The Chaos Of Drug Pricing in the US | GoodRx CEO Wendy Barnes

In probably 99% of the instances where you go to fill a drug, you're going to get a different price point depending upon where you go, what you ask for, and whether or not that pharmacy is looking for more competitive pricing outside of your funded coverage. It shouldn't have to be an or between your funded and a discount option. It also shouldn't be something that you or I have to ask for and/or search around and play detective. Hello listeners, and welcome back to the show. I'm your host, Halle Teco, and today I'm chatting with the president and CEO of GoodRx Wendy Barnes. GoodRx is a publicly traded digital health company that operates a free-to-use website in mobile app, offering prescription drug coupons and price comparisons to help consumers find the lowest prices for their medications. Welcome to the Heart of Healthcare podcast. I'm Halle Teco, and I'm Steve Krause, and every Monday we bring you the latest in healthcare innovation as we sit down with entrepreneurs and industry experts. So buckle up and join us as we figure out how to improve healthcare for all. Wendy, welcome to the show. Thank you for having me, Halle. I think that most of us know what GoodRx is as consumers, I've used it, but can you explain GoodRx's business model and who your customer is, like the customer that's actually keeping the lights on? Sure. Well, thanks for the question on the surface, it should be a simple answer, but I will say that the model has evolved over the years. So since the company's inception back in 2011, it originated really as a prescription discount marketplace that was largely driven through partnerships with PBM. So think about GoodRx contracting with the pharmacy benefit manager, and we in turn then accessed their retail network with discounted cash card pricing. We've since evolved and considerably in the last two to three years whereby those relationships still exist, but we've pivoted extensively towards direct contracts and relationships with retail pharmacies such that like nine of the top 10 pharmacies we work with we contract with directly. So the experience from a consumer standpoint, while that somewhat feels similar to the legacy model, the differences were able to get more aggressive with pricing when we work directly. I would also say the history of the company was largely around generic pricing and we have in the last few years started partnering directly with pharmaceutical manufacturers to buy down those heavier or more expensive brand prices. So now if you go on one of our digital assets, you'll see that there's a good mix of generics and brands where you can either download a coupon or it's just integrated at the point of sale. There's a lot more behind that, but that's really the short answer as to how the experience has evolved. Yeah. So if I look up a medication that I'm using and I see the different prices at different pharmacies, some of those deals could be driven by PBM relationships that you have and some of them based on the pharmacy relationship. Correct. And I would say and there's now an additive layer now that we're working directly with pharmaceutical manufacturers, particularly on brand medications. That price will also be heavily influenced by the point of sale cash price that the manufacturer is comfortable conveying in market. And so those prices will, you know, surface on our digital assets and then you can you can fill it and or you can have it sent to your home. So we work with pretty much every pharmacy in the US at this point. Yeah. We're all seeing all these pharma companies start their own kind of direct model, Lily Direct, Pfizer has one now as well. Novo cares. I think is what they call it. Talk us through this evolution in pharma now going direct to patient because it makes a lot of sense, right? Like those just cut out more of the middle men, but it's taken a long time to get to this point. Yeah. Also a great question and a timely one. I think backing up a little bit might be somewhat helpful for listeners. If you're not living in this incredibly complicated space, stay in and day out. A lot of large manufacturers have had direct programs actually for a long time, largely focused on patient assistance programs and or copay coupons. So it's not been unusual for some of these larger manufacturers, particularly through physician offices to have coupons or affordability programs that you could access maybe through the physician office, although obviously is the businesses become more digital, you could then also go to their brand.com pages. But in recent years, that's morphed and I would say Lily Direct has been at the forefront of that whereby they're engaging consumers directly and not just more so through hearing about it, perhaps through your physician. And while candidly we work with those same manufacturers on those programs, some of them are also embedded inside the good or X experience, or in some instances, we'll link out to those programs. One of the conversations I've been having with some of the regulatory politicians and or civil servants in DC is that as we think about improving drug affordability in general, one of the things we should be fixated on is the actual consumer experience. And generally speaking, most of us, particularly as we get older, we're not on one brand medication, we're not on one medication at all, you're typically on multiple medications. So we like to think about the experience as your whole basket of prescriptions. And therefore, the idea that we would want to go to say 10 different websites or consumer experiences to get one medication here, another one there, all of which are going to require you to register. Boomers are like no way. It's not an awesome experience. And most of those programs have a far lower claim rate, meaning you actually get through the whole experience and get your prescription than within an environment like good or X. So while we applaud the idea that you can convey a cash price, and boy, pharma has come a long way, and they're thinking about believing that they can not only do that for later stage drugs, but they can launch with cash pricing and we've got some great examples of that inside our environment as well. But the idea that we should continue to go down that path for every drug that comes to market just feels a little disconnected to me, which is one of the reasons we continue to work with pharma to say it should really be an end. If you want to have a separate brand.com program, go for it, but a platform like our environment where you're already engaging, you know, literally hundreds of millions of consumers are coming looking for price points, feels like a much wiser way. Yeah. So does that turn good or X into a pharmacy? No, we actually don't dispense, Holly, so we're not a pharmacy ourselves, but we do work with pretty much most pharmacies in the U.S. both retail and home delivery candidly, though, I mean, it's come up multiple times. There are instances where it perhaps would have been far easier to support a program if we had our own fulfillment, but I continue to contend that there are so many pharmacies in the U.S. There are 70 plus thousand that the idea that we need to be a pharmacy to do what we're doing for consumers. It just doesn't quite sit well with me when you think about, you know, limited capital to invest, limited M&A dollars. So today, my answer is no to that one, but I will reserve the right if mom is changed down the road. So I was reading an article you wrote in Fortune, which I will share in the show notes, and you wrote for too long the cost of prescriptions has been shrouded in mystery. Patients show up at the pharmacy counter only to be blindsided by costs they never saw coming, confused by copays, high deductibles, and opaque coverage results. It's no wonder almost a billion prescriptions are left at the pharmacy counter each year, and I was just shaking my head because I've experienced that. Most of us have experienced that. And I actually write about a case in my book where the price of the drug with my insurance was like 11 times more than what it was with a coupon discount code and how just that the change in pricing makes no sense. So I want to dig into that and price transparency. I have a few questions here, but let's start with what you stated, like whose fault is that? Fingers, why is pricing just so all over the map and inconsistent when it comes to prescriptions? Yeah, you know, gosh, that's a loaded question. It's good. We have a little bit of time here to unpack it. I don't know that it's anyone's fault per se. I will say like most systems, they evolve over time, and they evolve typically as a result of competitive pressures, and particularly for public companies, the need to meet quarter to quarter results. So look, it starts with pharma, manufacturers in general, right? Incredibly expensive to develop drugs, therefore they're going to set their own price points, and that's where all of this starts and the cascade of drug pricing where they're accountable to shareholders for the most part. Many of them are in fact public companies, if not, they're private biotech with VC with considerable stakeholders that they need to return investment to, but be that as it may, that cascade then starts pointing to, so then how do they gain access to consumers? to take their medications. That's step one with any commercial market strategy for a manufacturer. Typically, you're going to do that through a payer by getting access to a formulary. Because, of course, those payers are contracted with pretty much every provider in the US. And providers, they're the ones that generate those scripts. In most instances, of course, tied to an appropriate diagnosis to put you on said medication. And so the connection between manufacturer and payer has long been written about. And typically, you're doing that via clinical relevance, tied closely to financial incentive, which has morphed into the rebate game, which I'm sure you understand well as do most of your listeners. And so then you've got the gross tenet scenario inside payers who, in turn, of course, are contracting with retail pharmacies to fulfill most of these prescriptions. Or it's their own owned pharmacies. And those incentives can be slightly different. Having run pharmacy at a large payer for a good number of years, the incentives to fill a payer-owned pharmacy compared to maybe one in the network. We could probably have a pretty healthy debate about that too. But be that as it may. Then you've got the payer who's ultimately contracting with all of these pharmacies to fulfill those medications. And there are reimbursement rights set in those contracts. Every pharmacy chain is going to negotiate a little bit different with that long list of payers. And so for that reason, the pricing at the pump, if you all are the counter in this instance, can vary greatly from pharmacy to pharmacy. And truthfully, even with some of those pharmacies by geography, so some chains will ask for and negotiate for different reimbursement depending upon their geographical and competitive pressures across their chain of pharmacy. But sitting parallel to that, then you've got the actual employer or you've got the end plan sponsor also negotiating with the PBM or the integrated medical carrier for their billable payable rates. And so you may have spread in some instances where the contract with the pharmacy versus the actual plan sponsor. There's a delta. And there's some keep in there sometimes. Those are equal in which case, you know, that's defined as a transparent offering. But when you stack all of those things together, what you end up with are contracts that truly are 10, 20, 50, 100 pages long between the actual payer and the pharmacy in play. And then also those gross to net agreements that the payer has with the manufacturer. And when you triangulate all of that, it manifests for you and I as consumers with a litany of price schedules, tables, rates depending upon who your plan is, what geography, whether your commercial or government subsidized. And that is why in probably 99% of the instances where you go to fill a drug, you're going to get a different price point depending upon where you go, what you ask for. And whether or not that pharmacy is a looking for more competitive pricing outside of your funded coverage. And that's kind of where good or X comes in and discount pricing, cash pricing, patient pay pricing. It's referred to a number of things as you read about it. That, of course, is the legacy of what we do. But my strong push since being here is that it shouldn't have to be an or between your funded and a discount option. And if I'm wrong, it also doesn't count towards your deductible. If you pay, if you do the cash pay price. It can. So the interesting point you've made there is that we actually built the rails with all of the top PBMs and pairs they exist. It's called an integrated savings program whereby it can, it should, it does and some instances. And at a minimum, it surfaces the cash pay partnered with your funded so that you can choose, which route you want to go. But what's happened over time is that in the instances where the financial incentive for the payer isn't aligned to showing the lower cash price, it isn't always surfaced. And so the short answer is it exists. The technology is built. It just isn't always there for the taking. But I will applaud this administration for pushing on that. That is something that HHS, particularly Chris Clomp, and his new role as part of that team. And we just have them on the show. So yeah, yeah. So do you think that there's a future where drug prices could be the same for everyone? Like there's one negotiated price and each health plan might cover, I might buy into a health plan that covers 100% or 90% but the actual price is as listed as consistent for everyone. - Oh gosh, that's a tough one. Boy, I think. - I would say no to that, right? Like who would say no? - I think the short answer is that would be hard unless we're somewhat aligned on going to kind of a single payer system, Halle, and I think for all sorts of reasons, a single payer system is something that would be really challenging in the US. And on the whole, if you push consumers and you push employers on what that would mean from a benefit perspective, I think most would tell you in a 101 setting that having a single payer system that there isn't a strong appetite for that. However, that doesn't mean that a single consistent and/or at a minimum ubiquitous transparent cash price can't be visible to all of us regardless of what your funded coverage is or if you have no coverage at all. It should be much simpler to at least see what is the most competitive cash price. - Yeah, or at least have some guard rails around the bands. Like it can be no more than 10% of this price so that there's a little bit more fairness across patients feels like could be possible. - Yes, so it's certainly a lofty aim. - I'm dreaming here, I'm dreaming here. So you brought up PBMs and I do wanna talk about them because they are under a ton of pressure right now. Tennessee is currently looking at a law that would make it illegal for a pharmacy and PBMs have the same owner. The FDC just settled with express scripts and they'll be moving away from the rebate model. You were previously, as you said, President of Express Scripts Pharmacy, the PBM, that. I believe was bought by Sigma during your time there. Tell me about what is happening in the PBM world and where you think this is going. Sounds like we're going towards no rebates, a different fee model. - Yeah, I mean, gosh, I will say a lot of the national dialogue and same goes for different state-by-state dialogue. They're similar issues. I think they're getting a little more play nationally in the press, but a lot of these issues have been talked about and legislated in a ton of states for 10 plus and some instances 15 plus years, whether it's no spread, 100% pass through rebates. I will say that I'm gonna put the vertical integration on a side for a minute, but certainly state. - Can you define those other two, the spread, can you define those for us? - Sure, so effectively banning spread, for example, has been talked about in many states and at the federal level, meaning a PBM needs to, they cannot both pay and reimburse between the client and the pharmacy, a different reimbursement. Meeting those things need to be equal such that the payer in this instance, the PBM can't keep a component of that. So that's effectively, you're doing away with spread. The 100% pass through rebate also has been around a good bit of time. And even though the FTC settlement with express scripts noted that they will no longer be doing that, I would purport to you that my best guess is 99% of clients inside the top and largest PBMs are already 100% pass through rebate. So it's not, - And they announced last year, right? They announced last year that that's where they were headed anyways, so. - Yes, so it's just not, it's not a huge change. Having said that, I do think what is significant is that ensuring of rebate contracting, which was part of the express script settlement. And I do believe Caramark is in the midst of also providing a similar settlement, although the language behind it hasn't been published publicly, I think it's still not been disclosed that the idea that you're offshoring of rebate contracting, which is what most of the large PBMs do. So technically, think of it as an entity outside of the US that works directly with Pharma to contract those rebates for access to formulary. Most of those dollars are gonna be kept in that offshore entity. And then there's a price point that's passed to the payer in the US. That is actually the number that then express scripts or Caramarker Optum or fill in the blank PBM, passes to the end client or the employer or health system. So by letter of the law, they're meeting 100% of rebate pass through, but it doesn't mean- - The spirit of the law. - Yeah, there isn't margin being kept on rebate itself. But getting back to your broader question and what else may be happening. I see probably a stronger push in DC around transparency and reporting, meaning, and client should have better access to exactly how the claims are being paid, and what reimbursement rates and who's making what on those claims. So I do and I'm hopeful that that will continue to work its way through DC. But some of these other issues, I would lean in heavily to say they're already available to most clients to avail themselves of in contract. So it doesn't feel wildly different to me. But what does feel different, particularly in the last 12 months, is the push for cash alongside funded and the push for FARMA to embrace more direct to patient models, whether that's their own offering, as we talked about earlier, or whether it's working with channel partners to make those prices available. And I mean, I could be happier with that provision because we're not, again, looking to replace insurance. In fact, we wouldn't exist if insurance did everything that it was supposed to do in the first place. But we know that there will continue to be gaps just based upon the sheer cost of drug periods. So we're trying to and pressing on a consumer experience, we shouldn't have to choose. It should just be sitting side by side and be seamless. Yeah. Going back to the on-shoring, because that's something that I don't think a lot of us are familiar with, or at least I'm not familiar with, can you explain kind of how this came about? You know, you said it's not necessarily illegal, but like was like, it's a little shady maybe. How did this like come about? And what is what what is like the purpose of creating these entities in other countries to move money around? Well, I mean, I don't think it's any different than any company that offshores, you know, a portion of their business. Typically, there are considerable tax incentives to do it. And it's really, you know, just comes down to that, you know, tied to in this instance of this particular line of business moving outside the US. Yes, there are considerable tax incentives for insurers to do that. But again, it also allows them to buy letter of the law, meet 100% pass through objectives inside the US. And it's just really as simple as that. Yeah. And what about your thoughts on vertical integration? Do you see issues with health plans owning PBMs? Do you have any worries with if Tennessee does pass this law that there will be closures of pharmacies? Yeah. You know, gosh, I don't know where it's going to land. I do know that, you know, CVS has been pretty vocal to say that if it goes through that clearly they're not planning on divesting the PBM side, they would close pharmacies. And they've said that, said it very clearly. So that would certainly be an unfortunate outcome while I think it's fair to say that pharmacy is in some geographies overbuilt. It's not overbuilt everywhere. It's not entirely equitable with where pharmacies are located despite 70-some-odd thousand pharmacies existing in the US. There are still a considerable number of pharmacy deserts, largely in more rural areas. So that would be obviously an unfortunate outcome for people in Tennessee. As to the broader question on, you know, should payers be allowed to be vertically integrated? You know, I do think there can be benefit to that when it works in the client's favor, meaning you should conceivably be able to drive better rates for yourself as an employer when you're buying all of these things bundled together. But in many instances, it hasn't turned out that way for employers. It just hasn't produced more competitive rates. And so in that instance, I understand the push, you know, to kind of to pick some of those pieces apart. What I would also say is there are ample number of pharmacy benefit and/or payer providers you can choose that aren't vertically integrated. So it's not as if there aren't a host of choices for any plan sponsor to choose from to manage their benefit to include, you know, pushing on some of these same larger vertically integrated providers to say, I don't want these other components. Like, you know, I'm going to go in a different direction for my specialty pharmacy or my network. And we saw that with some pretty large plans in California. And those those made headlines was either last year, the year prior, where they effectively, I think it may have even been one of the large blues plans who said, hey, look, we're on bundling all of this. And Caramark, you're going to keep this piece. I think Caramark may have retained specialty. And the rest of it, they kind of gave to a multitude of players. Yeah. Do you think that PBMs have played a role, the fact that the three PBMs, the three large PBMs have 80% market share? Do you think that has played a role in the closing of so many independent pharmacies? Wow, that's a tough question. Well, there's no question that reimbursement pressures for any pharmacy, inclusive of independence. Often is what leads to their closure. Or they are at a point in their trajectory as an independent pharmacy owner, well, they will where they will often sell their pharmacy, but not the physical asset. They sell their file. If you will, to a larger chain, when they're, you know, ready to be done with their business. But there is no question that a multitude of pharmacies have closed, largely over reimbursement pressures. Not the least of which is, they're also struggling to get competitive cost of goods. So, right, it's an input and an output, depending upon how they're able to acquire good. All of that to say, I think most payers at this point are embracing more of a cost plus model. And it's been successful across the board. And I will mark Cuban cost plus model like that. Yeah, although he's a bit of a microcosm, right? As a home delivery pharmacy and a pretty small subset of drugs. But the thesis still holds. And when you think about different reimbursement models, I think NADAC may have been one of the first. It's, oh gosh, I'm going to put myself on the spot, national acquisition, something drug acquisition cost. It's a, it's a metric that's been around for a long time. It's a voluntary list of pricing that pharmacies submit their cost of good around a list of drugs. And off of that, then that is determined to be a NADAC plus that then the payer is obligated to pay that same pharmacy. And so, as you see, like CVS has moved to cost plus for all of their retail pharmacies. Walgreens is largely a cost plus chain. And NCPA and the broader independent pharmacy community community have pushed hard in a lot of their states for cost plus reimbursement. So I think in today's environment, it's, it's not uncommon to be able to secure payer agreements that are in fact cost plus. But, you know, be that as it may, there's still a lot of competition for those same prescriptions, both digitally and from just other competitors that are in that marketplace competing for those same prescriptions. And it's, it, we too, have invested in and have pivoted towards cost plus for all of the independent pharmacies that we work with. We know how important they are to the rural community, community specifically. But it's not always as simple as that. But on the surface, I do think moving to cost plus reimbursement has helped. Yeah. Given the closures of all these independent pharmacies, as well as the retail pharmacies that, you know, we have the right aid bankruptcy, both CBS and Walgreens have announced the closure of thousands of stores. What are you seeing this mean for patients? Are they just driving further to get their prescriptions or are they moving to online pharmacies? Yeah. Well, so in urban markets, the short answer is there aren't as many individuals availing themselves of home delivery, as you might think. It's a, it's a really interesting dynamic as a more and more of our consumer habits push to online for, you know, consumer package good types. Everything services in life. Yeah. I mean, it right. We, we, even our groceries, that's right. What's interesting is at least at present, you're not seeing a huge growth explosion in home delivery for pharmacy while certainly for telehealth programs and integrated offerings for conditioned specific type things. So think integrated weight loss offerings like we offer and others offer. That's more common, but for hey, I've left my physician office and I want that initial fill to be sent to my home. I want it to go to a digital pharmacy, not nearly as much. There's still something to be said for individuals wanting to go into a brick and mortar location. Now, do I think that will change in the next 10 to 15 years as your current 40, 50 year olds of which I'm in that category start pushing into taking more medications, becoming caregivers for elderly parents, and we're more conditioned. And certainly, you know, like my daughter's generation, much more conditioned to utilize, you know, a digital type asset to fill their prescription. I do think it seems, it seems hard to suggest it wouldn't grow over time, but I can tell you historically and at present, it's a very, very small component of overall prescription channel. It sounds like it might be demographics, like the folks who are using most of the prescriptions are more likely to want to talk to a human and go into a store, but kind of what I'm hearing is perhaps over, you know, as the younger generations get older and start taking more drugs, they'll they'll they'll be more comfortable with online. So that'll be interesting to see how that plays out. So when I saw Trump RX launch, I have to be honest, I thought immediately like, oh my gosh, that sounds like good RX, but actually you're like a core integration partner, tell us. us about about this. Sure. You know, it's been, it was about a year ago that our head of government affairs in DC gave us a call and said, Hey, Wendy, could you join a round table with some, some of the leaders at HHS to just have a conversation about drug pricing? They're trying to understand, they're trying to get knowledgeable, given the president's keen interest and one of the rare bipartisan areas of interest in bringing down drug prices and it was, yeah, it was about a year ago that we did that and I joined as did some leaders from larger digital pharmacies as did some larger more traditional pharmacies and some other more, I would say just tech focused solutions in the pharmacy space, not necessarily pharmacies themselves, but tech enabled solutions and it started more around what would you have to believe to be true to bring drug prices down in the US. So it was kind of a fact finding mission and that conversation ended up morphing into more one-on-one conversation, smaller group meetings with some of the people who had attended that initial one and ultimately landed on, you know, the president's leaning into MFN and how do you make that real and achievable for Americans? And so it took some twists and turns candidly as to what the government's objective was and then ultimately turned into, hey, why don't, why don't we host a marketplace as a government to convey drug pricing? As you can imagine, there were a lot of conversations that we were engaged in on that to say, okay, well, if you do, here's certainly some learnings because we've been at this, you know, for about 15 years and look, I will give all of the policymakers all the credit in the world for trying to get lower cost meds into American hands. I think that's a good thing. I also think, sure, I also think the reality of what MFN really means in the context of, you know, international prices for manufacturers and if it's just a squeeze the balloon and, you know, make it higher in another country so that we can perhaps not subsidize as American consumers, lower price points in other countries versus a true, you know, low cost price here in the US. We also spent considerable time pushing on the idea that all beneficiaries, if the government was going to lean into this, needed to be able to avail themselves of these prices and perhaps a lesser known fact around a lot of these drug affordability programs and in particular cash prices are that if you're a beneficiary of Medicare or Medicaid, most manufacturers dictate tied to that price that they're that you cannot participate if you're a government beneficiary because they don't want to trip up any of their best price offering and the regulatory code around it, it's a little gray as to whether or not it's permitted versus not. So one of the things that we pushed pretty hard on as a strong, strong advocate for consumer cash prices where that government beneficiary should be able to participate in these point of sale buy downs and I'll give HHS team good credit. These aren't easy things to change even though on the surface it sounds like it should just be the stroke of a pen. There are a lot of things tied to it and they did issue some letter guidance out of the OIG to help clarify that pharma would be in the clear, to convey these prices that they were going to present on TrumpRx. Kind of flash forward to when it launched earlier this year, we are an integrated partner for a lot of those drugs that are on TrumpRx. I do think the idea that there are less expensive generics that you could secure because I know that some of the criticism that the offering has taken in the media. I would say some of that is just more of a PRMIS candidly. I don't think their initial intent, Halley was ever to convey generic cash pricing although they may down the road. It was to try and get it. Yeah, they should know your options. Yeah, it was to try and convey better price points for some of those branded drugs of which sometimes a patient still needs to be on the branded therapy. So their aim out of the gate really wasn't to have generic pricing because I mean candidly between good Rx and other offerings, you can find competitive generic cash pricing in a number of places. So about one in four, one in five Americans are on Medicaid and the same administration that's putting TrumpRx together is also really defunding Medicaid. How do you think that's going to impact access to medication for that enormous population? Yeah, this is a, boy, this is a tough one. I will say we've had our team is had a fair amount of outreach from different state Medicaid policy makers saying can we just get information about good Rx or a minimum that individuals who no longer qualify in our state can have something, you know, some type of resource. The interesting thing about Medicaid eligibility, one, it's always been pretty choppy, meaning individuals come in in and out of, you know, eligibility to be covered anyway. So consistently, consistency and continuity of care have always been challenged for, you know, Medicaid participants, but throw in the most recent change, the number of individuals that will fall off coverage. We're just making best efforts to make sure that they know about who we are, how they can, you know, hopefully get what it is that they need to stay on from a therapy perspective through us or some other mechanism, if not us, but the true answer in addition to that is many individuals when they don't qualify for Medicaid, they're not necessarily going to spend the limited dollars that they have on health care at all, right? It's likely going to go more towards cost of living, I'm housing food. It's just in all around, you know, unfortunate situation, which again is why the press for ongoing brand partnerships, because those are typically the drugs that hurt consumers the most. It's why we keep pushing hard on our formal relationships to not just have competitive low cost generics, you know, it's one thing to be maybe a dollar better than someone else. That matters, and I don't want to trivialize that that matters, but it's wildly helpful. If a drug that otherwise was 1500 bucks and we can get it down to 100 or 150, that can be the difference between a life-saving medication and not for many consumers. So closing question for you, I like to ask this for all my guests, if you could wave a wand, a magic wand and change one thing about health care, and maybe for you specifically around how Americans pay for prescription drugs, what would that be? My wand, I think, would be a technological one, Halley, such that in the palm of your hand, most of us have advice these days, you would know instantly as you depart a physician office, or at a minimum before you go to the pharmacy with the most competitive cash prices alongside your fund, provided you had insurance, and if you don't have insurance, just knowing with the most competitive cash prices period and what your auto pocket will be always. Before you present to the pharmacy and taking that one step further, it would also be integration with the pharmacy, such that you can check out on your phone, and we've done that with a lot of pharmacies, so that again, we're not standing at the counter needing to hand a credit card, the lines long, they're busy, they don't need to look up any of your coverage information, it's just done, like an online consumer digital experience that we expect with pretty much everything else we buy. I mean, that's not even, that's like process more than technology, because you could build this tomorrow. I mean, it's like your physician asks, you know, you have 15 minutes with them, they're writing your script, and they're like, which pharmacy do you use? You have to tell them so quickly, but I will share with you my clinic has good RxCards right at like when you check out, so people are able to kind of know that that's an option and use it, so you should be proud of that, and I think that was a really interesting distribution strategy for you guys to actually work with the providers at the point of prescription. We do, we do, and we're also integrated with a number of EHRs, such that while cards are great, and many of us are tactile consumers, you like to see something hold something, again, my aim would be that it's just you're utilizing our app, it's integrated in the EMR such that again, there's, you don't have to stare at anything, go to up, it's just there and enabled. Yeah, amazing. Well, Wendy, thank you so much for your time today. Thank you. Thanks for having me, Haley. Thanks for listening to The Heart of Healthcare. If you enjoyed this episode and you'd like to support the podcast, please leave a rating and review, and don't forget to subscribe. The Heart of Healthcare is produced by Haley Teco and hosted by Michael Eskabel, Steve Krauss, and Haley Teco. The show is engineered, edited, and mixed by Kyle Moore. Visit our website heartofhealthcarepodcast.com for show notes and details.