On this episode of Inside Reproductive Health, Griffin Jones chats with Terry Malanda about patients’ freedom of choice. Terry, the owner of Mandell’s Clinical Pharmacy, believes that customer service is the North Star for long-term company growth. With all the consolidation happening, Griffin and Terry explore the current state of how consumers make their pharmacy decision and future trends on what will impact that decision.
Listen to the full episode to hear:
The debate on freedom of choice for patients to choose a pharmacy Why pharmacies can and should be providing additional services to patients, including benefits coverage and discount programs How consolidation of fertility clinics is reducing the choice that patients have when it comes to pharmacies and other services Why some pharmacies outsource their compounding, and what that means The virtuous cycle vs. the vicious cycle of customer service
Terry’s Info:
Website: https://www.mymandellspharmacy.com/meet-the-staff/
Twitter: https://twitter.com/mandellsrx
Linkedin: https://www.linkedin.com/in/terry-malanda-09ab9528/
Inside Reproductive Health is sponsored by EngagedMD. For technology that educates your patients with true informed consent, visit engagedmd.com/IRH for 25% off your implementation fee.
[00:00:51] Griffin Jones: Freedom to choose in Inside Reproductive Health. I like stirring the pot, but that one we'll save for another day, but you're probably already writing to Engage MD to cancel my sponsorship depending on wherever you're coming from in this sphere, Terry Malanda's probably like what the heck? Griffin had to introduce her podcast episode like that?
I did. I couldn't resist. We're talking about the freedom of choice for patients to choose what pharmacy they want to use among other things. We're talking about the freedom of choice for patients to choose what they want to choose and what that's like in the fertility space, with all the consolidation happening, reducing that choice that patients have when it comes to pharmacies and other services.
Pharmacies can and should be providing additional services to patients. At least according to my guests, including finding out benefits, coverage, and finding out discount programs, some pharmacies outsource their compounding. And we talk about the implications for that. And we talk about the virtuous cycle versus the vicious cycle of customer service.
My guest for today is Terry Melanda, co-owner of Mandell's Pharmacy. And we talk about all of this and more from a woman in business who has been here before. We've seen a lot of women as principals of their companies, and I was very happy to have her on the show, and I hope you get something out of the conversation.
And I look forward to your feedback. I know you'll give it to me, whether I want to hear it or not. Enjoy this episode of Inside Reproductive Health with Terry Malanda. Mrs. Malanda, Terry, welcome to Inside Reproductive Health.
[00:02:37] Terry Malanda: Thank you, Griffin. It's my pleasure to be here. It's great to see you.
[00:02:40] Griffin Jones: It's about time to have you on because you know that you're a good speaker and if people know you, they know that sometimes you're a little shy about, but I just thought of a couple years ago, Mandell’s sponsored a virtual event that we did.
It was a patient facing event. It was a virtual fertility conference. This was actually pre-COVID and, and, and you recorded your presentation, and my employees were like, she's so good. And I was like, she is so good. Somebody needs to tell her that.
[00:03:08] Terry Malanda: Well, well thank you. I appreciate the compliment.
I know I spoke at a public event, and I remember I brought a speech that I have prewritten, and then once I was there I just after hearing stories and patient stories, I just ripped up my speech and, and I winged it. So, thank you. I appreciate that compliment.
[00:03:25] Griffin Jones: Sometimes it's just like, you know, it's like having the seatbelt there, even though you're not gonna need it.
Right. And then you end up having a good conversation or a good talk or in the case of when I do, presentation, as soon as I see somebody's eyes, then I can go into a different headspace. And I become a better talker. At least I do from my vantage point who, who knows if the audience agrees or not.
[00:03:48] Terry Malanda: I think it's from the heart. I think when you speak from the heart, it's, it's a lot more genuine and I think that's what you do on your podcast. That's why we enjoy listening to them.
[00:03:56] Griffin Jones: Well, and that's why I wanted to have, when I wanted to just get kind of a State of the Union of what's going on in pharmacy, that you were the person that I thought of just to, to speak of, of what's going on.
We haven't had too many discussions on this show about pharmacy, and, because partly, Terry, because I don't know what the doctors, like, really should know and, and versus like, what's what, what might just be boring or incidental information to them. So can you kind of just give us like if you, we were at PCRS and a doctor was sitting down with you, and just said, like, Terry, like what's going on across the pharmacy field right now? How would you start with a really open-ended question like that?
[00:04:40] Terry Malanda: I think I would probably first back up a little bit and let them know how important it is to choose the right pharmacy, or for the patient to choose the right pharmacy. We're only a small part of the infertility picture. Obviously, the doctors have a lot more interaction than the nurses and, and a lot more to say and, and decide, but dealing with at the right pharmacy who truly understands what the patient is going through understands the role of a pharmacy, and how to best help a patient navigate through that portion of the journey, I think is really important.
So I think I'll probably stop start there. Then if you're asking about current events, I'd probably address the fact that there is so much consolidation happening and how it's changing it. Pharmacy's always changing. Always. The landscape is always changing, but right now there is a lot of consolidation.
There are a lot of companies that are buying out pharmacies and creating different models. Not that they're better or worse, they're just different. And I probably, you know, have a good discussion about that with a doctor, but I think the important thing when choosing a pharmacy is to make sure that the staff is very dedicated, that they're passionate about what they do.
And that the patient is gonna be in really good hands, pay a really good price, and have the support necessary, both educationally and frankly, emotionally from a pharmacy. That's gonna understand that. I always say that we and my family, we went through two things. We went through cancer.
Thank God my husband survived the bone marrow transplant in 2005, but we went through infertility in the 1990s, and they are both catastrophic illnesses. And, I think that no one who hasn't experienced it and dealt with it for a while, really understands just how disruptive infertility is in the life of the patient and, and the couple and the relationship and the finances.
And I believe that having a pharmacy who even just understands all of that is very important. And in order to do that, it can't, it has to come from the top and you have to have training the, the appropriate training and, you know, it has to come from the heart. I just believe that everything has to come from the heart and you're dealing with real people with real situations and a couple who are really struggling often just to get through this, and sometimes repeat treatments, et cetera. So, to go back to a pharmacy, I think it's just important for doctors to really know their pharmacy, understand what a pharmacy is, and how much a pharmacy can do for them. Our tagline is sort of, we make it easy for you, so we try to help as much as we can the clinic and the patient.
So it's really teamwork that happens when a patient uses us. So I don't know that all doctors know that I think that many do and many appreciate it, but I'm not sure that all of 'em understand it.
[00:07:26] Griffin Jones: Well, maybe we take the angle down. What can a pharmacy do for them? Because if I'm playing devil's advocate, Terry and I'm the CEO of a, a, a large network that has just consolidated a number of clinics, or even if I'm not, even if I own a practice and I'm the single provider and I'm thinking, well, like, choosing the right pharmacy's, like, yeah, I understand that some people may have more heart than others and, and some people might be able to do a little bit customer service, but at the end of the day, it's, it's the drug- getting the drugs to the people. And I wanna just get it to them for as cheap as possible, because the drug companies’ charging them a lot.
I'm charging them a fair amount, and I wanna just get them as cheap as possible. And so I'm gonna refer to whoever and, or they can choose whatever pharmacy they want or, or will use one that this private equity group has told us is gonna be cheaper across the scale, whatever it is. So you know, I'm coming with a commodity.
What is it that the pharmacies could actually be doing for them?.
[00:08:26] Terry Malanda: Well, I'll tell you what we do. And I know that we actually do the things that we say we do. For example, as soon as the patient starts out with us, we give 'em a full education on what to expect next. We also always, if the patient has any medications in their order, that qualify for discount programs, we encourage them to, we tell them we educate them on the discount programs and encourage them to apply because you never know the discount programs we happen to be, if we're always the number one pharmacy. For the discount program that our company runs with Toronto with compassionate care. I think there's been a consolidation of several pharmacies, and now we're kind of neck to neck, but I know that that is a result of all the education that we give patients.
We apply coupons. We're always looking out for the best price. We always offer the best price. And when we offer a price, we don't increase one thing to decrease the other. We have never done that. We're very proud of the fact that we're very transparent. With our pricing and kind of stay away from what I call gimmick.
Because I think the fertility patient has plenty to deal with and to have to try and figure out the very complex world of pharmacy pricing. We assist the nurses tremendously. So the other thing we say to clinics is with us, let's fax it and forget it. So whether the prescription comes in electronically or via fax, we are gonna handle it from there.
We do absolutely everything from A to Z. And if the patient, for example, in the insurance company, if it's mandatory, a situation where the patient has to use their own pharmacy that is with their insurance company. And we determined that the coverage is there. We handle the entire transaction and we notify the clinic. So, this way the patient always knows what's going on and the clinic always knows what's going on. We also try to work and really customize services for the clinic. So if you're a new clinic with our facility, we would ask things like, how do you prefer to be contacted?
You prefer email. Do you prefer to leave a phone call, get the right contact people. And we really do a lot of work up front to make sure that we're maximizing their time, not interrupting as much as we can and making it easier for the staff at the doctor's office. ‘Cause nurses work very hard, and doctor’s time is very limited.
We are fully aware of that. So we have an entire prior authorization department. We make sure the patients get their orders. And if the patient, if there's some sort of a delay, we make sure that we're contacting the doctor's office and contacting the patient and they, and trying to figure out a dose for that day.
And we're very highly successful at that. That usually happens like if in a very bad storm, I mean, I'm sure every office knows that sometimes when the weather gets in the way you, you're not able the patient is not able to get it, but we also, that's another thing we do. We watch the weather across the country.
And so when we see bad weather coming, we anticipate that we have a way to contact all the patients and get their order out either before the storm or after. So we do a lot of behind the scenes work and that takes a lot of service. It takes a lot of employees and, quite frankly, it's expensive.
But as far as providing those services. If you compare our pricing to other pharmacies who may not provide exactly the same degree of service, we're usually, if we don't beat 'em, we're right in that ballpark. So, I just believe that service matters to a patient. I was a patient, my husband and I got into infertility because we couldn't conceive, we had trouble.
I was 28 when I started trying, and I got pregnant when I was 34. So you know, it was, I dealt, we didn't do infertility back then. And I dealt with a different pharmacy, and I just was not very happy with the level of service, being a pharmacist, myself. I knew what you can do for patients. And so we just decided to specialize in infertility.
I mean, we were very lucky. We did a frozen embryo and that worked, and then our, daughters, they're 20 months apart. And she came without any help, which is amazing. So we have two miracle children who are grown now. And we absolutely are passionate, and we love doing what we do, and we love the feedback we get as far as how much we help the patient, and frankly how much we help the clinics.
And I'd love for you to interview some of the doctors that use us and, and ask them that question, because I'm pretty sure that they would vouch for everything I'm saying.
[00:12:43] Griffin Jones: Well, I know that if I interviewed different pharmacy owners, though, that they would say the same thing. So give me a couple of tangible examples of what practice owners should be looking out for, like, the level, like the specific service that makes a difference either in the care that the patient is receiving, or that is reducing staff burden. Because I don't know if Duane Read is still in business, but if they are, and I'm the CEO, let's pretend they are.
And I'm the CEO of Duane Read, and decide, we're gonna launch a specialty pharmacy infertility that my executives are saying the same thing. And I'm saying the same thing about the quality of service. And we got the best quality of service. And so what are the actual, like, what are as tangible as you can get?
What are those things that, that make the difference for patients and staff?
[00:13:34] Terry Malanda: Well, to be honest, any pharmacy, and I said this to doctors when I visit them and I'm trying to get them to prefer patients, any pharmacy. You're absolutely right at the beginning, you, you have a box of medication, you put a label on it and you, and you either ship it or get it ready for the patient’s pick up.
Right. Apparently, on the outside, pharmacy should be very simple, but it's all of the services that I've detailed. And it's not just saying that you do it, but actually performing the service and actually getting involved in solving the problems and the issues and the little idiosyncrasies that come along with, if the patients enduring their cycle.
For example, one of the things that we do that I'm, I don't know, you know, I'm sure maybe other people do, but I don't know. We take a complete history and we actually preface that to patients by saying that this is the only thing that we're filling for you. So we need to take, we're gonna ask more questions than your typical neighborhood pharmacy, because typically when you go to a neighborhood pharmacy, They wanna know your name, your address, your allergies.What's required by the board.
We go a lot further than that. We take a complete history of medications that they're on, and we also take a complete medical history. And we had had patients who have had conditions where they really shouldn't get a cycle, and, but they forgot to tell their doctor. And we have one particular patient, this was probably the best story we've had about six or seven, but, well, the best one was, we had a patient who had, had an estrogen-independent cancer. And when the pharmacist reviewed her initial information, she reached out to the patient and said, did you discuss this with the doctor? And she said, well, if she wasn't sure if she had discussed it, she had, if she had been specific about the type of cancer she had, so she actually had to call her clinic back.
It was, it was a long issue. So what ended up happening is about a year and a half later, she called and spoke to one of our pharmacists, the one who had called her, and she called and said to, she called, thanking her for saving her life, because what happened was she delayed treatment while she was getting all of her treatment.
And her cancer came back without having started any treatment. So she had a three year old who was a naturally conceived child. And she said to our pharmacist that she shudders to think that, had she started treatment, she would've thought it was a treatment that caused her cancer to come back.
So we got involved in a clinical pharmacy. We do get involved on a clinical level as it pertains to medications. And also as it pertains to medical conditions And I think really a better answer to your question is that, you know, this, I hope this doesn't sound selfish, but it's what we hear from clinics.
A lot of people say they're gonna do what, what certain services, but then it isn't provided. For example, there are patients who have coverage. We call it hidden coverage because there are some medications that are not specific to IVF, and we can run those through insurance, and we'll take the extra step of doing a prior authorization with the assistance of the physician's office.
And oftentimes that can save patients hundreds of dollars, but typically what we hear, and the reason we get referrals, is that sometimes those patients, if there's no infertility coverage, they're just cashed out. The benefit is not investigated. We have a team of four people who do just investigations for insurance.
So, I think it's a matter of providing the service that you say that you're going to provide. And our staff does that, and they do it really well. So, I'm very proud of our staff. Honestly, the training comes from the top, but it's there carrying out of providing the services that constantly give us great reviews.
And, and I think it's important for the doctor's office to be proud to recommend the pharmacy. And it's a reflection on them. So, we put a great deal of pride and dedication into our work, because we know that, at the end of the day, we're representing them as well. If we, you know, we're representing the judgment of that doctor's office.
And we take that extremely seriously.
[00:17:38] Griffin Jones: So, that you're, you're kind of getting to my next question, which is, is it enough for the doctors to care? Because I believe that the patients care because they say they do, there's yours, and a handful of others, that have really good reviews.
And you can, you can see what patients are saying, the reason why, part of the reason why you're on this show and, and I would allow a couple other people in your space to, to be in your seat right now- but not everybody- but, and part of the reason why it's you is not just because I know I've known you and Eddie for years, and I know that you're awesome.
People, I've never been a patient. So I don't know about that, but I do know how to read what patients are saying. It's overwhelmingly positive. And so I believe that, okay, it's enough for patients to care, is all of that enough for physicians to care, Terry?
[00:18:26] Terry Malanda: Absolutely. Because I think that. Doctors truly care about their patients.
I don't know if they understand just how important it is to recommend a good pharmacy, but I do believe that doctors wanna do the best for their patients. I mean, I come from a family, I'm the black sheep. I'm the pharmacist, you know, half my family are all doctors and I, I see it for myself. I mean, I can tell you my sister's a gastroenterologist.
I can't tell you how many times over my lifetime that she's, being a doctor, we've been at Thanksgiving dinner, and she gets a call. She has to leave and go to the hospital cause someone is bleeding and you know, it's not, I'll be there in an hour. It's medicine. It is an extremely dedicated career. I mean, I don't know if the general public truly has an appreciation of just how hard people have to work to become a doctor, how hard they have to study. And I do believe that doctors care very, very deeply about their patients. I just, I don't know that. And, and I believe that many of them do completely understand the difference that the right pharmacy can make. However, I just don't know if all doctors know that.
So I appreciate the opportunity, obviously, to speak to you, because you're asking really great questions. And if a doctor recommends a pharmacy and the assumption by the patient is that they're gonna be well-treated and well taken care of, and that they're not gonna run into a gimmick, or they're call is not gonna be unanswered, et cetera.
So we think about it. This is getting your medications, is, like, is like the -what do you call the pre- what do you call, like a movie?
[00:20:03] Griffin Jones: The trailer? It's the trailer to the movie.
[00:20:05] Terry Malanda: Getting medication is almost like a trailer to what's about to happen, because a lot of times, you're preparing sort of, but getting your medication, that experience is almost a trailer of things to come.
And one of the things that we also focus on is the psychological aspect of pharmacy. So we try to soften the blow and we educate our patients. You're gonna get a box, it's got a lot of things in it. However, you're not alone, you're gonna use one thing at the same time. I'm sorry. One thing at a time, you're going to be guided by your nurse.
Any questions you can call the pharmacy and that, that sticker shock of, of just opening up a box and seeing a whole bunch of needles is quite scary. And we started to do something about that when Eddie, my husband who's really in-tune with so many things, it's unbelievable. He was looking on YouTube and he started to, he found videos of people opening their boxes and looking at everything that was in it, and the look of shock and horror on their face, and years ago, we started to do that where we, we prepared the patient for the opening of the box there, they can call the pharmacy, and we can go over all their medication with them.
That's offered. And we also include things in the package to, to just so the first thing they see is beautiful and inspirational. And I, and, and we, our objective is to make people smile a little bit and look forward to the treatment as a positive thing. Not ever give false hope, because I don't think anyone in this field ever does that, but certainly just start this journey, best foot forward, and do everything that you can do in your power to increase your success. And by that, I mean we try to prepare people to be prepared, to be a good patient, a compliant patient. Because I know that, years ago, we used to get a lot of patients who would call and say, I forgot what dose my nurse told me to get tonight. Now, a lot of things are electronic now, so that has reduced, but years ago, when everything was just paper and you got a phone call before three o'clock, or before four o'clock, people would forget to write them down.
And we started preparing people for that. This is what you can expect when your nurse calls. Have pen and paper ready, write it down so you don't forget. Look ahead. The next few days, look at your medications and anticipate your needs, make sure that you have what you have, a huge one is to have the trigger, the trigger shot.
In my opinion, my humble opinion, is the most important injection in the whole, in the whole course of treatments, because anything else, if a patient makes an error and under-doses or overdoses, you could probably the, the reproductive endocrinologist can fix the problem. You, either, you can work with that.
You do bloodwork and you can work to correct that error. But if you don't have your trigger shot, when at the moment and time that the doctor needs you to inject, that's a big problem. So that's another thing we honestly, we don't have that problem because we educate people to, even if you're paying cash, your trigger shot is your insurance policy that you did not just throw away the last 10 days of your life- treatment.
And we educate patients on that. And we do it in a way where they understand what the importance of it is, and they always purchase their trigger shot along with their medication. Because it's that important. And it's knowing all the nuances of infertility and the things that can happen, or the things that you can prevent, and the amount of education that we try to instill in our patients and in writing, and also verbally that matter.
[00:23:30] Griffin Jones: So, now physicians are trying to think, okay, there's, there's a difference between pharmacies. I guess I've been hearing this from my nurses, or from my staff, and, okay, I'm starting to see that. Maybe it isn't just ‘send this piece of paper out, have the meds come back’ and that there's more to it.
You talked about consolidation and some things being different because of consolidation on the clinic side, it makes me think of something my dad says “the more things change, the more they stay the same”. And sometimes I think like, oh, that's just a ridiculous saying that my dad says, but I can kind of see what that means when I'm thinking of clinics, like, more things change, the more they stay the same.
So what is in the last couple years, just at a high level, what's different in the pharmacy world, and what's the same with consolidation happening.
[00:24:15] Terry Malanda: I think the only big difference I see as a pharmacy and consolidation is when clinics will lock in with just one pharmacy or two pharmacies.
And I think that that's kind of the insurance model, and anyone who's ever had to use mandatory insurance, it works great for many people, but then there be, you know, we're in America, we should have competition. It's not a one size fits all. And what I like to see is, you know, obviously we never go, shouldn't say never, but it's difficult to go back to the old days.
But I think patients should have the freedom of choice to compare and go to whatever pharmacy they choose. And a lot of times just by calling around for a price call they get a feel for who they wanna deal with. And I think that's, that's, one of the things that has changed in the pharmacy world a lot is the consolidation and then picking one, you know, one horse in the race.
Well, what if the patient doesn't have a good experience? How does that reflect on the, on the, clinic? So, I would, I always say, I'll compete with anybody. I'll put up my staff against any staff. And I would like to see an open market of just having a variety of pharmacies to choose from, and let us all compete.
But when, when people compete, the consumers win, and that's always been the case. I honestly, I don't think I can think of anywhere where, any instance where that's not the case. And as far as you probably shop a lot. So some people like Macy's more, some people like TJ Maxx, some people like Bloomingdale’s, and sometimes you need to go to different places to find out what you like best, but having the freedom to experience.
[00:25:59] Griffin Jones: I'm all Barney’s all the way, Terry.
[00:26:01] Terry Malanda: Are you?
[00:26:03] Griffin Jones: No, not quite, but I like fooling people sometimes.
[00:26:07] Terry Malanda: Well, I just took my son to buy some suits, I should have spoken to you, ‘cause I haven't had to buy a suit for my son in years, but he's in law school, so he needs suits now. So yeah, it's, I think that there's been a very big change in the consolidation now.
The interesting thing is going to be, to figure out what wins in the end. I'm gonna, I'm betting my horse on, I'm betting on the horse of service. I'm betting on service. I think that at the end of the day, patients are gonna want to be treated really well during such an emotional time, during a difficult time.
I mean, women are so strong. They really are. It's unbelievable to me that, I mean, I was a patient myself, and I was proud of the way I handled it. We're jacked up on hormones during this, and to be able to go through your everyday life and keep your calm, and be kind to others while you're jacked up on hormones, is not easy at all.
But I think that we're so focused on the goal of getting pregnant, that whatever they tell us to do, we're going to do it. And it takes a large amount of strength to be able to, you know, go through this treatment. And then, as a couple, I know that it puts a lot of stress on a marriage, or on a relationship, because it's all-consuming when you're going through it.
I think a lot of women have the same experience I did when I was trying to get pregnant, and it took us four-and-a half-years to get pregnant. When I was trying to get pregnant, all I would see, wherever I went was pregnant women and babies. That's all I saw. It's kind of like, I always compare it to when you're about to buy a car, and if you're gonna buy a car and you decide that you want, I don't know, like blue Volkswagen, right.
And you, you're on, you're on the highway, that's all you see or you see, you know, that you're so hyper-focused on one thing, and what your chore is of finding one that that's what happened to me, at least. And I know I've, I've spoken to, I couldn't count how many women I've spoken to going through this, and they have the same experience when you first start out.
It's not as grueling, but once you’ve had a few, if you are lucky enough to get pregnant right away, that's fantastic. But if you've had more than one failure, it begins to really dawn on you this may not happen and I know that would.
[00:28:25] Griffin Jones: And we're definitely starting to see, see this, this ability to choose service go away and that people might want.
So, because I'm going through all of this, I wanna be able to choose someone that's really easy to work with. That really adds value to the education that I need going through this. But I can't choose because this is the pharmacy that I have to use. And I'm thinking a lot of doctors are probably listening and saying, that's not my fault, Terry.
I would, you know, I refer to a number of different pharmacies, but if they use this insurance company or if they use this employer benefits broker you know, unless there's a shortage somewhere else, whatever it might be, they have to use this pharmacy so where is like the strain on choice starting to come from?
Is it coming more from, from clinics being consolidated or is it more from a decrease in cash pay in the marketplace?
[00:29:13] Terry Malanda: It's definitely coming more from the consolidation, from what we've seen now. There are also plans, as you mentioned, that are selecting just one or two pharmacies to deal within a network.
And I mean, we're in talks with all those companies. And I really feel like eventually will be allowed in because, as they grow, they'll have more needs for more pharmacies, and more, you know, treat more people and service more people. But I see it a lot in the patients who are still paying out of pocket, and they're being referred to a pharmacy now.
We don't have any exclusive deals at all. I can tell you that any office that recommends us recommends us because they like to work with us. But, we don't have any exclusive deals with anyone. I've never even asked for one. Maybe I should, maybe I should start asking for exclusive deals because our service isn't gonna go down.
But, we definitely have gained the trust over the years. I've been in infertility for about 28 years now, strictly pretty much all infertility. We started doing strictly infertility. About 20 years ago, we do nothing else. That's all we do, even our compounding services, all we do is compound sterile and non sterile for fertility patients.
We've actually turned down hormone replacement requests. And not that there's anything wrong with hormone replacement, but we wanna keep our focus on the fertility patient. And the more you order things down, the more difficult it is to offer the kind of service that we do.
[00:30:38] Griffin Jones: I wanna talk about that compounding, but you kind of like you, well, you tickled something in my brain that, I mean, you said you haven't approached anybody about it, exclusive deal.
And I'm thinking, well, why not? Like what there's, you know, six big networks. And then, you know, if you broke them up into a couple groups, there's a few, like really large groups in the country. And then you add Canada and there's one or two more in there. And, and so I think like, well, why not?
Why not broker a deal with one of them or approach one of them, you have the services look at how we can make this part of your end to end excellent patient care. Why have you not gone that route yet?
[00:31:17] Terry Malanda: Oh, like I said, I might have to start because sometimes, if you can't beat 'em, you have to join them.
Right. But you've known me for a long time, I think for years. And Eddie and I have beliefs and we truly try to run our business with those beliefs. And, one of those beliefs is that we truly believe that the patients should have recommendations and then go find the better one or what they, where they feel more comfortable.
And to be honest, we have grown consistently year after year after. And it hasn't been by forcing anyone. Do we make every patient a hundred percent happy all the time? No, but I would say we're 99.99999%. No, no kidding. No exaggeration. And we're very proud of the fact that we've grown organically.
We've grown through recommendations and from good service providing the best service. If the market continues to change to a point where we're gonna have to, you know, bid to be the only pharmacy, we might have to do that. But so far we have not approached any company. We have gone to every company and been allowed to be one of the choices in the network.
And that's what we're working on. We wanna be one of the choices once. We're one of the choices in the network. We want patients to pick us. We don't, it's hard. I don't even know how they do it. It must be hard if you're forced to use one doctor or one pharmacy, or, you know, to be forced to do anything is not something that.
I would prefer to be a part of, so I'll leave that door open because obviously the market keeps changing to a point where we start to not grow organically. Then we may have to change our business model, but I'd rather stay the course and hopefully make others understand that people need to have freedom of where they go for their medical services, whether it be pharmacy or a physician or anything else, I'd much rather.
Stay the course. And I'm not gonna, we're not gonna change the world, but IVF is not that big of a market. So I kind of hope to stick to our guns for as long as we possibly can. And try to affect the positive change. That's gonna be positive for the patients and positive for the clinics to be able to, we have doctors, we have doctors who used this for years and now their clinic has consolidated and they can no longer send to us.
They're not happy about that. You know, so I'm proud of the fact that they're not happy about that. I'd love to have their referrals back, but the market is small enough, yet big enough, where we can make up the difference for any losses. And like I said, we've grown year after year and it's all been organically.
We're gonna try to keep that up for as long as we can. And we listen, if we get, if we do get a negative review, We definitely act upon that. We find out what happened. We investigate. And sometimes the negative review is, you know,
[00:34:10] Griffin Jones: Sometimes there's nothing you can do about it. And sometimes, sometimes there is like what I'd say, and, and for the doctors listening, because they especially get sensitive to negative reviews.
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[00:36:03] Sometimes there's nothing you can do about it. And sometimes, sometimes there is like what I'd say, and, and for the doctors listening, because they especially get sensitive to negative reviews.
It's, you're looking for the patterns over time and it takes a really thick skin. But it's the right balance of, of humility, but not kowtowing to what everybody says. It's, you have to have the thick enough skin to be able to take in all of the feedback, knowing that not all of it is valuable or true or PC to, to distill down to the patterns, what are true.
And it's hard to do. And so I'd say like, if you, you know, one negative view, don't sweat on it, but when you do have when, and, but that's the benefit of quantity in feedback that if you do have thousands of customers and you can get hundreds of responses and, you know, two dozen aren't the best.
Well, then you look for the patterns between those two dozen, and, and so that's something that you do if you've given us a snapshot of, kind of the trend that's happening with consolidation. What about with compounding? How is this all affecting the way pharmacies compound or is it?
[00:37:18] Terry Malanda: Oh absolutely. Let me just go back to the review thing for a second. Sometimes our negative review is when a patient wants something that's simply illegal to do and, and we can't do it. So once in a while we, we sell drugs, right. So we cannot just say yes to everything, but we once in a while, someone is unhappy about some and we definitely start, you know, look into that.
[00:37:38] Griffin Jones: Oh, that's just a little, not, not from Mandell’s, that's coming right from Grif for all the enterprising street drug dealers out there. There you go. There's a lead gen source for you. You just go to the negative reviews of pharmacies when they're complaining about something that the pharmacy can't sell them to you.
There's your market. Just kidding. Legal disclaimer. Just kidding. Okay.
[00:37:58] Terry Malanda: Disclaimer.
I get it though you asked me about compounding, how that's changed. I'll go back a little bit historically, most pharmaceutical companies, if not every single pharmaceutical company that has ever existed, they started out as compounders.
If you ever saw the movie, It's A Wonderful Life. And you remember the scene with the pharmacist, you know, the scene right? Where he?
[00:38:19] Griffin Jones: Mr. Goer, I was trying to think of the pharmacist name. The pharmacist's name is Mr. Goer.
[00:38:24] Terry Malanda: Thank you. I should know that, but I don't. But George realized that he had put a poison in the capsules.
And so you remember that scene, that's how all pharmacies started out compounders. So compounding is an ancient art, as long as medications have been made or are tried. And there was a time when there were no pharmaceutical companies, then some of them had formulas. Some compounders had formulas that they found to be very effective and would be very popular.
And so they started to market the mass market and that was the birth of pharmaceutical companies. So. Compounding fits special needs for people. Not all of the compounds that are made in for the treatment of infertility are of it. None of 'em are available in the market on the market. So sometimes there are certain doctors who have protocols that require us to make special products that are going to help the patient get pregnant, create the right environment for the uterus and for, you know, increase the efficacy of the other medications and allow the patient to get pregnant.
How that's changed is that years ago, I'm gonna say this is about eight or 10 years ago. A lot of changes happened. There was a huge tragedy that happened in New England and that kind of woke everyone up as far as government agencies. And so the government started to change a lot of the rules and regulations and got much stricter.
With compounding practices and put in a lot of new and not easy to achieve regulations on books that combat pounding pharmacies have to follow. So a lot of people ran away from that. We built a bigger lab. That was our response was let's build a bigger lab, USP800, USP797, USP795 compliance and get several pharmacists certified to do sterile compounding.
I think that a lot of, I don't think I know that a lot of the pharmacies are outsourcing compounds and not necessarily a bad idea to do that, except that some patients. Don't like that because they have to now rely on two pharmacies to get what they need. And sometimes it's more than that.
Sometimes there are products that maybe a pharmacy doesn't sell. And so they have, they end up using two to three pharmacies. And what that's one of the reasons that some of the nurses, some of clinics are happy that we, we have everything that they need. Like, whatever it is that you need, we're gonna be able to make it, whether it's compound or any other medication.
We have everything that the patient is going to need to cycle. And you don't have to worry about. Tracking to see if a pharmacy sent it and then the pharmacy be sent it that they both get there at the same time and is every ready for the patient to start. So that's how it's changed compounding for us.
It's actually been a bit, a huge benefit for us to be able to compound.
[00:41:12] Griffin Jones: This might be my ignorance. Hopefully somebody else is wondering it so that I seem less dumb. But you mentioned in the Mr. Goer era. So back then, he probably would've been, not even called a pharmacist, right? Probably would've been called a druggist back in those days.
A druggist and you said from the druggist was born the pharmacist and born the pharmaceutical manufacturers making do actually making the drug. So why did compounding stay on the pharmacy stream and not become the responsibility or the role of the pharmaceutical manufacturer?
So I wouldn't you know, if we're lacking compounds, then why doesn't the doctor called the drug maker and say, this is what needs to be made?
[00:41:54] Terry Malanda: Because there are so many, for example, I'll just say market dose Lupron, I'll use a really good example for this and thank you. That's a great question by the way.
Cause it begs the question of why aren't manufacturers making it so micro-dose, leuprolide the typical three strengths that we make it in, which are the most popular 40 per 0.2 50 per 0.2 and 40 per 0.1. So it's 40 micrograms of lide in 0.1 or 0.2, right? However, there are different doctors through the country that they want 10 micrograms or they want 20 micrograms so there are variations. So anyone can make that, but in the world of compounding, when you make a sterile compound, you can only assign it. And I won't get too technical, but it either nine days or 14 days, depending on the circumstances under which they were made. And by that, I mean, for example, if I'm making a compound, the first two needle punctures, make it a 14 day compound.
If I have to put a third needle in the valve that that becomes a nine day compound. So with the variety of different strengths it difficult for a pharmaceutical company to make one or two strengths in enough quantities to make it profitable for them basically. So it's a very small part of a very large selection of medications that are used in fertility. And then for example, in progesterone when we give dating to compounds for example, our pharmacy, we had to do studies on the three main strengths that we picked. We did studies, their extensive studies are very expensive to do and very detailed.
And then if you can prove to the FDA that your compound is good in that container for that amount of time and that it's a sterile product and this really holds until your expiration that you can give it dating. So work with the dating. We have some studies that show things are good for six months, but we only give it four months or three months just because we wanna be conservative with our dating.
For example, another reason to, with compounds that one of the biggest things that we compound is progesterone and oil, and that is commercially available. It's available in Sesame oil and it's fairly inexpensive, so it works great, but it's a small cross sensitivity, but there is a cross sensitivity between Sesame, which is a tree nut and any other nuts.
So peanuts, cashew, anything. So any patient who has any kind of an allergyto a nut, you don't wanna risk using Sesame oil, maybe nothing happens, but there's like a 5% chance that you could have a reaction. And obviously in someone who's trying to achieve a pregnancy, you don't wanna have this complicated by some sort of severe allergic reaction.
So there are doctors that use strictly But there's one or two or three clinics in the country that I know of that strictly use the compounded formula because there's so many people now with allergies and nut allergies, and sometimes they don't even know they have it. So they prefer to use something that isn't gonna give 'em welts or swelling and itching, et cetera, because the, the reactions can be mild or they can be severe.
It typically they're mild, but if the patient gets pregnant and has to stay on progesterone for six weeks, it's pretty hard to inject six weeks into an area that's very sensitive and swollen and itchy it's torture. So the, a doctors who opt for that if they see that the patient's having a reaction to Sesame.
[00:45:16] Griffin Jones: So you can have challenges with compounding things like PIO or in general, it's certainly an inconvenience to the patient. If they have to go to more than one pharmacy for, to get a compounded script. But you said that the other pharmacies will reach out or refer out to other pharmacies or they'll outsource the compounding.
Do they ever outsource to you?
[00:45:38] Terry Malanda: Well, we get a lot of we do get patients that the prescriptions are transferred to us. And that's, you know, that we do help patients. We're not gonna turn patients out. So we do help patients. That being said, we have to be careful with that because as I said, we really focus on service, Griffin, and we had it happen a few years ago, where all of a sudden when all this happened, They started to refer to us.
And so what happened was we increased our batches that we make, we increased the size, but then along time, the holidays, and so less people cycled, we ended up throwing half the batches away. It was very unpredictable, extremely unpredictable. So we try to focus on servicing the clinics that are using them.
We bundle price and we try to make sure that we don't run out of product that has dating. ‘Cause obviously part of the reason to use our pharmacy is that the inject the medications have dating. They have good dating. So if you get the later week or they get the later month you, you could still use the product.
And ‘cause it was specifically made to be used within a certain amount of time.
[00:46:44] Griffin Jones: So you may have answered my next question then, which was gonna be, is the market big enough to warrant a compounding only pharmacy that is outsourced by other pharmacies? And so if the trend for other pharmacies is to move away from compounding to outsource more or is there a, is the market big enough for one person or one pharmacy just to say, okay, we're the compounding pharmacy, all of you can outsource your compounding to us, and then we'll do it for you.
So this is now specialized enough that you don't have to have it in houses, does the market bear that.
[00:47:17] Terry Malanda: I think it could, but compounding is so highly regulated that I think that it would, if you consolidate that portion of it, I think prices would really skyrocket because testing a batch is very expensive training your pharmacist, it's ongoing training or all the time that's expensive.
So it would be difficult, is it big enough.
I would wanna be that pharmacy put it that way. I think you would have a lot of waste because IVF happens in weight. So we usually try to compound based on sales, which is kind of what you're supposed to do, but when the market slows down, you'd end up throwing a whole lot of product away.
And if, you know, we could take losses that are small, but if you had to take a loss that big, that's a good question. Maybe if you had more dating for more products, there could be a pharmacy that did compounding. We're certainly set up to do that, but like I said, we focus on taking care of mostly our patients and we don't turn patients down, but we do focus on taking care of our patients.
So for example if we're in danger of running out of my 90 day or 60 day compounds, or I may have to make them a 14 day compound, we don't turn 'em away, but they don't get the benefit of having the extra dating. That's kind of the problem that you would run into. But a lot of, I think that's some of the pharmacies that compounding now have dating on progesterone.
Not all, some other pharmacies do have dating on their compounding, but some of the pharmacies that are doing the outsourcing, they don't necessarily have a lot of dating. So that's another factor that you have to consider. I guess that's what we've heard from patients.
[00:48:57] Griffin Jones: Then what do you see as what's going to change or you think are gonna be the biggest changes in the field in the next five years?
So I, particularly as it relates to the pharmacy space, but the IVF field in general, what are you paying in the next three, five years?
[00:49:12] Terry Malanda: Definitely consolidation. That's I think that's a big factor that's happening. There's a famous well famous to, I mean, everyone in the audience will know what I'm talking about.
But years ago there was a partnership that was made between a pharmaceutical company and a particular pharmacy and that in the end it didn't work out. So I think that this is going to be for a while and then services are going to change and come back. One thing that I have to mention that I think is a big change and I think a good one.
I love men, no offense to men. Yeah. I have a son. I have a husband. I love men. But it's nice.
[00:49:47] Griffin Jones: Right?
[00:49:48] Terry Malanda: No, no, it's just nice to see so many women prominent in the field of, in for two have pioneered. A tremendous amount of the research and they've come up with the treatments, et cetera, et cetera. But it's really nice to see that a lot of women are getting really involved in the business and, and coming up with business models and service companies.
Some of them have done very well. Some of them haven't done well, but it's just nice to see that in a field that it's so much dependent on, on the, the person carrying the baby, it's really important to, to see that women are getting into that field. And I kind of like it, I think I'm the only female pharmacy owner, I think, in the country.
I'm not sure, but I'm pretty sure, I don't know any other female, there were was one, but she had retired and it just.
[00:50:36] Griffin Jones: You're ahead of your time.
[00:50:38] Terry Malanda: Huh?
[00:50:38] Griffin Jones: You're ahead of your time. I don't think we'll be saying that 20 years from now. I hope we're not.
[00:50:42] Terry Malanda: No.
[00:50:43] Griffin Jones: But I don't think we will be.
[00:50:44] Terry Malanda: Absolutely not. And that's one way where I I'm seeing the market changing a lot.
And it's nice, you know, when men and women can come together and really set a goal and, and really go after it, I think I'm a believer that men and women think differently and that it's a great, it's great. When you put that together, you come up with excellent ideas. Because we believe that different people see the world in a different way, and it's great when you have different and not necessarily just men and women, just different people, putting their heads together and coming up with innovation and coming up with great thoughts.
And you can't put yourself in everyone's shoes, you know, it's you could say it, but it's hard to put yourself in everyone's shoes. And that's one thing I always try to do because I'm, I'm now older. I'm not in the age group of women who are going through infertility. And I always wanna listen to the, to the people who are in that age group.
And that's what we try to do as far, or is like marketing. And how are people thinking about different things, new trends, you know, it's just changing. The popular nation is changing. Our society has changed. And I think it's great to see innovation catching up with those changes and with all those changes and with all that individuality.
And I think that service is key to kind of, to tie it all up and a knot.
[00:51:57] Griffin Jones: So that I wanna talk about it a little bit. So I'm with you on the first two trends, more consolidation, at least for a while, more females in the executive and founder roles, I see that and so for you, is coming back to service, is it a Renaissance of service?
Is that something that you really believe is going to happen, or is that wishful thinking? Because my answer might have been different than it was eight months ago. I wanna talk about that, but is it for you? Is it something you really believe we're gonna have a Renaissance of service or is it-you hope we'll have a Renaissance of service?
[00:52:26] Terry Malanda: Here's what I believe. When the service aspect goes away, things will fail, and then service will come back because that already happened with the example I mentioned earlier. So I believe that you know, we've always said we never wanna get so big that we lose the personal touch, and we mean that we really do mean that.
And I think that when things get so big and so controlled in a matter of, you know, where profit becomes the number one driving force and that's, that's the force, the service aspect falls apart. So I think it's wishful thinking that will happen. Does that answer your question?
[00:53:07] Griffin Jones: A little bit, but I'm starting to see more evidence for your hope here in what's happened in the overall economy the last year and a half, since people have like, oh, like I'm not gonna work my restaurant job, or I'm not gonna work this service level job. Or, or even in client services in marketing agencies in 2021, there was a, for 40, the average understaffing of agencies was 40% in 2021. It was we're understaffed for 40% we were. And so was the national average and the quality in terms of like, delivery. We still delivered every, but of, like, just that extra service. Absolutely it's offered for us. And I'm admitting it to everybody here and, but also everywhere Terry, like I ordered a, you know, I ordered like a late night meal a few weeks ago and I ordered it at, at, you know, like 9:30 or something.
And, and then I go at, and I get there at 9:58, they close the tent and they're just closed up. And I'm like, I called ahead. I ordered, we’re closed-up. We're done. Or like, or all of the places that you called to make a reservation. It's just, nobody answers the phone or you make your order online.
And, and they say, okay, we'll deliver it next. You know, we'll deliver it on Tuesday and it's like a week later. And this is just across the board of, oh, really felt service suffer.
[00:54:25] Terry Malanda: I'm absolutely with you. But I would say this and I'm probably giving away more information than I should, but I would say this, you have to make your employees care about what they're doing.
And you have to, if that your employees don't care, if they don't understand, if they don't get it, that person doesn't belong in your, whether it's a restaurant or it's a clothing store or it's a pharmacy, or it's a doctor's office. I think that if you're not able to inculcate the importance of what your, these patients are in the case of pharmacy, what these patients are undergoing, how important it is to them, how they're, you know, people are taking out loans to pay for this.
They've been saving for years to pay for this. And if you can't get people who have a good enough heart to, to get that, to really understand. That, then, your service will go down. We spend a lot of time doing that. It's the urgency, the importance, the care that they have to have. And I can tell you that we coach our employees.
We will talk to them if they just don't get it, or if they don't answer those, we've had employees, like, leave a five o'clock to five o'clock bell ring, and then there's a message on their machine that they never picked up. But luckily we have other employees who check every phone before they leave. So that's a taught behavior and you have to go through a lot of people before you get the right people.
In the case of restaurants, that's a tough one where him, because you know, that's a tough one, but in our case, I think it's not difficult to have people if you're lucky enough to find people who have a good heart, I don't think it's that difficult for them to understand just how important their position is.
And their role is in this patient's journey and in this patient, having everything that they need. And we really instill a sense of urgency in our staff. So that every patient who needs to be serviced is serviced every day. Have we ever faulted on that? Absolutely, once in a while, a fax doesn't get through or something, you know, technical, it's usually technology actually.
But, and have we had employees who didn't answer an email or did not answer yes, but then they're spoken to it. If they can't correct that behavior. You have to run a tight ship. I would say to answer that question, you have to run a very tight ship and it has to be very personal.
[00:56:45] Griffin Jones: So you don't think it's as hard as restaurants in that sense, but I think it is Terry.
I think it, and part of the reason why you're feeling a little bit less in that sense is because you're always on top of it. And my hypothesis is that it's either a virtuous cycle or a vicious cycle. And for those that are in the vicious cycle, it takes a lot of discipline to get out.
And the virtuous cycle takes a lot of discipline to stay on it. But whether it's a restaurant or a client services firm or a pharmacy that I bet you, you know, if we were just starting out Terry and like we're recently qualified pharmacies recently qualified business people have good hearts, it would take us a, a, we would have a lot of pain in trying to build that team eventually.
We would do it because of who we are, but that's my point is that it, it is a constant investment to be able to, to do that. And, and now I'm really starting to pay attention to, like, even companies that are known for, renowned for their service are, have suffered. And I've been paying attention, like, who in this unprecedented labor market?
We’ve never seen anything. Like it is still able to offer quality service. Those are the people that I'm really paying attention to.
[00:57:55] Terry Malanda: Yeah, no, I agree with you and not to change a topic, but COVID has affected this country in so many ways. And as far as the economy, I just don't understand a lot of things. I don't understand how people aren't going to work, but yet a lot of businesses are thriving and it's just, none of it makes sense right now.
So I agree with you. I think that's a little bit of what you're trying to say. Right? Am I wrong?
[00:58:20] Griffin Jones: Yeah. I think, and then part of it is because it's like, well, I think part of the reason why people are doing well, it's like, yeah, I could go to another place to get that meal, but most people are in the same boat right now.
And so it's like part of the reason why they're doing well is, is just because this is happening to everybody. And so there are so few people that it, that really is reliable service every time right now.
[00:58:43] Terry Malanda: I think the big differentiator is if you treat your employees, that you give them a job or you give them a career.
So we try really hard to give people careers at Mandell’s, if you can perform, if you're really good, are a great employee, and you can really provide the service that we, we always say our customer service, we want it up here. Everyone who's interviewed here is that. And once they're hired as well, we expect it to stay up there.
And I think that for some people just it's a paycheck and they're gonna go. But I think some people understand that if you're serious about your position there, you're gonna get ahead. You're gonna grow with the company and we have a lot of people who've been there for a very long time.
So you know, I don't know that and all work is honorable and no way do I mean this to be, but if you work at a restaurant, you can work at, at another restaurant, restaurants are driving and they're dying for help. So you could work anywhere you want. So there's a little bit of a power shift, I think as far as employers trying to get people to work for them trying so hard, we went through that.
When COVID hit the whole country shut down, I mean, all, you know infertility shut down all elective services shut down and they were shut down. Luckily things reopened for infertility. But it was terrible because when, when they shut down, I was in Mexico.
When we got the news, we were, we had just gotten on a vacation and we didn't hit outside of the hotel room for four days. And it was terrible. We were gonna have to lay people off and we'd never had to lay anyone off. So we were very careful and really looked at. Didn't try to see who we could keep et cetera, et cetera.
Turns out that outta 23 people, 21 of 'em laid themselves off. They didn't. They said I don't wanna come in. I'm afraid. So I really struggled with that and it turns out they laid themselves off in the end. So there was a lot of fear and there, you know everything has changed so much. There are so many industries now that have found out that they don't really need to have someone in the office.
They don't have to pay a lot of office rent, especially in big cities, like New York city, et cetera. So I know I'm totally off topic, but it's just a very complicated phenomenon that's happening now. There's so many different ways to look at it. And in some ways it dones a lot of good as far as rearranging the way that Americans work, but in other ways I still don't know why so many people are out of work.
And so many people are looking for people to work, you know, so I really can't, let's hope in the next few months, more people will join the workforce.
[01:01:09] Griffin Jones: Yeah. And hopefully it isn't too ugly when the other shoe drops either. But we'll be ready if it does. Terry, how would you wanna conclude for our audience either about what you wanna see happen in the IVF space in the next years or what you feel that every practice owner should be cognitive of, of how they use a pharmacy.
[01:01:30] Terry Malanda: Oh okay. Thank you. I would like, if I had my wish, every physician would interview pharmacies, and, and then try give pharmacies a try. We had I won't mention her name, but we had a nurse here in New Jersey that would always give every pharmacy a try and then come back to us.
So go ahead and give other pharmacies a try sample though and see how they do. And then if you go with the, be the one that services your patients best, and I'm pretty, I'm very confident that we would win in that race. So that's why I'm putting it out there. And I would like doctors and nurses to understand that the pharmacy that they use plays a huge, huge role and in your everyday life with your patient and especially in the patient's life, I really think that we really help patients get through this journey as seamlessly as possible, at least our aspect of it, and do our best for them every day. That's our goal every day is to do our best for every single patient that we can. So that's about it.
[01:02:32] Griffin Jones: Terry Malanda thank you so much for coming on inside reproductive health.
[01:02:36] Terry Malanda: Thank you, Griffin. I appreciate the opportunity and I'll see you at PCRS.
[01:02:40] Griffin Jones: Looking forward to it. I'll be there.