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- [00:00]
Podcast Host / Narrator
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Will Kaback
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Will Kaback
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Will Kaback
Can I make my site firmer?
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Ari Weitzman
Can we sleep cooler?
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- [01:55]
Ari Weitzman
Good morning, good afternoon and good evening and welcome to the Tangle Podcast. The place where you get views from across the political spectrum spectrum, some independent thinking and a little bit of our take. I'm your host for today's episode, Tangles Managing editor Ari Weitzman and today we're going to be talking about Trumprx, the government website offering discounts on prescription drugs. How good that is, which drugs it covers. Is it an improvement over what's offered today? We'll dive deep into all of it and get you all the answers, plus all of the coverage from across the political spectrum on opinions about this new offering that you've come to expect from Tango. Before we dive in though, just wanted to make sure our podcast listeners knew about Press Pass, which is a newsletter only product that we offer that gives you a sneak peek behind all the stuff that's happening at Tangle and lets you know a little bit more about some of the people who make the work that we do possible. Today we're profiling associate editor Lindsay Knuth, our young Wisconsinite, and all the things that she provides to Tango's offerings on a daily basis, plus a little bit more about our business, the things that we're facing right now, the media, headwinds, all of that stuff. You get it if you subscribe to Press Pass. So if you're interested, go do that now. And I will pass it over to our senior editor, Will K. Back, who's filling in for John Reading in the newsletter today. So take it away, Will. I'll be back for my take.
- [03:27]
Will Kaback
Thanks, Ari. All right, here are today's quick hits. Number one, convicted sex offender Ghislaine Maxwell, a longtime associate of Jeffrey Epstein, pleaded the Fifth Amendment during a closed door House Oversight Committee deposition. Maxwell's attorney said she would only answer questions if granted clemency by President Donald Trump. Number two, the US Military boarded a Panamanian flagged oil tanker in the Indian Ocean. The ship is under U.S. sanctions for transporting illegal shipments of Russian oil. And the Pentagon said it was, quote, operating in defiance of President Trump's established quarantine of sanctioned vessels in the Caribbean. Number three, Iran's security forces began a crackdown on political opponents of the government, arresting at least seven politicians and summoning seven others to court. Number four, a Hong Kong court sentenced Jimmy Lai to 20 years in prison. The businessman and newspaper owner was convicted of publishing seditious articles and violating Hong Kong's national security law. And he has called himself a political prisoner. Finally, number five, the Cuban government said international airlines can no longer refuel in the country as it experiences a shortage of aviation fuel. President Trump has threatened tariffs on countries that supply Cuba with oil.
- [04:56]
Donald Trump
So we're here this evening to celebrate the launch of one of the most transformative health care initiatives of all time. There's never been anything like it. Starting tonight, dozens of the most commonly used prescription drugs will be available at dramatic discounts for all consumers throughout a new website. It's called trumprx.gov that's Trump. For years, politicians from both parties have promised to bring down prescription drug prices and make health care more affordable. But they all failed. It was all words, as usual. They failed and they failed badly. They tried doing this, some of them, most of them didn't even try because they never really had a shot at it. But I'm actually getting it done and it is done. Actually, this launch represents the largest reduction in prescription drug prices in history by many, many times. And it's not even close. You're going to see numbers that you're not going to believe.
- [06:01]
Will Kaback
On Thursday, the Trump administration rolled out Trump Rx, a government website offering consumers discounted prices for common prescription drugs. The platform functions as a hub for consumers, connecting them to manufacturer sites or offering coupons for purchases at pharmacies. President Donald Trump said Trump Rx will create millions in consumer savings, with those savings likely concentrated among the uninsured. In September, President Trump announced Trump Rx as part of a series of initiatives to bring down prescription drug costs in the first year of his second term. The president has negotiated agreements with several major pharmaceutical companies to sell their products at lower prices in the US in some cases pegged to the prices they charge in other countries, which is known as most favored nation pricing. Prior to striking those deals, Trump threatened to cap how much drug manufacturers could earn from Medicare if they did not agree to lower prices. Trump Rx had 33 drugs listed at launch, with savings between 33% and 93% off the list price. In a Thursday post, the White House highlighted examples of the expected price reductions for common medications. It said the monthly cost of GLP medications like Ozempic will drop from $1,028 to an average of $350, while fertility drugs like Gonal F will drop from $966 to $168 on average. It also said that additional drugs will be added to the site as Trump negotiates additional deals with manufacturers. Americans have long been paying the highest drug prices anywhere in the world, while other countries often paid pennies on the dol same drugs, president Trump said on Thursday. Under the agreements my administration has negotiated, the United States will pay the lowest price paid by any other country. Some healthcare experts have questioned how many consumers will benefit from the savings. In many cases, the list prices on TrumpRx are higher than what insured patients pay for the same prescription. Even with the significant discount applied. As such, the savings may be limited to those without insurance, particularly if insured consumers are not able to count the cost of drugs purchased through the site toward their deductible or out of pocket maximum. Currently, Trump Rx only offers discounted pricing to consumers paying in cash. My guess is that for most drugs, at least most brand name medications, people are likely to get a better deal using their insurance rather than purchasing a drug through a direct to consumer website. Today we'll break down the Trump RX launch with views from the right, left and health policy experts. Then Then Managing editor Ari Weitzman gives his take.
- [09:00]
Ad Voice / Sponsor Announcer
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- [11:45]
Will Kaback
Here's what the Right is saying the right is mixed on Trump Rx, with many saying it delivers on the president's promise to lower drug costs. Others, meanwhile, argue that the site subverts free market principles. In PJ Media, Matt Margolis wrote, Trump reduces medication costs and the left isn't happy Democrats love talking about affordability, but they rarely follow through. If they genuinely cared about bringing down drug costs, they'd be applauding President Trump's latest effort to slash prescription drug prices. Instead, they're attacking him. Trump Rx promises to deliver massive savings on medications, including wildly expensive weight loss drugs like Ozempic and Wegovy. In every sense, it achieves something that Democrats have talked and talked and talked about, but never succeeded in doing. For decades, American patients have been subsidizing drug costs for Europeans and their so called free healthcare systems. Europeans typically pay far less for new medications than Americans do, which means that US Patients should theoretically benefit from Trump's pricing changes. So why is the left more outraged over the fact that Trump's program is causing prices to go up in other countries and than the fact that Americans have been subsidizing socialized medicine abroad? In reason, Mark Oestreich called the new site Obamacare in Trump's handwriting. For most people, the discounts aren't really discounts. Roughly 90% of Americans are insured and their co pays are almost always cheaper than Trump Rx's cash prices. Medicaid patients already get the steepest rebates, more than 60% off by law. So Trump Rx adds little there. All of this bypasses the way Americans actually get prescriptions. Cvs, Walgreens and the rest are cut out entirely, replaced by a federally branded coupon pop up that punts you to a manufacturer's checkout page. Trump Rx looks like a deal, but in practice, it helps almost no one. If this sounds familiar, it's because the blueprint was drawn a decade ago. Washington shoved through the Affordable Care act with the same central planning arrogance resting on monopolistic deal making and government dictated price regulation. Trump Rx employs the same toolkit. One company receives favorable treatment, the government demands discounts in exchange for tariff protection, and Washington exerts raw power with no regard for the consequences. This leads to squeezed margins, less research, smaller generic drugs being driven out, and higher prices in the long run. Now, here's what the left is saying. The left is skeptical of Trump Rx's value, with some noting it only covers a small number of drugs so far. Others say the logic of Trump's approach to drug pricing is flawed. In the Atlantic, Nicolas Florco described the real winner of Trump Rx. The big winners of yesterday's announcement seem to be not patients, but drug companies. The Trump administration got drug makers to the negotiating table last year by writing letters to the companies threatening to, quote, deploy every tool in our arsenal to protect American families from the continued abusive drug pricing practices. End quote. Drug makers were able to turn that threat into a PR opportunity. When Pfizer cut a deal to participate in the program, the company's CEO was brought to the West Wing, where Trump called the drug company one of the greatest in the world. Drug companies have also successfully protected their ability to charge whatever they please for some of their biggest moneymakers. Many of the pharmaceutical industry's best selling products, some of which are among their most expensive offerings, are absent from the Trump Rx website. Take Keytruda, Merck's cancer drug that was the world's bestseller until it was recently surpassed by the weight loss and diabetes injection Tirzepatide. That drug retails for roughly $12,000 for a three week course of treatment, and it is missing from Trump Rx. Of the top 10 bestselling prescription drugs in 2024, only one, Ozempic, is listed on TrumpRx. In Bloomberg, Lisa Jarvis said the push for lower US drug prices uses bad logic. In exchange for tariff relief, companies agreed to match Medicaid prices to those paid by peer countries, to invest in research and manufacturing in the US and to sell certain drugs at a discount on Trump Rx. That might sound like a win for patients and taxpayers, but the lack of concrete details about the benchmark being used the prices paid by other countries are confidential makes it nearly impossible to evaluate the deals. Earlier legislation is already working to reduce Medicaid drug costs, meaning the US Might already be getting a better deal than its peers. It's also easy to imagine how countries and companies could game the system. Manufacturers, for example, could raise list prices abroad, making the benchmark the US Uses appear higher while quietly offering backdoor discounts. None of this is to suggest that the astronomical cost of healthcare in the US or the system's emphasis on treatment over prevention aren't problems in desperate need of fixing. Rather, it is to say we should price drugs based on the system in which they are delivered. That would require developing a thoughtful, transparent process for evaluating the cost effectiveness of drugs, something pure nations with lower prices already have. And now here's what health policy experts are saying. Some experts say government intervention in drug costs risks driving up prices. Others suggest Trump Rx's out of pocket payment requirement will hurt those it intends to help. In Cato, Jeffrey A. Singer wrote Trump Rx when government tries to build a market, third party payment arrangements tend to drive up drug prices. When insurers or government programs are paying most of the bill, patients have little incentive to resist high prices. In fact, they often push back when payers try to steer them toward lower cost drugs or pharmacies because any savings go to the insurer, employer or the government and not to them. Insurers, for their part, know that denying coverage or refusing to pay list prices can cause backlash from beneficiaries who feel entitled to whatever their plan covers. Injecting government into this space risks crowding out private innovation and inviting the familiar problems of political favoritism, coercion and regulatory corruption. If the administration wants to expand direct to consumer drug purchasing, the most effective role it can play is not to build a federal platform but to eliminate policy barriers that hinder private actors from competing, innovating and lowering prices on their own. Trump Rx risks substituting political allocation for consumer choice in a space that is only now beginning to function like a real market. In stat, Sean D. Sullivan and Ryan N. Hanson said Trump Rx has a fundamental flaw. The promise is seductive lower prices on brand name medications available to anyone willing to bypass their insurance and pay out of pocket. But for most Americans, this initiative represents not a solution to our prescription drug price dilemma, but rather a distraction from it. The fundamental flaw in the Trump Rx model lies in a misunderstanding or perhaps a willful misrepresentation of how most Americans pay for their prescription medications. Most insured people pay far less out of pocket when using their insurance coverage than they would by paying discounted cash prices, even when those prices are subsidized by manufacturers. Consider a common but hypothetical scenario. For older Americans, a patient with diabetes and high cholesterol needs two brand name Januvia and Repatha. Through insurance, they might pay a $35 copay for each drug, about $840 per year. The TrumpRx website will offer Januvia for diabetes at $100 per month and Repatha for cholesterol management at $239 per month. A discount from existing manufacturer list prices of $330 and $573 per month respectively, which is $4,068 per year. Paying cash requires an additional $3,228 out of pocket, or nearly 6% of their total income. For seniors already choosing between medications and groceries, this isn't a discount. Using Trump Rx would represent the equivalent of a tax on those least able to afford it. Alright, that is it for what the right, left and health policy experts are saying. I'm going to pass it over to Ari now to read his take.
- [21:08]
Ari Weitzman
That leads me to my take. There's an old saying about drug pricing. I don't remember where I heard it, but it goes like this. It costs the drug company $0.05 to make each pill, but it cost them $2 billion to make the first one. At the end of the day, any legislative framework that finds a way to offer fair prices to consumers under that dynamic is just simply going to be complicated and any step that the government is able to take forward should be celebrated triprx it does not help most people in general, but it will help people who need GLP1 drugs and fertility medication when those treatments aren't covered by their insurance. And we should celebrate that. That's the bottom line. Any other claims about this are just noise, but why GLP1 and fertility drugs? Out of all the discounts TrumpRx is offering, how does that benefit get narrowed down to only a few options for only certain people? Let's start with what TrumpRx is, which I think Forbes Jesse Pine summed up best And I quote TrumpRx is not a government run pharmacy. Instead it's a centralized directory and coupon generator that connects cash paying patients to pre negotiated manufactured discounts on 43 specific brand name drugs. End quote. Now let's unpack four of those elements specifically 1 pre negotiated manufacturer discounts, 2 cash paying patients 343 drugs and 4 specifically name brand first pre negotiated manufacturer discounts. This is important context for making sense of drug prices. Drug companies sell their product for a list price which frankly is a gratuitous sham based on exclusivity or perceived value or whatever. Pharmaceutical companies charge whatever they want for their drugs then negotiate those those prices down through considerable discounts to pharmaceutical benefit managers, the dreaded PBMs. This process obfuscates the true net price these drugs cost insurance providers at the end of the day and it often leaves uninsured people paying exorbitant prices that effectively serve not as needed profit for these drug companies, but as added margin for manufacturers. So if you are uninsured you and you're looking for a prescription drug, Trump Rx may provide a benefit for you. Second, cash paying patients. What if you're a person with insurance? If you do have insurance and your insurance covers the medication you need, then that's it. Trump Rx probably won't offer you any better price than what you get through insurance. If your insurance doesn't cover a drug you want or need, that's a different story. Just under 85% of Americans have some form of prescription drug coverage and about 80% of drugs are covered by those plans. Prescription drugs most commonly not covered by insurance are those prescribed for weight management, sexual dysfunction, hair growth and fertility. If that's your situation, then TrumpRx may provide a benefit for you too. Third, the 43 drugs Trump Rx covers TrumpRx discounts come in one of two ways, either negotiated discounts to manufacturer prices or coupons to be presented at pharmacies. Let's take an example. I take an albuterol inhaler as needed for occasional asthma. The Trump Rx offer for their name brand albuterol inhaler. AstraZeneca's Air Supra shows how I can buy an inhaler from AstraZeneca for a helpful 60% reduction of $201 from its frankly extortionous list price of $503.93. I don't even need TrumpRx to get that price. I can go straight to the website and receive the discount that the government negotiated. Other drugs have rebates in the form of printable coupons. If I want Pristiq to help treat depression, I can print out a 54% off coupon, get a prescription for the drug from my doctor and go to a pharmacy and receive this discount off the list price. But I have better options in both of these cases, which leads me to number four name brand drugs. Most drugs offered through tremprx are available already through generic alternatives. Pristiq's generic form Desvenlafaxine is available for about $30 and I can get a generic albuterol inhaler for under 50, if not better with a similar coupon through Goodrx or any other website similar to that. I'd have to be severely under informed to choose instead to go through the manufacturer's website itself, though happily I'm one of the 85% of Americans with health insurance coverage and albuterol is one of the 80% of drugs covered by my insurer for almost all the other drugs offered through TrumpRx generics beat out the discounted prices. So that leaves two kinds of drugs that I can get for cheaper from the government website than through other alternatives unless I have really good insurance coverage. Those two are fertility drugs and GLP1s. But that's still not the whole story. To get us the rest of the way there, I need to expound on our coverage of the Biden administration's Medicare Part d negotiations in 2023. We missed an important piece of context in our coverage that has haunted me for years, and providing that context from three years ago now helps to answer today's questions. Essentially, Medicare was able to negotiate down the prices for 10 drugs, including diabetes treatments, cancer treatments and blood thinners for people covered by Medicare Part D thanks to a rule passed in the Inflation Reduction act, or ira, allowing the government to negotiate prices. We focused on how much these changes would actually help consumers in our coverage, whether price fixing was a better word than negotiating to describe the changes, and what externalized costs would come from bringing these prices down like a disincentive to invest in innovation for drug companies. All of those were good things to cover. What we didn't explore was why these 10 drug prices were coming down without much of a fight from pharmaceutical companies. The IRA said that Medicare can negotiate the prices of the 10 most expensive drugs in the program in 2023, but only the ones that had already been FDA approved for a long time, specifically seven years for small molecule or chemical drugs and 11 years for biologics or those derived from living organisms. FDA exclusivity regulations and patents offer protections for pharma companies from competitors. Those protections are five years after approval for small molecule drugs and 12 years after approval for biologics. Usually these protections get extended a couple years further, meaning the IRA really took a few years of maximal profitability off the drugs covered by the law. Later this year, the next 15 most expensive drugs with nearly expired patents will be negotiated for Medicare Part D or B to take effect in 2028. Then another 20 will be negotiated in 2029. Those Medicare wins are time limited, since generics will soon come to market to beat out those prices. The discounts offered for GLP1 and fertility drugs through Trump Rx are similarly limited in time, however, and importantly, those limits are significantly longer for GLP1s. The patent for Semeglitude or Ozempic and wegovy expires in 2026. A Brazilian alternative is currently facing the long FDA approval process, but secondary patents will inhibit the availability of generic semaglutide in the US market until the early 2000-30s. Meanwhile, tirzepatide or Manjaro and Zeppelin is patent protected all the way through the late 2000s. As for fertility treatments, many drugs used to help stimulate gamete production or egg and sperm aren't available in the United States through generics or biosimilars, despite the fact that patents aren't restricting their development. In particular, recombinant HCG or Ovidril and FCH or Gono F have competitors in Europe but not in the U.S. trumpRx offers Gono F for $168, an incredible savings of about $1,800 over its availability through Goodrx or similar platforms. It also offers Cetrotide name brands Cetriralix acetate, which is already available as a generic. However, the Trump RX pricing offers another strong discount over what you can get today on the market, slashing the price from about $200 down to 20 for people who will be helped by GLP1 medication and fertility drugs, insurance often doesn't provide much savings, and these discounts through TrumpRx will be an enormous benefit. Maybe in the future other drugs will fall under that umbrella too, but right now the drugs that are under that umbrella are fairly limited. So we can say the new government site takes a small bite out of the enormous healthcare affordability problem in the United States, but not that big of a bite. This is not a monumental achievement, but it is a step forward and that's worth appreciating. All right, that's it for my take. If you want to hear me do a take of something that doesn't require me pronouncing long chemical names or reading off big numbers, you just gotta send an email into Will, W I l l retangle.com and lenwinow. Either way, I'm gonna send it over to my friend and our executive editor Isaac Saul to answer your questions for today. I'll talk to you next time. Probably pronouncing some more long names or reading off numbers. Have a good one.
- [31:08]
Ad Voice / Sponsor Announcer
We'll be right back after this quick break.
- [31:14]
Podcast Host / Narrator
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- [32:34]
Will Kaback
Well, not so fast. It's actually Will jumping back in here. We had a little bit of a late stage kerfuffle today for recording the podcast. Isaac's port that connects his microphone to his computer broke, so he's not able to record today's Reader Question. I'm going to step in and read it. Just a quick note up front. As you'll see in a second, this question is addressed specifically to Isaac, so the response comes from him specifically as opposed to the Tangle staff. All right, here is today's reader question. It comes from Will in Boulder, Colorado. What's up, Will? Love the name. How does Tangle avoid creating a cult of personality around the My Take section? If the goal of Tangle is to help liberals and conservatives see across the aisle what prevents the creation of a Tangle bubble where Isaac's Take is now the standard of truth? Here was Isaac's response to that question. This has always been something I've consciously tried to avoid. I first added in the My Take section only after beta testing this newsletter before it was added. The number one response I got from readers was, well, what do you think? You're a politics reporter and I'm curious for your opinion. People wanted some kind of closing analysis to round out the newsletter, and so I added a section sharing my own view immediately. The touch of personality seemed to make the product more interesting and engaging for readers, and it gave me a chance to be transparent about my views, which speaks to the Tangle mission. Still, from the very start, I never wanted my voice to be the part of the newsletter responsible for defining the truth. That's why every take starts with this disclosure quote reminder. My Take is a section where we give ourselves space to share a personal opinion. If you have feedback, criticism, or compliments, don't unsubscribe, write in by replying to this email or leave a comment. And I would just note for our podcast audience that message is the same. Now, as we've grown, we've consciously taken a few steps to try to ensure my opinion remains what it was always intended to be, just one voice of many. First, we're including more voices. So far in 2026, we haven't gone a single week where I've written every single take. Tangle has an editorial staff of diverse and challenging thinkers like Ari Weitzman, Will Kaback, Audrey Moorhead, and Lindsay Knuth. And you're going to keep hearing more from them like you are today from Ari. Second, we've added in staff descents to show that diversity of thought in other ways. We might not always have a descent to feature, but showing readers our internal disagreements when we have them keeps Tangled true to its goal of providing multiple perspectives in every edition. Third, we're simply trying to limit the size of the My Take section. Now, that's easier said than done, but we're slowly trying to bring the word count of that section down so that it doesn't dominate the entire newsletter. And of course, we make an effort to reflect on our work. We grade our own reporting and analysis at the start of each year. I write pieces all the time about being wrong or changing my mind, and we encourage our audience to challenge us, debate each other, and continue to have dialogue about these messy, complex ideas. None of this to me is a recipe for a cult of personality, though I do think it's a way to make nonpartisan, balanced and open minded news much more engaging and interesting. All right, that is it for today's reader question. Again reading in Isaac's voice. Now I'm going to take back over and take us home, starting with our under the Radar section. All right, here is today's under the Radar story. On Monday, lawyers for Rumesa ozturk, a Tufts PhD student arrested in March by Immigration and Customs Enforcement agents, disclosed in a letter that an immigration judge had terminated her removal proceedings. Oesterk was reportedly targeted for co authoring an op ed calling for US Divestment from Israel, and in their letter, the lawyer said the court dropped the case after concluding that the government did not meet its burden of proof to show she needed to be removed from the country. The letter states that Ozturk could be subject to redetention if the Trump administration appeals the ruling to the Justice Department's Board of Immigration Appeals, which is the highest administrative body overseeing U.S. immigration law. Reuters has this story and we'll put the link to it in today's show. Notes finally, here's our have a nice day story. Guinea worms are parasites contracted by consuming contaminated water, sometimes growing up to 1 meter long before painfully exiting the body through a blister. Although it is rarely lethal, guinea worm infections with were common not long ago, affecting 3.5 million people in 20 countries across Africa and Asia in 1986. However, thanks to an initiative started by former President Jimmy Carter, guinea worm infection is now close to becoming the second human disease to be eradicated after smallpox. Only 10 cases of infections were reported last year, an all time low and a 33% decrease from 2024. We think about President Carter's legacy, said Adam Weiss, director of the Carter Center's Guinea Worm Eradication Program. We continue to charge ourselves with his mission of alleviating as much pain and suffering as we can. ABC News has this story, and again, we'll put the link to it in today's show. Notes all right, that is it for today's edition. We will talk to you tomorrow. That's Wednesday and until then, have a great rest of your day, your morning, your night, whatever it might be. All right? Peace. Our Executive editor and founder is me.
- [38:24]
Ad Voice / Sponsor Announcer
Isaac Saul, and our executive producer is John Lowell. Today's episode was edited and engineered by Dewey Thomas. Our editorial staff is led by Managing Editor Ari Weitzman with Senior Editor Will Kbach and Associate Editors Audrey Moorhead, Lindsey.
- [38:38]
Will Kaback
Knuth and Bailey Saul.
- [38:39]
Ad Voice / Sponsor Announcer
Music for the podcast was produced by Diet75. To learn more about Tango and to sign up for a membership, please visit our website@readtangle.com.
- [39:02]
Will Kaback
Big news. Boost Mobile is now sending experts nationwide to deliver and set up customers new phones at home or work. Wait, we're going on tour? Not a tour. We're delivering and setting up customers phones so it's easier to upgrade. Let's get in the tour bus and hit the road. No, not a tour bus. It's a regular car we use to deliver and set up customers phones at home or work. Are you a groupie on this tour?
- [39:20]
Podcast Host / Narrator
We deliver and set up phones.
- [39:22]
Will Kaback
It's not a tour. Oh you're definitely a groupie. Introducing store to door switch and get a new device with expert setup and delivery wherever you're at.
- [39:29]
Ari Weitzman
Delivery available for select devices purchased@boostmobile.com hi.
- [39:33]
Donald Trump
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- [40:07]
Will Kaback
Purchasing manager at a manufacturing plant, you know having a trusted partner makes all the difference. That's why, hands down, you count on Grainger for auto reordering. With on time restocks, your team will have the cut resistant gloves they need at the start of their shift and you can end your day knowing they've got safety well in hand. Call 1-800-GRAINGER Click grainger.com or just stop by Granger for the ones who get it done.