COMING UP ON "CYCLE OF HEALTH," Dr. RICH O'NEILL AND COMPANY UNPACK THE GROWING BARRIERS TO HEALTHCARE ACCESS AND VISITING A DENTAL OFFICE IN DOWNTOWN SYRACUSE, THAT PROVIDES SERVICES TO UNINSURED ADULTS IN NEED.

AND IN THE LATEST MEDICAL STUDENT MINUTE, DANIEL MAHONEY EXPLAINS HOW GENETIC TESTING COULD ONE DAY BE OFFERED AS A PREVENTATIVE HEALTHCARE SERVICE.

THAT'S COMING UP ON "CYCLE OF HEALTH."

DON'T GO ANYWHERE.

YG.

IN ♪ ♪ ♪ ♪ >> HELLO AND WELCOME TO CYCLE OF HEALTH.

I'M YOUR HOST, DR. RICH O'NEILL.

TODAY'S TOPIC: ACCESS TO HEALTHCARE, OR MORE AND HOW IS AVISITTA HELPING AND WHAT DO PHARMACISTS ACTUALLY KNOW.

AND WHAT IS A PBM AND HOW ARE THEY REDUCING ACCESS AND WHAT CAN WE DO TO ENSURE OUR OWN CARE?

FROM VANISHING PHARMACIES IN HOSPITALS AND RURAL AREAS TO PATIENTS PAYING MORE FOR WHAT THEY CAN AFORD FOR NECESSARY MEDICATIONS, BARRIERS TO BASIC CARE AREN'T JUST INCONVENIENT: THEY'RE LIFE-CHANGING.

AND CENTRAL NEW YORKERS, AS WELL AS COMMUNITIES ACROSS THE STATE, ARE FEELING THE IMPACT.

NEARLY A MILLION IN NEW YORK STATE ARE LIVING WITHOUT CARE.

WHAT IS STANDING BETWEEN THE CARE WE NEED AND HOW DO WE BEGIN TO BRIDGE THAT GAP?

JOINING US TODAY TO ANSWER THESE QUESTIONS IS DR. JULIETTE MILLER, CLINICAL ASSISTANT PROFESSOR OF PHARMACY PRACTICE AND ADMINISTRATION AT ST. JOHN FISHER UNIVERSITY; AND MR. DEACON HOGAN, AMERICORPS VISTA MEMBER SERVING AT THE RURAL HEALTH NETWORK OF SOUTH CENTRAL NEW YORK.

SO, DEACON, WHAT IS A VISTA?

>> A VISTA IS A VOLUNTEER IN SERVICE TO AMERICA.

IT'S A FEDERAL PROGRAM THAT PLACES VOLUNTEERS AT NON-PROFITS TO HELP MAKE SUSTAINABLE CHANGE TO HELP FIGHT POVERTY IN COMMUNITIES.

>> IT'S A PRIVATE-PUBLIC PRIVATE PARTNERSHIP CONNECTING PEOPLE TO TRY TO SOLVE THE PROBLEM OF HEALTHCARE IN RURAL COMMUNITIES?

>> YES, THAT'S MY SPECIFIC PROJECT.

WE LOOK AT VARIOUS ACCESS TO HEALTHCARE IN RURAL COMMUNITIES.

>> YOU ARE DOING RESEARCH INTO THIS ISSUE.

>> YEP.

WE DO FOCUS GROUPS AND SURVEYS TO KIND OF TALK TO PEOPLE AND SEE WHERE THEY THINK THE PROBLEM IS.

>> OH COOL SO WE ARE GOING TO GET INTO MORE SPECIFICS ABOUT YOUR RESEARCH IN A BIT, BUT LET'S FIRST FIND OUT WHAT THE HECK PHARMACISTS DO?

SO, JULIETTA I ALWAYS THINK OF PHARMACISTS AND THIS IS NO KIDDING.

TAKING A BIG BOTTLE OF PILLS AND DUMPING INTO A SMALLER BOTTLE AND SELLING IT.

IT'S GOT TO BE MORE THAN THAT BECAUSE I KNOW GO TO SCHOOL FOR SIX YEARS TO GET A PHARMACY DEGREE.

WHAT DO YOU ACTUALLY DO?

WHAT DO PHARMACISTS KNOW?

>> IT IS A COMMON MISCONCEPTION THAT PHARMACISTS JUST STAND BEHIND THE COUNTER AND COUNT PILLS ALL DAY.

A BETTER WAY TO THINK ABOUT PHARMACISTS IS THAT WE ARE MEDICATION EXPERTS AND SO WE CAN ACTUALLY WORK IN A VARIETY OF SETTINGS FROM THE COMMUNITY PHARMACY THAT YOU TYPICALLY THINK OF OR A GROCERY STORE, BUT ALSO IN HOSPITALS.

WE CAN ACTUALLY WORK IN AND INSURANCE COMPANIES AND IN THE PHARMACEUTICAL INDUSTRIES.

THERE IS A LOT THAT WE CAN DO.

SO IT'S A FOUR-YEAR DOCTORATE DEGREE BUT THERE ARE TYPICALLY TWO TO FOUR YEARS OF PRE-REQUIREMENTS BEFORE THAT.

>> SO YOU ARE MEDICATION EXPERTS.

YOU MUST KNOW A LOT ABOUT CHEMISTRY AND INTERACTIONS OF MEDICATIONS AND SO IF I HAD SOME QUESTION, LIKE WE ARE GOING TO TALK A LITTLE BIT ABOUT MY EPINEPHRINE OUGHT OWE INJECT AUTOINJECTOR.

IF I HAD A QUESTION ABOUT THAT, COULD I GO TO YOU AND ASK IF THERE WOULD BE A PROBLEM WITH THIS AND OTHER MEDICATIONS.

>> YES, WE ARE MEDICATION EXPERTS AND WHAT IS GOOD TO KNOW IS THAT PHARMACISTS ARE CONSIDERED ONE OF THE MOST TRUSTED HEALTHCARE PROFESSIONALS AND WE ARE ALSO ONE OF THE MOST ACCESSIBLE AS WELL BECAUSE IF YOU THINK ABOUT IT, ANYBODY CAN WALK INTO A PHARMACY AND ASK THE PHARMACIST A QUESTION.

SO WE ARE VERY ACCESSIBLE AND YES, ABSOLUTELY, IF YOU HAVE ANY QUESTIONS ABOUT MEDICATIONS, PHARMACISTS CAN BE YOUR GO-TO.

>> YEAH, THAT'S AMAZING.

KNIFER ACTUALLY THOUGHT ABOUT THAT.

BUT YOU COULD GO, LIKE BECAUSE PHARMACISTS YOU CAN WALK IN AND GO UP TO THE PHARMACY DESK AND SAY HEY, I GOT A QUESTION REGARDS THAN SET AN APPOINTMENT NOW LIKE MONTHS IN ADVANCE WITH YOUR PRIMARY CARE OR WHOEVER IT IS.

SO YOU ARE AMAZINGLY ACCESSIBLE.

SO THIS GETS BACK TO YOU, DEACON, BECAUSE WHAT IS YOUR RESEARCH SHOWING ABOUT ACCESS TO PHARMACIES, ET CETERA, IN RURAL AREAS?

>> YEAH, SO ONE OF THE BIGGEST THINGS THAT WE HAVE FOUND IS THAT TRANSPORTATION IS A HUGE ISSUE FOR THESE RURAL AREAS.

THEY CAN'T GET TO APPOINTMENTS IN A LOT OF CASES THEY'RE PHARMACIES AND PROVIDERS, THEIR LOCATIONS ARE CLOSING DOWN.

>> SO PHARMACIES ARE CLOSING DOWN.

IN RURAL AREAS?

IT'S NOT ONLY RURAL AREAS BECAUSE I'VE HAD THREE PHARMACIES THAT I HAVE BOUGHT STUFF IN OVER THE YEARS, AND TWO OF THEM ON MY WAY TO WORK IN JUST A FOUR-MILE SPAN ARE NOW CLOSED.

WE ARE GOING TO GET BACK TO THAT.

I KNOW WE ARE GOING TALK TO YOU ABOUT THAT.

TRANSPORTATION IS A MAJOR PROBLEM.

IS THAT EXACERBATED BECAUSE A LOT OF PEOPLE IN RURAL AREAS TEND TO BE POOR?

AM I RIGHT ABOUT THESE DEMOGRAPHICS?

ARE PEOPLE IN RURAL AREAS, WHAT ARE SOME OF THE... >> SO PEOPLE IN RURAL AREAS TEND TO BE A LITTLE BIT OLDER, TEND TO BE A LITTLE BIT POORER.

THEIR DISTANCE TO THEIR APPOINTMENTS IS TYPICALLY LONGER SO IT CAN BE REALLY DIFFICULT FOR THEM TO EITHER FEEL COMFORTABLE, HAVE THE MONEY TO PUT THE GAS IN THEIR VEHICLE, FIND THE TIME TO GET TO THE APPOINTMENTS, ESPECIALLY IF THEY'RE WORKING.

SO ALL IN ALL, YOU KNOW, TRANSPORTATION CAN BE-- IT'S NOT SOMETHING THAT MAYBE I THINK ABOUT BUT IT'S DEFINITELY SOMETHING THAT FOR RURAL PEOPLE IS A LOT MORE PEOPLE.

>> SO, YEAH, IF YOU ARE OLDER AND THEN MAYBE YOU DON'T DRIVE ANYMORE OR IT'S BAD WINTER DRIVING IN CENTRAL NEW YORK AND YOU DON'T FEEL COMFORTABLE ON THE ROAD.

SO ALL THOSE THINGS WOULD IMPACT AND IF HAVE YOU TO GO, LIKE HAVE I TO GO, ABOUT A MILE AND A HALF TO MY PHARMACY, BUT OUT THERE SOME PLACE MIGHT BE QUITE SOME DISTANCE.

>> YEAH, WE EVEN HAD ONE PERSON DETAILED THE EXACT PROBLEM.

THEY DIDN'T FEEL COMFORTABLE DRIVING IN THE SNOW ANYMORE AND TO GET TO THE NEAREST OFFICE THAT THEY COULD GO TO WAS ABOUT A 30-MINUTE DRIVE.

SO THEY SCHEDULE IT ON A DAY THAT SNOWS OR MONTHS IN ADVANCE BECAUSE YOU DON'T KNOW WHAT THE WEATHER IS GOING TO BE, IT CREATES-- >> MINUTES IN ADVANCE HERE, ACTUALLY.

YOU DON'T KNOW WHAT IT'S GOING TO BE BUT GO AHEAD, SORRY.

>> SO FOR THEM, IT BECAME AN ISSUE OF I CAN'T GET TO THESE APPOINTMENTS IN THE WINTER.

SO I'M NOT GETTING THE HEALTHCARE I NEED DURING THOSE MONTHS.

>> AND JULIETTA, THAT INTERSECTS WITH THIS ISSUE ABOUT PHARMACY AVAILABILITY.

TELL BUS THAT.

>> ABSOLUTELY.

SO AS I HAD MENTIONED BEFORE, PHARMACISTS ARE ONE OF THE MOST ACCESSIBLE HEALTHCARE PROFESSIONALS.

BUT WHAT WE HAVE STARTED TO SEE IN THE LAST FEW YEARS IS THAT THERE HAS BEEN AN INCREASE IN PHARMACY CLOSURES AND THIS IS CERTAINLY IMPACTING RURAL AREAS AS DEACON HAS POINTED OUT.

AND THIS DEFINITELY IMPACTS THOSE WHO LIVE IN RURAL COMMUNITIES BECAUSE NOW THEY HAVE TO TRAVEL EVEN FURTHER TO BE ABLE TO GO TO A PHARMACY TO GET THEIR PRESCRIPTION MEDICATIONS AND GET THEIR HEALTHCARE QUESTIONS ANSWERED.

BUT AS YOU HAVE ALSO POINTED OUT, THIS IS SOMETHING WE ARE ALSO SEEING IN URBAN AREAS.

AND THIS IS SOMETHING THAT IS HAPPENING RIGHT HERE IN NEW YORK STATE.

SO FOR EXAMPLE, LAST YEAR, ABOUT 10% OF PHARMACIES IN NEW YORK CITY CLOSED ALL IN 2024.

>> WAIT, WAIT, WAIT.

10% OF-- ALL IN ONE YEAR.

>> YEAH, IT'S A BIG NUMBER.

>> AND THAT WAS THE YEAR MY PHARMACIES CLOSED IN 2024.

WHAT IS HAPPENING?

WHAT IS CAUSING THAT?

>> SOMETHING WE ARE SEEING IN SYRACUSE.

WE ARE ALSO SEEING THAT IN ROCHESTER, WHICH IS WHERE I LIVE.

AND SO A BIG CONTRIBUTING FACTOR TO THIS IS CALLED PBMs OR PHARMACY BENEFIT MANAGERS.

THIS IS SOMETHING THAT YOU MAY HAVE HEARD ABOUT IN THE MEDIA BECAUSE IT IS STARTING TO GAIN SOME ATTENTION ON BOTH THE NATIONAL AND THE STATE LEVEL.

AND SO ESSENTIALLY, PBMS OR PHARMACY BENEFIT MANAGERS, ARE THE THEY CAN ALSO MANAGE DRUG CLAIMS THEY CAN ALSO CREATE FORMULARIES AND DECIDE WHAT DRUGS THAT PHARMACIES ARE ABLE TO DISPENSE AND THE DRUGS THAT PATIENTS ARE ACTUALLY ABLE TO BE ABLE TO PICK UP FROM A PHARMACY.

SO THEY ACTUALLY HAVE A VERY HUGE ROLE IN RINGS PRESCRIPTION DRUG PRICES AND ACCESS TO PHARMACIES.

THE REASON THIS IS SO CONCERNING AND WHAT HAS LED TO A LOT OF PHARMACIES CLOSING, ESPECIALLY HERE IN NEW YORK STATE, IS BECAUSE THEY ALSO PLAY A ROLE IN REIMBURSING PHARMACIES FOR THE DRUGS THAT THEY DISAGAINST-- DISPENSE.

>> LET ME GET THAT.

THEY ARE SETTING THE AMOUNT OF MONEY THAT A PHARMACY GETS FROM THE INSURANCE COMPANY, RIGHT?

>> YES.

>> AND SOMEHOW THEY CONTROL THAT?

>> UH-HUH.

>> SO THEY SAY TO THE PHARMACIES, WELL, WE ARE GOING TO GIVE YOU A CERTAIN AMOUNT OF MONEY.

>> RIGHT.

>> HOW IS THAT ENDING UP WITH THEM GETTING CLOSED, THE PHARMACIES?

>> YEAH, SO BECAUSE THEY ARE THE ONES REIMBURSING PHARMACIES FOR THE MEDICATIONS THEY DISPENSE, OFTEN TIMES WHAT WE ARE STARTING TO SEE HAPPEN IS THEY'RE REIMBURSING PHARMACIES FOR LOWER COST THAN WHAT THE PHARMACY ACTUALLY PAYS TO BE ABLE TO PURCHASE AND STOCK THE MEDICATION.

AND SO IT FORCES THE PHARMACIES TO HAVE TO DISPENSE A MEDICATION TO THE PATIENT AT A LOSS.

AND SO, AS YOU CAN IMAGINE, THIS ISN'T EXACTLY A SUSTAINABLE BUSINESS MODEL AND SO THAT HAS BEEN WHAT HAS BEEN CONTRIBUTING TO A LOT OF PHARMACIES CLOSING, ESPECIALLY RIGHT AROUND OUR STATE AND RURAL AND IN URBAN AREAS.

>> HOW ARE THEY GETTING AWAY WITH THAT?

WHERE IS THE POWER LIE HERE?

WHAT IS HAPPENING?

>> YEAH, YEAH, THAT'S A REALLY GREAT QUESTION.

AND SO I THINK BECAUSE NOW WE ARE STARTING TO GENERATE MORE ATTENTION TO THESE ISSUES, LIKE I SAID, THIS IS SOMETHING THAT IS GAINING ATTENTION IN THE MEDIA.

THERE IS ALSO BEEN A LOT OF ADVOCACY BOTH AT THE FEDERAL AND STATE LEVEL TO BE ABLE TO PROMOTE HAVING MORE REGULATIONS AND MORE OVERSIGHT FOR THESE PBMs.

>> SO I GUESS THE QUESTION, LIKE MY WIFE ASKED ME, I WAS TALKING ABOUT THIS SHOW, SHE SAID WHO ARE THEY REALLY BENEFITING?

AND THINK THAT'S A REALLY IMPORTANT QUESTION.

I KNOW THESE PROBLEMS ARE NOT ONLY HAPPENING IN RURAL AREAS.

THEY'RE ALSO HAPPENING RIGHT HERE IN SYRACUSE AND OTHER CITIES AND OUR "CYCLE OF HEALTH" TEAM VISITED AMAUS DENTAL SERVICES IN DOWNTOWN SYRACUSE THAT PROVIDES FREE DENTISTRY TO UNINSURED ADULTS.

LET'S TAKE A LOOK.

>> AMAUS DEPARTMENTAL SERVICES PROVIDES DENTAL CARE FREE OF CHARGE TO THE UNINSURED AND UNDER INSURED PATIENTS OF CENTRAL NEW YORK.

THE FIRST YEAR OF OUR EXISTENCE WAS 2014.

AND WE SAW JUST A FEW PATIENTS AND PROVIDED ABOUT 10,000 DOLLARS WORTH OF FREE DENTAL CARE IN THOSE FIVE MONTHS.

IN THE TIME SINCE 2014, WE HAVE NOW EXCEEDED ALMOST 1,200,000 WORTH OF FREE DENTAL CARE.

>> PATIENTS THAT QUALIFY FOR AMAUS DENTAL SERVICES HERE ARE THOSE WHO HAVE NO ABILITY TO ACQUIRE INSURANCE.

OUR PATIENT POPULATION WOULD INCLUDE PATIENTS WHO ARE LIVING PAYCHECK TO PAYCHECK, PATIENTS WHO ARE ELDERLY AND LIVING ON A FIXED INCOME.

SINGLE PARENTS, REFUGEES, IMMIGRANTS, STUDENTS.

WE TRY TO PROVIDE THE LARGER MAJORITY OF DENTAL NEEDS, WHICH WOULD INCLUDE EXAMINATIONS, X-RAYS MEDICAL SCREENINGS.

ORAL CANCER SCREENINGS.

FILLINGS, CLEANINGS, EXTRACTIONS WE RECENTLY STARTED THE ABILITY TO PROVIDE ROOT CANALS FOR OUR PATIENTS.

AND WE CAN ALSO PROVIDE ON A LIMITED BASIS, SOME PROSTHETIC SERVICES LIKE HAVING A DENTURE MADE FOR THE PATIENT OR PARTIAL DENTURE, ESPECIALLY FOR THOSE PATIENTS WHO ARE MISSING A FRONT TOOTH, YOU KNOW, AND TO GIVE THEM SOME BITING ABILITY.

NO ORTH DON'TICS,-- ORTHODONTICSES, NO ADVANCED PROSTHETIC WORKS LIKE CROWNS, BRIDGES AND IMPLANTS.

THE PROBLEM IS ALL OF THOSE ARE -- THEY INCUR COST, A LABORATORY COST THAT, WOULD JUST BE DIFFICULT FOR US TO DO ON OUR LIMITED BUDGET.

A GREAT DEAL-- A GREAT NUMBER OF OUR PATIENTS DO HAVE THE ABILITY, IF THEY WERE ABLE TO AFFORD IT, DO HAVE THE ABILITY TO MAYBE TRAVEL TO MORE OF THE SUBURBAN AREAS WHERE MOST OF OUR DENTAL OFFICES ARE LOCATED.

IF THEY WERE ABLE TO GET TO THOSE OFFICES, THE COST OF DENTAL CARE TODAY IS SIGNIFICANT AND WITHOUT INSURANCE, TO KIND OF BUFFER THAT, IT SOMETIMES IS PROHIBITIVE.

>> WE HAVE A NUMBER OF DONATIONS TO START THE CLINIC BACK IN 2014.

AND THEN WE HAD A LARGE FUNDRAISER TO BUILD THE CLINIC WE HAVE NOW THAT OPENED IN 2017.

AND WE GOT CONTRIBUTIONS FROM A NUMBER OF FOUNDATIONS IN THE AREA.

WE GOT CONTRIBUTIONS FROM DIFFERENT DENTAL SUPPLIERS AND HENRY SHINE AND PATTERSON.

WE GOT CONTRIBUTIONS FROM THE DENTISTS IN THE AREA.

>> DENTAL SUPPLIES ARE ALWAYS NEEDED AND THEY'RE EXPENSIVE.

AND SHOW ANYTHING THAT THE COMMUNITY WOULD LIKE TO CONTRIBUTE IN TERMS OF TREASURE WOULD BE WONDERFUL.

WE DON'T ASK PATIENTS FOR ANY COMPENSATION, BUT THERE ARE A NUMBER OF THEM WHO WOULD CONTRIBUTE WHAT THEY CAN.

WHAT KEEPS ME AND MY STAFF GOING TO CONTINUE TO DO THIS EVERY DAY , I WOULD HAVE TO SAY IS THE GRATITUDE THAT WE RECEIVE.

AND I THINK WITH THAT GRATITUDE COMES THIS SENSE OF CAMARADERIE IN THE SENSE OF JOY THAT WE EXUDE AND THAT WE REALLY FEEL.

>> EVEN WHEN I WAS IN THE AIR FORCE I THOUGHT OF TERMS OF PUBLIC HEALTH DENTISTRY AFTER THE AIR FORCE.

GIVING BACK TO PEOPLE WAS ALWAYS IMPORTANT TO ME.

AND, YOU KNOW, DENTISTS MAKE A VERY GOOD LIVING.

THAT WAS NOT FOR ME.

YOU DON'T GET RICH IN THE AIR FORCE.

YOU DON'T GET RICH IN COMMUNITY HEALTHCARE CENTERS.

IT'S HARD TO REALLY PUT IT IN WORDS, THE FEELING, PARTICULARLY THE PEOPLE FROM AMAUS, BUT YOU HAVE SOMEONE WHO HAS NOT HAD TENT DENTAL CARE IN A LONG TIME AND FINALLY YOU ARE ABLE TO GIVE THEM THAT CARE THAT THEY NEED.

AND THE PATIENT MAY BE 65 OR 70 YEARS OLD, BUT TEARS SOMETIMES COME TO THEIR EYES SAYING I'M SO THANKFUL FOR THIS CARE AND I WISH I HAD IT YEARS AGO.

AND THAT KIND OF RESPONSE FROM YOUR PATIENT CERTAINLY GOES RIGHT TO THE HEART OF WHAT WE DO AT AMAUS.

>> WE SEE HOW FINANCIAL ISSUES PLAY A ROLE IN DENTISTRY.

IS YOUR RESEARCH SHOWING FINANCIAL ISSUES IN RURAL AREAS ARE A MAJOR CONTRIBUTOR TO THIS PROBLEM?

>> YEAH, SO ASIDE FROM ALREADY HAVING FINANCIAL TROUBLE PAYING FOR, YOU KNOW, BASIC THINGS LIKE GROCERIES AND THINGS LIKE THAT, A LOT OF THESE PEOPLE MIGHT NOT HAVE INSURANCE THAT COME IN IN EITHER PRIVATE BUSINESSES OR WHERE THEY WORK.

THEY CAN'T AFFORD IT OR IT'S NOT OFFERED TO THEM.

AND THEN WITH THAT,SOMETIMES THE INSURANCE WON'T EVEN COVER THEIR HIGH CO-PAYS SO THEY WILL AVOID GOING TO THEIR APPOINTMENTS BECAUSE THEY CAN'T AFFORD IT.

>> CAN'T AFFORD THE CO-PAY.

AND MAYBE THE CO-PAY FOR THE MEDICATION.

IT WAS REMINDING ME, MY MOTHER HAD ALZHEIMER'S AND SHE WAS IN A NURSING HOME NEAR THE END OF HER LIFE BUT SHE WAS A VETERAN.

PRIOR TO GOING TO THE NURSING HOME, I USED TO GET HER MEDICATIONS FROM THE V.A.

SHE WOULD GO TO THE V.A.

AND SHE GOT, YOU KNOW, HER MEDICATIONS THERE.

WHEN SHE WENT TO THE NURSING HOME, THE NURSING HOME SAID YOU CAN'T BRING MEDICATIONS IN FROM THE V.A.

HAVE YOU TO USE THIS PHARMACY THAT SHE HAD NO CHOICE WHATSOEVER ABOUT WHETHER TO USE THAT PHARMACY AT ALL.

AND NO KIDDING, THE MEDICATIONS WERE EIGHT TO 10 TO 15 TIMES MORE EXPENSIVE THAN THEY WERE AT THE V.A.

WHAT IS HAPPENING THERE?

IS THAT-- WHAT IS GOING ON THERE, JULIETTE?

>> WOW.

YEAH, I THINK THAT TIES INTO OUR CONVERSATION FROM BEFORE WHEN WE WERE TALKING ABOUT PHARMACY BENEFIT MANAGERS BECAUSE THESE PBMS ALSO OWN PHARMACIES.

THEY CAN OWN MAIL ORDER PHARMACIES OR PHARMACIES SUCH AS THE CVS AND BECAUSE OF THAT, THEY ARE ALSO INCENTIVIZED TO STEER PATIENTS TO USING THOSE PHARMACIES.

>> THEIR OWN PHARMACIES.

>> YES.

>> IS THAT A CONFLICT OF INTEREST OR WHAT?

>> IT'S A VERY CLEAR CONFLICT OF INTEREST AND THEY MAKE A LOT OF MONEY DOING THAT.

SO, YES.

>> I BET BECAUSE THERE MUST BE BILLIONS AND BILLIONS OF-- HOW MANY BILLIONS OF DOLLARS IN MEDICATIONS A YEAR IN THE UNITED STATES?

DO YOU HAVE ANY IDEA OR IS THAT JUST LIKE OFF THE MAP?

>> IT'S BILLIONS, POSSIBLY EVEN TRILLIONS FROM THE HEALTHCARE INDUSTRY, YES.

>> WOW.

AMAZING.

SO WHAT CAN PEOPLE DO?

WHAT CAN WE DO?

HOW CAN PEOPLE DEAL WITH THIS?

>> SO ONE OF THE THINGS THAT WE ARE FINDING IS, YOU KNOW, MAYBE IT WOULD BE BETTER TO KIND OF FIND WAYS TO CAR SHARE, GET TO PLACES THROUGH TRANSPORTATION.

LOWERS THE PRICES FOR INDIVIDUALS.

>> GET A NETWORK OF FRIENDS AND FAMILY TO DRIVE TO EACH OTHER TO YOUR APPOINTMENTS.

>> YEAH, AND IF THEY'RE ABLE TO MAKE THEIR APPOINTMENTS ON THE SAME DAY, THAT'S EVEN BETTER.

AND THEN PRETTY MUCH ANY WAY THAT THEY CAN FIND TO LOWER THE COSTS FOR THEMSELVES TO GET TO PLACES WOULD BE VERY BENEFICIAL.

>> WHAT ABOUT, YOU KNOW,MAIL ORDER PHARMACIES AND TELL US ABOUT THAT.

ARE YOU GOING TO GET A GOOD DRUG OR WHAT?

WHAT IS THE STORY?

>> YEAH, I THINK THAT MAIL ORDER PHARMACIES, THERE IS ALSO PHARMACIES THAT OFFER HOME DELIVERY AS AN OPTION.

SO THIS COULD ALSO BE A WAY TO HELP WITH REDUCING SOME OF THE BARRIERS THAT DEACON IS TALKING ABOUT; SUCH AS THE TRANSPORTATION CHALLENGES.

THOSE CAN BE A GREAT OPTION FOR SOME PEOPLE WHO NEED IT.

>> AND THERE ARE THINGS CALLED, LIKE I REMEMBER ONE CALLED GOODRX.

WHAT IS GOODRX.

>> GOODRX IS A PROGRAM TO BE ABLE TO HELP WITH PROVIDING DISCOUNTS FOR PRESCRIPTION MEDICATIONS.

>> IS IT LEGIT.

>> IT IS.

I HAVE USED IT MYSELF FOR PRESCRIPTIONS AND ANOTHER OPTION AS WELL FOR PATIENTS TO TRY TO HELP WITH REDUCING PRESCRIPTION DRUGS COST IS MAYBE TRYING AN OPTION LIKE THE MARK CUBIAN PHARMACY.

IF HAVE YOU HEARD OF THAT, THE COST PLUS PHARMACY.

THAT'S SOMETHING I HAVE USED MYSELF.

>> COST PLUS?

THAT'S THE NAME OF THE PHARMACY.

>> THAT'S A FOR-PROFIT ORGANIZATION, I WOULD ASSUME?

>> I ACTUALLY DON'T KNOW OFF THE TOP OF MY HEAD BUT I DO KNOW IT'S A PHARMACY AND THE INTENTION IS TO BE ABLE TO PROVIDE PRESCRIPTION DRUGS AT A LOWER COST TO PATIENTS.

SO IT'S ANOTHER POTENTIAL OPTION FOR PATIENTS TO TRY AS WELL.

>> I'M ASSUMING ALSO, WE COULD ADVOCATE WITH OUR LOCAL REPRESENTATIVES AND STATE REPRESENTATIVES TO HELP TO DEAL WITH THESE KINDS OF THINGS.

PUT SOME REGULATIONS ON THAT.

>> YES.

I AGREE.

I THINK THAT'S GOING TO BE THE BIGGEST WAY TO BE ABLE TO HELP WITH REDUCING THE ISSUES THAT WE'VE TALKED ABOUT TODAY, ESPECIALLY WITH REGARDS TO PHARMACY CLOSURES THAT ARE LEADING TO THESE PHARMACY DESERTS WHERE WE HAVE A SHORTAGE OF PHARMACIES, ESPECIALLY IN OUR RURAL AREAS.

BUT AS WE'VE TALKED ABOUT ALSO IN OUR CITIES, AND SO THIS IS SOMETHING THAT WE HAVE ALREADY BEEN STARTING TO DO HERE IN NEW YORK STATE, WHICH IS REALLY GREAT.

SO BACK IN NOVEMBER, THE NEW YORK STATE DEPARTMENT OF FINANCIAL SERVICES HAS ADOPTED REGULATIONS TO BE ABLE TO PROVIDE MORE OVERSIGHT FOR PBMs SO I'M EXCITED THAT NEW YORK STATE IS STARTING TO PAVE THE WAY FOR THIS.

>> TERRIFIC.

WELL, BEFORE WE WRAP OUR SHOW TODAY, I WANT TO INTRODUCE Mr. DANIEL MAHONEY, THIRD YEAR MEDICAL STUDENT AT UPSTATE MEDICAL UNIVERSITY WHO EXPLAINS HOW GENETIC TESTING COULD ONE DAY BE OFFERED AS A PREVENTIVE HEALTHCARE.

LET'S TAKE A LOOK.

>> HI EVERYONE.

I'M DANIEL MAHONEY, A THIRD YEAR MEDICAL STUDENT AT UPSTATE MEDICAL UNIVERSITY.

HERE WITH MY MEDICAL STUDENT MINUTE.

THE COOLEST THING THAT I HAVE LEARNED SO FAR IS THAT GENETIC TESTING WILL LIKELY REVOLUTIONIZE THE FIELD OF MEDICINE.

TODAY, HEALTHCARE LARGELY OPERATES ON A PHENOTYPE FIRST APPROACH.

CLINICIANS LOOK AT A PATIENT'S PHYSICAL CHARACTERISTICS.

THEIR SYMPTOMS AND DIAGNOSES AND THEN IF INDICATED, ORDER GENETIC TESTING MOVING FORWARD FROM THERE WITH TESTING.

CURRENTLY THE ONLY ROUTINE GENETIC TESTING IS DURING PREGNANCY OR NEWBORN PERIOD.

WHAT RESEARCHERS ARE DEVELOPING NOW IS A GENOTYPE FIRST APPROACH.

THAT IS, OBTAINING A PERSON'S GENERAL OL'IC UNDERMIN PINNINGS AS EARLY AS POSSIBLE TO PROACTIVELY TREAT GENETIC CONDITIONS BEFORE THE PERSON FALLS ILL.

IMAGINE THIS.

IT'S 2040 AND YOU WANT PREVENTATIVE HEALTHCARE.

LIKELY THE FIRST THING THE TEAM WILL DO ARE THE USUAL LIKE A PHYSICAL EXAM, FAMILY MEDICAL HISTORY AND ROUTINE BLOOD WORK AND THEN THEY'LL SEQUENCE YOUR PERSONAL GENOME AT A STATE-OF-THE-ART LAB LINKED TO THE LATEST MEDICAL RESEARCH TO DISCOVER CONDITIONS YOU MIGHT BE AT RISK FOR AND MAYBE EVEN WHICH MEDICATIONS, DOSES AND TREATMENTS MIGHT SUIT YOU BEST AS A GENETICALLY UNIQUE INDIVIDUAL.

THIS IS A BIG SHIFTED IN THE MEDICAL PARADIGM AND I CAN'T WAIT TO SEE HOW IT ALL UNFOLDS.

I'M DANIEL MAHONEY.

THIRD YEAR MEDICAL STUDENT WITH TODAY'S MEDICAL STUDENT MINUTE.

>> THAT'S ALL THE TIME WE HAVE, I WANT TO THANK OUR GUESTS: DR. JULIETTE MILLER, CLINICAL ASSISTANT PROFESSOR AT ST. JOHN FISHER UNIVERSITY; AND MR. DEACON HOGAN, AMERICORPS VISTA MEMBER SERVING AT THE RURAL HEALTH NETWORK OF SCNY TO HEAR OUR COMPANION COMMUNITY FM RADIO SHOW, CHECK UP FROM THE NECK UP, VISIT WCNY.ORG/COMMUNITYFM.

AND IF YOU WANT TO SEE THIS EPISODE AGAIN AND PAST SEASONS, VISIT WCNY.ORG/CYCLEOFHEATH.

DISTORTING YOUR SENSES.