The Cost-Effectiveness of Compounding Pharmacies - Episode 348

the data that's being pulled from thousands of samples being submitted from hundreds of these companies. I mean, it is insane. Over 80% of the drugs you buy on the black market, which is what's pretty much what it is, a black market, 80% of them do not meet specification. Can you imagine a supply chain where 80% of the drugs coming out of it weren't under spec? That is what has happened because the FDA has not allowed compounding pharmacies to make these.

Hey everyone, I just finished a podcast with Sean Nourian. From Empower Pharmacy down in Houston, Texas. This is a really interesting conversation we have talking about peptides, talking about the state of the FDA, talking about how compounding pharmacy can actually get you medications cheaper than you can get at your local pharmacy. There are many interesting things here to chat through, and I think you're going to find this a very interesting podcast.

He went from saving hearts as a cardiologist to rewriting the entire aging playbook. Dr. Jeffrey Gladden believes 100 is the new 30, and he's got the science to back it up. This is the Gladden Longevity Podcast.

Sean, welcome to the Gladden Longevity Podcast. It's good to see you, Doc.

Great to see you as well.

Yeah, good. I appreciate you taking the time. So tell us what's been going on at Empower. I know you guys are a pharmacy that started, you know, it's not like 20 years ago. I think if I'm not mistaken, it was a lot more recent than that. And yet you've really been on a growth spurt and expansion spurt. And I'm curious to understand what's, what's kind of going on for you guys. Yeah.

So You're close. We've been around for 17 years this July. We celebrated our happy birthday on the 1st.

Okay, great.

And since then, over the past 17 years, you know, how we ended up becoming one of the premier compounding pharmacies in the country is by one, working with providers like yourself to inform us on what is the best type of therapy for their patients and working with our medical affairs teams and our R&D department to create these very unique, stable formulations that work for, for many of these patients better than a commercial option could have helped that patient. So we see more and more doctors learning about personalization and customization and utilizing compounding pharmacies to be able to create, as what you would say, the best possible ecosystem within our bodies. And, you know, all our ecosystem is just a number of chemicals in certain amounts. And if some of those chemicals are off, we're off. You know, the disease states are due to— many of them due to chemical imbalances. So by working with providers that are learning about functional medicine, preventative medicine, longevity medicine, and creating personal protocols, we're seeing patients like never before getting access to these drugs at a lower and lower cost point, which is one of the great— another reason why doctors are now utilizing compounding pharmacies. Their patients can't afford the commercial option, and if the patient can't afford the medicine, what's the point of seeing the doctor? That doctor just lost a patient.

That's an interesting point, that compounding pharmacies will sell— and we found this to be true— that you'll sell something to a client. We don't sell, you know, we don't sell medications through the practice, right? And in Texas, there's a separation of church and state between pharmacies and physician offices. So we don't sell anything, but we, we notice, and of course we advocate for our clients to be able to get things at a reasonable price. And it's, uh, and for ourselves for that matter. So it's impressive to see that it's actually more cost-effective to go through a compounding pharmacy than it is to go through a retail pharmacy. And that's interesting.

There's several reasons behind that.

Yeah.

One is compounding pharmacies We don't have to go through a new drug application process. So it could take 10+ years and billions of dollars. No, we're allowed to use medications that have already been FDA approved. We're allowed to use those active ingredients to create another medicine, but in a different dosage form, strength, or combination. So that's, that's a huge R&D cost that we don't have to recoup.

Right.

Also, our supply chain is much more integrated than the traditional healthcare system where you have a manufacturer selling to a wholesaler selling to a pharmacy then going through a PBM and a carrier. Like, we're just going directly to you.

Yeah, that's right.

And so you're cutting out all the unnecessary middlemen as well. And number 3, there are 7,000 compounding pharmacies I have to compete with.

Yeah, very good.

Pharma doesn't have 7,000 other companies.

That's right.

They typically have 1 or 2 or 0 in many cases.

Yeah.

And so for all these reasons, that's the situation. That's why we have this situation we have here in the United States where drug prices just continue to climb 10% a year, year over year with no end in sight, but not in the compounding industry. Our prices go down. We track below inflation. And so that way a provider can be assured that their patient can get access, not just today, but for the rest of their lives.

No, I think that's a wonderful thing. I think, you know, everybody's cost sensitive and will always be cost sensitive and everybody's quality sensitive at the same time. So I think, you know, when people think about compounding pharmacies, we know that there's also not only a spectrum in pricing, but there's also a spectrum in quality. So maybe you can talk a little bit about the things that you do that ensure that people are getting what they think they're getting, you know, particularly with things like compounded thyroid and, you know, some other things are a little more sensitive to compounding. Maybe you can talk us through that a little bit.

Yeah. You know, the, the quality standards within compounding are well established. They've been around for millennia. All medicine was compounded before pharmaceutical companies existed. So there is, and the United States Pharmacopeia, the private agency that oversees the standards, And pretty much makes up the rules for compounding. They've been around for a very long time and they're constantly updating their chapters to always improve quality over time. And so if a compounding pharmacy is following the rules, then the medicine can be considered safe and is dispensable to patients. Now there's a level above USP called GMP, also known as Good Manufacturing Practices. And these are the standards that pharmaceutical companies have to meet and they are registered with the FDA. Well, compounders have a version of manufacture ourselves. It's called an outsourcing facility, a 503, and a 503 has to match those high standards, the same standards that pharma has to meet. And so what differentiates us is that we're both a compounding pharmacy, a 503, and an outsourcing facility. A 503. And so we use many practices that we've learned at our 503 and apply them to our 503. And so, so for example, you, you mentioned about your thyroid medication. It's probably a mix of T3, T4, you know, dosed in the micrograms of each. And I mean, having, you know, if a patient takes too much thyroid, just, just like 10, the therapeutic index, it's so narrow. That it could harm, cause a patient to feel very uncomfortable or have medication not work at all. And so what we do, not a requirement, but we, every single capsule we make, we send it through an automated check weigher that weighs that capsule one at a time. And if that capsule is off by a specific percentage, we reject it. That's not a requirement. That's, but that's the, that's the level of quality that we go to. And so by being a manufacturer that's been registered with the FDA for the past 10 years, we've learned how to apply the highest quality system in compounding at our 503. It's very nice to say it's like a combination between traditional pharma, but used at the pharmacy level where you can make millions of prescriptions a year, customized at the highest quality possible. So quality is a, is a very important point as well.

So with pharmacies like yours, are you routinely inspected by the FDA or that kind of thing? Or what, what's, what's the quality control here? So people understand what actually happens.

Sure. We're licensed in all 50 states. So that technically means anybody from any of those states can show up unannounced anytime they want. Them's the rules. And so we have people from FDA, DEA, state boards. Flying in all the time to make sure that the medications that we're making are indeed, uh, fall, fall the, the requirements of each individual one of those state or federal law books. And we have an entire compliance and regulatory and quality team that go in and ensure that our electronic quality management system is readily accessible so we can give them all the documents that they want practically immediately. We don't use paper anymore. Yeah, they're coming in and verifying every, every month.

Kind of like living under the, the weight of an, you know, unexpected audit at any time, probably several times a year kind of thing when people show up.

You should always be under the weight of an audit. You should, you should bet, you should run your organization fully audit ready. You should run audits on yourself.

That's right.

That's, that's how you create a true quality system. You're always trying to penetrate, find something wrong, use outside consultants inside departments and eventually create, create a system that is just like, let's say exceeds the standards.

Yeah. Beautiful. Oh, that's beautiful. So, you know, I think one of the things that's on everybody's mind these days is the whole peptide story, right? In terms of what compounding pharmacies can do and can't do it. I know, I think it was RFK came out with something, I don't know, a couple months ago talking about releasing peptides back and then the FDA is in the middle of it. Where does all that stand with regards to you being able to, you know, dispense peptides again?

There's a meeting of FDA's Compounding Advisory Committee on July 23rd and 24th. And they're looking at 7 peptides that people have asked to be allowed for pharmaceutical compounding. Of course, 5 others came off a safety list back in April and will get their own next hearing in February of next year. And so I want to be clear up front on 2 things. One, coming off the list isn't the same as FDA approving anything. And going into the meeting, FDA's own staff are recommending against adding all 7. So the honest headline isn't peptides approved. It's FDA is finally putting these under a real microscope.

Mm-hmm.

I think that's good. We've always thought the science and the safety and the data, that should decide this, not the marketing. And so we'll see the FDA make a recommendation. Of no, this 12 PCAC members, Pharmacy Compounding Advisory Committee members, the ones that decide and vote on whether these will get accepted, will listen to the FDA's argument and to industry's argument and patients' arguments and academics' arguments and see based on the data, the studies, and the evidence provided whether or not these chemicals are considered safe to be used in the human population through the 503 market.

Interesting. So 7 now, 5 later, and you think that not all 7 are going to get through. So that'll be interesting to see what comes.

You know what? I predict, I mean, if you look at the roster was recently updated.

Okay.

PCAC roster, the 12 members. And I mean, previously trying to get a drug nominated through the PCAC was an onerous process.

Why do you think that is? Why do you think it's so onerous? Is this Big Pharma kind of squashing stuff, or what do you think's happening?

Well, I think, I think it's a regulatory agency creating its own rules, and which is pretty much how the PCAC worked. It was a, it was agreed, it was created by the FDA, and it was populated by the FDA primarily. I think there were only 2 people on that have ever had actual real-world compounding experience. The other 10 are just, you know, people with experience growing up in the FDA. So they understand the FDA process of getting a new drug approved.

Right.

And now they're going to be asked to assess whether a drug should get approved with no double-blind placebo-controlled studies. No, you know, phase 1, phase 3, none of that. And they all said, look, well, we don't, this is not the evidence I'm used to seeing. So I can't say this is safe. And so they would always reject it. It is funny. Most of the votes. The two compounding members would be like, yes, add that. And the other 10 would like, no. So many, many substances did not get approved. And, you know, we— what's changed since then? I believe, uh, 8 members have been replaced in the past week, appointed in the past week.

Interesting.

And many of these members have real-world compounding experience. They understand what actually happens inside of a compounding pharmacy, what actually gets discussed amongst their providers. And they can actually talk about the evidence that they are seeing on the ground level with these biomarker improvements on these patients. I mean, many of these peptides, the, you know, the claims are remarkable. And so it can't just be placebo for many of these. And so, I mean, and if it works and millions of patients have tried it, and we don't see any serious adverse events, any significant ones that we do see with other drugs. I think that is the bar for safe and efficacious. So I'm optimistic that all of them will get approved.

Yeah, well, that's great. I didn't realize they just replaced 8 people on the 12-person committee. You know, I think from the clinician side, of course, we feel like there's a bureaucracy that has a locked-in mindset as to what kind of evidence constitutes evidence. It's worthy of approval. And you know, what's interesting to us is that we look at the things that do get approved and we shake our heads because, you know, different Alzheimer's drugs and, you know, cancer drugs. I mean, yeah, somebody lives 6 weeks longer, right? And it costs, you know, $300,000. I mean, it's, it seems so completely counterintuitively ridiculous that you feel like people are actually lost inside their own system of thought. That they would approve something like that and disallow something that, you know, there was so much experience with of, you know, improved outcomes for patients, clients, and reject it because it isn't coming through a particular, you know, data stream, right? Is really what it boils down to. It's really, to me, it's a case in point of people getting trapped inside their own thought process. And it's not to say that integrity isn't important. It's not to say that safety isn't important because those are, those are, you know, first and foremost in everybody's mind. But there are alternative ways to go about, you know, assessing the data, assessing, you know, outcomes and things like that, where you can get very comfortable with the fact that, you know, I mean, in our experience, we've only had like 2 adverse reactions to a peptide, and it was both related to the carrier that the peptide was in at the time. So it's pretty interesting. People have some allergic reactions, local little allergic reactions, but you compare that to, you know, a client we have right now that came to us outta Kaiser Permanente who was treated for psoriasis with nonsteroidal anti-inflammatories and, you know, just about put on dialysis with it, right? He showed up with a GFR of 14, you know, normal would be over 60, closer to 90 would be ideal. And, you know, a hemoglobin of 7, right? Because he couldn't make red blood cells anymore. And, you know, you see these kinds of things from the quote unquote over-the-counter safe drugs and it's, we never see that. With these ever. We never see anything close to that, right? So it's really, um, an interesting case. I hope that the FDA can make a wise decision. You know, the country needs a wise decision and it needs to be kept safe, but I hope that they can see just how safe these things are. So that would be a boon for everybody, I think.

Yeah, absolutely. I think, you know, any other decision is only going to put patients in harm's way as They will only be able to source them from research use only websites.

That's right.

And the data that's being pulled from thousands of samples being submitted from hundreds of these companies. I mean, it is insane. Over 80% of the drugs you buy on the black market, which is pretty much what it is, a black market. It's not a gray market, it's a black market. And 80% of them do not meet specification. Can you imagine a supply chain where 80% of the drugs coming out of it weren't under spec? I mean, that is craziness. That is what has happened because the FDA has not allowed compounding pharmacies to make these. And so if the FDA votes that these should not be made, all that will happen is the black market will grow larger, the Chinese cartels will grow richer, and these drugs will be made in China instead of America.

Yeah.

So I'm hopeful. I'm hopeful that the FDA will make the right decision.

I do like the idea of the compounding pharmacies making these because then you do know that there's integrity, you know, in the process of, of making them and verifying that they're made properly, verifying what's in the chemicals that come in.

They have to be a certain pharmaceutical spec.

Yeah.

They have to show that they're not dangerous. They don't have heavy metal toxicity. They don't have endotoxins, you know, The certificate analysis tests for all of these, like they would for any pharmaceutical product. We come in, we validate it, comes through validated supply chain.

Yeah.

Then the vendor gets qualified, the material gets qualified, the drugs are made in an actual cleanroom, not some guy's bathtub.

Yeah.

And they're, and they're, you know, they're tested for sterility and endotoxins, and you have stability studies done showing that the medication is stable over its shelf life. Would you rather have patients in that system? Or, or, or some, like some guy's making out of his house. Cause that's what's happening.

No, I know. I know. It's, it's kind of crazy, quite honestly. So let's, let's hope that the FDA comes along with that. So in terms of, you know, personalized medicines, what are some of the areas that you're seeing that you're making more and more prescriptions for? What, what's kind of front and center? I mean, hormones have always been a piece of it, of course, hormone replacement therapy. But there are some other things you're working with probably. What are those?

Uh, we manufacture and compound medications under 9 primary areas of treatment. You have men's health, which consists of men-related products that are somewhat related to ED, topical solutions, testosterone. So you get a little bit of that, but then you have some branch off into hormone replacement therapy, which also covers a lot of what's in women's health. And then you have weight management medications, GLP-1s included. Dermatology formulations, mental health, sexual health, and IV nutrition, and, and now peptides. And so with those, uh, with those 10 different areas, we can kind of COVID the entire longevity health and wellness functional medicine landscape and be that one-stop shop for the providers that want to utilize us for patients in any state in the country.

What about Reder TruTide? Are you guys compounding that currently, or what's, what's your status with that?

It hasn't been FDA approved yet, so compounders cannot legally compound it. Yeah, I have had reports that there are some compounders that are compounding it, and with all the pressure from Lilly trying to protect their drug, as soon as Lilly finds out that a compounder is making it, they stick the boards on them, and the boards do what they do, they revoke their licenses immediately. So we've seen a couple compound pharmacies that were making Retruditide have their licenses revoked in an emergency session. So while it can be— I compounder can make anything. Doesn't mean we should.

Right.

There are, there are some drugs that are just like, right now, in my opinion, a little more off limits than others.

Yeah.

And Retrutide is definitely at the top of that list.

And what, uh, where is Retrutide in the regulatory approval process?

Yeah, supposedly it'll get approved sometime in 2027. Given with how much Lilly is going to make off of this drug. They have been dumping as much as possible into accelerating its approval. And so I've heard some reports saying it may get approved as early as this year, the end of this year, and then others say maybe not till the end, uh, or of 2027. But yeah, once a— one thing is for sure, once it does get approved, I mean, it is going to be a wonder. It's going to make semaglutide and tirzepatide look like You know, drugs that should not be used in medicine. It's just like, it's just so much better across every other, every category you can imagine. So, you know, I think we're going to see a large market shift to retretotide and, you know, ensuring that patients and providers determine that a patient could benefit from a customized version of a GLP-1 that they will be able to make them. So that's a good, I think it'll be an exciting addition to our market.

No, we think so too. We think it'll be helpful. It's interesting. It does seem to lower heart rate variability and increase resting heart rate. We've seen that, we've seen that, that has been reported as well. So that's an interesting feature because typically we're trying to lower heart rate and increase heart rate variability, right? More parasympathetic nervous system tone. So we'll see how that plays out. I think there's a GLP-4 in the offing as well. I've heard that may be coming. You know, you have GLP-1, GLP-2, GLP-3, which would be retatrutide, and then GLP-4, which basically has 4 components to it. So we'll see how this plays out. But it's a really interesting area because it does, to your point, play into longevity. In terms of not only cardiovascular health and brain health and kidney health, but there does seem to be some benefits, you know, cognitive function, other things, right? So pretty interesting. The SGLT2s are also interesting in that regard. I think so.

Absolutely. I mean, there's, there's so many great indications that they should do practically everything is GLP-1 can help with. And we're finding out more and more reasons that they can be used. We sponsored a study at Baylor. Showing that GLP-1s, particularly tirzepatide, does improve sperm parameters.

Okay, interesting.

So especially in obese patients.

Oh wow. So sperm motility or sperm viability or—

Or progression, motility, count, everything. It's a great— I mean, it just shows you how obesity causes so many downstream effects.

Yeah.

Downstream comorbidities. And, you know, so GLP-1s are being used to help just about everything out there. There's a downside to GLP-1s. Mm-hmm.

Oh yeah.

40% of the weight you're losing is muscle.

That's right.

And muscle is the organ of longevity.

Well, it's one of them. It's not the, I, people get that wrong. It's not the organ of longevity. It's one metric of longevity, but yeah, it's important.

Right, exactly. I mean, to have to, to lose muscle mass while you're on therapy that's supposed to be making you healthy is kind of backwards. And so what we're seeing is a lot of patients, they're losing the weight. And then now that they've lost muscle, the tissue that burns more calories, that's right. And then the fat does. Now they're gaining the weight back even faster.

Well, that's because, yeah, that's because it actually suppresses ghrelin, right? Ghrelin is the, uh, the brain peptide that basically stimulates appetite. So if you suppress that and then you're not hungry, but if it rebounds when you stop the medicine, you've got more of it. Now you're going to, now you got, you're hungrier than you ever were. Right? And now you're going to be putting on fat in place of the muscle that you lost.

It's—

it can be tricky to get people off these. We have a whole strategy on actually how to transfer them off and maintain muscle mass while they're— if they are taking it. So there's an interesting molecule out there called calocurb ameristate that was discovered in New Zealand that comes from a hops plant that they did double-blind placebo-controlled trials and showed that the weight loss was equivalent to GLP-1, but it was fat and not muscle that was lost. And it stimulates endogenous GLP-1 but also Ccy and Cck rather, and Pyy were also stimulated that also have an impact on appetite. And it's, it's taken orally as a, as a, as a supplement, quite honestly. So if somebody's afraid of a GLP-1, it's something they can look into, Kalocurb. And you have to be a little careful with any of these drugs or medications or supplements in that you can end up with some diarrhea if you load in too much too quickly. But yeah, we've had good success with that as well. So yeah, interesting stuff.

Yeah.

And the great thing about retatrutatide is it's more muscle sparing than— Mm-hmm. Meglatide or tirzepatide. So that's right. We're talking just on the basis of losing muscle mass. I mean, that's going to be the go-to. There's no reason not to use it except price. And this is why compounding pharmacies are going to play a huge role in expanding access to these therapies to so many more patients.

I can imagine when retatrutatide gets approved, it's going to be very expensive, right? Of course.

Obviously, of course, and try to make their profit, try to make as much money as they can for as long as they can, right? Off your back.

That's right. Will they be able to get it cheaper through you than they could through Lilly?

Absolutely. Yeah. There's no reason for a comp. We, we don't need to charge. We don't need 99.5% margin on our products. That's what Eli Lilly is getting. They're, they're making 99.5% margin. That is, do you think that's right?

Yeah, that's incredible.

If you're, if you're a provider trying to put your patient on, on what may be a lifelong therapy and their insurance doesn't cover it, or they don't qualify because their BMI is not above 27, or, yeah, what are you to do? Pay $1,000 cash? I mean, come on, patients that the majority, vast majority of the population cannot afford $1,000 a month in cash. So thank God for compounding pharmacies, because without them There, one, patients wouldn't be able to access, and two, there would be no incentive for pharmaceutical companies to lower their prices. I mean, just look at what Novo and Lilly have done over the past couple years. They've cut their prices by, by one half to two thirds in order to compete, as they should. Great. And what's happened? Patients got more access to medications because— so compounders, we play a vital role. We are the last stop when it comes patients getting access in our system. And without us, I mean, I don't— our system does not become better. It becomes a lot worse. So we spend a lot of our time fighting pharma. Lilly is suing us. You know, we're having to meet Lilly and all the boards. They're trying to misinform your pharmacy board members in every single state to try to convince them to clamp down on compounding and not allow GLP-1s to be made. I mean, the amount of rules that the memos that get sent out from the board staff. Like, there's a, there's a battle in every single state all the time. And, you know, and pharma is doing their best to be able to prevent any potential competitors coming into the most lucrative market that's ever existed.

Yeah. Well, God bless compounding pharmacies at this point, because you know, you're really kind of fighting against a monopoly. And once there's a monopoly, you would think there would be an antitrust, you know, situation with pharma, but nobody's ever brought— seems to bring that up.

So, well, you know, there, there are, there are a lot of instances of price fixing that, that's been rampant in the industry. But, you know, our industry is unique in that you can have a patent, you can make something for ever— for 12 years for as much as you want. And sometimes, I mean, that doesn't— that is not in the best interest of patient access, really, ever is. And so the incentives for the system are, are not aligned.

That's right.

You know, and, you know, then compounding is just a system. Then thank God for compounding, because, you know, at the end of the day, nobody, no government entity can get in the way of the doctor-patient relationship. You know, it is really up to you to prescribe whatever you think is in the best interest of your patients. And every other prescriber in this country, that holds true as well. And so if you believe that some other medication that is not commercially available would benefit your patients, you can send that to a compounding pharmacy and you can be assured that patient is going to be taken care of very, in many cases, much better than the traditional pharmaceutical and healthcare system will treat that patient.

Yeah. No, that's really good for the audience to realize. What's nice is that you're licensed in all 50 states. We run into situations where different, we have people from many different states that come to see us and then it can be problematic to, uh, you know, get things to them, but you can ship to all 50 states. So that's, that's pretty nice. Yeah.

I mean, to get licensed in all 50 states and keep those licenses over 10+ years, I mean, that is a feat of compliance.

It is.

And that is what, you know, the systems that must be built, the, the, the quality management systems, the healthcare tra— the, the, the patient tracking record systems, the, the, you know, the compounding system, they all have to combine together and make sure that they are all, you abide by every single rule, not just for the United States Pharmacopeia, but for every individual state as well. And they all have different rules and the rules are always changing. And so it literally takes an army, a regulatory affairs team, a government affairs team to be able to ensure that the landscape is one, always being assessed and that we are processes internally, uh, uh, meet those qualifications. And then two, finding where there may be some rules that don't make sense, that don't help patient access, that give pharma its monopoly. And then we go in and we lobby and we educate and we make sure people understand the value of compounding because not many people know what compounding is. They're completely unaware. Compounding only makes up 3% of all prescriptions dispensed in this country. That's it. I think this country is becoming much more educated, especially because of the company's role in the GLP-1 shortage and now peptides as well.

Yeah, I think so. I mean, when I was practicing cardiology, I never thought about a compounding pharmacy because, you know, everything just went through a pharmacy. I remember when a compounding pharmacy opened up in a town that we were servicing and they sent me their information. I was like, I'm not even sure what I would use them for, quite honestly. Like, maybe they make compounded stuff for pain management or something like that. But, you know, it's interesting when you move into the functional space and all of a sudden you start trying to customize things for individuals, you know, based on test results and who they are and understanding them more deeply. The only place you can really get that is with a, you know, collaborating with a compounding pharmacy.

So absolutely, that's what we're here for. We're here to make sure that your patients get exactly what the doctor ordered.

Yeah, exactly. Well, cool. Anything else you'd like to cover? Anything else you'd like to share with us?

You know, it's just, you know, compounding, we're, we're going through a renaissance. It's such an exciting time to be in healthcare where patients can get access to all kinds of healthcare that we wouldn't be able to do through the traditional PCP and channels being created, telemedicine or specialty concierge clinics and everything in between that'll be able to solve whatever type of health issue that wouldn't be covered under your traditional policy under insurance. And the costs are going, you know, are getting lower and lower every single year, which means patients, more patients are getting access to these therapies, which means we're living better, healthier, happier, and more productive lives. And so it's such a great time. We're very lucky to be in this space supporting many providers like yourself that are doing God's work. So thank you.

Yeah, it's a very exciting time because there's so many breakthroughs. I think we're really going to crack the code on aging this year, actually. There's so many things that I won't talk about in this particular podcast, but we've actually gotten to a point where there's some amazing things going on that we're super excited about. So anyway, I appreciate you coming on and sharing with us, you know, your your perspective on Compounding Pharmacy and opening people's eyes to the, the good work that you guys do. So thanks for that.

Pleasure's all mine. Thanks for having me.

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