The late-summer Congressional recess is a time of the year when legislators leave Washington, D.C., and return home to the states and districts they represent. As part of the National Community Pharmacists Association's (NCPA’s) Month of Action in August, community pharmacists were encouraged to host one-on-one meetings with members of Congress to help them better understand the importance of pharmacy and its impact on their communities’ health and well-being.
Todd Eury, publisher of The Pharmacy Podcast Network, met with independent pharmacists and NCPA insiders in a special podcast to talk about the "Take Your Legislator to Work" initiative, which encouraged business owners to meet with their local representatives.
Guests included:
Below are a few highlights of the podcast.
Todd Eury: How did you build such a fluid relationship with your senator and get him to understand what is going to happen if you do not continue to be part of your community?
Michele Belcher: For my father and I, it was something that was very important to him to be a part of the solution, to try to make sure that the policy makers had the information that they needed to understand what pharmacists do. So, he had been doing this for years before I joined him in 1993. From that point forward for about six years, we made the trips to DC together. He showed me the ropes on talking with staff members. And with the senator in particular, I didn't meet him for probably 10 years, and I want to really stress for my colleagues that the relationships with the legislator's staff is just as important in building that groundwork as it is with the legislator themselves.
The legislator depends on the knowledge that the staff can bring them on the issues that are pertinent. I've built those relationships with both the staff at the state level in DC and with the legislator themselves. In the instance of Senator Wyden, I had visited his office and staff for probably 10 years and had great conversations always, and just never had the opportunity to meet the Senator (Ron Wyden, R-Ore.). Then, on a particular fly-in on my return flight home, lo and behold, who comes and sits down next to me in the exit row? Senator Ron Wyden. And so, a little bit into the flight, he says, "So, what brought you to DC?" And I said, "Well, funny that you should ask Senator, but I actually was in your office yesterday meeting with (named the staff member that I had met with)."
And I said, "I'm a community pharmacy owner." He says, "What pharmacy?" And I said, "Grants Pass Pharmacy in Grants Pass Oregon." And he immediately said, "Do you still have the soda fountain? Because I love those Coke floats." So, it immediately was a conversation that with a long, almost five-hour flight home, we were able to share and talk about a lot of the issues that we were facing. His staff had already often called to say, "How will this issue or this legislation impact your community pharmacy?" But it really changed in that he will always call and ask, "How will this impact you, Michelle?" And we've really built a friendship that when he's in town for a town hall or that type of thing, he will almost always stop by the pharmacy.
Now, anytime he's in the state he will call and ask, "Do you have another community pharmacy that you might recommend in this community?" In fact, we've done two in the last two weeks in different communities around. And I find that really exciting because I know how my staff gets excited anytime they feel like a legislator is here and observing what work they do and hearing from them how much they appreciate the work that that they do. And to observe that these last couple weeks in these pharmacies that never had a visit before was really, really inspiring. And to see the smiles and the excitement when that picture was taken, knowing that they would be able to take that home and share that with their families, I just find it really exciting.
Todd Eury: Something that has been very impressive is the consistency that the NCPA has provided for its members, for community pharmacy owners. And one of those consistent points is to make sure that you have the right information in order to talk with your legislators and policy makers. The way that they put the patient in front of everything really pulls through of what a pharmacy owner truly wants. We obviously have to make a business, you're a pharmacy owner, you have to stay in business. In its newest form, the NCPA's legislative agenda says, ‘pro patient, pro pharmacist.’ And we're putting that patient first knowing that that's what impacts our communities. That's strengthening our communities because you have a place to go for consistent, community access to healthcare.
Michele Belcher: I agree, and I think to your point of putting the patients first, I would say in two instances, with former Congressman Greg Walden, who passed a bill into law (the gag clause bill that was several years ago) he continued to tell a story that he and I had discussed at a pharmacy visit. And, and I've seen that with Senator Wyden as well, that there are examples of times in interactions with patients that I'll share with him. And those are what really seemed to resonate with them. They can go back, they can talk to their colleagues in Congress, but they can also then use that as they are fighting for us for a particular issue, because the reality is we're trying to stay in business for our patients. And we all have that exact common goal. And you know, I know because I experience it every day and I know that all my colleagues do as well. Those interactions that we are hearing more and more often, unfortunately, about the patient being steered somewhere, the patient not being able to afford a copay, all of the things that we know are going on. Those are the exact instances and stories that we need to share with our Congress.
Todd Eury: I want to introduce pharmacy owner Marc Ost to the pharmacy podcast, and into the NCPA's presentation on preparing for your legislator to get your whole pharmacy team ready for visits, and then how to properly leverage those visits to really help you in your community and in your state, and how this is going to affect the nation. Marc, welcome to the show.
Marc Ost: Thanks, Todd, I appreciate you having me on.
Todd Eury: Let's talk about you and your pharmacy. Tell our listeners how you got into pharmacy, how you became a pharmacy owner, where your pharmacy is, and a little bit about yourself.
Marc Ost: My name is Marc Ost. I am the co-owner of Eric’s Rx Shoppe in Horsham, Pennsylvania, a suburb of Philadelphia. Eric's Rx Shoppe was started about 13 years ago by my dad and Eric Abramowitz, who is my business partner and pharmacist in charge. I've grown up in pharmacy. My dad has owned multiple pharmacies my whole life and have really just been around it and ingrained in it. I actually never wanted to work in pharmacy growing up <laughs> and graduated college and worked in sports for a few years and was looking at different business ventures and decided to work with my dad for a few years and learned a lot. We moved on to Eric's Rx Shoppe and it is the definition of a community pharmacy. We know our patients. We do everything we can to help our patients. And since Covid hit, we've done our best to really be a resource for the community, whether it's with information, education, tests, vaccines, or access to products that are hard to get. And today, we've done close to about 65,000 Covid vaccines.
Todd Eury: What are the challenges right now that you've been able to communicate to your legislators to really have them understand context and the impact on their community, on their constituents? How do I get the attention of my congressperson?
Marc Ost: It was not something that was a hundred percent planned, in full disclosure. Our political relationships really started during the craziness of Covid vaccines. We were dealing with their State Department of Health, and we had a few hundred, maybe a thousand doses of Moderna. And the Department of Health said, "You gave your second doses as first doses." And we said, "No, we have data that shows that we've given first doses and second doses, and we had the data to back it up and prove it." In turn, we reached out to our state senator and our state representative who both were gracious enough to spend hours on the phone with me listening to the issues and then eventually presenting those issues on our behalf to the department. And, you know, that really created the relationships because they were certainly helping us by advocating on behalf.
But there was also a time where people were calling their office nonstop saying, "Hey, how do I get a Covid vaccine? Or, where can my grandma get it, who needs this?" We became a huge resource for them in that area. So, it was really a very big bidirectional relationship that has flourished ever since. Using those connections that we made just led to other introductions to other politicians. And then talking about a lot of it in the beginning was really Covid vaccines, but then transitioning to some pharmacy issues that we're having. Here's patients that work for this employer that want to come to a pharmacy but can't because they're restricted. Here's a Medicare patient who comes to our pharmacy and has a copay of a hundred dollars, but he can go two minutes down the road to a chain pharmacy and doesn't have a copay. So, it's really been about patients. It's been about the patient experience, it's been about access, and it's been about providing that best service. And what we've tried to really share to the legislators that we have spoken with is we can't always provide the best service because there are so many restrictions on us from PBMs.
Todd Eury: Talk to us about the steps that you would suggest a pharmacy owner take to prepare themselves for, reaching out to their congressperson as well getting them in to come in and visit with them.
Marc Ost: I can tell you off the bat, the first thing has been using NCPA resources. NCPA has been awesome with providing information, providing contact information, providing one-page handouts, and everything that we needed in order to really educate ourselves on what they're doing, but educating the legislators too about what's going on. The second thing I would tell you is collaborating. One thing that really has blossomed, in my opinion, during Covid was a collaboration between community pharmacies, locally and nationally. It is such a great community of owners and pharmacists today where, if you have a question, someone has an answer to it. We are also part of CPESN (Community Pharmacy Enhanced Services Network) and the PPCN (Pennsylvania Pharmacists Care Network) networks. And, same thing, that has been a great resource for when there's a new service or a new product or something that we don't know how to do, or want to learn more about.
Someone is probably already doing it, so we don't need to reinvent the wheel. We are able to really collaborate and do that. And even politically, look, we're in Pennsylvania, other people have relationships with politicians. So, whether it's our pharmacy or a friend's pharmacy, it doesn't really matter, we should all have really the same M.O. and the same agenda of what we want to accomplish. And I think being able to talk to fellow pharmacy owners and getting involved in different organizations has given us insight of my issues, which may not be the same as an issue of someone in a rural area or someone in inner city, but they can all be accomplished together and brought up and advocated because you are advocating for independent pharmacy. You're not advocating just for Eric's Rx Shoppe. We're not meeting with a senate representative to talk about our specific issues. We're talking about pharmacy and independent pharmacy-specific issues, and just educating ourselves on what the issues are for ourselves. And talking with others has been a real eye-opening experience.
Todd Eury: What do you tell pharmacy owners in preparation for reaching out to their legislators as a coach?
Karry La Violette: I think some people are sometimes intimidated, but they shouldn't be. They're constituents of those members of Congress and state legislators as well. And nothing can really tell the story more than inviting them into your pharmacy and showing them firsthand, with patient examples, of how it affects the patients, with how it affects their small businesses, things that they can see firsthand and see what they are dealing with. Elected officials always like to go visit small businesses, especially in election year. This is an election year this year and we try and do everything we can to make it as easy as possible and do a lot of the lifting our staff can provide - talking points, tips, et cetera. But nothing can replace that in-person experience in the pharmacy where they can see all the different things that pharmacies are doing.
They are giving vaccines. They are dealing with a patient's insurance. Just to see that firsthand is really, really powerful. And the more pharmacy owners we can get to do that, the better. And it's not just federal legislators. Our month of action has been focused on federal legislators, but it is state legislators, it's city council members, it's governors, it's insurance commissioners. That is a more important role now, too. You know that the number one pain point for our members is pharmacy benefit managers. You never know when that next state legislator is going to run for federal office, so it is great to get to them and build a relationship early on.
Todd Eury: Can you highlight what we are planning to do for the education of community pharmacies and then opening doors for them to meet up and to speak with our lawmakers?
We're very excited that next year’s “Fly-In” will be in person, on April 26-27. In addition to the actual pharmacy visits and the pharmacies, it really gets their attention to see that their constituents are willing to spend the money to come to D.C. and meet with them and their staff. It really does go a long, long way. It shows the dedication and how important this is to their business. And we try and keep it short because we know how stressed the system is and how a lot of our members are short staffed; we try and make it as easy as possible for them to leave their pharmacy and get back.
It's fly in, get briefed, and fly out. It is really a day where you fly in the night before and then we'll brief everyone in the morning, the issues that they would be lobbying on, and then everyone blankets the hill and meets with their members of the House and Senate. We try and keep it short because we know how much of a time commitment that is. We end it with a congressional reception where we invite the members of Congress to come and socialize a little bit. Hopefully, that will still be able to happen. I can't <laughs> say for sure, but you never know, things change. But that's typically how we try and run it.
That's an opportunity for some members of Congress that had a committee hearing or something came up that they couldn't meet with their constituent and their staff did for them to come to the reception and talk to them. So, there are two opportunities; we can't control the congressional schedule and hearings happen and votes happen, and that takes precedence. But again, I also would just emphasize how important it is to meet with staff. I know in our Month of Action we've had several congressional staffers go to pharmacy visits in addition to the members of Congress. And it's very helpful. The members of Congress have (just in the health space) many issues there are to deal with. We're one part of that, but to keep up on all of that, it's so important. They rely on their staff so much to become experts on some of these issues. I know some get discouraged sometimes if they have to meet with staff, but it's essential and it's just as important as meeting with the members sometimes.
Todd Eury: What are the top three things that you could coach our listeners on today with regard to topics to get the most impact of staging that meeting and that opportunity to talk with our legislators?
Karry La Violette: The mail order example (patient steering) is a very good example. What we find effective is just explaining to members of Congress and their staff how this works. A lot of them don't necessarily know that some patients are still steered to mail order, right? We're all for people choosing that. If they want to have that, that's fine. People choose to get their medicines however they want, but to force seniors into mail order or where the counseling is so important to make sure they're adherent, et cetera. And just providing those examples. What I would say to the listeners is don't assume at all that a member of Congress knows what a PBM is or how this system works.
You'd be surprised in meetings on the hill where they don't even realize all the other middlemen in the middle of this, how a medication from the manufacturer actually gets to the pharmacy. So just explaining that system and then how the PBMs control so much of it, and the price pressures on them, the small business owners. The one thing they cannot control is the reimbursement that the PBMs are based essentially on a charge along with the plans. They can control their labor costs; they can control other parts of their business. They can buy better, but it's the reimbursement piece (where pharmacies have no control). And people don't realize that at all.
A lot of Congress just don't even realize the PBMs are very good at flying under the radar. You know, right now they're the Fortune 15 companies in the United States that no one's ever heard of, unless you happen to look on the back of your insurance card, you know, <laughs> and see Caremark on there, or Express Scripts. But I think what really gets their attention is the patient stories. I think the steering of patients really has gotten a lot of attention, and especially in the rural and underserved areas where we are the only lifeline for some people. And there are pharmacy deserts that have been created by the big chains pulling out of these smaller communities where it's just not as advantageous for them, business-wise.
To listen to the whole podcast, click here.
Did you host a member of congress during the NCPA's Month of Action? We would love to hear from you in the comments section below.