Alicia Kerry J. Mica , Senior Lobbyist

1. APhA Webinar Series: Pharmacy Site Visits with your Congressperson or Senator Alicia Kerry J. Mica , Senior Lobbyist Mary-Ryan Douglass, Associate Director, Grassroots Advocacy & PAC July 12, 2017

2. APhA Webinar Procedures You will see the Audio Mode menu screen. • Please Click – “Use Telephone” if you would like to dial-in to listen to the webinar. Dial the number listed on the screen. Once you have been connected, follow the prompts which will ask you to enter the Access Code followed by the Audio Pin. • Please Click – “Use Mic & Speakers” if you would like to listen to the webinar through your computer speakers. • To be respectful of others, please mute your telephone or microphone until you would like to speak or ask a question.

3. APhA Webinar Procedures, cont. Follow along with the PowerPoint displayed on the screen. • In order to ask an audio question during the Q&A portion, you should scroll over the icons and find the “Raised Hand” icon. Once you have found the “Raised Hand” icon, the organizer will unmute your line, and you will be able to ask a question. • In order to ask a written question during the Q&A portion, you should type a question in the question box of your control panel.

4. Advocacy

5. Advocacy WHAT IT MEANS The word “advocacy” comes from the Latin word for “voice.” “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.” -Margaret Mead As a pharmacist you are both a constituent, and an expert in pharmacy services. By advocating for your profession, you make sure your voice is heard! Build relationships with your Members of Congress Identify & research issues Lobby for or against specific legislative issues

6. Advocacy, cont. WHY PHARMACY VISITS ARE IMPORTANT Personal meetings are the most effective means of political communication. Visits are useful for introducing legislators to a large number of constituents and voters. Demonstrating how pharmacists can help patients in a real world setting humanizes the issues. Visits help to build relationships between you, other colleagues and the legislator.

7. Advocacy, cont. According to a Congressional Management Foundation Study Over 90% of congressional staff surveyed say direct constituent interactions have more influence on lawmakers’ decisions than other advocacy strategies Over 90% of congressional staff surveyed say citizen advocates are more influential and contribute to better public policy when they provide personalized and local information to Congress

8. How to Initiate and Conduct a Pharmacy Visitwith Your Member of Congress

9. Step 1: Find Your Legislators Visit the following website to search for your elected officials based on your home state https://www.usa.gov/elected-officials. The contact information for your legislators’ DC and local district offices will be available on their websites.

10. Step 2: Pre-Plan the Visit • The best times to schedule a visit are during a congressional recess, also known as “recess” or a “district work period.” • August Recess – July 31 – September 5, 2017 Determine a few days that would work in your schedule to host a Member of Congress • Check to see if the Member you are requesting to meet with is a co-sponsor of the provider status legislation (H.R. 592 / S. 109). • If they are not a co-sponsor yet, check to see if they co-sponsored the bill in the previous Congress.

11. Step 3: Invite the Legislator • Call the Members’ District scheduler or their DC office with an invitation. • You may be asked to follow-up with a formal letter • Find out the correct place to send that letter (email, fax) • Find out to whose attention it should be sent (Member, scheduler, district director, chief of staff) • Don’t be discouraged if it takes several invitations before the legislator accepts; they have many demands on their time. • Find a time that is convenient for both you and the Congressperson or Senator.

12. Tips for Calling a Legislator’s Office • When calling the office, ask to speak to the Scheduler • Identify yourself as a constituent and a pharmacist. • State your first and last name, hometown, and the reason for your call. • Include the name and location your pharmacy/school. • Include information about the issue(s) that you would like to discuss during the visit • You would like to highlight some of the patient care that you provide to the community

13. Tips for Calling a Legislator’s Office, cont. • Leave a good impression - Be polite in tone and language • Provide your complete contact information. • full name • e-mail • mailing address • telephone number • If the Member is unable to meet with you during August, ask the staff if there is another time that s/he will be back in the District that they can visit instead • Thank the staffer for his/her time.

14. Step 4: Prepare for the Visit • Develop a schedule that allows enough time to tour the pharmacy/school and to enjoy informal discussion. • Usually 30 – 60 minutes • Find out who will be accompanying the legislator from their staff. • APhA Government Affairs staff can help by providing educational materials such as legislative issue briefs.

15. Step 4: Prepare for the Visit, cont. Try to include colleagues or other associates who you know are politically active locally or who have a special relationship with the legislator or staff member. Let your colleagues know the exact date and time of the visit in advance.

16. Key Planning Documents Prepare a HIPAA form for them to review and sign before a tour. This shows that you take patient privacy seriously and elevates in their mind to the work you do as a pharmacist. Ensure that any helpful resources or other materials are available for distribution to the staff at the meeting. Use the resources at www.PharmacistsProvideCare.com to show how many counties in your home state are medically underserved, and how pharmacists are trained and accessible providers.

17. Be Prepared to Answer Questions • What patient population does your pharmacy serve? • Where does most of your revenue come from? • What services do you provide? • Which are most helpful? • Which are the most used? • Which are most underutilized? • What outcomes have you achieved? • What challenges do you face in serving your patients? • What type of demand does your community have for your services?

18. Step 5: During the Visit Welcome everyone. Introduce colleagues or associates by name. Remember, all citizens are constituents and potential voters. Keep the visit focused to encourage questions and open discussion. Keep track of time. Don’t rush the visit, but keep things moving. If they are not a co-sponsor of the provider status legislation (H.R. 592/S. 109) yet, the goal is to secure a commitment for co-sponsorship of the legislation. Localize the issue whenever possible. If there is a particular need in your community (e.g. high diabetes rates, limited public transportation, highly rural), provide specifics of how pharmacists can help.

19. Step 5: During the Visit, cont. Use personal stories! Make the connection between your efforts improving your patients’ health and how it should be considered in health care reform or deficit reduction plans. Ask if they have any questions. Directly ask the legislator to support our provider status legislation, if they do not already do so. Arrange to have someone take photos of the visit. Give the legislator any materials you have prepared for them. Get the contact information for follow-up. Thank the legislator for their time.

20. Step 6: Post-Visit • Follow up thanking the legislator and their staff for their participation • Send a thank you email/letter detailing highlights of the visit. • Include photographs from the visit or copies of media coverage. • Report to APhA on your visit. • APhA members who conduct pharmacy/school/practice site visits this summer will receive complimentary admission to the APhA-PAC Reception at APhA2018 in Nashville, TN. • Keep in regular contact with your Member of Congress.

21. Pharmacists Provider Status Talking Points The Pharmacy and Medically Underserved Areas Enhancement Act H.R. 592 / S. 109

22. House Bill 592 and Senate Bill 109 • S. 109 introduced on January 12, 2017 by: • Sen. Chuck Grassley (R-IA) • Sen. Bob Casey (D-PA) • Sen. Susan Collins (R-ME) • Sen. Sherrod Brown (D-OH) • H.R. 592 introduced on January 20, 2017 by: • Rep. Brett Guthrie (R-KY) • Rep. G.K. Butterfield (D-NC) • Rep. Tom Reed (R-NY) • Rep. Ron Kind (D-WI)

23. House Bill 592 and Senate Bill 109, cont. • The language in these two bills are identical. • H.R. 592 has 200 bi-partisanco-sponsors. • S. 109 has 43 bi-partisanco-sponsors. • These bills would: • Amend section 1861 of the Social Security Act to recognize pharmacists’ services within Medicare Part B (outpatient services) • Pharmacists’ services would be covered and paid for under Medicare Part B if they are provided in medically underserved communities

24. House Bill 592 and Senate Bill 109, cont. H.R. 592/S. 109 will enable Medicare beneficiaries in medically underserved areas (MUPs, HPSAs, MUAs) to access covered Part B services from their pharmacist. Does not require Medicare to cover new or different services. Limited to state-licensed pharmacists. It does not change state scope of practice for pharmacists. Pharmacist services would be reimbursed at 85% of the physician fee schedule. The legislation has strong bi-partisan support.

25. Provide Supporting Rationale Describe the health care provider demand & how the bill will expand access to underserved areas. • 91% of Americans live within 5 miles of a pharmacy. • The Association of American Medical Colleges projects that, by 2020, there will be more than 91,000 fewer doctors than needed to meet demand, and the impact will be most severe on underserved populations. • Over the next two decades, the number of Medicare enrollees is expected to grow from 50 million to over 80 million. • “The role of the pharmacist can be extremely helpful to bridge the gap between the clinician and patient. They really need to be part of our team.” – Dr. Fernando Guerra, medical director for the San Antonio Metropolitan Health District

26. Provide Supporting Rationale, cont. Identify how the bill will decrease health care costs. • Minnesota Medicaid MTM program: Pharmacist-provided MTM services decreased health care costs from $11,965 to $8,197 per patient per year. • North Carolina ChecKmeds MTM program: Pharmacist-provided MTM services to more than 15,000 NC Medicare beneficiaries saved an estimated $10 million in health care costs • The United States spends almost $300 billion annually on medication problems including medication non-adherence.

27. Provide Supporting Rationale, cont. Most legislators do not understand a Pharmacist’s value, education, and training – EXPLAIN THIS! • Pharmacists graduating today have a Doctor of Pharmacy (Pharm.D.) degree – a post-graduate degree that requires a minimum of 6 years of college to complete (some programs require 8 years). • Pharmacists have moremedication-related education and training than any other health care provider. • Pharmacists have advanced education and training and are accessible providers ready to help but they are not reimbursed by Medicare for their services.

28. Review Allowing Pharmacists to be reimbursed for their services will expand health care access, increase compliance, improve health outcomes, and ultimately decrease costs. Pharmacists have advanced education and training and are accessible providers ready to help but they are not reimbursed by Medicare for their services. The bill has strong, bi-partisan support and the support of all of the pharmacy community.

29. Discussion & Questionswith special guestFormer APhA President Matt Osterhaus

30. Take Action and Learn More For more information on APhA’s provider status activities, please visitwww.pharmacistsprovidecare.com

31. Contact Information • Mary-Ryan Douglass • mrdouglass@APhAnet.org • 202-223-7181 • Alicia Kerry J. Mica • amica@APhAnet.org • 202-429-7507