Risk & Resolve
The Risk & Resolve Podcast is your go-to resource for insightful conversations at the intersection of leadership, business ownership, and the insurance industry. Hosted by Ben Conner and Todd Hufford, this podcast dives deep into the challenges and opportunities that leaders face in an ever-changing world.
Each episode features candid discussions with business owners, industry experts, and thought leaders, exploring topics like innovation, risk management, and the strategies that drive success. Whether you’re an entrepreneur, executive, or insurance professional, you’ll gain actionable insights and inspiration to navigate today’s complex business landscape.
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Risk & Resolve
Unveiling the Hidden World of PBM Consulting
Trevor Daer, President and Founder of Granite Peak Analytics, reveals the hidden complexities of Pharmacy Benefit Managers (PBMs) and why specialized consulting is crucial for self-funded health plans. He shares his journey from corporate burnout to creating a company that helps employers navigate the convoluted PBM landscape and avoid overpaying for prescription benefits.
• PBM consulting helps benefits advisors navigate pharmacy complexity and secure better contracts for clients
• Granite Peak Analytics was founded after discovering independent pharmacies were being squeezed by PBMs while employers overpaid
• The pharmaceutical supply chain involves manufacturers, wholesalers (McKesson, Cardinal, AmeriSource Bergen), pharmacies, PBMs, and employers
• "The Big Three" PBMs (Optum, Express Scripts, CVS Caremark) control 80-85% of the market and are vertically integrated with insurance carriers
• PBMs have approximately 45 different revenue streams, creating misaligned incentives where they profit as drug costs increase
• Employers without specialized PBM consulting typically overpay by up to 50% on their pharmacy benefits
• Pharmacy costs have grown from 4-5% of self-funded plans to 25-30% today
• Rebates create perverse incentives where higher-cost drugs are often preferred over lower-cost alternatives
• Current trends include rising GLP-1 costs, specialty medications, and biosimilar adoption challenges
• Active management of pharmacy benefits is essential, especially with expensive new therapies
You're listening to Risk and Resolve. And now for your hosts, ben Conner and Todd Hufford.
Speaker 2:Welcome back to another episode of the Risk and Resolve pod. I'm your co-host, ben Conner, along with Todd Hufford. Today we have our special guest is Trevor Dare, and Trevor is the president and founder of Granite Peak Analytics, which is a firm that specializes in PBM Pharmacy Benefit Manager analytics, and I'm proud to say that Trevor is our PBM consultant. So I'm excited for the journey today and hear Trevor's story, maybe share what the heck a PBM consultant is. What in the world does that mean? And then get into the state of the PBM and RX world for all of us nerds that care about that kind of stuff. Trevor, thanks for being with us.
Speaker 3:Thanks for having me and congrats on launching the Risk and Result podcast.
Speaker 2:Yeah, thanks, we're having some fun so far. So tell us a little bit about Granite Peak when you started it, why you started it and kind of what problem Granite Peak is solving in the world.
Speaker 3:Yeah, absolutely. It's kind of a long story so I'll try and keep it short. But we first of all. Your question is funny what the heck is a PBM consultant? Because I was reminded of this question not being all that clear about a month ago by a well-known consultant that I consider a friend and a client and they were like what does PBM consultant even mean? I'm like, you work with us, you know what a PBM consultant is and they're like no, I mean like what does it mean? What is it? I don't really like I know you're valuable and I know you help us, but what really is a PBM consultant? So I started thinking about how our outreach happens and how. I've always just assumed that the market knows Whether you're a newer advisor or an experienced advisor. You just know what a PBM consultant is. Turns out that's not the case.
Speaker 3:Highest level A PBM consultant is an individual or company that supports your pharmacy benefit strategy, primarily in the self-funded health plan space. So what being a PBM consultant means for us is partnering with benefits consultants or third-party administrators or MGUs or TPA stop-loss carriers and helping them navigate the complexity of pharmacy. So what we do is, especially as a benefits consultant. You've got all these pieces and parts that you're trying to navigate and build and you know, pull this part out and then plug this part back in and build the stack and make it all work. And we call it kind of unbundling the self-funded plan. But then bundling it back up so it actually works is not an easy thing to do. So we sit on the side usually of the advisor as our client and help them guide their clients to the most cost-effective or best-fit pharmacy benefit manager, if you will. So we view ourselves as really an extension of the benefits consultant to help in what is really a very complex and narrow niche in the one of a thousand things that they're working on in a health plan.
Speaker 2:So when and why did you start Granite Peak?
Speaker 3:Granite Peak was the brainchild of a pharmacist friend of mine and myself, and this was September of 2019 is when the LLC was actually created and what facilitated it was.
Speaker 3:I went to work for a good friend of mine and pharmacist, mike Matovich, and he had created a company that was basically a group purchasing organization for independent pharmacies, and I had spent my whole career in TPA self-funding world and we can get into a little bit later on like what made me take the leap out of it but about half my time there was spent in pharmacy benefits.
Speaker 3:Mike managed a cost plus pharmacy that we had started, so you might say we were way ahead of Mark Cuban in that regard, way less successful when it comes to brand awareness and those types of things, but I think ahead of the game as far as how do we bring transparency to an opaque industry, and I was the PBN.
Speaker 3:I started peeling back the onion on the PBM contracts and really realizing a lot of things were wrong or disingenuous and it kind of lit a fire in me to like fix it, because I kept asking a lot of questions that I wouldn't get acceptable answers to and Mike was the pharmacy operator that when we brought on clients and found the right PBM partners. They could be the mail order pharmacy partner and so when I left there, mike and I had developed a reputation with a lot of our TPA clients of just being like if they had pharmacy questions they just came to us. So although I went to a pharmacy GPO as an employer, we still did, like back of the napkin, pbm consulting. You know, does this proposal for the new cost plus meal order make sense for us as a plan? Can you analyze our data and tell us? You know things that maybe we should be doing, that we're not?
Speaker 3:And we would always just do it because it was like yeah, of course we will things that maybe we should be doing that we're not and we would always just do it because it was like, yeah, of course we will. Um, simultaneously, if what I learned about the independent pharmacies and the dynamics with PBMs is they independent pharmacies are like farmers, in my opinion, like they bought. They buy everything at retail and they sell everything at wholesale and they don't really have any control over the prices on either side. So, um, what we were trying to fix or I was kind of tasked with fixing was going across montana and meeting with payers uh, regional carriers or small mid-market carriers, work comp companies, and they primarily worked with what we consider the big three pbms. So the big three pbms are optum, express scripts and cvs, caremark. Those are the entities that control about 80 to 85 percent of the market.
Speaker 3:And what we were trying to educate them on was from mike's. He's a pharmacy owner and an owner of this group purchasing organization was you're a Montana based company and your PBM decisions are actually driving your community pharmacies out of business. They're paying them so low, below cost in many cases, that they can't survive, and in Montana's rural right. So in many cases this lone community pharmacy is the only healthcare you can get within 50 miles. Like they're not just the pharmacist. They're the help you read your labs, you know, help you make doctor appointments in the bigger city. So they're really a hub of care. And so our job in these meetings, or what we intended to do, was meet with them and say did you know that your decisions and none of them knew right, the decisions you made to select this PBA like you're impacting them negatively.
Speaker 3:And then my job was based on my background in PBM contracting and management was to say oh, by the way, you're not just driving them out of business, You're getting taken advantage of in the meantime, like you're not paying the lowest you possibly could. So what your independent pharmacies are getting paid is not what you're paying. You're paying an inflated amount and there's a middleman in between that's taking a lot of that. So you're driving them out of business and you're overpaying for yourselves and your people, and we had about five meetings Go ahead.
Speaker 2:So what was happening in Montana? Independent pharmacies are getting squeezed to the point of they're selling something for less than what they bought it for. The employer is actually paying more than what a market rate would be for the medication, and that value is being extracted by a pharmacy benefit manager who actually provides zero value in the transaction outside of taking the money from both parties.
Speaker 2:Right Outside of adjudicating the copay electronically and facilitating payment, there's nothing really else that was happening in that but really in any other market in the United States economy. You don't need to do a copay. You just pay the price for the medication and you leave, or you pay the price for the TV and you leave, or you pay the price for gas and you leave. There doesn't need to be in a separate party, and if it is, it's it's a visa and they take 3% Right, like yeah, well, that's wild.
Speaker 3:Right Like yeah, well, that's wild. So there were these market dynamics happening and then, as I got to understand why independent pharmacies would group together to buy, is so they?
Speaker 3:would have a little bit more control over their wholesale price, that they were acquiring for Right. And at the time I joined Mike and his team like they kind of had that whipped acquiring for Right. And at the time I joined Mike and his team like they kind of had that whipped, like he had a really cool mousetrap that he had built that got him into some pricing that was really unachievable for even most larger buying groups and group purchasing organizations. So he's like I need you to handle the payment side, like you need to educate these people and I'll help you. So we tackled it from two different vantage points. But I was employed by his company and we were representing independent pharmacies.
Speaker 3:We had about five of those meetings and at the end of every single one whether it be the work comp provider, the regional carrier, the you know, the bigger broker houses that had self-funded business in Montana they all said we had no idea. What would you like us to do and which? If you're trying to sell something to someone, that's the best thing you can be asked right, like we had no idea. What do you want us to do with this information? Well, guess what? We weren't selling them anything, we were just educated. And so in every meeting. We're like, well, number one, we wanted you to be aware. Number two, next time you're looking at different PBM providers or your contracts up, maybe hire a PBM consultant to help you and like we can recommend one if you get to that point. And three, maybe ask you know you'll this will resonate with you. Then maybe ask your broker why they've recommended this PBM to begin with, because they're probably getting paid to place the business with them. And they're like, oh, wow, yeah, yeah, I mean, that makes sense, makes sense, okay. So we, we walk out of these five meetings, or I guess I should say we walk out of these four meetings and we drive across the big state of montana and get time to catch up and we're like, man, that meeting went really well, like they really understood what we were trying to tell them, like I hope, I hope something will happen.
Speaker 3:So then, after you know, a few months of follow-up, like it's not their core business, um, there's, we couldn't help them do the work, so they just sort of like went on with the next thing and we just became a squeaky wheel and it's like, yeah, we get it, we understand the problem, but we just don't have time and energy and resources to deploy. So after the fifth meeting I couldn't even tell you which entity it was we were meeting with. We're driving back. This is funny because Mike's a pharmacist. I've been in the business for a long time and like to think that you know I'm a fairly quick study, but it took us till the fifth meeting, coming back, where we had this light bulb where we were like hold on a second, we're not making any impact, we have to do the work for them. They're literally inviting us to do some work. They're saying we had no idea what should we do and we're just leaving the meeting like, well, here's some ideas. We'll talk to you later. You know, meet you in six months.
Speaker 3:So we're driving back after the fifth meeting and we're driving by Granite Peak and Mike goes do you know what the tallest peak in Montana is? I'm a fourth generation Montana and I pride myself on knowing these things and I couldn't tell him. We're literally driving by it, I mean in the distance, and he goes it's Granite Peak's granite peak. Oh my god, cool.
Speaker 3:It's kind of weird that I wouldn't know that. I'm actually disappointed in myself. And he goes where do you think it is? And we're a big state and we're in the kind of south central. What you see on postcards of montana is like glacier, right northwest montana, mountain ranges, the rockies, and I'm just kind of thinking, and now I'm embarrassed that I don't. I don't know what it was and I don't know where it's at. So, my gosh, I don't know. Mike, he goes, it's right there, it's literally out your window and we kind of core also okay, I should know this, but I don't. And it's not because I don't want to know this, it's because just nobody told me, nobody educated me on it, and it was kind of like the parlay in the granite peak, which is like these people don't know what they don't know. It's not because they don't want to, it's because no one's educated them appropriately. And so it was that conversation plus like we have to do the work. But doing the work like a pharmacist and an insurance guy with excel spreadsheets are a recipe for disaster that sounds like a bad joke, yeah yeah, it's like pharmacist and insurance guy walk into the bar with an excel spreadsheet and yeah, they
Speaker 3:walked out with nothing, but that was where the idea came from and it was like okay, well, I can't represent you, mike, and your pharmacies and these payers, so we have to create a separate LLC. What are we going to call it? Well, granite Peak Analytics analytics, because our joke was gpa um. Our combined gpa in college was a 4.0, so it was like he had a 2.0 and I had a 2.0 um. Not completely accurate, but also not completely inaccurate, so there's a lot of plays on the name which are kind of funny when you get into the story. But he was like okay, we'll create the company. And I was like before we do it, though, we've got to find an underlying data analytics engine. We can't just do this with spreadsheets. The data is too complex, they're not good enough with excel to make this work. So, anyway, we found a, we found a foundational like data pharmacy, data only analytics engine and we're like okay, when you create the company.
Speaker 3:And then we created the llc as a 50 50 partnership in september of 2019, and I'll never forget, like as soon as I got the articles of incorporation and the secretary of state like came through and I was like holy smokes, like I, I own 50% of this business that we just started. That is worth nothing. Do I know enough to even be doing this? I was like I had this, like I was so confident until the moment that the LLC was created and, all of a sudden, the doubt crept in. I'm like do I know enough to be advising people about this? Surely there's people more qualified. And it was kind of like I don't know. I wouldn't call it imposter syndrome. It was just like you know, you're going and you're confident, and then, as soon as it gets real, you're like well, wait, is this a good idea? So that's that's where it was started September of 2019.
Speaker 1:I'll stop there because that was a lot. That's good, trevor. I've always wondered why the PBMs never have gotten disintermediated. My grandfather graduated IU Med School in 1926, and I've got the fortunate benefit that he kept all of his canceled checks. And one night recently I took my daughter to dinner and just as some way to pass the time as we're waiting for the food, I brought out this brick of checks and they're large size and they've got these funny little holes in them to cancel them. But you'll find this interesting. He regularly wrote a check to a company called the Upjohn Company, which of course no longer exists.
Speaker 1:I'm not exactly sure which pharmaceutical company bought it. I think it may have been Johnson Johnson. But here, as a local physician, he's buying pharmaceuticals. I have no idea what it was, but he's buying it directly from the manufacturer. Now, those checks were written in the early 30s. I have no idea what it was, but he's buying it directly from the manufacturer. Now, those checks were written in the early 30s.
Speaker 1:So sometime between the early 1930s in America and today there was this creation of a wholesale market which became the PBMs. So if I'm a manufacturer of any kind of medication, I kind of look across the landscape today, and there are some big players right CVS, walgreens, walmart, kroger, costco. I can totally understand why a manufacturer of drugs would not want to sell to small, independent pharmacists or even small grocery stores that have pharmacy operations. But why do manufacturers still sell through PBMs? Or, I guess, conversely or inversely. Why does a Kroger, if you will work with a PBM, when they've got so much volume? Why aren't they buying directly and why haven't the PBMs been disintermediated by these large retailers?
Speaker 1:Boy, that's a loaded question. Um didn't mean the reality is, yeah, the reality.
Speaker 3:what is on the buy side? You have what are called wholesalers, and really they are just a distributor of the manufacturer's medication. So there's actually a big, there's a big three on the wholesaler side. It's McKesson, cardinal and Amerisource Bergen. Those are the big three on the wholesaler side. So they negotiate contracts with the buyer of the pharmaceutical. So in most cases is the pharmacy on what they, what they can get the drug from the manufacturer from, have a reasonable markup or margin or in some cases, unreasonable markup or margin and sell it to that pharmacy. And so then you have you have the buy side, which is we're buying from one of those big three. And so then you have the buy side, which is we're buying from one of those big three, regardless of whether you're a mom and pop or you're.
Speaker 3:Now there's kind of one-off like generic wholesalers and stuff that you'll see across the market, but by and large like it's the same on the buy side as it is on the PBM side. It's just different companies. So there's a big three that cover most of the market side. It's just different companies, so there's a big three cover most of the market. So if I'm a Kroger, um, you know I'm likely working through one of those wholesalers to acquire my drugs. Now the whole point of a wholesaler right Is like they can get the medication to me on time and they can negotiate a better deal on those with the manufacturer than I could directly. So there's a middleman in that scenario and very few entities are big enough to not only negotiate the price point that you can get through a wholesaler, but also just the facilitation of getting it from the dock to your pharmacy. The logistics of it yeah, the logistics side of it.
Speaker 1:Okay, I hadn't thought about that. That's a good point.
Speaker 3:Yeah.
Speaker 3:So that's a very high level of why you see most of the pharmaceuticals running through those bigger wholesalers, because they've got the logistics side figured out and they're constantly negotiating with the manufacturers. Now on the payment side, you have the pbm. Pbm doesn't buy or sell a product. Um, all they do like take their, unless they're owning their own pharmacies. Take that out of it like the true. The true two primary components of a PBM is negotiate with the pharmacy what you're going to pay them and negotiate with a manufacturer on brand drugs what you're going to get a rebate for, two foundational things that a PBM do. Well, if you go back to the thirties, there were no rebates. You know drugs were inexpensive. Um, well, now you look at a self-funded plan and like a quarter of the spend, 30% of the spend, is going to pharmaceuticals. It used to be 4% to 5%, yep.
Speaker 3:So what started as an idea? So it's almost like there's always a couple of bad actors too, like pharmacies that were making too much money. So then we input a prescription benefit manager to negotiate and make sure that pharmacies don't charge too much to health plans Like this is kind of like as commercial health plans are coming of age. You know what was ERISA 1970, something you know pretty soon. Now you've got self-funded plans and I don't have this memorized.
Speaker 3:But the first PBM was really just an ID card and to not necessarily adjudicate the benefit but to obtain the data, because it was more of a managed care play. These health plans at the time didn't have the pharmacy data and they realized if we can get the pharmacy data, our picture of health of this individual becomes a lot more clear. So that's where the first PBM was kind of founded, under this great idea of we need more data on these people to help them manage their care. Well, fast forward through the years it became look at all this data we have Now. Let's vertically integrate. Now our job is not necessarily to negotiate on their behalf, it's to negotiate on our behalf and extrapolate all of that as profit. Oh, by the way, we are either owned by a mega insurance company or we're so big and profitable we bought one of the biggest insurance companies in the country so.
Speaker 3:So that's, you know, the cost and the complexity of pharmaceuticals. I think has been one thing, but it like the negotiation with a pharmacy on what you're going to pay them. There's not much negotiation that goes on there, so it's really just a transaction of hey, I'm supposed to have a $5 copay on this generic, the generic's 15 bucks. My card runs through a computer and it allows the patient to pay five instead of 15 and not have to do what we consider reimbursement plans. Right, I pay 15 and then I submit. All. Right, the shoebox effect. Right, I'll keep all my pharmacy receipts and I'll submit them all to my health plan. That's what a lot of folks used to do. It's just a full reimbursement plan.
Speaker 2:So PBMs have evolved your grandchild 95 years later. Right yeah, In the form of canceled checks.
Speaker 3:Exactly, exactly. I don't know if I answered your question other than to say it's highly complex and there's a lot of hands in the pot and there's a lot of money involved, other than to say it's highly complex and there's a lot of hands in the pot and there's a lot of money involved.
Speaker 2:So is there a world where pbms, like health plans, could operate without a pbm?
Speaker 3:yeah, that's what I was gonna ask yeah, I think when you talk about disintermediating, I think that world can exist. Let's take, like, if you look at generic drugs in general, fairly inexpensive right. Um, now the pricing changes and very substantially depending on your pbm deal and the pharmacy you go to and all those things. But in general the average cost of a generic should be about 20 bucks. So do you really need an intermediary to facilitate that transaction? It's kind of like do I need, do I need, an insurance company to facilitate my primary care and insure my primary, my annual exams? Like no, you don't. Like our car insurance doesn't cover oil changes, so why are we trying to insure these small expenses?
Speaker 3:So I do believe that if you just looked at the generics, and yes, there's outliers, but there could be a world where you just had an adjudicator, um, or like because with the evolution of health plans and high deductibles and things like that, like people want credit for what they're paying. So really that would be the disintermediation, where you pay a flat transaction fee, they make sure you get the right benefit and it applies to your benefits and that's really their only job. Like you don't need to negotiate a better deal on a $7 generic. Like you got it for $6.50? Okay, great.
Speaker 1:There's no juice.
Speaker 3:Yeah, there's no juice there. So I do think Ben's actually asked me this question before. Why do we even need these guys? And that is usually my answer Now. The problem now is you have high-cost brand drugs. Well, in any given brand drug let's just say typical, don't even talk about specialty the manufacturers compete for formulary placement by offering what's called a rebate, and that rebate can be 50% of the drug cost, percent of the drug cost. That's why pbm still have a major place in the american ecosystem is because of how manufacturers get placed on formularies to then get in the hands of consumers, and it's a rebate bribe that can sometimes be really substantial. So, without some type of entity now you can call it whatever you want pbm or pba or someone that's going to the manufacturer and saying hey, we had a patient fill this and you know we put it on this tier. So they would. We know you're offering a rebate for that. Give it to us. I don't know who else does that. So so couldn't we?
Speaker 2:just get rid of the PBM. Have someone like Stripe or Visa adjudicate payment, keep Granite Peak involved, and then what Granite Peak does is it takes the information and then you go to the manufacturer and say you owe the plan this rebate. Get rid of the pbm altogether, use a, you know, have a visa or some sort of payment methodology that takes like a flat dollar amount per transaction and then we're on our merry way yeah, we.
Speaker 3:I mean we'd end up being essentially a core function of a PBM at that point and we're submitting to the manufacturer. Now the problem with that is at least starting off. I don't have a lot of leverage with App-V so you could say, hey, we're running you through Granite Peak, go get me a great rebate on Humira. Well, app-v is going to go number one. We don't know who you are. Number two, if you want a rebate, it's going to go number one. We don't know who you are Number two.
Speaker 3:If you want to rebate, it's going to be way lower than anyone else because you don't have any volume. So then we get to a point where the bigger PBMs are going to come in and say these guys are getting like half the rebates that we can get. And that's unfortunately how competitive bid processes still place a high level of reliability on how much rebates we can get. So if I'm showing your client that through Granite Peak and Stripe I can in a year get them $100,000 in rebates in the disintermediated arrangement, and one of the more established PBMs is like we can get you $300,000. Well, which one are you going to take?
Speaker 2:Should employers be buying that way by looking at rebate value?
Speaker 3:My opinion is rebates are an unfortunate piece and part of our pharmaceutical supply chain. You can hate them all you want, they're a piece and a part and they've gotten so big that you can't ignore them. So should you get them when they're available? Yes. Should you chase them to get the largest rebate possible? No, because typically if you chase a rebate, you're not paying the lowest possible price, right? It's like, for example, you've got a $1,000 drug that offers a $600 rebate. Your net cost is 400.
Speaker 3:Well, that's one of the games that PBMs play is like. Well, we're going to put that on the highest tier because we'll take a chunk of that rebate when it comes in. Well, why wouldn't you put the drug that's only $250 on the formulary and take that highly rebatable one off? Well then, you can't hide your pricing and make money here and make money there. So it always comes down to alignment of incentives, and the PBMs in general, their alignment of the incentive is to, especially in the larger markets. They answer to Wall Street they need to make money, and they make money as costs go up, not as they hold costs down.
Speaker 3:So understanding that then allows you to evaluate different opportunities, right To do things a little differently.
Speaker 1:Go ahead, Todd what would happen if tomorrow rebates were outlawed? What would the downstream reactions be? If all rebates were outlawed, what would the downstream reactions be.
Speaker 3:If all rebates were outlawed, that would be a great day. I think Some unintended consequences I can't think of would obviously occur. But if rebates were outlawed in the US, I think you'd see more pricing parity with other tier one countries where we've gotten rid of the rebate game. So the pricing for a brand drug specifically, you have to compete on price, like net price. There's no more back end rebate. There's no more net price. There's no more back-end rebate. There's no more bribe. There's no more steerage. There's no more steerage, unless it's like we'll give it to you at 400 bucks and we'll give it to you at 600. It's no longer like well, we'll both give it to you at retail at a thousand, but on the back end I'm going to pay you more. It's just like here's the price. And then let's compete on clinical efficacy. And why are drugs better? That's another problem. It's almost like we'd have to outlaw rebates and then we'd have to change the FDA approval process to actually consider clinical effectiveness, which other countries do Right. We just don't like.
Speaker 1:We approve a drug and don't consider the fact that maybe better, more cost-effective drugs are out there do you have a feel for what percentage of the pbm revenue is in rebates versus any other sources of their revenue?
Speaker 3:it's definitely changed over time. There's a great um, there's a great graph and I'm blanking on the name of the company that put it together but it basically showed PBM revenue over time and where it shifted. So I'd say rebates used to be a higher percentage of revenue for them, but over the years that's been targeted. So whether it's been targeted, you know, by public perception, um legislation, federal investigations, yeah, or consultants saying we want all our rebates, why are you keeping those? Those should go to employers. The first thing they did is they just shift.
Speaker 3:So in a world of like, we have to maintain a certain margin. The PBMs say, okay, well, we'll give you 100% of the rebate, but now we changed the definition of rebate, so we'll give you 100% of what we've defined but we're still going to keep it over here. So I wouldn't trust a lot Like I think gosh Optum just came out and said we already passed through 98% of rebates and now we're going to pass through 100. It's like that seems a little disingenuous to me. But you can kind of track Gosh. I really wish I could give a shout out to this company because I think it's nephron research is the name of the company, but they have tracked pbm revenue over time and it went from like highly spread, so making a lot of margin on generics between what we pay a pharmacy and what we bill a plan to rebate and manufacture fees, and then now it's primarily in specialty pharmacy, like if you own your own specialty pharmacy, that's where all the costs are and that's where we can generate more revenue. We'll pass through more of the rebate.
Speaker 3:So it's a complex question to say it depends on the employer. Like we've seen employers where the broker was keeping all the rebate, so PBM was making zero or a portion thereof. I don't think they're making zero, but the broker was keeping all the rebate, not passing it. That's crazy. Yep, yeah, wild, like fall off your chair, type numbers right when you're like how is that? And then you talk about transparency and you look at the deal and you're like well, technically they were transparent. They wrote on this contract like we are going to absolutely hose you and make too much money and the employer signed it.
Speaker 3:So, you know, it's like they were transparent. That's what we all want, right? Is transparency? Yeah, that that's a long-winded answer, which is typical of the answers I give, because it depends. But the larger pbms that have prime, the big three that have primarily worked on spread traditional type arrangements rebates have been a part of their revenue stream for a long time and they've just simply adapt to well, what do we call a rebate? What do we not call a reb rebate?
Speaker 1:So here's the visual I'm coming up with, Trevor, I've got on the far right side, I've got the manufacturers. I've got Lilly, I've got AbbVie, I've got all these manufacturers of drugs. On the far left side, I have employers that have their employees that they're trying to provide for, Right smack in the middle we have the pharmacist. Okay, so those are three different parties, but then there are two intermediaries Between the manufacturer and the pharmacist. We have basically the group purchasers the McKesson, the Cardinals, the Amerisource, Bergens, and so every pharmacy, whether it's Kroger down to your local one store, mom and pop in small town America, they're using this wholesaler to negotiate with the manufacturer. Then, in between the pharmacy and the employer, who's advocating upon the employee or the American population, you have the PBMs.
Speaker 1:Now let's camp there for a second. We also have the big three. Right, Our whole country is based on the big three. Every industry has a big three. We've got Express Scripts. Seems kind of unrelated to anybody, seems pretty independent. But then we've got CVS, Caremark. How is it that an employer is supposed to be negotiating with the pharmacies when the PBM itself is owned by, if not the one of the largest pharmacies, and then the third one, Optum? Many people know most don't is a UnitedHealthcare entity, so now it's a. You know it's a pay. How do those three relate to each other, and is one better than the other in their setup?
Speaker 2:Well, Todd, fact check on that Express Scripts is owned by Cigna.
Speaker 1:Oh, that's right. So we have two plans that own it, and one is owned by the one you're trying to negotiate with.
Speaker 2:And CVS owns Aetna, so they did the reverse acquisition. So they're all vertically integrated.
Speaker 1:So how does that work when you're trying to negotiate Trevor?
Speaker 3:Well, talk about misaligned incentives, or we call you know fox guarding the hen house. When you look at a core, the core duty of a PBM is to negotiate with pharmacies. Right, I mean, that's just like at the highest level we want. I, as an employer, will want my Pm to negotiate a price with the pharmacies. That is fair. If my pbm owns 15 000 retail pharmacies, what's the likelihood of them negotiating with themselves? Really, really well, I mean, you're like it's just the math doesn't math right.
Speaker 3:And then you add in mail order and then you add in specialty the. The amazing thing about um cvs is like now they're into manufacturing, now they're manufacturing humera, biosimilars. So now not only do they control the benefit, design, the pharmacy, pharmacy reimbursement, they're controlling acquisition costs and distribution. Talk about vertically integrated. How that's legal, I have no idea. It's like it's got to be a loophole, um but and then sold in a package, probably a rebate to Congress on that one.
Speaker 2:Yeah, you know what I mean. Yep, yeah, probably.
Speaker 3:Yeah. So that's why a lot of times people say, too, they're like well, what's the likelihood of you know PVMs being outlawed or you know this happening and I'm like it's too much money? Yeah, pretty pretty slim to none, like it's a bipartisan. They agree pharmacy costs are out of control. They agree that what they understand of pbms is probably not great, um, what they don't agree on is wow, I'm gonna lose that big old check, um, and what pharma has done a good job of is started painting the pbm as the bad guy, because it used to always be big pharma. Right, big pharma has done a good job of is started painting the pbm as the bad guy, because it used to always be big pharma. Right, big pharma's greedy, um, you know, big pharma fueled the opioid crisis, all these different things, and big pharma was always in the crosshairs and pbm just kind of operated under the like we're just doing, god we're just doing.
Speaker 3:God's work over here negotiating with those big bad guys. Well, they've slowly built up these massive, massively profitable enterprises. That is fine, like I'm I'm a capitalist. Like go do good work and make money, but doing it under the guise of like we're helping, when there's so many misaligned incentives and places they're getting paid. Like I think last time we looked at like different ways of traditional PBM can get paid, it was like 45 different ways they can make money. So when you go to negotiate with those entities, you just kind of know what you're going to get. It's like so it's an education process with the client. What you're going to get, it's like so it's an education process with the client.
Speaker 3:I can get you to better or less bad, but I can't. I can't align someone's business model. I can't realign that through a contract. Even the best negotiation, the best you know scale, whatever it is like, I can't change their business philosophy and model through a really good contract. And they understand that and they get like you know. Then there's other options out there. There's the middle market that is looking at the 85 percent dominated by the big three and saying that's a lot more prominent and get validated by things like Mark Cuban putting his name behind some of them by lawsuits that are coming out as far as like Arisa based lawsuits which I think two of the three have been thrown out already, but I don't think they'll stop so did I answer your question?
Speaker 2:Yeah, yeah, okay, well to think of. Like you, you say that it's vertically integrated fox watching the hen house. You know who's going to negotiate with themselves, but you know there's really only one entity that can get involved and provide pressure and creativity and that's an employer. That is the only party. I guess Congress, they could legislate that, but if they're getting a rebate themselves, if you will, you know, from from, from these companies to allow them to stay intact, and Congress really doesn't know what they're doing anyway. So really it comes back to a savvy employer with being headstrong and creative. Right, like that's it.
Speaker 1:Well, and having a partner that can adjudicate it, because an employer by themselves can't go to pharmacies and make the plan. They've got to have an independent PBM that's willing to work on their behalf, right.
Speaker 3:Yeah, and a benefits advisor that gets it and can put it together, and a.
Speaker 1:PBM consultant so.
Speaker 2:Yeah, I mean, I was going to ask about that Trevor, like, what would you say to an employer who, at this, at this stage in the game? And obviously, like, let's be real, you, you stepped out into this because you saw the need. So you're, you're biased to the, to the concept, but like, like, what is an employer facing if they don't have somebody that is special, a specialist, a consultant, in this PBM space? Like, what are they facing if they don't have someone like you on board?
Speaker 3:I mean overpaying substantially. By substantially I mean upwards of 50% sometimes on kind of all facets of their pharmacy plan. So you've got you've got all these different areas where PBMs can make money and their response when getting pressure is always like well, our deals are negotiable. It's like well, if you don't know how to negotiate it, and why would you expect a manufacturing company to be able to negotiate a pbm contract? Like that's what they face. And those are the things we identify over and over again where it's like you know you've got clients who have been with the pbm for years and years and never renegotiated their contract. So it's st, stale and it's old and the PBM is making money hand over fist, but until the pain is too great or they realize somebody educates them and helps them realize like yeah, they take you golfing and do all these nice things because they're making so much money on you, it's not because they're keeping your cross down. Sometimes you to help and that's where we come in is educate with independent data, like we're not trying to sell a bill of goods. It's like we'll just tell you what the data shows us and you can make an informed business decision just like you would any other business decision you make.
Speaker 3:So I will caveat that with, like I've said multiple times, two primary things. One, I don't think our business should exist. It shouldn't have to, like we saw a need. Um, we've been fortunate to work with great partners and help a lot of folks, but if pbms did what they say they do, we wouldn't need to exist and, candidly, we shouldn't need to. It's just that's how the American pharmaceutical system works, is they're going to extract as much profit and revenue that they can and basically put it back on the buyer who's writing the check, which is the employer and the patients. It's their money, right? Pbm is not going at risk for anything. They're just taking the employer's checkbook and writing checks on it. Right, taking the employer's checkbook and writing checks on it, right? So if, if, something.
Speaker 3:And then the second thing I always it's always weird because people are like you're telling me your business shouldn't exist. I'm like it really shouldn't, like it does and there's a reason for it, but like if everybody did what they're supposed to do, we wouldn't need to be here. And then, secondarily, like if Congress fixed it, if they did something and they've made progress in the past few years, honestly, like they've given us some gifts that I never thought they would. But federally, if they could fix it, I would be OK with that. Like if they just like legislated me out of a job and everybody in America all of a sudden could afford their medicine and stay compliant and all the games were kind of removed, like I'd be totally okay with it.
Speaker 3:I'd find something else to do. I don't know if I'd be as passionate about it. I'd probably have to be like a youth sports coach or something. But uh, like I, that's what I. That's how I really feel is we shouldn't need to exist, but we do and we and then if we ever didn't need to exist, like that means that hopefully the american people are getting the best deal on their medicine yeah, unfortunately, I don't have a whole lot of confidence that the congress is gonna gonna do anything about it.
Speaker 2:I mean, I, I just thought in this last political cycle, when, when, uh, when a congress person or the president or whomever like celebrate that they negotiated like five drugs, it's like, wow, good job, guys, you negotiated five drugs. How many are there again? Yeah, like, get out of here with this. You know, like I don't if, if I, if they're, if they're dancing the celebration dance on five drugs. Like I don't have a whole lot of hope that we're going to get a movement on that front. Um, so, um, no, no, along the consultant path, I can say from, from our perspective, um, our partnership has been fantastic. Um, and the consultant path, I can say, from our perspective, our partnership has been fantastic.
Speaker 2:And what I've appreciated about the partnership is number one. It's a partnership that's committed to excellence and making sure that we're holding folks accountable, good folks accountable Like I, like our PBM partners. I think they are well-intended, um, but there there needs to be accountability and we, we found opportunities there. Um, you know, just a slight rounding error that you found, my friend, where, even just last quarter, we uncovered that, just because of a manual, a manual entry error, uh, we found, uh, almost a half a million dollars of rebates that should have been paid, that weren't, and they may have caught it later. But we didn't have to wait till later. We were proactive and Trevor's team found it, and so it's just, we're keeping our eye on the ball. We're committed to excellence, we're committed to sound practices on the contract side and that sort of thing.
Speaker 2:So, number one I think that's been fantastic. Number two is not only are we reviewing data, trends and those sorts of things, but we're having strategy calls about how do we do things better. Have those dream calls too, really, where it's like can we replace a PBM? Can we do it? Is there a way to do it? And going back and forth and having an expert to you know sharpen the saw with has been fantastic. If there's a business leader out there who is not connected to a pharmacy benefit consultant within their health plan, it's a huge mistake. I can say that I know that. Trevor, when I first heard you kind of share your business model, like immediately, I was like we got to have something like this on board. Do you remember who you were introducing at that conference that I met you at. Do you remember that?
Speaker 3:Yeah, I was introducing Dr Marty McCary, I believe.
Speaker 2:Yeah, fda director. Now he wasn't then no big deal, I think I called him a goat.
Speaker 3:I was like he's the Michael Jordan of you know, of all these things. I can't remember what all the things were, but it's pretty cool. Yeah, it's Marty. Dr McCary has always been like super forward thinking and, I think, at least well intended. So yeah, and he always speaks very, very well. So I thought he knocked it out of the park, but yeah, that was it. Yeah.
Speaker 1:The funny thing about business.
Speaker 3:Business too, I agree. I agree that was a great pick. I always think it's funny too, because that was pretty early on in our journey as a company and you were working with a pretty good PBM at the time. So even after we met, I reached out to just say like hey, really enjoyed meeting you. I just want to tell you like you're working with a good entity, like there's probably not a lot of room for us to help you at this time, like kind of pigeonholed myself into not winning a deal, and you were like no, I need your help, like right now on this group, and I was like okay, yeah, we can do that.
Speaker 3:Maybe I should have led with that, I don't know, but it just, it happens organic and I think our partnership's been great because of that, because we're not afraid to just be direct with each other. And I do feel like the dream killer sometimes, because Ben comes with like these amazing ideas and I'm like man, ben, I just don't know, see how that, like I can't get there in my mind, but maybe it's still possible, right, I don't want to kill the dream, but that's where I think we've come up with a lot of cool, creative solutions for our clients, just starting with this big what if and then kind of tailoring it back.
Speaker 2:So it's been a pleasure.
Speaker 2:It's been very good, and one of the core values for our firm is excellence in the details, and there is no way a broker can do everything and if they can, I wouldn't believe them. It's impossible. You have to surround yourself with the subject matter experts that can elevate everyone's game, and so you know we always look for those. First of all, we demand partnerships that make us excellence and excellent in the details, but we also, you know, subscribe to that, to that idea. If we find the right partners, somehow one plus one ends up equaling five. When you find the right partner, that math actually happens and it's it's. It's wrong math, but it it tends to exist Still maths?
Speaker 2:Yeah, happens and it's, it's wrong math, but it it tends to exist still maths, yeah, yeah, it does. Um, before we, before we close and before we get to our final question, I wanted to talk for a little bit about, um, just the state of of pharmacy, um, some trends to watch out for, uh, some things that you're seeing from data and information, um that you think will be opportunities or challenges that can ultimately be opportunities for employers in the next, you know, maybe through the end of the year, as things are happening in the PBM and pharmacy world.
Speaker 3:Yeah, I mean trends, boys. I mean all the trends are up and it's it's our favorite um. I, I guess we I would call it a four-letter word. You know glp ones um, that's a trend that everybody's experiencing, some worse than others. I think being able to be open-minded and creative about solutions there and understanding the difference between covering for approved conditions like diabetes and covering for things like weight loss that most plans don't cover, that's really critical and important.
Speaker 3:Specialty drugs aren't going away. They're in the pipeline, more and more of them. Specialty drugs aren't going away. They're, they're in the pipeline, more and more of them. Manufacturers are are peeling back on generics. Generics have been deflating for a long time and you know it's hard, it's hard to make money in that market. So I think they're focusing a lot of their efforts on specialty drugs and have been found, you know, to be successful and it's amazing.
Speaker 3:It's amazing time to be alive in the sense that science has come so far. And you know I look at a lot of folks that have like rheumatoid arthritis and they can use one of these biologics to help them live, you know, virtually pain-free life. It's amazing, you know my, my grandfather passed away of. You know complications from rheumatoid arthritis at a fairly young age. So the fact that we have this science available is great, but it's always balancing, like at what cost and who's going to pay for it, and that's you know.
Speaker 3:Budgets are strained, and healthcare budgets especially. Budgets are strained, and healthcare budgets especially. So what I see in the data and the trend now we've got tariffs right Everybody's like well, what's going to happen with tariffs? I don't know is the answer. I get the intent. The intent is to bring manufacturing back to the United States because the majority of drugs are not manufactured here. Will the tariffs work? I don't know. Will they be passed through?
Speaker 3:Right now, pharmaceuticals, as of today, have been exempt from the tariffs, from what I've seen. You know, as of this morning, will that continue? I don't know. But those are things to consider. You know, maybe more into 26 and watching what happens there. So you've always got.
Speaker 3:You know, every January most brand drugs increase 10-ish percent, 9.9%. So you've got continued kind of inflation. You've got utilization increases. So you know, I don't think anyone's got a silver bullet, but you're surely behind the eight ball if you're not actively managing your pharmacy plan, like if you just executed a three year PBM agreement and you're just like, well, let it ride. And you know, increase premiums and stuff to like. You're really missing out out and at this point, based on the fact that, like putting your head in the sand and saying I didn't know is not really a reasonable defense, especially in our, in our RISA case anymore, like pharmaceutical expenses are so front and center in the news and in lawsuits that you can't be like, well, I didn't know. Um, you have to be doing certain things to show that you can't be like, well, I didn't know. You have to be doing certain things to show that you've done your due diligence and you've been a good fiduciary of your plan.
Speaker 2:Yeah, so from the lawsuits you're talking about fiduciary responsibility to the members of the plan. And just for context, around tariffs we're recording in early April.
Speaker 2:So obviously this will be released later. Um, but at this point in time uh tariffs of china have gone up and there has been what a 90-day uh freeze, uh for everyone else, uh to let us settle, and negotiations I guess uh happen with the trump administration and uh the the you know, 75 nations that have reached out, or whatever that may be. So just some context around uh tariffs. But yeah, I did see that uh, pharmaceuticals were uh uh exempt from that. I think it's pretty interesting. Like there's a lot of pharmaceuticals that are manufactured, like there's a lot of pharmaceuticals that are manufactured overseas. In general, that to me seems like a like a defense. That's a defense issue rather than like a like an economic issue.
Speaker 3:Right. Yeah, no, I don't disagree with that. I think I don't know the numbers off the top of my head. We were just doing some research. My team was on like what percentage do we get from overseas and which countries are they coming from? And I think you know a fair amount comes from India. And we were just in this world where if it shows up in American pharmacy, we we suspect it's safe and there's been a lot of cases where that's not true. Right Like right. Especially we've had some gosh, at least in the last 10 years. Right Like manufacturers come in pharmaceuticals coming from China having issues. Right. So I do To your point. I think it's more of a security issue but there's such an economic impact to it and I mean we subsidize the rest of the world. That's just the point blank period facts, like we overpay for pharmaceuticals and that allows other countries to get them for less.
Speaker 2:Which makes it a little interesting that they're exempt from tariffs.
Speaker 3:Yeah, yeah, I was surprised.
Speaker 2:You would think that that would be something to pursue other countries about, especially because the tariffs is. Tariff and trade deficit is what the administration is focusing on, versus tariff and trade deficit is what the administration is focusing on. You know, I think. One thing, another thing just to highlight from a trends and some things that came out from our conversations that I found fascinating. You mentioned GLP-1s and they're being approved for a lot of different disease states. But what's really interesting and actually our team did some research on this too Um, like, it is approved to be used for sleep apnea. Um, and it's really, you know, it's so easy to see, like, like, what they're doing, cause obviously you, you lose a lot of weight on a GLP one. So any condition that can be improved with weight loss, they're going for approval, plain and simple. But what's interesting, what our team found about that is it still recommends, even if you take the GLP-1 for C-Papnea, it still says the clinical guidance is to still use the C-Pap.
Speaker 3:So it's not replacing the CPAP in that expense. Yeah, no.
Speaker 2:So that that goes back to active management around GLP ones, because, like full confidence to say this, if you are covering GLP ones like carte blanche for whatever it's approved for, your health plan will go bankrupt. Your employees will pay more. That is a spiral to hell with that type of a strategy. So tough decisions that you have to stay on top of and manage. And also something to know is there was a biosimilar that came out for Stelara speaking on the rheumatoid arthritis front, but is that necessarily a great alternative at this point? The biosimilar for Stelara?
Speaker 3:I mean, I think we can glean some things from Humira, which was the biggest blockbuster drug of all time, and biosimilars finally made it to market and it was kind of like the market didn't really know what to do with it. Specifically, going back to the rebate game, so we saw slow adoption for two reasons One, not being placed on formularies by PBMs fearing losing their AbbVie rebates. Two, being placed on formularies but not being preferred or guiding patients to the biosimilar. And then three was provider adoption. So providers have been using Humira to treat and the patient has responded. Well, you know they're going to be hesitant. They're also influenced by drug reps. So you know you take kind of all those different components and the Humira biosimilar conversions were slow. I think they've gotten better as we've had more options and you've got pbms that I think are really making the best net cost decision. Also, rebates skyrocketed to maintain market share for humera too. So it kind of made the decision hard. It's like well, we do we give them the upfront or do we get the better net cost, time, value, money, all these different things right. So all that to say, I think Stelara launch will be better. I think the market's more prepared for it and providers, specialists, that really deal with these conditions. I think if they had success moving a patient from a Humira brand to biosimilar, they're going to be much more open to the Stellara conversion than they might have been otherwise. So I do think it'll have a positive impact.
Speaker 3:The reality is, what we also see is these things called rebate credits. So the house will usually win, or always win, if you're working with the big three. So even if they give you, if someone fills the Stellar Bio similar, it's substantially less. Yes, you're going to lose the rebate, but it should be dollar for dollar. And what we're finding oftentimes is it's not dollar for dollar, like the house gets more and the employer pay, like it looks good because our top line went down. But when everything settles out with rebates, it's not the lower net cost because they took a little chunk. So just something to keep an eye out on. We could talk about that for another hour probably.
Speaker 2:Wow, man, it's interesting talking about PBMs and taking money from here to there and the legalized theft that comes along with pharmacy benefit managers and the movement of money. But we're thankful, trevor, that we have you on our team, that we can call foul when a foul occurs. But wanted to end our conversation today with our two questions that we ask all guests, and the first one is what is a risk that you have taken that has changed your life?
Speaker 3:I'd say the biggest risk I took is I had spent almost a decade, right out of college, with a third-party administrator and I kind of you know what do they say climbed the corporate ladder and I was at a point in my life that I was completely burnt out in all phases emotionally, spiritually, physically and I needed to make a change. And I knew I needed to make a change and I knew I needed to make a career change Like that would. That was one of the primary reasons for a lot of different dynamics that were happening there and I took a leap Most people don't know this. I quit my job and leapt into a startup that wasn't even Granite Peak, it was a corporate wellness startup. And I remember coming home and telling my wife like, hey, I quit my job and I think I'll have it through the end of the month, and most people don't quit their job without a plan B. And I'm like I had a plan B. It's in my head, I'm going to do this, I'm going to be a part owner in this, and it's I. Just I needed to do it Right. It was like it was my. It was my get out of jail free not saying I was in jail, but it sure felt like it, um, just where I was in my life.
Speaker 3:So I took a pretty big risk there and, um, it definitely changed my life. It changed my life for the better. I learned a lot about business when that fell through and I needed. You know, at that point I was like, okay, now I need to figure out a way to find a job because this didn't work out and it all worked out. You know, it's amazing, like I'm right where I'm supposed to be doing exactly what I'm supposed to be doing. But it was sure hard in between. Um, that startup wellness, corporate wellness company was was the the catalyst to get me moving in a direction that I probably needed to go, but it didn't end go but it didn't end up being right.
Speaker 3:Yeah, it didn't end up being what actually, you know what, what I envisioned it being it, just, it just got me on the path and, um, there's a little touch and go for a while and a lot of prayer, a lot of you know. Hey, honey, just trust me and me going. I actually don't know what's going to happen, but it all worked out. And that's where Mike Mitovich grateful for him coming in and being like you know, I was going to become a broker. This was before remote work, right.
Speaker 3:So you're a guy in Montana who's worked for a third party administrator for a decade. You've got a lot of experience and like good, unique experience. But you can either go work for one of your two competitors One's Blue Cross, the other one's, owned by Cigna, Just felt wrong, neither of them were close enough, so, again, remote work wasn't there or you can work with a broker, like become a broker consultant, and so those were kind of my three options. Until I give a lot of credit to Mike Matovich going, don't take any of those until I can put together an offer for you. And had it not been for him, granite Peak would have never been formed, so Wow.
Speaker 1:Our clients and our team is ever grateful you can go home tonight and tell your wife that Connor and his clients are thankful that you made that very difficult decision. It worked out. It worked out. Our second question is this Is what is left yet unfinished that you have the resolve to finish or complete?
Speaker 3:Oh man, oh man. I think what's really unresolved for me is just feeling like there's so much more people to help and educate and, candidly, just like giving people, giving people that come to work for us an opportunity to kind of do something a little bit different and learning from my own burnout. So I'd say, like what's unresolved is like I always say when we hire someone, like we do a lot of good work and we're not perfect and we make mistakes, but we've got a lot more people to help. And also I want you to live a life that, like you never even could imagine. Like that's you're not going to burn out. Like we're going to have busy months, we're going to have busy weeks, but we shouldn't have years that you're just like grinding away until midnight, like that's not a life. And so let's do really good work and crush it, but let's not, um, let's not do what I did for too long, which was kind of sacrifice the important things in life with my family and relationships that were much more important.
Speaker 1:So you're casting a John 10, 10 vision for your teammates that they could live life to the full.
Speaker 3:Yeah, yeah, I mean, I've never really thought of it that way, but, um, I really believe that I think we've we've got a lot more people to help, whether that be people that join our team or people that we work for as clients, and so, um, I feel like we're just getting started. I mean, we just hit the 90,000 lives threshold. So it's like, like, you know, a lot of people out there yeah, we're, we're not the biggest I I couldn't say I imagined getting there. Um, when I started especially when I started and went, is it, can I do this? Give a lot of credit to uh, you know I practice what I preach, you know. Give a lot of credit to uh, you know I practice what I preach. You know we tell advisors, uh, you know, if it's not your core competency, like, hire us, we can make it a core competency.
Speaker 3:Um, my core competency was not selling, so I hired Ryan Miller as a sales coach. Um, very recently, like tech, not my core competency hired a fractional CTO back, not my core competency, hired a fractional cto. Like, I think those are things that just being vulnerable and knowing that we don't know everything is what will continue to drive us and resolve to help more people, like you said. Yeah, 90 000 it's a big number, obviously. 100 000 is like well, that's awesome and we've been fortunate to help that many people, but it's like it's only 100 hundred thousand out of I don't know what the commercially self-funded world is. The last numbers I've seen were pretty darn big and we've got a lot of work to do.
Speaker 2:It's a lot of opportunity, trevor, thanks for, uh, thanks for joining us today. Um, love hearing your story and and uh, talking PBM and just uh, it's cool to hear just even what you just said there, like fractional CTO and Ryan on the sales front. So we talked about of excellence in the details, like all the little things matter. Um, so, thanks for joining us. Thank you for to our listeners for joining another episode of Risk and Resolve. We will catch you next time, thanks for having me.
