Impact at the State Level | E. Michael Murphy, PharmD, Advisor State Government Affairs at APhA

Speech to text:

Mike Koelzer, Host: [00:00:00] Michael for those who haven't come across you online, introduce yourself and tell our listeners what we're talking about today. My name 

Michael Murphy, PharmD: is Michael Murphy. I am an assistant professor for clinical pharmacy at the Ohio State University college of pharmacy and the advisor for state government affairs at the American pharmacist association.

I think where we can focus our conversation today is really this unique opportunity that we see within states to advance pharmacy policy, to get more patients, better access to pharmacists provided care. And that's exactly what a PHA is focusing on with building out their state government affairs team, finding ways to better support states and state pharmacy associations to achieve exactly what we go to school for so long to do as pharmacists to best take care of our patients.

It's 

Mike Koelzer, Host: cool to me to hear you say that a P H a is there for the patient still and giving patient care because as a business person and some of the listeners being business people, we wanna say, alright, jump over that. Where's the damn money? Come on. I'm running out of funds here, but ultimately if we're not as pharmacists able to give care to the patient, ultimately the whole thing dies to the ground because that's ultimately how our payment's gonna be there by making people better.

Mm, 

Michael Murphy, PharmD: exactly. And, and that really, from my perspective is where we can focus, because if we can showcase to our patients from across the country, all of the different services that we can provide, then. We can start to see more demand for those services. More patients want to come in to receive those services for our patients.

Now we have to overcome those initial legislative and regulatory hurdles. And after that really, once we can see that there's the potential for revenue generation from pharmacists, that's where we. Switch things over, the patient care models can adjust. Uh, maybe community pharmacies can adjust the types of services that they're providing to patients.

And now it's actually a sustainable financial business model for them. And we see more patient demand coming in for these types of services. So I, I completely agree. I think that we need to focus on the patients, but if we're doing what's right for the patients that revenue generation's gonna come, we're gonna be able to create sustainable business models for members of the profession of pharmacy.

When I've looked at 

pharmacy, 

Mike Koelzer, Host: I've kind of looked at our, well, let's just say the independent world where I live mm-hmm and I've looked and I've. Well, it's kind of like someone with a cancer diagnosis where you've got to have enough saviors to come in and give someone saviors being a doctor or a new medicine, or hope that the patient has to make it to Christmas or whatever the, whatever the savior is to give somebody six more months to say, all right, now we got six more months.

Now let's see if there's better medicine out and things like that. So I think that the payment models with the force that we can come in with legislative action and with judicial action with the different states coming in front of the Supreme court and so on, that's good. That might give us six months, but then we cannot lie there in a coma for six months, hoping that we hit the next financial crisis.

Jackpot for lack of a better term. It feels like a jackpot in our world of losses. But during that time, when some new life comes there, that's where we need direction. Like your giving of saying, all right, fine. We got six more months out of it, but now we have to add value to it. 

Michael Murphy, PharmD: Hmm. And that value creation, I love that you hit on that because that is such an important piece of this.

You know, we can pass expanded scope of practice laws all over the place in states across the country. But if pharmacists aren't. Uh, walking through that door. Once that door is open and patients are coming into the pharmacy door to look for those types of services, then it doesn't matter all of these laws or regulations that we're passing.

We need to be able to showcase both to our patients and to other members of the healthcare teams, our physicians, our nurse practitioners, our physician assistants showcased the value of pharmacists provided care, both the therapeutic and economic value that can come from the care that we provide. And that is how I believe that we will really start to drive increased demand for the services that pharmacists can [00:05:00] offer to our patients.

And, and as I mentioned also to these other healthcare professionals, Why 

Mike Koelzer, Host: is the state so important in your job of saying this is a state governmental affairs and not just like governmental 

Michael Murphy, PharmD: affairs, a PHA has a broad government affairs department, and I am lucky to be, uh, one piece of that overall team really focused on state issues.

You know, we have individuals that are focused on our federal issues, what's happening in, uh, the capital. And we have individuals that are focusing on all of the different regulatory agencies, the FDA, the CDC, the DEA, we have individuals that are helping to provide support and guidance. So pharmacists know exactly what is happening within all of these different agencies.

And if there's a need for action from members from across the country where we've recognized that there's so much opportunity is within. Is within the states. Hmm. Because the states are oftentimes where legislators, lawmakers can be a little bit more nimble. Things happen a lot more quickly in the states.

And oftentimes when you see Congress passing a huge legislative package, they're usually looking for states for some innovation to see what's worked, what hasn't worked and where can we take some of those lessons learned, apply and apply it to nationwide change. So where I see so much opportunity is to pass great policy at the state level and pass it in multiple different geographical areas and showcase all of this value that we've been discussing and hope that because of our strong partnerships within our overall government affairs team at a PHA that can result in national change.

Mike Koelzer, Host: One time. I talked to a county commissioner and I asked her where her direction and her political life was going to go. And she said she wanted to stay at the county level. And back when I was a kid, I'm like, ah, that's BS. You just probably can't win anything else. , I'm just thinking everybody wants to just like move up and get the power and the popularity and things like that.

But as I age and realize that I'm never gonna have a political future, I haven't tried. I know I never will. But as I age, I can see the personal satisfaction of dealing with levels where I really know I'm making an impact. And I forget who I was talking to, but an earlier guest and they were saying that at the state level, you're still talking to.

Let's just say, politicians who really have a handle on certain areas, even of certain areas of the city where the pharmacies are, but at the federal level, even though you're dealing with, let's say house representatives, their area might feel a little bit too big to some people. And so the state level, especially the state, I guess, house representatives really have a good feel on neighborhoods.

Michael Murphy, PharmD: Oh yeah. I completely agree. I mean, these are, uh, Individuals that are really embedded in their communities. And for many of them being a lawmaker is not their full-time job. There you go. Exactly. Oftentimes they are out, you know, maybe they're the local pharmacist. Yes. They could be, you know, uh, anyone from within that community.

And they're really embedded in it and can really listen to their constituents. One of my favorite quotes that I love to share, especially when I'm talking to students, is a conversation I was having with a past state rep from Ohio. And he told me that if he heard from five of his constituents about an issue, that wasn't a notice to him that that was a huge issue that he needed to spend a lot of time focusing on.

Five people, five people. I, and that, I mean, that's almost, you know, you, you can call it five people and get people to call their legislators to talk about an issue. No problem. And that's where I really think that there's so much opportunity within the profession of pharmacy for topics around grassroots activism and professional advocacy within the profession of pharmacy to reach out in addition to your members of Congress, but also to your state lawmakers to form that relationship.

And you'll be surprised how quickly you can really create some positive influence and ensure that we are passing [00:10:00] policy. That advanced pharmacists provided care services. You 

Mike Koelzer, Host: started all this with a blog called the grassroot pharmacist, right? 

Michael Murphy, PharmD: Mm-hmm. Yeah. So me and a couple friends started that during the pandemic.

Uh, we had been, uh, me Nimit GLE and Lucy west, and, and then we brought on Matthew Wessling as well. Uh, we, during the pandemic saw on social media, all these changes that were coming so quickly, these rule changes, these legislative changes. And while we were seeing all these changes, we realized that there was sometimes some misinformation being shared around these topics.

Some confusion when it came to topics, even commonplace discussions within our profession, topics like provider status or scope of practice expansion. So we thought, what else are we gonna do? We're all sitting inside. Yeah. Uh, we, we might as well start a blog focused on something that we're really passionate about, which is ways that you, as an individual can advocate for these changes, can understand some of these big health policy changes and what you can do.

To really, uh, feel empowered in your voice to talk to legislators about these important issues. Now 

Mike Koelzer, Host: I gave you the benefit of the doubt saying that that was from your heart, but I do have to also. Let the listeners know that you're from the Ohio mafia. You've got Antonio, Antonio. Yep. And you've got Scott.

Yep. Both Ohioans. Yep. And you're just part of that mafia. And they said, Michael, do something to make it look like you belong. And then we're going to get you up here. What's in the sauce in Ohio? Why are you guys all powerhouses? in pharmacy leadership. 

Michael Murphy, PharmD: Well, we have been lucky, uh, to be a part of a time where the legislature really started to listen to pharmacists and the concerns that they were facing.

That's not 

Mike Koelzer, Host: luck that's because of you guys. That 

Michael Murphy, PharmD: is, and largely because of people like Antonio Chacha and also pharmacists that have been working very closely with the Ohio pharmacist association here in the state. I'm talking about people like Jen ROEs, St. Batty, Miriam, Misha, ODA. These are individuals who really helped to showcase to members of our legislature.

What are some of the challenges that we're seeing as a result of the pharmacy benefit manager industry and how can we work with payers to adjust the payment models for pharmacists to allow them to start receiving services, receiving reimbursement for their patient care services? And what we saw is we saw legislators get really excited around this idea of provider status or payment for pharmacist services within the state.

And we saw a lot of our managed care organizations recognize the potential for return on investment by incentivizing the pharmacist to do exactly what they're trained to do, provide patient care, set down, talk with their patients about their medications, and identify opportunities for improvement. And you know, what we saw, we saw patients decreasing their rehospitalization rates.

We've seen patients better understand how to use their medications, and we see both the patients happy with these services and the pharmacists. So excited to go to work, being able to sit down and talk to their patients and feel that patient connection and relationship building. It's so empowering to see, uh, all of that, that positivity coming from pharmacists, especially during a time when, in these past few years, it's been really hard for many of our community and independent pharmacists.

Mike Koelzer, Host: All right, Michael, but are you guys like the Beatles that you have some people that just happen to come together and then, I mean, you're all powerful on your own, right? And you come together and form the Beatles, those people you mentioned, let's say there's a half dozen. You mentioned another dozen that's out there that you haven't mentioned.

Why was Ohio there, some of you that got it going? Why are we seeing so much from there? What quality was in the couple, few people that got this going. 

Michael Murphy, PharmD: Mm, that's a fantastic question. Uh, I would love to say that Ohio is out there and they're completely unique and no other state is like them, but that's not true.

There are other states that have passed provider status legislation. There are other states that are moving [00:15:00] forward in pharmacists being reimbursed for their patient care services by these various payers, which was different in Ohio. And this is largely the work of Antonio Chacha was the ability to leverage the media, to get the media interested in this story.

And that's the reason that we see this. We've got a handful of reporters from Columbus and Dayton and Cincinnati that are constantly looking at these challenges within the profession of pharmacy and wanting to report on this. We have seen that fuel even national coverage. Now on some of these advanced payment models for pharmacist, patient care services, we, we see other states, I mean, Kentucky just passed a, uh, payment parody bill, uh, uh, recently to allow pharmacists to be reimbursed for their patient care services.

We need to be going out and talking with members of the media about these new opportunities for patients, because not only is this good for us to see this great press, but it's also important for our patients. And this is how we're going to drive value and demand for these patient care services that pharmacists can now offer and be reimbursed for in various states across the country.

Mike Koelzer, Host: Antonio, how did he get his PR in front of the press so much? Was it his persistence, maybe his enthusiasm. What do you think it was that the press saw in him that attracted the press to him? Hmm. 

Michael Murphy, PharmD: I mean, so the best person to ask that question would obviously be Antonio, but I can say, uh, from my perspective as someone that has, uh, definitely seen Antonio as a mentor, uh, that what he is so good at is sharing a story in a very abbreviated way that really hooks someone from the media.

And, and that is where he's been very effective. In addition to knowing how to frame it in a way that's really gonna get them interested. He's able to bring it. Data to support that. And that's exactly what you've seen in his consulting and research company, uh, that he currently, uh, is, is the leader of, yeah.

He's able to really showcase that research. And that's what pharmacists, I believe, need to be focused on to really get more media attention on some of these advancements. We need to understand how you frame the message so that it is enticing to the media. And how can you bring it with you? Some of those specific interventions stories that data that's really going to sell them after they've gotten hooked.

Mike Koelzer, Host: I had Tony on the show and I'm pretty sure his father was a pharmacist. And he decided pretty quickly during his first, uh, calculus class or something that pharmacy wasn't gonna be for him, but he's got the history and the data to bring that together, which is important because there's been a lot of whining and complaining too.

A lot of people know about pharmacy, but until you bring those numbers there, it's hard to move that forward. It seems. 

Michael Murphy, PharmD: Oh yeah, exactly. I mean, until you actually showcase to these lawmakers where the issue is and what is the data supporting the complaint, it's understandable to put yourself in the shoes of a lawmaker.

You have these individuals coming to you saying that, uh, this is happening to them in this setting, and this is happening to them in this other setting. It's hard for them to really put that together and see the bigger picture. And, and that's the reason that research and scholarship is so important as a piece of this overall policy puzzle.

Uh, we need more individuals out there publishing. Uh, challenges within the profession of pharmacy are ways that we can ensure that dispensing models are being reimbursed fairly so that patients can receive their medications. And in some of these advancements, I mean, we were just talking about the implementation efforts of some of these policy initiatives.

We need to be talking about ways that we can successfully implement these policies and ensure that we're sharing that across the country so that when a state passes a new law, they're not starting completely from scratch and figuring out what we need to do. They can say, oh, look, Tennessee did exactly this a few years ago and I can build off of their success and learn from the lessons that they learned in order to advance even more quickly, instead of having to start completely from the bare bones.

What am I even doing to implement this policy 

Mike Koelzer, Host: on the show? I talked to an attorney and we were talking about the Arkansas [00:20:00] versus the PBM, whatever 

Michael Murphy, PharmD: PCMA. 

Mike Koelzer, Host: Yeah. PCMA, whatever that is the organization that represents the PBM mm-hmm and she didn't wanna make it sound too easy, but she was basically saying, well, now that Arkansas can move forward with some of their complaints that were satisfied by SCOTUS, I'd be kind.

Surmises this from talking to her, but there's some states that they were so downtrodden that they didn't even have laws on their books pro pharmacy that could be enforced . So it's like, everybody's saying, all right. Yes, pharmacists can do this, but there were no laws that pointed to the direction that pharmacies even should go.

And so I can see in those cases, Sometimes it's not even the fight that these states have to put together. It's just the law to say, all right, now we have the law now let's 

Michael Murphy, PharmD: move forward. Yeah, exactly. And I mean, it really comes down to education and that's what pharmacists are so good at, is providing education to our patients.

We just need to change that audience, that audience change is going to be the legislator or the overall public to help them to understand what are the issues that we're facing and also the value that we can provide. And that's one of the things that I feel has been so effective in Ohio is utilizing the media to provide that overall education, both the education of the value of the pharmacist, but the challenges that our current pharmacists are facing.

And from that, we've seen people coming out and asking questions about. Pharmacy policy topics that I, I, I didn't have the wildest idea that they would even know about, but they come to me and they say, Michael, can, can you give a presentation on, uh, the pharmaceutical supply chain? And this is me giving a presentation at a, uh, a geriatric community, uh, center.

And they have an interest in this because they're seeing it, they're having discussions about it within our overall community. So that's where I feel like exactly, like you're saying, it's about providing education, uh, to our lawmakers and to our overall public so that we can advance these policies that we really wanna see, because at the end of the day, it's all about the patient.

And that's exactly what we're trying to do. Make sure that the patient gets the care and the medications that they need to be happy and healthy. 

Mike Koelzer, Host: You know, Michael, if I was sitting here from a PHA and you weren't on board yet, I would say, let's hire this guy. Here's why I think that that three legged stool is so important.

I think I know I missed it years ago. I would go to political breakfast, you know, and we would just, we would either talk about pharmacy or maybe complain a little bit about the insurances, but we didn't probably do it effectively with both. You know, we probably focused too much on one, not enough on the other or vice versa.

That is so important. But then you gotta drop out of that quickly and focus on the patient. That's that big leg, because if you get too tied up in these areas of the PBM against pharmacy, it's easy to lose sight of that patient so that three-legged stool is important. And. I think that's finally though, where social media, maybe some of this long form content, maybe you being invited to talk at this senior home, even though you thought, why would they be interested in that?

I think that the whole level of awareness opens up. It's kind of the, with no disrespect to the Hollywood women, it's kind of the me too movement of pharmacy where there's so many people finally talking about this. People start to connect the Dots and say, oh, those three go together. 

Michael Murphy, PharmD: Oh yeah. I completely agree.

I mean, there has been a lack of education around the pharmacist for years. Two, the public and lawmaker's defense it's because our profession has dramatically changed in the past 50 years. My grandfather, uh, was a pharmacist when he graduated in 1959, the profession of pharmacy was dramatically different than what it looks like today in 2021.

And over the course of his 49, 50 year career, uh, things changed dramatically. So it's not surprising that there is, uh, lack of education and misunderstandings around the role of the pharmacist, but that's where we can. Really step up and ensure that we're not just [00:25:00] talking, as you said, uh, to ourselves about yeah.

Issues within payers and PBMs and, and you know, our focus on the patient. We need to share that externally. We need to be joining, uh, our community meetings. Like you said, uh, going out, talking to members of our community about what the pharmacist can do, how we can provide additional services. In addition to us joining and being a part of associations, like a PHA, we can also join, uh, larger organizations that are external to just the profession of pharmacy.

And talk about the role and value of the pharmacist and help to bridge some of that education gap. 

Mike Koelzer, Host: Give me an example of one of those organizations. Are you talking about some kind of a health or medical organization? That's not necessarily pharmacy, but you've got. Other people 

Michael Murphy, PharmD: listening. Yeah. Yeah, of course.

I'm thinking the American public health association, for example, has a section devoted to pharmacy. They already have individuals that are looking at this. We need more pharmacists to go there and talk with the physicians, the nurse practitioners, the public health experts to talk about what is the appropriate role and value of the pharmacist and what can we do?

How can we contribute to the overall healthcare team when, when it comes down to it? Uh, the pharmacist is the medication expert. And even though there has been a lot of misunderstanding around what the pharmacist can do, that isn't going to be solved by us remaining. Quiet. We need to speak up, get out there and talk with the other members of the healthcare team, our lawmakers, and our patients in the overall public to help them understand.

What is it exactly that we can do and how can they help us get there? 

Mike Koelzer, Host: So these organizations have the same conventions and crap that pharmacies do too. 

Michael Murphy, PharmD: Is that right? Oh yeah, of course. Really? Of course. Yeah. So, I mean, you know, in addition to you being a part of a local or state pharmacy association, that's gonna be advocating for you.

And in addition to you being a part of a national association, like a PHA to advocate for your, uh, your profession at the state and national level, you can be a part of, uh, External associations like the American public health association, uh, the American heart association, there's, there's an association for everything and you can be a part of these associations and help to provide some of that education.

Like we were just discussing and, you know, being a part of that overall community and discussing some of the important things happening within the profession of pharmacy and within the healthcare system. Overall, that's really 

Mike Koelzer, Host: interesting cuz whenever I think of like the American heart association, I rarely think of an association.

I think of it just like that. This envelope that shows up to my house and I throw away , you know, I don't think of that as an organization, but they have trade shows and stuff 

Michael Murphy, PharmD: like that. You think? So? Uh, I, I don't know the specifics around the American heart association, but I would be surprised if they did not have, uh, different conferences that they put on similar to some of our different professional associations.

Now their, their, their focuses are obviously different. They're focused on cardiovascular health, but you know, the members of these different associations can come together to advocate and, and talk about the issues that are relevant to that overall association. And pharmacists should be a part of that overall conversation.

Do you like going to trade shows? I, I mean, I did in the past, I love to go to conferences. Um, and, you know, walk around and get to talk to everyone. It was one of my favorite things to 

Mike Koelzer, Host: The wholesalers would force you to go to their annual show, you know, and they'd give you a discount. So I'd walk down the main aisles.

And I didn't want anybody talking to me or catching my eye or something that I hated. And some people would come out and, you know, Hey, do you want to try a, do you want a Tootsie Roll or something like that? You know, I hated that. My opinion, they should put all of them behind glass. And just let me go up and look and let them be like zoo animals in there, just doing their thing.

I don't want to talk to those 

people. 

Michael Murphy, PharmD: You just wanna be window shopping. I, I can understand that 

Mike Koelzer, Host: I wanna 

window shop and occasionally pick up an ice cream. Goody bar or something like that. They have, I just want a window shop. You do see a lot of people there talking to those people. I suppose if I was interested in something and maybe in my old age, in the store, I wasn't really open to a lot of new stuff.

It does give you a really good chance to sit and talk to those people for a long time. And they probably appreciate it. They probably get bored just standing there. Well, 

Michael Murphy, PharmD: and especially for [00:30:00] someone like me that you know, is a natural extrovert and just, uh, has been missing, uh, being able to, to talk with people.

I, I can't wait for the next time that I'm in an exhibit hall and getting to be around all those people and talk about all the exciting things 

happening. 

Mike Koelzer, Host: Are they starting up now? Let's see. I guess they were always in the summer. Were there any really big shows that you know, of like a PHA was your annual already 

Michael Murphy, PharmD: or so our annual was in March.

Um, it was a, uh, virtual annual, yeah. This year. Um, our upcoming annual, um, is in March of this coming year. And, um, at, at this time it is, uh, planned for, in person in San Antonio. So I'm excited to see everyone there. That's gonna 

Mike Koelzer, Host: be a, you know, kind of a thrill to get everybody together, again, eating together and all that stuff.

Michael Murphy, PharmD: That's pretty cool. Oh, it's gonna be fantastic. I can't wait. I've got a countdown going. Yeah. 

Mike Koelzer, Host: So Michael, you are a assistant professor and I, I always see still, like when I'm looking in pharmacy schools and you see some of these old people, I mean, older than I am even, I remember being like, let's say I was in school when I was in my early twenties or whatever, and you'd see, the professors were probably, they seemed like.

Old Farts but they were probably 30 and now they're probably 60. And you still see the assistant professor. What does that mean? When do you get to be. like the king 

Michael Murphy, PharmD: the king I'm I'm guessing that is a full professor. Yes, yes. Status professor. Yeah. Yeah. So there are, uh, different tiers of professors. Um, when you generally are coming into an academic institution, uh, you come in as an assistant professor, you stay at that assistant professor level, uh, for a certain number of years based on your contract.

And after so many years you put together what's called a dossier, or it's essentially a portfolio of all of the stuff that you've done, everything that you've done with teaching, with scholarship, with service, and, uh, with your practice setting, you put that all together. And you submit that both to internal and external reviewers to go up for promotion.

If they, uh, if they give you the stamp of approval, then you, uh, then you evolve to associate professor. And then after so many years, you go through that process again and then become a full professor. That's the general way that things happen. It is, uh, it is dependent, um, based on that timeframe and the steps that you have to do, uh, dependent on both the college and the university as a whole, uh, there's specific policies within each academic institution, but that's the general.

Mike Koelzer, Host: So it sounds to be less about what you know, and really what you've gathered and kind of put forth. 

Michael Murphy, PharmD: And what I will say is that, that gathering of the, the research that you've done, the teaching that you've done, uh, the service that you've given back to the profession and to the college, that is a, uh, uh, an, an example of what you know, and what you've contributed to the overall college in that way, I suppose, 

Mike Koelzer, Host: the more, you know, the more you can offer.

So it's kind of a circular thing. Yeah, exactly. You were off then went back to get your MBA. 

Michael Murphy, PharmD: So, yeah, I have, um, I was out for a handful of years and have always had this interest in, in business and figured, uh, as an employee of the university, uh, I can get tuition reimbursement. So I, you know, during the pandemic, what else is there to do other than, uh, go back to night school?

So it's been a fantastic experience. I've really appreciated everything I've learned so far at the Ohio state university, uh, Fisher college of business, but it's been really, really impactful for me as a new practitioner pharmacist, especially someone that's so interested in the health policy field to better understand the business side, because as we all know, Everything always eventually comes back to money.

Yeah. And even if you're trying to pass policy, it's important to understand the financial implications of whatever policy that you're advocating for, because, uh, that's going to lead to either its success or demise with the specific legislator that you're advocating to. Do you have your MBA yet? No, I'll be graduating in spring of 2022 coming right up here.

Yeah. Yeah, almost there. 

Mike Koelzer, Host: Are you going to feel better having those? Initials behind your name when you're talking to people, because I know that the common thought would be well, no, Mike it's how much we know when it's the actual [00:35:00] training. I know all the stuff that you could tell me, but come on, Michael.

Seriously. Is it gonna be cool having that behind your name? So you can tell like the, uh, legislators, which often might be attorneys or something you can be like, Hey, I can match that. 

Michael Murphy, PharmD: Uh, you know, I, I can understand that perspective, you know, that's never really been, uh, the reason yeah. That I, I did this or, or really the, the thing that was really important to me, it was gaining that difference of perspective.

I've always been someone that's cared deeply about ensuring equitable access to healthcare. Uh, and knowing that I have this big focus on policy efforts, I wanted to better understand the business side of things so that, you know, I can use that right now in my career. And for whatever I have coming up on the horizon, I'll be able to better understand both, uh, what things are like as that practitioner, but also how the business side of whatever organization I'm working for, uh, is working.

What 

class 

Mike Koelzer, Host: So far it was the most interesting, or let's say interesting slash the most useful and what class so far would you think? Eh, that was maybe a little thick. That was maybe a little more than I'm either more than I'm gonna use or more than my interest was at when I took it. Mm. 

Michael Murphy, PharmD: So probably the most beneficial class that I've taken, I would say it's either a throw up between operations or any of the numerous leadership classes that I've taken.

The leadership has been really beneficial to understand. As I start to work with more individuals working with my students, how can I successfully mentor. Provide coaching to them, uh, to make sure that they're going to be successful. And from the operation side, that's been very helpful for me as I take a bigger look at the overall pharmaceutical supply chain and understand the different roles and pieces of that supply chain.

Because even though we're talking about medications, you know, yeah. Operations is operations, right? And supply chains are supply chains and there's similar characteristics to both, yeah. A class that, um, I feel like hasn't been as beneficial. I gotta say almost all of them. I've been able to get something really positive out even, uh, some of the classes, um, that I initially may have not been as excited for.

Um, one that comes to mind, uh, was focused on. Competitive analysis. And I wasn't really sure what I was going to get out of it. And I'm taking the class right now. So you'll have to ask me again at the end of the semester. Yeah. but, but right now it's been really interesting looking at the overall market of a specific industry and doing an analysis to understand what are the different trade offs that organizations are providing to really showcase the value of either the services or products, and being able to compare that when making decisions of what trade offs you want to make in order to differentiate yourself from other, uh, firms within an overall industry.

Mike Koelzer, Host: Back years ago, when I graduated from pharmacy school, I worked for a few years and I decided to go back and get my MBA. Well, I decided to go, but I never did because here's why I had to get accounting, which was one of those classes. When I talk about something that's a little bit too thick for me, it would've been accounting.

So I had night classes. So three weeks in a row, Monday, Wednesday, Monday, Wednesday, Monday, Wednesday. And I hated it. I couldn't stand it. It was four hours of class on Monday, followed by doing homework Tuesday for the whole week, cuz it was four hours. You just came back to take another four hours on Wednesday, which was another week of classes, really cramped.

So I did this pattern Monday, Wednesday, Monday, Wednesday, Monday, Wednesday. Well then the 4th of July came on a Monday and then the second semester was gonna start up. So I. Anybody would just figure that you don't start a semester on a Wednesday after the 4th of July on a Monday, it naturally is gonna start the following Monday.

Next Monday, I'm waiting for the teacher to be up there, smiling and saying, all right, let's all get in a circle and tell people, you know what our name is and who our favorite Disney character is or something like this. I'm waiting for one of those days. This guy's already like writing on the board.

I look at the person next to me. I'm like, what's going on? She's like, well, we're, you know, we're five hours into this because they had started [00:40:00] class on the Wednesday instead of on the next Monday. Oh no. Who would do something like that? so my decision for my MBA, I'm like, I'm already gonna be eight hours behind on accounting, which I hated.

And so that was the last time I sat in the classroom when I was sweating bricks and closed my book and decided to walk out forever. 

Michael Murphy, PharmD: That's quite the story. And I can, I can understand that as well. I mean, starting a class on Wednesday, right after the 4th of July, that that's a 

Mike Koelzer, Host: challenge. It's almost like the college had something out against me.

I can tell. I don't take no, I'm just joking. 

Michael Murphy, PharmD: I I'm sure they were thinking exactly about I'm sure they had it out for 

Mike Koelzer, Host: me. I know they did. I know they did. No, but commonly I think MBA classes would be interesting. I think it's kind of a cliche when people say you don't need MBA classes because it's a bunch of accounting and a bunch of stats and all that kind of stuff, but you had mentioned there's some cool leadership classes.

I mean, mm. It's probably pretty cool. 

Michael Murphy, PharmD: Oh yeah. I, I think so for sure. I mean, don't get me wrong. Uh, you, you don't need an MBA and I, I don't think that it's a requirement to be in a leadership position. Yes. But for me, I figured I was at the time in my career where it made sense. I had the, I had the time, uh, in my, you know, both personal and, and professional life and I figured I might as well go, go back, get some education.

Also, I'm a nerd. I love going to school. And I figured I might as well keep going while I still can. 

Mike Koelzer, Host: Was there any degree that was curious or. that tempted you versus the MBA or would it have been pretty much the MBA or maybe nothing else right 

Michael Murphy, PharmD: now? Oh, I mean, I, I was thinking about a master's in public health as well, especially over the past couple years, we've really seen our public health officials, uh, and the impact that they can have on our overall community.

Um, but ended up going for the MBA really because of my interest on the business side of things and, and better understanding, um, that when it comes to the policy efforts I'm gonna be advocating for. But, uh, who knows maybe the MPH is in my future, but I'll definitely have to get the approval from my wife, Robin first.

Mike Koelzer, Host: Do you think there's another duration of school in there somewhere? 

Michael Murphy, PharmD: Uh, we'll see. I'd like to catch this football and run across the, uh, run into the end zone before I start planning my next play. Right. 

Mike Koelzer, Host: So you're weak then. Michael. Are you actually teaching some things? 

Michael Murphy, PharmD: Oh yeah, of course. What are you teaching?

So this semester I teach a class called healthcare, citizenship, uh, advocacy and change making. And what this class is for undergraduate students at Ohio state university. So we've got pre-pharmacy students, pre-med, pre-nursing, uh, we've got some people from our John Glenn college of public policy.

Uh, we've got all these different students. And what we do is we talk about how the US healthcare system is built, and better understand that system. And then we talk about all of the different members of the overall healthcare team. And we bring in experts from each of these different professions to talk about what is your role on the healthcare team and what are the specific issues that your profession is facing?

And what you would be surprised to hear is just how we're. We're focused on patient care. That's the end all be all goal for us with pharmacy policy. It's the same with them. Their focus is on what they can do to best help the patient. And what I really hope that we can do through this class is to build change makers that can understand how the system works and what you can do to appropriately influence and create change within the system.

And by better understanding all the different professionals that make up the healthcare team, we realize that instead of us fighting against each other, we should be working together to advocate for these changes to improve the overall system. It's cool that 

Mike Koelzer, Host: we're in a profession that financially rewards us.

If we do. A good job of helping people. And what I mean by that is there's some jobs that let's say like a stock broker or something like that. They might have a lot of different end goals, but. The real end goal is to make money for everybody. Now you can say, well, it's really to save marriages because you're gonna send people who make money to Hawaii and have a second honeymoon and all that.

I know that, but I mean, that's a stretch it's really to make money, but in healthcare there's a very tight correlation between, Hey, if we help people, we can [00:45:00] pretty easily show how we can make more money doing this. It might take some legislators and getting the PBMs outta the way and things like that, but it's a pretty tight and a pretty cool correlation.

Michael Murphy, PharmD: Mm-hmm I completely agree. And that is exactly why we are seeing more of a transition within our overall system to value based healthcare and to identify what are the specific clinical quality metrics that we can use to honestly grade the value of care that our healthcare professionals are providing.

And how can we measure that and appropriately, financially incentivize that, so that we allow for our professionals that are doing a really good job to continue to do a really good job and expand the types of services that they're providing to their patients. Because like you said, they're helping more and more patients get healthy.

Mike Koelzer, Host: Yeah. That's a damn irritating thing about the PBMs is that they pulled off so much money, but it didn't change a damn thing about. Healthcare, you know, if anything, and added a ton of money into the equation. And I know there's COVID and things like that, but our life expectancy hasn't improved or things like that.

It just was a big 

Michael Murphy, PharmD: fiasco. Oh, yeah. I completely agree. Especially in our public insurance system where I really see the most dramatic impact is at either end of the spectrum with the patients at the end of the, at the end of the line that may see additional costs and higher copays for their medications.

And at the other end of the spectrum are taxpayers that paid more and more money than they needed to. And if that didn't, that went into this black box that we didn't, weren't able to completely follow where this money was going and it wasn't appropriately allocated. So I, I, you know, of course we can talk about pharmacist issues.

And I know that you've talked about this on your show previously, but, but, my big focus is on either end of that section and ensuring that taxpayer dollars are being allocated appropriately. 

Mike Koelzer, Host: When you say the one end, you're not talking about end of life, you're talking about people that just really need healthcare, right?

Yeah, 

Michael Murphy, PharmD: exactly. So, at either end of the supply chain, I gotcha. 

Mike Koelzer, Host: Do you think the PBMs world history just repeats itself? Do you think if this was thrown into a different period of time, 

Michael Murphy, PharmD: Potentially. I mean, the reason that PBMs were created was because drug prices were skyrocketing and these, these industries came in and, and said that, Hey, we can provide, uh, and, and be a middleman between all of these different stakeholders and help to negotiate prices down.

And for a long period of time, they did help. And there's, there's evidence to support that they did help bring down the price of medications, but, uh, over the course of many years, because of, of variety of different variables, um, one piece being, and that's the reason that we're seeing more laws pass is an ineffective amount of government oversight.

And regulation into the marketplace, uh, and problems with misaligned incentives within the PBM industry, the PBMs have done exactly what is aligned with their mission. Many of them are for profit industries and they have been very, very profitable. So how do we ensure that those misaligned incentives do not end up harming different pieces of that supply chain, the taxpayers, the pharmacies, and in the end, all patients that are receiving the medication.

We can do that a variety of different ways by ensuring that there is appropriate oversight and that there is enough sunlight coming in and transparency in how this overall system is working. 

I 

Mike Koelzer, Host: always said I wasn't a big one for the government sticking their nose and stuff, but. Sure. Seems like they should do it now.

I mean, you can talk a lot about supply and demand and let the free market run its course and things like that. But it seems that when you've got sneaky deals and dark alleys and things like that, it's hard for nature to run its course without someone saying, Hey guys, here's the rules let's play by the rules at least.

Michael Murphy, PharmD: Yeah, exactly. I mean, what, what, [00:50:00] what's the term, the invisible hand, the, the invisible hand that guides the supply and demand of our free market. Uh, there's something wrong with it within the healthcare industry and, and specifically within our pharmaceutical supply chain. So we can either continue on and say, Let's hope that this solves itself, or we can take action.

And one of the ways that we can take action is through passing legislation and regulations to ensure that there's appropriate oversight. And that we were talking about Arkansas earlier. That's exactly what they did. And they won their major SCOTUS case showing that it was, uh, that it was allowed. 

Mike Koelzer, Host: I don't think this is in your budget, but let's just pretend that you had a private jet all right.

And unless this was an important part of it, you didn't have your school duties right now. You were just the PHA duties with state governmental affairs, and now we're coming out of COVID and you have this private jet. What would a week look like for you? If you were flying around meeting governors or going to different states and then popping back to the US capital every so often, what would you do with a private jet to really make an impact on you?

Michael Murphy, PharmD: Well, let's also throw in the assumption there that, uh, this is a free private jet because I, of course, would be spending all member dollars appropriately. It's a free jet 

Mike Koelzer, Host: that you don't have to worry about the environmental footprint or the cost or whatever. I'm gonna lend you. My private jet now, what are you gonna do with 

Michael Murphy, PharmD: it?

I would love to be going and working with state pharmacy associations to support them in their efforts, to get pharmacists paid for their patient care services and advance different policy efforts. So for me, You know, I would probably start off flying over to Colorado and meeting with Emily. Who's their executive secretary there at the pharmacy association and talking about some of the conversations that they're having right now with their department of Medicaid to begin the process of figuring out how do we enroll pharmacists as providers within the state.

Then maybe I would take John over to Hawaii. I had a fantastic meeting with them. Uh, last week I met with members of their state pharmacy association and also the Dean of their school, uh, of pharmacy. And we were talking about, uh, some ideas around new legislation that could be introduced to allow pharmacists to be reimbursed for their patient care services.

Uh, so after heading to Colorado and Hawaii, you know, maybe I would head back to DC, uh, to meet with Scott and Antonio and different members of our government affairs team at a PHA. To talk about new and exciting advancements and the policy that we can work on advancing to get patients the care that they need.

So definitely a lot of travel, uh, but a lot of good conversations with different stakeholders and, uh, especially state pharmacy associations. 

Mike Koelzer, Host: You know, what's interesting because the jet I was talking about who'd you meet with? And so on, it sounds to me like the states are different enough and even have different personalities that you should be actually talking to them because they all have different needs and I'm imagining different histories and different politics.

Oh yeah. And I wasn't getting at this with the original question, but do you think the day and age of having to physically go places versus video meetings, do you think that there's going to be a resurgence or a need for those in person meetings is something lost in video? 

Michael Murphy, PharmD: That's a great question.

I think for those high stake meetings, uh, especially with important or influential individuals. You can't beat a face to face, set down, meeting, even an extended meeting, going out to lunch and really getting to know someone, that relationship building you, you lose some of that. Some of it's all, it's all business, really, you know, you do the, if you're, you know, from the Midwest, like we are, you do the 10 minutes, uh, get to know each other at the beginning of a call.

Yeah. But it's not the same as sitting down for 90 minutes over a lunch or a beer and getting to know someone. So I think that we've definitely seen a lot of opportunity from zoom and teams and the different online softwares. And you know, some of the travel will not be necessary, but for those really important [00:55:00] meetings where you really need to, to sell something or to make that final deal, at least from my perspective, I think that's still gonna happen in person.

It's 

Mike Koelzer, Host: different. Not being in person. It really is. Yeah. Maybe it's like, well, we don't need six meetings in person a year, but you should have one. So like you say, you can go to lunch and then drive in the Uber together to the airport, whatever. I mean, there's, there's relationships that are made and then maybe the next time you're on the video or something like that.

But there's certainly room for that still. 

Michael Murphy, PharmD: I think so. And especially if you're working, um, on something that is potentially sensitive or, or you're not quite sure if you're actually gonna form a partnership. I think being in person, uh, is one way to actually showcase how. Intentional and valuable, you see the potential partnership being.

And I think that it really shows, um, whatever organization you're representing is willing to invest the resources to actually take you there and, and showcase that there's something actually there and there should be some incentive to go into business together. 

Mike Koelzer, Host: Where do you think you'll find your joy in like three years from now?

What percent of your week would you like to have where in front of the students versus sitting in meetings at a PHA versus meeting with state governments? If you could break your week down into like percentages, like five, 20% are 10% and 30%, how would you. That down. 

Michael Murphy, PharmD: Mm. Yeah, that's a good question. I would say probably 20% of my time working on teaching, uh, directly with students 20% of my time, probably focused on research or scholarships.

So I do research on all these things that we're talking about, policy implementation, what's happening in the states. How can we take some of these lessons learned over here and take them over here? Uh, and then that remaining 60% of my time probably split in half, uh, both focused within a PHA meeting with individuals to talk about the things that we're doing and ways that we can advance our policies and the rest of that.

Working with states or state pharmacy associations, state legislatures, and other members of national associations to advance. Exactly what we're talking about. Uh, the different policies and advocacy efforts to get pharmacists paid, to expand our scope of practice and to ensure that there is, uh, fair and sustainable reimbursement for the medications that we're providing to our patients.

Mike Koelzer, Host: It seems like when I talk to some pharmacists, they talk about still wanting to be with patients because it kind of gives them life. And so on. It sounds like I'm hearing from you that maybe the students are the ones that keep you young and motivated and then that's the future and that kind of thing.

Michael Murphy, PharmD: Yeah. I love getting to work with my students. So I, I teach both in our undergraduates, uh, courses, but also in our doctor of pharmacy courses here at Ohio state. And. Feeling that energy, getting to work, uh, with them and talking about really these exciting advancements in the profession. I, they get excited, gets me excited and, and it, it just really gives me the energy for all these other exciting things that I'm working on in 

Mike Koelzer, Host: a college.

Like the Ohio state university, what are the actual requirements of teaching at college level? Is it BS? Is it having a doctorate? What's the level of bringing somebody in? 

Michael Murphy, PharmD: Hmm. So it really depends on what that person is teaching and, um, also that person's past experience. Uh, so, so for me, um, I just came on board at the same time as a couple other new faculty members.

We had gotten residencies and also completed postgraduate fellowships focused in academia. Uh, so we had a lot of postgraduate training. Uh, there are some other individuals that just recently started. They had graduated with their pharm D and they had gone out in practice for, uh, five to 10 years. Got a lot of really, really good experience and then transitioned over and wanted to teach and give back a lot of that experience that they had gained to their students.

So it depends on the institution, what their requirements are, but, uh, if, if you have a good experience and if you've got some, uh, good experience in also teaching students both as a preceptor or in larger lecture workshop type of teaching, then you know, I, I would say, uh, look for a job application and, and throw in your name.

You never know what's gonna happen 

Mike Koelzer, Host: [01:00:00] on your LinkedIn. I don't know if you know this, you know how you can follow people. Sometimes you don't even know you followed 'em, but you follow bill gates on your LinkedIn profile. 

Michael Murphy, PharmD: Oh, I had no idea. Okay. 

Mike Koelzer, Host: Well, I don't know if he follows you. Maybe he does. I could check back anyway.

Let's say he doesn't have a degree. He could probably teach a class at Ohio State if he wanted to. Right. Oh, I'm sure. Grade school. Sometimes you have to have to be a teacher. You have to have a grade school teaching certificate. But I imagine for college, it has to do with who you are, what, you know, maybe when it gets into a certain doctoral program, you have to have this or that.

I'm not sure. . 

Michael Murphy, PharmD: Yeah, I, I'm not sure. And like I said, when it comes to a lot of the academic institutions or even the specific colleges, they have specific policies, um, that they need to follow. So generally, um, I, I would say that many of our faculty members have either a Pharm D or a PhD or some type of, um, master's level education.

Um, many of our faculty members, um, have that level of education, but, but some individuals have had different experiences that support, uh, exactly the expertise that they're sharing with their students. 

Mike Koelzer, Host: On your jet. Well, excuse me, on my jet, which I'm loaning to you, you've gifted to me, loaning loaning.

What level you only get to pick one, a level of a state government that you get to talk to. You get to pick one. It can either be the head of finance in the state, whatever the hell that would be, or the governor or the, you know, whatever the state has. And you only get to pick one level of federal government.

Who would you fly out and talk to? What's the name of that department in the state you would talk to, to have a lunch meeting with and who would it be on a federal level to talk to? 

Michael Murphy, PharmD: Hmm, that's a good question. I would say I would potentially. I feel like there's no need to focus on some of the states that have recently passed legislation or are already in the process of advancing some of the things that we're talking about in one state, uh, where I think that there's a lot of opportunity is Indiana.

They have been working very closely with their department of Medicaid, um, and, and several individuals from Butler university and the Indiana pharmacy association. Um, Veronica Vernon, um, a as well who works very closely with, uh, with both, um, has been working closely with their department of Medicaid, uh, to talk about some of the advancements of how pharmacists can get paid for their patient care services.

Right now, pharmacists can actually receive, uh, tobacco cessation reimbursement for providing those services to patients. So I would love to sit down with, uh, maybe the chair of their Senate health committee. And talk about, uh, the important things that pharmacists can do in addition to just pro providing tobacco cessation counseling, but all of the different services that pharmacists can provide and the need to expand pharmacist's ability to do that through appropriate financial reimbursement for those services.

So that's probably who I'd talk to on the state level, feds, feds, you know, I, I, I would love to sit down, um, with, with a lot of people, uh, at the federal level, but I, I think setting down, um, with the chair people, um, from the committees where the pharmacy and medically underserved areas enhancement act, which is the Medicare pharmacy provider status bill currently is referred to and talk to them about.

What we are seeing in the states and the return on investment that those governments are seeing and the need to work with pharmacists and incentivize them more and leverage them to provide the patient care services through allowing them to be reimbursed under Medicare part B. So I think talking to those specific chair, people within those committees could help.

Showcase the importance of prioritizing this legislation, uh, which would lead to hearings and more discussion within the overall, uh, policy process. 

Mike Koelzer, Host: So those might be senators or our representatives that are on different committees that then report back to that. 

Michael Murphy, PharmD: Yep, exactly. So on the house side and the Senate side, um, I, I, I can't remember the specific committees.

I think there's the ways and means, uh, and then a subcommittee on the house side [01:05:00] and then the finance committee on the Senate side. But, but don't quote me there, our lobbyist at a PHA Alicia, Carrie Mico would, uh, definitely know the answer to that. 

Mike Koelzer, Host: Someone's listening to this and they say, ah, He's a, I had a guy tell me one time, he walked by me.

He said, this is a fairly intelligent looking guy. I'm like, I only got fairly from him. I dunno why, but they'd say Michael sounds like a fairly intelligent guy with a good direction. They're gonna get to their destination work or home or something. And they're gonna sit down at the computer and have about three minutes to do something.

What would you tell somebody who's listening to this to do with three minutes? Would you sign up for your newsletter? Would it be to go and send one of those form emails to someone in the government? Would it be signing up for a PHA, uh, or looking at the PHA website? What are you gonna tell someone to do with three minutes when they're done listening to this?

Well, 

Michael Murphy, PharmD: In addition to you joining a PHA, I would say before, even going and sending a letter to your legislator, look up who your five elected leaders are. Who are your leaders at? In the US Senate in your two US senators, you're a member of, uh, the US House of Representatives and then your state lawmakers, and just learn their names.

That is the first step of feeling more comfortable in reaching out to them. When an issue comes up, uh, us as being a part of this democracy, there are elected leaders and we can let them know when issues arise, but the first step is knowing their name. So that's where I would start with three minutes and it can take you probably even less than that.

It's not 

Mike Koelzer, Host: rocket science. You probably go in and put your zip code in and say, who are my leaders? And I think it probably gives you a list, doesn't it? Oh, 

Michael Murphy, PharmD: exactly. You go on to Google. You say, who are my elected leaders? You type in your address and you can find exactly who they are. And then joining a PHA, we can show you, provide you the resources to use that information and how to effectively advocate to those individuals.

Mike Koelzer, Host: And you said it, some of these things are like, they gotta hear from like five people, you know, and I know the feds are bigger, but sometimes it doesn't take much. And these are humans. Well, arguably these are humans on the other side that aren't supposed to represent us, but it's true that they actually might represent us.

Michael Murphy, PharmD: Exactly. And it is part of your first amendment rights to be able to petition your government. If you have grievances, if you have an issue, it is your right to be able to reach out to your elected leaders. Uh, the first step is getting to know what their name is, how do you contact them, but then reach out and reach out and let them know your perspective on important issues within the healthcare system and profession of pharmacy.

Mike Koelzer, Host: Well, Michael, golly, this show was good. Having in the show. 

Michael Murphy, PharmD: Nice meeting you. Yeah, it was fantastic. Thank you so much for inviting me. You know, when you 

Mike Koelzer, Host: meet people, there's always like figureheads, you know, and I know that Scott and Antonio are just the figureheads, but pretty soon we get down to the people that really do the work.

And we're finally talking to 'em 

Michael Murphy, PharmD: Well, no, believe me, Scott and Antonio, they are the change makers. They're making things happen. They sure are. And I feel very lucky to get to work with 

Mike Koelzer, Host: them. It's really cool. Seeing what you guys are putting together, and I'm gonna tell you the Ohio, the Ohio Beatles. I already got Antonio and Scott at like John and Paul and you can be Ringo or George and they'll be another one in there somewhere too.

Yeah. Yeah. I'm sure. But the parts all came together there. So we really appreciate your guys' leadership. Keep it up. Yeah. 

Michael Murphy, PharmD: Thank you so much. And thanks again. This was a lot of fun. Thanks, Michael. We'll talk again 

Mike Koelzer, Host: soon. All right. Take care. All right. Bye-bye.