Working In Oncology
Working In Oncology

Episode · 2 months ago

The Oncology Sales Ecosystem: How It Works & How It’s Changing w/ Richard Stein


Oncology office staff might find themselves asking: “Who are all these reps? What’s the deal with these emails, calls, pamphlets, and visits?”

The umbrella of oncology sales can be complex. It includes several roles and touchpoints, from securing sales to guiding physicians and nurses to helping educate patients.

Richard Stein, Former Senior Manager, Inside Sales at Amgen, joins us to provide a deep dive into how the oncology sales ecosystem works, as well as the relationships between sales and practices.

We talked about the specifics of each position, how these positions can overlap with others, and how COVID-19 has impacted the way everyone communicates and works together.


Here are the show highlights:

- The difference between inside and outside oncology sales reps (4:00)

- How COVID-19 has affected relationships and sales processes (20:16)

- A rep’s guide to setting expectations with physicians and office staff (28:58)

- How can we empower patients to advocate for themselves? (33:17)

- Tools and resources to help patients pay for their treatment (41:21)

To hear more interviews like this one, subscribe to Working In Oncology on Apple Podcasts, Spotify, or your preferred podcast platform.

You are listening to working in ancology, a podcast and video show that spotlights ontology practice staff andindustry. Influencers who work behind the scenes to shape the future ofacolade, the more knowledge the ecologycommunity shares with each other, the more we all grow, let's get into theshow, welcome to working in acholoe on yourhost for the day at lisa evans, i'm joined by richard stein, former seniormanager and of inside sales at m jan alicia. I everybody hey richard,welcome to the show i've been really looking forward to our conversation.Today you have twenty plus years of oncologist sales management and salestraining experience, and i know our listeners are going to find so muchvalue in what you are going to share today. I hope so so before we get into the conversation,can you tell our listeners and viewers a little about a little bit about you,your background and what you do sure so i have been in, as you said, i've beenin on cology sales and i've been an encolere manager and national senhousetrainer and oncologist for you know over twenty twenty five years andstarted out selling adria myson, believe it or not. I'm aging myself, alittle bit so branded adra, minson and specialized in a lot of solid tumorsthrough the years o breast cancer color recto cancer, prostate long globles,oma, ovarian head neck, really the gambit of solid tumors and and a littlebit of liquid toomers as well. It's been a wonderful career and it's beenreally great, being able to help patients, fine therapies that work forthem, and so i'm just happy to be here and hell bolt and we're glad to haveyou here richard. Can you tell me a little bit more of why you went intoanchoy? Well, i mean it was kind of very serin dip itis. I started off witha very very small company called kobi pharmacia and one thing led to anotherand cobby pharmacy: a purchased adria labs which had the acholoe side andjust you know, stayed in an cology and i had you know a lot of success with it.So my mother is a breast cancer survivor, she's been thirty plus yearsaout, and so for me, this is kind of personal. It's a i love being able tohelp people who had loved ones, who've been affected by cancer and talking totheir physicians and providing information and the science to help thephysician make a great treatment therapy that is best for them so thatthey can. You know, although you can't say it in a clinical discussion to helpthem live longer, have a good quantity of life, etc. All bout back to thepatient advocate everything, as everything has to be about the patientan so. You have a long record in the sales industry and as an office staff,sometimes you're overwhelmed by the different people who come in the office.Who are they? What do they do? Why are they all sending the emails? Why arethey all tending me pamphlets? Can you help us kind of pars out like who is?Who who are all these people coming to visit me, because we all love visitors?We all love to like the chat to you, but who are they and what are theydoing on my phone yeah? I so so, basically, who are they and what isthere? What is their purpose in the office? Yeah yeah? So with that being said,depending upon the sales organization or the sales company they may be, andnow post covin, it's very possible that they're using more of the the sales arm of an inside salesprogram and those sometimes are used. The inside sales people are used topromote legacy products that may not be...

...promoted by the outside salesrepresentative, but still has a use within the office. A great examplewould be like new lasta, which is heavily used to prevent any kind offebrile, eutrope nia, which can be life threatening, but isn't necessarilysomething that's talked about by an outside sales represented. So you haverepresentatives like that who are still promoting and trying to maintain marketshare for older products. Then you have the outside stales represented thatactually are knocking on doors and calling on the physicians and withinanchoy the chemo nurses. If the office or facility like a hospital or a largeclinic, they may have their own pharmacy, so they're going to speak topharmacists. As far as a dosing, an administration, okay, they'll speak tothe nurses, about side effect and therapeutic benefit and they'll speakto. Obviously the doctors about therapy therapeutic benefit. Who are the rightpatients who are the wrong patients and then also you may have an outsiderepresentative talk to somebody, the office manager regarding reimbursement.You know making sure that they get they're coating the medicationcorrectly so that the office or the physicians getting paid so ja codes.What not and then there's also again depending upon the company and whatthey're going to do so. We talked about inside, say we talked about outsidesales, then there's a key account manager. If the office is part of alarge franchise of medical offices like in the state of florida, you haveflorida cancer specialist. That would can be considered a key account becausethey influence many many different satellite offices. So you would makesure that if there were contracts within a particular product there ispull through with that, etc. Then, also, if you're talking about a very largepharmaceutical company, they may have nurse educators who would go in andeducate, nurses about side effect, management, drug adherents andcompliance, making sure that the nurses are because nurses, whether it's achemo nurse or an oncologist and oncologist fied nurses or sometimesnurses, the turnover is, can be high. So they're, constantly educating thenurses about side effects and or about a treatment protocol or your drug ispart of so there's constant education and and other programs, and then alsoyou might have a reimbursement specialist that would go into theoffice and make sure and educate the office manager to make sure thatthey're getting reimbursed from insurance, they're doing j codescorrectly. As answering questions, if something is denied, they may help theoffice to a certain extent on making sure that there's pull through. If,let's say something is denied- and it's being let's say it's a brand new drugand it has a brand new drugs, they have a interim j, nine nine nine code andthat takes a while for a permanent code to be assigned to that drug. So theymay help with that. You know some time of t o t r t e a d, sixteen ninety typeof thing or if it's being challenged, okay, the insurance company, that's a lot. I also hear a medicalside, pleas on that the term that, yes, thank you yeah. I bet you almostslipped our conversation, so medical science, leason would obviously work onthe medical side. That's conversations that an outside sales rep can't talkabout so the outside sales representative is is bound by what thethe prescribing information says that has been approved by the fa. Medicalscience. Liason may get into conversations that are medical and alsotalked about clinical trials. That an... may participate in or a largepractice may be part of so medical science leason would ever like anentire state or states, and they would handle that so they're part ofmetathesis side and not sales. So that's why they're, separate and andand thanks for bringing that up and almost passed my mind no ray. So if youwant to talk, you want to ask someone about kind of the medical details, the ready upcoming trials. You want tospeak to the medical science ly. The medical person knows things at theoutside sales person may know about, but can't discuss, but sometimes they don't know to detail what a ms ldoes know, and so, let's say a physician: you have a drug, that's forbreast cancer, but there's clinical data that has been presented at asco oresmo and those are all medical study groups that actually put together. Youknow, conventions and everything like that for medical information exchangeand the doctor says: hey i've heard about your drug, it's approved forbreast cancer, but i heard that it's. It has good clinical benefit in, let'ssay lung or another, two or time an outside sales representative cannotdiscuss that there they're really there. The only response is, is that you knowdoctor i've also heard of that. But clinically i can't discuss thatclinical outcome with you. Let me transfer you to our medical departmentand that's where an ms l may come in, or somebody from the medical side willthen approach or contact a physician either by email or by phone call andgive them that information so richard it sounds like if i want tohave a deep science research conversation. The person i want tospeak to is the medical science lesrel. Like i said i, the sales person canonly discuss with a physician the prescribing information that wasapproved by the f da for that drug and the disease state that it was that thefa approved in it anything outside or what's called off label has to gothrough medical, okay and there's a ragin. For that i mean you, don't wantsomeone in sales to talk about something that isn't approved. Thatwould be illegal and it would be very bad, and you know the medical side isgoing to have all the ins and outs regarding the clinical trial, the patient types. Now it's verypossible that the that, once that, sometime in the future that drug mayget approved for that other disease state. But until that happens, that'sall medical information got it okay, so they are. The sales wraps are kind ofbowed within. What's previously, then very legal. That is a legalconversation that you cannot deviate from. Okay. If your drug was approved,for, let's say breast cancer, you can only speak about breast cancer and howit was used in the clinical trial. Okay, that's good information for everyone tohave, and so, if i have a question about reimbursement or a question aboutbuilding or coconina and the reimbursement specialist is the personthat i need to exactly well, i mean the representative may have someinformation and the information that the outside sales representative hasmaybe just be enough. You know what is the new ja code? It's this okay boomdone, but if it's something you know, sometimes the outside salesrepresentative will work in conjunction with the reimbursement specialists andif the reimbursement, specialist, you know it's an added layer of value forthe office. You know. Obviously the outside sales representative is goingto be in that office, more so than maybe the reimbursement specialist,because that reimbursement specials by... know for the most part, probablygoing to have a larger territory or cover a larger area. Okay, so again,sometimes you know the reimbursement specialist usually comes in when youknow someone's thrown a wrench into the wheels of of getting things done, and it's maybea little bit more difficult or more advanced than maybe the outside salesrepresentative has knowledge of they call in the reivers specialist for backup help me an take this reimbursement, specialist has detailed and a depth ofknowledge in regards to the negotiating and navigating through the insurancereimbursement process, got it okay and then the nursing education specialists.This is, if i have a question about the actual treatment protocol, so it wouldbe treatment protocols. It would be some in some offices that theoncologist nurse will mix and administer the drug, so it's makingsure that they understand how to how to mix if the drug needs to bereconstituted or prepared in any way prior to delivery to the patient. Sothere's that there's also side effect management. What to look out for makingsure that the nurse is educated enough to discuss side effect management withthe patient. So you know there's. You know there wasa drug that i went sold a long time ago and one of its major side effects wasreally bad diarrhea so and so for the patient. It was a drug for color rectocancer, which you know kind of makes sense that if you have a tumor in thecolin, those cells that are obliterated by the chemotherapy have to gosomewhere, and so diarrhea is, is a you know, a common kind of you know kind oflike an ah yeah, it's going to go somewhere and be eliminated by the body,but there were two types of diarrhea. There was a coloner which was an effectthat happened during the administration of of the medication, and then therewas a secretory which happened after the the administration of the drug inafter the patient went. Oh so there was how to manage that, and you know trust me when you, whenyou mention the word diary, everybody's ears perk up and nobody wants tyreso.It was educating nurses over and over and over again, because you could saysomething five six ten times and until somebodygot it correct, they would forget something orleave something out. So it was a constant education and then you alsohave to put into into consideration the patient. You know, whereas you may havespoken to the nurse twenty five times, i'm making that number up, but thepatient's hearing it for the first time- and you know the patient you have toyou- know- take a consideration, the patient. Maybe this is their first timeever. Getting chemotherapy chances are probably is they're scared, it's anunknown. It's, regardless of what the side effect profile of the drug may be.They're scared, they're, anxious they may be. Have a family member with themand then also depending upon the patient. May they may not be all there,they may have all their witch jack. Dad yeah distracted, stress stress exactly so, and you knowthey may be very they may be older, and may you know you know, may just not you know the lights are on, but noone's home, but but they need to have they need to have the therapy. So it'sa constant education. It's making sure the patients are comfortable and it'ssetting expectations. If you, if a patient, took aspirin and didn't knowthe side effect of aspirin and then something happened, they'd be veryalarmed. Oh yes! So it's it's kind of trying to put a patient at ease andsaying: hey, listen, you're going to be...

...taking a medication. This is what we'redoing. This is why we're doing it- and this is what could happen and if itdoes happen. This is how you deal with it and you manage it and putting thatpatient's fears at ease as much as you can, but it's setting expectations asopposed to not telling the patient anything and having them go throughthis. You know this journey and that's where you have these really bad. Thesereally bad stories of people, saying oh, you know so and so took hemotherapy and they gotreally sick and you know that ever happened to me. I don't, i would neverdo it. So it's it's really conditioning that patient to to be to be a selfadvocate and say: listen, you know, you know, you've got a you got to takecharge of your own, not only of your own health, but also how to deal withside effects that you're going to have. So you have a good experience and asmuch as one could have by getting chemotherapy and also you know not onlydrug compliance but drug adherents. So you don't want someone to getchemotherapy once and say i'll. Never do it again. You want to make sure that,because the longer they stay on therapy and complete it there better chances ofthem of having a good outcome or a better out okay. So if we want to talk about keeping patients on therapy, the nurseeducation specialists who we want to speak to and may in provide of tesneyto that, along with the outside sales, represent okay, we may partner togetherand maybe do a lunch just for the nurses and and just you know, make surethat they are that there are and the key, the acol nurse educator willprobably have sly decks and more information than an outside salesrepresentative would have to make sure that those nurses are are in the loopand in the no got it so way. Long ago, before corona virus times, we used to have these meetings inperson and we used to each a potman together and learn about the newestdrugs. Now we can't do that as much so. Can you tell me how has the coronavirus affected? The relationship that you see between you know all thesedifferent people inside outside sales? The key account context with the nurseeducator. How do you see this relationship change now that we can'tdo so much in person interact or yeah? I know corona virus is put a, you know,put a halt to a lot of different sales and a lot of different industries and alot of different businesses and everything regard you know and andpharmaceutical sales as well has been affected by it. So, like you said, youknow prior to ovid, you know outside wraps, we were welcomed and you knockon the door and- and you know you schedule something or lunch- you get tosee the doctor and you speak to hit to he or she and the nurses et ce. Nowwith you know, things like zoom and webeck and other depending upon whatcompany you work for and what deal they've worked out with whatever videomeeting supplier zoom has been, you know in programs like it have beendefinitely a way of, maybe in the future the you know, you've had anumber of doctors and doctors will. The doctors will literally dictate in thefuture. How detailing and talking to them will be, i think, you're going tohave some doctors who love the interaction the face to face and nowthat people are being vaccinated and and everything like that, i think youwill have some doctors who will start to open up their offices again and, andthen that's going to be wonderful. You know, because that's clearly the bestway to do it face to face interaction having and building that thatrelationship with a physician and knowingexactly how they treat theirphysitheistic based on their tumor...

...types that they have and how theypresent, because everybody presents differently and some patients are, aregreat candidates for a medication that one might be selling and some patientsare not and that's why there are so many different kinds of medicines outthere. With that being said, you have physicians who have gotten used to nothaving reps in the office and they probably enjoy it and like it, they probably get to see more patientsand and what not, that saugh i mean, and you know, and that's and that's allgood. If that's what works for that doctor fantastic. But there is there'sstill a need for drug rats, there's still a need for that interaction, andi don't know what that is going to look like in the future. I think it's waytoo early to tell, but i think inside sales programs will grow and outsidesales representatives are going to have to be very, very nimble on being ableto utilize the technology that's out there and whether it's a phoneconversation, an email, zoom presentation and out outside salesrepresented, is going to have to adapt to that technology and adapt to thosethose different ways of for lack of a better way of saying it of selling andeducating their physicians on their medication. So i think there's going tobe a shift. I just don't know to what degree, andthe other thing is is that if you're a sales representative who's a little bitolder and set in their ways, i think they're going to struggle with it. Youknow i know people who are not much younger or older thani am and hate computers. I'm afraid i don't know what to do. I don't know howto open up a pd, and i iiii and i think those the people if they are inindustry they're, going to have a real, tough time. Adapting the one thing thatwe know in the universe that is constant, is changed. This is going tobe another piece that is going to change and people are going to have tochange with it. So, like me, you may want to clean up the back back rate ofyour house and not see my refrigerator if i'm talking to a physician on zoombut but yeah, i think the video conferencias like like a zoom and thenhaving your clinical presentation and then go, and i because that clearlypeople learn by that are vi visual as well as verbal. So if you can provide avisual content to your presentation, it's always going to be a bee benefitto you got it okay. So you think that a lot of the changes that werenecessitated by ovid are going to stay. I think to a certain degree. Yes again,i think it's early. I don't know to what degree. But yes, i think you willfind that physicians will do more learning. Online physicians hadhad that with ces and another other type of medical education in the pastfew years, but i think the role of outside sales representative willdefinitely be embracing online learning, as well as the pharmaceutical industrywill be presenting more content to physicians online, so existing salesraps are going to need to maybe listen to their physicians and were wherethey're more comfortable yeah. I mean honestly what i would always do when iwould, when i would go and meet with a physician. The first time would be. Youknow, dor tell me how you like to have a pharmaceutical representative, detail you and then that's how i wouldgo and do it you know a rep should never go in with their own agenda. It'salways the doctor. It's always the staff and you need to adjust your yoursales presentation to them and how they met, how they want to learn and howthey accept information, as opposed to...

...just going in with your own agenda.You'll you'll never be successful long term. So you know dor tell me how youlike to have a sales representative, discuss medication and the science orclinical trials with you tell me and that's how i'm going to present to yougoing forward and if the physician wants more of a you know: hey, listen!I, like, after i've, seen all my patients at five thirty six o'clock.Will, you know, send me a link and i'll give you fifteen minutes. Perfect camefine. Some physicians will say you know what you know. I like the day break anda lunch. You know give me a sandwich and i'll talk to you and we'll do itthat, like some physicians, i send me an email- and you know, as arepresentative as you're building a relationship with that physician,you'll start to say: hey, listen, you know i'm going to be by next week. I'dlove to stop by on tuesday is at a good time for me just to take five minutes,yeah sure and you'll be able to blend in face to face, and maybe but i thinkthat the video presentation will be part of something to what degree idon't know. As far as you know, what percentage of detailing will be, butyou know, video presentations, you know you got to go with the flow, astechnology gets, more advanced people will adapt to it and, as a sales sailstap. I think i have a right to expect that that pen, within your day, patience, yea andagain, it's setting expectation with the physician, hey look, you know ifthis is how you like to be how you like to discuss clinical information. That'show i'm going to discuss clinical information with you. You know ifsomebody is more ver, you know some doctors, don't like the slick, what youcall madison, avenue, sales presentation booklets to have all theleague neat charts and everything like that and the bullet points. Somedoctors just want you to take out a clinical trial and and talk to me aboutit. Hey doctor, you know, let's, let's go and let me talk to you about themethods of the trial, who were the demographic in the trial who were therewhat the what the clinical outcome was. This was a side effect profile and it'sall right there in science. It's facts: some doctors, don't like the madisonaven because they don't. They feel your only cherry picking out certaininformation. So if you give them, if you discuss the trial with them fromthe clinical tree print, some doctors love that that it's all about what works best forabsolutely it always comes down to what is best for the patient and discussing what patient group you know.Dor, you see rest cancer patients. Let's talk about those type of patientsthat were that. I want to talk to you about that were in this clinical trials.They were, let's say, er positive pr negative. They had a lymph nodes thatwere three three centimeters, larger or or more and patient time explorebetween thirty seven and forty five, i'm making up all of these graphicthings. But you know doctor you do have patients who present with breast cancerlike that, and they may say yes or they may say. No if they say yes, you'd sayyou know. Okay, that's great! Are you using my product in that patientpopulation? If they say no, how come why and then get into that conversationthat clinical conversation doctor? Let me show you this clinical reprint. Youmay be aware of it and let's talk about what the clinical benefit was for thosepatients, you know and then you get into you get into a conversation, andthen you know, dr after our conversation will you now use myproduct in those patients. If they say no, then you got to go back and kind ofunderstand why? If they say yes, then you know you get a commitment, you know,okay, i i want to come back in a couple weeks. You have a patient in mind. Yes,okay, i want to come back a couple weeks and talk about how that patient'sdoing you know if no well, you know i'm...

...going to come back and i'm going totalk to your nurses and- and i want to make sure that you know if they do havea patient doctor. Is it okay? If i talk to yournurses to make sure that when you put them on my product, they're educated,to know how to outis use it and discuss side effect, management with thepatient, yeah ope sure go ahead. Talk to my nurse is great okay and thenmaybe i'm the way out i'll try to talk to the office manager, aboutreimbursement. Okay, oh see, and that's that's what that's what's known in theindustry is a total office? Call you talk to the doctor. You gain commitmentfrom the physician. Then you educate the nurses and then you talk to theoffice manager and anybody else. Sometimes there are social workers andit may be hospitals that may talk to patients about the anxiety and productare about the benefit of therapy and what not and you talk to anybody andeverybody that touches that patient, so that the ever the patient has along theway, all the tools that they need to get the belton all the support from theclinical side, i mean the you know. Obviously it's it's always best for apatient to have supported home and you know and have people around them thatyou know are going to make sure that they're doing what they need to do totake care of themselves while they're on therapy and everything like that. Sothere needs to be a support system and again it comes down to settingexpectations absolutely so we want to make sure thatthe patients start therapy and stay on therapy and have all the support thatthey need to be successful in that way. Yes, so we already talked about kind ofsetting expectations for side effects. Can you tell us a little bit what ersome kind of roadblocks that you see, sometimes in your work for patience,starting and staying on therapy? Can you? How can we empower our patients?So you your right to advocate for themselves. So it's on. It's reallyimportant for h, the outside sales representative, and sometimes theinside the inside remote representative, to educate the nurse or whoever isgoing to administer the medication to the patient, and a lot of the newertherapies that are coming out are pills. Kemah rape in the form of an oralmedication, so that is where also the specialty representative comes intoplay. If the medication is a pill or an oral oral therapy and if it's infusiondrug, where a patient is going to go to a clinic and then sit down to it and ina chair and get infused, so it's extremely important that thoserepresentatives educate the nurses consistently over time about the sideeffects. Okay. So this is a diferent group of people, so the infusion andalso specialty a so the specialty l address themseparately. So the infusion nurse is going to give a patient and you got toremember it's not just one drug. Usually it's a combination of drugs soand each drug in that combination is going to have a potential side effect.So it's making short and you know- and there are different drugs, so you mayhave one patient in chair a that is getting a certain protocol and in shareb, is for a different tumor type or a different tumor, and a chair see againa different tumor and different problems and different different drugs.So that nurse has to know a lot of information and juggling a lot of sideeffect management information that they have to. They have to verbally tell thepatient and those patients may have a language barrier they. You know you mayhave patients like you know down in south florida. That may be primarilyspanish, so that nurse has to be bilingual, to be able to talk andeducate those patients, and there may be cultural...

...barriers. There may be a lot ofdifferent things. Bottom line is that information has to be given and thepatient has to understand what it means for them. Getting that protocol orcombination of drugs and what therapies or side effects they're going topotentially experience. We've all heard stories of so and so new somebody orhad a family member, the head breast cancer and they lost all their hair.Well, if you didn't know that you were going to lose all your hair and youwoke up one day and and most of your hair was still on the pillow, it bevery shocking and scary and you'd have a lot of anxiety and and it's a physical manifestation of your diseaseand you'd, be scared, and you probably wouldn't want to do it again. So it's you know, that's you know,that's why it's so important for the nurse prior to therapy to say this iswhat could happen. Chances of you losing your hair is very high, expectto lose it if you don't you're lucky but expect to lose all your hair expectto be nauseous and if you're nauseous, we have medicine, make sure that you're,okay and so we're going to write you a prescription, so you can before you gohome, get it filled, we'll call it in, for you so it'll be at the cd or thewall. Greens on your way home. Let's me say what your encouraging is a frank,culturally relevant explanation of what the side effects are absolutely everytime to your are a time and sometimes the patient, to go on. I know i knowand i, but sometimes the there's, a care giverthere that never heard it before. So i guess how it over with the caregiver, hey, look. I've already talked to your father, your mother, yourbrother sister, your husband, your wife, about this, but i want to tell you thisis what you should look out for an some patients have grown up. You know youdon't bother the doctor unless you know you're going to die. You know and- andsome like i was mentioning before- there's there's a very high chance whenyou get chemotherapy with a portion of products that are out there to geteutrope, which is a a dropping or having your your white blood sailsdropped to a very, very low and your white blood cells are there to fightoff. You know bacterial infections and keep the healthy. So if you get eutrope,nia you're going to get your gin to get fever and that's called febrile, neutropeni and if you have a fever post therapy, that's a bad thing and it'slife threatening and if you have a fever, you know and the chills. Oh imaybe i have i'm have the flu or maybe i'm getting sick or i have a cold. Itisn't anything related to kemaes, i'm not going to call the doctor, that's amistake and they need to know that because you know, god forbid, you getfebral neu tropea, which is life threatening and then and then thepatient starts to crash and then all of a sudden they're going to the hospitalat make it. You know it could be to lay or, and that might delay another roundof hemotherapy which could be problematic so so yeah. So it s it'salways. You always have to make sure that the patient understands. Sometimesyou may want to have the patient. Repeat it back to you. Okay. What did ijust say? You know? I just want to make sure that you understand the severityregarding you know. If you lose your hair, it's not the end of the world.It's going to grow back. If you know, if you are nauseous or nauseated, we havemedication that can help. You not feel that way. You don't have to besuffering. There are things there. You know if you have diarrhea there there'sa protocol regarding some over the counter anti diarial medication thatcan help you so that you don't get because you know if you have really baddiarrhea, and this is an kind of...

...diarrhea that you went to a restaurantand the cook you know didn't, watch his hands. This is really bad diary. It's a lot worse thanif the young, you know, if someone's older and they don't have the besteating habits and they don't drink, maybe gator ate or this or that they'regoing to get dehydrated really fast. And if you get dehydrated, there's awhole, a whole list of things that can happen. That can you know be detrimental to thatpatient's health. So it's just constant communication, it's constantexpectation setting and it's a constant education process exactly so we talked about side effects.Another barrier, two patients accessing information or accessing drugs, ratheris money. A major concern. Rihow. Am i going to pay for these drugs sure, so so what tools and resources areavailable to patients? And that's a you know, a great question- and you know ihear this by you know some people in my own family. Well, you know so and sowanted to get this, but it was so expensive and so they can get it or youknow they're spending a so much amount of money. Well, if you have privateinsurance, i would say pretty much any in every pharmaceutical company has a private insurance program for thepatient to get which would pay the gap or the the co co co payment. Part ofthat. So a lot of companies will issue the patient, a credit card which willcover that out of pocket. Okay and then, if you are, if you don't have privateinsurance and let's say you're on medicare or medicaid, then there is. There are foundationsfor your disease. You know through the american cancers society, there'spancreatic society there's so many different foundations that you canapply to and there there when you apply, the criteria is very liberal. I knewone of that. If even if you made two hundred and fifty thousand dollarsor more, you still were eligible to get money from the foundation to pay thatco payment. So when i was a sales manager, there was, i believe, a physician who had cancerand the physician got money. So it's a very liberal, it's a very liberal. Theprograms are usually very, very liberal. I've never heard anybody be denied, buti'm sure it happens. I mean i'm not the end ill, be all of information on thesethings, but there are a ton of information and a ton of things and allthe patient really has to do is ask their nurse for their doctor. It isn'tsomething that that is usually something that they, you know freelydiscuss or will bring up, because you know, if you have private insurance,you have prive insurance and, and everybody just thinks that okay, it'sgoing to get cover. Well, sometimes it doesn't- or sometimes it's going to youknow, depending upon the insurance that the patient has some insurance doesn't cover. What'swhat are what's called catastrophic injuries? Some insurance doesn't cover cancer. It all depends on what their employerhas chosen for their employees, okay, so as office staff. Would you encourageus to be impacts pro active if he were sorry or to be pro active and say heyif you have problems paying for this medication? There are resourcesavailable to you, yes, and i think, as an office as the office manager shouldbe asking those probing questions regarding insurance and they will knowwhat their insurance will or will not cover, based on the insuranceinformation that they've given them when they've signed in so if and whenthey need to have any kind of chemotherapy that that conversationshould be a detailed conversation and...

...asked a lot of probing questions, andsometimes it's a very easy fix. You know you know here, fill out this formand, like i said, if you're, if you have private insurance, sometimes the drug company will will issue you acredit card. That is only good for that that office or that that medical,medical therapy and it's a visa card, and it's it's by the company and andthe company- is basically funding it through a foundation that they set up,and so the companies you know gives them money constantly, but the company's out of it, becausethe foundation manages it kid, okay, so so yeah, so the company can't say: wellwe as a company, we denied you, it's not us. It's the foundation and they'rethe ones that either are are accepting it or denying it, but the company isconstantly funding it, because the companies are aware, if you knowoutside of anchoy, there's a there's, a there's: a medication therapy forhepatitis cy, that's a cure, what's a very, very expensive cure, and you knowa lot of times, you'll hear now on commercials. If you can't afford thismedication, the company has programs to help you do that, so that the patientsare getting educated, so yeah. So that would be he that would be the office manager itwould. It could be also the nurse that would say. Listen. You want to talk tothe office manager about this and it might be about a foundation. It mightbe about a reimbursement program that the company is offering. So there areprograms out there for patients. Absolutely and patience should not be,should not be shy about asking okay so on both sides. So patient should be proactive and office. Staff should be bringing up these conversations withpatients and it sounds like the process for applying. Is it's prettystraightforward? The requirements are pretty liberal and actually use. Thebenefit sounds like it's pretty easy. Ah i mean but, like i said, o every youknow every year, i'm sure we all have gone like for a physical or everythingin the beginning of the year and one of the first things out of their mouth.When you check it is, has your insurance changed and yes or no, and if it has you know,let's you know, do you have your w insurance card yeah here here you goand the other thing is is that if you're, if you are, if you are apatient and you are participating in a financial reimbursement program at theat the end of every year, the beginning of every every new year, you're goingto need, if you're still getting therapy you're going to need to updateyour information and re and basically reapply and andand go from there and once you re the process is extremely simple: it's nothard! If you have your own computer, an office might say when you get home justyou know, here's the web link, fill it out and you're done or sometimesthey'll say. Listen, you know, let's do it right now i'll do it for you and theomen. It's finished. I sam easy richard. You have given us so muchgreat information. This has been an great conversation. I think a so muchfor joining us at lesou. Thank you so much for asking me, and it was very grateful to have been asked andthanks again for the opportunity you are so welcome, or so for any of ourlisteners who want to reach out to you with any follow up questions. What'sthe best way for them to do that, the best way to reach out to me is i'm onlinked in richard stein, and you know that would be the best place to reachme is unlinked in you see my face. I've got it. I got this picture and andwould be more than happy to help out anybody as much as i can within myability awesome. So i will leave a lake or add a link to your linked in in theshow notes. Perfect richard again, thank you so much for sharing yourinsights with us today. We really appreciate you being a guest on thiscon. Thank you so much realise, and i...

...look forward to if you ever needanything or any other help. You want to ask you to join again, i'm more thanhappy to do stuff. Are you satisfied with your patientscurd speed to therapy, or are you just settling? You can improve patientoutcomes with bioplast pharmacies? Power is to the first ever two hours today to gather promise. It's faster, it's easier for you, the interpeter, tolearn more visit. Iopu rx com you've been listening to working in ancology to ensure that you never miss an episode subscribe to the show in yourfavorite podcast player. If you're listening in a e, podcast lovely lee atof the show just have the number of stars you get the podcast to dirt.Thank you so much for listening until next time e t.

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