Transcript for "Don't Wait, Migrate: How to Navigate Network Exits & Retain Patients with Medicare Plan Comparisons": Welcome to today's webinar, why EnlivenHealth. Our topic today is don't wait migrate, how to navigate network exits and retain patients with Medicare plan comparisons. Thanks for joining us today, and thanks for holding on while we started a bit late. Appreciate that. Before we get started, I'd like to highlight a few housekeeping items. Please keep your please type your questions in the q and a tab to ask questions throughout the presentation. We'll be sure to answer your questions during the dedicated time towards the end of our session. Lastly, we are recording this webinar and will email the recording to all attendees. And now I'm delighted to introduce our speakers. Marvin Guardado has worked with community pharmacies for over ten years. He started at AmpliCare in 2015 where he held several notable roles. Marvin currently heads in EnlivenHealth's solution sales and strategy team for Medicare match. He ensures customers are set up for success and contributes to the product road map by aligning market expectations with product capabilities. Joe Williams is an independent pharmacy owner and cofounder of Apex Pharmacy Consultant, where he helps pharmacy teams improve efficiencies, optimize Medicare services, and scale smarter using PioneerRx. With four successful pharmacies in North Carolina and ventures like Med Smart Insurance under his belt, Joe brings a practical values driven approach to every stage of pharmacy pharmacy ownership and advocacy. And without further delay, I'll hand it over to Marvin. Yeah. Hey. Thanks, Nikki. Thanks for the for the intro, and thanks everyone for joining us and waiting a couple minutes for us to get on. And, we're here in the back half of of August. Right? So kids are going back to school. My friends are scrambling to set up fantasy football drafts, and my yearly optimism as a cowboy fan is at its peak. It's, like, only downhill from from here. Right? So that that also means that, AEP season is around the corner. So, let's take a look at our agenda as we head towards, October. And it's shaping up to be a chaotic AEP. Right? We're gonna have carriers pulling back. I know some of you probably seen some of that in earnings calls and in some other publications. We have a lot of carriers pulling back in a number of plans that they're gonna be offering next year. PSAOs are leaving networks, and that's creating a, real opportunity for pharmacies to, step in, you know, while others are pulling back and having a more passive approach. And, you know, Warren Buffett had this line. Right? I saw it somewhere in the Internet on a meme, and it said it was Warren Buffett, so I'm gonna believe it. So be fearful when others are greedy and be greedy when others are fearful. And carriers are pretty shook right now, so it's a perfect time for pharmacies to to step up, right, and help their patients because there's gonna be a gap in communication. And patients are gonna need help this fall. It's gonna be a lot of change, so there's gonna be just, another year of carriers adjusting to the inflation reduction act and some other headwinds that they're facing. And, you know, if your pharmacy is not part of the conversation, someone else gladly will be. And they don't know the patients like you do, and they definitely don't care about your pharmacy the way the way you do. So, real quick, let's just start with our mission. You know, in EnlivenHealth, we're celebrating our fifth anniversary this year. And over the past five years, we've come together a few different companies, Amplicare, FDS, Ateb, Market Touch Media. And at our core, mission is simple. It's put pharmacy teams at the center of care, and we do that by building digital tools that pharmacies, use to improve patient care, strengthen population health, and grow in a sustainable way. So joining us today is a user, Medicare match, user back since the Amplicare days. So over the years, you know, Joe's become not just a customer, but a friend. True pillar of his community is in North Carolina and a leader amongst his peers. His pharmacies held average of 450 patients every year with plan reviews, and he's built a business that goes beyond, beyond the counter to support, other owners as well. So, Joe, why don't you tell us a bit about yourself, your pharmacies, and the other businesses you're running, and how plain comparisons fit into all that? Okay. Thanks so much, Marvin. Guys, I gotta apologize. I was the reason we're running behind today. Everything works smoothly during the test, but, you know, when things went live, it all fell apart. So, if my hair looks wild, it's because I was running my hands through it as I couldn't get anything to work like it was supposed to. So, hey, that's what it feels like at the counter right now at your farm. Your hair's still long now. I know, man. It's I have to wear the glasses just to cue it out of my eyes. Right? So, but, but thanks for the introduction. Yeah. I, I have been around for a long time in in terms of this platform. It was even before that. It was way back on the iMedicare days and been around a good while. I really I've always credited, at one time, I would say that this was the only external platform that I would leave my PMS for. So if I was not inside my pharmacy management system, the Amplicare MASH product was the only one that I would actually go to because it was the only place that I found enough value to break myself from my workflows. Right? Pretty early on that a passive approach was not gonna get us where we needed to be. Too often in in the first, you know, part of the year, we would have to say goodbye to to loyal that, you know, had had decided whether they knew it or not to enroll in a plan that we weren't gonna have a relationship with. And I I wasn't I wasn't well informed enough at the time to to know what those options were. And so way back when, we we got involved in the in the review process, to, you know, going through plan options with patients. And and through that, you know, we were able to kinda educate ourselves on on really what was happening and what that landscape like, what were the rules, how did you do things. And so, you know, now and, you know, if it what happened years ago where we would say goodbye to a patient, now if we get a, a patient that finds out that they're out of network, we see it as an opportunity to have it, you know, have a conversation with those patients. You talk about things beyond the pharmacy, what this has done for us. One of the things that we offer through, Apex is is helping patients or helping pharmacies, excuse me, to clean up their third parties. You know, garbage in, garbage out when it comes to data. So a lot of a lot of pharmacies, they don't take the time to build out their third parties like they should. And so they just know that that patient has this been in this PCN. You know, what you learn at the pharmacy level is once once you really put that patient all the way down to that specific plan that they're in, you're better able to assist that patient with, you know, additional, opportunities that that plan may provide to them. You know, like, and I'm not I'm talking beyond, you know, what's an an advantage and what's a PDP. Right? So, of course, PDPs, you know, you can't fill Part b meds on those. And so, you know, having a patient in a MAPD would you know, you would be able to help them a little more, and and it's a little more streamlined than the old Part b methodologies. Right? But we go way beyond that now. We're we're we're down at such a granular level that you're really the more information you have, the the better off you are to help those patients. And and so then, you know, a couple years back, we started seeing that other pharmacies around the country were, becoming the agents or pharmacists were becoming licensed agents. And and, you know, given that we have learned so much along the way, that was the neck the next natural evolution. And so then we did start Med Smart Insurance, and it has become you know, to be honest with you, Marvin, I thought I thought that once we became a licensed agent that we wouldn't need those tools anymore that we were using in the pharmacy. But I'll be quite honest with you, they've become that much more valuable now, because it helps us to better streamline this entire process. Right? The agent portals that we use, they're they're, you know, they're specific to those carriers for drug comparisons. Right? So if I'm still using my Amplicare products at the beginning, I'm now no longer inputting all these different drug formula formulas into those additional carriers. So what I thought was gonna be a product of the past for me has now become, like, step one of my process as an agent. So, you know, it's, it's funny that, you know, I owe a lot to Amplicare and and the Aladdin team now for bringing me up in this world. And I thought that I would, you know, be passing by, and now it's just as valuable as it was when, you know, I was learning so much of, you know, through that platform. Yeah. No. Absolutely, Joe. And, yeah, we've seen this natural evolution where, you know, you were, like you said, very involved from the start and then where it's where it's gotten to now. And, you know, you made a good point. You are you know, with all these other, projects you have going on, you are a pharmacy first and foremost and seeing how that these different plans and these different medications on different plans are treating you reimbursement wise, right, is gonna be key for you to decide what you where who you're gonna be in network with. Right? Which is something we're gonna get into today. And then that determines, you know, on your other side of the business, which plan you're signing patients up for. Right? So, yeah. It it doubly important and that's something that, you know, we've seen a lot that trend with other independents and same thing. You know, they we've seen some people that left, came back, and said, you know what? I actually need it more now than when I was just doing the pharmacy. So appreciate that, Joe. I'm gonna come back to you in just a bit. But first, I wanna bring up kinda talked about a little bit, in the beginning is what's happening in Medicare now, because, you know, before we dive into how pharmacies, how Joe is responding, it's important to understand where the landscape is gonna fall this year. And, and again, you know, carriers are stepping back. Right? They're pulling back. They're seeing rising costs. High medical loss ratios are forcing them to really re rethink their Medicare strategy. And there's several reasons why, but the big driver has been the inflation reduction act, which took effect this year, right, with the $2,000 out of pocket pack, cap. That's going up to 2,100 for 2026, but that shifted a lot of burden over to the insurers. And that means that there's a a a multiyear recalibration on how they're gonna structure these plans. I mean, just today, for example, we saw there was a Sonder health plans in Georgia in several counties that, they became insolvent because they just could not, they could not turn a profit and they've they're shutting down their plans prior to the end of the year. So in those counties in Georgia, these patients have, until September 30 to choose a plan so that they could remain they could keep some sort of insurance until the end of the year. So these are things that we've seen happening across the board the last couple of years, and we're gonna see that exasperated during during AEP. Right? And that's a that's a local, more regional plan. Right? UnitedHealth, they're cutting plans. It's gonna impact 600,000 Medicare Advantage members. WellCare and Cigna, they're consolidating their PDP, offerings, and they're moving from three PDPs down to two. You know, think about how many patients you have on these plans and what their reimbursement looks like today, especially on brands. This could be an opportunity for you to identify these patients and, guide them to better options. Right? Because PDP premiums, they're expected to to rise again this year, and that's gonna continue to push people into Medicare Advantage Plans. So pharmacies, you know, really need to get comfortable with talking and including MA plans in their reviews because there's gonna be an opportunity for more revenue for the pharmacy there, and we'll get into that, some of the things that Joe is doing. And, you know, on top of all that, we all know reimbursement trends haven't improved. Right? They're still going down, and that's why we're seeing more PSAOs that are rejecting, you know, certain large Medicare networks and leaving it up to the individual pharmacies to decide, what's best for their their business. So, you know, with that, Joe, when the decision is left to the individual pharmacy, how do you determine whether it's worth it to stay in a network or walk away? Well, I I mean, in this case, you know, it's like a lot of other things. It's it's gonna come back to margin, at the end of the day. Right? You know, when we all when we all graduate from pharmacy school or biopharmacy, we we know that we're charged to care for all of those members or all of those patients that walk in our doors. But, you know, you do have to be a business person now. You I mean, I'm not saying you have to go get your MBA, but you do have to understand margin. You do have to understand that you have to make a minimal amount of profit, across, you know, your book of business in order to be sustainable. So, you know, while while I know that, you know, in our heart of hearts, we just wanna take care of the the, you know, our neighbors down the street and everybody else. If if you're not sustainable, you're not gonna be there for the next generation or in some cases, you're not gonna be there for the next five years. So, you know, what we've seen in recent years is, you know, some of our PSAOs luckily have been have been pushing back more and more against some of the the major PBMs. And they fought I mean, they fought, you know, hard for us over the years, but, unfortunately, they were just yelling into a bottomless whale, you know, and all they were hearing was echoes. Right? And so they weren't getting they weren't getting a whole lot back in some cases from some of those PBMs. And then so the PBMs have decided to leave. I'm sorry. The PSAOs have decided to leave. Now what happens in a lot of those cases is the pharmacy will receive, you know, knocked out message from that PBM. It's it's specific to your location. And sometimes those things are, you know, not as straightforward as you might wish they were. So rather than saying, hey. Your PSAO has decided to no longer contract with us. Would you like to stay in? It's it's quite the opposite. It's, hey. Your PSAO has turned us down. We are offering you this. And what they are offering, generally speaking, is is a worse contract than what the PSAO turned down. And you have, let's say, in the most recent one, you had twenty days to intentionally opt that. You you have to take the to yourself to send them a declination. I do not wanna be in your plan. I do not wish to participate. And and so we do we just had that happen with another one. I I think our I don't I don't wanna mention too many names, but, you know, the largest one of the largest, PBMs right now does not have a PSA or relationship. So all of the pharmacies that are gonna be in involved with that that PBM are gonna have direct contracts. So you can see this one in two ways. I I love your, the Warren Buffett statement there. Right? So what the best thing that could happen is every pharmacy that does the math and says that that PBM relationship is not gonna be best for us, they should all decline. And then what's gonna happen then is the PBM is gonna take a look at the landscape, and they're gonna realize that they don't have network adequacy for pharmacies in a lot of areas. And then it will better enable those pharmacies that they wish to participate to achieve a higher rate of reimbursement. It's very difficult for a pharmacy to negotiate directly with the PBM to get a better rate of reimbursement than your PSAO would. So, you know, it could be that you're in a rural setting or it could be that you maybe have some, you know, large employer that is insistent that you participate or something along those lines that creates leverage for you. But by and large, it's very difficult. So when you're when you're in these particular situations and you are direct contracted either either because of, because you had to, because your PSA is not in there, or you're a pharmacy that has decided to take the direct route, the most intelligent thing that you could do is is look at that payer landscape across your book of business, see who the plans are that are most advantageous for you, see the ones that the threshold for reimbursement is sustainable, And then make the decision that you're not gonna do business with anybody that is below those numbers. And and in doing so, you create this wonderful opportunity for yourself that you can have a very straightforward conversation with the patients that you're gonna be meeting with that, you know, hey, miss Smith, you know, I know you you like the plan that you're on. Unfortunately, we're not gonna be accepting that next year, and I'd really love to talk to you about what your options are for next year. Now a lot of people are afraid of that conversation. It's, it's there's a little bit of chicken little here in our industry, unfortunately, where the sky is falling. Right? And so what you have to take the two steps back and remember is is that reason that you're gonna drop that plan is because you can't afford to accept it. So I know you're scared to lose missus Jones, but you have to remember that if missus Jones stays where she is and you keep accepting that plan next year, it's not miss Jones that you're not gonna be able to take care of in the next couple years. It's gonna be all of your patients because you you logged yourself into an unsustainable relationship. So, you know, like I said, at the end of the day, it's gonna come down to margin. It's gonna come down to what you can do. You know, if you're in a PSA or you're in direct contract relationship. But remember your PSAOs are dropping these TBMs for a reason. Right. So don't feel well, I've got a lot of patients in this. I need to keep them. No. Because the contract that they're gonna offer you is worse than what the PSAO turned down. So just be mindful of that. No. Absolutely. Well well said, Joe. And, you know, once you've thought through that piece, the next thing that usually comes up is, you know, what what, what I do now? I opted out. What now? What tactics do I use do I deploy to support that that strategy? So once you've opted out, Joe, what what's your next step? Biggest thing is gonna be patient education. Right? I mean, you've you've gotta get the word out. Go ahead. Start earlier than later. Go ahead and start scheduling these conversations with these patients for open enrollment. Make sure that you've got a game plan together. Make sure that you know who the payers are that you're gonna be accepting. Make sure that you have some idea of what those provider networks look like for that plan if we're talking about NAPDs. You know, just make sure that you have a really good understanding of what the rest of those alternatives are. Get ahead of this because those PBMs are gonna be doing the same. And you don't want the first notification to your patient that you're no longer contracted to come from the PBN. Because in doing so, you have to remember that they're gonna be protecting themselves and try to maintain that life. It's gonna be a very different conversation than if you had it. So this is a this is a great place for, you know, messaging at your cash registers, messages through recorded phone calls, messages through text campaigns. This is a really, really important phase of that decision. Make sure that you are the one that is controlling the narrative. Be above board. Be honest. Do all of the things. And just make sure that the patient knows that, you know, it it was a business decision that led to you no longer being able to participate in that plan. You really want to keep them. You love the patient. You wish that the plan was better to do business with. That's kinda how I capture that. Right? And you can talk about sustainability. You can talk about the fact that you cared for them for, you know, in in in the case of a couple of my stores for generations, and you don't want to stop that legacy of care. So, you know, just get ahead of it. Control the narrative. Yeah. No. Absolutely. Control the narrative is huge. Like you said, once those letters start going out, someone else is is is putting out their own narrative, and it's usually like, hey. Your pharmacy has decided not to be in network with your plan. Here are three other pharmacies that are in the area that you can go fill out, and it's gonna be, you know, your big box competitors that they're being pushed you. And a lot of times, you know, with Joe, you know, you're probably in a better position because they know you do these plan comparisons. So if they get a letter like that, they'll come to you. Right? But think about a lot of the folks out there who their patients don't know that they're they've offered anything like this in the past or, you know, again, they haven't offered this. So they may take that letter and, you know, pharmacy doesn't hear from them again. They just don't see them in January period. That's a great that's a great point, Marvin Guardado. And I mean and that has even happened to us. That's happened to us in situations where we did have a relationship with the patient, but but the way that the letter was written, it didn't look like the patient had any options. You know? So and and you don't know what you don't know. And so if the patient doesn't really understand what can and can't be done, the the next the next, word you hear from that patient may be that other pharmacy requesting that transfer or in some cases, nothing at all because the the the pharmacy or the patient themselves do a work around and they just have the doctor send new scripts and you just realize a couple months later, hey. I haven't seen such and such. Or you get a refill to same rejection when you, you know, run their sinks or etcetera. You know, it's there's any number of things that you where you wanna find out, and that's not how you wanna learn about this. You you wanna have that conversation. You wanna get ahead of it. It's, just being proactive. And it's not hard at all. I mean, because when you start dropping, entire PBMs, you know, your data doesn't have to be super, super clean in order to capture who those impacted lives are gonna be. Right? So so getting, you know, getting that kind of information out there is is not as hard as as a lot of folks think it is. And I know you guys have tools that can help those pharmacies with those communications. So, yeah, there's there's really no excuse to to just be passive in those changes. That's right. And, you know, the reality is also a lot of pharmacies, you know, you mentioned those that fact that goes out that it's not that clear on what it's indicating. A lot of pharmacies don't even see the facts from the PBM. Right? Or they forget to send it back and they end up automatically opted in. And like you said, the PSAO has opted out for a reason. Right? So when the pharmacy is not taking action because they didn't see it, they forgot, they put it off, they procrastinated, they're opted in. And, you know, who can afford to to buy at those rates? Right? Especially some of those brine rates that we saw on some of these these networks. So that sounds like it's happened to you. You know, it's just as important for you to reach out to those patients even though you haven't opted out, to talk them through their options. Because, again, staying in that plan, like Joe said, they may not be able to see one patient, but that could turn into you not be able to serve the community anymore if you're filling at those rates. So if you didn't get a chance to opt out, you know, treat this as if you did and start engaging with those patients. That's right. That's right. No. That's that's exactly right. I you know, it did this did happen to us, in '25. And, you know, what we did was is we worked, I mean, extremely diligently to touch every patient that was, you know, going to be carrying over, same plan year over year if if we knew that that plan was completely unsustainable. And and what you find and and a lot of people think this is a super daunting task. It's really not as hard as you think. A lot of the patients that have been enrolled in some of these plans for years and years and years, quite frankly, some of those plans that they're on should have been sunset years ago because even the same carrier has has created several other plans over the years that are, you know, way better for your patient. Right? And so when you when you you know, you're in a situation like we were in and and you no longer you you know, you're contractually obligated now because of an opt in that you didn't really choose to do, the smartest thing you can do is just, you know, do the work. Sit down, do the comparisons. It is not very difficult to help that patient discover a plan that is way better than what they're in. It actually opened my eyes to opportunities for patients that I didn't even realize were there until we were sitting down face to face. You know, sometimes you just think, well, they're loyal to this or they're loyal to that. You don't know until you're talking to them. And and then after you have the first conversation with them and they're gonna provide you with that same level of trust that they provide to you when you're filling their prescription, you become their source of truth. Right? And and so, you know, sitting down and and starting the conversation about what their options are for next year is gonna be the first the first, meeting of many that you're gonna have. I've I've I've come to help people with a ton of stuff just because the that when they saw that the relationship could exist beyond the pharmacy counter into the back, you know, we've we've helped them with, you know, signing up for Medicaid, doing additional programs. I mean and and and it just it opens the door for for just a stronger relationship between you and those that you're serving. And and like I said, the the craziest thing, it always works out, is when you don't think you have any other options, if you just start by communicating and just talking with them, you'll find out nine times out of 10 that there is a better alternative to them that also just happens to work out really well with the pharmacy. Yeah. Absolutely. They're gonna be you're know, not gonna be loyal to you if you're not engaging them in, navigating, a change that they must navigate to. So yeah. Absolutely. Sometimes you overestimate how loyal they are to certain plans when they're seeing you at least once a month. Correct. Correct. Yeah. Excellent point. Yeah. And, so, you know, Joe, you know, life is a series of trade offs. At least that's what my therapist tells me. So, you know, when it comes to, you know, when it comes to direct contracting, you know, what what are the pros and cons? I'll be honest, sweetie. You know, you know, we've we've, Benjamin, John, and I, we've done some, some, like, webinar series on this very thing. And and what you come to realize is that, you know, for better, for worse, and I I think for better, to be quite honest, PSA has exist for a reason. Right? Generally speaking, 80% of pharmacy owners, they don't understand reimbursement methodologies. They they just don't. And the number may be higher than eighty percent. It may be closer to 90 or even more. And so having someone that can negotiate on your behalf is a good thing. They they understand the implications of various types of reimbursements, even effective rates. You know, a lot of those are there for a reason. Some plans happen or some PSA is using some PSA is don't. But, you know, to think that you, on at your corner drugstore where you've got three major competitors around you, you know, and you're in the shadow of the big boxes, the thing that you can solely negotiate a better contract than somebody negotiating on behalf of hundreds of thousands of stores is is I don't wanna say naive. It it it you're you're a little over you're a little, you're a little too sure of yourself. Right? You you I told you earlier, you have to have something that you're offering. There are opportunities out there for rural contracts. There are implications of, say, three forty b. There's, you know, of course, there's LTC at home that we all know about. There are, you know, there are avenues that you can do, you know, well with a a PBM in those direct relationships. But generally speaking, if you are a straightforward non rural brick and mortar, you know, count poor, lick and stick style pharmacy, just a straight dispensary, it's it's tough. It's tough. So if you're if you're looking to do those kinds of things, you have to make yourself valuable to them. I know that there's been a lot of success over the years with CPSN pharmacies or CPSN style pharmacies that they're offering, you know, additional clinical services, and they've been able to entice at least at least they found other avenues, you know, to to to make that relationship a little bit stronger. So, you know, the, it's it's a tough battle. It's not for everyone. And also when you go direct, unless you have some sort of an administrator that's gonna be helping you, if you're walking away from the benefits of the PSAO, you know, you gotta ask yourself, well, who's gonna be doing my reconciliation? Who's gonna be helping me with compliance? You know, who where where is my check rights gonna go? What what's gonna be happening, you know. So there's there's still quite a bit that's gonna have to be handled by you if you do completely sever the relationship that you have with the PSAO and go direct, and you have to have a plan for that. And, you know, I it's it's not a decision that any pharmacy should take lightly, and it should be part of the grand plan. Okay? You don't wanna get too granular when you're making these kinds of decisions because you have to think of the downstream impact of what you're gonna be doing. You know, are are you gonna subcontract someone else to do these things? How are you gonna capture those lives? What's your marketing message gonna be? How are you gonna reassess annually? You know, can you renegotiate? When the last PBM that I opted out of, and many of us here, opted out of it, I received a letter, requesting that I counter. You know, now that I've said no and and they had stated what their unsustainable rates of reimbursement were, they offered a counter. And I know of a a lot of pharmacies that did that counted. Now some of you asked for a million dollar dispensing fee per claim and no surprise, they turned you down. I would I would recommend that you be realistic in in your request. Right? Let them know that you're a serious business owner. I know that I've heard of watermarks with, you know, all kinds of obscene gestures and all those kinds of things. And they're funny in the moment, but you pretty much will just kinda blackballed yourself from being well, potentially blackballed yourself from being able to have a real discussion with them later. So, you know, get into that. If you don't know how if you don't know how to renegotiate that, believe it or not, your PSA would probably help you there. They'd probably help you walk through numbers. There's specialists. There's consultants like, you know, us. There's there's tons of people out there that can help you to try to maybe create a scenario where you could continue to do business with them in a sustainable fashion. So, there's some of your benefits, there's some of your downsides. It is not straightforward. It is not for everyone. But staying in contracts where you lose on every claim, that's also not sustainable. So don't so don't so it is a decision that you have to make. It is something you need to be aware of. Yep. Sounds it's not black and white. There are a lot of trade offs. Right? And it's specific to the pharmacy oftentimes. You know, if you're offering, like Joe said, some of these other services, then there's more that you can bring to the negotiation table. But, yeah, that that you know, that's gonna cover the contracting side of it. But, you know, at the end of the day, the contracts are one part of it. Then it's how's this gonna impact patients? You know, what does that mean for, their access to your stores or them continuing to to, fill out your pharmacy in the in the subsequent year? And, you know, we want to take a look. We we we took a look at the data, you know, with our customers and our utilization and what that looked like in terms of, retention the following year. And the patients who got a comparison at our, stores that are using Match, ninety seven percent of them continued filling up the pharmacy this year. Right? So that's ninety seven percent. If you're free throw shooter, ninety seven percent, you're automatic. Right? Right. Compare that to seventy six percent of patients who did it. Right? So it's a 21 difference in retention. And, again, that's not just revenue. That's patients walking, not just PBM revenue. That's patients walking through your door that have access to OTC, a front end material, front end merchandise, any clinical services. So so, Joe, what have you, you know, what's what have you seen in your stores when it comes to plan reviews and then subsequent year having those patients continuing to fill with you? Absolutely. No. I think it's a great question. I I think of plan reviews as as a marketing strategy, to be quite honest. And in in in your chart there, what it's not capturing is the referrals that I have received from my stores from a patient that I did a Medicare comparison with. I I mean, once a week, I would I would get a phone call back or we would get a new patient across one of the from at least one of the stores. Remember, I'm I'm doing these for four stores during open enrollment where, hey, I want you to meet with, you know, my aunt, my mother, my grandmother, my sister, my brother, my kid, etcetera. We have households now where we had maybe one member of the household or we had a a a a, the matriarch or the patriarch, and now we have the rest the family because we did a Medicare comparison. Maybe they came in with the senior so that they could make sure that they were dealing with someone that was trustworthy. I get that a lot, you know. My newest store, every comparison I did in '24 I'm sorry, in '23, I was doing for the first time. So I don't know that there was someone over a certain age that there wasn't a child within, you know, an adult an adult child to make sure that this guy was gonna do, you you know, do the right thing by you. And and what ends up happening in that is they see that you do really understand what you're talking about. You do understand, you know, the world of Medicare. And and quite frankly, in a lot of cases, if we didn't already have that family member, now we do. So if there's a lot to be said for that. And then year over year, I tell the patients, even if they're a new to 65 or maybe they're a c SNP conversion midyear, you know, they're like, alright. I'm all set. Great. I was like, yep. You're all set. But don't forget, we're gonna talk again in, you know, October to December. Right? This is this is something that we're gonna do every year. This is no different than changing the oil in your car. I don't care how well your car is running. If you don't go in and do your preventative maintenance, it will eventually break down. Right? So, you know, don't forget about me. I'm your guy. I'm, you know, let's stick with this, oil change analogy for a second. I'm the mechanic that you can trust. Right? So, you know, if somebody else is calling you and somebody else is doing this, I really want you to just allow me to continue to help you with this year over year over year. And so, you know, the same way that I'm, you know, I wanna fill all of their medications and I want them to make all their OTC purchases in my pharmacy. I don't want them walking into other pharmacies and getting things because I can't do it. So this is the same way with this method. I I don't want you talking to a whole lot of other people and getting mixed messages and then and getting confused and, you know, well, this person told me this and this person told me that. I want them I wanna be so so developed in how I understand these plans that they see me as that single source of truth. And then as far as, like, the retention piece here goes, there's there's more to it to than that as well. If you think about it, a lot of the plans now, especially the MAPDs, they're gonna have additional, incentives. Like, they're over the counter items, they're over the counter purchases. So one of the things that we've really tried to do in the past is make sure that, you know, for the plans that we were enrolling patients in, whenever possible, we wanted to have a relationship with that OTC card benefit. And and that way that we could remind them during the enrollment. Hey, don't forget. You know that x number of dollars a month that you're gonna have for food and grocery or OTC and grocery, you can spend a portion of that here in your pharmacy. We've even, you know, if if they had a prescription that was written for say, loratadine or something along those lines that we're filling in the back, and and they're a fixed income patient. Well, hey. Let's take you know, you have this prescription. We're gonna show you the exact same item over the counter, and you can buy the 100 count bottle. We're gonna save you money, but, you know, you're building loyalty in doing that. And then once they pull the card out, you know, is there anything else that you haven't thought about? Do you need this? Do you have do you have that? And we just try to make sure that we give them every chance that they can to leverage the benefits of the plans that we've helped to enroll them in. And it's it's it's worked it's worked really well for us. And I'm not I'm also not afraid, you know, socially, when I encounter a a provider and say be it a be it a dentist, be it a medical provider, be it anyone is, you know I just wanna let you know, you know, we had a great conversation with a patient the other day and they told me how important you were to their health care. And we made sure that the plan that they enrolled in, you know, you were in network. And and, you know, you might not think about that, but if an agent came by your pharmacy and told you that they they were keeping you in mind, you would appreciate that from that agent. Right? And so in our case, as as pharmacists, as frontline health care workers over here, that's also making sure that we keep that that triad or I guess in my case, it goes beyond that because we're talking about other providers as well, like their dentist and whatnot. We're keeping everybody together. You appreciate loyal you create loyalty amongst your community members. So there's tons of way to get additional value out of these interactions beyond just that one session right there in your room. Yeah. Absolutely. You're looking at the patient holistically and setting that expectation that they're gonna talk to you on a yearly basis about this. And I love the way you're connecting with other providers in the community. And in the event that, you know, they need a referral, when they're looking at some they're they're with a patient. You know, they know Joe as their back and, you know, it's just really connecting the dots in the community with the patient, looking at the patient holistically. And a lot of that just starts with helping them understand insurance. Right? Because that's how they access health care. That's how they access their providers. And guiding them through that is just integral in having other broader conversations, with with the patient. And that's gonna matter even more when we're talking about Medicare patients. Right? And that's gonna bring us to our next point that is, why it's so critical is that seniors drive the bulk of clinical revenue. Right? So and I mentioned before how, you know, we combine a few different companies over the years. You know, one of our solutions, the medical billing solution, we looked at the data there and saw that almost three quarters of successful medical bill claims at the pharmacy were for seniors, right, for Medicare patients. So when we're talking about engaging these patients and making sure they stay at the pharmacy, it goes beyond that PBM revenue. And if you're doing anything clinical, if you're looking to get into clinical services to build to the medical benefit, these patients are gonna be foundational into, doing that. So, you know, does Joe, does that, you know, does that line up with what you're seeing at your pharmacies? Are Medicare patients the ones that are not just only driving prescription but also clinical services? Absolutely. Absolutely. It's it's a very narrow, category for non Medicare clinical services at my stores unless it's cash pay. Nearly nearly every piece of clinical services that we conduct that is billable is, is related to Medicare, nearly all. And and and to I don't know if it's possible. I guess by design. Most of the larger payers that do have those clinical opportunities for independent pharmacies, they also tend to align on the reimbursement side as well. I I I I wanna believe in my heart of hearts. I give I give them maybe sometimes more credit than I should, but I wanna believe that they see the value in independent pharmacies. Now don't get me wrong. I don't need hate mail. I I know that they should be reimbursing us more a 100 percent. I agree. But I figure I figure I I feel like they're trying to create some sort of a balance. Maybe maybe it's an appeasement piece. I don't know. But I do know that the payers that that tend to treat us the best also are offering us those clinical opportunities. I I would just advocate that you take advantage of those because if they're not gonna continue to offer them if nobody's doing them. Right? And and, you know, this is going beyond your your tips and and your MTN type stuff that there's there's so many opportunities out there for our pharmacy, Marvin. We've talked about this a lot in the past. You know, we're doing blood pressures. We're doing a one c's. We're we're doing, transitional care visits. In our pharmacies, we do CCM, for with with clinicians. We we even have pharmacy do annual wellness visits. And, you know, we what we try to do is we try to have that big picture mentality, tie all of these things together. And if I have a patient that has a particular unmet need, unmet un unmet need, those types of programs are things that I talk to patients about during a comparison. Right? So, hey, I see that you have this. You suffer from this disease state. You have this state of life. You have this. You have that. Well, the more well versed I am in those types of programs, I can kinda tie together a a patient with these unmet unmet needs that some of these other plans may be able to fill. And and and and naturally, I'm gonna know the most about the ones that my pharmacy is able to participate in. Right? And so it's it's, it's not gonna it's not gonna convince me to sell a pharmacy tomorrow, you know, what we're able to do and just solely concentrate on that, you know, in clinical services. But I do think that we're continuing to head in the right direction, and I do think that we've rung some bells at some of the payers that, you know, pharmacies are demanding to be at the table for these types of services. Yep. Yeah. Absolutely. We talked, you know, at the start of this, how these carriers are experiencing higher medical loss ratios. Right? They need pharmacies in some areas to lower those ratios, and, it positions pharmacies that are offering these services to, provide them with something that they need. Right? Because you need that they you need to offer something to them that will help them with their margins. And, of course, you know, you expanding into these other services, you know, we know how that's gonna gonna help you. And, you know, putting it all together, you know, the Medicare patients, they're gonna be your backbone to prescription depending on your, you know, your community, your demographic, and clinical services. And that's why, I saw a couple questions on the chat about MA plans, Medicare Advantage Plans, but that's why it's worth looking a little closer at, Medicare Advantage Plans because those are becoming more and more important, every year. And, you know, for a lot of patients, MA isn't just the alternative. It's becoming the default. And there's gonna be some for pharmacies too. That's for sure. I you know, you you talked earlier about, you know, reducing the number of PDPs per carrier. You know, I'm not I'm not an expert on the subject, but I would imagine that as time goes on, there will be fewer and fewer PDP options. I mean, it's been happening now for quite some time where they're they're really trying to do everything that they can to motivate patients to enter a an MAPD. And if you know anything about the way that the dollars move in that area, PDPs don't tend to be profitable at all for these companies. And the reason that I'm I'm sure they're mandated to offer them, to some degree. But then I would also think that it's more of a marketing thing so that they can introduce you to their company if you're not ready for an MAPD yet and you you're gonna come on our PDP. And now we can start reaching out to you to talk to you about these other these other products. I, I do think that in most markets and and I and I know that some of you in Kansas right now are saying, no. We don't like MAPDs because nobody accepts them. There are markets where MAPDs are still not really strong because they can't put together provider networks. But by and large, MAPD is gonna be, you know, the the biggest, you know, piece of your business. Right? And you as a pharmacy, you need to understand what what the opportunities are across all of those, carriers. You know, we talked about things like OTC benefits. We we know that for diabetic supplies and things like that, those pass through these claims, you don't have to do, you know, the old school methods for p for, you know, Med B. So they they do facilitate a a an easier way of doing business. But there's there can also be other opportunities for for a pharmacy to maybe get into some of those clinical services, especially on a smaller mil regional system scale. UnitedHealthcare as a whole is not gonna give your pharmacy your one location on the corner, in the shadows of the big box as a contract more than likely, to do something. But unless it's a pilot or you have the backing of a large integrated network like CPSN, but, you know, there are gonna be opportunities out there for you. And so you need to understand the differences and the nuances of each of those plans so that when that opportunity arises, you can take advantage of it. Yep. Yeah. No. Well well said. And we have now 58% of Part d beneficiaries are on an NA plan. Right? And that trend has accelerated since COVID. It's gonna continue to accelerate it. There was some talk with the administration this year that people, as they become newly eligible and the agent of Medicare, that they would automatically be opted into an MA. Now, you know, I don't know if that's really ever gonna materialize, but that just tells you the momentum that MA has. So when you're not talking to patients about MA, you're you're you're focusing on just a small segment of plans that are dwindling, then you're really limiting your your your options. And, you know, for pharmacies, if you're credentialed and contracted with payers, you know, and you are able to bill, as a provider for services like immunization, point of care testing, you know, that advantage plan can directly impact the advantage plan the patient picks can can directly impact your ability to serve them with some of these services. Right? And, you know, Joe touched on the OTC plans. A lot of these MA plans, especially, these special needs plans, they're gonna include an OTC benefit, and patients can use that benefit at your pharmacy. I saw a couple questions about the OTC OTC card, and it's about just mapping who that carrier is and who they're using as their, processor. Right? So there's, like, three or four in the market. So making sure that you look at how many of my patients do I have on certain carriers and then seeing if it's worth it for you to talk to these processors so you're able to to take these cards. Right? Because that could be that could turn a patient from a negative margin to a positive if there's nutrient depletion opportunities. There's other opportunities for you to help them engage in their health, but they otherwise would not have paid out of pocket for that. But they have a debit card like OTC card, that they can use at at at your pharmacy. And, you know, last point on that is is on going back to drug reimbursement is, you know, patients are gonna naturally gravitate towards lower premiums. Right? That's just premiums is what they have to pay every month. It comes and more often times, it comes out of their Social Security check automatically. Where co pays, you know, we don't like to to to to to think this, but if patient doesn't have the money, they're not gonna fill this month. But a pay premium, they have to pay every month. And if you look at PDPs this year in 2025, there's only one with a zero or zero premium. And that that was that WellCare value script plan. Right? And, you know, you could go back and see what that reimbursement looks like for you on those on the brand side for that plan. And then meanwhile, you have about three quarters of advantage plans that offer $0 premium on their drug. So that's opening it up to a broader list of those zero premium plans, making it easier for you to match those patients with plans that, not only meet their needs, but it's gonna be more sustainable, for you, moving forward. Yeah. No. That that that's really, really well said. It's it's those enhanced benefits is what they referred to. There's enhanced benefits in the MAPDs that are available still in a lot of cases, in a lot of areas that have no premium. So you'll have a patient that will come to your pharmacy that does not have a premium because they're on a particular MAPD, and then they won't have any co pays at your pharmacy. They can see their primary care doctor for free. And essentially, unless they have, you know, some sort of catastrophic event, they go on expensive brand drug, they get admitted to the hospital, what have you, a patient could go an entire year and and not have any out of pocket medical expenses, health care or pharmacy. And then they could get their additional benefits, their dental, their vision, their hearing, OTC benefits, transportation benefits. There's, you know, a ton of things that they that you can provide them access to that they will be able to receive, you know, absolutely free outside of their Part b premium that they'll be paying for unless they're on Medicaid. So, yeah, there's you you need to get in the game with MAPD. You really need to become familiar with it because if you can't have that intelligent conversation, if you can't be that source of truth with them, you're gonna be at the mercy of whoever else they come to put their trust in. And if and if that person, you know, doesn't and then I hate to I hate to say anybody does anything they shouldn't do. But if that person doesn't always have the best of intentions or if that person, you know, doesn't really think that there's any value in the pharmacy that they choose and they can go to an independent or they can go to a CVS and it's all the same or quite frankly, they go to mail order and it's all the same, then you're not, you know, you you really are at risk of losing good, you know, patients, long time patients. And, so understanding the landscape, understanding what the patient's options are, and being the one that is controlling the narrative and and and educating them is there's absolutely no downside to it. You can only help. Yeah. No. That's a great perspective, Joe. And and that really is gonna bring us to the practical side of things, and how you can put all that into action at your pharmacy, this year and subsequent years to to come. Right? We talked about the big picture, right, your contracting decisions, whether it's through your PSAO or direct, the role of Medicare Advantage, growing role, and how plan comparisons build loyalty and allow you to have broader, more holistic relationships with the patient. Next step is putting it into practice with your own community and your own patients. And, you know, we're gonna host a guided walk through of EnlivenHealth match. It's gonna be a short hands on session where we'll show you exactly how to use the platform from identifying patients who would benefit the most. Again, if you are opting out any of those plans, identifying those patients, those BIN, TCNs, start communicating to them that you're gonna, have other options for them this fall, and running the comparison all the way through enrollment, and seeing how different those plans impact both the patient and the, pharmacy's bottom line. So if you take what we've covered today with Joe, see how it works in real life, this is the best way to to do it. Right? So you can click on the scroll link below. You You wanna sign up for our next session. That's gonna be, in a few days for the, the quick walk through. So that's gonna be just me. I won't have Joe with me. So I don't know if I'm gonna lose most of the audience when it's just me, or maybe we just bring you back, Joe, just to sit there with your face, make sure that, pharmacies feel supported by by colleague, a peer. But, you know, before I wrap up, I wanna point you to our next webinar. It's gonna be called the MVP method. This is our our our next, guest speaker we're gonna have. That session's happening September 16 at 1PM, and our guest is gonna be, Whit Moose, I heard just a few minutes ago. So, you know, North Carolina's really repping AP this year. So between Whit and Joe, yourself, you know, we got Dean Smith and coach k of of Medicare. I'm Smith. I'm Dean Smith. I'm just thinking about I'll say that if you're really gonna do this and you're gonna do it right, you cannot scale. You you you cannot optimize it. It's not gonna be an integral part of your workflow without this product. The thing that you're going to manually build these drug profiles on, you know, medicare.gov in in any sort of valuable fashion, like, in terms of being able to to to touch enough of your patients, it's you know, you're just you're overconfident. It it can't be done. And when you can have a software like this that that helps to organize that data, that can help you even, you know, point out things that you didn't realize was an opportunity, it's really invaluable. And, I I don't I don't know how anyone could do it without the tool. So that's that's what I'll offer you here at the end. Yeah. Thanks, Joe. And, I know we're a little little over, so I'm gonna walk quickly walk through some of these questions, the chat. I felt like a Twitch stream earlier just trying to trying to address all the chat questions here. So some of them are towards you, Joe, so I'll direct them toward you. First one from Nicole. Joe, what's one lesson you've learned from the past, AEPs, and what would you pass along to other pharmacy owners heading into this year? Don't make any assumptions. Too often, you know, going to the comparison with a patient where I think that what's I would think that was what was obvious to me was obvious to them, and and have my mind just completely, you know, blown away that maybe it was loyalty, to a plan, maybe it was loyalty to me, maybe it's loyalty to a doctor. You know, I've I've been shocked at times when I I made an assumption, and I just knew that this was how a conversation would go and it would go the opposite. And I'm not saying it would go to my benefit or or against me, but it would just it would go the opposite of the way that I would assume it was. You know, I I have a patient in particular. I think of him every time I I think about this kind of question. He pays $400 a month for a a part f supplement, and he pays a $120 a month for a p. And it's an insane amount of money. It's an insane amount of money. And it's it's beyond the max out of pocket of, you know, any good plan in our market. And he just smiles and passed me on the back and says, I'm a stay right where I am. And when we dropped his plan, he smiled and said, I'm a stay right where I am, and then just continues to pay cash with us even though he pays a $120 a month for a PDP that he can't even use in my pharmacy. So just I don't don't make any assumptions. Just, you know, state the facts, tell them everything. You lead the horse. You can't make a dream. That's right. Great advice there. So next question is, how do you get your staff brought in on doing comparisons, especially when everyone already feels stretched thin during the fall? I love I love these questions, Zach. If you ever get to hear me present, I love these questions. Number one, it's it's your fault. It's been on finance, just so you know. It means that you either have a clunky system that you're trying to use and it's breaking up your workflow and it's not efficient. You you have to what what you're doing for AEP and what you're doing quite frankly for everything else in your pharmacy should operate as smooth as the next e script that's hitting your system. Okay? There should be a way that we handle this. It should be completely integrated. You should be leveraging your PMS. It it it shouldn't feel like it's an obstacle. It should feel like this is what we do. Okay? If you've got a lot of other clunky processes, like I'm the inventory guy. So it's like if you're manually ordering and it takes you two hours every afternoon. If you're sitting down with a map on the wall to build your delivery route, if you're doing all of these old school things that were done thirty years ago, and you're wondering why no one wants to do your new ideas, it's because you haven't let your workflows evolve. And I don't I can't see who typed these messages, so this is not directed towards anyone. You know, you need to take two steps back. You need to look at your operations. You need to try to make them as efficient as efficient as you can, you need to leverage all available technology, you need to retrain, you need to create scripts, you need to create better, methods of communication that your staff can use, you need to automate everything that you can. Don't put blinders on when you're trying to initiate a new program and just think that the questions are about the program. The questions are about your total operation. Okay? So start with the basics, clean up everything, automate as much as possible, leverage your technology. And then when you add in a a a new initiative, you just plug it in to the to the machine and it just starts working. That's that's how that works. And then if you think I'm oversimplifying, I promise you I'm not. You know, start with things, start with inventory, start with automation. It's all connected. It all flows together. Right? So you start with that appointment model and then it just becomes a flywheel. So absolutely. Question here from Rami Joe. Joe, do you recommend we become insurance agents to be able to better recommend MAPD plans to our customers? Alright. Yeah. I do. I, I'm a licensed agent. I I have a an agency of we actually help a lot of other, pharmacies and people. I cut my teeth with Amplicare, and it helped me to really wrap my head around how plans were structured and and how they worked. If if you're not familiar at all with with what in MAPD, you know, what all of that entails, the best way that you could do that is to is to become an agent because the the licensure phase, the contracting phase, it's a it's a pretty it's a pretty solid leveling course. It is not something that you are going to passively do though. If you decide that you want to become an agent, I pretty much will had to take, take a week off, lock myself in a room, and just put my head down and and only look up when it was time to eat or sleep. And, that's what it took for me. I gotta, you know, I'm like a lot of you. I'm busy. I have a lot of things happening. And so it it really it it really was a big undertaking for me to get there, but it is so fruitful. It it you the things that you'll learn in that process will make you will make you better at every comparison that you do. Yep. Great advice. And, Joe, I know you you said you got your agency. You've been talking about it online the last few days. So, certainly, you know, an opportunity if you you feel that that's the direction you wanna go in. And, you know, if you don't have the time or it's something where you're dipping your toe in the water and you're using our program to kinda get started, as Joe said, you know, we partner with agents also HP one. So if you don't wanna have those m and a conversations because the health benefits, the doctor networks, then, you know, like I said at the beginning, be involved in that conversation. Whether you delegate that then to someone like Joe or a local agent, you know, if you're working with us and you wanna work with someone from HP one, they're gonna keep them at your pharmacy. They're gonna make sure they're on a plan that's gonna be sustainable for you, and you're, using them as an extension of your stats. So, yeah, certainly, if you're looking to do it all the way as Joe, then, that certainly is a direction to go. But there's other options and other paths for you to go that are hybrid, that are more laid back, or you can take control of the, the entire process. That's a good point, Marvin. Becoming a licensed agent is is honestly it's not for everyone, just because of the commitment that it takes to get it there. So yeah. But, you know, I've there is a place for you along the spectrum. You definitely shouldn't be doing nothing. Okay? You have to do something. You have to create a a a plan, and then you need to initiate that plan. You need to do it sooner than later, especially if you plan to have an impact this upcoming, open enrollment. For sure. And then, and also keep in mind, like, I know a lot of people just look at this as as the fall open enrollment, October 15 to December 7, and then they forget about it. But it remember, we said almost what is it? Almost sixty percent of people are on MA. So from January 1 to March 31 is Medicare Advantage open enrollment period. So anyone on an MA plan can switch to another a MA plan. So if your pharmacy wanna extrapolate and say the Aids like the market, you know, 60% of your pay Medicare patients are able to switch plans again in the fall. So really look at the Christmas as, like, a little break, and then you're back at it and engaging patients that are on MA plans. That's that's well said. And if, you know, if you're really gonna dive deep into this, you you do need to enjoy that Christmas break because that's all that it is. When you start back in January, you will stay very, very active January through the March. And to be quite honest with you, if you if you familiarize yourself with the SEPs, the special enrollment periods, you've come to understand that Medicare open enrollment I mean, I I don't wanna say it doesn't end, but there are are any number of ways that a patient can find themselves into a better plan. Marvin, I'm a grab a charger real quick. Yeah. No. Absolutely. We're just gonna a couple of questions more directed towards us. So CA said, will you include will you have, a comparison chart of MAPDs enhanced benefits and premium? So, CA, you would have access to that within the, platform. Right? So once you pull up a patient, it's gonna load up your Medicare plan, all your the meds they're filling with you, and you'll be able to see the different benefits on the MA plan. So certainly look to join us in our demo where we dive into it a bit more, in a in a few days. Another one we had in here is, Joe, you're right back in time because I think this is for you. Courtney asked, can you point me in the right direction of how to become an insurance agent? Yeah. Sure. We'd love to be able to help you there. You can go to medsmartinsurance.com, medsmartinsurance.com. We're, gonna be running some webinars actually, Thursday that'll start bringing you up to speed on what you gotta do as well as your other options. Sure. Thank you, Joe. Michael says, can you get a list of OTC cards and what advantage plan goes with each card? What we do have, Michael, that we could send you is a list of all the plans that have an OTC benefit by state, what their benefit is, the annualized amount. Right? Because some of them will be, let's say, $30 a month. Others will be $100 a quarter. Others will be, like, $200 every six months. Right? So we have a standardized yearly amount. And then from there, if you wanna simplify it a bit, all UnitedHealth plans, they use Solitran. I think it's called s three. Then we have the OTC network, which processes them for Aetna plans, and I believe also for Humana. And then we have Nations Benefit, which, Pioneer has that integration with. I think those are more regional plans. I'm not quite sure which ones map up to that. But for the for the larger ones, we got, again, Aetna, Humana, OTC network, United Plans, Solutran or or s three, and and United actually owns that that company, the process. Yeah. Because some of those are those systems are kinda clunky, to be quite honest with you, because it is external in in some cases to your POS, you know, because they don't have the right interface with most of them. But still, it's fruitful. It it's driving them in the door. You know, you're having the conversations about partners and profit. Hey. Since you're not spending any money out of your own pocket today, you know, it's it's just gonna get that. It's, you know, why have you just, you know, you just wanna leverage everywhere that they can do business with you and then just go from there with it. Al, I saw your questions. One which one here? It's a PSA that doesn't always let you know what plans they have not worked out of contract until the week or so before October 15. Does it not give us too much time for us to figure out what customers have those plans and try to get them into another help? So you're right. Right? Sometimes, some of these things are finalized very late into October. We had years where some deals are still being worked out after the start of of open enrollment, after the start of AEP. Right? So, what I would suggest is, the the plans are loaded and ready, on med.gov October 1, and then you're able to start, enrolling patients October 15. But if there's any change that you notice, something that happened late because what happens with med.gov is that if a PBM agreement and we had this group in Florida and Alabama or Georgia a couple years ago where they, contracted with a PBM very late in the game. It was, like, until the September. So med.gov did not reflect that data accurately. It was gonna take them about four to six weeks, and we know we only have, like, eight weeks during AEP. So what we did, they let us know, and we we we customize it, and we manually made those changes for them. Right? So if there's anything that you're hearing where information is coming in late, not being reflected accurately on net.gov, then we'll customize that for you. You just have to let us know. And if you're a customer already, we'll we send an email out in September saying, hey. This is the PSAO. We have you marked as any direct contracts you're expecting to be in, for 2026. Does all this information look accurate so we can try to get ahead of that? But, but, Al, you're right. When this stuff happens late, so I would just say, let us know, keep us in the loop, and we could, update that, accordingly. Hey. If I could if I could add to that just for quick mark. Okay. I don't know. I can't see if that's what it is. But, make some friends, actually, as I go, Make sure make sure that they are and you know who they are and kinda stay in touch with you and and and try to get some idea of what's going on there. All PSAOs are created equal. That's the thing that you need to remember. If you have a PSIO that you don't feel like is sharing enough information with you or keeping him in the dark, your requirements are not satisfied with them. There are other options. You know, there's I don't know too many situations where you are forced to keep one single PSAO. So just to keep that in mind, just keep that in mind. Yeah. Thanks a lot, Joe. You broke up a little bit, but I think, the gist of it was, you know, you wanna keep in touch, have a good reliable contact at your PSAO, and all PSAOs are not built the same. Right? So, just make sure you have that relationship so you're able to receive that communication for them, when when when you need it. So that's, yeah. I mean, great advice there. Right? You wanna make sure you have someone you can trust over there you can rely on and not just, a, a general mailbox. Right? So, so last question here, Joe, is is it enough time to get licensed as an insurance agent for this upcoming open enrollment? Yeah. If you're gonna do it, you better start right now. If you're gonna try to be unlicensed, you have to you have to think you take your state requirements. You're gonna have to study some state. They require a minimum number of study hours to be able to sit for the exam. Some states require that you not only become a licensed agent, that you become a licensed Medicare agent, and there may be a minimum for hours for that test as well. So you're gonna have to do that. Then you're gonna if you then you have to schedule and take exams exams in North Carolina to take two. When you're back for exams, then you have to go through the licensure. But If State Department of Insurance, yeah, the fingerprinted and all the code, they need to take steps. The FBI background check, etcetera. You you have to go through contracting with individual carriers. If you wait too long in a season, they might not be accepting another contract at that stage because it's too far in. They don't have the bandwidth. So you you also have to go through, your AT and T get Medicare to make sure that you're qualified to see our Medicare products. There are a lot of steps that can go in there. And if you wait too late in the season, it's really difficult to try to play catch up and do that. So if you're gonna do it and you wanna be active this year, well, then you better get started today. But this is very important. This is a huge but. Just because you're not gonna be ready for this enrollment doesn't mean that you still shouldn't do it if that's something that you wanna do. Okay? If you if you said, alright. It doesn't look like I'm gonna make it. Just click on back burner and forget about continue to push forward, and then you're ready in January. Then you've got the first three months of the year and you have SCT until the enrollment. Just just, you know, if you can't do it, set your mind to it, establish your study schedule, go ahead and and and get the partner that's gonna make sure that you're gonna be successful. They're gonna help streamline and process it and just get started. The tools and tricks and tips to learn along the way and the ability to help patients at a whole level is valuable. Both for you, the patient, pharmacy, everybody involved. So I I need to say, you know, I never regretted it. I'm so glad I did. Yep. So if you're looking to get started for this AP, you get started right now, today, tomorrow. Look at your state requirements. Right? It's gonna be different requirements on study hours and some other criteria. And, you know, if you're looking to get into this, it's probably more of a long term thing, right, not just one AP. So if you miss the deadline for whatever reason, you know, you got like we said, you got the first three months of the year and then the subsequent, years as well. So I know we went a bit bit over. Right? So, and I really appreciate everyone submitting their questions, everyone else, providing them with their time. And, Joe, thanks again for joining us. You know, your expertise in this area is, you know, is unmatched, and, I thank you for spending time with us today. I know this AAP is gonna be a challenging one. Right? Because a lot of the changes that we saw, but that's a big opportunity for you as pharmacy to step in and and be that voice while others are are retreating. So we'll send some follow-up links, that we shared today. Again, in the meantime, sign up for the guided walk through of Match, and then we have our next webinar with Marvin on September 16. Joe, again, always a pleasure. Everyone, have a rest of your day, and we'll see you next time. Thanks so much, Marvin.