Narrator - Dr. Abel 00:00 Welcome to HelixTalk, an educational podcast for healthcare students and providers, covering real life clinical pearls, professional pharmacy topics and drug therapy discussions. Narrator - ? 00:11 This podcast is provided by pharmacists and faculty members at Rosalind Franklin University, College of Pharmacy. Narrator - Dr. Abel 00:17 This podcast contains general information for educational purposes only. This is not professional advice, and should not be used in lieu of obtaining advice from a qualified health care provider. Narrator - ? 00:27 And now on to the show. Dr. Sean Kane 00:31 Welcome to HelixTalk. Episode 145 I'm your co host, Dr. Kane. Dr. Khyati Patel 00:35 I'm Dr. Patel, and today in this special episode, name advancing the profession contraceptive prescribing by pharmacists in Illinois, we have two important guests who are here to discuss the impact of professional advocacy and resulting professional advancements in the state of Illinois. These two guests have been at the forefront of the agents of advocacy change, and that has resulted into pharmacist ability to prescribe hormonal contraceptives for patients in Illinois, according to the bill, which is now a practice act in the law. And we will take a deeper dive into their efforts to make this change possible and how it will impact the patient care in Illinois, and probably its implications, and you know, on possibilities of further advancement of pharmacy practice, all the while highlighting the importance of advocacy from very beginning when you're a student pharmacist. Dr. Sean Kane 01:27 So why don't we go ahead and introduce our guests here? So I'll introduce our first guest. Garth Reynolds is an alumnus of the University of Health Science and pharmacy in St Louis, College of Pharmacy and Southern Illinois University Edwardsville Business Administration Program. He's worked in a variety of community practice settings, including independent regional and national chains. Mr. Reynolds is also an adjunct Clinical Assistant Professor at SIUE School of Pharmacy, teaching pharmacy jurisprudence, pharmacy advocacy and leadership development, healthcare technology, pharmacy and healthcare regulation, drug diversion and prescription fraud. Also, Mr. Reynolds is faculty for the various APhA and NASPA certificate training programs, and has received an APhA Immunization Champion Award for partnership. He is a past president of the Illinois pharmacist Association, or ipha, and since January 2013 has been the executive director of the ipha. He's also a producer of the Pharm talk podcast from ipha, where they discuss a plethora of topics pertaining to pharmacy, profession, regulations and practice. Dr. Khyati Patel 02:34 Act Welcome. Mr. Reynolds, thank you. Thank you for having me. And our second guest is someone close to home. Dr. Louis Solano, he's an alumnus of Rosalind Franklin University College of Pharmacy PharmD program and also the Master of Public Health Administration program. He's dedicated much of his career practicing at Walgreens, 17 years, to be specific, and currently in his capacity, he serves as a pharmacy manager at Walgreens and Vernon Hills. He's been there in this position for about two years. He's also an adjunct lecturer and Preceptor for Rosalind Franklin University, where he teaches various topics in self care, community, pharmacy practice and immunizations. And along the way, he has collected many accolades and awards as a student and now as a new practitioner. And he was a very active student leader at IPhA as well as the college APhA-ASP chapter. So welcome back, Dr. Solano, thank you. Glad to be back. All right, so before we get started kind of talking about the advocacy itself, maybe lay out the land and see you know where, where is the landscape of pharmacists' ability to prescribe these contraceptives and so I'm gonna say that always like it does. Things started with California and Oregon. Shortly followed it somewhere in 2016 Yeah. Dr. Sean Kane 03:48 And really, since that time, 19 states are currently allowing pharmacists to prescribe contraceptives. This includes Illinois and a variety of other states. Illinois is actually one of the more recent ones to join the ranks. Dr. Khyati Patel 04:00 That's absolutely right. So we have Arizona, Arkansas, California, Colorado, Delaware, District of Columbia, Hawaii, Idaho, Maryland, Minnesota, Nevada, New Hampshire, New Mexico, Oregon, Utah, Vermont, Virginia, West Virginia. And like you said, Dr. Kane, Illinois is the last one to join in. I believe five other states are working on their similar bills. So we're going to probably see a 24 almost half the states in America to have this law. Dr. Sean Kane 04:26 And I'll be honest, Dr. Patel, before we kind of thought up this or brainstorm this episode, I actually wasn't even aware that this was a thing that was kind of going on. So it was really interesting to dive a little bit deeper. But this is pretty hot off the press news. So this bill was passed and signed in July of 2021 which is really not that long ago, yeah. Dr. Khyati Patel 04:46 And surprisingly, you know, despite the pandemic difficulties, you know, the bill passed pretty fast. The governor signed it in July 2021 and it went into effect January of 2022, and as we all worried. About who's gonna pay for this services. Good thing is that this law includes some provisions and allows insurance to have about until January 2023 to kind of come up with mechanisms where they can pay the pharmacist for this cognitive service. Dr. Sean Kane 05:14 And you know, we're gonna in our show notes. So again, HelixTalk.com episode 145 we will have links to the specific bill and acts on our website if you want to get into the to get into the nitty gritty details, we'll kind of cover it a little bit. But actually, today we're focusing on other aspects in terms of the professional advocacy. But I think it is worth kind of mentioning kind of landscape of what are some of the laws like in the United States and then Illinois in particular, yeah. Dr. Khyati Patel 05:37 And then if you look at this law in general, through different states that have passed it. Most of the states refer to these contraceptives as the pill or the patches. Some of the states allow the vaginal ring as well as the depot shots to be administered. All of these states require pharmacists to complete additional training that is either approved by the State Board of pharmacies or their public health department. And most of these states require pharmacists to conduct proper patient counseling and assessment prior to prescribing, and then follow standard procedures that are put in place now. Dr. Sean Kane 06:10 Dr. Patel, when we went through an older HelixTalk episode where we talked about Naloxone prescribing from a pharmacist perspective, we had some data about kind of uptake in the community in terms of how often pharmacists were doing this thing, this new activity came out. Do we have any data? Certainly not for Illinois, because it's too new, but for some of these older states, like Oregon, New Mexico, California, anything like that. Do we have any data on what is the uptake like, and who is actually taking advantage of this new service from a patient perspective? Yeah. Dr. Khyati Patel 06:38 So not a whole lot of data. However, there is a couple of different organization power to decide, as well as birth control. Pharmacist, excellent website. I want to give them a shout out to get the infographics and look at some of the data that we have. Like you said, most of the data come from states that have had this law approved a little bit earlier, such as Oregon and New Mexico, and they found that 46% of the pharmacies in these two states are prescribing contraceptive and they also looked at, you know, whether there was a difference between rural pharmacies versus urban pharmacies, and they didn't find any difference. 39% of the rural pharmacies and 46% of the urban pharmacies were participating in this prescribing. And if we specifically look at the state of Oregon, 10% of the new prescriptions for their Medicaid enrollees were written by a pharmacist. So this kind of shows that it definitely this, this provision definitely is filling in the gap that there is in the community. And then also looking at the Medicaid population in Oregon, we found that only in the first year of this law being implemented, 15 unintended pregnancies were avoided, and the healthcare dollar savings was somewhere in 1.6 million range. Dr. Sean Kane 07:53 Then if you look at things like Oregon, California, Colorado and Hawaii in terms of who is using these services, the patients are more likely to be younger, more likely to be uninsured and have less education than patients that go to see a physician, for example, for an oral contraceptive, Dr. Patel, in terms of the cost. So you mentioned that it's a cost savings. Who's actually paying for the services in the states that this has been implemented in? Dr. Khyati Patel 08:18 Yeah, so the data on the insurance coverage is still not there yet, I would say that none of the states have private insurances covering the services. Some of the states have managed their Medicaid programs to cover these for the consultation. And obviously the product is covered, just like any other prescriptions, and some pharmacies are going out and charging flat service fee of about 30 to $50 per consultation. And if we kind of further look into the demographics again, who's seeking the services? These are patients between the age of 18 to 35 mostly, most of these patients are insured. Most of these patients have seen their PCP in the last one year. And most of these patients also have had prescriptions prescribed of a hormonal contraceptive. Dr. Sean Kane 09:04 So we've kind of gone through the basic landscape in the United States of pharmacists prescribing contraceptives. Oral contraceptives primarily fill in the patch, like you said, but we have two wonderful guests here today that are going to help us understand a little bit more about Illinois specifically, and some of the implications to the practice of pharmacy, Mr. Reynolds. We'll start with you. You know, you have a lot of experience with kind of the legislative background of this bill, and just in general, I'd say, could you just give us a very brief overview of kind of the life cycle of a bill or an act in terms of from conception of the idea all the way through implementation, especially as it relates to how advocacy groups like ipha are involved in that process? Speaker 1 09:47 Sure, and thank you for that question, because it's, it's a lengthy process. It's and it's a very slow process at times. And I'll use some House Bill 135 to kind of illustrate this example. So Representative mussman from Schaumburg came up with filing a base bill for birth control for pharmacists being involved. And we worked with her in looking at that language and really helping build it out. Because when it was first put in there, it was really just looking at giving pharmacists authority, which was where, and you, you guys have mentioned it in some of your review, is where some states still are, and California is the biggest example. And a lot of play in a lot of ways, California still hasn't succeeded until they finally got the payment portions on there. And that was one thing that we talked with with Representative must been saying here, we've taken a look and done an analysis of all the other bills that have passed and that are out there right now, if we really want to make sure that this is a success, we have to have the payment component of it. And she was on board, and I said, but it's going to be a new payment, right? And so that'll be a new challenge, in addition to the practice challenge of the the assessment and consultation for contraception, and that's where the biggest portion of this comes from, is, is, yes, we were now going to be able to, as pharmacists, be able to help bring more access for contraceptives for women in Illinois, but it also establishes the solid Cornerstone foundation for provider status, for us, being able to actually get paid and get credentialed on the insurance side, both for Medicaid and commercial payers, which some states still don't have the commercial payer component. And we were adamant, we have to have all these pieces together or they won't work. And Representative mussman Got that, and she she she worked with us as we started looking at how best to approach the bill. And basically, you take the idea and you you write it all out, and then you give it over to what's called the legislative reference Bureau, or LRB. It's a team of attorneys at the General Assembly that basically take whatever bill language it is and formats it into that this would go into the Pharmacy Practice Act. This goes to the insurance code, this goes to public aid code, this goes to the public public health code. And so that at least gets you a starting bill. And then, of course, the process happens on the legislative side. We introduced this in the house the number of times that we did this, because we did not get it passed. In the first year, it actually took four swings to get the hit the ball. And we we had a lot of challenges, and a lot of that was working with the medical society and looking at how that was going to work with the interaction with the patient, and that's where we got to the agreement of a standing order, and then there was discussions with the state about a statewide standing order, which we preferred, because that would have provided better consistency across the board. There's some internal politics I won't go into here that that's why statewide standing orders aren't used much in Illinois as they are in other states. And what we prefer in other states across across the country. And then we had to have the discussions with Medicaid to figure out how that was going to get paid, and that we were adamant that we were wanting to be paid at the same rate as a nurse practitioner and a physician assistant. And then the same discussions with the commercial insurance side. And some of those went easier than others. I think the hardest part was really getting the discussion between the healthcare organizations, and it was having support of other organizations, including, you know, on the pharmacy side, you've got ich, p, i PHA and I CHP and the Illinois retail Merchants Association, which are not a lot of pharmacists realize that really help with pushing a majority of the pharmacy voice forward. And all three of our organizations work very hard to make sure that pharmacy speaking as one family voice, and that really helps with moving legislation forward. We actually had a lot of support from the nurse practitioners Association and group, because they saw that we were trying to help advance. We also had support from Planned Parenthood and from ACLU, Illinois, and that also helped as well. And most importantly, was ACOG, the American College of Obstetricians and Gynecologists, their Illinois chapter had been working on nationally, had been working on papers promoting this. Actually, they were promoting more for birth control to go over the counter, which that kind of got stuck into a legislative bullet point that we had to continue to overcome because a lot of opposition legislators, particularly from conservatives, thought, Oh, well, we'll just wait till it goes over the counter. And it was an educational standpoint of how that's not a quick process. Yes, there's been applications filed, but they can be there for decades. There's applications have been there for decades that have never. Had a hearing, and so this is to continue that interim step and being and being able to provide so it's once you get that that bill kind of solidified together in one chamber. That's a majority of the work, because once you can get it passed out of one chamber, yes, there might be some minor modifications in the second chamber, because you got to go through the committee process again in both the House and in the Senate, and then it goes to the governor's office. And the governor's office, we'd already lobbied and worked with them. They were already on board, which you're kind of lobbying the governor's office, because in advance of that, because you're working with Medicaid to make sure that they're on board. You're working with public health to make sure they're on board, and the Department of Financial and Professional Regulation to make sure they're okay with the changes to the Pharmacy Practice Act. So you've already lobbied three different parts of the governor's office with getting those three departments on and usually, unless there's some major political reason, the governor's office is okay once the departments are in agreement. It is a lengthy process, and it's just a lot of time. It's timing. And as you said, the bill passed quickly. It was nightmarish because of when we started moving. It because it was in a later in session, and when it started moving. And things can move very quickly, very fast, and you always want to make sure you have your votes ready. And so usually we like to have a little bit more time earlier in session to get it out of one chamber, instead of doing the one two punch, which this bill did towards the end the latter half of session. Dr. Khyati Patel 16:37 So Mr. Reynolds, it looked so easy on paper. Look at the bills process, you know, it looks like it got introduced in January, and by May, Governor had already signed it and got into the effect, you know, and in July. But it definitely helps to have expert like you come and tell us the struggles and the collaborations and the persuasion and, you know, a lot of back and forth that it takes for something like something that's monumental to occur. So thank you for that insight. And I think one of the questions we had was, you know, what were the supportive groups and what were the kind of like groups in opposition? So your response kind of explained to us. I read in this process that in lot of the states, states like Colorado, it was a multi professional approach, where all of them advocated for that. And one thing I want to point out, and importantly you mentioned, is that the ultimate goal is to make this over the counter without any intervention from any healthcare providers. But you're absolutely right. We're not there yet in many different ways. So what I've read is that this authority, by having pharmacists, you know, come into play in and keep them, quote, unquote, behind the counter, is somewhat of a middle ground that everybody's ready to accept and arrive. And so that's what we're that's why we are here. We are going to have 24 different state hopefully with this provision, Mr. Dr. Sean Kane 18:02 Reynolds, one thing that I thought was really interesting that you touched on is obviously the role of, you know, the pharmacist organizations here was to move the bill forward, but also, really to provide some guidance and education to the representatives to fully understand why OTC birth control is so difficult and why it may not happen in the time frame that they're expecting. Also looking at the other laws in other states to understand what are some of the issues and how they've been implemented, and how can you make the Illinois law even better? I think I assumed that, but maybe didn't appreciate it as much as kind of what you mentioned. There's so much nuance here that really goes below the radar to the typical pharmacist or pharmacy student in terms of all of these nuanced details that are really important to make that Bill successful, right, right? Speaker 1 18:46 And that's it's one of the fortunate things about being in the United States for looking at pharmacy legislation, you've got 50 experiments going on. One of the organizations that ipha is a part of is NASPA, which is one of the larger national organizations that most people aren't aware of, and it's the National Alliance for the state pharmacy associations, and allows us basically to talk to each other and compare about what's going on our in our legislatures, and to have proper liaisons with the national organizations, which help with support and a lot of overall national Gathering, a data gathering, but a lot of our discussions is on legislation. We're having weekly discussions about this bill, whether it's a PBM bill, 340, B, contraceptive, advancement, HIV, PrEP and PEP. We're looking at all the different ways that we're all working together. And we're looking at trends. You know, we'll look, well, how did this bill work? Don't go what? Don't use the way we did it. It didn't work that way. Use this way. You use what Minnesota did, or use what Illinois did over here, and merge them together. And so, if anything, it helps with trying to promote model language faster because of our collaboration together, because we're not in competition with each other. That's. A great thing about it, and we share and collaborate almost 100% on everything. So it's, it's really helpful with accelerating the advancement of policy because of of these programs, and in the networking that we do through NASA and through the national organization. So it really helps us with getting to perfected language quicker, and I'm glad that you brought back up about educating the politicians. And that's probably the hardest part with this bill, was we had to navigate ignorance and misinformation, and there's still a lot of stigma. I've always said that this bill was how to achieve provider status by climbing up the wrong side of the mountain, because it is such a politically charged and probably the most politically charged medication group to achieve any policy advancement. And that's that's what makes it difficult, because we heard statements I thought would I would hear out of a B movie, television show out of the 60s, and I was hearing it in 2019, and 2020, and 2021, by elected officials on both parties. And so it was really trying to keep your calm in a lot of those hearings, because you hear something that far out of left field, you just want to completely ignore it or bash it, and you have to be respectful and just try to reflect and reframe it and try to help educate it without making it even worse. And that's where you know, we were glad to have multiple academic experts from many of the colleges throughout the state working throughout this process, testifying in stake, about closed door stakeholder meetings, to testifying in the hearings themselves. And it's always good to kind of have the pharmacists that are actually going to be helping implement some of the stuff in front of the microphones, helping support what we've been telling them already. From from from the lobbying and advocacy point of view, Mr. Dr. Sean Kane 22:02 Reynolds, you mentioned earlier that it took four tries to get the bill be incorporated into the Pharmacy Practice Act and things like that. Again, we'll have the full act linked on our show notes at HelixTalk.com but in your mind, what are some of the key pivotal tenants of the law that were must haves that eventually did become part of the law. Speaker 1 22:23 Well, the must haves that were in there was that we had to have some type of structure to guide pharmacists on what we can do. And so that required us to change the definition of practice of pharmacy, which allows us to provide the assessment and consultation. And you want to leave that open ended, you don't that's the one thing that's difficult with the way we view policy a lot of times pharmacists and other healthcare providers. We want it spelled out to us from a to triple Zed, and that's not how you do law. You want to keep it in a broad statement and allow you a lot of wiggle room. And so we were looking at the standing orders and really trying not to dive into the weeds, and that's where a lot of discussions and negotiations happen, where you're really trying to keep everybody from adding on all this stuff. Because just like we just need a standing order that gives the framework allow the pharmacist and the physician to decide what's going to happen. Give some basic guidelines that we're going to follow the CDC guidelines, and that will have screening assessments. Unfortunately, we got a training statement in there. I continue to battle training statements, not that I don't think it's always good to have refreshers. I do because it's part of our continuing education and, most importantly, our continuing professional development. But no other healthcare provider has training requirements added on to that, and I continue to feel as it's an insult of asking the medication expert health care provider to continue to have to have education on how medications work, when other educators could benefit from that education and they don't have to have it as a legal requirement. And so that those type of trainings are those type of requirements are becoming less and less now, but it's, again, it's, you have to decide what hills are you going to have the battles on? And so having a training program is fine. Is annoying that have to put it in there, because to me, it's a little insulting to the pharmacist, but it's a necessary evil to get this passed and so, and it helps us with providing additional guidance to pharmacists so we make sure that everyone's on the same par. So, I mean, there's some there is some benefit to it. But with the hormonal contraceptives, that's one thing to remember. It's hormonal contraceptives. So originally, in some of the language, it said, just the the oral, vaginal and transdermal dosage forms. That's not in the final bill. So it's all hormonal contraception. Now that leaves out some newer dosage forms, because now we have some new forms of contraception that pharmacists could be could be providing, and that'll have to be a discussion in the standing order between the physician but it's not they're not considered hormonal contraception, so there's still a lot of room here. But the most important thing. Is the pharmacist has to educate on all forms of contraception and help the patient guide them to what's the best for their decision making, for the patient's decision making. And that was one thing that was adamant from all the groups that we you know, they don't want pharmacists just pushing to the product that they can dispense so they can make money on it. And again, it's hard try not to get insulted, because I'm like, Well, do physicians prefer one product over another because they have a clinic downstairs and they know that's going to where they're going to get it filled. So let's not get into these arguments that are unnecessary, and let's keep talking about how we're going to help the patient. So the reasons why there's different time frames in the bill on Medicaid and commercial insurance. We knew Medicaid would be an easier step up of getting it approved, and that's why they had, like, six months to be able to file the state plan amendment, which are working on right now, actually, and this is where tragedy has become a fortunate issue for us. Where for community pharmacists stepping up to be able to provide monoclonal antibodies for covid 19 actually helped us step up an emergency process for them to get credentialed and to be able to bill and document on the medical side for Medicaid. So we built the process of how it's going to work for contraception, using for dealing with covid. So it's sometimes you have to you do learning and from avenues that you didn't think you were going to be able to build that process, but it's kind of helped us. We were hoping to be able to have that same conversations with the commercial insurances so we could get that credentialing pathways there, because that's the big thing for pharmacists to understand on this billing it's not as a quick turnaround like today. If I wanted to, if I was a community pharmacy, I could sign a contract, and by the end of the day or tomorrow, I could be filling with any PBM in the country, most insurances, it's going to take you three to six months to get credentialed, and every pharmacist is going to get credentialed. It's not the pharmacy buildings don't provide care. The practitioners provide care, and that's the big change, and that we're going to get paid in quarterly or longer cycles, we're not getting paid in 14 days or less like we do right now on prescriptions. So it's going to be a whole different mindset for pharmacists to get into. And that's one of the reasons why we ask, Where are helping, working with the provide additional education programs on the billing and documentation, so pharmacists are used to providing that, but again, that comes with the responsibility of providing patient care and in the cognitive services, that it comes with the responsibility of proper documentation, and we have to be able to step up to that if we want these rights. So that's that's really the kind of the two halves of the bill you've got, the the professional right to be able to provide the clinical service and then the billing component to help build the foundation. So those were it was hard at times to balance those, to make sure they didn't get once one of those skewed over the other, but you had to make sure that they they were kept being kept together, because there were many times where we're like, well, we'll just pass the pharmacy part now and then we'll come back and talk about the payment. And we couldn't do that because we didn't want this to end up like California and some of the other state in Colorado, which had major hiccups, trying to get that other component on there so you could really activate the service. Dr. Khyati Patel 28:31 So, and I think kudos to Illinois to kind of learn from the other states and really put in this payment, you know, component and the structure. And like you said, it will take a little bit longer for it to be figured out, but it's there, and even if it's a delayed payment, we'll hope for the payment services to come through. You mentioned a really good point about training, and you know, if that makes them sleep better at night, then so be it. We'll do another training. Are there any approved trainings in the state of Illinois. Yet for this particular program, we're getting there Speaker 1 29:05 where it's probably going to be a number of programs, because APhA has developed one of their own that they've had for about three years. I believe Oregon University has developed one that NCPA helps promote. And then I know birth control. Pharmacist has also developed a program. We were trying to go through the process. We pulled different experts together from the various colleges to help IPhA and ICHP kind of through this process, and we've kind of come up with they're almost equal. And it's we figured, well, you may work for XYZ chain that may already have an agreement with one program, and we didn't want to cause an issue. So as long as they're ACP credentialed, you're going to be okay. And we at least want you to go through at least those three there's not going to be any tracking process or anything that you have to do with the board. The board may review your CE credit. To make sure if there's ever an issue and you don't have it on in your in your E profile, yeah, you're going to have a problem, but please make sure that you do provide training beforehand. What we're developing from I PHA and I CHP jointly together is that we'll have an additional CE program talking about the bill more in depth, and then also talking about that, we've worked with our academic experts around the state to add on an additional update module, because all the three programs are not 100% up to date, and we want to make sure to address any newer medications, newer indications, but also special patient populations, because one of the issues I know we had a lot of questions about was dealing, especially with younger women, and making sure that, you know, we're being respectful, especially this may be their first time asking for this type of service, and, you know, and there's other issues that we may need to address as well. We want to make sure that we're properly providing pharmacists with those additional soft skills to be able to properly handle those type of situations and communications to the patient. Then most importantly is the billing and documentation. And there's a couple of states that have actually developed well versed documentation and billing programs, and there's no reason for us to recreate the wheel, so we're working on those finalizations of those agreements. So we really want to make sure, at least from the professional organization's point of view, we want to make sure that pharmacists are well prepared to do this. Yes, according to the act, you can just do like the APhA program, and you'll be done, but we want you to go a step further and make sure you're doing it appropriately by going through the additional steps just to get a well rounded approach on the training and make sure you're fully up to date. Dr. Khyati Patel 31:52 That definitely makes sense. Yeah. Now, Dr. Solano, hearing all of this, you're working as a community pharmacist. We heard about the training and, you know, complying with the law, mandate and billing and all of that. How do you think this impacts your practice and community, and how do you think it will impact patient care in general? Speaker 2 32:12 So honestly, I really, I'm really excited about this bill and how far it's come. And thank you to Garth and his people for doing bringing this to the finish line. But I think, as a community pharmacist, as you said, before, covid has really brought a lot of things to the forefront of what we didn't think was possible before. As a practicing pharmacist, now, I'm using, you know, instead of using a standing protocol for immunizations or covid tests, we're using me my NPI, my provider's number, right? So that's a huge deal for pharmacists, and basically breaking the groundwork for other things we can be doing. So to hear this is another thing to be adding to the plate, I think is really exciting. Of course, I like the additional training and stuff like that that you know, just to kind of make sure we know the groundwork of what it should go should be going forward. I think that as far as the workflow goes, or, like, as far as those additional components we're already filling, like standing order covid tests, right for the over-the-counter COVID test. So that's already impacting additional people coming and asking, oh, can I have my covid test for the month of January, February? And so we fill that as an additional prescription of the pharmacy. So it's kind of taking that extra step to make sure we acknowledge the patient, making sure we're doing that for them, and just adding an additional step. So I think as far as oral contraceptives, and kind of seeing how this will look like, it will take a little bit of more. It's just getting used to right. Some people are not used to change or anything like that, and I've encountered that in the past. But I think for the most part, it can be a huge benefit if done correctly and the right type of settings, as long as we are able to be it, to adapt and learn as we go. Because, of course, we won't hit it right out the gate right away, but as long as we learn from it, I think that's the huge thing. As far as impact on patient care gonna be huge. People that don't necessarily have to go to their physician to get another refill on a oral contraceptive is is, you know, paying another copay or whatever. But I mean, also getting paid for our services is huge too. So I think it goes kind of hand in hand, and not having to go see the doctor for something they're used to and getting month to month. So I think the impact there can be beneficial, even for people who don't necessarily have insurance or, like, have that access to care, or don't even have a primary and need oral contraceptives, I think will be, you know, huge. So I think overall, the benefit as long as they're able to adapt from these incoming changes and be trained, not only just pharmacists, but technicians too, and what their role is in all of this will overall benefit the greater good of the patient and the practice of pharmacy and what we can do moving forward as well. Dr. Sean Kane 34:36 You know, I think one thing that we touched on earlier from Mr. Reynolds is the importance of that reimbursement component to it. Do you think that because that is already in place, that that alleviates the workload, but addresses the workload in some way for the typical community pharmacist, that now there's money available to allow for more staff, or money available to allow for the time for that pharmacist to engage in this activity? Speaker 2 35:00 Be Yeah, I do. I do agree the incentive of being reimbursed or being paid for services is good because then they'll be more inclined to want to do it. I mean, not only for the fact that it's good for the patient, but then now they're feeling that there's a new scope of practice that they can add to their building resume of things that they can benefit from for patient care all around so yeah, and they're just kind Dr. Khyati Patel 35:20 of learning this law more in detail. I like to let our audience know that this is not mandatory for all pharmacists to follow. It's completely on a volunteer basis. So as we're talking about changes in workflow and stuff, it's going to impact the pharmacists who really want to do it, and hopefully the bigger employers, or the companies other companies, are willing to support the pharmacist to practice this and provide these services. So Dr Dr. Sean Kane 35:47 Solano, one thing I didn't appreciate again prior to this episode was that you actually had a lot of involvement in this bill through your IP and app experience, also not limited to your involvement as a student with ipha, a bunch of opportunities at state pharmacy meetings, networking with pharmacy leaders in the state. Can you give us a little bit of background understanding of what was your role for ippi and appy for this bill, or just for advocacy in general? Sure. Speaker 2 36:16 So I think advocacy is huge in general, because we were able to do what like I keep, like stress to people, is that legislation allows to do, to do what we do every day without it, like the Pharmacy Practice Act, we couldn't do what we're doing every day. So what I did with with Mr. Reynolds here is I, I was able to kind of see the background of what he does and kind of dig into this bill. So what I, you know, I was back in 2018 when I had this experience with him. So it's four years ago. So you know, this bill has been discussed for quite a while. So I think, from for the elite, from this perspective of this bill, I was able to kind of see what he did, what he entered as he's discussed. He had to interact with all these different people. I got to, I got to sit in with some of those meetings with him. I know, I remember one time we got to go to the state capitol as well to kind of discuss that. I was able to actually draft, help, draft up one of the early editions of the bill. So I kind of take the bill and kind of retype it up and kind of, so can we have a working document so I was able to see that overall, you know, it was one, one snapshot of what this huge bill was. But I think I felt really empowered, because I was able to kind of be part of it in a small, small scope, but also to see what advocacy is, how important it is to the professional pharmacy or any healthcare profession in general. So it's important to get involved early on, because of the fact that all of these will add up to more and more people seeing what it's like as a student, but also as a practitioner, and what the benefit is of advocating for our profession. So being able to start from the starting line and going to the finish line and seeing, Oh yeah, talking to legislators, talking to your other people that will can help get involved and be excited about pharmacy is huge. So I was able, I'm really excited and very thankful that I was able to be part of that experience with Mr. Dr. Khyati Patel 37:56 Reynolds. And I think working with students on this issue, you know, in the pharmacy curriculum. But students are all on a different level of comfort when it comes to advocacy, talking with the lawmakers. And I think they can choose, pick and choose. You know, what they want to do. It could be as simple as maybe writing a pre templated letter and putting their name on it and say, Please support this bill. Or it could be actually going making appointments talking with their legislators, or getting involved like you did, and drafting the law languages. And thankfully, ipha provided that opportunity to our students as well. So good piece of info. But if I were to ask you, both of you, just to kind of share in a statement or two, what would be a direct message for our young learners and student pharmacists about importance of advocacy. What would that be? Speaker 1 38:45 Well, I would say that advocacy is essential for the profession to thrive and to remain relevant. It's something a former professor of mine said in a very first class. He held up his pharmacist license and said, Who says you're a pharmacist? He says it's not the school that you graduate from. It's not NAB P It's a bunch of 100 to 150 individuals elected by the public who don't understand your profession that decide what you do every day, and they can take it away just like that. Dr. Khyati Patel 39:16 That's very impactful. That's very impactful. Speaker 2 39:19 I would say advocacy is as little or as big as you want to be as a student. That's where it starts, even as other other parts of pharmacy but I think the biggest part is it can be as big as inviting a senator to your school, which I which I did, which is awesome. Having Senator Dick Durbin here on campus back during my third year Pharmacy school would be one of my highlights of being an advocate person. So I really recommend even just drafting a letter that's been pre printed is huge. And writing to your fellow Congress member, even going to DC and advocating there at that level as well is very impactful. So I say it's never too late to get involved, whether as a student or as a practicing pharmacist, just get involved. Dr. Sean Kane 39:58 So really, for both of you. One thing that comes to my mind is, you know, in the mirror now we have Naloxone for prescribing with pharmacists. We now have contraceptives for pharmacists. In my mind, at least as someone so I practice in an ICU. I don't see this every day, but I would expect that those two issues were broadly pushed because of the need in the community, the need for the opioid epidemic being such a terrible thing, and also for access to younger women, especially uninsured women who need the access to contraceptives. Where are things going after this? What is 510, years down the road, in Illinois or in other states? Just in general, what does that look like, given where we've been and where you think we can realistically go? Speaker 1 40:45 Well, we're definitely not stopping. I'll tell you that much, because we're already, we're already chipping away, and we continue to chip away at this glacier that we've been working on for a long time, of getting pharmacists to the full recognition as a healthcare provider, and we're working on that right now. We have a bill that's going through the general assembly right now on HIV PrEP and PEP so pre and post exposure prophylaxis and a lot of what the framework we established with the contraceptive bill is what was used for this bill. And so it helped alleviate a lot of conversations and helped allow it to get wheels a lot quicker. Now this is a this is a shortened session this year, but that's for some other political reasons, but there's still hope that this bill, if we can get it out of committee this week, it could actually get out of the house pretty soon thereafter and get over to the Senate. So there's a lot of hope there. It's just a real shortened session. Instead of going to May 31 we're going to April 8 this year because of the census and the primary being moved. But in addition to that, it's kind of looking at what's happened since covid The federal government created a paradigm shift for the profession of pharmacy by recognizing us for our skills and our knowledge and our ability to be in the community and in the health system, and basically helping provide covid testing and covid vaccines, and not just providing it, but by prescribing them. So we are prescribers. That's one thing that we have to understand right now, pharmacists are prescribers since April of 2020 and that's something that now myself and my counterparts around the states and with the national organizations, we have to work hard to make that permanent. And so covid is starting to look like it's going to go away, but it's still going to be a long it's still going to be with us. We could probably still have additional ways, but we may have some rollback of some of these rights that we've been given, but we're continuing to work hard to help have those conversations, and it's changed how we had conversations with the HIV PrEP and PEP bill, the original bill had pharmacists prescribing it. So that's the newer approach, is that. But it did get pushed back to a standing order, but it was a conversation, is actually a negotiation point. So it's not just, oh no, pharmacists aren't going to be prescribing we actually had a discussion about it. So that's that's changed. That's a whole newer phase where we are so down the road, pharmacists are going to be doing a lot more in the professional realm, and this is something that we've been training pharmacists to be able to do for the last 20 years, and it's just been hard to pull away these barriers and columns and mountains that have been there from a legislative point of view, because it's really a legislative point of view that's keeping us from doing our jobs and what we're trained to do. Because everywhere we've done pilot programs, you take the chains off of our hands, we can help people, and we've been able to prove it every every time we've been able to decrease health care costs and increase health care outcomes. Every single time, it just said we got to allow us to do it. And you know, look what happens when you allow us to do our jobs. 70% of the US population was immunized by a pharmacist. That's what happens when you allow pharmacists to do their jobs. And so we just need to be able to allow us to do that in other realms as well. And I have to give it to Dr. Solano for being one of the first pharmacists to state not only to be providing covid vaccines, but also providing the needed covid testing and writing prescriptions. And I think that's something to be able to have on a piece of paper and handing it to a patient, and it's got your name as the provider of care. That's got to be something. Speaker 2 44:45 Yeah, when I, when I first wrote my first lab order for actually doing antibody testing, because we can do that as well, it was just really surreal for me, just because it was like, wow, I can do something like that, and now I'm seeing my name on prescriptions for covid immunizations, covid over-the-counter COVID tests. It's like, my name is out there. Like, it's amazing, because pharmacists are in every sort of practice, hospital, community, pharma, we're everywhere. So it only makes sense for us to be able to do what we do, you know, and the access that we have. So I really hope in five to 10 years from now, we're doing more than we could ever have imagined. You know, doing more maybe instead of just covid test, doing strep test, doing flu test, being able to prescribe, you know, Tamiflu or an antibiotic, depending on what they have, that would be huge for patients. And again, it's access to care that necessarily don't have the time or the money to go and see a physician for a copay of, you know, $50 so I think this is the just the beginning. As Mr. Reynolds has said, I think the sky is the limit, so I'm really excited to see where we go from here, absolutely. Dr. Khyati Patel 45:46 And then from an educator perspective, you know, with seeing all these changes that the actual practitioners are willing to do in the community, gives us the inspiration and motivation to incorporate some of these learnings early on in the curriculum as well. So thank you for all you do at the state level, Mr. Reynolds, and at the community pharmacy level, Dr. Solano, we appreciate it. Dr. Sean Kane 46:07 So with that, I think this has been an amazing episode. Thank you so much for your involvement today. We do have some show notes so you can go to HelixTalk.com again. This is episode 145 you can see some links to the actual bill and things like that. We're also on Twitter at HelixTalk, where we released some clinical pearls the previous episodes. We love the five star reviews and iTunes, or wherever you get your podcast, so keep those coming. So with that, I'm Dr. Kane. Dr. Khyati Patel 46:32 I'm Dr. Patel. Thank you again, Mr. Reynolds and Dr. Solano, it was wonderful having you. Thank you. Thank you. And I'm gonna say this, Dr. Kane advocate hard. Narrator - Dr. Abel 46:44 If you enjoyed the show, please help us climb the iTunes rankings for medical podcasts by giving us a five star review in the iTunes Store. Search for HelixTalk and place your review there Narrator - ? 46:55 to suggest an episode or contact us. We're online at HelixTalk.com thank you for listening to this episode of HelixTalk. This is an educational production copyright Rosalind Franklin University of Medicine and Science.