Should Pharmacists Be Allowed to Prescribe Medications & Offer Treatments? James Lott of Scripted

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James Lott 0:00
that man could have potentially died and not in the way because the drugs not available. It’s because of poor outdated policies and a broken healthcare system.

Alexander Ferguson 0:13
Welcome to UpTech Report. This is our Applied tech series. UpTech Report is sponsored by TeraLeap. Learn how to leverage the power of customer stories at TeraLeap.io. Today, I’m excited to be joined by my guest, James Lott who’s based in the Chicago area, and he’s the founder and CEO of Scripted.co by Script Health. Welcome, James. Good to have you on.

James Lott 0:34
Hey, Alex, thanks so much for having me today.

Alexander Ferguson 0:37
Now, if I understand correctly, your focus is is wanting to help power up pharmacists and kind of give them a whole new way and in today’s environment, help me understand like, what’s the problem? In very short, because we’ll dig into it more into the episode, but very sure, what is the problem that you see that have been set up to solve?

James Lott 0:54
Well, I think the problem is that we have all these doctors educated pharmacists that have for long who are in every community for a long time not been utilized correctly by their communities. COVID was the first time that these pharmacists got to really show what they’re capable of. And pharmacists are ready to convert and start doing more clinical services at the pharmacy to expand access to care.

Alexander Ferguson 1:18
So you’re wanting to kind of play a role with them to help power them to provide more service more options. And I think a lot of people, even consumers, myself included, didn’t realize how much a pharmacist could do. And I feel like our prep conversation also is like the competition that they’re having also in the pharmaceutical area mail buy in direct mail solutions, like Mark Cuban just launched this thing. There’s just so much competition. Do I understand that? Right?

James Lott 1:46
Yeah, there’s also a tremendous amount of competition. drug prices is an easy political point. If you really, if you saw what Mark Cuban did, he was clever. You know, he’s like, you know, taking on the drug industry talking about how drug pricing is too high. This does not bode well for brick and mortar pharmacies, because honestly, when brick and mortar pharmacies when their business model doesn’t work, they close down. And pharmacy deserts is a real thing. When people don’t have pharmacies, they’re like they’re less likely to have good health. So there’s a lot there. But one way all these pharmacies can fight it, is by delivering these high margin services that are clinical and help their patients in need for non urgent and acute care. You’re actually a pharmacist yourself. Yeah, I am. I am a pharmacist, actually. And my background is in pharmacy and public policy specifically.

Alexander Ferguson 2:40
Wow. So it’s like you understand the space intimately. I always appreciate founders journeys like this, where they, they understood the problem because they were there. But like, did that just naturally lead to be looking for the solutions? Or I mean, where did it all culminate for you?

James Lott 2:57
Yeah. So when I was a pharmacist, and I did all my education here on the south side of Chicago, which I’m really proud of, when I was a pharmacist, I moved out to the Seattle area, and they always put young pharmacists in like kind of marginalized communities, areas that nobody else wants to go go to. But I actually thrive in those kinds of environments, because people there, they don’t expect a lot. But with me, I, me and my team, I trained them to give a ton. And me being like, at the top of my game, helping patients made my staff better in May patients come to us first, after a year of being being their patients would come to the pharmacy first because they knew our staff was competent, and helpful. And they would come and ask me questions before they ask their doctor. But I saw it going on so many times where I was like, wait, you know, why? Why can’t you just need an asthma refill? And you’re going out of town tomorrow? Why do you have to wait for your doctor? Why can’t I just up this prescription for you. And then there was one time specifically regarding this asthma, where a patient did come into the pharmacy and he did not have insurance. He basically asked me if there was an over the counter solution because he didn’t have a doctor that he could use. And I said, well, the things over the counter aren’t that great. But if you must, you can go and get this. This epinephrine inhaler there. As he was walking there, he collapsed. He fainted. And I kind of broke protocol, kind of don’t tell anybody. I went and got a prescription and asthma inhaler from the back. And I administered to him and it saved his life. The fact that what I did could have potentially gotten me terminated from my job and potentially even fined by the State Board of Pharmacy and other folks. That’s stupid. I have a doctorate degree. The man knows what he wants, as long as I’m reporting that to if he did have a primary care doctor, um, I think that should have been you know how that transaction would have gone. That man could have potentially died and not in the way because the drugs not available. It’s because of poor out policies in a broken health care system.

Alexander Ferguson 5:03
So has the policy situation changed? Are pharmacists able to do this? Like, what where are we now?

James Lott 5:10
Yeah, so actually, the policies have changed. And at scripted, we are taking full advantage of those policies that have changed. Several states actually allow pharmacists to prescribe instead. In fact, 48 states have some language to allowing pharmacies to prescribe pharmacists to prescribe. Now, a better question is, why hasn’t this been scaled or actually rolled out? Well, it’s because of big misalignment of incentives. And the way that that states did it, they made it extremely difficult. pharmacists have to jump through so many hoops to do it. And pharmacies at the end of the day, their core model is filling prescriptions, unless there’s been a proven model that something’s work. And there is a very big, you know, opportunity in terms and economic incentive to do it. They’re risk averse, and they’re not going to do it. They need somebody to come and kind of like build the car for them, give them the keys to make it super, super easy. And that’s where our scripted KCO was born.

Alexander Ferguson 6:09
It’s like the the policies thankfully changed. But it just is too difficult to make it happen to make to make the change. Hence, technology comes into play. I always love when technology can save the day. So I haven’t understand. In briefly, how does your technology work? What is it doing to make it the pharmacists lives easier?

James Lott 6:28
Yeah, so I’ll go about this one wave. So the first transaction that ever happened on our platform, a 41 year old woman walked into her local doctor’s office in a rural rural area in the West Coast. She knew she had a urinary tract infection, which is super common in women, very painful and uncomfortable. And so she just goes to the doctor’s office didn’t have an appointment. And the doctor said, I’m sorry, I can’t see you. Were backed up for about three weeks. So this woman had to go find her own solution. So she did what a lot of people do. She went to her local pharmacy, got something over the counter. She actually went to the pharmacist and said, hey, does this work? Well, and the pharmacist says, well, it’s it’s okay. But we actually have something better. We just started using this platform called scripted. Why don’t you scan this QR code here? You’re going to answer some questions about your your condition today. I’m going to review them, use it using this platform. And if you’re eligible, I can issue you a new prescription for a effective antibiotic. Now the way scripted works is scripted allows the patient to answer questions on a digital questionnaire on the platform, the pharmacist has what we call clinical decision support. Based on the patient’s responses, the pharmacist is flagged for anything that might be alarming, but can ultimately quickly decide if this patient is eligible and meets the criteria for this for a prescription antibiotic. And if she does, the pharmacist will write the prescription. If she doesn’t that pharmacists will notify the doctor and refer her to a physician where she can get more immediate care. Of course, pharmacists want to get billed for the services through the patient’s insurance. And we are working on that right now. And then be able to like basically send any information to necessary folks like the government, or the physician or anybody else. So there’s a ton of backend functions that have to happen, where if the pharmacist didn’t do it themselves manually, they’d be out of compliance. Of course, our platform works with all those things, makes this whole process seamless.

Alexander Ferguson 8:36
I remember I imagine when you mentioned earlier that the policy has changed, but it’s just too much work to change is probably all that reporting and having to fill out the right paperwork. And it’s like they’re not built for that. Hence why a system like yours takes care of that regulatory concerns of having to go through the right procedures that everyone’s covered. Is that right?

James Lott 8:54
Yep. And then the in the happy ending to that because we built all these things into the platform. The patient was the pharmacist reviewed, saw the patient was eligible rotor and antibiotic. The patient paid 39 bucks cashed in this visit in the future will be free, hopefully with our insurance. And the patient went on our way. She didn’t have to wait three weeks. She didn’t have to get a bandaid. She got a painkiller. You know, it’s like the question is, how do we scale this experience to every zip code in the United States? And that’s what we want to do at Scripta Darko?

Alexander Ferguson 9:28
I mean, I actually have a personal story connected to this I’m curious is this type of situation where even if you’re like you’re traveling and you can’t go see your doctor, but you know what you need, you could just go to a local pharmacy and use this is that right? Just like the European way Okay, okay, cuz like my wife and I, we were traveling, similar situation. We weren’t around and we couldn’t get what what she needed, but like this type of solution would have been so, so powerful. So outmanoeuvre stay like what’s the, what’s the barriers to rolling this out? Is it just a Fear of okay we got to get a adopters are what other is things are in the

James Lott 10:05
way. The biggest problem I would say are twofold. The two biggest problems are number one who’s going to pay for this. Consumers are used to going to their pharmacy and getting services for free. Pharmacists don’t want to do that. They’re taking on new roles, new liability is taking up more of their time, they’d like to get reimbursed for their services. The good news is the the payers that we’ve talked to health insurance companies, they’re willing to pay, it’s just a big disconnect between the pharmacist and the payers. And there’s no standardization there either. So that’s one thing. The second biggest thing is the laws. There are 50 states and 50 different ways to practice pharmacy and to work this up. So building out a system that is scalable across all 50 states is really difficult. You have to really care about this problem. So unfortunately, we do. And then there are a lot of other nuances. But those are things that we again, believe that technology can kind of help solve the problem.

Alexander Ferguson 11:03
Are you in a certain number of states so far and working to expand? How’s that work for you guys right now?

James Lott 11:09
Yeah, we are in. We’re currently in 11 states and the states that we’re in represent, I think about 44% of the United States population.

Alexander Ferguson 11:17
Wow, gotcha. So, but it’s I like your point is like you’re committed to the problem. And it’s just a continual roll out of finding the highest opportunity areas and expanding from there. You mentioned also earlier, the the pay people who’s going to cover this, who’s going to pay for this? Ideally, insurance covers, what about people who don’t have insurance, but then they just simply pay the pharmacist directly? Is that would that be an option?

James Lott 11:41
Yeah, in the example, we gave earlier for the first transaction that that woman was able to pay cash for the visit, and unaffordable cash price. But again, if you really want to talk about adoption at scale, it’s really difficult to do that without the payers actually wanting to pay. And you know, what we’ve seen so far as everybody would like to figure this out. But there’s so much fragmentation amongst pharmacists and how they do things. There’s these Rockstar pharmacists who are small, independently owned, some of them have already figured this out for themselves, not many. It’s probably like less than, you know, 200 nationwide of the 60,000 pharmacies, but they’ve done it, but they don’t share their knowledge with other people. And because because of those types of things you don’t have the scale that you need. And of course, that what we’re trying to do is we’re trying to go in and get those people to work together with us. And we kind of go all go at this together, because that’s what needs to happen for broad mass change to happen at scale.

Alexander Ferguson 12:42
Wow, isn’t it? I think there’s this there’s about 60,000 Farm pharmacies in the US, is that right?

James Lott 12:48
Correct. And 35% of them are independently owned. Um, it’s actually kind of interesting. It’s, it’s, we’re for easy numbers, you can just say 1/3 are independently owned. 1/3 are owned by CVS, and Walgreens, and Rite Aid. And those big guys, those three big guys, and then the rest are like grocery chains, and regional pharmacies.

Alexander Ferguson 13:10
It’s a good way to look at that those those three buckets. Interesting. I mean, when it comes to like, CVS, Walgreens, I feel like CVS is they’re really growing. They’re minute clinics. And so like some of the bigger guys are starting to grapple on it. But they’re still imagine having trouble at this whole situation, too.

James Lott 13:24
Yeah. And that’s a good point. Some people ask us about our strategy, because they’re like, well, there’s a Minute Clinic and all these stores, well, to date, there are today there are 10,000, CVS stores, they’re going to roll, they’re going to roll off about 900 of them. But even though that round those 900 There’s still only one in nine stores that have a Minute Clinic, I don’t think that there’s ever been I don’t think that there’s anything in the current plans for their ever to be 100% capacity of minute clinics at every store. I don’t think that business model actually is that works because you have to pay a new staff member nurse practitioner or run that. Whereas with scripted, we’ve developed a platform where the pharmacist could, in a timely manner, roll out these services that we’re offering. And that can be done at all stores that where states allow it.

Alexander Ferguson 14:13
I mean, that’s the biggest thing is not having to add new car new team members, because that’s a major cost to be able to offer this I just again, I we mentioned earlier at the beginning is I don’t think most consumers and maybe even pharmacist, I don’t know know that they can prescribe do most pharmacists know this now and it’s just consumers don’t realize it. Yeah, they

James Lott 14:31
they know and if you talk to a pharmacist about it, pharmacists are having their own little kind of powwow right now about working conditions. So it might be a little triggering for them to hear this but but we you know, we’ve thought it we’ve thought of that too. I’m a pharmacist and I really do have a lot of compassion for pharmacists and their time and how busy they are. So we think of thoughtful solutions. And we also know the industry needs to change some new practices before this can go at scale.

Alexander Ferguson 14:57
I feel like with with COVID, of course is better huge push for everyone to go into the local pharmacy get get get their vaccines done and other types of vaccinations done. But even I feel like you mentioned there’s like COVID medication coming up that could be prescribed.

James Lott 15:11
Yeah, yeah. So that’s been interesting. So So first off, pharmacists, I mean, if we want to quantify pharmacists impact, if we want to quantify pharmacists impact of how many vaccines they’ve given, they given over 229 million vaccines. 229 million vaccines have been given by pharmacists in this nation. That’s a lot. And imagine, imagine if pharmacists were not vaccinating pharmacists just started vaccinating really at scale like 12 to 15 years ago. So it’s pretty new, but take away that we would all still probably be waiting on our vaccines today, you know, so um, but yeah, with the other thing, the COVID pill, Pfizer has created a pill that is showing, I think something like 89% effectiveness that reduces hospitalization and death in high risk patients, which is phenomenal. Now, we’ve seen some unprecedented policy. And again, this goes to how complex it can be, where the FDA, they didn’t fully approve the drug, they gave what’s called an emergency use authorization, which is just kind of like a temporary approval before the data comes in. Now in their approval, they say only nurse practitioners, physicians and physician’s assistants can write the prescription excluding excluding pharmacists. So at scripted, we personally wrote a letter to the FDA, asking them to explain why because in the last pandemic, which was the h1 in one flu pandemic, they they gave a UA to another flu drug, but they did not put that authorization. So we asked them why and they actually responded. So we got a lot of insight for the FDA. But if you want me to go into that I can but I’m just showing this is how complex it can be. It can be complex at the federal level, you know, obviously a pharmacist to prescribe that drug that could save a ton of lives, right. And they know how So

Alexander Ferguson 17:09
there there is a huge need for for being able to get easy access to medication and being and since the pharmacists are already there in the local neighborhoods, etc. It just makes sense to be able to give them if they have the training, they have the knowledge and the right systems in place. I feel like it makes sense and they should have the ability to do more.

Unknown Speaker 17:30
Exactly. Exactly.

Alexander Ferguson 17:32
So what are you excited about? When you look at your technology and the environment industry? where it’s headed? What can you share what’s on the roadmap, and what are you working on?

James Lott 17:42
Yeah, well, what’s on the roadmap is we are working with some of the most passionate pharmacists in the country. And I’m not saying that for a good sound bite, like that’s actually true. Like, for instance, one pharmacy, we are partnering with, has adopted this clinical model, and literally has turned her pharmacy into a clinic, she now does more revenue in clinical services than she does in prescriptions and growing and she just wants to she saw a wonderful, she wants to help other pharmacists kind of learn her model sharing with with us by way of scripted being kind of a vehicle to connect the community. You know, when you have that kind of a network of potentially hundreds or 1000s of pharmacists all working together and sharing their knowledge. That’s how you scale change. That’s how you scale access to care. And, of course, you know, we are contacted fairly often by you know, some of the pharmacy leaders in the traditional retail setting Chain Leaders, they’re contacting us asking us questions as well, about our model. So, but what we’re excited to do is solve a problem, you know, I started this company, completely wet behind the ears as a social entrepreneur, because I knew I wanted to bring actual change to healthcare. It’s taken, it’s taken a while, but we have an amazing business model that’s sustainable and scalable, and is really going to solve a problem. And it’s not that often you can find something like that and put that to work. So we I’m really proud of myself, my team, and just kind of all the pharmacists who are who think that this is is worthy of their time and implementing into their their business models.

Alexander Ferguson 19:18
What is what is the future of local pharmacy look like then to anything?

James Lott 19:22
It’s funny you say that we actually got, we were actually featured in a study by not a study but a white paper by Deloitte, talking about the future of pharmacy and we were one of a few companies listed in there with our model. I mean, I’ve heard everything from you know, just like pharmacists like doing a quick blood test and, you know, being able to get all your labs and do a health wellness check right then and there that takes five to 10 minutes to pharmacist prescribing and doing things like that. I think that from the pharmacy leaders we’re talking about The consistent thing we have is pharmacists need to stop counting pills and start spending time with patients and bettering their health. Now, I think that there’s in the next five to 10 years that will happen. The question is how? Nobody has a good answer for that. But that’s why again, I feel like our team us, you know, being working side by side with our pharmacists and them helping us they want to help us build this product, which is amazing. I think that we’ll get there first. And we’ll probably show the rest of the, the rest of the profession how to how to get it and how to do it. Right.

Alexander Ferguson 20:37
James, thank you for sharing this journey that you’ve been on and the vision that you’re painting of the future of pharmacies, this this is I’m excited. And and I see I see the vision. So awesome.

James Lott 20:49
Thanks so much, Alex.

Alexander Ferguson 20:51
Absolutely. And we’ll see you all on the next episode of UpTech Report. Have you seen a company using AI machine learning or other technology to transform the way we live, work and do business? Go to UpTech report.com and let us know.