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Transcript

Ben Markland: [00:00:00] All right. Thanks for joining us, everyone. Today I have with me Lisa Collier. She's with PRAM. She is a second-generation CEO of a company that was started by her father, and very interested in talking today a little bit about what it looks like to kinda be a legacy leader in this industry. So tell you what, Lisa, start out, tell us a little bit about you, and tell us a little bit about what PRAM does and tell us kinda what got you to the CEO position.

Lisa Collier: Okay. It's complicated. I have a hard time really explaining a very good way to explain PRAM, but I'll say we are a, an MGU for pharmacy specifically. We're a consulting firm for pharmacy specifically, and a TPA, again, specifically for pharmacy. My dad, who started the company 37 years ago now, it's wild, he stumbled into pharmacy and really [00:01:00] created a fantastic niche for us. And we've been really lucky been, being able to provide for our families, and honestly, for me, it's been all about creating something that I can be proud of, that my family, my siblings, who are also in the business, can be proud of, and that our dad can be proud of. And really trying to expand upon what he's created, which is a really strong foundation in the pharmacy world, but as the industry's constantly changing. So it is all about morphing and changing and becoming something stronger and better all the time, and creating better products that are specific to our industry and our partners. So listening to what our partners have to share with us in terms of feedback and what they're seeing in the space and again, listening and as we grow and become something different, we have to focus on technology-

Ben Markland: that's right.

Lisa Collier: 'Cause that's huge. And so that's been a, probably a primary focus for me is [00:02:00] technology, but also the pharmacy world and creating new and better products for our partners.

Ben Markland: That's great. So you mentioned kinda keeping up with the changing industry. Tell me something that, that you see right now that's changing right in front of your eyes and maybe something you guys are doing to kinda adapt to that.

Lisa Collier: Yeah. Gosh, so much. I would say even the PBM space specifically is changing. It was really all about the focus was on the big three, and their focus is unfortunately on their shareholders, which is great for the shareholders, but, our focus is really gonna be more so on the actual members, our partners, what they're trying to create and build, and then also on the members who are the ones who are actually using the plan, and the employers. And so I've seen a really big shift in focus to the smaller PBMs that are growing, and I think that's key for honestly creating better products and programs. And we choose our PBMs specific to the project that we're working on. They're all [00:03:00] different, and they're all good for specific things. And because of that, we've just been able to, say, "Hey, this one really focuses on generics, so for our generic-only product, we're gonna bring in this PBM. But for our specialty products, pharmacy-specific specialty programs, we're gonna bring in this PBM, because they're really good on certain things." And so it's really about identifying who's good for which project. And I love that the focus has really been these smaller PBMs have really gotten a lot of growth and-

Ben Markland: And you've found who does what well.

Lisa Collier: Yes.

Ben Markland: And that's who you like to partner with-

Lisa Collier: Absolutely.

Ben Markland: In a certain situation. I tell you what, just to back up a step not everybody in our audience is an insurance person.

Lisa Collier: Sure, sure.

Ben Markland: So explain to the audience a little bit what a PBM is and what their role is for the- I guess to say for the broker and to the employer as well.

Lisa Collier: Yeah, so a PBM stands for pharmacy benefit manager, and they are really who adjudicates the claims. When you walk into the pharmacy you hand them your card, [00:04:00] right? And they run that through a system, and that system is what adjudicates the actual claim, which means it's gonna run it up against the benefit. They may tell you, "Hey, you have a $10 copay for this medication." And that is how the claim actually gets adjudicated. One great thing that is in addition to running it up against the benefit is that it will actually run these point-of-sale edits. So at the point of sale, they'll be able to identify, "Hey, you're taking this drug under a different name. Let's stop that so that we can identify that and make you healthier," right? If you're not doing that. And then there's all, all sorts of other point-of-sale edits that they do as well, but so they're good for various reasons. PBMs do serve a purpose. So we bring the PBMs in who don't know a lot necessarily about risk structure. We bring the carriers in who don't know a whole heck of a lot about the pharmacy space, and we bring those two together to create these products based on risk and strategy. We'll help to create the formularies that are right for the project that we're [00:05:00] doing and the actual formularies and whatnot, and then we also will do the underwriting for the carriers.

Ben Markland: That's interesting. I think based on my experience and just working with all of our brokers, in the pharmacy world, the end consumer is really not a huge part of a purchasing decision. If you go to a doctor, and if they tell you gotta take this drug, no one's usually questioning it. And with pharmacy, that drug can cost $5,000 a month, or it can cost $5 a month. And, we're in a world where a consumer, that's kinda irrelevant to them. It does matter to an employer if you have a huge spend because you're getting a big old rate increase, right? Having another entity in the middle there almost being a part of that, I think that's important for the, very important for the end consumer. And then when you talked about risk, it's important for the insurance company too to know- that, hey, here's something that maybe you could be taking something differently. I understand, a doctor's responsibility is to get somebody something that's gonna treat their condition. But not [00:06:00] always a one-size-fits-all there. You might have a couple options, and as a consumer, it's not really, in healthcare in general, the consumer isn't, when someone else is holding the pocketbook, they're not as, part of that purchasing decision, right?

Lisa Collier: Yeah.

Ben Markland: So that's where PBMs come in. That's where you guys come in to figure out the right PBM. So I think that's extremely important. That brings me to another question, though. So obviously, GLP-1s, big time. Big buzzword right now. Everyone knows the weight loss drugs, but ultimately it's to treat different things like diabetes being the number one. But, we're seeing a lot of people's pharmacy spend go way up because a lot of people are on this medication.

Lisa Collier: Yep, absolutely.

Ben Markland: So I'm curious, is there something you guys are doing or trends that you are seeing specifically around those drugs to try to help this be more affordable or try to find some ways to work better with employers to get those delivered to the members?

Lisa Collier: Yeah, absolutely. There's lots of different things specific to GLP-1s, but to take a step back that is how a formulary is created, and that's why it's super [00:07:00] important for us to identify those medications in which, they might be new, but that doesn't mean they're better. So we want to identify the most efficacious drugs that are also the most cost-effective that we're steering the members to, and maybe we provide them with a $0 copay to incentivize them. There are all sorts of different ways in which we incentivize the members to choose medications that are gonna be better. But one thing that is new and leads into your question is there's actually something called PGX testing. What that really is personalized medicine, so it's kinda like the DNA cheek swabs, and you can swab your cheeks and whatnot, put, send that back in the mail. They test it, they analyze it, and they'll be able to tell you what medications will properly metabolize within your body. And it has been a real game changer in terms of it's huge. It really saves money on the employer side. But on the member side, I have so many stories I could share, in all honesty.

One, I'll just share my [00:08:00] own. If I were to ever get some sort of, have some sort of a stroke or something and they, I go into the hospital, their first line of defense almost always is gonna be warfarin, right? And I can't, my body won't properly metabolize warfarin, so I'd be in trouble of, at risk for-

Ben Markland: And you know that only because you-

Lisa Collier: I know that because I took-

Ben Markland: You've been pre-tested on this stuff

Lisa Collier: Yep.

Ben Markland: That's very interesting.

Lisa Collier: And, but there's so many examples. I mean I have lots that I could share, but really good stories, powerful ones, that have come out of this. People in, at the mental health area that it's huge game changer for. And then actually on the GLP-1s. So they recently, our main company that we really for the PGX testing, they came out with a test that will look for whether or not the GLP-1s will work for you. And it is really interesting because, as an example, I know somebody who took them for many months and tried, probably one medication and then went on to the other medication, and they tried them for probably a year and it didn't work for them.

Ben Markland: [00:09:00] That's an expensive trial and error, right?

Lisa Collier: It's an expensive trial and error. And it did not work for them, and so they're, spending that time and money and kind of heartache almost, right? Not trying something different, and that medication did not work for them. We had them tested, and it showed, It wouldn't have worked for them It wasn't ever gonna work.

Ben Markland: Okay It was never gonna work. Very interesting.

Lisa Collier: So really in terms of regarding GLP-1s, I would just say make certain that, A, they're gonna work for you. B, a lot of employers are focusing specifically on whether or not you actually need it. If you want it, there are ways to bring down those costs in terms of finding compounding versions or, there's all sorts of other options. But yes, it is a huge thing in the space right now and trying to find what is right for each member and each employer and how they wanna address it.

Ben Markland: So do you see the industry trending towards people doing more preemptive testing? It sounds very uninvasive. You're swabbing your mouth right? But how do we get everyone to do that? 'Cause it sounds like that-

Lisa Collier: I agree.

Ben Markland: Could really [00:10:00] be a huge thing on-

Lisa Collier: It is huge.

Ben Markland: On every side of all the people involved in that situation.

Lisa Collier: Yeah. In my opinion, absolutely, and they're even kinda getting into the wellness area as well. And, hey, what are you genetically missing in terms of vitamins and what should you be proactively doing, right? In my opinion, yes, everyone should be tested. Everyone should be tested, but it is expensive. And, right now it's actually come down quite a bit in cost, so now it's only around $300. But we can bring it onto a new group and have it be on a PEPM basis, so it's very low in cost. And we can just add it to everybody, and honestly, it's very well worth the cost long-term for not only the members themselves, but for the groups because it really helps to save money and get more folks healthier and back at their job.

Ben Markland: Yeah No I think that's great. I didn't know that existed. And I think hopefully our millions of viewers here now know. Anyways, but no I think and obviously, so you guys do work with brokers, and a broker would be your distribution channel. So I think if you guys were to get some brokers on [00:11:00] board I think that's a fantastic sales pitch.

Lisa Collier: Yeah, it's huge.

Ben Markland: And it's a way, look, we don't have to do the expensive trial and errors that are gonna knock out your medical plan if you can get your employees to take this test and, it's gonna work before you even have the ailment that needs to be treated.

Lisa Collier: Yes. Absolutely, yep. There's all sorts of proactive programs. Another one is our opioid clinical management program, and that's also proactive, can identify members who are at risk for opioid addiction five months prior to the addiction phase. These are really amazing, innovative programs that are out there today, and we definitely try to incorporate them into our-

Ben Markland: That's very interesting.

Lisa Collier: Our overall.

Ben Markland: All right, so Lisa, let's rewind a little bit back to your personal journey with PRAM and just your career in general. And, as I mentioned earlier, Lisa's a second-generation leader of this company. Tell me what you're kinda doing to carry on your father's vision as far as leadership goes, as far as the direction of the company. Tell us your thoughts on that. What are you doing there?

Lisa Collier: Growing up, he really taught me the value of [00:12:00] learning about the industry, the pharmacy industry in general. He would make me memorize the top 100 medications, how to spell them, what they were used for.

Ben Markland: Oh, so much fun, right?

Lisa Collier: Yes, I remember I was 16, and he would drill me, and that's, I think, a really good basis for us to understand hey, it's crucial to understand everything you possibly can. Constantly be learning. Try to be better every day and do what you can to really change things and make a difference and provide value. And I think that's something that he really provided to me, was be proud of what you do. Bring a lot of value to your clients and your members, and be able to look at yourself in the mirror every day and be, happy with yourself and what you've done, and own your job. Own it.

Ben Markland: I think that's great. We actually, One of our recent guests, we were having a similar conversation about culture. And, now because I think a lot of the world works from home now. And culture's difficult to kinda manufacture over a Zoom meeting, right?

Lisa Collier: Absolutely, yeah.

Ben Markland: But, you're working for a company that was founded by your [00:13:00] father, that's been around for 30-plus years. The culture's kind of ingrained in it. And maintaining that, obviously, people that put that at a high level of importance, as is done with the company that I work for as well I think, that's how you really get to keep people, and you get people there really thinking about the greater meaning. It's not a joke I use. It's not a J-O-B. This is what I do-

Lisa Collier: Exactly.

Ben Markland: And this is what I like to do. It's not a paycheck.

Lisa Collier: Yes, thank you. Yeah.

Ben Markland: That's nice. Probably not gonna do a J-O-B without a paycheck, right? But you get to keep the winners when you have a situation-

Lisa Collier: Absolutely.

Ben Markland: Like that, the culture of your company is clear and everybody's on board.

Lisa Collier: Yeah. Making certain that you're doing exactly what you want with every project, and what needs to be done, and yeah, absolutely. It has to be right. And you have to be proud of what you've created.

Ben Markland: Tell me about that. Tell me a project that you guys are working on right now, or one that maybe you see a little ways down the road that's exciting you.

Lisa Collier: Yeah, so actually, we just did a project with you. And we recently had a partner come to us, [00:14:00] and they wanted something that was a little bit unique in the space, and that is a gap product. So again, gap products are out there, but they're focused specifically on medical. So what our partner wanted was a product on the pharmacy side to pair nicely with their medical. So that's what we went to, back to the drawing board to create, and I'm excited. It's just launching now. And we hope it'll be a real winner for, everybody in the whole, ecosphere of what we've done, and that's always the goal.

Ben Markland: Do you see the pharmacy side getting more ingrained in the medical side? Or do you see-

Lisa Collier: Definitely.

Ben Markland: It go in the other direction?

Lisa Collier: Honestly, it is very ingrained on major medical. But outside of that space, it's really not. And we've really been trying to go back to the carriers and say, "Hey, when you create this product, let's include the pharmacy now- so that it's included." It is the first product that most members are going to use within their insurance, and so it's [00:15:00] crucial that it be done right, and that, our partners are proud of what they're providing to their members. So it's a huge part of what the medical should include from the beginning.

Ben Markland: So Lisa, building new insurance products it takes a, a knowledge of the gaps that are out there and what you need to do to kinda fill those gaps for your customers. Walk me through how you guys approach building a new insurance product and getting it out there for delivery.

Lisa Collier: Yeah, so when a partner comes to us, A, we always need feedback. We always wanna really understand what the problem is. And then once we understand that, we also have to know everybody's goals. From every angle, we need to understand the goals, and then we also need to know the budget. So once we know those three things, we can really go to work on building what it is that we're trying to create, and again, the ultimate goal is for the broker, the employer, and the member to win.

Ben Markland: Now, when you have a partner come to you and give you a budget, how realistic are they usually?[00:16:00]

Lisa Collier: It's always on the low end.

Ben Markland: Yeah, okay. Of course.

Lisa Collier: It's always on the low end. And we try to meet that budget. And really, there are so many things, so many complicated little nuances that we can do to change the plan designs to try to meet that goal.

Ben Markland: Okay. Fantastic. So Lisa, I know we talked briefly about a PBM, and you explained kind of what they're doing, but, there's a lot of employers that they work directly with the PBMs, so you're there to actually change the conversation or facilitate the relationship.

Lisa Collier: Absolutely.

Ben Markland: If you could elaborate for the audience a little bit about, what does PRAM do in working with the PBM, and how does that change what it looks like for the end customer?

Lisa Collier: Yeah. In all honesty we're looking at it from a different perspective than just working directly with the PBMs. So we have a much different viewpoint of the space. We get the viewpoint of the carrier, of the actual broker. We get the viewpoint of the members and the employer, and we really want to build something that is not only focused from [00:17:00] the PBM side, who has one singular focus, right? We're really going to take the 360 view of the carrier, the PBM, the members, and the groups, and the brokers, and bring everybody together so that we are auditing the PBMs, we are making certain the claims are adjudicating properly based on formulary, based on plan design, based on budget, everything, all of the taking care of the members and making certain that they are getting the service that they need operationally. So we're really oversight for all of it. We package everything together, and then we provide it to our partners. It's custom. It's flexible. We wanna, again, do exactly what the client needs.

Ben Markland: There's ultimately a lot of moving pieces and a lot of entities involved, and you guys are kinda, wrangling it all in for everybody.

Lisa Collier: Yeah, bringing it all together. Yeah, absolutely.

Ben Markland: So no I think it's great, and Lisa, I appreciate you sitting with us today. And I think it's fantastic what your father built, and obviously, he has [00:18:00] the right person carrying the torch.

Lisa Collier: Thank you.

Ben Markland: Moving forward.

Lisa Collier: Thank you.

Ben Markland: So thanks for joining us, and thank the audience for joining us as well.

Lisa Collier: Thank you.