Clear Health (00:01.41)
Hey everybody, welcome back to the podcast. Today is a really special one. can see behind the scenes of how a pharmacy performs and what troubles they run into. Today we have Jeremy Counts, who is a pharmacist and he's actually a passionate advocate for pharmacy reform. He owns and runs Counts Family Pharmacy in Blacksburg, Virginia and has seen firsthand the damage PBMs are doing to independent pharmacies and patient care.
Jeremy Counts (00:01.661)
Hey everybody, welcome back to the podcast. Today's a really special one. You can see behind the scenes of how a pharmacy performs and what troubles they run into. Today we have Jeremy Counts, who is a pharmacist and he's actually a passionate advocate for pharmacy reform. He owns and runs Counts Family Pharmacy in Blacksburg, Virginia and has seen firsthand the damage PBMs are doing to independent pharmacies and patient care.
Clear Health (00:31.36)
And he doesn't just talk about change, he's actually on the front lines of it. And he's also on the board of Pharmacists United for Truth and Transparency. And he's been instrumental in pushing legislative efforts like the Save Local Pharmacies Act and building bipartisan support for HR 9096. And today's podcast is something you definitely want to listen into if you're wondering why your medications may not be covered.
Jeremy Counts (00:31.577)
And he doesn't just talk about change. He's actually on the front lines of it. And he's also on the board of pharmacists united for truth and transparency. And he's been instrumental in pushing legislative efforts like the save local pharmacies act and building bipartisan support for HR nine zero nine six. And today's podcast is something you definitely want to listen into if you're wondering why your medications may not be covered.
Clear Health (01:00.296)
or possibly costing too much. So Jeremy, welcome to the podcast.
Jeremy Counts (01:00.535)
or possibly costing too much. So Jeremy, welcome to the podcast. Hey, I'm glad to be on. The PBM industry is complicated. It's annoying. is, well, giant racket. And so any opportunity I can take to come on and talk about it and give people kind of the inside view of what's happening, I'm glad to.
Clear Health (01:26.252)
Yeah, it definitely is a racket and that's what I kind of want to get into today. Just how much of a racket it is and what control they have and kind of they're really behind the scenes and people don't really see what's going on I think. So I think today will be a good kind of enlightenment about what you face and what I think patients feel but they don't know why. I think that's a big part of it.
Jeremy Counts (01:26.469)
Yeah, it definitely is a racket and that's what I kind of want to get into today. Just how much of a racket it is and what control they have and kind of they're really behind the scenes and people don't really see what's going on I think. So I think today will be a good kind of enlightenment about what you face and what I think patients feel but they don't know why. I think that's a big part of it.
Clear Health (01:56.206)
So can you kind of tell me, you run the pharmacy in Blacksburg, right? Your own pharmacy. And how would you describe a PBM to somebody who's never even touched the water on that?
Jeremy Counts (01:56.445)
So can you kind of tell me, you run the pharmacy in Blacksburg, right? Your own pharmacy. And how would you describe a PBM to somebody who's never even touched the water on that? Well, the people who process your claims for the medication in real time, that's your PBM.
The person who's telling you you've got to be on this medication instead of that medication, that's your PBM. The person who is telling you you have to get a prior authorization, that is your PBM. They are another middleman in the drug supply chain. This one just happens to have control of everyone. They are the person that's in between your insurance and your pharmacy. They're the person who's in between the insurance and the drug manufacturers.
They're the person who's in between the, wholesaler and your pharmacy in a lot of ways. So they have a huge amount of power and they've scaled it quite a bit because these companies, they not only occupied that space, they've also become vertically integrated with the insurance companies. You've got, your top three PBMs owning 80 % of prescriptions while you have.
all three of them vertically integrated with a large insurer. It's, it gives them incredible power. It's a huge, antitrust issue. There's a lot of misaligned incentives and it's something that we've got to get control of before it gets worse because we are quickly reaching a point of no return. Yeah. Yeah. And, I completely agree because I first heard about it when I had my clinic, clear health medical.
Clear Health (03:39.404)
Yeah, yeah, and I completely agree because I first heard about it when I had my clinic, Clear Health Medical, and I actually went to a pharmacist, my local pharmacist, and I said, hey, would you like to be on my podcast and talk about troubles that you're having? And they literally told me, they're like, we're afraid of retribution from the PBM. And I was like, yeah, yeah, yeah.
Jeremy Counts (03:48.527)
And I actually went to a pharmacist, my local pharmacist, and I said, Hey, would you like to be on my podcast and talk about troubles that you're having? And they literally told me they're like, we're afraid of retribution from the PBM. Yeah. I give no shit. Like I do not care. What are they going to do? Pay me less. I've got ESI right now. They were threatened to kick me out of network because of the work that I'm doing in Virginia, with the single PBM bill. called their bluff on it. I told them this retaliation.
What you're pushing back on is actually illegal in Virginia how you're doing it is illegal and I absolutely Will not sign something saying that there was a breach of contract which was over normal every day Board of inspection finds that every single person gets Mm-hmm. and you know what sometimes that's what it takes. It takes somebody saying no Because that's what I did against like certain insurance practices or even managers that I had to deal with in the past
Clear Health (04:33.822)
Mm-hmm. Mm-hmm. Yeah, and you know what? Sometimes that's what it takes. It takes somebody saying no because that's what I did against like certain insurance practices or even managers that I had to deal with in the past. And I was like, I just simply told them no. And I was like, and they're like, and they didn't really do anything. And I think that people are just afraid sometimes of saying that, you know, even if it's legal or not legal, right?
Jeremy Counts (04:46.939)
And I was like, I just simply told them no. Yeah. And I was like, and they're like, and they didn't really do anything. And I think that people are just afraid sometimes of saying that, you know, even, even if it's legal or not legal, right? Like there's, there's a, there's kind of this hesitation to stand your ground with your principles. Yeah. And it's, it's tough because I mean, they could keep me on a network, no problem. And this is ESI. They have a.
Clear Health (05:02.656)
there's kind of this hesitation to stand your ground with your principles.
Jeremy Counts (05:16.663)
a huge amount of scripts that like I feel and I'm relying on, but I really, in the end, I kind of hemorrhage money on those scripts. So I was like, well, what's it matter? You know, I'm not going to do this, but your regular pharmacist who, know, don't have lawmakers in their corner that they know, and they don't have the social media presence that I do. And they're not able to get out there and really like how lot what's going on. You know, if you're under in that situation, come.
Come to us at putt, we'll help highlight it and let you fight back a little bit because a lot of them feel like they can't actually respond. No, they feel like they've got to jump through every hoop they're given. it's, it's understandable. You know, what, what are they supposed to do with these giant companies that have so much control of their business? So if anyone out there ever encounters this, please don't hesitate to reach out so that we can help push back for you.
I, I'm able to do a lot of things and say a lot of things. And I think a lot of times I'm protected because they don't want me to get overly riled up. and other pharmacists, they may not have that. So if that's you're experiencing that, you know, I'll give you a megaphone, you know, come I'll, I'm happy to help. Yeah. Yeah. I think that's great because, you know, as doctors experience it that
Clear Health (06:27.63)
Mm-hmm.
Clear Health (06:38.956)
Yeah, yeah, I think that's great because, you know, us doctors experienced it that with the insurance companies, right? Like, you know, they're just kind of one step away from the the PBMs there, but they just they laid on us and require all these metrics and crazy stuff. I mean, just bonkers stuff. And so it's good to have somebody who you can like turn to and be like, OK, what can I do now? Because sometimes it's either they they will just quit, right? Like they'll quit.
Jeremy Counts (06:44.027)
with the insurance companies, right? Like, you know, they're just kind of one step away from the, from the PBMS there, but they just, they laid on us and require all these metrics and crazy stuff. I mean, just, yeah, bonkers stuff. and so it's good to have somebody who you can like turn to and be like, okay, what can I do now? Cause sometimes it's either the, they will just quit, right? Like they'll quit. They're not gonna, they're, they can't do anything else. Yeah. Yeah. Yeah. They'll.
Clear Health (07:08.77)
They're not gonna, they can't do anything else.
Jeremy Counts (07:13.543)
they'll have to jump through whatever hoops and sign something that says they were in a breach, that they were in breach of contract, even though they weren't. And that gives the PBM leverage to do whatever they want whenever you sign that document. So a lot of people aren't going to know that they're going to panic and sign it. And these companies are used to applying that kind of pressure and get them whatever they want. It's important to try to push back.
And every single pharmacist should do it in whatever way that they can.
Clear Health (07:45.782)
And can you kind of describe for my audience, like how does the PBM limit maybe their access or availability and maybe how describe a hidden cost that they may be paying for on the back end?
Jeremy Counts (07:46.009)
And can you kind of describe for my audience, like how does the PBM limit maybe their access or availability and maybe how describe a hidden costs that they may be paying for on the, on the backend? absolutely. There's a ton of hidden costs. they will hide a lot in their quote unquote rebates because they have to have their rebates to bring down drug costs from the manufacturers. And that's, that's complete nonsense. They're actually accelerating,
list costs, is what patients are paying based on most of drug list costs. think it was Johnson and Johnson's transparency report was 65 % of drug list process in the United States are going to the PBMs to be passed along to plan sponsors. They've basically made it to where if you're not in their little coupon club, you're not going to be able to access brand medication unless you're rich.
And they want it that way. They want everyone to have to run through them. So it inflates the list costs. You know, you've got 65 % going in and they'll claim, well, we pass on all the rebates to the employers. That's a complete bullshit. Uh, they, they will disguise a lot of their negotiated, uh, rebates and discounts. They'll disguise them as fees. They've got group purchasing organizations, uh, that aggregate these rebates offshore sometimes that
will keep a bulk of that on top of the fees that the GPO keeps and it will accelerate costs for everyone else while they get to pocket a ton and claim that, well we passed on a hundred percent of rebates. Yeah. You passed on a hundred percent of 50 % of the rebates that so they, that's how they skim and make money. Then there's also the, the nonsense with the fees that they will charge pharmacies or the rates that we get once
Clear Health (09:27.374)
Mm-hmm.
Jeremy Counts (09:40.059)
we get onto once we learn kind of what they're doing and we adjust, they'll come up with something brand new, like the generic effective rate. That's their new favorite one. They have like generic effective rates, brand effective rates. So they'll show with the claims, look, this is how much that we're paying out for these pharmacies. And then they come back later at the end of the year and they claw a lot of that back saying, well, you were supposed to get, you're a
generic effective rate was like 20 % of AWP and you were, we paid you at 30 % over. So we're going to call that back. That extra money, the plant sponsors aren't seeing that. Like state Medicaid, they're not seeing that. The three axis report in Florida, that's what they found. Like whenever they banned spread pricing, they moved a lot of their spread over to paying their own pharmacies more money and by overpaying community pharmacies while clawing that back later. So.
They've got a lot of ways where they can inflate costs and put as much pressure on us as they want. And everyone else gets caught in the middle. And a lot of people, they're just like, yeah, but my co-pays are $10. You're paying for that in your premiums. All of that is being taken out of your paycheck. Like just because you have a $10 co-pay doesn't mean you're not paying for the rest of that drug. Yeah. Yeah. And people don't see that. They don't see like,
Clear Health (10:49.55)
Mm-hmm.
Clear Health (10:58.124)
Yeah, yeah, and people don't see that. They don't see like, I'm paying this massive amount of insurance and that's actually what's like, they're getting charged for it. They're getting charged for these medications. We're like, look, it's on the list, but it doesn't matter because it's like way overpriced. so when somebody does, so I've always wondered this, when somebody has like a good RX coupon, is
Jeremy Counts (11:02.397)
I'm paying this massive amount of insurance and that's actually what's like, they're getting charged for the, getting charged for these medications. We're like, look, it's on the list, but it doesn't matter. Cause it's like way overpriced. Yes. And so when somebody does, so I've always wondered this when somebody has like a good RX coupon is, is that really a coupon?
Clear Health (11:26.998)
Is that really a coupon?
Jeremy Counts (11:29.596)
It's not really a coupon. It's a way to extort money from us. They bring in the fucking good RX cards and they'll charge us like a $6 fee. And they're like, oh, wow. It brought my payment down from what my insurance had. Or a lot of times they like to bounce it down to good RX automatically. Now CVS does, and that lets them game the effective rate more. I actually have a write-up on how it could be used doing that.
Clear Health (11:55.182)
Mmm.
Jeremy Counts (11:56.209)
But GoodRx, all they do is set you a co-pay based on whatever they want to because GoodRx actually works as a third party price fixing scheme between the PBMs because they buy these networks and they're able to collude with the PBMs and they're kind of this little third party out there that allows the PBMs to collude. So they get all those contracts and they set their rate on the lowest thing that they could find and then
while they're doing that, they charge the pharmacy $6. And a lot of times the GoodRx card, we're going to give you that price anyway, because it's going to be right around what we're doing. In the wash, it's going to come out to where you're all right. There's some that we would lose a ton of money on and there's some that we would make a ton of money on if we use that instead of our actual cash payment basis. But in the end, GoodRx, they just...
take $6 from the pharmacy, sells the patient's healthcare data and they're on their way. There's no reason for them to exist. Yeah, yeah. And that's the other thing you don't realize is that they take the patient's data and they do use it. Like they definitely use it. they use it. They sell it. It's bad. CVS, what they're doing with patient data right now, they were using it to sign up for a...
Clear Health (13:02.712)
Yeah, yeah. And that's the other thing you don't realize is that they take the patient's data and they do use it. Like they definitely use it on.
Jeremy Counts (13:23.581)
calls to lawmakers and form letters to lawmakers using patient information. I mean, they were posing as patients. Jesus. is anything going to be done about it? No, because CVS health is worth a fortune and they give a lot of money out. So it's frustrating. You know, they don't play by the same rules. These are, these are giant corporations that have as much power and wealth as European countries. And that's what we're fighting against.
Clear Health (13:32.588)
Jesus yeah
Clear Health (13:53.87)
Yeah, yeah, and I know that the direct primary care doctors like me, we only do a subscription base per month. And so, and it's low, it's like, you know, anywhere from $50 to $75. And what we had found was when we would try to send our patients to like CVS or something like this, the drug would cost an insane amount. I couldn't get hold of.
Jeremy Counts (13:54.109)
Yeah, yeah. I know that the direct primary care doctors like me, we only do a subscription base per month. And so, and it's low. It's like, you know, anywhere from $50 to $75. And what we had found was when we would try to send our patients to like CVS or something like this, the drug would cost an insane amount. I couldn't get hold of
Clear Health (14:22.498)
the pharmacist at CVS ever. And what we started doing was giving out certain medications just wholesale from our office. And so, because we couldn't, you can't figure out a way around it unless you take that power yourself, right? Like to do that. But as soon as I find like a logo pharmacist that I can use, then I'm like, I don't wanna, I'm not distributing medications anymore.
Jeremy Counts (14:22.737)
the pharmacist at CVS ever. And what we started doing was giving out certain medications just wholesale from our office. And so, because we couldn't, you can't figure out a way around it unless you take that power yourself, right? Like to do that. But as soon as I find like a logo pharmacist that I can use, then I'm like, I don't wanna, I'm not distributing medications anymore.
Clear Health (14:51.852)
because now I have that local pharmacist who is like far better than me at it. But, and they can circumvent some things by offering things for cash themselves. Is that something that you have found pharmacies doing more? Like I'm trying to figure out if I can get it from the wholesaler with no interference, can you guys do the same thing?
Jeremy Counts (14:52.037)
Because now I have that local pharmacist who is like far better than me at it but And they can circumvent some things by offering things for cash those cells. Yes, is that is that something that You have found pharmacies doing more like i'm trying to figure out If I can get it from the wholesaler with no interference. Can you guys do the same thing?
As far as a wholesale, yeah, I work with DPC docs. I go to a DPC doc. Shout out Doc McCarthy. He's awesome. DPC docs, natural allies with independent pharmacies, just full on complete natural allies. And I'm actually supportive of DPC docs doing a little bit of dispensing because that works for some patients. Like there's a particular group of patients where that's going to work pretty well for like, whenever you're out there doing it.
Clear Health (15:19.98)
Mm-hmm. nice. Yeah. Yeah. Yeah
Jeremy Counts (15:43.301)
Yeah, absolutely. If you've got patients that they cannot find a medication or they can't get service, you know, if that works, then that is great. if you can find a local pharmacy to kind of take that burden and a lot of liability off of you all, it is a headache dealing with drugs. but if you're in an area and you don't have a pharmacy that's worked, that, will work with you or there's an independent around or your patients are getting price gouts, absolutely looking to doing that stuff. We got to take care of our patients.
Clear Health (15:57.538)
Mm-hmm.
Jeremy Counts (16:13.211)
But we're natural allies. And I think a lot of it, there's a synergy that comes along with working with, DPC docs that I think it needs to be kicked up a notch. And we really need to organize and push on the legislative side to get the reforms that we need. Cause we're the ones out here who's really trying to like put market pressure on these bastards. Yeah. Yeah. And that's what I just moved from.
Clear Health (16:31.83)
Yeah, yeah, I think so.
Clear Health (16:36.886)
Mm-hmm, mm-hmm, yeah, yeah. And that's what, I just moved from Detroit and I know that there's Plum Health there. And Plum Health is growing really well, which is really nice. And I know they're putting a lot of pressure. And I know that the town that I'm in now, which has EBO MD,
Jeremy Counts (16:42.235)
Detroit and I know that there's There's plum health there and Plum health is growing really well, which is really nice and there I know they're putting a lot of pressure And I know that the town that I'm in now which has Evo MD They're putting a lot of pressure as well because they have like six clinics and they're doing really well But a lot of people are you know, they're like well
Clear Health (17:01.774)
they're putting a lot of pressure as well because they have like six clinics and they're doing really well. But a lot of people are, they're like, well, I can't use my insurance. And we're like, we know, but we have to take the power back and then redistribute it in a fair and equitable manner, I think. So I know you touched on, what's that? Yeah.
Jeremy Counts (17:11.773)
I can't use my insurance and we're like, we know, but we have to take the power back and then redistribute it, you know, in a fair and equitable manner. think. Yeah. Um, the insurance industry as it exists needs to be dissolved. Absolutely. You can go to a DPC doc. can get most of your meds. Like I'm rolling out a program for medication where it's like $50 for a month, uh, $50 for a year supply and $25 for a month supply.
And that takes care of most of your basic generic meds. You know, you go to a DPC doc and then you do that and you're on a few meds. You don't have to pay all of this. They, ACA came out and it absolutely just destroyed insurance plans that were actually useful. I'm, I miss paying a hundred dollars a month for a catastrophic plan because that's the only thing most people need. They, they don't need all of this paying for every single thing or, you know, bringing down quote unquote costs because
Clear Health (18:01.805)
Mm-hmm.
Jeremy Counts (18:08.113)
We're paying for all those costs. It's going into our premiums. Yeah. Yeah. It's pay. We're paying for it, but then you get nothing on the other end. No. So you're, you're like, you're just living on fear and then, desperation. Yes. You know? so I knew earlier you had said that the PBMs have a, like a strong control because they're vertically integrated.
Clear Health (18:12.674)
Yeah, yeah, we're paying for it, but then you get nothing on the other end. So you're like, you're just living on fear and then desperation, you know? So I know earlier you had said that the PBMs have a strong control because they're vertically integrated. Can you explain kind of what that means for our listeners?
Jeremy Counts (18:36.263)
Can you explain kind of what that means for our listeners? Okay, so think of it as kind of like this little pyramid. You've got your insurer up here at the top. Down below it, you've got like your PBMs that they own. Down below it, you've got the pharmacies that they own. Whenever a PBM has...
something above it, something below it as far as the chain and how it exists, that's vertical integration. You go up and down the supply chain. PBMs, whenever they have the insurer who's contracting the PBM, they're contracting with their own PBM. When they have their own pharmacies, they're able to say, well, we're gonna sell you this plan. And this puts a lot of pressure on the smaller insurance plans too. They're able to offer these bundled deals
in which they say, well, we're going to save you this, so this much money on your health plan while they're hiding a lot of their costs in the PBMs because it's a black box employers and plan sponsors in general end up paying a whole lot more with what they think is a sweet deal. And when they do that, it makes all the other plans seem cost inhibitive on the actual plan side. So they're able to apply pressure up and down the entire supply chain because they have a kickback exemption.
And that's the rebates. Yeah. And that was something I found fascinating too, which is if, I had a kickback, I'd be sent to jail. Yup. You know? And, and I'm like, wait, these guys can get kickbacks on this? yeah. They get caught for outright fraud when it comes to claims every single year and they just get a slap on the wrist and a fine and go about their way. And that has to stop. Like they're going to have to repay some of this money or they're going to have to be held accountable.
Clear Health (20:00.94)
Yeah, and that was something I found fascinating too, which is if I had a kickback, I'd be sent to jail. And I'm like, wait, these guys can get kickbacks on this? I'm like.
Jeremy Counts (20:27.579)
Otherwise it's going to continue. They don't, they don't care. They don't even blink whenever there's a hundred million dollar fine. They don't care. They'll just continue doing it because they're making billions. Yeah. Yeah, exactly. When it's so such a small percentage of your paycheck, you're like, I don't even care about it. Yeah. They'll take their slaps on the wrist and go on and we, we need to see someone to actually hold them accountable and go after them from fraud. Because if you like, if I were to
Clear Health (20:33.752)
Yeah. Yeah.
Clear Health (20:38.486)
Yeah, yeah, exactly. When it's so such a small percentage of your paycheck, you're like, I don't even care about it.
Jeremy Counts (20:54.973)
Be convicted of fraud. I would be banned from any federally funded program ever CVS Caremark Express scripts opt-on every single year. They're getting fined for that kind of thing But no one kicks them out because no one goes as far as bringing fraud charges They just they slap a fine on them They say you need to repay this money, and then they just go about their way and we repeat it every single year Yeah
Clear Health (21:22.668)
Yeah. And I know you have this badass handwritten letter from Lena Kahn at the FTC.
Jeremy Counts (21:24.549)
And I know you have this, this bad-ass handwritten letter from Lena con. Yeah, I do. That was the FTC. Yeah, that was, that was a good day. That was actually the day they dropped their second interim report. Lena con, arranged for it to arrive that day for me. So that was pretty cool. I got it framed and hanging up in the pharmacy. working with the FTC was a blast. I try to work with any agencies that I can, to try to.
bring something down on the PBMs in a lot of ways. Work with lawmakers, try to get legislation passed, but Lena Kahn is the truth. Let me tell you, like Lena Kahn, that is a hero. And she put herself on the line in a lot of ways and really came out swinging against these bad actors. And she set a tone that is gonna be nearly impossible to shake going forward.
Clear Health (21:57.986)
Mm-hmm.
Jeremy Counts (22:23.451)
because everyone from now on at the FTC, they're going to be compared to Lena Con. Yeah. And I felt the same way. I felt like she was really speaking from her heart and, know, with a, with a lion's mane. Yeah. You know, she was just going after stuff left and right. And I know that people were afraid of monopolies. In fact, I heard in some of the large,
Clear Health (22:29.07)
Mm-hmm, mm-hmm. Yeah, and I felt the same way. I felt like she was really speaking from her heart and, you know, with a lion's mane. You know, she was just going after stuff left and right. And I know that people were afraid of monopolies. In fact, I heard in some of the large hospital chains that I got to sit in some meetings with before that they would not advance on certain mergers.
Jeremy Counts (22:50.619)
Hospital chains that I got to sit in some meetings with before that they would not advance on certain mergers Yeah Specifically because of what she had put in place exactly Yeah, it was I was like, yeah Yeah, that's that's what you got to do to get things done the the investigation into PBMs was huge Antonio dropped his report
Clear Health (22:59.122)
specifically because of what she had put in place, which was, I was like, yeah.
Jeremy Counts (23:17.127)
the three access report out of Washington showing all the mail order price gouging. then Lena Con and the FTC come out with that interim report right afterwards. And then Jake Ockenclaw drops the pharmacist fight back act at the putt conference, announces it being filed. That was a really good time in pharmacy. It's frustrating that Trump fired Bedoya and slaughter because they've been really, really good on these issues.
And they're not really fired like he can't fire them. But it it kind of delayed action on the FTC lawsuit against PBMs as far as the insulin list prices. And I think that was all a of political maneuvering maneuvering to like buy time with some of these investigations. They'll be reinstated, I'm sure, unless the Supreme Court does something wild.
But it was good to see Andrew Ferguson, who is someone who is trying to, you know, look into PBMs. He unrecused himself, so that this lawsuit could go forward. So that was encouraging to see, and I'm hoping to see, Bedoya and Slaughter get back to full time doing this stuff. And hopefully that doesn't drag out so we can finally get them in court and hold them accountable. Yeah. And who is.
Clear Health (24:40.812)
Yeah, and who is Andrew Ferguson? He sounds really familiar.
Jeremy Counts (24:42.319)
Andrew Ferguson, he sounds really familiar. He's the new chair of the FTC. Okay, okay. So how did you actually get to work with FTC? Like, did they call you or like, how did that work out? I'm loud. It started off like Lena Kahn started follow me on Twitter.
Clear Health (24:47.552)
Okay, okay, okay. So how did you actually get to work with FTC? Like, did they call you or like, how did that work out?
Jeremy Counts (25:05.614)
I do a little bit of work and communications and stuff with like American economic liberties project and stuff. Who's really into anti-monopoly and that kind of got my voice out there a little bit more. And, they started taking notice. And so when I started emailing them, whenever they were just like, need, you know, evidence, we need to talk to people who's in this. I'm like the damn right you are. And so there I am beat a loud mouth. And you know, a lot of us input, that's what we did. Like we were.
We were like, okay, you know, the FTC is making this call. We need to back them up. We need to give them everything that we can and do that. we've got, of our board members have spoke to the FTC, been interviewed, came out and talked to them, just kind of, you know, gave them a lowdown on how things were happening because they actually care about how things play out on the ground. Unlike health economists who are the most arrogant.
assholes on the planet and I cannot wait for all of them to line up and kiss my ass because I was right all along. Thank you health economist because we were gaslit for years by these, you know, University of Chicago tops who were no, no, you just don't understand the complex, the complexities of the healthcare system. Little pharmacist. fuck you. Yeah. Who doesn't understand the complexities now? You didn't see any of this playing out on the ground. So it turns out we were right.
Clear Health (26:10.958)
Yes.
Clear Health (26:24.27)
Yeah, yeah, yeah, exactly. you know, I've talked to some of those people before and I just kept harping on them. I'm like, well, what about lab prices? What about medication prices? Like, how do people keep paying for these exorbitant prices? Like, is that going to change? Like, and it's just such a simple thing to answer, but they would always reply like, well, it's really complicated and.
Jeremy Counts (26:31.215)
Yeah, yeah, exactly. Yeah, you know, I've talked to some of those people before and I just kept harping on them. I'm like, well, what about lab prices? What about medication prices? Like, how do people keep paying for these exorbitant prices? Like, is that going to change? and it's just such a simple thing to answer, but they would always reply like, well, it's really complicated and we don't want to go there. And, know, like it's complicated to you because you actually don't live it.
Clear Health (26:53.474)
We don't wanna go there and you know, like it's complicated to you because you actually don't live it. Like that's why it's complicated.
Jeremy Counts (26:59.939)
No, exactly. It's complicated. They approach things from the standpoint that everyone is acting in good faith and all their market mechanisms act as intended. And that is not the real world. They do not live in the real world. yeah, it's, it's showing more and more every year. And there's a reason that the health economists have gotten gone pretty quiet here over the last, you know, couple of years. I mean, they look stupid.
Clear Health (27:24.014)
Yes.
Clear Health (27:29.742)
Yeah, I think they've gone quiet and I think our side has gotten a lot louder. I think that's what's happened, yeah.
Jeremy Counts (27:30.011)
Yeah. I think they, they've gone quiet and, I think our side has gotten a lot louder. Yes. What's happened? I we have to get loud. Otherwise we're extinct, you know, especially independent pharmacies. Like you, most pharmacies and, I'll give a shout out to Kyle blueberry pharmacy. I, I have this argument with him the time about, and he's like, well, everyone should just go to straight cash and do it that way. I would love to do that. Every pharmacy would love to do that.
Clear Health (27:40.206)
Yeah.
Clear Health (27:48.653)
Yeah.
Jeremy Counts (27:59.341)
Absolutely. The problem is, is a lot of pharmacies, don't have the kind of cash volume or they won't be able to get that kind of cash volume to survive. And so we still get underpaid and we get milk dry on that end, just, you know, trying to get a little bit of profit out of these plans when we're filling most everything for free, just to keep a little bit of that volume when, you know, we could scale down, but whenever...
Your cash volume is not going to even be enough to pay your rent. You can't really do that. And it's something that I'd like to see more pharmacies move toward. But it's not like this panacea for every single pharmacy because you've got to be in the right location and you've got to have the right demographics. Otherwise it's not something that's going to work. Yeah, that's so true. You know, you've got to have a little bit of a of gold on the sign.
Clear Health (28:29.454)
Mm-hmm.
Clear Health (28:48.748)
Yeah, that's so true. You know, gotta have a little bit of a pot of gold on the side before you transition into that type of model. Because, you know, when I was transitioning out from insurance into cash base, it probably took like two years until I was actually like making something that was sustaining, you know, maybe some food for me, you know?
Jeremy Counts (28:55.099)
before you transition to that type of model because when I was transitioning out from insurance into cash base, it probably took like two years until I was actually making something that was sustaining maybe some food for me. Exactly. So yeah, that's what people don't realize is that you gotta have the right market and you gotta have either
Clear Health (29:16.078)
So yeah, that's what people don't realize is that you got to have the right market and you got to have either you got to have a second job or you have a little pot of gold stashed up.
Jeremy Counts (29:23.355)
you either got to have a second job or you have a little pot of gold stash cup. Yeah. Yeah. You can find your niche on like front end items or whatever, but it's, really rare to find some kind of like niche specialty item that you can sell. That's going to make you enough money to make up for your backend losses. And a lot of pharmacies were bolstered through, you know, the advancing in clinical service and it played out the exact way that I was telling all of them that it would play out.
If we don't get a base on reimbursement, they're going to take every single dime that we make from any kind of vaccination or anything else out of what we're being reimbursed for our drugs. And that's what's happened. now they're, CVS right now isn't even paying an administration fee for vaccines for pharmacies anymore. So, you know, they, they tried to use us and they played us in our desperation. They want to use us to try to take physician market share.
And that's their big play is make pharmacies desperate, try to make them take on even more work, try to take it away from the physicians. And I'm trying to tell all the pharmacies, fucking stop. Like, listen, we can't just give everything away all the time. We've got it like nail reimbursement right now, or everything's going to be taken away from us. Like we need to unite with the physicians. We need to unite with everyone and we need to make these pushes and we need to keep everyone in their own lanes.
Clear Health (30:29.111)
Yeah.
Jeremy Counts (30:46.609)
where we are actually taking care of the patients and everyone is happy. We've got to take it back because they love making us like squabble over little things. Like they love it. And that's one way they've been able to do things is divide all the healthcare providers, divide even subdivisions within the healthcare providers, make them squabble. They're not focusing on what they should be focusing on, this corrupt insane system. So we've got all like,
you not and get together before, you know, it gets so desperate that physicians are going to be in the, the situation that pharmacists are in. Like they're, they've already started with you all, but you still got time. Like you've got to, you're not, and you've got to start pushing back now. Yeah. Yeah. And I, that's why I'm so glad for the, direct primary care Alliance and like they're lobbying efforts and stuff. If we didn't have that, like it would be.
Clear Health (31:32.45)
Yeah, yeah, and that's why I'm so glad for the Direct Primary Care Alliance and like their lobbying efforts and stuff. If we didn't have that, like it would be brutal. You know, if we didn't have certain laws that establishing like that we are not insurance and that's one of the laws like that was passed, you know, and several states within the past like five or 10 years, we finally got that, you know, on the books and
Jeremy Counts (31:42.695)
Brutal you know, we didn't have certain laws that establishing like that we are not insurance and that's one of the laws like that was passed, you know and several states Within the past like five or ten years. We finally got that, you know on the books and I think we all we do we need to have like a single voice. We can't be cats in a box and we have to actually get out there and
Clear Health (32:01.398)
I think we all, we do need to have like a single voice. can't be cats in a box and we have to actually get out there and one lobby like show like a little bit show of force in, you know, in Washington, DC or at the capital of your state. which is actually kind of fun if you ever go into it, it's, it's, it's interesting to see how these lawmakers, how their mind works.
Jeremy Counts (32:12.169)
one lobby like show like a little bit show of force in you know in Washington DC or at the capital of your state which is actually kind of fun if you ever go into it it's it's yeah it's interesting to see how these lawmakers how their mind works and why they put these certain laws into place because I did it about 10 years ago and you're like that's why they're doing it you know yeah sometimes it's not always money
Clear Health (32:29.406)
and why they put these certain laws into place. Cause I did it about 10 years ago. And you're like, that's why they're doing it. Sometimes it's not always money. Sometimes it's an encounter in the medical field they had, or maybe at a pharmacy, you're like, what's the solution? And maybe their friend tells them, hey, this is the solution. And it's not a real solution. It's just something that they think might work.
Jeremy Counts (32:41.413)
Sometimes it's an encounter in the medical field they had, or maybe at a pharmacy, and they're like, what's the solution? And maybe their friend tells them, hey, this is the solution. And it's not a real solution, it's just something that they think might work. Yeah, it's absolutely essential. And that's the thing is, if we all united and we had a single pack and a single voice and we're punching out in the same way, we would have a lot of weight behind those punches. We really would.
especially on the state level, like you look at like the amounts that are being spent on the state level, a pharmacist, physicians, everyone else, I mean, they could get behind and rival, rival a lot of this that's going on in the state level. You know, national level is a little more complex. It's a little more, you know, difficult to get changes on the federal level, but it's absolutely necessary. Otherwise we're not going to win. State level changes are great and it can, you know, keep you afloat while the ships.
Clear Health (33:13.134)
Mm-hmm.
Jeremy Counts (33:39.153)
you know, going down, but without any kind of federal changes and major swings, we're not going to save healthcare. Yeah. Yeah. It's true. And you're right on the state level is, is where it's at. Yeah. Because yeah, national is very, it's difficult. but yeah, doing it on the state. it's a little bit smaller group and you can get in to actually talk with them, which is, which is what's important.
Clear Health (33:48.558)
Yeah, yeah, it's true. And you're right, on the state level is where it's at. Because yeah, national law is very, it's difficult. But yeah, doing it on the state level, it's a little bit smaller group and you can get in to actually talk with them, which is what's important. So what, is there a group, I know you're a board member on the one group I mentioned.
Jeremy Counts (34:09.585)
So what is there a group? know you're, you're board member on the, on the one group I mentioned, is there, is there a, is that the group where people should go to and, join and, absolutely. you want to fight leadership and stuff. Yeah. If you want to fight, whether you're a pharmacist, we've got physician members, we've got technician members. If you want to fight back against this, you know, join pharmacists united for truth and transparency, truth, rx.org. Like.
Clear Health (34:15.968)
Is there a, is that the group where people should go to and join and, and, you know, look to for leadership and stuff?
Jeremy Counts (34:38.417)
We don't sit around like we don't want you to just like join up and well, we'll just let everyone else fight. When you join up, like we give you marching orders, you know, we say you need to get involved. You need to press here. Like you need to get involved in the state. need to press these things. And that's what we do. Every single board member we're out there. Like I spend more time at this point in advocacy and, and writing white papers for lawmakers. Then I do even with my pharmacy, like during session, it's insane. Like.
Clear Health (35:02.84)
Mm-hmm.
Jeremy Counts (35:08.165)
This is what we do. Like I live this, like I live for the battle. Yeah. Yeah. And I think that, that's something that people need to learn. Like I almost wish we had some type of class, you know, and, and, pharmacy and medical school was like, this is how you get the bill written. And this is how you contact certain state legislators. And yeah, because there's, there's so many companies that, know, they're against this and they want to.
Clear Health (35:13.838)
Yeah. Yeah. And I think that, um, that's something that people need to learn. Like I almost wish we had some type of class, you know, and, and, pharmacy and medical school was like, this is how you get the bill written. And this is how you contact certain state legislators. And because there's, there's so many companies that, know, they're against this and they want to literally want to take our money.
Jeremy Counts (35:37.649)
They literally want to take our money. Yeah. And is it for their own purposes, right? They really want to get in the middle of that, that transaction flow. And a lot of times they'll do it with like making laws. Yeah. like the anti kickback or I can get kickbacks. You know, I'm actually working on something right now. we're trying to offer some things for, pharmacy schools and even medical schools. They want to have it as far as
Clear Health (35:39.906)
and use it for their own purposes, right? They really want to get in the middle of that transaction flow. And a lot of times they'll do it with like making laws, like the anti-kickback or I can get kickbacks, you know? So.
Jeremy Counts (36:07.043)
showing people how to get active and how to lobby and putting together a good team because that's important. Like you can have people out there and you know, I I'm a bit of a, know, I, we'd like to use animals. Like you want a team with like a rhino and an ostrich and a, and a giraffe and a lion. And I'm, I I'm playing every single realm of that one, but
I am traditionally a bit of a rhino because I like to go in, I like to cause a ruckus and I like to knock everything down. Build a team around that. If you build a team around that and you get everyone unified with a voice, you could really, really do some damage. And that's what I've done in Virginia. And I think a lot of our future physicians, our future pharmacists,
They need to be equipped with that kind of skillset, even something as simple as being able to assemble a team, being able to know how it's going to work. And a lot of times with the, your everyday healthcare professional, they just need to get over that first hurdle of, contacting my lawmaker really isn't all that scary. If you equip them and give them the confidence and give them that kind of voice and they get over that first initial hurdle, they will keep doing it. They will be emboldened and.
That's why pharmacists, you know, they've got their backs against the wall. You know, we've got them riled up, you know, we've got them excited. You got to give them something to believe in. And whenever they're speaking out now, they're not afraid. And so that's why you see them getting so loud and physicians, they need to start doing that. Don't wait, wait until your backs against the wall really come out and start swinging now. Yeah. Yeah. And I think that's seriously important. That's, that's really good work. so one of the things I used to do is.
Clear Health (37:48.238)
Yeah, yeah. And I think that's seriously important. That's really good work, actually. So one of the things I used to do is for lunch in the practice where I was in a while back, I would say, hey, why don't you guys, why don't you have lunch together in my office, talk about a few things. And then I would call our senator or representative and just do it right in front of them and be like, and then would see me do it. And cause I wouldn't tell them I was going to do it.
Jeremy Counts (37:55.943)
for lunch in the practice when I was in a while back, I would say, hey, why don't you guys, why don't we have lunch together in my office, talk about a few things. And then I would call our Senator or Representative and just do it right in front of them and be like, and then would see me do it. And cause I wouldn't tell them I was gonna do it. So I just do it. And then they'd be like, it's like that easy? Like you just pick up the phone and you call. And I'm like, yeah. And it made you, you'll probably get his.
Clear Health (38:16.142)
So I just do it and then they'd be like, it's like that easy? Like you just pick up the phone and you call. And I'm like, yeah, and you'll probably get his little, you know, the lackey, but that's okay. That's all right. Those guys are great.
Jeremy Counts (38:25.913)
little, you know, the lackey, but that's okay. exactly. Those guys are great. And if you're pressed for time, just leave a message. It is not that hard. Like the press button, leave a message. And those lawmakers, they know if they're getting call volume on something, you know, their staff informs them and they start looking into it. So, you know, it's important, even if you're not given some big long-winded speech. And I mean, they're probably going to hate that anyway.
Clear Health (38:34.998)
Mm-hmm.
Jeremy Counts (38:51.377)
You know, just get there, get the call volume, say what bill you're supporting. That's really helpful. You don't have to like do this entire thing and, you know, testify in front of everyone because you know, a lot of that is a lot of what's going on nowadays is a lot of communication and their minds are going to be made up more behind the scenes, but it's still important to participate and be there because, and I'll give you an example. Like in Virginia, our bill got sent to a kill committee. they sent our bill to,
Clear Health (39:01.058)
Yeah.
Jeremy Counts (39:21.499)
social services committee instead of healthcare, which was a way to try to kill the bill. And what we did was, and because the committee members, they were all from Northern Virginia where there's not a lot of independent pharmacies and there's not a lot of political pressure there. And so what we did was we brought in a few pharmacies, pharmacists from their area and they came in and they gave testimony while we brought in a ton of pharmacists in white coats.
and pharmacy students and pack that entire committee room to the point where we made saying no far more painful than saying yes ever would be. If you can't get a yes, then make no as painful as possible. And you may get a procedural move that just advances your bill or you may get an outright yes, like we did. Like never take no for an answer. Just keep piling on. Like there are ways to do that. Then there's other times with like money committees. If you go and you try to like bring a bunch of witnesses,
Clear Health (39:58.819)
Yeah.
Jeremy Counts (40:19.751)
They're gonna get really fucking annoyed with you because that's a money committee. They do not care. Like it's, gotta be careful about it. Always listen to your lobbyists. They're gonna know kind of the backend and when that's gonna be appropriate. But you know, get out there, be loud, be heard, do those sorts of things and definitely contact your lawmakers, whether it's email calls, fuck both, do both of them because with volume, they pay more attention. Yeah. Yeah. That's so true. So what
Clear Health (40:22.574)
Yeah. Mm-hmm.
Clear Health (40:44.194)
Yeah, yeah, that's so true. what are some of the bills that you, are you working on any bills right now? I know I mentioned some of the things, but can you kind of go into those a little bit?
Jeremy Counts (40:48.269)
So what are some of the bills that you are you work on any bills right now? I know I mentioned some of the things, but yes, kind of go into those a little bit. Yes. Right now, still in Virginia, we've got we ended up rejecting the governor's amendments and got that through. And now the Save Local Pharmacies Act is back on his desk as it left the General Assembly with no amendments. And now it comes down to either he's going to veto it, sign it or just leave it.
And if he just leaves it, it becomes law. That may be what happens. And we're hearing it's kind of 50 50 right now, which is really good considering this bill was supposed to die in subcommittee. we've brought a lot of pesh, a lot of pressure. A lot of it has been just getting pharmacists, you know, out the grassroots effort. It's been organizing, a strategy, quick response. I put together think tank in Virginia to help.
our lobbyists turn around like white papers really quick. we've caused a lot of disarray on the back end. We've, cause a lot of disarray on the front end. We have brought the house every single way that we can. And now it's back to the governor and it's just putting pressure on him. And it's, it's been a long damn road for this bill. And it's been a curve ball every single day with something new that we've had to respond to.
That's because the health plans that lobby has owned Virginia for over two decades. Now they've been the most powerful lobby in Virginia. So it's been tough to get beyond that, but we've, we've managed. And a lot of that is getting your people coordinated and cooperating behind the scenes. And that's a lot of what I do, both on the state level and the national level. And a lot of times I'll give input, to other states, organizations.
people who run those organizations to try to get them to not squabble with one another and sit down together and try to figure out a way forward because you're not going to advance anything until you get a unified message. Cause you're just going to confuse lawmakers and they're going to just put it down. They're not going to care. You don't want to do that. Get organized and start swinging. And sometimes to get organized, you're going to have to step outside of your organizations.
Jeremy Counts (43:11.189)
kind of like I did in Virginia and, know, make a think tank of people who are from these organizations so that they can come together and they can operate outside of any kind of, organizational politics and really focus on the issue. When you do that, I mean, you really start, start bringing a singular voice and everyone kind of starts working together better. And then, you know, national level it's pharmacists fight back all the way. right now,
They've got these other PBM bills and you know, they would have been great five years ago. We don't, we don't have five more years. Incremental steps aren't enough. And so we're, we've got pharmacists fight back. we are waiting for it to be reintroduced right now. that is in the works. there'll be news on that coming up and whenever that drops, it's going to be full weight behind that one. But those are the two major things I'm looking at. I really want to help Iowa, coming up.
in their next session, I really want to help Massachusetts as well. and I think Mississippi would be a good state to kind of help, but, I'm always going to do Virginia national, but there's other States where I think if they had just a little bit more oomph or a little bit more organization behind the scenes, I really think they could kick it into high gear. And see by.
Clear Health (44:32.852)
Mm-hmm. And see by by forming a team do you mean like maybe like a pharmacist an attorney and then a lobbyist and Maybe a doctor or something like that. Like they could maybe form a team. Is that what you're talking about?
Jeremy Counts (44:35.963)
By forming a team, do you mean like maybe like a pharmacist, an attorney, and then a lobbyist and maybe a doctor or something like that? Like they could maybe form a team. Is that what you're talking about? Yeah. If you're wanting to do an overall kind of healthcare push, I was talking about pharmacy specific bills. we, we, we formed a team from the different organizations. Like you'd have like, CPSN here in Virginia. We've got Laura from that we've got putt, which, you know, I am.
Clear Health (44:53.55)
Mm-hmm.
Jeremy Counts (45:04.719)
And then we've got VPHA. Karen came from that and then VCPA, Steve Hill. And then we got Anna Peoples who came over who is a member of pretty much everything, but she is excellent and she's got great ties and she is really good with the media. So you get people who bring their own strengths, who have their own personality types that compliment one another. And you're able to get a lot of things done when you do that. Get the right kind of team.
And you get together and you meet multiple times a week. You have a group chat going to where you're constantly talking about this. You have people, you you turn around these white papers. Yeah. Everyone gets assignments. Hey, you need to contact this lawmaker. You need to put pressure here. You need to talk to this person. You need to say this here. When you get a team that gives that kind of input and is at that kind of level, it gives your lobbyists such a good weapon because they can't be everywhere all the time.
Like they need something like that. You know, you're basically giving them a giant hammer because, uh, beforehand, like poor Howard and Howard's in a great job, but he'd have to try to do these white papers and everything that I turn out. He'd have to do them himself while he's trying to push for these bills. And we just gave him that extra and you know, let him, uh, uh, him and Charlie kind of, you know, they know the lay of the land. They know the politics behind the scenes. They know exactly where pressure needs to be. They pointed and we did. And.
It's worked really, really well. wow. That's, that's a really awesome to hear. so if people are tired of all of this shuffle games played by the PBMs and insurance companies, what is the best way for them to fight back against them? number one, you can join us at putt. Like we'll give you marching orders. We'll get you as involved as you want to be.
Clear Health (46:33.082)
wow, that's really awesome to hear. So if people are tired of all of this shuffle games played by the PBMs and insurance companies, what is the best way for them to fight back against them?
Jeremy Counts (46:58.397)
You can go to truth rx.org join up. We'll give you a marching orders. If you're really interested in doing things, we'll put you on task force, whether it's state specific bill specific, whatever, like we form teams and we send people out hitting. And that's, that's how we get things done. Um, if, uh, it's something that you're kind of just like looking into or dabbling in, if, uh, start reading up on kind of what's going on, uh, it, may be a bit confusing.
But get involved with your state organizations, start going out and talking to your lawmakers and get a relationship with your specific lawmaker that represents you. That is so important. Everyone needs to be talking to their own lawmakers. They need to try to establish a relationship and they need to keep that relationship. Yeah. I think that's a really good advice. when I was in Michigan, I started forming a little bit of relationship with a representative of John James.
Clear Health (47:48.194)
Yeah, I think that's really good advice. When I was in Michigan, I started forming a little bit of relationship with Representative John James. And it was great to talk with him. And I go to the meetings where he was at and talk with him a little bit more. And you really see like, OK, this guy will actually go and do stuff for us if we talk to him about what needs to be done.
Jeremy Counts (47:57.749)
And, it was great to talk with him and, I go to the meetings where he was at and talk with him a little bit more and, and you really see like, okay. This guy will actually go and do stuff for us. If we talk to him about what needs to be done. Yeah. Yeah. It's good to have lawmakers like that. They'll surprise you sometimes. And yeah, I'm reminded constantly. they are people.
Clear Health (48:14.626)
So, yeah.
Jeremy Counts (48:22.299)
Like they're people to remember that everyone, like sometimes things play out behind the scenes and you think, it's just money. Money's here, no, they're people. Like they are affected by things. So it's always keep that in mind with your lawmakers. Yeah, it's true. Whether they have a white coat or a P coat, they, they're real people behind there. have real problems that we all, that we all actually face sometimes. Yeah. Well, I really appreciate you.
Clear Health (48:22.856)
Yeah, yeah, yeah, yeah.
Clear Health (48:36.214)
Yeah, it's true. Whether they have a white coat or a pea coat, they're real people behind there. They have real problems that we all actually face sometimes. Well, I really appreciate you coming out and talking the truth about what's going on with these PBM reforms and how people can help out their local pharmacist. Is there anything you wanted to shout out before we kind of...
Jeremy Counts (48:52.317)
coming out and talking the truth about what's going on with these PBM reforms and how people can help out their local pharmacist. Is there anything you wanted to shout out before we kind of close it down? Fuck PBMs. Yeah, good one. I think I'll make that the intro. I'm a simple man. Simple man doing simple things. Well, I appreciate you coming out.
Clear Health (49:05.492)
Close it down.
Yeah, good one. I think I'll make that the intro. Yeah, yeah. Well, I appreciate you coming out and speaking on the Clear Health podcast and it will definitely have you back for sure.
Jeremy Counts (49:21.257)
and speaking on the clear health podcast and it will definitely have you back for sure. Yeah, it's a pleasure. I love doing this stuff. Like love talking to you, doc. I love getting on here and letting people know what's going on. And I love even if we could get one person out there to listen to this and start fighting. It's worth every second. Yeah, it sure is. Thanks so much. Hey, thank you doc.
Clear Health (49:42.498)
Yeah, it sure is. Thanks so much.
