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From Political Novice to Seasoned Advocate: Getting Involved in Provider Status

Nov 07, 2014
Gloria Sachdev, Pharm.D., B.S.Pharm.

Gloria Sachdev, Pharm.D., B.S.Pharm.

MY POLITICAL “CAREER” BEGAN with some notes scribbled on a napkin at a Starbucks in the fall of 2007. It was just me and my department head putting our heads together and jotting down what would eventually evolve into a strategic plan to gain provider status for pharmacists in Indiana—a change that would open the way for Medicaid and other payers to reimburse pharmacists for clinical services.

Three years after that meeting, it seemed that the timing was right to share this plan with a broader audience. I set up a meeting with the president of the Indiana Pharmacist’s Alliance (IPA), an advocacy organization whose mission is to support and advance the profession of pharmacy in Indiana.

Though I had never met IPA’s president before, she was highly supportive and presented our idea to the Alliance’s board. They voted to add the effort to lPA’s legislative agenda.

This was great news as it meant that we would have the support of a paid lobbyist. At the time, I had no idea how critical it was to have that element on our side. Momentum was building, and though provider status was the principal goal, reaching it would require interim steps and time.

Setting the Stage for CDTM Expansion

Our first step to enacting provider status was to expand the scope of collaborative drug therapy management (CDTM) for pharmacists to encompass all practice settings. During the three years between that first coffee shop strategy session and my meeting with the IPA president in 2010, my involvement in CDTM included laying the groundwork to support CDTM expansion.

I set up the first CDTM protocol in an Indiana health system, collected outcomes data, expanded the role of pharmacists in direct patient care in my health system, and worked to help other systems achieve the same.

Shortly after meeting with the IPA president, I found myself in the world of legislation development when I was asked to be IPA’s legislative chair. My intent was to share an idea, not to lead the charge.

I accepted with a little bit of hesitancy. Despite having no idea what the bill process was, I assembled the best team of colleagues I could think of and dove in. My team drafted a CDTM bill in six weeks, worked tirelessly researching CDTM laws in other states, built a grassroots network, and developed marketing materials.

For the next several months, I was immersed in the murky, perplexing, often disorienting arena of state politics. Luckily, experienced government affairs experts from IPA and ASHP guided me through the maze.

Unlikely Bedfellows

We spent considerable time rallying support from influential professional groups, including the Indiana State Medical Association, which originally opposed our CDTM bill. I met with them and explained the role of the pharmacist in team-based care and was able to bring them around to taking a neutral position.

As a community, we wanted more pharmacists to function at the top of their licenses.

We could live with a neutral position vs. an opposing position, which would have assured death for our bill. After months of negotiations, ups and downs, and sudden, unpredictable swings of fortune and momentum—not to mention a walk out by the entire Democratic delegation of the Indiana House of Representatives because of a completely unrelated issue—the governor signed the CDTM bill into law!

It was a significant victory, but that was just the first step. As a community, we wanted more pharmacists to function at the top of their licenses. So, from 2011 to 2013, we held several educational programs, passed additional bills to expand pharmacist immunization scope, and added a statute to ensure that “pharmacist services,” not just “pharmacy service,” were recognized by Indiana state Medicaid.

Our upcoming challenge in the 2015 state legislative session is to develop a provider status bill that delineates scope and payment for pharmacist-provided MTM services for the Medicaid population. The last rung on our ladder will be to get private carriers, such as Anthem and United Health Care, to recognize pharmacists as providers.

A Key Seat at the Table

Since 2013, it has been my pleasure to be state Sen. Ron Grooms’ MTM senior policy advisor. He is a retired pharmacist and pharmacy owner. My role is to keep him current on relevant issues, assist with legislative language, develop marketing material for lobbyists and other legislators, and help organize grassroots efforts.

From left, (front row) Indiana state Sen. Ron Grooms and Indiana Gov. Mike Pence; (back row) unknown bill supporter, Gloria Sachdev, and state Rep. Steve Davisson

I also have the privilege of supporting state Rep. Steve Davisson, a practicing pharmacist in an independent pharmacy in rural Indiana. Thanks to these gentlemen and the support of the pharmacy and medical community, we’ve had tremendous success over the past four years.

Both of our pharmacist legislators were up for re-election Nov. 4, and both won handily. I was happy to help Rep. Davisson by asking a pharmacy resident at the Purdue Center for Medication Safety Advancement, a former student of mine, to help organize a student telethon. She and a pharmacy student got 20 other pharmacy students to call on voters three separate evenings. My primary role was to pay for pizza and drinks.

Though I am not sure where my policy path will lead, I am excited to be part of the process of change and share that passion with the next generation. I established an elective legislative clerkship rotation at the State House several years ago in which students have the opportunity to spend one month with various legislators.

This fall, it is my great pleasure to be the course coordinator for a new required health policy course at Purdue. In this course, students are exposed to the nuances of policy analysis and development on current hot topics.

In terms of the important advocacy work that ASHP is doing on provider status, namely bill H.R. 4190, it’s important to note that this bill defers pharmacist scope of practice to each state’s practice act. Thus, working at the local level allows us to expand our act to assure pharmacists are permitted to function at the top of their licenses. It has been my honor and privilege to work with the ASHP’s legislative team on H.R. 4190 and to be on their Council on Public Policy this year.

From Political Novice to Seasoned Advocate

It’s still hard for me to believe that before I began working on the CDTM legislation in 2010, I had never even written a letter or sent an email to a state or U.S. congressional representative, had never made a phone call, or participated in any political endeavor.

I truly believed that my contributions would not make a difference, and therefore, I did zero.

But I owe the 2010 IPA president tremendous gratitude for giving me the opportunity to be involved. There is something to be said for just diving (or being pushed) into the deep end of the pool. I now know that every voice counts, every call counts, every letter counts.

Change occurs whether we choose to be at the table or not. To have the future we want as individuals and as a profession, we’ll must rally and be present.

 –By Gloria Sachdev, Pharm.D., B.S.Pharm., Clinical Assistant Professor of Pharmacy Practice, Purdue University College of Pharmacy; Adjunct Assistant Professor, Indiana University School of Medicine; President and CEO, Sachdev Clinical Pharmacy, Inc.

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