Fighting for Provider Status | Michael Hogue, PharmD, President APhA

Transcript Disclaimer: This transcript is generated using speech-to-text technology and is intended to capture the essence of the conversation. However, please note that it may contain multiple spelling errors and inaccuracies. It should not be relied upon as an exact or comprehensive record of the discussion.

Michael Hogue, PharmD: Hello, Michael. Hello, Mike, how are you? 

Mike Koelzer, Host: I'm doing well. Thanks for joining us. Thanks for having me, Michael, for the listeners that haven't come across you online, introduce yourself and tell the listeners. Why are we talking? I'm 

Michael Hogue, PharmD: Michael Hogue. I am, uh, the current president of the American Pharmacist Association.

I'm also the Dean of Loma Linda University School of Pharmacy. And, um, we're gonna have a chat today. I think about provider status and the future of our profession. Do I have to call you 

Mike Koelzer, Host: Mr. President? 

Michael Hogue, PharmD: No, that's not necessary. Michael will do. . 

Mike Koelzer, Host: When I looked at the LinkedIn today, you are an expert in immunization, and I know that one of the benefits or gifts that pharmacists can bring to the medical profession provider status, I think would be immunizations.

Is it coincidental that you bring that expertise to the presidency of the pharmacist association? Or is that planned? 

Michael Hogue, PharmD: I think it was, uh, coincidental. I. Began working, uh, with pharmacy based immunization delivery back in 1996, when I did an executive residency at a PHA headquarters in DC and part of my, uh, task while I was in my residency program was to work with a staff team there, uh, to really launch the national pharmacy based immunization delivery initiative.

Wow. And at the time we only had nine states that were authorized, uh, were. Since we're authorized to administer vaccines. Uh, we've now gotten to all 50 states in the territories. And, uh, and at that time, pharmacists weren't routinely trained to provide immunizations and to do immunization practice. And of course, as you know, now it's a standard of care and, uh, uh, a C P E requires that every pharmacy school teach.

Pharmacists, how to administer vaccines. So I've been a part of that movement since it began, uh, some 20 what, four years ago now. and, uh, I do think that the timing's great. I mean, because we are in a public health crisis and, um, COVID requires a vaccine. Uh it's. It gives us a great opportunity to make the argument that we need to be recognized at the federal level.

Mike Koelzer, Host: Now, wait a minute. So I must have this wrong because provider status would be for pharmacists to be able to get paid for things. All the great work you did on immunizations over the last 24 years, pharmacists are paid for that already. How does that J with provider 

Michael Hogue, PharmD: status? It's a great question. Vaccines are a little bit different than.

Many other things. So maybe first of all, what would be useful for listeners to know is that the practice of pharmacy and the practice of all healthcare professions is really governed at the state level. There aren't practice laws in the United States that govern practice of a discipline across the entire nation.

That's very different. We're one of only a handful of countries in the world that has that approach, where we give the independent states the authority to govern the practice of a discipline, but that's the way it works here in the us. And so each state has the right to do that. Um, For flu vaccine and pneumococcal vaccine, uh, pharmacists were recognized as mass immunizers.

So it's really sort of a supplier type, uh, equation, uh, through the Medicare part B benefit, uh, to provide flu and pneumococcal vaccines. And then of course, because pharmacists, uh, are dispensing drugs and vaccines or drugs, the Medicare part D benefit. Clearly covers pharmacists giving immunizations through that benefit.

So what we have here with COVID is a little bit different because COVID vaccine is not statutorily covered. And so CMS is gonna have to make decisions about how they will pay for the vaccine. And they have announced that they're going to cover it under Medicare part B as in boy. But now the agency's gonna have to make a decision.

Will they pay pharmacists to administer that vaccine? And it's in the hands of the agency at this point to make that determination as it relates to vaccines, uh, we don't have statutory authority in the profession of. Pharmacy, uh, to bill Medicare, part B for pharmacists providing patient care services. And that's what we're talking about.

When we're talking about the federal provider status, we're talking about getting Congress to give us statutory authority. To bill Medicare part B for pharmacist 

Mike Koelzer, Host: services. The reason why some of the immunizations are covered and so on is that they sort of go along for the ride in part 

Michael Hogue, PharmD: D that's partially correct.

Part of it is because they, uh, are drugs and, uh, some of the vaccines are covered under the drug benefit. And then influenza pneumococcal vaccines are covered through a special law that was passed many years ago. Uh, and that's how that's exempted. So vaccines are a little bit more complicated, I guess you could say.

And, um, but everything else in the healthcare world on the outpatient basis is covered under Medicare part B, except for pharmacist services. And that's the thing that's missing. And that's what we're advocating. 

Mike Koelzer, Host: Who's the biggest opponent of that. 

Michael Hogue, PharmD: You know, Mike, it's really difficult to understand how anybody, uh, could oppose pharmacists' patient care services.

I mean, consumers in rural communities and in urban communities across the nation. Uh, Are struggling with access to care, especially during the pandemic. And we have underserved communities throughout this country that desperately need additional providers in order to be able to get the healthcare services that they need.

And it is just mind boggling to me. How anyone in Congress, how anyone in the administration, how anyone at the agency level and how anyone in. Role would want to restrict consumers, being able to access critical healthcare services and every single day that goes by that, um, uh, CMS or HHS fails to clearly articulate that pharmacists or providers every day that goes by that Congress fails to act on this particular issue, giving pharmacists provider status under part B.

Every day that goes by that the president does not issue an executive order. Demanding that HHS give pharmacist provider status is another day where patients are denied critical healthcare access in their local communities from their pharmacist. It's a travesty, it's a tragedy and it is a huge public health issue that must be addressed.

And that's why we're pressing so hard. Consumers deserve to have access to. Comprehensive healthcare services provided by pharmacists because in many communities, the pharmacist is all they got, they have nothing else. They have no other healthcare provider to provide those services. If I'm looking 

Mike Koelzer, Host: From the outside, I'm kind of always following the money.

So in my mind, I'm saying Congress and the Senate and so on, they probably don't care all that much. Who would be losing out on this? Well, maybe the nurses and the doctors, are they the biggest foes of this? 

Michael Hogue, PharmD: Well, the reality is, is that, uh, you know, organized medicine has historically been very opposed to expansion of practice authority of any of the professions.

The nurse practitioners have battled with the, uh, with the American medical association, uh, the. Uh, PAs sometimes have battled with them as well. And, and, you know, the AMA has been a problem. Uh, they just have, I don't know any other way to put it. Um, I, I can tell you that in local communities, throughout the United States, physicians love working with their pharmacists.

They're very supportive. So how organized medicine has come to a different conclusion? I have no idea. I can't can't explain. 

Mike Koelzer, Host: It seems like it's, uh, highly structured. Lobbying, keeping them out. 

Michael Hogue, PharmD: It is. 

And I think the other thing that we have to recognize is that pharmacists being added to Medicare, part B as providers is not going to cost the country money.

In fact, we're not taking money away from anyone because. The patients who are accessing pharmacists provided care services are not getting care period. Anyway, in many cases, right? They're they're, they don't have access to care. Pharmacists are providing access to care to people who are being disenfranchised by our healthcare system.

Our healthcare system is failing consumers. Left and right. It's failing our seniors and Medicare is failing our seniors by not providing comprehensive access to pharmacist care services. And so we don't believe that this is a net cost to CMS. In fact, we believe that when pharmacists do this, we keep people out of the hospital.

Heck yeah. We keep people from having to go to the emergency room to receive their routine care. We can help reduce the overall expenditure. And we think that that's a story that we're not making up. The literature is replete with articles about this and, and evidence, the evidence is showing it. If 

Mike Koelzer, Host: Right now you've got a ticket and it said you can write.

Anybody's name on this ticket, who would be the people that you'd wanna talk to? 

Michael Hogue, PharmD: I would like to be in the room to be able to hear the story of what pharmacists can do. I'd like to have, uh, the white house administration, including the president, as well as the leadership of both the Senate and the house, the leadership.

Both of those, uh, bodies, you know, Senator McConnell, uh, and Senator Schumer are leading, uh, in the Senate. Uh, but they, uh, have not given anything more than lip service, frankly, to pharmacists provided patient care services. And we need both of them as leaders to step up and understand that this is what the American people need.

And, um, you know, the president has been supportive generally speaking. But we need action. And, uh, again, it's it. While people talk about all the good things pharmacists can do, uh, for every day that we don't act we're, we're leaving Americans in the lurch without the services that they need. So, I'd love to have the president in that room.

The white house advisors related to healthcare. Uh, of course, uh, Alex AAR needs to be in the room, uh, as the secretary of health and human services. And then the leadership in the house and the Senate, they need to hear this message loud and clear, uh, that pharmacists must be providers under Medicare part B.

Mike Koelzer, Host: Okay. Michael. So now all these people are in the room and they've all heard it. If that happened, would. Have expectations, something could change or have you been burned enough times where even if they heard about it, you still think there is a lobbyist standing outside that door, telling them not to do it.

Where do you think the next hurdle is besides people not hearing the 

Michael Hogue, PharmD: message? Well, there's no question that, uh, that the lobbyists are a big influence. I mean, there's just no question about it. You know, I think that probably, uh, there's a lot of dancing that goes on in Washington. Well, I know it's not probably, I know it's true.

There's a lot of, uh, a lot of politicians who speak out of both sides of their mouth. They wanna try to please everybody, but, you know, here's the deal. The Medicare program was created 50 years ago. The laws were written a really, really long time ago. Uh, I think your listeners would be hard pressed to identify any healthcare professional, any healthcare professional, who isn't listed.

That law. Okay. Yeah. Except pharmacists, pharmacists are noticeably absent. Now, how is it that a law passed 50 years ago excludes and has excluded for all of this time? The single most accessible healthcare professional. In our nation, as stated by the, uh, by HRSA the health resources services administration, HRSA says, pharmacists are located in more zip codes in the United States than any other healthcare provider.

So if that's the case, and if we believe that pharmacists can provide care and are capable of doing it and we do, and if consumers want it and they do. Then why is it that we have this continued barrier of a law that was passed initially 50 years ago? Why can we not make the simple change to add pharmacists in as providers?

I don't understand it. It does not make any sense at all. The only reason that it's not getting done is because of the greed of organized. And the greed that exists in the politicians and in lobbyists. And there's so much greed in Washington that we are now denying people who don't have access to healthcare.

Otherwise we're denying them continued access by this charade that we're playing in Washington. And so it's time to stop the charades. It's time for us to act and to actually do something meaningful, to change the health and wellbeing of the consumer. We can do that. If pharmacists are added into the Medicare, uh, laws to allow us to be providers 

Mike Koelzer, Host: back in 1970, then when this law was made, did it make more sense back then to leave pharmacists off of it?

Or do you think that was a greed issue back then? What were people thinking? If you could imagine back 50 years ago, that kept pharmacists. Off of that. And have we changed enough that we should be put on it? Was that a good move 50 

Michael Hogue, PharmD: years ago? Yeah. I mean, it actually reflects a change in the profession of pharmacy.

I mean, there's truly been a big change in our profession over that period of time. And I think that's what it really represents. No one thought about pharmacists needing to be providers because they saw pharmacists as the purvey. Drugs. Uh, and even in hospitals, um, the, the concept of clinical pharmacy was just being born in California, back in, you know, in the late sixties and early seventies.

So it just wasn't a thought in anybody's mind at that time, but the profession has evolved and has changed so dramatically that we now understand that the value that pharmacists add to the system is. The pill , it's not the medicine. It's how the medicines work, you know, at a PHA headquarters in Washington, DC, if you go into the grand rotunda of this beautiful old historic building, there are two very modern statues in that building.

And if you walk in the front door on the left hand side is a statue of a pharmacist holding a mortar pestle with a patient beside. And it says at the bottom of that statue from making medicines. And then on the right hand side, the statue has a DNA, uh, strand, and it has a modern pharmacist with a child standing in front of the pharmacist and it says to make medicine's work.

And so in the headquarters of a PHA, there's this beautiful picture. As you walk in the front door that says from making medicines. To make medicines work and that's what's happened over the last 50 years. We were making medicines when this law was passed. Now we are making medicines work, but the law has not changed or recognize that tremendous change in the professional responsibility of the pharmacist.

I want provider status as a pharmacist. I want our profession to have that kind of recognition, but I just gotta tell you as the son of two, uh, parents who are Medicare beneficiaries, who have. Uh, serious, uh, chronic health conditions and serious underlying conditions. I mean, my mom's a cancer survivor.

My father is, uh, you know, has a pacemaker defibrillator. My mom and dad live 3000 miles away from me. I need my mom and dad to have a pharmacist looking out for their medication therapy and taking care of them. I need them to do that, but guess what? They don't have access to a pharmacist to provide the services that they need except for their son that, you know, but they need to have, they need to have their local community pharmacist actually engaged in that and getting paid for it because they need that service.

So as a consumer, And because I have parents who are consumers under the Medicare benefit, I can say wholeheartedly they're being denied what they could have and what I see as optimal care because Medicare won't cover it. They won't cover the benefit. 

Mike Koelzer, Host: That has to change Michael, the structure of the American pharmacist association.

I know the Michigan pharmacist association is the funnel down from the American pharmacist association. Is that the same for all 50 state associations under the American pharmacist association? 

Michael Hogue, PharmD: Well, the state pharmacy associations are all independent organizations, but all 50 state pharmacy associations, as well as the Washington DC association and the Puerto Rican pharmacist association and the Guam pharmacist association are all.

Uh, formally and officially affiliated with the American pharmacist association. So a PHA has a policy making body, uh, in its house of delegates. That's made up of representatives from all 50 states, all of the US territories, as well as all of the national pharmacy associations, uh, as well as all of the branches of the uniform services in the US and that 400 member policy making body.

Sits down together annually to look at the critical policies facing the profession and to make statements about that. And, uh, so that's how really the organization and structure of pharmacy comes together. I think a lot of pharmacists think that, you know, the national associations, for example, don't get along or they're competing with each other.

Uh, no, it's not really not true. I mean, what, what I see in, in the last, uh, uh, 120 days in particular, Is that the national associations have never worked more closely together. We've issued multiple statements jointly and together we've, we've worked on multiple initiatives. We have telephone conference calls almost daily, uh, among the government affairs staff of all of the associations working hard.

to move forward, the profession of pharmacy. So pharmacy is in fact, a whole lot more United. 

Mike Koelzer, Host: Are you referring to Michael, the national community pharmacist association, things like that when you're talking about the national heads? Yeah, 

Michael Hogue, PharmD: so we, we work very closely with CPA, with a S H P with a S C P uh, with, uh, The, uh, college of, uh, neurologic and psychiatric pharmacists, uh, with you, you name it.

We work closely with CDs, even, uh, we work closely with everyone who is helping to advance pharmacy's mission and purpose, and these associations are. Very much United on this provider status issue. They're very much United on the idea of increasing consumer access to pharmacists provided patient care services.

Mike Koelzer, Host: Michael people always say, we need more pharmacists and politics, and then we need. Pharmacists on the national level, even in your opinion, would like that help right now? Are there any pharmacists in Congress? 

Michael Hogue, PharmD: Absolutely. We need more pharmacists involved in, uh, advocating for our profession, both in the state house and in the, uh, Congress, we have one.

Pharmacist in the United States Congress, um, representative buddy Carter from Georgia is a pharmacist and he is the only pharmacist in the United States Congress. And I have to tell you that, uh, if we had, um, you know, 10 or 15, uh, buddy Carter's in Congress, uh, this would be a much easier story to tell because.

There would be many more voices who would be helping, uh, Congress understand what the issues really are. The first thing that 

Mike Koelzer, Host: comes to my mind is like, well, they'll push more bills and things like that. But also these people just know each other, right. They know each other as friends or acquaintances and they talk and they can see the respect they have for them and so on.

And none of that can certainly hurt. 

Michael Hogue, PharmD: No, absolutely not. And, and having pharmacists, uh, in state legislatures and in. Congress is really a critical thing to happen because there are many, many, many matters that come before the US Congress that are important to pharmacists. I mean, you gotta stop and think about it.

Pharmacists are. It spread throughout our economy. I mean, we've got pharmacists and hospitals. We've got pharmacists that own small businesses. We have pharmacists that work for large corporations. We have pharmacists that own large corporations. We have, you know, we have pharmacists in long term care facilities.

We have pharmacists that work in the government. It's hard to imagine too many things that would come through Congress that couldn't benefit from the ideas and the insights of a pharmacist. And so, uh, you know, especially if there are young people listening to your show, I really want to. People think carefully about who they believe is representing them in the halls of the state house and in the halls of Congress.

How is your voice being heard? You know, one way to have your voice heard is to be an active member of a PHA and your professional specialty organization, as well as your state pharmacy association. But the other way. Is to actually put yourself out there and volunteer for committees and volunteer for, uh, being on political task forces.

And, when the opportunity comes up, run for mayor of your town, uh, become a city councilperson, uh, run for the local school board, uh, become involved in state politics, become involved in national politics. It really is important that pharmacists do this because if we don't stand up for ourselves, no one else is gonna stand up for us.

You've 

Mike Koelzer, Host: fired people up. But when you said get involved in your local council or your local politics, it seems so far removed from. A national thing like this. And I imagine that you can see that connection, but we little people seem like we have trouble seeing that connection. What is the connection by a pharmacist joining a neighbor association or a county commissioner or a city mayor?

How does that translate to federal provider laws? For example, 

Michael Hogue, PharmD: Now it's a great question. And I'll tell you it is. Important to remember that all politics is local. Mm. Each one of these representatives represents a specific district within a state, especially in the house of representatives. Gotcha. And they have constituents and, you know, I have always made it a point to know my member of Congress.

Shake their hand. I met them. I know them on a first name basis. I made sure that, uh, and when I owned a pharmacy, I made sure that my Congressman was in my pharmacy and had a chance to, uh, see what the issues were in the pharmacy. Really. I go to their political breakfast. Uh, it doesn't matter what party they're in.

Really? It doesn't, it has no, it is not a party dependent thing. Uh, I don't care what part you're a part of, as long as you support pharmacy, that's what I'm interested in. Right. And so, so we, we take time to get to know on a local level. And then, you know, I, I had the experience, uh, as you know, I've recently moved to California after living in Alabama for, for many, many years.

And, um, I, uh, had the opportunity this last week to do some advocacy with my former state representative in Alabama. Because he and I are on a first name basis. Um, and, and we have each other's cell phone and I don't abuse that privilege. Uh, but I reached out to him and asked for his specific support around provider status and he gave it to me.

He gave me the support that we were looking for that comes with a relationship and anybody can have that kind of a relationship with their Congresswoman or their Congressman. All they have to do is just reach out and say, "That's really where it starts. It starts with a hello. 

Mike Koelzer, Host: So you're telling me that every pharmacist owner, if they wanted to, they could be maybe, or maybe not on a first name basis, but they could know their congressperson and their two senators.

Representing them 

Michael Hogue, PharmD: federally. Absolutely. Uh, it's a little harder to get to know your senators because they have to cover an entire state. And so that's a little bit more difficult. Yeah. Uh, but it is very possible to do. And, there's no reason in the world. You shouldn't know your house of representative members again.

Gotcha. There's so many issues that come up that are related to pharmacy. You know, provider status is the current one, but we've got tons of other issues that affect pharmacists and the business of pharmacy. And we need to be able to know these people and talk to them and ask, and be able to advocate effectively for what it is.

We. Are trying to accomplish as a profession. And, you know, I think, uh, Mike, the other point about that is it's critical that we support our state pharmacy associations by joining and we support a PHA by joining and, and I, you know, I'm. I'm saying this with all sincerity, we're a part of a profession.

We're a part of something bigger than ourselves. And, and yeah. Sometimes we are too busy to be able to do the things that you and I have been talking about in terms of advocacy and getting involved. Yeah. But what we're never too busy for is to support our profession through our membership. Because when all pharmacists join and are a part of something, then those associations can take that voice that we need to have, but maybe don't have time to have, and we can amplify it.

Then we can make it bigger. 

Mike Koelzer, Host: Does the profession of pharmacy, not manufacturers, but does a profession of pharmacy have lobbyists ? Are lobbying against something, just like the AMA is lobbying against us. 

Michael Hogue, PharmD: yeah. You know what I'm 

Mike Koelzer, Host: saying? Right. Is there anybody we're trying to 

Michael Hogue, PharmD: block or anything? Well, you know, to be honest with you, Mike, there are very few laws that come before the US Congress that we find ourselves having to fight against.

Occasionally it does happen. But what does happen more frequently is the federal agencies like CMS and FDA, and the DEA will try to adopt rules that could really negatively impact our profession. You know, compounding is a great example, you know, we've tried to. Maintain strength of the pharmacist and, and the, and the autonomy of the pharmacist to be able to compound.

But, but we've, that's been an uphill battle with the FDA and the FDA has many times attempted to Institute rules, uh, and promulgate those regulations, uh, on pharmacy. And we've been effective as a profession, as professional association, having our people intervene and stop those erroneous, uh, Regulations from going into effect and more times than not, we're successful at putting the breaks on those things for all intents and purposes, as it relates to the everyday practice of pharmacists and the business of pharmacy, um, Regulations have the same effect on our daily practice as a statue or a law.

Uh, so regulations are critical and being able to being able to impact regulation, just as important as being able to impact laws themselves, 

Mike Koelzer, Host: It kind of seems like anybody that's under a permit or something like that has had to deal with more regulations. 

Michael Hogue, PharmD: Absolutely. And the pharmacy business is a highly regulated business.

No question about it. 

Mike Koelzer, Host: So Michael you're now in California. And I imagine you've gotta take some physical trips. C's I guess, a different issue. I imagine you've gotta take some separate trips over to DC. How often 

Michael Hogue, PharmD: do you have to? Well, actually right now, um, I'm not traveling to DC on a regular basis, uh, simply because it's just not safe.

Uh, to do so. And, uh, last week, the DC government adopted a, uh, uh, a quarantine order for, uh, individuals from California who come into DC, unless you're coming in to work with Congress. Um, you have to quarantine for 14 days. So essentially that. Wow, but, uh, stop any trips that I make to DC uh, but you know, thankfully we have technology and we can accomplish a lot, uh, using, uh, using technology.

Is this a paid 

Mike Koelzer, Host: position at all, or is this volunteer? 

Michael Hogue, PharmD: It's an elected volunteer position. The president of a P H a receives the smallest. Stipend, uh, to cover, uh, some direct expenses, but it's a very tiny stipend that we receive. Gotcha. Yeah. It's a volunteer position, 

Mike Koelzer, Host: But you're spending a hell of a lot of time on this.

Michael Hogue, PharmD: Right? Well, I'm passionate about it. It, it, you know, you do the things that you enjoy and you find time for them. Things that you enjoy. Uh, I enjoy advocating for our profession and I literally, uh, love a PHA. I just can't say it strongly enough. And, and because I have this deep seated passion, it's an honor and a privilege to serve.

It's a, it really is a joy for me. So I don't see it as work at all. I see it as just a privilege and an honor to be able to do it on behalf of the profession. And I, I get up every day excited to be able to advocate for the profession of pharmacy 

Mike Koelzer, Host: when this is done. I know they probably don't fly you out on a helicopter or something, but it's gotta be kind of a, kind of like a cliff that you almost fall off after being so busy for the year, or I imagine you, do you stay as busy almost the next year, kinda helping the new administration 

Michael Hogue, PharmD: come in.

Yeah, so, so serving as president of a PHA, the. Three year commitment. You serve a year as the, uh, president elect of the association, a year as president, and then a year as immediate past president on the board. So it is a three year cycle, definitely. Your year as president is your most intense year that, uh, that you're involved in.

But, um, you know, I'm the, I'm the 165th pharmacist in American history to be the president of a PHA. So it's kind of neat, wow. It's kind of a neat thing to get to do. So, uh, yeah, it's, it's an honor and I. I thought I would get to do this once in my lifetime. I'm gonna give it everything I got, uh, for as long as I can.

Is there an 

Mike Koelzer, Host: unofficial spot, like the year before your president elect, what kind of people are those? Are they in a certain position or could they like it? Pick someone out of a cornfield somewhere. Yeah. 

Michael Hogue, PharmD: Any, any member of a PHA can seek the office of president of a PHA, most people who do so are people who've been involved with a PHA at some level.

And, and, uh, uh, but we have pharmacists from every walk of the profession. Um, uh, just a few years ago we had our very first nuclear pharmacist who became, oh, president of a PHA, Nikki Hilliard from Arkansas. Um, we've had, uh, federal us public health service, pharmacists that have been president of a PHA and George arch Andal and, uh, Lisa Tory.

Um, we've had independent pharmacists and there's too many names to mention there who have been. President, um, chain pharmacists, academic pharmacists, like myself. Uh, there's a hospital pharmacist that has been the president of a PHA. So literally everyone, uh there's in every walk of pharmacist has been president Colonel Eli Lilly was the president of, uh, A PHA at one time, just as a port of, oh, is that right?

Yeah. , 

Mike Koelzer, Host: That's really cool that all the different areas have actually been president of this association and not just a, you know, a sister association. 

Michael Hogue, PharmD: Yeah. In fact, we've had several presidents of a P H a. Who also served as president of another pharmacy association at some point previously, and then became president of a PHA later independent 

Mike Koelzer, Host: pharmacists that listen to this.

A lot of times they're listening on their way to work or on their way home. And. They've had a pretty tough few years. What makes it tougher is looking into the balance and the check look and seeing that maybe red, or if it's black, it's probably lower than it has been a long time. What would be your pep talk?

Michael Hogue, PharmD: To them. I think what pharmacists, especially independent community pharmacists need to hear is that your community needs you. Uh, what you are doing is meaningful work and it's important work. And I often think about the fact that normally, um, the. Prize, uh, the, I say the prize, that's kind of almost a cheapened word.

I don't want it to sound like a cheapened word, but the success that we oftentimes strive for professionally often comes after a period of seriousness. And intense trial and challenge. And there's no question that independent community pharmacists are in the middle of one of the most intense and serious challenges of our profession.

Um, we are being hammered from all sides with DIR fees and, uh, uh, PBMs that are engaged in. Really what ought to be illegal business practices. There's certainly unfair business practices. And if a PHA has anything to do with it, they'll be deemed illegal. Uh, and, and, and, and then on top of that, we're providing care services to communities and payers expect us to do it for free, and they don't expect any other healthcare provider to do things for free.

So there's a lot of, uh, there's a lot of unfairness, but let me just say this. The COVID pandemic has provided a glimpse into the critical, vital nature of the pharmacist. As, uh, as a critical piece of a community, we can't afford to lose that critical component of our communities in our independence.

Pharmacies, we just can't. And, I think that the legislatures, the governors, the consumers are starting to wake up and say, Hey, I have to have my pharmacist. Let's fix this system and get us into a position where the pharmacist is in fact available. So I would just encourage you pharmacists. I know it's tough right now.

Hang on, hang on. Just tie it out on the rope. We're working hard. I can tell you we're working very hard at the federal level to try to get these changes incorporated, that, you know, get DIR fees outta here, eliminate provider status enacted so that you can get paid for the true patient care services that you're providing.

You should be able to get fair reimbursement for the product that you're providing, and you should be able to get compensated for the service you're providing. This will turn around the economics of independent pharmacy practice. This will turn around the practice that's going to happen. I have a very good feeling about where we're at right now.

We have the ear of the administration. We have the ear of Congress. We have the ear of the state houses. We have the ear of the legislatures and the governors. We've got to capitalize on this moment. If there was ever a time that we need every pharmacist standing up and fighting for their profession and fighting for consumers.

It's now, it's right now. There's never been a more important time to do it. If we keep pressing, I promise you that there's a brighter day coming over the hill. That we're about to top and it's gonna be a beautiful day. And, uh, I really believe that's true. And that's what we're striving for. 

Mike Koelzer, Host: Well, Michael, you were in the shoes of, of, independent.

Did you. Owner store. Yeah, 

Michael Hogue, PharmD: I was a partner in an independent pharmacy in Alabama, but it's been many years ago. The economics have changed drastically since the days that I was an independent pharmacist. Uh, I did work with the chain pharmacy industry for a little bit as a chain pharmacist and, uh, uh, but most of my career in terms of practice, I've worked in ambulatory care.

I've worked in clinics alongside physicians. Doing, uh, comprehensive disease management and so forth. Uh, but, uh, yeah, I, you know, independent pharmacy is, uh, was where I cut my teeth. It's where I learned about pharmacy and practice pharmacy. I practiced pharmacy as a farm tech before I came to pharmacy school at a small, independent pharmacy in Metropolis, Illinois.

Hummus drugs, which you'd been in business for about 125 years. And because of the unfair business practices of the Illinois Medicaid department, that pharmacy ended up closing several years ago because it just couldn't survive. But I, you know, I have to tell you, it's a sad story and it's a story that's being repeated throughout our nation.

We've got to put the brakes on closures of pharmacies. We have to, we have to turn this economic, uh, situation around. Uh, and get this into a position where independent pharmacists can be successful and can provide the care that consumers need. Certainly 

Mike Koelzer, Host: During COVID we're on the front line there, and we always are, but it became very evident then Michael, a pharmacist , is gonna be listening to this, and certainly we would like as many members.

In a PHA as we can. And we'd like people to run for city things in Congress. And so on. What's the most effective thing a pharmacist can do if they have their phone in their hand, listening to the podcast right now, or they're at their desk, listening to the podcast, or they're gonna be at their desk. Is there anything they can do on the computer?

As far as in email reaching out doing something, and let's say, they've got like 10 minutes to give to this. What's the best thing they can do right now? That's gonna affect the federal level over the next. Let's say 30 days or something. What can they do there? So 

Michael Hogue, PharmD: right now, one thing that we need every pharmacist to do is to go to pharmacist.com.

That's pharmacist.com. And on the right hand side of the pharmacist.com website is a take action button. They need to click on the take action button. And within two minutes, just put your name, address, and email in, and this will generate an automatic letter to your specific members of Congress. That means your senators and your house members.

And we'll generate a letter to them asking them to take a positive action on provider status. That's the number one thing that you can do. That's uh, easy takes two 

Mike Koelzer, Host: minutes. Let me be the devil's advocate on that. Yes, it's easy. And it takes two minutes, which is what I was recommending. but does that make an effect on anybody?

I know it's not a vote, but do they see the numbers? 

Michael Hogue, PharmD: Yeah, they actually do. You can take a little longer than two minutes. I mean, if you really wanna make it even more effective. Yeah. You can edit the text of the letter when the letter pops up. Uh, there's a place in there where a pharmacist can say. I want you to do this because here in my town and list the name of your town, this is what I'm doing for my patients.

And if we don't put provider status in place, I won't be able to provide this service for my patients any longer. And so you could personalize it again by just taking the same link pharmacist.com takes action center. And then when the letter pops up before you hit submit type in a couple of sentences about your own personal story.

Then your Congress person will see that this is a personal letter, um, and, and it's coming from your heart. And so I really still think Mike, that this is a very effective way to reach your member of Congress. The second thing that I would say that is important to do is if you've got 10 minutes, Make a phone call, a telephone call to your member of Congress.

And, and what I mean by this, it really is fast. It doesn't take long at all. You can call the switchboard of, of Congress at, uh, at the US Congress. You can call the switchboard and say, I wanna be connected to Senator so-and-so's office. A staff member will pick up the phone and when the staff member picks up the phone, you need to say, hi, I'm.

Michael Ho I'm a constituent I live in, in Yucaipa, California. And I'm one of your constituents and I want, I want the Congressman to know, or I want the Congresswoman to know what I expect. That she supports pharmacist provider status under Medicare part B. And I expect that the Congresswoman will, uh, support a bill that eliminates DIR fees.

And it's very important. To me as a pharmacist. And I can tell you I've made those calls many, many times. It literally takes three minutes, maybe five minutes to be able to have that quick conversation. You're not gonna get to talk to the Congressperson. You're not gonna get to talk to your Senator, but you will get to talk to a staff member and let your voice be.

I will tell you I've actually been in the halls of Congress. Uh, I've been in the offices of these Congress. People when a vote is about to happen on the floor of the house or the floor of the Senate and their staff are taking calls. Minute by minute, the phones are ringing off the hook and they literally have a tally sheet.

Yay. Or. Yay or, and they're making marks and they're saying, you know, that yays, the consi, the, the constituents of our district are two to one saying that they want this thing to pass Senator, and they're literally marking down what kind of support they're getting. So. Don't underestimate the power of an old fashioned phone call to a member of Congress.

And the difference that that could actually make in helping us get across the finish line. 

Mike Koelzer, Host: Yeah. Because the difference is that it's like, especially in those cases, it's not like a bunch of neighbors of mine are gonna be calling and say, Yeah, but we're yay for DIR fees. I mean, that's right. They're not getting those calls, you know?

So anyone who calls you on that is going to flip something a hundred percent. It's not just gonna compete against the negative. It's gonna be a hundred percent in the 

Michael Hogue, PharmD: right direction. Absolutely. Right. Mike, I just cannot tell your listeners enough how critical it is right now to make those phone calls to Congress and to write those letters.

Making a phone call will have so much impact in the coming few days, especially in the coming weeks, Congress is gonna be passing another bill, uh, related to COVID and, um, whether pharmacists are in it or not is going to largely depend on whether or not members of Congress have heard. From pharmacists they're gonna wanna know are their constituents interested in this issue.

And if they hear enough from their constituents that this is an important issue, then they'll support it and they'll even drive. It. They'll even be happy to drive the train to get it. Done. If they feel like their constituents think it's important enough. So we've got to fight. We have got to fight. Get your pharmacy text to call, get your pharmacist to call.

Get everybody that works for you to make a phone call. You can exponentially impact our ability to get the provider status language passed, and the DIR fee language passed. By simply picking up the phone. It's a simple thing 

Mike Koelzer, Host: to do. And Michael, for people that aren't used to calling, or don't think they can call, I imagine you've never told anybody this.

And then after they called their head exploded or they dropped dead from fear or something, I bet the afternoon goes on. Even after they've made a call, that might be 

Michael Hogue, PharmD: uncomfortable for them. Yeah. And it's, and there's no reason to be uncomfortable. Let me just tell you. Uh, most of the people working in Congress, put their pants on two legs, one leg at a time.

Uh, they, they are no different than me and you, uh, common average everyday people. And they, um, appreciate hearing from constituents in the district, just as much as, uh, the Congressman or the Congresswoman does as well. 

Mike Koelzer, Host: Yeah. Their job is really to listen to us to, to get those 

Michael Hogue, PharmD: calls. It. That's why they're there.

They're there to listen and they're to act on our behalf as their constituents 

Mike Koelzer, Host: A couple years from now, somebody says, Michael, you've been working so hard and. Now we need you to do something. You're gonna do something from nine to five. It can't be traveling with your family. It can't work with pharmacies.

It's gotta be a hobby or something that you've wanted to do. And they say, you've gotta do it for 40 hours a week for a year. What's that gonna be for you? 

Michael Hogue, PharmD: Well, that's a great question. Uh, I've always said that if I could have a second career, I'd be a travel agent. Uh, a tour guide. I remember when I had a chance, uh, to take a group of pharmacy students to London and study the British healthcare system for about, uh, Uh, two weeks.

And, um, I watched the blue badge, uh, the blue badge tour guides in London and how passionate they were about telling the history of London and the stories that go along with each of the buildings and, uh, all of the things in London. And I just thought that was so much fun. And, um, I think I'd probably be.

A tour guide, uh, 40 hours a week if I had the opportunity because I love history and I love to travel. So that's probably what would be my second career. 

Mike Koelzer, Host: Well, I know that was just a fictitious question, but it's not, like you said something like, you know, you're gonna join the NBA or, or something like that.

So I think you actually have a shot at doing that in a few years. 

Michael Hogue, PharmD: Well, maybe so maybe there'll be an opportunity for me to do it. I certainly enjoy traveling. 

Mike Koelzer, Host: Well, Michael, we appreciate everything you're doing. Thanks for your words of hope. I know I'm gonna get on to send a letter and I'm even gonna make those phone 

Michael Hogue, PharmD: calls.

That's critical. That's exactly right. So just remember those two things, make your phone call to your member of Congress and go to pharmacist.com and, and send in those letters. It's 

Mike Koelzer, Host: critical. All right. We're gonna leave it at that because it's so important. Thank you, Michael. Thank you. Appreciate it, Mike.

Thanks for all you're doing.