In this episode, hosts Brad and Michael are joined by plastic surgeons leading the way in medical weight loss: Dr. Alan Durkin, Dr. Johnny Franco, and Dr. Jonathan Kaplan. They discuss the evolving regulatory landscape surrounding weight loss drugs like tirzepatide and semaglutide, the impact of the FDA removing certain drugs from the shortlist, and key compliance considerations for practices offering these treatments. Tune in for insights on navigating the complexities of medical weight loss from those shaping the industry.
Listen to the full episode using the player below, or by visiting one of the links below. Contact ByrdAdatto if you have any questions or would like to learn more.
Transcript
*The below transcript has been edited for readability.
Intro: [00:00:00] Welcome to Legal 123s with ByrdAdatto. Legal issues simplified through real client stories and real world experiences, creating simplicity in 3, 2, 1.
Brad: Welcome back to Legal 123s with ByrdAdatto. I’m your host, Brad Adatto, my co-host, Michael Byrd. Now, Michael, we just finished recording an amazing webinar with three of the most top geniuses when it comes to semaglutide and peptides and GLP ones, and I’d love to hear your thoughts.
Michael: I’m really excited, audience. We finally, after 19 seasons, figured out how to produce the best content for you, the audience. And unfortunately, we just figured out that we needed to get three people that were smarter than us to do most of the talking, because you’re going to be blown away by these industry leaders on the whole medical weight loss front. And we truly did not speak as much as we normally do. [00:01:00] We listened and I was attentive the entire time just hanging on every word as they got into these really exciting conversations about what’s happening in the marketplace.
Brad: And for audience members to understand, this is a special, and yes, it is an hour, it’s not mistaken. You are going to be blown away how fast that hour’s going to go by because I can’t believe how fast we record it. But we’re going to let you guys jump in and here we go. And we’re good. Well, as everyone starts rolling in, we’re going to get started in about 10 or 15 seconds. I want to have everyone have a chance to kind of get in and join us, and I’m looking over and making sure our people are joining. I’m getting nods from the person in charge. So I’m going to get going because it’s be a very exciting evening. We’re excited to spend the next hour with you and this incredible all-star panel we have to really talk about compliance and considerations for medical weight loss.
And before we get started, I kind of want to jump back in time. In December of 2022, [00:02:00] I was speaking at the business of launching your practice. It’s a resident symposium put on by ASAPS. And at this faculty dinner, these plastic surgeons are sitting around talking about this wonder drug that they were using. They were using these really big pharmaceutical drug terms that, I don’t know if I can still pronounce them, but what I learned is they were using it and their patients were using it, and they were all losing weight. And then a few months later, our phones just started exploding because people, mostly doctors and entrepreneurs were learning about this new Wonder drug, this medication management. They want to really learn more about it. And in fact, obviously, that they’re not the only ones that took notice. A report that we just read from the American Society of Clinical Oncology suggests the weight loss drug market could reach about a hundred billion in the next five years.
That’s a hundred billion. That’s more than the GDP of a lot of small countries. So as you can see, people are very interested in this. And although the medical industry, there’s been obviously been a big shift, mostly dramatically and mostly positive. But believe it or not, some food giants are not so happy. [00:03:00] Kraft and Campbell have reported declining snack sales in the last couple quarters, and they’re blaming something called GLP ones. Michael, I’m not even sure what that is. I mean, can you imagine the horror of Twinkies sitting on shelves for years at a time? Actually, I think it’s probably okay. I think Twinkies are built for that. Twinkies are going to survive this guys, don’t worry. But with over 42% of adult Americans classified of obese, there is this demand to find an effective weight loss solution. And the few people I might know that might want to lose 10 to 15 pounds here and there, so there’s an interested audience out there. And so, there’s a very big positive economic and health news that we’re hearing. But with everything comes new challenges and major unique challenges, especially with the medical weight loss. How does a practice navigate this with this quickly evolving weight loss market? We were talking about that right before we jumped in here and really maximize its benefits. So Michael, I’m going to turn over you and see if you have any thoughts before you kind of get rolling from here.
Michael: To give a little context, you know that’s what I love to do. [00:04:00] And so for most of the audience, y’all probably are familiar with this and I’m setting it up for those who are curious about this whole weight loss world. You have these two products that are FDA approved. You have Ozempic and Wegovy that are Semaglutide, and Mounjaro and Zepbound, which are Tirzeptide.
Brad: Those are those fancy words I was talking earlier.
Michael: Yes. That’s why you had me say them because I know that your New Orleans Cajun would get in the way. And so, the panel that we have will be able to expand more on why this is such a big thing clinically, but from a, what we’re seeing from a business perspective is that there’s an opportunity because these are FDA approved drugs and they’ve been historically on what they call a shortage list, which is allowing for them to be compounded. [00:05:00] And so from our perspective, we’re looking at the regulatory framework that we always do, which is there’s a practice of medicine happening, but then you also have the compounding elements of some pharmacy issues. And then you potentially, depending on how it’s being done, have some dispensing issues that go into it. And so, those are the types of conversations we’ve been having. And then we’ve just as we’ll learn more about today, there’s just been a rollercoaster ride on what’s been happening kind of on, on the FDA home front.
Brad: Yeah. And for those joining us, I’ll get a little housekeeping. You are encouraged to ask questions. There is a Q&A box that you can drop questions. As you drop them, we’ll get to that as we’re blocking time at the very end so that we’ll have time to answer your questions. And if those not familiar with Zoom there’s a Q&A button located on your Zoom toolbar, and you can use that to ask your questions. if you’re on a mobile device, [00:06:00] you got to tap on your screen to bring up the toolbar, and then you’ll see the Q&A button and everything I’m just saying, Kennedy is going to drop into the chat box so you can see that. And if you don’t have a question but you’re having technical difficulties, just use the chat feature and that way we can kind of help take care of you from that perspective. But Michael, I want to get this all-star panel going. Our housekeeping is done, and we’re excited to have from coast to coast. We got you covered. We got from San Francisco to the Florida, a little stop off in Texas here. I mean, it’s just going to be a great panel, but let’s get going. I’d love the panel just to kind of spend a little time introducing themselves. So Michael, for those that don’t know you, why don’t to introduce yourself.
Michael: So my name’s Michael Byrd. I am a partner at ByrdAdatto, and one of the hosts of this podcast with you. Brad, do you know your name?
Brad: Adatto?
Michael: Yeah. Brad Adatto. We’re health care attorneys and we help medical practices with any number of issues including compliance [00:07:00] questions like we’ll be talking about today.
Brad: Awesome. All right. Well, Alan, why don’t you bring yourself up and introduce yourself.
Alan: Oh, yes. Well, thank you for having me. My name’s Alan Durkin. I am a Plastic and Reconstructive surgeon. I am located on the Treasure Coast of Florida. I run Ocean Drive Plastic Surgery, Dermatology, and Med Spa. We’re kind of a boutique destination aesthetic center. I also serve as chairman of the Division of Plastic Surgery for Cleveland Clinic, Florida, and the Vice Chairman of the Department of Surgery and I’m the Chief Medical Officer for VO Med Spa. Those are kind of the big things that I do. Relative to this, I am a very proud client of ByrdAdatto, and Michael has personally kept me above ground since 2023. So thank you for that. And we got involved kind of early on with the GLP programming through our med spa network. We have a national training center. We’re really, really big fans of this. I agree with Dr. Franco. I think that these medications will have a seminal effect on the future of [00:08:00] American medicine, and I think it’s going to be profound for generations – so happy to discuss it, and thank you for the invitation tonight.
Brad: Absolutely. And speaking of Dr. Franco, Johnny, want to jump in here and introduce yourself?
Johnny: Yeah, my name’s Johnny Franco. I’m a plastic surgeon here in Austin, Texas. Probably see some of you guys at ASAPS in about two months, six weeks or something like that. My biggest disclosure is, I’ve personally lived the GLP life. You know, I’m down about 90 pounds on the medication myself. And that’s really what introduced it to our practice. And actually right around where you guys were. I think I started in October of ‘22. We brought it into our practice November of ’22, and have been rolling ever since. At this point, we see over a thousand weight loss patients a month in our office. What’s interesting and the reason I love that you guys do this, I’ve done a lot of webinars as these guys have, but with one of your associates Sam Pondrom, and it’s been so great. Because I’m every time, if anybody’s been following it, the FDA, the statements [00:09:00] are almost a rollercoaster ride. And I think you guys are going to get into it to make sure that this is something you really have the heart for. But he is almost so chill about this. Like, I’m like, ‘Oh, a big decision.” He is like, “Eh, it’ll be fine. Or eh, this is going to take time and stuff.” And so it’s just almost a calming for stuff. You guys do the same, and so definitely a shout out to you guys for kind of pointing out the fire a little bit.
Brad: Well, awesome. Glad you’re here too, Johnny. And now Jonathan why don’t you jump in?
Jonathan: I’m Jonathan Kaplan. I’m a plastic surgeon out in San Francisco and have a busy weight management program in our practice, but I’m mostly here talking and representing our company, DrWell, that helps is a provider to consumer platform. So if you think of direct to consumer websites like RO or Hims, they make it easy to access medications for patients. But the problem is, after they get the medications, their relationship is with a website. So what we do is we’re a provider to consumer platform as opposed to a direct to consumer platform where we provide all that technology to make it easy for [00:10:00] patients to sign up with. But the difference is, they’re then connected with a health care provider. So we make it easy. We provide that technology to make it easy for the consumer to sign up online for these medications. We help with the monthly trends subscription processing or prescription processing, so that there’s like an automated generated prescription in the backend of our platform. So the provider can log in, submit the prescription to the pharmacy that has a license in the state where they’re shipping the medication.
And because of that, because we have so many providers that we’re handling all the prescriptions for, we get these large volume bulk discounts for our providers, so we have better rates than a lot of GPOs out there. And then also we have a general counsel that is attorney and a pharmacist, its actually an attorney that ByrdAdatto connected me with; that is our general counsel that helps keep us apprised of all the legal things that are changing out there, so that all of our providers that are using the DrWell platform, they’re also apprised of the legal changes. [00:11:00] And we’re just always helping make things as easy as possible for the providers to sign patients up, to submit prescriptions and do it all legally.
Brad: Awesome. Well, like I said, we’re very excited for everyone to be here and for everyone to learn. And so we’re going to really start with this very first question. This is just for the doctors and not doctors of law, Michael, just the real doctors. And so for this one, we want to understand from your perspective, discuss the impact that you have seen over the last few years that the medical weight loss drugs has had on the aesthetic market. And Johnny, I think I start with you first.
Johnny: I mean, it’s been huge for our practice. And if you look at it nationally, QSight actually released their numbers for 2024. And practices that were involved with the GLP were up about 10%, practices that were not were down two to 5%. And so, pretty big swing there if you think about it for, for most practices, especially taking it around the country; that’s been us in total. And what’s been interesting is that [00:12:00] even in this kind of crazy economic year stuff, the ripple effect it’s had because it’s increased our skin tightenings, our surgeries that have changed as well. Honestly, lipos have gotten more fun. Tummy tucks have gotten more fun. You know, we’ve been able to be involved in their journey, which I think us as plastic surgeons have a really, really unique opportunity to see patients from the very beginning during their weight loss journey, their transformation surgery, and then all the way to the end. And I don’t know that very many specialties have the ability to kind see people throughout this wave.
I’ll tell you what’s going to be interesting, even going forward with these GLP is not only just the weight loss, but there’s so many new indications coming out for these medications. What’s going to be interesting is how those patients who never got in it for weight loss, but they’re going to have the sequelae of the volume loss, the skin laxity, and then you’re going to see some even stronger drugs hitting the market likely this year from some of the big manufacturers, and so even more rapid and massive weight loss. I think we’ve only scratched the surface. [00:13:00] I think there’s a huge second cosmetic wave coming. But I also think there’s such a unique challenge. I have this concept I’ve been developing called the Ozempification of aesthetics, which is this unique patient population with very unique needs. And then how we treat them along that, because we’re seeing issues in really young patients that we typically associate with our more mature patients. If you would say.
Brad: It’s fascinating. Alan, what are your thoughts?
Alan: Yeah, I wanted to dovetail again on what Johnny said. My practice is a lot of face; that’s at least 80% of what I do. So the term ozempic face is now part of the zeitgeist. Whereas if you think about it, years ago, it didn’t. We got introduced to this biochemically or pharmacologically, however you want to say it, but I try to look at this through the perspective of the patients that are now on it. So let’s say that you’re just watching from the outside looking in, and I just remember one [00:14:00] morning I woke up, I read the Wall Street Journal, and all of a sudden the Wall Street Journal’s talking about this new class of medications called GLP. I can’t imagine that literally no less than 1 million people called a physician that day and said, what does this mean?
So that was really from the outside looking in. because I was trying to put myself there; that’s where it really started. And if you look at grassroots movements, because that’s what this is, I mean, that’s really how it started. It’s not like they’re direct to consumer saying get sexy. They’re not, this is a type two diabetic medication, but the demand for it is absolutely – it’s tectonic. It’s just beyond anything. I mean, you have shortages all over the place, so the impact that it will have on really every specialty is going to be remarkable. But the one on plastic surgery, I agree with Johnny, it’s going to be profound. And if you really look at aesthetics and just step back and really look, what do we do? With the exception of breast augmentation and fat grafting, almost everything we do is subtractive. [00:15:00] A tummy tuck subtracts from you, liposuction subtracts from you, a blepharoplasty subtracts from you, a facelift subtracts. Well, so does this medication. This is the exact same thing.
So when you’re talking about what specialty does it fit; well, very few people subtract like we do. Orthopods don’t do that. Rheumatologists don’t do that. So it’s kind of a gambit here. I personally feel that the impact on aesthetics is what we make it. And I think if we do nothing, it’s going to be profound. But if we’re smart about it and we really try to own and become the true experts and the cornerstone of this therapy, I, I think the opportunity to make aesthetics a long-term growth vector for American medicine will be here for almost 10, 20 years. Because there are – I just like Dr. Kaplan mentioned before we got on, there’s four or five more coming. This is not the end of the story. This is chapter two, and I think there’s at least 12 to 13 chapters left.
The other thing that’s happening is there’s a trickle-down effect is the med spa delivery system is here to stay. [00:16:00] The reality is, I anticipate they’ll continue to creep in what we’re calling now mainstream medicine. But the first thing that we see, so Med Spa Network is another entity that we have, we do a lot of national trainings, mostly for, for non-surgical aesthetics. But now 30% of our people are asking for how to manage GLP. So it’s trickling down to every level, and I think that nobody has really galvanized a specialty behind it, but I think plastic surgery has a sincere opportunity to be that sense.
Johnny: Don’t think there’s this unique though, time period, because you have the pushback from the filler fatigue. You have people who like myself, the last thing I want to be is someone to tell me, “Oh, let’s put some filler in your face that’s fill you back up.” It’s like, “No, I work so hard to not be full.” And so now it goes to the subtraction, you’re doing these things, and so it’s almost this perfect storm. You have these people losing weight. Jonathan will probably get into a little bit, but even this wellness wave that has followed with some of that, I saw in one of his talks in terms of peptides and other things. So you’ve seen this whole like, [00:17:00] evolution that’s kind of come together in a, in a perfect storm.
Alan: Yes, yes. I absolutely agree. And consider for a moment, I mean, if this medication is going to affect Kraft Foods, every cardiologist in the country knows about it. Everybody. There’s not a specialty it’s not going to touch. But I don’t think this – I don’t know, I mean, obviously I’m self-invested, right? Just got to be honest about that. But I also think I’m right.
Jonathan: That’s the thing. Oh, sorry.
Alan: Please, John, go ahead. I’m sorry.
Jonathan: That’s the thing is that it’s outside of the plastic surgery community, what we’ve seen in our network is that we have cardiologists coming on board. We have OBGYNs, we have dermatologists. Because what everybody’s realizing is that everything they’ve ever been treating the underlying cause of that was obesity. And maybe you could also say the underlying, underlying cause of obesity is the food supply in America, but that’s another topic. But anyway, so instead of everybody treating the sleep apnea [00:18:00] or the acne or the erectile dysfunction, when they realize that all of the most common causes of those things I just mentioned is obesity, that’s when you’re going to see all of the different practitioners in America treating obesity. So, we’re all obesity doctors now because this is the biggest thing since penicillin. Now, the thing is, what’s going to be interesting about that is because providers are going to start to understand the ones that are typically insurance-based, they’re going to realize that this is a cash pay opportunity.
It’s really fascinating to talk to doctors who are typically insurance-based. They really almost don’t believe you can accept cash for services. They almost think it’s illegal that you have to go through insurance. So they’re going to learn that this is an opportunity for them to accept cash, not be dependent on insurance. And so you’re going to see more and more people coming, not necessarily into the aesthetic space, but into the cash pay space. And it’s actually going to have an effect on these traditionally insured providers, that they’re going to be able to stay independent longer. They’re not going to have to get bought out by a hospital or absorbed by a hospital. It’s really going to change the entire ecosystem [00:19:00] of health care providers in America, and no drug has ever done that before. But it really is going to allow people to start expecting cash pay subscriptions for medications. And like I said, everybody’s going to be, not an obesity specialist, but an obesity doctor.
Brad: You know, Jonathan, to that point that you just made. So some of these doctors who are used to the commercial payers; are they trying to get the commercial insurance to start paying for any of these? Love to hear your thought on that?
Jonathan: That’s their go-to because they don’t know any better. They don’t realize that there’s the cash pay option, and not with the name brand because that’s way too expensive over a thousand dollars a month for the cash pay over the name brand. They don’t realize that compounding pharmacies exist. They don’t realize that those are less expensive and that there is a profit margin that you can build into getting it from a compounding pharmacy. So yes, their initial inclination is to go through insurance, but what they’re going to quickly realize is as of January 1st, and this is true every year, more and more insurance plans are dropping [00:20:00] coverage or reducing coverage. Now, you may see Mercer Consulting had a study last year showing that payers were going… that 41% covered these medications the year before, and then the most recent year they covered it 44%. So it went from 41 to 44% saying they cover it, but it’s false. It’s that they’re saying they cover it, but they’re saying that we cover it, but your copay is going from $25 to $775. So you can say you’re covering, but it’s nonsense. Nobody using normal language would consider that coverage. So the insurance plans are reducing coverage. I’m seeing patients all the time saying that their plan dropped them, Kaiser raised the BMI to 40. So they’re all making this more and more difficult for insurance to cover because of the expense of it. So that’s why these providers are going to realize that, oh, there’s a cash pay option.
Brad: Yeah. And I did see, I think this is the beginning of last year or somewhere last year, the state of North Carolina used to pay for these weight loss drugs and then [00:21:00] they dropped it because it was so successful – because that makes a lot of sense.
Jonathan: I’ll give you specific numbers. In 2023, the North Carolina State Employees Insurance Plan spent a hundred million dollars on Wegovy – one drug, $100 million, which was 10% of their entire budget in 2023. So as of April, 2024, April 1st, 2024, they dropped coverage of obesity meds.
Alan: Let me ask you this, John, can I just dovetail on that, because that’s really interesting. So now, let’s say for a second that they spent a hundred million dollars in 2023, and they did the same thing in 2024, they didn’t drop it. What do you think would happen long term to their health care costs relative to the weight loss in that patient population and their overall cost long term downstream?
Jonathan: Well, the immediate effect would’ve been increased premiums for everybody, every because they would’ve had to find a way to pay for these medications. But the problem is that you could say that 20 years down the road, these people would’ve been healthier, they wouldn’t have had to had blood pressure, they wouldn’t have had cardiac disease. [00:22:00] But the problem is nobody wants to wait those 20 years to recoup those costs. None of the insurers do. They just assume you’re going to switch to somebody else in the meantime and you won’t be their problem at all. So theoretically yes, but not in actuality.
Alan: I’m terribly sorry, just to dovetail to that. Do you think it’s 20 years? How long do you really think, let’s say you take a hundred people, right? Just because they are on a school board, whatever, a hundred people, how long do you think would be the interval? This is for everybody, where you would see a recoup of that cost relative to the new medication? I’m really just curious.
Jonathan: I think it’s a great question and I will answer it. Rather than just saying what my feeling is, I’ll answer it with the best data that I have. And that’s from the Congressional Budget Office, which is a nonpartisan entity of Congress, that the CBO said that based on the current cost of these medications, the ROI is not there. So what they’re saying is you definitely will eventually save money [00:23:00] on offering these medications, but the cost of the medications have to come down enough to where the cost of the medication long term, over the course of somebody’s life is ultimately less expensive than those additional medical issues that you’re avoiding. Does that help? They said that there’s no question these medications could bring down the cost of care if the cost of the medications come down first. The ROI isn’t there unless you lower the price from a thousand dollars a month to $500 a month, for example.
Johnny: And I guess Alan, I saw a stat where people typically change their private insurance every two years. If they’re changing every two years because if you think about, not people like us that are stuck in our job, but most people they’re changing jobs, especially our younger people. And so, they’re like, if people are changing every two years, we’re never going to reap the benefit of this.
Jonathan: And I think a really important thing to know is just the way we’re talking about compounded medications and people paying out of pocket for it, the insurance companies know that people are willing to pay out of pocket. So the insurance company’s like, well, we don’t need to cover this. [00:24:00] If we wait long enough, they’re just going to pay out of packet for compounded medication.
Alan: Well, that I see. So like there’s two forces here. So I have an insurance component, the Cleveland Clinic, all that stuff. And so anytime that an insurance takes over a procedure that we have fee for service, I’ll be fair, like it poisons a lot of the market and it pushes a lot of us out. It just does. So look at upper lid blepharoplasty, you know, a lot of us will concede, we don’t take insurance, we don’t do any of that. I have to fight with the ophthalmologist, but the long and short is the insurance thing not getting into Wegovy, I would respectfully argue that’s probably a benefit long term to the market. Anecdotally, the reason why I was asking that question is like what I’ve seen in the short period that I’ve had this as part of our armamentarium is I’ve converted at least eight or 10, I mean, ASA3s to ASA2s or ones and operated upon collectively. And Johnny’s point about every two years you’re doubting your insurance carrier. [00:25:00] We’ll never know that data, but I just respectfully submit, I think that that’s a comprehensive misinterpretation of the effect of this medication long term. I can’t prove that and I would never discount the data you’re saying, but just anecdotally, I keep seeing it over and over again. And I’m hopeful that there’s more and more discussion about like that return on investment from the…
Jonathan: And in five years?
Alan: Really from like a cardiology standpoint, right? Because I’m not talking about how to get somebody in my operating room as much as I am is give people eight to 10 years of extra quality of life.
Jonathan: And you may be proven right in five years, not 20.
Alan: Yeah. I’m interested to see that. I think that’s going to be – I mean, once that happens, well then the insurance thing will happen again. But you know, that’s going to be the true promise of the medication and its effect on our country.
Brad: Well, and this is going to lead perfectly into this next question really, which is you’re kind of beating around right now, is like the medical weight loss drugs. The news is constantly changing, right? From a compliance perspective, we hear about all these different lawsuits that are out there. [00:26:00] We got obviously the FDA that’s happening on again off again. so let’s kind of start sorting through this a little bit, and for this next part I want to let really think about the regulatory landscape. I guess this is a legal track too. So Michael, I’d love to hear your thoughts on that. And then I’m going to bring the panel back in. First off, that was fascinating.
Michael: It’s amazing. As much as there’s so much legally happening, both of us have been communicating with all three of the panelists throughout this and have learned from them updates. This is so fast changing. I can I remember this summer going back and forth on a text with Johnny Franco and I was getting an email from Jonathan the same day when all the latest was happening. And so, it’s a full contact sport just to try to understand what’s happening. So I’ll give as much of an attempt at a color [00:27:00] by numbers explanation of what the regulatory landscape is as I can without lulling us all into sleep. So, the basic premise of this is that you have the FDA, which regulates approved medications. And so we keep tearing this term compounded drugs.
Compounded drugs are not in of themselves. They’re not approved by the FDA. And so what allows compounded drugs to be used in the marketplace is when they are copies of a commercially available drug that are allowed by the FDA, but they are on the FDA’s, what they call shortage list, drug shortage list. And so, that’s what we’ve been experiencing over this time period over the last couple of years. And so you have Semaglutide that are still on the list right now, and then the last several months you have tirzepatide where we’ll just call it – it’s complicated. [00:28:00] The quick version is that the status changed to “available” in August of ’24, and that caused an uproar of what does that even mean? it was determined that it still means that it was on the shortage list. And then in October of ’24 it was, it was deemed resolved, which takes it off the shortage list, except the FDA changed their mind a few weeks later. And there’s been lawsuits filed that are going on throughout all of this.
And then in October of ’24, the FDA ruled again that, no, it is resolved. And they set forth a timeline that we have a February date and a March date where the compounding is supposed to stop depending on the type of pharmacy. And then even more recently, we’ve heard [00:29:00] the FDA that while these lawsuits are pending, that they’re not going to enforce this ruling. And so to say that it is complicated is an understatement. It’s a moving target and it makes our conversations with our clients complicated because there’s a risk management perspective. And really the pharmacies are on the front lines from a risk perspective, but the doctors have to manage it. There’s some risk because you also have to contend with the pharmaceutical companies and the risks that they may turn towards a practice. But you also have to plan for when these drugs are not available and how are you going to run your business. There’s a lot of moving parts. I agree, I think Alan said earlier that we’re on chapter two of this story, and I absolutely [00:30:00] believe that to be true. I think if we talked again in April, that we would have all new things to talk about.
Brad: Obviously. Well, Jonathan, love to hear your thoughts on this too.
Jonathan: Yeah, lots of layers. So right now it is available, the FDA says there’s not going to be any enforcement actions while there is this litigation between the Outsourcing Facilities association, which is the representative of 503B pharmacies, suing the FDA, and actually now Eli Lilly is a defendant as well. So they’re not going to enforce any penalties while it’s in litigation. But let’s say that it does really go off the shortage list. Well, there’s a couple things. One is the millions of Americans, maybe, at least hundreds of thousands, if not millions of Americans that are using compounded meds, will then go back to try to get the name brand drug and then it’s going to go back on the shortage list. Because if you really look at the number of Americans that are candidates for this medication, if you look at just the [00:31:00] indications, it’s 136 million Americans that are candidates for these medications.
So if you do the math once a week, four times a month, 12 months out of the year, that’s 26 billion injections that the pharmaceutical name brand companies are going to have to come up with, 26 billion with a B. So I don’t think they can really do that. They need the help of the compounding pharmacy. So again, if it goes off the shortage list, compounding pharmacies can’t make it that they can’t handle that influx of they’re going to get. So that’s why I think the compounding pharmacies are always going to have a place. But even still, the compounding pharmacies, legally, there’s a loophole that they can use where they adjust the dosage by 10%, then they can keep making a non-standard version of Tirzepatide that’s not commercially available. The provider just has to provide a reason why the patient needs this and can’t use the name brand drug. And these are all things that we’ve built into the DrWell platform to allow the providers to make those adjustments in their subscriptions and get the patient’s consent to change over that prescription to make it as seamless as possible. So we’re preparing for all of these eventualities.
[00:32:00] But the other thing, the other big unknown right now is that RFK Junior, Marty McCarey, they’re compounding pharmacy friendly, but also just the simple fact that these medications still are on – they’re in shortage even if the FDA doesn’t believe that. And so, our general counsel, again, the a guy who’s the pharmacist and the attorney has had conversations with Marty McCarry and with RFK Jr. and even though they’re not technically confirmed yet, they have both given assurances – now their politicians to some extent. So we’ll see how far that goes, but they’ve given assurances that this is going to go back on the shortage list. So I think in the immediate term, we’re okay to continue getting Tirzepatide; in the long term, there’s going to be alternative routes to get Tirzepatide, because I think people are going… I think the politicians are going to quickly realize that there is going to be a new demographic. It’s the Ozempic demographic. They’re going to be ozempic voters out there that are going to be very upset if they’re compounded less expensive, more affordable version of these medications becomes unavailable to them. [00:33:00] They’ll remember that at the midterm elections.
Brad: That’s fascinating. Alan, what are your thoughts?
Alan: I agree with that. I think it would be an interesting thing to see if you yank all of this off in a fairly… We have all this litigation going, and so they’ve agreed not to enforce anything, but let’s say that the litigation fails, I still don’t think they’re just going to slam a door. I just don’t think they’re going to do that. And secondly, I don’t know how they would do that. The other thing that I think throws a little bit of a monkey wrench into all of this is, right now, as I understand it, there are, I think four new competitors coming out in the market. Isn’t that correct? Is that coming out? As I understand it, there’s four new GLP this year. So that’s going to really change things too, in terms of the market, because you don’t know what the messaging’s going to be on those and you don’t know who they’re going to target.
I think that some of the newer ones coming out – so take Botox, everybody’s got [00:34:00] Botox on their website, but really it’s a neuromodulator, but it’s still Botox. So it’s always going to be tirzepatide semaglutide, but something’s coming around the corner. Discord ,X fine, Xeomin are here and they’re all doing fine too. That’s also going to happen. And the question becomes one of is, what if somebody creates something and says, we don’t want to put it through insurance. I’m eager to see if somebody’s going to do that, because whoever does that creates their own market. It creates their own market. So, so imagine somebody comes out with something and they say, you can’t get this through your insurance, can’t do this, can’t do that. It’s 5% better and it’s cheaper than your insurance. Who cares? And all the cardiologists will get it too, and they’ll run it through their insurance or do something. You see what I mean?
I think that the government will go back and forth, back and forth, back and forth. And at the end of the day, I think private industry’s going to solve this for all of us, because I think somebody’s going to come up with a better mouse trap that’s going to go. If the compliance is going to affect us seeing patients, imagine somebody’s pouring a hundred million into a drug pipeline; they’ve got to have something that they’re… [00:35:00] this has got to be on their radar screen on some level. And I don’t think that they’re going to put a drug out there that they can’t keep up with it. That’s what I think. But I’m obviously a little bit left field there, but you have so many different medications. I find it also interesting that ASCO is publishing data on Ozempic. I know that there’s a risk reduction.
I’m a big cancer guy. No ifs, ands, or buts about that. I don’t wish to disagree with that at all. But also consider clinical oncology is a drug delivery. They understand how that insurance thing works. I’m going to look at that article, I really do. I can’t imagine they would be – I would imagine they had a sour viewpoint on keeping it in insurance. And that’s really, I think ultimately, if private industry gets the sense that it’s going to fall out of insurance, and gosh, I hope it does. I really kind of hope it does, then it’s an open market, and ultimately somebody’s going to figure out a better way to price it down, and all of us are going to win, especially our patients will. That’s what I’m hopeful for, but we’ll see. But in the meantime, I think you’re right too about the ozempic voting initiative. If they yank that, somebody’s going to lose their job at the highest levels of government, I’m sorry. I just don’t see that. That would be a disaster. That would be a disaster.
Brad: Johnny, what are your thoughts?
Johnny: Yeah, I mean, if you just listen to what Michael, Alan and Jonathan said, I mean, one of the – probably like them, we get somebody that reaches out and visits our office at least two or three times a week. And I always warn people a little bit, and I’m not trying to shy anybody away from bringing wellness into their and weight loss into their office stuff. But I think if you were adding a med spa, if you’re adding any service line, I think they need to know this is a real deal, and it’s going to take a real structure and time and effort to it. The time of just having the field of dreams where you just bring on the weight loss and people are going to be flock into your house; [00:37:00]Jonathan’s whole business is trying to help practices be competitive. And so, because there are so many other alternatives out there right now.
And so I think one, you have to have a real business plan. Two, I think you need to have somebody that’s going to spearhead it consistently because there’s so many changes, not only from the FDA, but both what Jonathan and Allan brought up. There’s going to be new medications in the market this year, some from possibly new companies, but even some new medications from the companies that already have medications on the market. There’s some other long-term stuff coming. But if you can’t keep up with that, you’re going to be underwater doing things that are off the deep end, and you don’t even realize it because it was kosher six months a year ago and all of a sudden something’s changed, but you just missed it because you weren’t on it. I always try and give people a little bit of word of caution of just making sure, taking the time to build the infrastructure and then who’s going to spearhead it right now to stay up with all of that because I think there are a lot of changes. [00:38:00] The only thing I would argue with Alan about is I don’t think there’s only 12 more chapters. I think there’s probably about 90 more chapters to go in this book.
Brad: Well, y’all keep talking about all these drugs and I know Johnny and Jonathan, when we had y’all on our podcast both times I asked you all this question is, there are a lot of people that just are afraid of needles and the thought of injecting themselves more than once a month is not something they’re very interested in. Are any of these new drugs or are you hearing about people still working on trying to have a pill form of this that meets that same criteria?
Alan: There’s a couple out there already.
Jonathan: Yeah. There’s Orforglipron that Eli Lilly is making. It’s a small molecule, meaning that it doesn’t – it has the effect on the GLP ones, but it’s not a long peptide chain that can degrade in the stomach. And so the idea is that – and Eli Lilly said that was probably going to come out in 2026, but the thing is, it’s a daily pill, and I am shocked that to say this, [00:39:00] but I think I would’ve always thought people would rather a pill than a shot. But I think the thing that’s going to be surprising is that people may actually prefer a once per week shot, just like they would even prefer a once per month shot that Amgen’s working on, that I don’t think people want to take a daily pill. The other thing is with the daily pill, based on the preliminary studies; it was upwards of 88% nausea, 88% that’s like higher than any of these injections.
So even though a pill sounds great, I think that people don’t want to take a daily pill and they certainly don’t want to take it and it’s going to give nausea 88% of the time, even if it doesn’t lead to 88% of people quitting. But it’s always cracks me up about these studies where they say, yeah, most of the symptoms were nausea and vomiting, but they were mild to moderate. I don’t know if you’ve ever vomited, but vomiting is never mild or moderate. It’s always the worst day of your life.
Johnny: That’s what’s super interesting. You know, they have the some orals coming to the market that either late this year, early next year, kind of [00:40:00] depending; there’s actually multiple companies working on that. The other thing that’s super interesting, and Jonathan alluded to it, is these long acting injections, because some of the side effects have actually been shown to be much better because of the way the bell curve and the way they distribute. And so the once a month – there’s even a university company working on a gene therapy that would be a single treatment to some of these receptors. And that’s obviously much further down the road, but pretty interesting. I mean, if you get to a once a month shot, a once a quarter shot, I mean, gosh, to me, that is super attractive. I don’t take my allergy medication every day and I forget. Gosh, so there’s definitely, to both their points just scratching the surface of the cool stuff in progress. I saw a stat where there’s something like 120 in the realm of the LPs medications in clinical trials right now.
Jonathan: Yeah, there’s a good bug from Stats.
Alan: I absolutely believe that number.
Jonathan: [00:41:00] Stat news, which you, I think you have pay a subscription to see it. But they have an obesity tracker where they show all the meds in the pipeline, but Stat, I think they’re owned by the Boston Globe. But anyway, it’s $400 a month, excuse me, $400 a year, you can get a subscription and that you’ll be able to see their obesity tracker that shows all the drugs that are in the pipeline. It’s pretty interesting.
Brad: That’s crazy.
Alan: So there is a medication too that’s out right now called Calocurb. I haven’t used it, but it is actually developed by the New Zealand government and it’s over the counter in New Zealand. It’s in the United States, and it’s sold over the counter here and they actually have sincere data. But to John’s point – to Dr. Kaplan’s point, yeah, their big thing is nausea. And you got to take four pills, I think three times a day for like a week, and then you got to take it three times a day. So there’s some problems with the oral delivery currently, but that is a viable option and a lot of people are using it to come off of injections, to your point about not liking the needle. [00:42:00] Water will always seek its own level.
Johnny: Interesting thing is, is I don’t know if you’ve seen, like some of the obesity clinics have even incorporated some of these other medications that have made themselves so cost affordable for patients like Contrave and some of these that are just such minimal pricing for patients. There is a whole concept and of people building resistance. I think there’s this concept of maintenance that I know Jonathan talks about as well in terms of this. And you know, some of those are still TBD. I mean, the cardiologist, a friend of mine is like, this will be the next data. And so it’ll be interesting to see where that plays out in terms of dosing and to people’s point about shortage. If the cardiologist now start recommending this to every single person, I mean, talk about the increase there even beyond this, because like for me personally, I’ve struggled a little bit of where I want to be in terms of medications because I feel really good in terms of my weight and [00:43:00] my own mindset had changed.
When I first started the medication, I was working towards a goal that I’m going to get to a good spot, I’m going to come off these medications and now I personally do a low dose at least once a month. My dad died at a really young age of a heart attack, coronary artery disease, and he was pretty thin. And so, with some of the stats out there, it almost doesn’t make sense for me as a high risk person not to be on some of these medications when seeing some of the cardiac literature. So I think there’s still a lot to play out in terms of dosing, things like that for that.
Brad: Yeah. Another question, Johnny. You were talking Johnny a little bit this about this, but I’d love to hear Jonathan’s perspective. As people are trying to, you know, if someone’s listening to this and thinking about adding this medical weight loss clinic talk about some of the traps that they’re just not thinking about and y’all learned it probably the hard way, but what should they be considering? I’ll start with you, Jonathan.
Jonathan: Yeah. I think the biggest one, and I say this, this is the invisible elephant in the room because it’s in the room, but nobody knows it’s there, [00:44:00] is Legits Script certification. I mean, this is not a legal issue, it’s just a financial issue is that most people think Legits Script certification is, that’s what you need if you want to advertise these medications on Google or TikTok. And that’s true. And so if you post something about Semaglutide and you’re not Legits Script certified, Google will take down your ad. Okay, no big deal. Whatever you stop advertising, maybe you start seeing GLP ones. But the thing is, the where Legit Script certification actually has some teeth is that if you are accepting payment for these medications, like card not present, like you’re running a subscription every month, you’re charging them over the phone or you have their card on file, the point is, the card’s not there. That, believe it or not, in the Visa and MasterCard terms and conditions because you’re taking payment with a card not present for a high risk category, medications are part of the category that’s like pharmaceuticals and pharmaceutical sundries, but it’s a high risk category that Visa and MasterCard will cut you off for all of your Visa and MasterCard payments [00:45:00] if you’re not Legit Script certified and you’re accepting payment for these medications, or if you’re doing it for psychiatric meds, things like that.
So that’s another thing that people aren’t even aware of. They’re like, that’s not even on anybody’s radar, that if you’re not Legit Script certified, you’re going to be in trouble. And it’s not just that you have to be Legit Script certified, but you also have to work with a payment processor that accepts high risk payments in that same merchant category. So, it’s those two things. And then the third part of that three legged stool is that you have to use pharmacies that are also Legit Script certified, or NABP, which is National Association of Boards of Pharmacy, a member of the NABP. It’s kind of this crazy thing. And the thing with the problem with Legit Script certification is it takes several months to get, it costs anywhere from three to $5,000. You got to provide them with a lot of paperwork. I mean, that’s one of the reasons that DrWell, that we became Legit Script certified are in the process of that, so that all of the providers that are submitting prescriptions through us are all protected because we do use a high risk [00:46:00] payment processor. And with the Legit Script certification, you can submit those prescriptions and not worry about losing your Visa and MasterCard privileges, which is really crazy. That would be the biggest takeaway for me because whenever I talk about this, nobody has any idea that this is even a thing.
Brad: What about you, Alan?
Alan: The big thing that I’ve been impressed by is that people don’t recognize that a lot of times your malpractice insurance is not going to adequately cover you. The good news for, for us is our complication rate is low, but it is a mistake to think that it doesn’t exist. Mitigation of risk is what lets us all sleep when our head hits the pillow at night, so that’s a real important buzz term. I’ve been deeply impressed, and I’d actually love to hear – so Jonathan, you’re speaking to probably more practices than me. I think it’s got to be 80, 90% of people don’t even know that part. Like, it’s a lot. [00:47:00] Johnny, as I recall, we harped on that hard at ASPA. That message has got to get out. The other thing that’ll be interesting with that is does that preclusion prevented from entering hospital based systems? Cleveland Clinic won’t touch it, not unless it’s coming straight from the manufacturer. You know what I mean? So you have these different hospital systems, they’re looking at cut. There’s a hospital out there that’s not cutting cost right now, but they’re not doing it on this.
Jonathon: I think it’s just a matter of time.
Alan: I hope you’re right. I do hope you’re right on that. I do, I’ll be interested to see that you because one of the things, they don’t like to admit it, but they’ve made health care so expensive because now it’s a barrier to entry for anybody coming. They almost made it too expensive for themselves too. It’ll be interesting to see. This would be a good revenue stream for them. And I think they’re not going to take it because they don’t have health – you know what I mean? Because it’s so outside of their normal paradigm that they’re willing to make a mistake rather than risk change. That’s my fear. [00:48:00].
Johnny: I think a couple of things that we see that I feel people miss, is one, you know, really typing up your business plan, your protocols in your office, because then it also sends the message to the office that this is a real medication. I know we talk about weight loss, but you guys have both mentioned it. It’s a real medication. You got to take it seriously and treat it as such, you know, consents. I think consents are something people sometimes forget, again, especially if you’re using the compounding from a level of transparency and kind of just making sure that you’re having a good discussion with them. And there’s lots of different ways to implement some of that. And then the other thing that I think people don’t, and it’s gotten better. I think there was some bad actor – a lot more bad actors earlier, but I still think there’s some, and I think there’s going to be more in the market. But whether you’re going to get your certificate of analysis and all those type of things to make sure that what you are doing is a good partner if you’re not going through Dr. Well, or something like that. But, but even Jonathan wouldn’t have any problem being like, “Hey, here’s our proof, here’s what we have,” and if they’re not [00:49:00] willing to share that stuff with you, then that’s probably a bad sign.
Brad: Yeah, very bad sign. And I know there was a question earlier Alan, you actually answered, but it had to do with the issues with malpractice insurance in general that certain carriers don’t know how to handle if you’re using compounded product versus actually using name brand. And I saw you answered that, but for those that didn’t read that in the Q&A, if you want to answer that question for everybody who didn’t see it, can you answer that one again?
Alan: Yeah, absolutely. And so it’s hard for me to defend an insurance company, but in this scenario, I kind of see it, so please don’t think that, I think the compound pharmacies are below board. I don’t. But from their perspective, they’re being asked to indemnify a physician for a medication and they really don’t know what’s in it. Or at least they can claim that. So that’s really, as I understand it, their consideration and their concern. Now, whether it’s a real valid concern or it’s a get out of jail free card, [00:50:00] I don’t know, but that’s the argument as I understand it. so usually if you’re doing this stuff, you want to provide yourself some sort of gap coverage, or you’re going to get very conservative very fast. It’s not a true gap coverage, but there’s a company called Olive Arch, and they provide a third party coverage. I don’t have any affiliation with them, but they’re a good company and that’s who we use. But if you’re doing this remote, for example, if you have these large spa systems like say VO, that’s a big deal. That’s a big, big, big, big, big, big, big deal. So corporate, it’s up to each individual. That’s a big responsibility to grasp, and that’s going to hit all of them. So Ideal Image is going to hit there, and I don’t think they’ve started GLP. I might be wrong about that, but it’s got to be a compliance issue because they’re not quite [00:51:00] as flexible as a smaller organization like Dr. Well, Austin Plastic Surgery, Ocean Drive, Med Spa Network, even ByrdAdatto. I mean, they have huge corporate issues.
Brad: Well, one of the things we’ve learned in that space also is that every single state insurance commissioner has different rules. So certain things that we’ve had structured in New York that worked fine, that you try to restructure that in Ohio, and then the insurance they were trying to get doesn’t even exist. So it’s just going one of those weird things that as you get down to these nuances, and especially this new stuff, especially when and you’re talking about obviously weight loss drugs, but we see when they don’t even understand what a med spa is, they’re like, “Oh, wait, we don’t even have insurance for ‘med spas’.” You’re like, “It’s not a med spa.” It’s having the insurance companies, we’re talking about insurance a lot, but the state agency, the state actors, they’re still trying to catch up to a lot of this stuff also. We got about 10 minutes left, so I de I definitely want to start some quick takeaways, but Michael, I’d love to hear your first takeaway. [00:52:00]
Michael: Yeah. Excuse me. It’s fascinating and I think that the biggest takeaway I would have is, and I’m kind of cheating from what Johnny said before we started, is, if you’re going to be in it and you’re going to do this, you need to embrace it. I know Johnny was thinking of it probably from a business commitment perspective, and that’s certainly super important. I’m coming at it from a compliance perspective too, which is, you can’t stick your head in the sand with the stuff that’s so confusing. You need to lean into it; the three panelist that we have on here have been doing so, and that’s part of what’s allowed them to be successful through the first two chapters, but also setting them up for success for what we don’t even know is going to happen in the next couple of months. [00:53:00]
Brad: Perfect. Alan, what are your final thoughts?
Alan: So my thoughts are is I’m probably going to put a coat of wax on Johnny’s car when I’m out in Austin for ASAPS. You know, that’s number one, just to get a little bit of his shine on my GLP plan. I think it’s again, when I started plastic surgery, all of the non-surgical stuff really hit, and I got to tell you, the regenerative aesthetics, all of that has radically elevated my career. And I just think it’s just an amazingly good time to be in aesthetics. I think GLP is the next iteration of that. And I think it’s just going to be an absolute independent engine for aesthetics, wellness, and really feeling better about yourself, really for the rest of my career – I do. I think that the opportunity to adopt this and make it part of your culture and your practice should at the very, very least, [00:54:00] be looked at very, very strongly, especially in plastic surgery and in the med spa space. I anticipate that the training requirements, that the access to it, I think it’s going to wax and wane, wax and wane, wax and wane. And I do think that private industry will ultimately solve it because this market, again, we’re in chapter two and we think it’s big now. Let’s wait. I don’t know. I don’t think obesity will go away in a generation. It could take a couple of generations. I’m excited to be here and it’s just a fantastic conversation. It’s hard not to carry it on.
Brad: Exactly. Johnny, your final thoughts.
Johnny: Yeah, it’s interesting to what Alan said. For the first time, I guess in over 10, 15 years, we didn’t increase in obesity, but even with all the GMPs, we only went down like 0.7% or something. So not even a full point. So it shows you how much work we still have to do or opportunity. I guess the last [00:55:00] thing I would leave [00:55:00] people with, and to Mike’s point, I’m definitely a big fan. If you’re going to do this, you’re going to have a business plan. You’re going to think about this from A to Z. But remember too, the journey of weight loss and this journey that the patients are taking is windy and it’s long, so there’s a lot of different stops along the way. And if you’re here in Texas, there’s probably four or five Buc-ee’s between here and Dallas. You could pick any of those to be your home base. And so, if it’s offer in the LPs or peptides, that’s one. If you want to be the ozempic-base specialist, because I do think there’s some unique challenges, the ozempic, but I think there’s a lot of different places you can be and really make a meaningful difference for patients. And so really thinking about that and being like, what resonates with me? Where do I want to put my time effort? Because there’s these huge opportunity costs, and I do think to do this well, like all the panels have talked about, it is going to take time and effort, either you or somebody you truly trust in the office. And so, figure out where along that journey because I do think there’s multiple spots that you can help people. [00:56:00]
Brad: Love it. Jonathan, you want to help close us out?
Jonathon: Sure. Thanks. This has been really, really fun as far as being part of the GLP one revolution. It’s so much fun. You’re treating lots of patients, you’re making their lives better. If you’re a surgeon on this call, then you know you can only treat so many surgical patients in a week, whereas you can treat hundreds or thousands of patients a month for weight loss. And so it’s really gratifying as a doctor; this is what we came into this for, is to make people feel better or be better. And so it’s really great, and it’s also very lucrative, but because there’s a lot of money involved, that means there’s going to be a lot of regulation and laws and lawbreakers involved. And so, there’s going to be more laws because of that to try and protect the space. And because we’re dealing with compounding pharmacies, if this is your first time dealing with a compounding pharmacy, and you’ll notice things change a lot and that makes you anxious, remember that that’s really just the status quo for the compounding pharmacies, that they’re always in flux, they’re always having to adjust to meet the new laws put on them by FDA. [00:57:00]
So you need to definitely raise your threshold of what makes you nervous if you want to be a part of this, because there are different things that are coming out, different laws that are changing, but it is still, at the end of the day, really fun, really gratifying, really satisfying, and financially beneficial. And if you don’t have this incorporated into your practice, to some extent, you’re really going to be left behind. I know this sounds self-serving, but it really is hard to do this on your own to try, if you’re trying to have this other part of your practice and trying to keep up with the laws and the regulations, and that’s what we do at DrWell is we help providers. We basically give them that additional layer of management to help protect them from all the craziness that if they were having to – we’re like the buffer so that you’re not seeing all this craziness all the time that we are like just kind of making sure that you’re doing your thing while we take care of the craziness.
It’s going to be a wild ride, but it’s going to be worthwhile, it’s going to be fun, and you’re going to have a lot of happy patients that are going to go on to do other things. [00:58:00] But that’s what’s kind of crazy about this space. It’s not a loss leader. It’s not like Botox just is an additional thing you do on top of surgery. This can actually drive all of your operating expenses. This can be covering all of your operating expenses each month so that whatever big procedure you may do, you can just put that in your rainy day fund. So it provides you with a lot of security to know that you don’t have to do this many more operations. Like, you’re still going to be able to pay all your employees with just GLP ones, and then you can do all the things that you enjoy doing as well.
Brad: That’s awesome. Well, we cannot thank you guys enough for joining us again. We’re covered from coast to coast with you gentlemen. We’re looking forward to seeing all y’all in Austin, I guess in a few short months. But thank you again for joining. And our audience members, thank you for participating and hopefully you guys enjoyed it as much as I know Michael and I did. So thanks again. Thank you.
Jonathon: Thanks for having us, you guys.
Alan: Have a great night.
Brad: Well, welcome back. That was an amazing episode. Like I said, we’re really enjoying it, and we’re looking forward to spending time with you next [00:59:00] Wednesday when our partner, Dr. Jeff Segal, comes and joins us and we’re going to talk about patient abandonment. Thanks again for joining us today. And remember, if you like this episode, please subscribe, make sure to give us a five star rating and share with your friends.
Michael: You can also sign up for the ByrdAdatto Newsletter by going to our website at byrdadatto.com.
Outro: ByrdAdatto is providing this podcast as a public service. This podcast is for educational purposes only. This podcast does not constitute legal advice, nor does it establish an attorney-client relationship. Reference to any specific product or entity does not constitute an endorsement or recommendation by ByrdAdatto. The views expressed by guests are their own, and their appearance on the program does not imply an endorsement of them or any entity they represent. Please consult with an attorney on your legal issues. [01:00:00]
