that phrase because it’s how it’s like used in the law a lot, imagine that’s just a hospital. Okay, so say I have a hospital, you know, Joey Mattingly Memorial Hospital, and I service enough patients that are Medicare, Medicaid, and lower income areas, but it doesn’t have to be like 90%, it’s like 12 or 13%, it’s still, but it’s enough that I’m providing. Because if you come into my ER and you don’t have insurance, we’re going to treat you, right? And so, like the hospital may be losing money on some spots and it makes money on other parts. And the 340B program enables us to buy these drugs if we have an outpatient pharmacy, if you come to our ER and get prescribed a drug and then go to our pharmacy, if you have insurance, like we literally can bill your insurance the same price as if we paid full, full boat for that drug. And so, the discount we get as the hospital. So now imagine, sorry, I’m like talking with my hands, knowing that this is a podcast and this is an audio form. So, imagine for the listener, you’re buying at this incredible discount compared to like all other pharmacies that don’t qualify for this discount. And you’re selling it at the same price as the other pharmacies. So, what that means is you make a much larger gross profit margin on that one sale.
Mel Whittington: And when you say you, you don’t mean the manufacturer of the drug. You mean the hospital. Which is just weird to think about.
Dr. Joey Mattingly: The hospital. Right. Yes. This is a transfer of dollars from the manufacturer to the hospitals. So, drug manufacturers, thank you all for subsidizing this program. Now, manufacturers, I think, for the first 20 years of the program, no one, like, it wasn’t controversial because hospitals, if you had your own pharmacy, that was the pharmacy that you would use. If you didn’t have a pharmacy, you could contract with one pharmacy. So, then you could say, I’m gonna name Joe Mattingly’s Memorial Hospital is gonna contract with Joey’s brother who owns the pharmacy nearby. And we’re gonna contract with that pharmacy and they’re gonna provide our pharmacy services and they’re gonna get the discount. But in 2010, there was clarification, or I guess I’m trying to think of how the OIG, I can’t recall exactly how it shifted, but basically the determination of a hospital could only have one contracted pharmacy to we could have an unlimited number of contract pharmacies. And then the question is, well, what do they do with those profit dollars? Well, that’s a different conversation.
Mel Whittington: So, just to recap, because this is a lot and I’m learning a lot.
Dr. Joey Mattingly: I’m sorry.
Mel Whittington: No, no, no. I don’t want to cut you off because I’m enjoying all of this conversation. But 340B was developed to provide a way to, for hospitals compensate uncompensated care. And so that would be when you’re saying what are these dollars for, my thought would then be that they are being used by the hospital to offset uncompensated care. But that might not be the case.
Dr. Joey Mattingly: Well, so I wouldn’t say it that way. I wouldn’t say it then. It’s, you know, at the end of the day, I like the counterfactual thinking process, right? So, take 340B away today. OK, now ask yourself, would a Johns Hopkins invest in land, buildings, resources in downtown Baltimore, or would they just move clinics to Montgomery County?
Mel Whittington: Interesting.
Dr. Joey Mattingly: So like, I mean, that’s the, like, you need, and again, I’m a former Kroger district manager. I’ve been, I’ve been a part of a pharmacy chain that closed down a pharmacy that wasn’t profitable. Okay. So, like when you have to close a business, and again, those, that’s a for-profit company, not for-profit hospitals still need margin. No margin, no mission as nonprofit execs often say. So, take the 340B away tomorrow. What will happen? You’ll have to see a reduction in staff and workforce at the covered entities at the hospitals. So that means providing less care to all patients, whether you’re uncompensated or not. And yeah, I mean, honestly, it has been an incredible shift of dollars that would be going to the manufacturers. And that’s probably why it’s kind of popular from a political standpoint. It’s like, well, who’s paying for it? Well, government’s not paying for it. The manufacturer’s paying for it.
Mel Whittington: Right. Interesting. Yeah, but I appreciated your call out to any potential manufacturer listening to this podcast. Like, thank you for providing this. And it does seem like it’s been in the news as of late more because there’s been more scrutiny about how that kind of wealth transfer, how that bucket of money is being used and if it really is being used for its initially intended purpose. I wanna end with one more topic because I read a recent Health Affairs Forefront that you authored. It was titled, “What Makes a Drug Special? Understanding PBM’s Pharmacy Definitions.” And the article starts out by saying that prescription drug spending has increased substantially in recent years, growing to more than $630 billion in the US in the year 2022. And of that, 51% of total pharmaceutical spending was on specialty drug products. And then the article set out to help readers with the question that I’m glad it wasn’t just me that’s had for my entire career and that is what the heck is a specialty drug? So, can you help us out here? What is a specialty drug? Why is it special?
Dr. Joey Mattingly: Yeah, as you read it, you probably heard my voice. I’m like, this is the type of thing that I was very much like interested in. And again, I had a great student on rotation with me. And what I do with my drug pricing rotation students, I always say, “what do you think’s dumb in our health care system?”
Mel Whittington: Yeah, that’s awesome.
Dr. Joey Mattingly: And I usually start I start the rotation like, “what do you think’s dumb and how can we fix it?” And this particular student was like, yeah, it’s kind of dumb how we have specialty pharmaceuticals. And like, doesn’t make sense why some are special and some I’m like, that sounds like a great six-week project for you. So, he did a fantastic job getting a paper out in that short time. When you think about specialty definitions, and this is why I often kind of go back to is that it ultimately ends up being a cost issue. What ends up happening with a specialty definition, and this is where I think we need manufacturers and pharmacy benefit managers to kind of help us with this because I think maybe they’ve both, I don’t know which came first, the chicken or the egg kind of thing, whether it was the PBMs looking to say, OK, here’s a big part of our spend. Let’s control it by defining it and calling it special. It has to go through a specific we’re going to control which pharmacy it goes to. Oh, we’re going to own that pharmacy as well. Right. So, it’s part of it. It’s that let’s control it all. And we can pick on PBMs, but we can look at hospitals the same way that have built their own specialty pharmacies and are trying to kind of maintain everything. So, let’s ask, is there a clinical need for it? Like is there a clinical rationale? If so, like let’s be real clear about that. What additional things are the patients gonna get? What are the, you I would love to see, I would love to see all pharmacies have the ability provide specialized care for the patient populations that need it. Walgreens piloted years ago, like these different HIV centers of excellence. And, you know, you can have independent pharmacies as well that provide very specialized care in certain conditions, and they might market it and advertise that. And you that’s the thing, like you recruit a pharmacist that’s got additional training in an area like, yeah, when you want that specialized trained pharmacist to help manage patients? Absolutely. In concept, it’s a really good thing. The problem is, and that’s why we wanted to point out in the article the inconsistencies, is that it really just kind of goes back down to money. And then it’s like, well, I don’t think that’s appropriate. I don’t think it’s appropriate to just say, this is an expensive drug. And so, we’re going to take that out of this group and put it over here.
Mel Whittington: Well, I’m glad it’s not just me who is really confused about the specialty drug definition. And I’m glad there’s students and you who are helping us understand it.
Dr. Joey Mattingly: I’m hoping we might even have a couple legislators interested as well. I’m hoping.
Mel Whittington: Fascinating. Okay.
Dr. Joey Mattingly: Yeah. I was real excited to get a call from a particular Senator’s office and it was like, get out of here. I was like, I was like, I was like, “get out of here.” Well, because like, you know, again, this was a student, uh, uh, it was like a student paper we’re working on. And I was really, you know, it’s something I’ve been wanting to write for like a decade and just haven’t got it off, you know, got it out there. And, and the fact that it got picked up by, you know, and you know, that’s why I always tell my students, like, you never know like what. You put these ideas out there and maybe today, maybe tomorrow, maybe in 10 years it gets picked up. And so, I’m hoping, fingers crossed, we might see some legislation over the next year that tries to create a federal definition.
Mel Whittington: Oh fascinating. Look at you, Joey. That’s so cool. Okay, we are wrapping up. We do always like to wrap up our episodes with one final question. I’m actually really intrigued to hear what you’re going to say to this. And the one final question we like to ask everyone is, what is the best piece of advice you have ever received? This doesn’t have to be work related. It doesn’t have be pharmacy related. It could be, you know, tennis tips.
Dr. Joey Mattingly: Yeah, I’ll probably be nerdy and I’ll go with one of the things that my, I had a chance to interview the CEO of Kroger when I was a student as part of like my Capstone in the MBA program and I spent an hour or little over an hour with him and it was it was an incredible meeting and an incredible like experience and I was only 23, 24 at the time so it’s just kind of cool seeing this leader running this Fortune 20 company and he just said, “Joey, whatever you do, wherever you are in your career, always find your mirror.” And I was like, “what do mean?” And he used the reference of like, and he’s kind of old school. He’s like, “you know, like if you’re leaving the office or leaving the house first thing in the morning, you check the mirror to see if your tie is on straight, if you have anything in your teeth or whatever.” He’s like, “you know, the hardest thing in my job today is that people around me want to tell me, you know, everything’s great when they’re not. Right. Like they want to tell.” So like, he’s like, “find the humans around you that’ll be a good mirror for you and can reflect back. Like, what are you, what are you portraying? What are you giving? What are you, what are you, you know?” And I didn’t take it to heart early enough in my career. And I remember one of my first pharmacies, I was really just struggling, and I was having a real bad day, and it was one of those tough days at the pharmacy. And I wear my emotions on my, you know, I don’t hide it very well. And I had an 18-year-old technician who was excited about maybe going to pharmacy school one day, she was like, “you really hate your job, don’t you?” I was like, “oh my God,” I think I cried on the way home. I was just like, “okay, I’ve got to do a better job.” Like, you know, and she was a great mirror. She was like, you’re, really showing that you, you know, you’re not happy. And so, for me, it’s like, find, find a good mirror, have people around you that will be honest with you, tell you both the good and the bad out of love, not that they’re just trying to pick out your flaws, but they’re trying to like truly, truly help you.
Mel Whittington: Joey that’s terrific. You’ve been so gracious with your time. I’ve learned a lot. I appreciate you. Thanks so much.
Thank you for listening to this episode of Perspectives. If you’re interested in participating in future podcasts or would like to learn more about the Leerink Center for Pharmacoeconomics, please email cpe@medacorp.com.
