fbpx

The Legal Drug Dealer Podcast

Getting Pharmacy as a profession Closer to The Patient

March 3, 2020

Medication Therapy Management

With Swapna Chakrabarti, RPh & Marilena Grittani, RPh

This is a lengthy and very informative episode, with a very close to my heart colleague. Swapna Chakrabarti, RPh. 

We are talking about Medication Therapy Management and how patients, caregivers, and family members can benefit from it. 

Since it is a service included on Medicare part D plan, if you have more than 5 medications or more than 2 chronic diseases, you should demand it

Some of the most relevant points we made are:

  • who is this episode for? This is for patients that are Medicare Part D, and have all the benefits of their insurance because this type of service is included. Not free, but included in what you already paid. So it’s no extra payment. If you are a caregiver for somebody that has Medicare Part B and has medication therapy management as a service as well. And for everybody else that has a family member, a loved one, a parent, a grandparent, an in-law that might be having or that could have issues with their medications, and you know that they need help, but you don’t know what to do
  • “I went to pharmacy school in India. And we came here for graduate school, not as a practice not oriented towards practicing pharmacy but more towards the research. So I came to Pittsburgh for my masters and did my masters in medicinal chemistry and I hated it. I don’t know why. But then what I know why because when I was in pharmacy school, the aspect of the medicinal chemistry, which is basically not just the synthesis of drugs, but how the drug actually works in your body, at the chemical level was so fascinating”.
  • It’s hard, It is too it’s hard. It’s complicated. It’s not the pharmacist that you see dispensing, filling up the vials with your medication. That is probably the last step in a long series of steps that we have taken to understand your medication. And that’s not the only thing we do
  • In the healthcare professions, Pharmacists actually top the lists of the most reliable healthcare professionals and that is definitely a historical reason for it. But we definitely want you to know, that we are not in there just to make money. So then we just fill your prescription bottles and get you out of there as soon as possible. That is not what We want to do so don’t look at us through that lens. We are people, we are compassionate, we want to help you. So if you have to wait a little bit longer to get your prescription at the pharmacy, that’s probably a reason for it.
  • I think it’s one of the noblest professions because we are there to help people use our expertise. But yeah, we are people too, we get our frustrating this we have. So when you are dealing with treating them, as we would expect a pharmacist to treat you kindly treat them kindly to as human beings, it’s we are not just in there, just to save face just to make money off of the prescriptions that we are filling for you.

"Every time I call these patients and I talked to them, it's amazing how many simple things can be changed, can be fixed, can be added and it makes such a big difference in their quality of life, let alone the whole fact that excess of medications are going to cause all kinds of side effects and cost them more."

Share on facebook
Share on twitter
Share on pinterest

Listen To The Episode Here

If you think that you or someone you know can benefit from the information shared in this episode, please share it with them. 

And don’t forget that, if you are subscribed to our mailing list, you got the informational sheet that Swapna Chakrabarti, RPh prepared for you. On this occasion is about Tips For Medication Therapy Managment.

As an attachment to our weekly email, but if you are not subscribed, make sure you subscribe to it, and you will get immediate access to it, and you will be up-to-date for future episodes.

Swapna is not only a great friend, but an awesome advocate for her patients and she really cares about them.

She, also, knows how to explain stuff the way that we all get it!!!!!

Let me know what you think about our conversation and if you have any questions!!!

comments@thelegaldrugdealer.com

"...treat them, as we would expect a pharmacist to treat you kindly, treat them kindly to as human beings, it's we are not just in there, to make money off of the prescriptions that we are filling for you.."

Subscribe & Review On iTunes

Are you subscribed to my podcast? If you’re not, I want to encourage you to do that today. It would be best if you didn’t miss an episode. I’m adding a bunch of bonus episodes to the mix, and if you’re not subscribed, there’s a good chance you’ll miss out on those. Click here to subscribe in iTunes!

Now, if you’re in the giving mode today, I would be really grateful if you leave me a review on iTunes, too. Those reviews help other people find my podcast, and they’re also fun for me to go in and read.

Just click here to review, select “Ratings and Reviews” and “Write a Review” and let me know what your favorite part of the podcast is.

Thank you!

"... patients don't have just one doctor... And the older they get, the more doctor they have! "

Links Mentioned in this Episode

Join our Community

And never, miss an episode…

Also,  we will announce upcoming: Events, Bonus Episodes, Special Activities, New Trainings, and more…

Episode Transcripts

Marilena Grittani, RPh  0:07  

Hola, Marilena Grittani here. Welcome to The Legal Drug Dealer Podcast. I am a registered pharmacist, and also your host. 

Marilena Grittani, RPh  0:16  

This is Episode 12. And I’m pinching myself as I said that because I could not believe that I’m already going through episode number 12. This is a dream come true. I didn’t think I was going to go this far. And most importantly, I didn’t know that I was going to have so many experts and people open to communicate their expertise to the community. So I am very grateful for each and every guests that I have in my podcast so far. 

Marilena Grittani, RPh  0:50  

Now, this episode is extra special to me. Because today you have with me somebody that was my mentor. has been since then. My friend, my trainer, my supporter, and also the first person besides my husband that knew about this new project called The Legal Drug Dealer and the podcast. So I needed to get her involved in this and you need to know all what she has to say. 

Marilena Grittani, RPh  1:23  

It is a pretty lengthy episode, I have to say. So, make sure you have the time to do it or make sure you come back to finish it, if you don’t have time at once because it is packed with a lot of information. 

Marilena Grittani, RPh  1:39  

So, who is this episode for? This is for patients that are Medicare Part D, and have all the benefits of their insurance because this type of services is included. Not free, but included in what you already paid. So it’s no extra payment. If you are a caregiver for somebody that has Medicare Party and has medication therapy management as a service as well. And for everybody else that has a family member, a loved one, a parent, a grandparent, a in-law that might be having or that could have issues with their medications, and you know that they need help, but you don’t know what to do. This is what you need to listen. Because sometimes you feel that you don’t have the power to help them. But with this episode, you’re going to understand what needs to be done and what you need to do to achieve that for your loved one. 

Marilena Grittani, RPh  2:44  

It is interesting, it is deep is in detail, but it’s also in a language that everybody will understand. I hope that you get as much details and information as we wanted to give you if you have any questions you know, you just have to email me at comments@thelegaldrigdealer.com , and I’ll be happy to respond them or send it to Swapna to help me out with the answers. 

Marilena Grittani, RPh  3:07  

But mainly, I want you to pay attention and understand that you have a way to help yourself with your drugs and your issues. And you also have a way to help, those ones that you love and are in a lot of medications and you understand they need help and support, or those ones that are in a medical facility that they just got discharged and you know, it’s a mess. So find the time to listen to this, learn, maybe take notes, we have a really good document that is going to give you more information and remind you of the tips that certainly I have prepared for you. And I hope that you do enjoy this. I’m going to stop talking because there’s a lot coming. 

Marilena Grittani, RPh  3:52  

Welcome Swapna to my podcas The Legal Drug Dealer. How are you?

Swapna Chakrabarti, RPh  3:57  

I’m very good. Marilena, thank you so much forinviting me and having me over on your conversation. 

Marilena Grittani, RPh  4:04  

Absolutely. You know, I love you; you know, I trust you. And you know, I learned tons of stuff from you. So if somebody that I want to talk to my listeners is somebody that I trust, and the person is you. So thank you for accepting the invitation

Swapna Chakrabarti, RPh  4:20  

You are very welcome. And you are very sweet. And I would not just to say it, but I would definitely say the feeling is mutual because we go way, way back to and I’m glad that we go way back and we have kept in touch, even though we are so far away from each other. And that because we share this common passion of pharmacy, among other things. I’m glad that we are doing this and helping out others who would want to know more about our profession and what we do and also how best to get information from us. 

Marilena Grittani, RPh  4:56  

Yes, and to take advantage of what we can do for them right didn’t even know what we do and they miss out with stuff is that definitely help like what you do. So let’s just talk first of all, why did you become a pharmacist? I never asked you that. So I am very curious.

Swapna Chakrabarti, RPh  5:14  

Yes, you never did and thinking about it. I did wonder going back a long, long time. Growing up, I always thought I was sure that I was going to be a doctor. Because I thought that was the coolest thing is when you were a kid and you go to the doctor, when you come back, you’re feeling good. So yes, that’s what I wanted to do is help people feel good. But I didn’t get into the medical school that I wanted. But I wanted to stay within healthcare. And I wanted to stay in a field which would let me be with patients in a way that I can still help them and pharmacy was that profession for me. And I’m so happy that I went into pharmacy and I did will Totally anywhere else and just go into a lab to do something else. Because pretty much all of my life that is what I have ended up doing is helping patients helping people with their sick, not by diagnosing them as the doctor would, but by helping the second part of it, which is their therapy. So I’m very happy that I went into pharmacy enough roundabout way.

Marilena Grittani, RPh  6:19  

To be honest, I think that what we do is even more long lasting because the doctor diagnosed them and every six months they check them but we get with the patient almost every month, 

Swapna Chakrabarti, RPh  6:29  

Every month Exactly.

Marilena Grittani, RPh  6:31  

For one medication. So we have the opportunity to see them to talk to them to interact, if they have a side effect that we are able to see stuff like that, that people don’t think about even though you did not diagnose them, you have more chances to see that

Swapna Chakrabarti, RPh  6:45  

Exactly. And then more often than not, especially with the elderly population with the patients. They don’t just go to one doctor. So yes, the doctors have no meaning and that they are treating the problem that the patient is gone therefore, but the patient is a whole Human Being it’s a person who and there are other issues going on with them. And us as pharmacists by just having access to their medication profile and being able to talk to them. We have a almost a 360 degree view of what’s going on with them. So I think it’s much more effective way to handle the person as a whole.

Marilena Grittani, RPh  7:22  

Yeah, I love our global right?

Swapna Chakrabarti, RPh  7:24  

It is absolutely. Okay.

Marilena Grittani, RPh  7:26  

So tell us when did you graduate? How long ago? How long is it graduated? Swapna is younger than me. So…go ahead.

Swapna Chakrabarti, RPh  7:36  

Well, yes. Nowadays you do have to scroll back a lot to go back into the date of birth, the year of birth, but that’s okay. So, pharmacy school, I graduated in 1997. Actually, I went to pharmacy school in India. And we came here for graduate school, not as a practice not oriented towards practicing pharmacy but more towards the research. So I came to Pittsburgh for my masters and did my masters in medicinal chemistry and I hated it. I don’t know why. But then what I know why because when I was in pharmacy school, the the aspect of the medicinal chemistry, which is basically not just the synthesis of drugs, but how the drug actually works in your body, at the chemical level was so fascinating. I just thought that’s what I wanted to do and born to drug discovery, which is another thing that pharmacists do, but that’s a different episode altogether. 

Marilena Grittani, RPh  8:30  

It is.

Swapna Chakrabarti, RPh  8:30  

But during that time, actually, I realized that I didn’t want to continue in research. So after that, I being a foreign graduate, there were so many steps that I had to go through in order to be first of all at par with the pharmacy graduates here, which makes sense absolutely, because the curriculum is different. So I had to go through 1500 hours of internship.

Marilena Grittani, RPh  8:51  

Me too

Swapna Chakrabarti, RPh  8:52  

Take two exams before setting for the NAPLEX

Marilena Grittani, RPh  8:55  

Me too.

Swapna Chakrabarti, RPh  8:57  

And then once we got the NAPLEX when we decided to do live in California so, had to take  the state law exam of California. 

Marilena Grittani, RPh  9:03  

Me too!

Swapna Chakrabarti, RPh  9:04  

Exactly. So that was the first part. And that happened in 2001 

Marilena Grittani, RPh  9:12  

So you became a licensed pharmacist in the US in 2001. Exactly. She’s been 1819 years. That’s, that’s it.

Swapna Chakrabarti, RPh  9:22  

And then I’ve actually gotten licensed in five different states. 

Marilena Grittani, RPh  9:27  

Me too!

Swapna Chakrabarti, RPh  9:31  

Exactly.

Marilena Grittani, RPh  9:32  

He was born in India and I was born in Minnesota. We are twins.

Swapna Chakrabarti, RPh  9:37  

That’s the only difference. So yes, it’s been it’s been an involved journey and and something that I’ve really enjoyed so far. And this what actually what we’re going to talk about now is I think of it as a pre existing situation with all pharmacies but one that actually is coming to the forefront and I see it more as a future of Where we as pharmacy professionals are headed

Marilena Grittani, RPh  10:02  

So, I 100% agree with you. So besides what we’re going to talk about what other jobs have you done as a pharmacist? What What else have you practice as a pharmacist?

Swapna Chakrabarti, RPh  10:14  

It’s primarily been retail big chain. Well the first one I started it wasn’t that big of a change. It was just, small chain in California IT WAS THE BEST!!!.

Marilena Grittani, RPh  10:26  

Hello to all our Longs Drugs. God I miss my Longs Drugs So BAD!!!!

Swapna Chakrabarti, RPh  10:32  

We do and I tell stories about how if, I mean it’s business, I get it and but a business with a mission. That’s how it was. And oh, I guess that’s a whole nother podcast topic. But we kind of added to business in healthcare. But yes, that’s where I was and my my professional experience has been in retail, other than the MTM and that I’ve been doing for a while,

Marilena Grittani, RPh  10:58  

which is where we met to certain as pharmacy as an intern graduate, which means that I already had my degree, but I had to work on my hours, do the 1500 hours that she was talking about yet those and I needed to take my test my California test to become a pharmacist. So basically, that pharmacy had two pharmacists with completely different training, Right?!

Swapna Chakrabarti, RPh  11:24  

Right!.

Marilena Grittani, RPh  11:24  

From two different continents. Technicians were like, Okay, this is different. We got it and but the patients got the benefit out of it, because absolutely got different views. And we learn from each other, because webinars very detailed for the research part. And that’s not me. I’m more of a personal person. Yeah, exactly. So we both learned from each other. And I remember her said, Did you have this journal? Did you have this pharmacy letter? I’m like, No, no, no, it’s just like, you have to read it. You have to, like thank you for training me. I mean, it was a true mentorship. First of all, secondly, I felt like I could do it because I was a person and third, to see you interacting with patients there. And the way that they will come to talk to you the way that it shouldn’t be that you have the time to talk to them, right, the time to explain to them what it was and what they need to be looking for. And the patients asking you questions and respecting you say: “Swapna. What do you think about this drug?” Right? Is this okay for me, based on everything else that I’m taking? When we said because we agreed on that, that longs drugs that was a small chain pharmacy, they had like 400 stores all over California, Oregon, and Hawaii. Be we had that opportunity? that mentality of the company was we are here for the patient.

Swapna Chakrabarti, RPh  12:44  

Exactly. Exactly. 

Marilena Grittani, RPh  12:45  

We are here to make money, but…

Swapna Chakrabarti, RPh  12:46  

 Yeah, absolutely. It’s a business and I am so happy actually that that’s how I got started. Other than like a small neighborhood pharmacy that would be the best experience but other than that That’s pretty much what we what I got. And that’s how I started. So I the five that I valued the most about what you just said about interacting with the patient, or having that medication while in my hand and then talking to them and encouraging them to ask questions and know more about their medications. We have that opportunity to do that with patients and we have to remember we had patients who would be there for years, they would never want to change the pharmacy. And that’s how you I mean, it is you’re taking care of a person, literally, so those relationships matter. And I would say most of the pharmacists, at least the ones we know, did enjoy that. Yeah, who were there they appreciated that that is what they trained to do. And they were imparting that that knowledge that information to the to their patients. It was not just customers, they were our patients. I feel like that is the difference when, they change from being patients to customers. Then it’s all bets are off.

Marilena Grittani, RPh  13:59  

Yeah.It became a business. It was not a healthcare think anymore.

Swapna Chakrabarti, RPh  14:02  

 Exactly, exactly.

Marilena Grittani, RPh  14:03  

And that is the part that I criticized so much on my episode number three, I believe. And Funny enough, out of all the episodes that I have published so far, thank you for the support by the way of my listeners, the one that has the least downloads is that one.

Swapna Chakrabarti, RPh  14:19  

Really, we need to get word out, to the pharmacist because I would like to hear more from pharmacists. Yes. What they think?

Marilena Grittani, RPh  14:27  

I don’t know why. I don’t know if because people don’t like chain retail pharmacies like CVS, Walgreens, all those eckers or what have you, or it is because they know it, they think they know it. I don’t really know. But I stayed so many things. They’re like, why I don’t like them. I mean, I’m not opposed to their business. I just… my drive and my objective as a health professional is my patients health. And if kind of facilities don’t allow any of what we just discussed that we need to do at Longs. That wasn’t not only what we were trained as a pharmacist to do. It was what the company encouraged us to do.

Swapna Chakrabarti, RPh  15:08  

Exactly, absolutely. And they had associated health that we needed, they provided that,and they encouraged it, too. So it was not just at the pharmacies wanted to do it. We were in an environment that encouraged it. So it was it was perfect… I miss it so much!

Marilena Grittani, RPh  15:22  

It was I love my Longs. So kudos to the owners and the marketing team and also the pharmacy supervisor that we had at longs drugs. I don’t remember the supervisor, the guy that we had in your area. I do remember Nasiba which I have been in touch with. Oh, that’s good. And again, she have not aged one day. I don’t know what this lady does. She had like four kids. Oh my god, she’s so beautiful. So Mrs. Nasiba Makarem, doctor in pharmacy. Hi to you from Swapna & Marilena.

Swapna Chakrabarti, RPh  15:26  

Oh my, the pharmacy supervisor I started off with was Connie Irwing she just she was the best mentor you could ever because I was I was new I mean I was new in terms of I was new to the country I was new to the profession year straight out of her lab. So this and so she encouraged me and I’m so thankful that we always need those…the help of the mentors, don’t we we need to help us and big 

Marilena Grittani, RPh  16:20  

And because of what you did with me, and the way that you make me feel and the confidence that you create in a me as a retail pharmacist. I got motivated to do it with every single other pharmacists that I trained on all the new pharmacists that go on rotations that I supervised or that I mentor or that I that I was a preceptor. Yes. I just tried to do that and make them feel that, what you learn at school is in books, this is real life. Exactly things these people are breathing, they have blood pumping by their heart, they have feelings. It you need to you need to understand that part.

Swapna Chakrabarti, RPh  16:57  

Exactly, exactly.

Marilena Grittani, RPh  16:59  

So I learned from you, thank you for that Swapnita!

Swapna Chakrabarti, RPh  17:01  

You are very welcome

Marilena Grittani, RPh  17:02  

I love you. Yes, yeah, thank you, thank you. You know I love you because you’re a lovely person. But professionally speaking you’ve been really important to me

Swapna Chakrabarti, RPh  17:11  

Thank you so much. That’s why this is really exciting for me to see this new venture that you have embarked on and I’m again very thankful that you got me in with you to share to have a conversation about what we are doing as pharmacists and let’s see where this goes 

Marilena Grittani, RPh  17:29  

You were my accomplished in the beginning because when I talked to you what six months ago. Like Swapna, I want to do something different. What do you think and you’re like Mari that’s too many ideas. I don’t know what you want to just narrow that down. Talk to me later. And here we are talking. No, we did was good.

Swapna Chakrabarti, RPh  17:45  

It worked.

Marilena Grittani, RPh  17:45  

Yes. So okay, what motivated you to help your patients? Why would you so kind and so into them, that I copy you and I do the same now?

Swapna Chakrabarti, RPh  17:56  

Oh, my goodness. All right. Well, if you think about it, A very simple thing. It’s literally I mean, you, you hear it since you were a child, is that you want to treat others the way you would like to be treated.

Swapna Chakrabarti, RPh  18:09  

Right? Yes, you are. They’re doing a job. But no, not exactly. You are not just an employee there, you have something to give to the other person in front of you. And that person in front of you actually is in need of something. And they are they expect you in a way if you think about it, to help them out to navigate this extremely complicated thing that isn’t happening to them.

Swapna Chakrabarti, RPh  18:36  

And as far as what motivates me is I like to think that when my parents go to a pharmacy or when my kid goes to the doctor, that is how I want them to be treated. When I go, I at least have some form of control so I can, I can probably ask for things, but when they go they don’t know they don’t they are not prepared. They don’t know how things happen. They just know that they’re sick, that they’re hurting, that nothing’s working. They’re in a state of frustration, people who come into the pharmacy, and not there because they want to, they are not happy being there, to begin with. So every little thing that you can do to ease that 15 minutes, 20 minutes, half an hour, they are there. That is a human thing to do. And that I’m hoping, like, as others see, they will do it more and this would be much kinder place around us. And also because as a pharmacist, again, that’s what I trained to do. And I would be doing my training my professional disservice, if I didn’t impart that to the other people who are coming to me for help. So whenever I am with whoever it might be a patient who I’m dispensing the drug treatment with somebody who calls me on the phone and asks me, what do you think of this, I’m relying on my intellectual side, I’m getting that information, but I hope to bring my human side as well, to treat somebody with basic sympathy and kindness that I want them to also treat me with.

Marilena Grittani, RPh  20:07  

Exactly. And I think that I got that from you, I every, every time that I talked to people that I trained, I tell them, I want to treat my patients like if they were my child, if they were my sister, if they were my brothers, my husband, my mother; Because if I do that to other people’s family, eventually that’s going to happen to my family as well when I’m not there to control and help them.

Swapna Chakrabarti, RPh  20:32  

Exactly. Absolutely!

Marilena Grittani, RPh  20:34  

It is human kindness. So Absolutely. Thank you for teaching that and for showing me that and yeah, I never knew where I got that from. Now, I do think you remind me that yes, it does work better. So just to this point that Swapna brought up. Anybody that does not have this type of service in the pharmacy that they go to make a change because they’re pharmacists out there that have the focus that the company that we used to work for had, which is patient care. It was not to fill 600 prescriptions a day by one pharmacist and one technician. It was, how many patients did we help? How many people did we support? And did the professional and healthcare related actions that they needed, not only with medication, but also explaining to them what they would do, what to expect, what the next step is, and what not to do? Because people don’t know. I mean, for us, this is second nature. You talk about levothyroxine taking a lunch with milk and we have seizures were like, WHAT!!!!????

Swapna Chakrabarti, RPh  21:45  

Exactly. LOL

Marilena Grittani, RPh  21:46  

I have so many patients that do it all the time, and they don’t know. So that is my area of expertise. And that’s what I need to talk about. And we’re going to talk about Leothyroxine one day, because I mentioned the three times already and so that that is what we need to do.

Marilena Grittani, RPh  21:59  

So That’s what we love to do. Because that’s what we trained for. That’s what we went to school to do. So if you’re not getting this service, if you’re not getting this dedication, if you’re not getting this professional help that you need from a pharmacist, you are going to the wrong pharmacy. That’s all what I need to say.

Swapna Chakrabarti, RPh  22:17  

And I do believe that like I said, for most part the pharmacists go in with the same motivation to help people and when they graduate. And when they are in all of these situations. Pharmacists also end up being frustrated, because they’re not doing what they want to do, because they are people, people, they want to be there and talk to the people talk to the patients face to face and take care of them. So for the most part, that’s what we trained to do. And that’s what we love to do. And I just hope that the trends that we have been seeing in our profession that, they are reversed soon enough where we can go back what I used, I remember we had pharmacists who were much older than us and they will tell us of the good old days, but it was one pharmacy, one pharmacist in a town and then you everybody in that town. To some extent, that’s what we did. We had long term relationships with those patients, even though we were a bigger pharmacy, but I envision the pharmacy profession going that way, again, with all of these other things that we we are here to offer to our patients.

Marilena Grittani, RPh  23:21  

And I do to just imagine being a patient that goes to Swapna us his or her pharmacist, and then you get a new doctor. And then you get a new prescription. And he comes to her and she’s like, hold on. Mrs. Smith could not take this drug because I know,because I’ve been her pharmacist for years, that she had this reaction to this drug that she’s taking this other medication, and she could not take this I’m going to talk to the physician to explain this because this doctor does not know her. Right? And I do, and I’m protecting my patient. So the doctor will be like Oh, thank you for catching that. Let’s just work with what what do you think I should use for the same goal. With the same objective to be achieved, what other medications do we have that would not affect her or would not interact with the other drugs that she’s taking? When you have a pharmacist, you want somebody that knows you. So but unless your case, your medications and remembers you, so it will be easier to detect any issues. Then if you go to a different pharmacist every day, or you have pharmacists that have 7000 prescriptions to fill a day, they have no way to memorize any of that. So again, if you’re not getting that service, you’re going to the wrong pharmacy. That’s all what I want to say. 

Marilena Grittani, RPh  24:33  

What Swapna, tell me about the other job that you started after you stop doing retail, that’s all I want to talk about?

Swapna Chakrabarti, RPh  24:40  

Oh, yes, that is exactly what we’re going to talk about. So well, I started in retail, everything was going hunky dory. But then as a family, we moved. We moved. enormous number of times for my husband’s job. 

Marilena Grittani, RPh  24:53  

Me too!

Swapna Chakrabarti, RPh  24:53  

They were all they were all good moves. I enjoyed every one of them.

Marilena Grittani, RPh  24:58  

Me too!

Swapna Chakrabarti, RPh  25:00  

 But the problem with that is that you find a job that you stick with and and also my children were young at that time. So I thought that would be a good time for me to take a break, raise the family. And then once we came here about six years ago, we were hoping to stay here for a while. I’m in the greater Boston area now. And this is when I came across a fascinating concept that a group of pharmacists had started, which was offering MTM services… which is Medication Therapy Management services directly to the patients. So now if you think about all the things that we talked about, what did we talk about, we talked about the pharmacist being there to monitor the person as a whole, in terms of the medications they’re taking in terms of the medications like prescriptions, and the over-the-counter medications that you’re taking. So when you’re standing in a pharmacy, you have access to that, yes, you are doing two different jobs. You’re doing the dispensing part of it, you’re giving the medication, making sure you have The right medication for the right patient, based on the doctor’s orders. And you are also going through everything, the history of that patient, in terms of their medical history. And in terms of their medication history, you’re making sure that the drugs that they have received are pertinent to what they’re being treated for, and that they work well together. So now, if you take just that part out, which is the part I love, I enjoy, I think that is what I was trained for. And I’m good at it. If I might say so.

Marilena Grittani, RPh  26:33  

Very good, not just good… Very good.

Swapna Chakrabarti, RPh  26:34  

That is what essentially medication therapy management is. Is on an individual basis. You look at the patient profile of all of the medications of the prescription, non prescription medications, vitamins supplements, everything that they’re taking, and you are talking to the patient directly. You’re getting the information from the patient as to what’s wrong with them, what do they think is wrong with them, Right? and what are they taking it for? So in a In a very general sense, this is what we do is we provide this review service once a year, maybe twice a year, depending on the condition of that patient. And then, depending on what we get from that review, we offer suggestions. Tthe suggestions might be in terms of why aren’t you taking this medication everyday like you were supposed to? Is it too expensive? Can we find an alternative for you? Or it can be Why are you still taking this medication, when what you were treating finished six months ago, “because the doctor told me and because the pharmacy filled it”

Swapna Chakrabarti, RPh  27:36  

I mean, these are everyday issues for these patients who most often the ones we deal with are the elderly people, they’re on their own. They’re trying to take care of these things, but they don’t have time or the expertise or somebody to do that with them. So medication therapy management is literally as it says it’s your entire therapy regimen. We are managing medication therapy. We’re not managing the disease state, but we are looking at you as a whole. And we are reviewing every single medication that you are taking, have taken, will be taking. And most importantly, the way I see it is I’m empowering the patient. I am educating the patient to know exactly what they’re doing, why they’re taking the medication, so that they can ask the right questions. Yes. So in a nutshell, that’s what medication therapy management is.

Marilena Grittani, RPh  28:29  

Well, it wasn’t a nutshell, but it was wonderful. You got me you got you got me chills here because it’s exactly what it is. But it also is think about your parents being 60 something years old or 70 years old right? This many medications and exactly when anything go. You wish. If you were a pharmacist like we are, that you could help them but if you’re an engineer, if you’re a lawyer, if you are a sales, man, if you do whatever you do, that has Nothing to do with this right? We want to help you to know how.

Swapna Chakrabarti, RPh  29:04  

Right? Absolutely

Marilena Grittani, RPh  29:05  

They are clueless in the same way that the patients are. Right?

Swapna Chakrabarti, RPh  29:07  

Right. And we are professionals, we know this, but as a person, when you go into the doctor’s office, you are nervous, because a your health is not what it should be. So yeah, you are in there for a problem that’s been bothering you. And you’re not there thinking, Okay, I need to talk to all of the talk about all of this stuff. I need to remember all of this stuff. I have all of these questions. You’re not thinking that. I don’t like to use the phrase, but you’re technically at the mercy of the staff there, whether it’s the nurse or the doctors, and we pray, we assume that they catch everything, but they are humans too. And we are trained professionals as a pharmacist. So that is an extra layer of security of accessibility in terms of a pharmacist, where the patient can ask, why am I taking this what is this for, the problems that I’m in Having Is this because of this new medicine I started, you don’t have this kind of time when you are in the doctor’s office. So the thing that I have absolutely enjoyed in this is that I don’t have time constraints. When I do a review with my patients, I’m on the phone with them. I wish I could do a face-to-face which that I promises to connect face to face and teams, which one of these days I’ll figure out how to get on that. But right now it’s with on the phone, and it’s at a time that is convenient for them. They are in their house, they are comfortable. So now that attentive now whatever I tell them, they want to pay attention to it, and it’s obviously going to be in their benefit. So I really appreciate this chance to be able to talk to the patients. Most often. I’m on speaker is the wife, the husband and somebody else. It’s a joint effort because there are people who are taking care of that patient. It’s not just the patient themselves. So I think it’s a really effective way, To empower the patient themselves and also as professional for usto monitor what is it that they’re taking.

Marilena Grittani, RPh  31:06  

True. And most of the time, when you go to the doctor, you have five minutes to talk to them, and they re in a rush, and then you have no time to discuss issues that you’re having that may be related to the drug. And you don’t even think about it. Like, I can’t sleep now. And then the doctor said, Okay, let me just give you a sleeping pill and you’re like, hold on, find out why he can’t or she can’t sleep. Right? Is it a medication that she’s taken?

Marilena Grittani, RPh  31:31  

Well, let me just tell you this is a joke between Swapna and me and any pharmacists that are out there listening, if you’re not a pharmacist, we will explain.

Marilena Grittani, RPh  31:39  

So this patient came to me once and said I need a sleeping pill and taking this over the counter sleeping pills because I can’t sleep. And it was a brown bag, meeting those workshop that patients will come with all their medications and ask questions to the pharmacist. And the patient was telling me I can’t sleep and I need help. I’m taking this over the kind of medication and I said okay, so tell me what you’re taking how you’re taking it and she said, Well, I take this in the morning and I take this at night. She was taking Wellbutrin at night

Swapna Chakrabarti, RPh  32:08  

Of course. LOL

Marilena Grittani, RPh  32:10  

So she couldn’t sleep and she’s like I’m taking all these meds and then the day I’m tired, I feel awful My life is miserable I want to die I’m like Hold on a sec. Wellbutrin is a medicine that needs to be taken in the morning because he wakes you up, it doesn’t let you go to sleep. So if you take it at night, it’s not going to let you and you’re going to have all these issues; if you change that most of those problems are going to go away and she looked at me like Are you serious? Is this all what it is? Why didn’t my pharmacist tell me that? One more time,she was going to the wrong pharmacy or to the wrong pharmacist, which is a possibility and and everybody says nice and cool as Swapna or me…. Come on people!

Swapna Chakrabarti, RPh  32:51  

No, of course not!

Marilena Grittani, RPh  32:52  

That is so simple. So when you are doing medication therapy management with an expert like Swapna This is very easy to find out again, it was a joke for her and me because we know what the patient on yourself, you didn’t have any idea of that. So these are things that we can catch very easy. You don’t need to be taken night medications, you need another prescription that is going to cost you other side effects. So it’s very simple. And how many times have you take out medications instead of adding more Swapna? Because itis not needed!

Swapna Chakrabarti, RPh  33:26  

Exactly and that more and more. That’s what we see right that maybe you started taking a medication for a certain condition? Yes, if it’s a chronic condition, maybe it was at one time, maybe your blood pressure was not being controlled by just one medication. So they added another medication to it. Now it’s been four years and nobody has really taken a look at it to say, okay, what’s going on? Why do you have 12 prescriptions that you fill every month. Sometimes you don’t fit well prescriptions because you can’t afford them and the one that you decided Not to fill, is the one that you wanted. So decreasing the number of prescriptions is when I look at a long medication list, that’s my… that’s literally the first thought that comes to my mind is do you really need to be taking all of these? And who decides this? How is the patient going to make this decision is like I’m not. And believe me, the patients do sometimes. I don’t need to take this anymore. It’s working. I’m done. But no, that’s the problem with the wrong medication that you stopped taking.

Swapna Chakrabarti, RPh  34:31  

So I mean, I have I have older relatives who they refuse to accept the fact that they are diabetic, because their blood sugar always comes normal. And I asked them, are you taking your medicines? She goes, yes. That’s why it’s normal. If you stop taking it, it’s not going to be… But they do they decide okay, it’s everything is fine now, so for one month

Marilena Grittani, RPh  34:52  

I got fixed.

Swapna Chakrabarti, RPh  34:54  

Yeah, exactly. So and these things ideally, if you ask me what we do I would like to do it even more frequently, I would want to meet to to talk to that patient, it doesn’t have to be the half an hour, 45 minutes an hour that we normally do to do to conduct a thorough review. I hope there is a way we can set this up in the payment system, which eventually is all it comes down to. If you have a follow up call every three months, when a patient is in their 60s and 70s. They need that kind of hand holding. If everything is fine, yes, I just talked to them. 10 minutes, everything is good. That’s it. But that, oh my goodness, every time I call these patients and I talked to them, it’s amazing how many simple things can be changed, can be fixed, can be added and it makes such a big difference in their quality of life, let alone the whole fact that excess of medications are going to cause all kinds of side effects and cost them more.

Swapna Chakrabarti, RPh  35:51  

 So this is something that needs that powers that be you need to focus on more in that in integrating this medication therapy management practice into everyday workings of the pharmacists, we can follow them, more closely and eventually prevent hospitalizations prevent side effects. And we are helping the doctors take care of their patients. That’s the biggest thing. But it’s not we’re not questioning them. But if I ask somebody a question and I find out that they’re taking the wrong medication, I can call the doctor and tell them that this is something not right. You might want to take a look at this, you might want to switch it to this. I’m not questioning their judgment, I am supplement whatever, the care that they are giving.

Marilena Grittani, RPh  36:34  

Well, on that point, I talked on episode number seven with my friend, and now my hormonal replacement specialist Sharzad Green. And she mentioned something that was very eye opener to me because this fight is happening, but she put it in words. She said that it’s a triangle: where the patient, the doctor and the pharmacist work together for the therapy to work the best. The doctor does diagnosis And he knows or she knows what the patient needs, right? As an as a solution. They don’t know what would do it. Right? They don’t know which one would be the best dress doing because we have so many options. So that is our part, we will say okay based on this and this and that and the knowledge that I have that they don’t, because as I said on episode number 2, we do study not only medications for 10 semesters, but also we we studied therapeutics, which is how the drug works in the body.

Swapna Chakrabarti, RPh  37:33  

Exactly. 

Marilena Grittani, RPh  37:34  

Swapna, did you know that USC (University of Southern California) has 20 semesters of therapeutic and drug information in the pharmacy program? My goodness, I know and that’s very close to what we did. And back in Venezuela, one nice day pharmacy and you know that Harvard Medical School has one therapeutics semester, and one medication semester is just ridiculous. It is!They don’t didn’t go to school to learn drama.

Swapna Chakrabarti, RPh  38:03  

Absolutely, yeah, that’s not what they do. And that’s not what they should do. Their focus has to be on something that needs to be like a delineation of what the doctor does. The conclusion that the doctor reaches and then, the people who went to school for five years, six years… You know the drugs? You know what it is, you know what the medications are, you know, the newest ones because we have to have our continuing education credits every year, keep them up, we know what’s happening out there, and the medications available and have the perfect fit for the diagnosis and the medication that that patient needs.

Marilena Grittani, RPh  38:41  

Absolutely. 

Swapna Chakrabarti, RPh  38:41  

That’s she’s absolutely right in terms of it being a triangle, in that we are all connected in making sure that, the medications working with therapies working for the patient.

Marilena Grittani, RPh  38:51  

The other advantage that I see with what you do and medication therapy management is that patients don’t have just one doctor… And the older they get, the more doctor they have. So the fact that Dr. A doesn’t know what Dr. B’s doing the doctor sieges order, and they just got in the hospital because they fall, they have a fall and then they have all this new medications that they change at the hospital because they didn’t have it in their formulary. And now they don’t know what to do. They have duplication of therapy. And then, which is the part that I hate ( I’m sorry for using that word that is so heavy, but it’s true) Some pharmacies only want to fill prescriptions because the more prescriptions they feel the more money they make. Right? Right. Yes, they would actually not even care if you’re using three or four drugs for the SAME PURPOSE because, they meet their quota.

Swapna Chakrabarti, RPh  39:42  

Yeah, yes, absolutely.

Marilena Grittani, RPh  39:44  

And they will put you in automatic refill and they will fill 90 day supply. So if your family member or yourself you’re 7080 years old, dealing with life with pains with aches with whatever you have, and then you get at your doorstep. A lot of bottles with a bunch meds and you’re like, it says that I need to take a treat. Today I’m gonna take them and then they end up taking 15-20 medications that are not necessary. 

Swapna Chakrabarti, RPh  40:09  

Absolutely!

Marilena Grittani, RPh  40:10  

This is why you need a pharmacist that you trust, to say Hold on one second!!! These three drugs are the same thing. Why are you taking the three of them? Well, this was a This was dr. A. This was at the hospital. That’s why I’m taking the three of them. And that’s what you’re having fainting issues.

Swapna Chakrabarti, RPh  40:23  

Exactly. Absolutely.

Marilena Grittani, RPh  40:25  

Becasue you are taking too many meds.

Swapna Chakrabarti, RPh  40:26  

So absolutely, yeah. And that, that what you just the scenario that you just described, which is usually post hospitalization that they were in there for a reason they came out, they come out with a whole new list of medications. Yes. At home, they already had a set of medications for three months. Like you said, Everybody encourages everybody to get three months supply of medications, which is in a way good for chronic medications. When it is stable when your life stable. Your whatever condition you’re trading it for is normalized. It’s maintained on it. Yes, it works, but it’s not something like this happens when you’re in a hospital and you’re back, and you have a whole new set of medications. Nobody told you what to do with the old medications. So you’re continuing that and you’ll have a whole new set of medications, you’re taking all of them together.

Swapna Chakrabarti, RPh  41:14  

Not just that, because even even if it’s not that extreme, something as simple as you’re going to a cardiologist, because you have high blood pressure or your newly diagnosed, you have been given a blood pressure medication, which is older than dirt. Everybody knows, everybody takes it, but that cardiologist doesn’t know that you have COPD (congestive Obstructive Pulmonay Disease) or you have asthma, and that blood pressure medication is going to make it worse. If you have breathing trouble, you’re not going to go to the cardiologist, you are going to go to your pulmonologist or your primary care doctor.

Swapna Chakrabarti, RPh  41:49  

Or the ER,which is worse because they have no record of you;  the now your condition. Yes, your blood pressure is being controlled. Everything is fine. The cardiologist has no reason to call you for a  follow up, but you can’t read and you keep the pulmonologist keeps adding inhalers, but you are not fixing the problem. So when I, as a pharmacist, I take a look at it, I have access to your entire medication profile. I see it right there, that you shouldn’t be taking this blood pressure medication. It’s a simple swap of something else which will do exactly what your medications doing. But it’s not going to make your symptoms worse. It’s that simple because no nowadays, we don’t go to just one doctors, specialists and super specialists, but every single part of our body, and as we age, as the body keeps experiencing more and more symptoms as it gets dragged through the ages, we have to see specialists we all go through that it is and if you’re talking about the inhalers. This is again, one of the most common things I see is very rarely do you see a patient on one inhaler, right? you have a maintenance inhaler that you’re supposed to take Schedule two times a day. But then you also have a rescue inhaler, which works quickly because you decided that you wanted to walk to day, because it’s nice outside, which is beautiful. you absolutely should. But then you feel short of breath. So you need a rescue inhaler. When I talked to the patients, and they told me I have a green inhaler and a red inhaler, and then the green inhaler, I do twice, you know, I just do it sometimes in the morning and I don’t do it in the evening. I don’t need it. And then, I use the red inhaler one in a while…. I am like,  do you know why you’re taking these do know that it works completely differently. Because this is something that I wouldn’t say 100% of the patients but I would go even as far as to say 85% of the elderly people that we talked to, they have this they have a problem with breathing. So they’re so something as simple as this, which that one prescription can last for a very long time if you’re using it correctly, and all of the other problems associated with it. So, somebody approaching Professional does need to monitor these things. And the good thing is these instructions, simple things, when you when you tell them to the patient when they are comfortable when they are attentive, it states, they want to do what’s right, right?

Marilena Grittani, RPh  44:12  

Becasue they understand

Swapna Chakrabarti, RPh  44:14  

They understand and you’ve taken the time to explain to them that this medication is going to open your areas, keep them open. So you have to take it two times a day, you cannot just take it once daily. Ok, fine. And, they make a mark on it some way, whatever way they use to keep track of their medications. And it helps, so everybody wins. And that I believe, is the biggest advantage of this program off of medication therapy management program that a pharmacist provides.

Marilena Grittani, RPh  44:40  

Some people are not aware of the fact that when you go to a doctor, the doctor takes 15-10 minutes, they need to see all the tests that you’ve done. They need to listen to you. They need to diagnose you and they need to tell you the medication to know so explain everything. There’s no way that that would happen. 

Swapna Chakrabarti, RPh  44:56  

Exactly, exactly

Marilena Grittani, RPh  44:57  

There’s no way, so that is why We, the third part of the triangle comes into place. That is we are the drug experts, we are the ones that know and will explain you and we’re the ones that have the time and the accessibility to to get it done. And we’re talking about accessibility. Why don’t you talk a little bit more about that? Because it’s beautiful. It’s true.

Swapna Chakrabarti, RPh  45:18  

I absolutely believe, that pharmacists are the most accessible healthcare professionals out there for anybody in our entire healthcare system. We are there, leave the part of expertise because we’ve already talked about it. We are all trained professionals, doctors, nurses, nurses are trained for what they do, which is an amazing work that the nurses provide and I can’t stop. If once I start talking about how cool nurses are, I won’t stop so.

Marilena Grittani, RPh  45:44  

We agree on that, they are the best!

Swapna Chakrabarti, RPh  45:46  

Yeah, exactly the best. Doctors are trained to do something, nurses are trained to do something and so are the pharmacies. But I honestly believe that we are the most accessible, because we are there in front of them and ideally in an ideal world. We do not have the time constraint that the others do. They are not coming to visit us at an office,where there are five other peoples waiting in the waiting room and they are just getting through. That’s the biggest thing you need time. We are there to give you time, even in a pharmacy, even in the retail pharmacy. We’re standing right there, literally you can reach up, ask the pharmacist a question and we will come out and talk to you.

Swapna Chakrabarti, RPh  46:23  

It literally speaking, that’s how accessible we are. And in terms of the questions about your medication, about your therapy, we are the most accessible because we are trained, We are the experts in what medicine you’re taking, why you’re taking it for and how it’s going to work in your body. For all of your listeners, if you can accept and agree with this fact;  that way, I think you’d be able to use your pharmacists up better, for your own benefit that we are the most accessible experts, health care experts for you, and we are here to help you. Like I said most people go into pharmacy school for this reason.

Swapna Chakrabarti, RPh  47:00  

It’s certainly not to make millions and millions of money. That is not why we are there for…

Marilena Grittani, RPh  47:04  

Because we don’t, we don’t.

Swapna Chakrabarti, RPh  47:07  

It is actually this. This is a caring profession. And so if you are not like Marilena said, if you’re not getting that care, you know what asked for it as a patient, it’s your right. And if you don’t, then there are other pharmacists where you should be headed.

Swapna Chakrabarti, RPh  47:25  

Yes, exactly. And you touched on a very important point that healthcare in terms of payers or reimbursement is being changing too. They are giving more and more responsibilities to nurses, right, because nurses PayScale are cheaper than pharmacists and doctors. So if we talk about scales, doctors are the best paid, at least in reimbursements = insurance and Medicare why’s that pharmacist, I will tell you for comparing this 3% professions and then nurses, right so they want the cheapest person To do the most

Swapna Chakrabarti, RPh  48:00  

Exactly,

Marilena Grittani, RPh  48:01  

Which I agree if is if they’re capable. Yeah, yeah. What do you think that a nurse that study, a year and a half to become a nurse, or three years to become a nurse that had to learn how to do you know IV and how to get the blood drawn and how to do all what they do, And they barely study, one semester of pharmacology knows everything about drugs? Do you think that that’s the correct person to ask?

Marilena Grittani, RPh  48:28  

Let’s just put it in this example up there, the car’s not moving forward. And then you think, okay, who am I going to talk to? I’m going to talk to this guy. That’s sold the car that’s the one that is going to solve the problem. It’s going to be like, No, I know there’s a problem. I can hear it but don’t know what it is. Go talk to the guy that fixes cars. And that’s it. He’s the expert. He’s the one that knows. So don’t put that pressure on a nurse,that doesn’t know because that’s not what she was trying to do. A nurse would probably tell you or should tell you , go Talk to your pharmacist. And if you’re a pharmacist, the one that you are the mail order people that you call to ask for for answers are not giving you the service that you deserve,that you need and it’s important to you. Well go somewhere else is that simple.

Swapna Chakrabarti, RPh  49:15  

Right, exactly. And the whole scenario that you mentioned about the nurses, I actually, do come across that a lot. Because some of my patients who might call on the phone, they are in nursing homes. So lo and behold, now I am not talking to the patient or their caregiver. It’s not a loved one who takes care of them at home. But when I call it’s the nurse, and technically… Yes, they are supposed to know everything that they’re giving their patient, but they are going off of the chart. They are, like it says here, I asked them, Why are you giving them anti nausea medication, when you know that they just had a fall two weeks ago? Because there was no stop order on it. So, they are continuing to give them the medications and you don’t question The attending doctor, whoever has written so there are a lot of layers in the therapy of a patient, which, yes, as a patient, there is no reason why you should. 

Swapna Chakrabarti, RPh  50:09  

No, absolutely not. It’s not your job. But we as professionals, we as pharmacists know that there are these gaps and that we are here to help. We are ready and trained to do it. Just let us do our jobs. But as a patient, it’s absolutely important for you, to take ownership of your own therapy. It’s extremely uncomfortable. Yes, you are sick. But just because you’ve been given a medication, don’t just take it… ask what it is. Why are you taking it? Ask questions so that you understand, how you are being treated? And if something doesn’t feel right, do not hesitate, always ask. And the pharmacist is right there,for you to ask. answer your questions.

Marilena Grittani, RPh  50:10  

That’s their job and that is your right. Exactly, exactly. So that this applies not only to the people But to the family members?

Swapna Chakrabarti, RPh  51:02  

Yes. Oh, yes

Marilena Grittani, RPh  51:03  

Spouses, children, parents, and also the caregivers because these days we have people that are by people that are not family when we when you do MTM, I know you also talk to caregivers,

Swapna Chakrabarti, RPh  51:16  

Yes. And so you are absolutely right in that if Usually, it may not be the patient who I’m talking to because the patient doesn’t know what they’re taking, because that is an outside health person, not a family member or somebody who’s coming to help. The way we do this MTM services is basically we conduct a review, right? So It’s called a CMR or a comprehensive medication review, where we ask either the patient or the caregiver to basically gather everything that that patient is taking in terms of vials, in terms of over the counter medications and we go one by one by one. We literally do that like okay, if so if somebody says that I see a prescription for Atenolol, and I would ask Do you know what you’re taking it for? What are you taking it for? I don’t ask are you taking it for blood pressure, because they will say yes. If I asked them, are you taking it for sleeplessness they will say yes. So, I it’s an I think it’s a normal human response. So I would ask, do you know what you’re taking it for? Three times out of five? They don’t. They’re just taking it because is there

Marilena Grittani, RPh  52:16  

Because the doctor told me to take it

Swapna Chakrabarti, RPh  52:18  

Exactly. And sometimes it’s written on the label what it is fo; it used to be it used to be a big deal when we were working as dispensing pharmacies, but really, you have to write to them those How is the patient more or not, but more and more they don’t, it’s just that take one tablet twice a day of take one tablet quantity. So we go over each of these medications. And then, whatever I see as being a problem if there is a problem, right? I offer solutions for them. I will tell them okay, change likeyou said, switch the time that you’re taking it because you are not, or don’t take your levothyroxine in the afternoon with lunch or milk, right?

Marilena Grittani, RPh  52:58  

It won’t work. If you do it that way, it won’t work…

Swapna Chakrabarti, RPh  53:00  

It won’t work!!! Inhalers. If, if you’re having difficulty breathing and getting that technique, right, there is a thing called a spacer, that you add in where you’re breathing normally. So these are simple things that I can provide. Do I trust that they will remember all of it? No. This is a conversation that you’re having. But there is a follow up to this in that. I, as a pharmacist, I send out a printed, a solid list for your reference to keep as all of the medications that you’re taking and what you’re taking it for. And in addition to that, we’re talking about the caregiver part, is that is also an action list is like what do I need to do as a patient or as a caregiver? So yes, it’s a lot of paperwork, but if you think about it, it’s accessible for the patient and the caregiver. You take it up and you look at a thing, but I didn’t see this last time. Mr. Smith, what are you taking it for? Mr. Smith is tired and he is sleepy. He doesn’t know. You have an accessible document a printed a piece of printed paper, which says okay, this is For your anxiety attacks, maybe you shouldn’t be taking it every day, you take it only as it. So that I think is a very good deliverable. But the result of the CMR;  is that you get a printed list of all of your medications for the person that you’re taking care of. And also what you need to watch out for, right? What it what is an action plan, we call it the action plan is do this, don’t do that. Try to do this and then follow up if this happens. So that way, you have that concrete thing. You’re not relying on that one hour of conversation you had with me six months ago.

Marilena Grittani, RPh  54:32  

And remember it.

Swapna Chakrabarti, RPh  54:33  

And remembering it!

Marilena Grittani, RPh  54:34  

And sometimes the action plan includes the pharmacist is going to contact your physician to cardiologist talking about that Atenolol that the person was taken and couldn’t breathe, because the person had COPD or asthma as well. So then the pharmacist is going to follow up with the pulmonologist as well as the cardiologist and then we will see what happened and maybe you will get a different prescription or a different schedule, whatever applies to you. And that’s part of the action Plan written and you receive it. The other thing that I see the medication review document useful for is for you to take it to every physician that you go see 

Swapna Chakrabarti, RPh  55:09  

Exactly

Marilena Grittani, RPh  55:10  

Make a copy and bring it to the cardiologist, take a copy and bring it to the pulmonologist. And this is what I’m doing. And this is what it is. And whenever we update it,  whenever the pharmacist updated, get a new one and replace it. So everybody knows where you are, what you’re doing, what we’re looking for what we’re working on, and the most important part to the ER, that’s what you take. You don’t take your bag of 27,000 bottles that you have at home, right, right, that paper that has everything on it.

Swapna Chakrabarti, RPh  55:40  

And so that is why, when I talk to my patients, that’s the thing that I I tried to say at least two to three times so that they remember it and make it a part of their habit, is to have this list accessible to have a certain place where maybe it’s in a folder of all of your medicine related stuff or it’s in a folder by itself, preferably as Your loved ones know; To let the caregivers know that this is where it’s for. Because if you are having shortness of breath and chest pain and the EMTs, and they want to take you, you don’t know where it is, right? So this is people, have their lists medication list on their smartphones they might have but not everybody likes it, not everybody knows how to use it. And again, if you are anxious, if you are in pain, you will not remember to take out of your phone. This is it’s old fashioned is old technology, it’s paper, but it’s useful and it’s accessible. And it’s there where your spouse, your children, or whoever or the outside nurse that helps, who comes to take care of you. They know that it’s in this drawer in this purple folder. And when we talk to you as like I said sometimes I call every six months and every time I talked to you, whether your list has changed or not, I am going to generate a new one and send it to you, at your home address. So all you have to do is you replace it. How are the doctors that’s another thing that’s important because you have for doctors. Sometimes when I access the patient’s fight on the computer, the wrong doctor is associated with the prescription. And then if I call them that’s not going to be able to help anybody. So that’s another thing that I verify that a pulmonologist is writing your inhalers not your cardiologist, not the physician assistant who works with the cardiologist. So those are very minor things but that’s how we are trained to think about your therapy. We do that the best and that’s why the MTM is like so important!

Marilena Grittani, RPh  57:32  

I love it. So okay, this is how beautiful and perfect and I believe that every single listener that is they’re like oh my god, I never knew that this was done. This is so important. We need to get this for my mom doing my grandma doing my in laws because we sometimes have to take care of her-in-laws. How How are we paying for this and how

Swapna Chakrabarti, RPh  57:52  

That is the biggest pev peeved

Swapna Chakrabarti, RPh  58:00  

This, you know, they started off as Medicare, basically demanding all of the insurance companies who provide party services for their, for the Medicare recipients to offer this as part of their insurance. I would say even after what almost 10-12 years of this being in the industry, it’s not the norm, which is sad that it does not this is how it should be. The reality of our healthcare system is we are still being paid by the insurance companies, everything is dictated by the insurance companies.

Swapna Chakrabarti, RPh  58:31  

Thankfully, that is enough study being done that has enough data with all of the studies which showed that for them for their bottom line to this is way more beneficial. So we Yes, we can reveal dreaming of the day when this becomes the norm But till then, mostly it’s pharmacists who are affiliated with insurance companies, because then you have access to the roster of those patients. And you have basically, access to multiple doctors that that that patient is visiting. What I like and I, I hope I can do soon, is me acting as a provider myself, affiliating myself with a clinic or doctor’s office or even with the pharmacy and independent pharmacy outside and offering that as a service on its own. Like a standalone service and that we get paid. There are pharmacists that I know could do that on a person to person level, where it’s the patient and the pharmacist by themselves. You sign up for the service you get every six months or every year it’s a fixed rate; that hasn’t caught on yet because if you think about it in terms of division is just another expense;that you are signing on to we have concierge doctors Yes, this is concierge pharmacy services.

Swapna Chakrabarti, RPh  59:47  

And if you ask me personally, that is the way to go. The pharmacist does not have to be dependent on somebody else’s practice to be affiliated with them to be paid for this service. So as soon as we can get certified as providers, by Medicare by CMS (Center of Medicaid and Medicare Services), this is going to happen so fingers crossed.

Marilena Grittani, RPh  1:00:08  

That is another story that and that’s why you need to listen back to my episode number 9, where it talks about what I was doing the capital here in Arizona fighting for this because we are not providers and we make them because that way we can build directly insurance and get paid for the service, that is so important. Now you understand how important it is exit we’re not getting paid to do that. So there you go. But as it is right now, this is what exactly the situation is. If you are older than 65 and you have Medicare Part D, your insurance must pay for that it is included in your policy. You don’t have to pay extra Medicare demanded the insurance companies to do this because as Swapna said, studies have shown that this services, have improved the expenses and the suffering of the Patient; and even insurances like it because it’s cheaper for them you don’t go that frequently to the ER you get that many problems that they have to pay for it. So, that is included. So whenever please I am begging you, whenever you get a phone call from a pharmacist that says I am here to do your MTM service. Don’t decline it!

Swapna Chakrabarti, RPh  1:01:19  

Don’t hang up on them.

Marilena Grittani, RPh  1:01:21  

First thing that comes out of our mouth, this is free, and they’re like there is nothing free and they click hung up on us, right. Understand that. No, we pharmacists are not telemarketers. We don’t want to do that. We just want to help you. I know that’s not the norm. I know that this is how people get caught into this scams. I understand that. But when you hear the words, medication therapy management and you have a pharmacist to do it with you and then they know stuff about, you because we will know the doctor said you go the medications that you take the where you are your address, your date of birth everything!. Simply because the insurance gives us That information when we know all that it’s not a scam, we know everything. So we are working with your insurance company to do this.Enjoy that. 

Swapna Chakrabarti, RPh  1:02:09  

Use us. Exactly. This is a service. And as of now it is like Marilena said it’s mandated by Medicare that the insurance company has to provide it for free. So this is an hour of your time, hopefully just once a year, if everything goes well, that is going to help you throughout the year it has going to help you understand your medications better. And also to ask any of the questions that you don’t have time to ask for you and for you forgot when you went to the doctor’s office. So absolutely, when when we call you maybe on behalf of insurance companies for now, due to conduct this review with you, if it’s not convenient, there’s always a chance that we make appointments I call patients couple of days later. Usually when I call them and they’re driving, obviously we don’t want to do that then, we want you to be relaxed at home, maybe enjoying your coffee or tea or whatever it is;and then it’s a One on One chat and and trust me you, you will not regret it.

Marilena Grittani, RPh  1:03:04  

And if you as a family member of a spouse, parent child, have the time to be their present with that. Just do it just listen to what we have to say and then understand what it is and then trust it,because it is again in these circumstances it is paid by the insurance company and is free of charge.

Marilena Grittani, RPh  1:03:23  

Now, if you have as Swapna said, is once a year or every six months depending of the case, but if the patient got in the hospital, you have another one because there’s doctors in the hospital that have changed the medication whether it’s because it’s causing you harm is because they didn’t have that drug or because they changed something. Then you need to review it again, and then we will probably call you with that. A change to do it again. So don’t decline it. Don’t think that we are there to take your money we will not ask for a credit card. It is already paid for that is one side of MM, these days.

Marilena Grittani, RPh  1:04:00  

Fortunate as Swapna also mentioned, there is a bunch of us pharmacists that are doing independent work, we are doing this on a daily basis, having office time to see patients one on one to do this, whether you have an office that they come over to do it or doing online, which today technology is so great that we can do that. So you see in each other, you can actually show me the bottle that you’re talking about, right? And then we can discuss it, and then train and educate you and make you understand what you’re doing. So you will understand and do it mindfully and consciously, about it. And if you have any questions when you go to your doctor, you can say my pharmacist told me this and that and this is what I’m doing. And then if the doctor has any questions, you have our number, and they can call us and do that. Again. It’s part of the triangle of service. That is for your health and your benefit. I know, that today because of the fact that we’re not providers, which is the “law thing” they think that the only thing that we can do is to dispense medications and you’re ready learn with me that that is not the case. And today only with what charting explained there’s not one medication that she has dispense so far. She’s just talking about them, but she’s not dispensing them.

Swapna Chakrabarti, RPh  1:05:13  

Exactly.

Marilena Grittani, RPh  1:05:13  

So then they don’t believe that we do that because the laws are from 1940. Then we didn’t have cell phones. Hello. So why is the law still there, they need to modify the law to say the pharmacists are capable for this, their doctors in pharmacy, they have study of these, they’re specialist on this. They’re experts, we need to pay for that. So that is something that we’re advocating for. We’re trying to get reimbursed so we can bill insurance the same way that your doctor bills insurance, and then we get paid for our time, and we will do it more. Sadly, there’s a bunch of pharmacies that are unemployed and the whole country because there’s not enough jobs for us. So, if this situation occurs, if we get approved to be providers, and then we can do that ourselves, the problem gets resolved. Patients are going to get better service, doctors are not going to have to deal with all that many problems, insurance companies are not going to have to spend that much money in patients with problems that we couldn’t solve. And then a bunch of pharmacies that are unemployed are going to have a job to do, doing what they went to school to learn to do for years. So it’s a win win situation. I am very passionate about this. 

Swapna Chakrabarti, RPh  1:06:17  

Very well said. Yes, you absolutely you can read the passion very eloquently.

Marilena Grittani, RPh  1:06:23  

I love my profession. I love my patients. And I care about everybody like if they were my family. So I truly encourage you to think about this and listen to what we said. And then call your insurance company and make sure that what we said is true. And then whenever you verify that, you will trust us and then do what we’re telling you to do. So Swapna Any other comments that you might have for MTM before we go to another side of our conversation?

Swapna Chakrabarti, RPh  1:06:48  

I do have a few tips which we talked about. So maybe we can post it will be posted on the episode webpage. So that way it’s just basic thing that you may not necessarily think of, in terms of issues. You keeping it accessible, what would be the best practices for splitting your medications, whether you’re taking them in like in boxes, you keep them in the vials. So I will have a few of those tips and we’ll make sure that you have access to those. But in terms of MTM itself, I would highly encourage you like Marilena said, you have two or more chronic conditions. Which is how Medicare determines that you need an MTM. You can call up your insurance company and make sure that that is that’s the service that they’re providing. And you will get a phone call from a pharmacist, who wants to do what have you with you. And if that’s not a time that is convenient for you fix the time, schedule it and make sure you use this very, very useful opportunity.

Marilena Grittani, RPh  1:07:45  

For those of you that are on the mailing list. Whenever you receive the email saying that we got the new episode posted on Tuesday. That particular document that Swapna, is talking about gets on that email, so you don’t even have to look for it. Now if you’re not in the mailing list. What are you waiting for? Right! Number one and number two, I will have in the episode patient will have a clickable link where you can get it from if you go to www.thelegaldrugdealer.com/12. That is the page that is going to be talking about Swapna and everything that she talked about and the links for that document that she prepared for us. And you’re going to love it, it’s going to be very important. Whether you you are at that age, whether your parents are at that age, where your caregiver, or you know, somebody that you love that might needed: your grandparents, your people that race you, I don’t know anybody might benefit from that. So make sure you get it. All the information there and I will put a picture of something in there so you know how pretty she is 

Swapna Chakrabarti, RPh  1:08:44  

Thank you Marilena, you are too kind.  

Marilena Grittani, RPh  1:08:44  

So again, thelegaldrugdealer.com/12, which is the number of this episode.

Marilena Grittani, RPh  1:08:53  

So with that, I want to ask you questions as a pharmacist because, we’re still a pharmacist; even though you did a good You’re left to do MTM. Yes we are pharmacist sub division of pharmacy.

Swapna Chakrabarti, RPh  1:09:04  

Exactly.

Marilena Grittani, RPh  1:09:05  

We are still pharmacist. So what is something that you think that most patients don’t know about pharmacy as a profession?

Swapna Chakrabarti, RPh  1:09:12  

It’s hard, It is too it’s hard. It’s complicated. It’s not the pharmacist that you see dispensing, filling up the vials with your medication. That is probably the last step in a long series of steps that we have taken to understand your medication. And that’s not the only thing we do. In the healthcare professions,  Pharmacists actually top the lists of the most reliable healthcare professionals and that is definitely historical reason for it. But we definitely want you to know, that we are not in there just to make money. So then we just fill your prescription bottles and get you out of there as soon as possible. That is not want We want to do so don’t look at us through that lens. We are people, we are compassionate, we want to help you. So if you have to wait a little bit longer to get your prescription at the pharmacy, that’s probably a reason for it. I think it’s one of the noblest professions, because we are there to help people use our expertise. But yeah, we are people too, we get our frustrating this we have. So when you are dealing with treat them, as we would expect a pharmacist to treat you kindly treat them kindly to as human beings, it’s we are not just in there, just to save face just to make money off of the prescriptions that we are filling for you. Other than that I absolutely love being a pharmacist. So all the things that we talked about for the last hour or so. It’s just, I couldn’t have been happier in any other profession. 

Marilena Grittani, RPh  1:10:51  

True. Agree. We can feel that. So one thing I wanted to add there, even though the company that we are working for has that intention. They only think That they want your money. We are not like that. So are the only ones protecting you from, anything that could harm you. And we’re not the ones that are taking the money from let’s keep that in mind. Yeah.

Marilena Grittani, RPh  1:11:13  

Okay, tell me something funny or cute that happened to you in a pharmacy? Do you remember anything? 

Marilena Grittani, RPh  1:11:17  

We had an older couple who would come into the pharmacy. The gentleman was the one who had like, I don’t know, 10 prescriptions, then stuff just kept adding in his prescription list and his wife,was the one taking care there of German descent. I remember very specifically, his English was it was okay. It wasn’t the best. And I don’t know that was the reason but he was very reserved. He wouldn’t talk much but his wife couldn’t. She just she was there to talk to everybody in the pharmacy. Everybody knew her. The nicest lady. And the funniest, thing was every Friday, this is remember this is California and this was long as drugs. So we would sell out we had record sell alcohol. Every Friday. She would get the Giant bottle one and half liter bottle of wine. It was the same wine. And she’s like, No, no, it was all in good fun. And I mean, she was too She was older person too. So we would always make fun of her. But we had… she’s been going to that pharmacy for the longest time ever. And we ended up like me and her, along with her husband, we ended up building a really good rapport. That she would call me, even if there was no reason to because something was bothering her for herself. And she didn’t do a lot of medications. And so we had this as this relationship almost six-seven years. And when I was ready to leave, you wouldn’t believe it. She actually gave me, because she knew about me. I am I’m from India, and so we would talk about those things. She would tell me things about Germany, from her ancestry she would ask, so I must have talked about it. I don’t remember how she gave me a Sanskrit to German dictionary. Cheese. This is my gift for you so that you would remember me, I have had this for the longest time is this old copy. And because of our shared heritage, I guess, I don’t know where she would get it from or why she would have a Sanskrit to German dictionary, but I still have that with me. And that was a gift for me as a goodbye, friends. It’s like, it can’t get any better than this.

Marilena Grittani, RPh  1:13:17  

I know and you have moved like a thousand times, even to India and then back to the US.

Swapna Chakrabarti, RPh  1:13:22  

Oh, yeah. Oh, yes, absolutely. I have it here in my bookshelf. It just warms your heart, because you hear all these bad things about people doing bad things to each other. And then you get experiences like this. And it just, it just makes you feel good about humanity in general.

Marilena Grittani, RPh  1:13:38  

Yeah, that that was a good way for them to understand that you were a human being as well.

Swapna Chakrabarti, RPh  1:13:44  

Yeah, yeah, absolutely. I have one more question for you. Yes. You were talking about your bookshelf. The tell them to gossip. I know everything about

Swapna Chakrabarti, RPh  1:13:54  

Oh My goodness the gossip.

Marilena Grittani, RPh  1:13:56  

So, what are you working on besides drugs and medical And being a drug dealer, what are you? What are you working on?

Swapna Chakrabarti, RPh  1:14:03  

Well, now that you asked me besides dealing in drugs, I’m thinking of dealing in dreams in in terms of writing my favorite thing right now…

Marilena Grittani, RPh  1:14:13  

She looks so happy right now. Is her new passion.

Swapna Chakrabarti, RPh  1:14:15  

Yes, it’s my project. It’s my favorite project. I’ve done taking up a lot of my imagination and time, I am writing very actively my debut historical fiction novel. And something that has been in my mind for a very long time just didn’t get it on to doing it this year iIt is; and it’s already it’s the first step is done in that writing of the first draft, which is really scary. And it’s extremely gratifying to see it all out there, not just in my head, were it has lived for a few years now. But yes, it is a story of a young woman, a 20 year old Indian girl living during the British rule of India in 1919. So living under colonization, and it’s not a story of the big heroes of the freedom movement that we usually know about in history, because history is a story of the big moments of huge impact that people had which and events largely. But this is a story of simple people, of common men, of ordinary folk who obviously lived in those days, they lived normal lives like you and I do. They’ve been through relationships, they had their own lives. And then there was this big tent on top of it all, a big supporter of the colonialism of the British rule and whether you want it or not how the events that are happening around you; they are huge role in determining who you are, and the choices you make. So that is something that I’ve tried to explore with this. 

Swapna Chakrabarti, RPh  1:15:46  

And I am an avid reader, if I could, I would just sit at home all day and get somebody to make me food and sit and read. But unfortunately I do that but in all of my readings and all of these years I have found this vacuum about The history from India, in terms of the colonial. We know a lot about like the really ancient history that it because it’s in such an ancient civilization when you know what’s going on now with all the tech boom with the computers, but there was this 200 year period when the British ruled India. And that is a huge aspect of India’s history. And there’s not a whole lot of literature about it. So that’s my goal is to familiarize readers in the US and hopefully in in Europe as well, if I can get it published there, about this fascinating piece of history of this giant subcontinent; which is what it was at that time, which later became like four or five countries, and how things that happened. In Britain… yes, they do have an appreciation for it. It is a former colony, but their view about it is very different. Completely.

Marilena Grittani, RPh  1:16:53  

Exactly

Swapna Chakrabarti, RPh  1:16:53  

Right. So but I think especially in the US, we don’t have that appreciation of the culture. idealism outside, because thankfully we haven’t had this here. America has never colonized other people. It’s a very different culture. So I’m trying to explore a few of those aspects and hopefully will be out very soon.

Marilena Grittani, RPh  1:17:15  

Okay, so two things. Number one, kudos for you, to making your dream true by yourself with your own hands and your own fingertips and your ideas. We will 100% support you. And I’m sorry to say this, but we have listeners in Germany, in Spain, in South Africa, in Russia, in the Philippines in Japan. And yeah, all of them are want to buy your book because, now that you talk so beautifully about it. They’re like, when is the book coming out?

Swapna Chakrabarti, RPh  1:17:45  

Thank you.

Marilena Grittani, RPh  1:17:45  

So what we’re going to do and I promise you, my dear listener, that the day that she gets it done, I’m going to bring her back and that’s what we’re going to talk about.We are gong to do a bonus episode, only talking about her book and her passion, and then for all To understand the times of colonization by the British in India, and a love story because that is wat it is about.

Swapna Chakrabarti, RPh  1:18:09  

That is what it is. It is a love story.

Marilena Grittani, RPh  1:18:12  

So, look Swapna, now is out in the universe. Now you must delivered.

Swapna Chakrabarti, RPh  1:18:17  

I shall, I shall now that you have declared it to all of your listeners, I guess I need to get cracking and get it out there quickly.

Marilena Grittani, RPh  1:18:25  

Okay, so one more thing before we finish this, I a hundred percent us your friend as your colleague and somebody that knows how good you are and how much benefit you can create for your patients. I encourage you to get in to do MTM services independently. And if any of my listeners want to have Swapna as a pharmacist, you just have to email me and I will email with the information so she can do one on one. And trust me, I learned from her and I think I’m pretty good at it. But I learned from her so there you go. That’s how good she is. Don’t forget that. My email is comments@thelegaldrugdealer.com.  Miss Swapna Chakrabarti, my dear friend and fellow pharmacists great cook and now a writer, is here for you, to answer your questions so make sure you send them to me and I will pass them over to her and I promise I will have her back whenever the book is ready because we all want to read it Don’t we? Anything else before you before we go anything that you want to remind everybody before we close the episode

Swapna Chakrabarti, RPh  1:19:27  

No. Listen to the legal drug dealer she speaks the truth. She will give you information as it should be given in some in a way that you can understand it and pass it along to your friends to family, subscribe to her podcast for sure I do. She is very interesting topics, something things that you wouldn’t think of in terms of a pharmacy or a pharmacist. And I definitely encourage you to do more of that Marilena and I hope all of our listeners will pass The word along, and more of us will be educated in terms of what we need to do to take care of ourselves and how to manage our medications better.

Marilena Grittani, RPh  1:20:11  

Yes, exactly. I now have a PR person her name isDr. Swapna Chakrabarti. I am so much it is It was fun. It was very informational. I know that my listeners are going to enjoy and get educated by this and I know I’m going to have a lot of questions and a lot of people are going to be doing their MTM reviews with pharmacists. Thank you so much for opening this window for them for the patients and for the caregivers.

Swapna Chakrabarti, RPh  1:20:35  

Thank you so much, Marilena, I it was a pleasure as usual to talk to you and talk to you in this conversation, in which we have included are all of our patients. Thanks for doing this and I had a great time.

Marilena Grittani, RPh  1:20:47  

Me too. I miss you so much. And I hope that we do this soon because the book is coming. Thank you. Bye bye.

Marilena Grittani, RPh  1:20:58  

As I said it was a long epic Episode. And I wanted to apologize for that. But I’m not feeling guilty because you got everything and anything that we wanted to say that you needed to know, if you are one of the beneficiaries of this type of services, or if you or your loved ones are in need of this type of service, because now it’s available there.

Marilena Grittani, RPh  1:21:21  

If you need somebody to help you with it, whether it’s Swapna, or somebody else, shoot me an email at comments@thelegaldrugdealer.com and I will try to find you somebody that I trust to match you with. And hopefully you will get benefits from that. If not, I know that I will get a list of pharmacist very soon put together into website where you will find those people not only in the library command, but their interest that could help you.

Marilena Grittani, RPh  1:21:46  

I will be working on that on put together a list of pharmacists that work in this kind of services and then you can find whoever matches you with your personality better.

Marilena Grittani, RPh  1:21:56  

So that’s it for this episode. Thank you so much for listening. Remember to subscribe to the podcast give us a review if you have time. And if you have any questions, don’t forget to email them to me at comments@thelegaldrugdealer.com and I will respond to you directly. Also, don’t forget to visit the legal drug dealer. com our website to for you to look around and for you to see, what we have there. And while you’re there, click on the Instagram icon to follow us on Instagram and your Facebook icon to join our private Facebook group community.

Marilena Grittani, RPh  1:22:30  

And also, don’t forget to subscribe to our mailing list, so that way you won’t miss any episodes or documents that any of my guests or myself prepared for you will be included on that email next week. I will be having a solo episode again after the third one. With an interview. It’s time for me to do a solo episode. In this episode, I will be doing a little recap of the episode number 10. With Veronica we’re talking about geriatrics and death episode. 11 where I was talking to Dr. Carla Michelle and talking about confronting fear and moving forward after it. And then of course about this episode number 12 talking about medication therapy management with my friend Swapna Chakrabarti also I will be talking about the book that I’m writing and if you’re a pharmacist or you know pharmacist, I want you to listen to that part specifically because I do need help.

Marilena Grittani, RPh  1:23:26  

So with that, I’m done with this episode. But before I go, and just in case no one has told you today, I wanted to take a minute to remind you of, how awesome you are on how lucky are those that have you in their lives. Thank you for being the awesome you that you are.

Marilena Grittani, RPh  1:23:43  

Have a wonderful rest of your day. 

Marilena Grittani, RPh  1:23:45  

This is Marilena Grittani the legal drug dealer.

Marilena Grittani, RPh  1:23:48  

Bye for now.

Scroll to Top