Ms. Heinze is a freelance writer based in Vancouver, British Columbia.
We have all heard the slogan, "Think local, act global," and when it comes to getting the pharmacy industry's concerns known at the government level, it is a pretty good concept. As respected members of their communities, pharmacists are well positioned to bring about change through advocating their cause—and the effort starts in the store itself.
"From my experience, advocacy starts right at the pharmacy counter," said Tim Gallagher, RPh, vice president of pharmacy operations at Astrup Drug Inc in Austin, Minnesota. "We need to put a face on pharmacy. The patients need to know who we are."
In the simplest sense, this means developing relationships with patients through introductions, handing out business cards, and posting a photo of the pharmacist on the wall. "Those are the things they can start with as far as fitting it into the workflow of everyday dispensing and counseling," Gallagher said.
When the local media arrive to cover a pharmacy-related topic, Gallagher urges pharmacists to get out from behind the counter. "If a news media person—particularly a TV station—wants to do a spot at your pharmacy, do not let them show you counting pills on your counting tray. We have to educate patients, payers, and legislators about the fact that pharmacists have so much more to offer, and medication therapy management is where it is moving towards, so we need to continue to talk about that."
From there, pharmacists can reach out to their communities by joining the state pharmacists associations and at least one national association as well. Additionally, it is important for pharmacists to get to know their elected officials. "They need to send e-mails and letters to their delegation in Washington, and they need to contribute financially—at least to their legislators on the state level."
Developing relationships with politicians also is a key factor in conducting effective advocacy, says Bruce Gingrich, chief executive officer of LifeChek Drug in Richmond, Texas. "Personal contact with people that make decisions in the legislative branch cannot be overemphasized," he said. "A letter is fine, and so is a telephone call, but it makes a huge impact to have contact with your local people. Talk to them honestly, and talk to them about how it is going to affect you, individually, and the community—that is what they want to know."
Gallagher notes that some states, such as Minnesota, offer political contribution tax refund programs allowing individuals to donate up to $50 to a legislator or $100 per married couple. In the end, it does not cost anything—and it reaps results. "When you see them at the capital, they remember that you gave them a check for $50, and more importantly, they remember who did not give them money," he said.
Michael J. Ayotte, RPh, director of government affairs at CVS Caremark Corp, notes that the level of regulation in the pharmacy profession dictates the need for pharmacists of all experience levels to get involved in public policy advocacy. "The burden of added or unnecessary rules and regulation can hamper the growth of our profession and can dramatically impact the business model of community pharmacy," he said. "Therefore, it is important that pharmacists be involved and at the table discussing these issues—it is our livelihood and practices that are being discussed."
While the scope of issues they choose to become involved with will differ depending on the pharmacy and its business model, undoubtedly, they have plenty of ground to cover. Average Manufacturer Price, compensation for counseling, and reimbursement for generics under Medicaid are all hot topics, and pharmacists are burdened with keeping their own operations liquid while awaiting payments that are taking longer and longer to be processed.
"Probably the biggest issue for us right now is one of prompt pay," Gallagher said. "The third-party payers—the pharmacy benefit managers (PBMs) under Medicare Part D—are hanging onto our money longer. In my mind, it is the biggest financial issue facing community pharmacists right now. We pay our bills every 2 weeks to the wholesaler, and the PBMs hang on to our money—sometimes for up to 3 months."
For Gingrich, advocacy is a means of protecting the practice of pharmacy. "I believe that we provide a great value to society," he said. "If you have reimbursements that are so low that you cannot do business, then obviously your survival in the profession is impacted strongly." While pharmacists will remain a necessary part of the community, he notes that a considerable portion of business is compromised if the industry does not continue to underline the significance of the reimbursement issue. "It will never be eliminated—there will always be a need for pharmacists—but a big chunk can be taken out; not to mention, the impact that it has on the community and on health care as a whole. I do not think the politicians see that."
In addition, the issue of pedigree and how regulations will ultimately affect the community pharmacist is confronting pharmacy. "We are so overregulated right now—not only on a state level, but also on the federal level—that every time a new mandate comes down the pipeline, it costs us money," Gallagher said.
Due to their size, chain pharmacies like CVS can draw on resources such as in-house government affairs teams that monitor and speak out on regulatory and legislative issues. "Chains are the largest employers of pharmacists, and we are the predominant supplier of pharmacy services," Ayotte said, noting that in addition to his company's government affairs department, CVS develops Web-based tools to communicate timely news on advocacy issues to their pharmacy staff.
So, where can pharmacists find the time for advocacy? Gallagher believes it involves saving time in other areas of the practice. "The secret is systems: setting up the pharmacy properly so that you have the proper workflow and the technicians trained properly so that you are adequately using your staff," he said. Data entry and making phone calls to insurance companies are not tasks that need to be performed by a pharmacist—they can be delegated to a technician. "For the things that do not really require a pharmacist's knowledge, you have to push that toward your technicians and your cashiers and just spend more time with patients."
Gallagher urges not only seasoned pharmacists, but also those new to the profession, to make advocacy part of their regular activities—if anything, to ensure that the career they embarked upon represents what they imagined it to be. "These college graduates come out of school highly educated, and they have these expectations of how they want to practice pharmacy," he observed. "If they do not get involved, and if they are not an advocate for the type of pharmacy that they want to practice, they are going to get stuck in a job where they are essentially on an assembly line—on a machine, pumping out as many prescriptions as possible—and they are going to be really disappointed. What is in it for them is ensuring that the type of pharmacy practice that they went to school for is the type of practice that is going to be there when they get out of school and as they continue throughout their career."
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