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Turning LTC Pharmacy Attention to the States

Have you heard the saying that states are the “laboratories of democracy”? There is ample evidence that this is true. For example, recreational cannabis use remains illegal under federal law, but recreational use is legal in 18 states, and more seem to be joining their ranks every year. Without making a judgment as to the prudence of the policy, it’s obvious that this would never have happened without advocates turning their attention to state-level action.

Consider North Dakota. Since 1963, state law has required pharmacies be owned by registered pharmacists. You will find no chain drug stores or big-box retailers selling prescription drugs in North Dakota. Big retailers sponsored a ballot initiative in 2014 to get voters to overturn the statute. They failed.

States Dictate What Pharmacists Can Do

Medicare is very important to long-term care pharmacy, so we spend most of our time talking about federal health policy. The LTC profession has spent many years working to get Congress to pass a law declaring pharmacists to be providers within the Medicare program. Despite strong support from individual members of Congress, the bill never crosses the finish line.

OK, you respond, you’re interested – but what would advocacy at the state level be able to achieve? Good question, but you already know part of the answer. Who licenses your pharmacy, and who licenses pharmacists? The states! (Did I say you already knew this?) Recall that federal legislation proposed in years past would have allowed pharmacists under certain circumstances to be compensated for services they were legally allowed to provide. Who determines what a pharmacist can legally do? States determine pharmacists’ scope of practice.

If pharmacists were able to persuade the state legislature and governor to allow them to prescribe drugs, the pharmacists of that state would be legally able to prescribe, just as physician assistants and nurse practitioners often can.

How about pharmacy licensing? LTC pharmacies, with all their distinctive characteristics like closed doors, 24-hour availability, delivery, and specialized packaging, are typically licensed by states under the same standards as retail pharmacies. So how do you tell the difference between a bona fide long-term care pharmacy and one that just calls itself that? Good question, and another area for potential advocacy.

Getting Started at the State Level Is Easy

The list of opportunities is long at the state level and compared to lobbying at the federal level, working with state legislators is fun. The majority of state legislators are truly citizen legislators. They have real jobs outside of politics, and their service is often a sacrifice they willingly make to serve their fellow citizens.

State representatives and senators are constantly asked to make policy on issues they know little about. This is where you come in. They need and want to hear from you. Professional lobbyists can tell a credible story, but nothing beats a constituent from within the legislator’s district with real-life experience.

I hope this sounds like something you want to try. If so, getting started is easy. First, find out who your legislators are. You have two (unless you live in Nebraska, and then you have one). Just like Congress, most states have a House of Representatives and a Senate, and you are represented in each body. Check your legislature’s website (this is Pennsylvania’s). Many have a section where you can discover your state representatives.

Making Strong State Connections

Next, make an appointment to visit. In addition to an office in the state capital, legislators have offices in the local district, which is much more convenient if you live far away from the capital. The first meeting can be a brief meet-and-greet – or something more, such as a pharmacy tour. Legislators like to get out and visit local businesses, meet employees, and find out what you do and what they can do to help you be more successful.

In addition to the legislators, make sure you develop a staff-level contact you can cultivate as a friend of your pharmacy. When a crisis arises, there is nothing better than having one of the legislator’s senior staff you can call to inform them how important an issue is to you, a local constituent.

The key is to stay in touch. A one-time meeting is nice, but unless you make regular contact with the legislator or senior staff member, you won’t have earned loyalty – and that’s what counts when you need to accomplish work in the states.

X Factors in Effective State Advocacy

- Remember, even though Washington, DC, gets all the attention, the real action for pharmacy is in the states.

- Your legislators need your help in understanding the problems you face. Getting them to know and trust you is important.

- Be consistent with your communications. Stay in touch because when you need their help, you will have already established a relationship.

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