Nashville Blockchain Meetup – August Meetup with Dr. Phil Baker on Prescription Waste

At the August Nashville Blockchain Meetup, we caught up with Dr. Phil Baker, Co-Founder of RemediChain and the Good Shepherd Pharmacy. In this episode, Dr. Baker discusses how he is developing a blockchain solution to address the financial and environmental problems of prescription waste. Across the nation, over $100 billion worth of medication is destroyed each year. REMEDICHAIN accepts donated prescription medication and puts it in the hands of patients who would not otherwise afford it. Blockchain’s transparent, secure and immutable ledger allows for a safe and confidential distribution of medical information.

About Good Shepherd Pharmacy
Good Shepherd is a nonprofit pharmacy designed to meet the needs of people who can’t afford their medications. The GoodShepRx membership program provides access to at-cost or donated medication to over 1,000 vulnerable patients with chronic conditions. In 4 years Good Shepherd Pharmacy has dispensed over $15 Million worth of donated prescription medication to vulnerable patients in Tennessee. In 2017, Good Shepherd Pharmacy gained national recognition for the creation of a prescription repository which accepts prescription donations from any individual in the United States. In 2018 the team launched RemediChain, a blockchain platform that connects people who wish to donate unopened chemotherapy drugs to those who would not otherwise be able to afford their life-saving medication.

About RemediChain
RemediChain is a consortium of prescription donation programs and colleges of pharmacy dedicated to tracking prescription drug waste and resolving the financial and environmental problems associated with it. RemediChain members post donated prescriptions to a decentralized ledger to create a virtual inventory of donated prescriptions across the country. The RemediChain ledger matches medication donations with vulnerable patients while ensuring the highest levels of traceability. The virtual inventory is made available to a national network of facilities dedicated to serving vulnerable patients. RemediChain is a member of Tokenize Tennessee, a trade organization focused on realizing the full potential of emerging technologies to drive a new era in the state. For more information, visit https://www.remedichain.com.

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Hello, I'm Philip Clothiaux. And you're listening to the Hashed Health Podcast. This show is dedicated to everything health care and blockchain related.

Here at Hashed Health, we have begun this incredible journey of developing blockchain solutions for healthcare. And we have the privilege of being able to talk with amazing people about this subject every single day. The goal of this show is to include you in these conversations. Join us as we host meetups, attend conferences and conduct interviews with our friends and other industry thought leaders. You can find more content like this at Hashed Health.com. That's w w w . h a s h e d h e a l t h . com or connect with us on Twitter @hashedhealth. Here we go.

Welcome, everybody. This is the August meeting of the Nashville Blockchain Meetup. I think we gained a few people from thirty six eighty six, so thanks for coming across the river. Thanks to our speaker Phil for coming all the way up from Memphis to tell us about his project. This wouldn't happen without some of our sponsors. So thank you to hashed health, to BTC media, to Frost Brown Todd and to LBMC. And our last sponsor and the one that is responsible for our venue tonight is WeWork and I handed over. We've got some cool stuff going on at WeWork. Yeah. Hey, guys.

Well, first off, welcome. Thanks so much for donating your Thursday night to come out and engage in this conversation. My name is Emily Bruce and I am the community manager for our downtown location, actually. So really excited to be a part of this. this evening. Um, with we work, you know, our whole mission is to help create the future of work. So we're a global community of creators. We have over eight hundred locations spread out across one hundred and twenty four cities. Now, don't quote me on that because next month it'll probably be double. So I was lucky enough to be a part of the original team that activated this Nashville market. And it's so cool to see from 2017 how we've grown in size to now two thousand members in just Nashville. And really, our mission is to disrupt the traditional office space, disrupt that definition. We want people to be excited and look forward to coming into work. It takes up so much of our time. We want you to be engaged and productive while you're here. So that's the idea behind all of the events and the beer on tap and the Kombucha. And at the end of the day, we want also free to look back and be able to say that you really did what you love. The other exciting thing that's going on with us is that if you haven't heard, we are opening up our third Nashville location on October 1st. We'll be adding another 500 members to our growing community. That's gonna be in music row in a class A brand new construction building. And right at the corner of 18th and Chet. And because we love Giles and Hashed Health so much, we actually worked with our team to create a valued partners discount code. So if you're interested, we have two free months. So October-November of our 24/7 coffee shop style membership. Love to give you more details. Get you the hook up. It's just for everybody in the room tonight. So one time exclusive.

Come and chat with me after the event if you have any questions or if you want to get the hook up. And I'm again, really excited to welcome all here. So I'll hand it back over to Giles.

Thank you so much.

Very cool. And that is gonna be an awesome building. I think it's the tallest thing on Music Row and it'll have a view that takes every advantage of that. So I'm going to turn it over to John Bass, our CEO at hashed health. He spent a lot of time recently thinking about consortia and health care and how companies are coming together around specific use cases. Well, you'll see it's going to play right into our presentation for tonight. But I think this is a great way to kick it off. So, John, thanks.

Hey, everybody. Thank you for coming out. Thank you. Thank you. It's been a while since I've talked at the meetup. Well, this is thank you for coming all. This is a meetup that's been going on for since, I think 2015. And we were used to do these in bars. And then we kind of this thing exploded during the crazy crypto days over a thousand members and we've kind of floated along since then. Over the last three years, Hashed has been very focused on mostly B2B blockchain initiatives and distribute ledger initiatives with large enterprises. Our customers are mostly U.S. and European pharma companies, health care insurers, payers health systems and federal state organizations and large I.T. companies through those projects. You know, the work we do in blockchain, it really kind of has to hit this little sweet spot between a use for the technology and why do you need a blockchain to solve that problem? And then an innovative business model that's attached to the use of that technology. What new and innovative business model is made available through the use of a digital asset or a distributed ledger or blockchain? And then is there a network of organizations or people, entities that are psyched to say, you know, to join that network and to do that, use that business model to solve that problem. That is really hard work. A lot of people the hype cycle is kind of like wavy a little bit because there's lots that can go wrong. Technically a non-technical reasons why those things don't come to life. There's a lot of use cases that we've tried that have kind of failed over time and there's lot of use cases that all the clients we work with have tried and failed.

And a lot of times they're failing for non-technical reasons. The business model doesn't have enough ROI, you can't get through legal, you can't get through procurement. It's hard enough to get a health care application through procurement at one company. It's much harder to get it through procurement at five or six companies that are looking to join a consortium. So there's a lot of reasons why that can be difficult. And so as we've seen those spaces emerge over the last three years, we've really started to think we've found some of the low hanging fruit that checks all the technical and non-technical boxes related to bring meaningful work in this space. And now we're seeing consortia that we're a part of and consortia that are, other people are convening out there in the community coming to life. And over the last couple, about the last month or so, we've been releasing some of this research that we've been doing. And I've had help from the team at Hashed Health to start to dive into some of these details. And so the write up is out there on our Web site. It's on our blog, we've done two to these blogs so far. Actually, we've done one. And the second one is going to be released on Tuesday. Nick, we tried to get it out this week, but didn't do it. It's coming out Tuesday and it's designed to kind of look at this activity over the last year and start to look at kind of what we can learn from from what's been happening in the enterprise healthcare blockchain space in twenty eighteen.

Last year there were two kind of large consortia that came together, one. The first was called the Synaptic Alliance, called Gulliver and Mike Jacobs at Kyle's at Humana and Mike's at Optum met up and decided to create a utility across the industry for provider directories. So this is how insurance companies handle their provider directory data. And it's a real big problem. And it's an example of two, you know, two. And now it's kind of become more it's Quest and Multi-planet and Aetna competitors saying, hey, look, we can't solve this problem by ourselves. Let's try to work on it together. And so they're coming together in a group to solve a common problem through a data synchronization effort. And so basically, they're all basically using a blockchain to synchronize each other's data sets and look for how those data sets are different and then solve those discrepancies. The second 2018 initiative that was that became that went live was professional credentials exchange, and it was aiming at solving the credentialing problem for practitioners in health care. So physician credentialing is a problem that has been around for forever and it hadn't gotten any better. It takes on average, six or eight months to credential a physician. They're losing about seventy five hundred nine thousand dollars per day during that process. It's a huge revenue cycle problem and it's one that each individual hospital really struggles to solve on their own. Yet they're still they're kind of doing this work and they're verifying these credentials and they're storing all the credentialing data in a database.

And so this kind of data market concept allows those facilities to open up that data set to others in the community who need to access it. Solving the revenue cycle problem and creating value from what exists exists today as an idle kind of cost center in their organizations. You're creating value from something that traditionally has been a cost and which is which is a secondary kind of value proposition. So that's a really interesting consortium that's coming around this data market concept. WellCare Anthem NGS Spectrum Health Center Health Link. Dimensions Texas Hospital. Jackson Health. A bunch of basically health systems and payers coming together. And then in 2019 you've seen kind of a flurry of consortia announcements across a number of different pharma, mostly pharma insurance companies.

And at this point in time there's very few large insurance companies and large pharma companies who are not involved in one of one or more of these projects. The health utility network is the IBMs network and really kind of kind of evolves around fabric, the fabric SDK it includes IBM,Aetna, Anthem HCSC, Cigna, PNC Bank and Sentara. So again, competitive organizations coming together to kind of collaborate and solve issues.

You Got US, which is focused on the Blue Cross Blue Shield Network, your own data in clinical data, interoperability. You've got metal edger and a couple other pharma focused initiatives. And we're going to talk about remedy change tonight. But Metal Edger is solving the track and trace problem or aimed at solving the Track and Trace problem. And then Melody is really interesting. It's a federated learning solution where a bunch of pharma companies are sharing. They're they're they're doing AI on their chemical libraries and then they're sharing that AI across the network so that if you're a part of this network, you have access to information which helps you improve your drug discovery process. So, again, large competitive organizations coming together to work together on solving a drug discovery problem that they all struggle with today. So these are things where, you know, you have trouble solving yourself so you come team up with a community of others and solve it as a community. Most of these are in the US, Melody is primarily out of the EU and they're on a variety of different protocols. It's kind of a mix between a ethereum forks of ethereum and enterprize ethereum and then some DLT protocols as well. So this is a lead in to to Phil's talk because Phil's project is one of the most interesting, I think on this whole list of really exciting projects. And I won't try to explain it 'cause Phil will do much better job than I would have that. If you're interested in some of this work, I encourage you to go look at the stuff we've been writing about on the hashtags blog and then you can learn more about these projects. And at this point, I'd like to introduce Phil Baker, who's come up from Memphis to talk about Good Shepherd and the Remedy Chain project. Thank you. Thank you, John.

Thank you. I want to just say thank you all for coming out tonight. And thank you very much for having me here to speak. It's really an honor to be included in your host group. Guys, I'm Phil Baker. I'm a pharmacist, lives in Memphis, Tennessee. Graduated pharmacy school from the University of Tennessee of Memphis in 2005. Went to work for a pharmacy chain called Kroger, was a pharmacy manager there for about six years until I just took, quite frankly, got burned out with quotas and just doing more and more and more on your feet, 14 hour days and seeing people getting turned away at the register for an ability to afford their medicines. I left there to go be director of pharmacy for a small hospital in Memphis and did that for a few years. And while I was at the hospital on the weekends on my personal time, I would meet with primarily old people in their homes, empty out their medicine cabinet, and go through all their medicine with them and make sure they were on the fewest, safest, cheapest medicines available. So we're talking grandmas that never throw anything away. We would empty the medicine cabinet, throw half that stuff away, make sure I mean, without fail, I would find that they'd be on to the same medicine or a double dose or the kidney doctor had them on the same blood pressure medicine as the heart doctor, get all that straightened out and then communicate back to the doctors.

The final list of what they should all be on, what needed to be discontinued and what not. That process is called medication management. And so in 2013, the Lord called me to start a non-profit dedicated to doing just that service and which I did. And very shortly thereafter, an organization contacted me and said, If you would be interested in opening a charity pharmacy in Memphis, we can provide you with about 80 percent of the medications you're going to need for virtually no charge. And so initially, I didn't want to open a pharmacy. What I was doing was cognitive. It was a way different. But in praying over that, the Lord made it clear, of course, wanted me to give medicine would of poor people for free. And so we fund raise for a couple of years. And in September of 2015, we opened Good Shepherd Pharmacy in the Hickory Ridge Mall in Memphis, which is a dilapidated old mall in South Memphis. We opened the pharmacy and a former bath and body works, which was really convenient because everybody worked. So so they have lots of shelves which you need a lot of shelving and a pharmacy. We had like eight thousand square feet and we probably needed eight hundred, but it worked out really well for the first three years.

We let me get this forward. I can do that. So. Good Shepherd Pharmacy, what's different about our pharmacy is we opened up with about 250 drugs that were that we've got through manufacturer donations that were free for low wage, low income uninsured patients, which was great, 250 drugs is wonderful, but it wasn't nearly enough. So we really quickly realized that if we ordered the stuff that we couldn't get for free and we just sold it, it cost, then people could afford their medicine. It was really that simple. We our first patient. We literally took her from six hundred dollars a month down to 60. And so we realized, hey, if we charge a monthly membership fee, she's going to save 500 bucks a month. We can charge her 40 bucks a month as a membership fee. We can keep a roof open over our heads and she saves tons of money. So we're the first that I know of membership model pharmacy in the country. Our members pay a monthly membership fee of $50 a month if they can afford it. If they can afford it. We sliding scale that down to zero as necessary. And then they get all of their prescriptions either for free or at cost. And it costs means the costs that the pharmacy pays for the medicine. I always use the example of Plavix, which is one of the most commonly prescribed drugs in the country right now.

30 generic Plavix at a regular pharmacy will run you anywhere from 50 to $250. Our cost on that is about eighty five cents. So people always go, Oh, I bet that's cheaper, but they really don't realize how bad the markup is on prescription drugs. Where we focus is on chronic medications. So there's two kinds of meds. This is my mozo box with simplest way to explain it. Two kinds of meds. There are chronic meds and acute meds, acute meds or the stuff that you take for less than six months. That would be pain medicine, antibiotics. You're just gonna do a short course and you're gonna be done with it. Chronic meds, you're gonna be on for six months, usually for the rest of your life. Diabetes medicine, blood pressure medicine, cholesterol medicine, all those things. We're really good at lowering the cost on this. Chronic meds, the stuff we know you're gonna be on that we can order in bulk kind of our secret sauce is we sync up all of our patient's medications so that they're all do at the same time so that we're filling prescriptions four times a year for each patient. Only that way everything's in one package. Remailer, reformasi, everything gets shipped out together and all of their medicine is kept on the same schedule all the time.

We just this year added We we are a mail order pharmacy. We added same-day delivery through a project called Scrip Ride that I'll talk about later on in this presentation.

So no insurance, no 30 day fills. All the current pharmacies in the country are built around 30 day fills. The way pharmacies make money is in three ways transaction fees, the markup on the drugs and dispensing fees. And so those are a lot better when you do twelve films a year versus four. And so we don't do any. If a patient needs a medication between our Sept ship dates, then they get just enough pills to last until the next ship date and then everything goes out back up together and everything's kept on the same schedule 50 bucks a month and on all medications at cost.

We opened in September of 2015. Since that time, we've served about thirty five hundred patients. I need to update this slide. We've got a thousand patients on the books right now. At any given time that we're serving fill in refills for our membership. Fees have generated about closer to 2 million dollars in revenue and we've read dispensed about $18 million worth of donated medicine that would have otherwise been flushed down the toilet for these 1000 patients in terms of what we can't get for free.

We saw order about one hundred thousand dollars a year for a thousand patients of drugs that we actually have to sell it costs. So just kind of give you an idea that looks like most of the medications that we get come through three nonprofit wholesalers.

The Dispensary of Hope is the biggest one there right here in Memphis. AmeriCares and direct relief are becoming bigger.

What that looks like is Pfizer doesn't want to donate a single bottle of pills to Phil Baker in Memphis, Tennessee. They want to donate a pallet of pills to one place. So these guys accept big donations and then they distribute it to charity pharmacies all around the country. And so this is where we primarily this is where we've gotten everything up till now. This is really good for the cheap stuff. The manufacturers are quick to donate that. It started with stuff that was short dated, but the tax benefits have gotten so good that they pretty much keep us in stock with everything that they're willing to donate. The really expensive stuff and these are all oral chemotherapies are in the hands of patients. And so until we started the remedy chain program, there was no legal way for people to donate those medications. Pharmacies can't accept prescriptions back into the pharmacy once they've been dispensed. There are a few programs around the country that allow hospitals and nursing homes and health care facilities to donate unused meds. But there were none that allowed individual patients or. Family members to make a donation.

And so we politic-ed for two and a half years and worked with the state of Tennessee to get a law passed so that we could start a reclamation program that allows us to accept donated meds from individual patients. Good Shepherd Pharmacy is five people in Memphis, Tennessee, a small nonprofit. I knew we couldn't just open up the flood gates and accept anything anybody wanted to donate. So we had to be specific. We chose oral chemotherapies because they're the most expensive medicines and they're also some of the most wasted. 40 percent of cancer patients pass away every year and they're on these meds when they pass away. And so that was the genesis of the Remedy Chain program. Really early on, people started coming into the pharmacy with bags full of medicine and they'd say, hey, my grandpa was on hospice with cancer. I've got all this medicine. It's unopened. There's nothing wrong with it. And I want you to give it away to poor people. And that was illegal. So we changed, got the law changed that we could start this to make that happen.

That the Web site. So two and a half years to get the law changed.

We finally could start legally accepting donations in October of last year. What that looks like is we threw up this Web site is kind of an MVP to see what would happen if you go to remedy change dot com. You can do two things. You can either donate an unused medicine or you can sign up to get on a waiting list for a medicine that you may need. Since October, we have brought in two point two million dollars worth of oral chemotherapies, about one hundred and fifty individual donations. These medications are a thousand dollars a pill and we've gotten about one hundred and about one hundred and fifty individual donations that have come in, about half of them from family members.

And the other half from cancer centers. A handful of cancer centers around the country where the patients have taken the meds back to the cancer center. That's the kind of the front end of what we're doing. You guys are a blockchain group, so I won't try to explain that to you.

What the blockchain piece looks like, you know, all this work was happening well before I learned about blockchain. The truth is, in February of 2018, I read a little book called Blockchain for Dummies or something like that. And I'm not a technical person at all, but it just kind of clicked in my head. That blockchain like this would be a great use case for blockchain. These are really high dollar valuable physical assets that can be tracked in the U.S. We track medications from the manufacturer to the wholesaler or distributor to the pharmacy and then we don't track them any further. So when we reclaim a medicine, it's off the grid, so to speak. Blockchain is the way that we reestablish chain of custody. And with all the systems that are being built out there with metal, ledger was mentioned as a really good one. We can reestablish chain of custody. We can backtrack that chain of custody on the medication and create a recreate the chain of custody from a blockchain perspective and then follow that to either it getting dispensed to a patient or being destroyed. The the remedy chain consortium is a blockchain network where the nodes on the network are universities and repositories like Good Shepherd. So the universities are the the nodes in the sense that each one will hold a copy of the ledger. You know, through consensus though, add delete drugs where we're basically maintaining a virtual inventory.

The repository sites are where the meds are coming in and where they're going out. So they're adding data to the ledgers and the universities are backing those up. It's kind of the database. The while it's great to read dispense medicine. It's equally important to just not flush it down the toilet. And there is no organization in the US that tracks prescription waste. So the Remedy Chain Consortium is dedicated to re-dispensing as much as we can possibly read dispense. And the goal is to re dispense everything ultimately. But the umbrella mission is about prescription drug waste and tracking that and seeing where the big wastes are and how we can affect that and how we can change that. And that's why the universities are really interested. They're interested in capturing this data that doesn't exist anywhere else so that it can be studied so that we can possibly influence manufacturing principles. Ideally, if everything were manufactured in blister packaging, single unit dosing, then everything could theoretically be re dispensed. If we can assign a dollar value to say, hey, Pfizer, this forty five thousand dollar drug, if you'll invest a million dollars in blister packaging, it'll turn around and allow us to recycle 16 million dollars worth of meds that we can make that case. You can't manage what you don't measure.

And so we want to start by measuring and tracking medication waste and actually what is now not just in the US but around the globe. So a couple days ago, we did a press release to announce we just signed the Lebanese American University in Beirut, Lebanon. We're in talks with the University of Zimbabwe to come on as well. And what's interesting is. While prescription waste is the overall umbrella mission of the organization, each country represents a different use case for blockchain. So in Nigeria, for example, counterfeiting is a real problem in the US. Its waste just stuff being flush. But in Nigeria, it's counterfeiting. And in Beirut and in the Middle East, where the governments tend to pay for the medications, then the black market is a big problem. You know, drugs making out of the supply chain, being stolen, black market. And so we're putting together this consortium that is prepared to apply blockchain in different ways for different use cases. We've currently got four or five universities and we have repositories in Texas, Iowa, Tennessee and Georgia.

So the goal is to have one repository university payer, at least one in every state and to build a national network so that we can distribute these medications to patients who need them before they expire.

We were recently chosen to participate in the FDA pilot with the Remedy blockchain team. And the pilot we proposed to the FDA was to look at donated meds and redistributing them to repositories all over the country like I just described. After they accepted us into the program, they said we'd love your idea, but you can't use donated meds. So we kind of had to rethink everything. And what the pilot project is now and the reason there's a a drone up there is we're looking at a lot of like mental ledger and different systems are looking at blockchain from manufacturer to wholesaler or distributor. Nobody is really looking at inter or intra hospital system transfers. So what we're gonna do is we're going to transfer some temperature controlled medications between two hospitals using a drone in North Carolina to zap us both in building the blockchain system. That's going to keep track of all that at the same time. So that's actually kicks off within a couple of weeks. And there'll be they're going to publish the results from all of that. I think in January of next year. Another blockchain project that we're working on that's kind of interesting is scrip ride, and that's can be you can check that out at scrip ride dot org where mail order pharmacy. We serve low income people that don't have a lot of money. Postage went up this year like 17 percent in January. We had to raise our shipping fee from $5 to $10. And then in June, it went up again and we were like, man, we can't charge fifteen bucks a package.

What are we going to do? So our folks are low income. They're paying ideally they're paying 50 bucks a month for their membership fee. We thought, man, it'd be great to leverage our members to make pharmacy deliveries and let them earn credit, potentially crypto where they can pay down their membership fee, 10 bucks per delivery. Pay down your membership fee. Five deliveries, your memberships free that month. And so we built out scrip ride to do just that. And in February of this year, we did a beta test with it where we use six volunteer drivers to deliver 200 packages. We charge $10 per package. So that allowed us to put two thousand dollars right back in our pocket, which for our little nonprofit. That's a that's that's like a two thousand dollar donation. That's a lot of money. And when that happened, it kind of clicked in my head. Well, this isn't just about prescription deliveries. This is a platform that any nonprofit can use to leverage volunteer drivers in the same way any nonprofit that does any sort of deliveries, whether it's prescriptions or teddy bears or meals. They can leverage this to have people volunteer their time to make these deliveries and save that expense. What kind of push this over the top was when I found out that you can actually write off your mileage as a charitable donation. Right now, that's 14 cents a mile, but it's there's legislation in place to hopefully push that up to 58 cents a mile next year.

That the same rate that you would write off for business. And at 58 cents a mile, that that's pretty significant. You can make a, you know, a few hundred miles of deliveries in the course of a year. That's that's worth writing off your taxes. And so scrip. Right. Has been something that we've incorporated into Remedy Chain and into Good Shepherd Pharmacy and that we're using it to make these deliveries. But we're also tracking the medication all the way from donation to pharmacy to patients hand from a blockchain perspective. And so script. Right. Again, it's and it creates a new mechanism for community members to support the charities they love by doing delivery services, kind of how all three of these projects come together is here. Good Shepherd Pharmacy. We recently partnered with Eli Lilly to get what's supposed to be an unlimited supply of free insulin to provide to low income folks. We've got delivery of five hundred vials of insulin and the folks that we're serving with this insulin haven't been able to afford it. So they haven't been getting insulin for quite some time. That means they need a glucose meter. They we get the insulin and vials, which means you need to use a syringe to drop your dose, which a lot of people don't know how to do. There's an education component to this. So the way that all three of these come together is we use Good Shepherd Pharmacy. These kids you see over here, these are all fourth year pharmacy interns who are delivering the insulin, using the scrip right application to the patient's home where they sit down with them.

They show them how to use the glucose meter. They show them how to use their syringes, and they ensure that they put it in the fridge and get it all in, tracking it all on blockchain, all in one nice little package, if you will. So I show that to say that while we're talking about three separate projects, Good Shepherd, Remedy Chain and scrip. Right. They really all do play together in this unique way. We partnered with all these organizations. We've really just kicked this off. We started accepting donated medications in October of last year, but everything really happened this year. And it's just incredible how far we've gotten so fast. And so a lot of partners, FedEx Institute of Technology, University of Memphis, Lipscomb was the first university to get on board with the program. They're the founding node in our blockchain network. And then most recently, the Lebanese American University in Beirut. And this is the founding team. You see myself up there. And I I've made this this morning on anybody's names on there. That's Kevin KLOSSON from Lipscomb University. He's one of the co-founders, i.e., they are net. Robert Miller works for Consensus Health. And Jason Fisher has a software development company out of Romania. He lives in Memphis as well. He's our CTO and then myself. And and that's it. That's Good Shepherd.

I loved your presentation, and I think what you're doing is really important. I don't know what politician it was. I've got a bad memory. I think it may have been Bernie Sanders who recently took a group of people up to Canada in reference to the cost of insulin and found out that you can get it up there for a lot cheaper to get us here. Right. And we know that's true around the world. So we have a pretty significant problem here. I have two parents who are both. They're both living 82 years old. They're separate in different parts of the country. But, you know, they rely on pharmaceuticals, of course. And I would say that, of course, pharmaceuticals are very important for keeping people alive. Probably both of my parents would not be alive were it not for pharmaceuticals. So I'm not anti pharmaceutical. And yet we see so many problems with pharmaceuticals. I'm from Indianapolis. Eli Lilly is in Indianapolis. I grew up with everybody talking about how Eli Lilly is just the most wonderful organization company in the world. And yet they were the first ones to produce methadone, which, if you read deeply into it, has not helped the heroin opioid epidemic, but rather as it continues to harm it. There's a lot of literature on that. I don't consider it controversial anymore. I consider it factual.

So, you know, there are states now suing pharmaceutical companies for gross negligence in talking to people about opioids and saying, you know, this is going back a few decades saying opioids don't really pose a threat. You don't have to worry that much about it. And again, states are suing these companies for gross negligence. And I believe it is gross negligence. I believe it's putting profit before people profit before planet. And that disturbs me greatly. So, again, I love what you're doing. I cannot say anything negative about it at all. But I can say a lot about than I can say a lot of negative things about pharmaceutical companies and about the direction that we started out into the turn of the century with the Carnegies and the emphasis in universities, medical schools on pharmaceuticals, as opposed to an emphasis on preventive medicine and nutrition. One more thing. Charles, thanks for that. Because, you know, I can talk forever. But one more thing is that I talked to two years ago. I met a young lady at the dog park when I was there with my dog. She was a third year medical student at Vanderbilt. And she said two dates at that time. They had she had had not a single class on preventive medicine or nutrition, that everything was memorizing pharmaceuticals, memorizing pharmaceuticals. So, again, while I love what you're doing. My question to you, I know it's shocking that I would actually have a question. My question to you is, where do you see. Let's just talk about this country, because it's my country. The rest of the world tends to follow sadly sometimes. But where do you see America? 50 years or 100 years from now? Do you see us having a pharmacology based a chemical based health care system or do you see us possibly being wiser and moving over towards natural remedies, preventive medicine and end nutrition? Thanks.

Yeah. Great question. So I'll get on my soapbox, but I'll tell you briefly that I think that health care is the biggest threat to our national security. I think it's my generation's World War 3, and it's a problem we've got to figure out. I think the solutions are going to evolve trite. Price transparency and blockchain could play a big piece of that. I am optimistic. So I do think we're going to figure this out. I think we're gonna get past this opioid epidemic. Contrarily, I don't see a huge piece for blockchain and fixing the opioid epidemic there. Already the most controlled substances in the world. Blockchain doesn't add a whole lot there. I hope I'm wrong, but yeah, that's kind of that's my take on it.

My two cents.

I'm serious. Thanks for your presentation.

I wonder how do you assess the patient's need and the fact that they can't afford or they can only afford a certain amount, and especially for patients who maybe they can afford their medicine right now, but then their car breaks down. They have a five hundred dollar bill and then all of a sudden can't. So they had to, you know, prove that.

I'm so glad you asked that question, because our policy is we take everybody's word for the first 90 days, wherever you're at. Like I I've known doctors that make 150 grand a year. Some of these meds like. These chemo meds, if it's forty five thousand dollars a month and it's a 80:20 insurance plan, then you've got a $9000 co-pay. Wealthy. I couldn't do that. I couldn't do that to him for the first fill. You know, so I say that to say that we don't have a strict policy in terms of what income limits are hard to determine how we scale down that membership fee. We meet them where they're at. We do after we get them going. We walk through. We always meet people in crisis. So they've usually just had their first heart attack and now they're going to be on these four meds for the rest of their life. And or they found that they've got cancer. It's never like good news when they come to us. You meet them where they're at. We walk them through the first 90 days. And then at the second 90, we're like, okay. Can you do 10 bucks a month? Can you do. You know, we just start having a conversation with them as long as they're talking to us and they don't just cut out then. We keep having the conversation. If you can't pay this month, you can't pay. But you need to at least let us know what's going on.

We want to be praying. We're a Christian organization. We pray for our members. We have a prayer list that we pray for every single morning. And we walk through that crisis with them to get them to a place where they can they can contribute and help us keep a roof over our head and continue to serve them on the cancer side. And this is kind of the blockchain piece that didn't get into there. Every state is its own island in the sense that each state determines who can have these meds. In Tennessee, they have to be low income and uninsured in Texas. It's first come, first serve. Where you got insurance or not, it doesn't matter. So from a blockchain perspective, when we match up a donation that came from Tennessee that goes with a patient who lives in Texas, we got to smart contract our way to say, okay, this patient is insured, but they're low income, so they qualify in this state for this matter or whatever, so that we're making sure when the donation is made, if the patients on the waiting list and they made all the certain criteria. Up, up, up, up, we know that the shipping label is going to print off on the donation is made is going to be to the Iowa reclamation program. So it go straight. There's they can dispense it to the patient.

So that's a little different. And that's why there's two answers to that question. Yes, sir.

Thanks. You may have mentioned it, but when you were trying to figure out this problem, how did you land on blockchain? Was the right solution, the right tech solution to help you solve this problem efficiently?

It was it was literally I read a book that was Blockchain for Dummies. It wasn't titled then I forget what it was now, but it was a little pamphlet about because I'm not technical, I'm not a coder. I couldn't hook a printer up. I'm really I'm not exaggerating. Say, I'm not at all technical, but I read how the cryptography work.

The hashing, how digital assets work. And it just just clicked for me that this is a great use case is a great use case. Every drug has an NDC number, which is a stroke code has a lot number. It has an NDC. It's like it's coded hash that you've got your you know, perfect, perfect works out, presumably. So that was I'm a Christian, I would say just inspired. And I wasn't certain, though. Hey, I have this great idea. What happened was I looked on LinkedIn to find anybody blockchain in pharmacy. And that's how I found Kevin KLOSSON at Lipscomb University Cinema blind email that said, hey, I'm this nonprofit guy in Memphis and I have this idea. What do you think? And from there, he made introductions. And a year later, you know, here we are. This really happened quickly.

But hi, this is I feel really moved by this business model. I think it's really cool what you're working on. It strikes me you mentioned price transparency and it strikes me as you explaining how Good Shepherd handles. I'm kind of taking them at their word for what they can afford, that you're proving you're proving a totally new business model that isn't focused. Doesn't have to be focused on vulnerable populations at all. And you've already changed laws. So my first question is, is there a broader vision for attacking things like EMS and like the price transparency issues? And what is that? And my second question is, how do partners like Eli Lilly think about that? Like, how are you pitching that to your stakeholders?

Well, your second question answer first is I don't know how they're thinking about it. Like right now, we're small, we're under the radar. They Eli Lilly connection with the insulin came through those three wholesalers that I mentioned earlier. Wasn't me on the phone with them working a deal by any means? The insulin thing was a pilot program they piloted for two years that once the pilot ended. Then we got looped into the next wave.

So that was that one price transparency and PBS. Ms. Good Shepherd. I talk about low income uninsured patients, but only 60 percent of our thousand members are low income and uninsured. A lot of them are have insurance. It's just cheaper to get their meds from us. So if you have insurance and you have a $10 co-pay and you're on 10 drugs, it's 100 bucks a month. You can probably get those same drugs from us for your $50 membership fee plus $4 and 50 cents for the drugs that we can't get. You know, it just makes financial sense to use us. So the business model like you can. We've proven that you can. You can be an honest pharmacy without marking up drugs. We've extended that this year to working with self-insured employers where we're doing the same thing. We. Are completely transparent about what we're charging the employer for the prescription. We make our money on a fixed per employee fee, per employee per month fee, and whether that employee's on one prescription or 10 at the fees the same. And then where we can be honest and then work by seeking them up, we could drive prices down crazy because once every 90 days we order in bulk can get better deals and pass that onto the the the employer. And so like that said, that has spun off this whole other business that we're doing. That's completely true. It's called ERA our X. If you wanna check that out. But yeah, that's that's.

How do you select the universities or people who organizations that can run the nodes. Is it available to any university would be interested or do you get them some way.

Yeah, we we blamed it on universities because there are six colleges of pharmacy in the state of Tennessee and I thought if I can get just a couple of those and we could do a cool program in Tennessee, we got Lipscombe and then the phone started ringing. The University of Memphis does not have a college of pharmacy, but they wanted blockchains, a hot topic. They wanted to be on board. And then specifically, prescription waste data is a bigger deal than I realized. Any area. So the universities, their currency. I would say in my opinion, their currency is studies like anything that they can recruit funding for to do a study on. Is a good thing. Blockchain is a good in that area. And then prescription waste data where there's no data is another one. So they're interested in it specifically for those. So originally it was colleges of pharmacy and then it's since then it's just it's open to whomever. It doesn't necessarily have to be a college of pharmacy. The data is being added by the repositories. Good Shepherd is a repository. USDAW is the legal entity that can touch a prescription.

Say this is safe to reuse and a lot of states don't have them, but a few do. And so the they're the ones that are actually adding data to and taking and dispensing data. You know, removing drugs off of the ledger. The universities are just holding that, keeping it secure. And then ultimately studying it. And in any and it doesn't have to be university either very large health care or organization, a big hospital system. It could. It's wide open within Lebanon. We're with the Lebanese American University. But we're having lots of talks with the Ministry of Health. The Lebanon was strategic in that it's a first step. I have a heart for. There's two million Syrian refugees in the north of Lebanon. And I want to give meds over there some kind of way. Those refugees don't need thirty thousand Arkema Ms. As they need like blood pressure. They need the regular stuff. So it's a first step. The system that allows chemo meds is going to allow everything else. But that was the intention behind that. And I say that to say Ministry of Health, we've been in conversations with them. We could partner with the government in order to get meds into the country. We have to go through the government anyway. So we're looking to see what that will look like in Zimbabwe and in most of the African countries, like counterfeiting is the big thing. And so Zimbabwe, we're talking to the University ISM's of Zimbabwe. At the same time we're talking to the government. It's just like maybe they'll fund the university to do it or or maybe they won't. But that's where it's at.

Thanks for talking to us. Really impressive implementation in a short amount of time. I was wondering if you could just speak a little bit about the way your blockchain works, nuts and bolts wise. Is there like a data validation amongst these disparate parties or what are you doing on the actual under the hood?

I don't know how much I can get into that. So like I said before, like every drug is pretty identifiable in that it has an NDC, a lot number and expiration date. These drugs are getting QR codes in serialised. That's another kind of big things happening in pharmacy right now. Where does the manufacturers are tracking to the package level? Previously, they only ever track to the Latin the lot, which may be a thousand packages or maybe a hundred. It's completely variable, but now they're tracking it to the package. And so that's helpful for what we're doing in terms of validating we that's really simple because the the buck stops with the repository. So legally, once the pharmacies at the repository says this is good to go, then it's good to go. And it's been validated. There's no highly technical process to that.

Are you tying it from, say, you said the tracking really flows downstream from manufacturer to wholesaler to pharmacy and from there you lose track. And so when this gets back into the data stream, are you tying it all the way back upstream?

We are now ideally in a couple of years from now when d-s.c assays in place, there'll be systems where we can just do it like that. And metal ledger would be one of those systems. There are several others. They don't exist today. But the drugs we're looking at these the specialty meds, they go through a handful of pharmacies around the country. They're not being dispensed at Walgreens. They go through specialty pharmacies that are contracted. I say that to say that it's pretty easy to backtrack and we get them. We know what pharmacy they came from. We know from the NDC number of the lot number, especially who manufactured them. So it's usually two data points between that and we're backfilling that data.

Now, if they are serialised, then it's even it's that much easier, less tangential question is this do you do as a repository? Are you verify? How are you verifying that drugs have been stored safely or safe for reconstruction?

Yeah. OK. So we can only read dispense tablets and capsules. It's like only the safest stuff. It's tablets and capsules in pristine condition.

Nothing injectable, no patches, no inhalers, no creams, tablets and capsules that are in the original manufacturing packaging, which means the box unopened or they've been blister packaged. A lot of times hospitals and nursing homes all poured out of the bottle in blister package. It were allowed to use those. Lucky for us, these chemo meds, I had that picture of those totes, they come in pretty fancy packaging, which is blister packaging already. So that makes it really simple. But we're what we're not doing is the Amber Vial you get from Walgreens. You know, that's been open where I'm accepting those to dispose of them and to track them. But we're only re dispensing the safest meds. The only proper way to dispose of it, incinerate them. And so we want a grant from the Assisi Foundation in Memphis in January of this year to pay for our own incinerator. And we haven't bought it yet, because I'm going to have to believe it or not, a commercial grade incinerator that burns its own smoke and is DEA compliant is fifty thousand dollars. It's not that expensive, but where you can put it is very, very tricky. So I'm going to have to run to locations whenever we finally do buy it.

Just to follow up on the blockchain elements, specifically, the universities are running nodes. Can you talk about what it is they're running, in other words? Is it? You also reference metal ledger. Is metal ledger the blockchain layer or is that a separate.

So metallurgy. What's the blockchain? OK. Wasn't what what platform are we. Yeah. That's the question. Right now we're we're building on Enterprise. Theorem. However, we got a really sweet offer from a company and it's done some cool stuff on Hyper Lecher just last week, and so we're about three weeks into the build and we've gone, oh man, we need to hear these guys out. So I don't know that we won't end up on hyper ledger before it's all said and done. But that's what we're at right now. As of today, we're building on theoryand. But you're clearly not using the public at theory. I'm not on yet. The goal is to use the public theoryand. Oh okay.

You know, I'm wearing an Oregon shirt. So for all you Auburn fans, good luck this weekend. And I see the Lipscombe connection up there. So. I also went to Lipscomb's So You Make Me Proud. I'm here because some Mr. Christie at FedEx said that you see interesting things in missing live on the green. So I can be here to hear you. And this is really fascinating. What's the lesson in in sort of blockchain resilience? What would be the lesson that you've learned that you would want us all to take away?

Whoo hoo!

The first thing that comes to mind is that it's so early on every like there's nobody's got nothing. Don't know a nicer way to say that. There's a lot of people talking about projects and talking a whole lot. And when you get down to what you would have, you actually believe you actually done. There's very little actually going. It's very early on. Like I read Blockchain for Dummies 18 months ago and I'm considered an expert in the field. It's that early and that's encouraging. That's a good thing. But that that's the first thing that comes to mind. Second thing is it's wide open. It's the Wild West. And a guy who doesn't know who guy who read Blockchain for Dummies 18 months ago can get a national campaign going pretty quickly and actually affect lives by using blockchain. You know, it's really it's simple to understand why at least I shouldn't say that so many people get confused. What is fundamentally really simple to understand, which is about data transparency, data integrity, people working together for the right reasons. Blockchain is one thing, but decentralization is another. The whole concept is just really it's exciting and so that they'll be the thing I'd say. Quick question here.

Who's funding you guys and moving forward? How do you expect or anticipate or hope to grow?

The the long term answer is that the universities will pay an annual membership fee in order to be members of the consortium to have access to this data that allows them to recruit funding to do studies on the data. So a win win in that regard. There's a bunch of different ways that we could monetize it. To date, we have gotten we've gotten $5000 from Lipscomb University and it's all the money we've gotten. That way, it's not a whole lot. Everybody that's involved in this project's doing it on their own dime. We're looking at. We've got a really good opportunity. We're running a small business innovation research grant with the National Institutes of Health and Néstor Cancer Institute. That looks like a home run for us. But those things are never guaranteed. I'm proud to say that, like, we're just I honestly believe if you take care of people, the money will take care of itself. And so we're just pressing forward. I've got 2 million dollars worth the drugs that show that and and having faith that it'll work itself out.

Quite frankly, we're not I'm not I mean, I didn't ask for a donation. Like we're not kind of doing that thing. We're just looking for new partners. And as we sign up more universities as potentially more revenue. And if we get this big grant, then that will definitely help.

Well, thank you so much, John. Thank you.

You've been listening to the Hash podcast presented by Hash to help find more content like this, hash health.com or come to our next meetup and join our growing community of blockchain professionals, enthusiasts. Learn more at Hash Health.com. Thanks for listening. We'll see you next time.

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