Advocacy: An Essential Skill for the Modern Pharmacy Student

People have many reasons for wanting to become a pharmacist, ranging from personal encounters with pharmacists and witnessing experiences of friends and family members to stories they have read online about the profession. One commonality for most pharmacy students, however, is that they enroll in pharmacy school to help people.

The desire to help people was a big reason I applied to pharmacy school. However, one thing I found early on in my internships and rotations is that sometimes laws can prevent pharmacists—the most accessible health care professionals—and pharmacy interns from working to the best of their abilities while ensuring the utmost patient care.

Laws vary depending on the state that you practice in. In some states, when a patient runs out of an important medication, pharmacists must contact the prescriber for a refill. They can give an emergency supply, but if the physician doesn’t answer the refill request, pharmacists cannot legally give the patient additional medication, which may put the patient at risk. Additionally, before states started passing laws banning gag clauses, legally we pharmacists could not inform patients that paying cash for certain prescriptions would be cheaper than using their health insurance.

In New York, I can give patients their influenza, pneumonia, or shingles vaccinations, but when they ask to get their hepatitis or human papillomavirus immunizations, I have to send them to authorized providers. If patients with newly diagnosed diabetes are terrified of using their blood glucose monitors, I can coach them through the steps of using the machine, but I cannot prick their fingers and draw blood; that would be against the law.

When facing these issues, I found myself wondering, “Why can’t I do this service when it would be in the best interest of the patient?” This is why pharmacists and student

pharmacists need to advocate for legislation, to practice at the height of our profession and provide the best patient care.

PLAID: MAKING THE CASE FOR EXPANDED PRIVILEGES

Pharmacy Legislative Advocacy Invitational Day (PLAID) is an annual event held at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences, to educate legislators and first-year students on how laws affect patients, pharmacists, students, and the general public. The most important goal of this event is for students to learn about legislative advocacy; there they get the opportunity to talk to legislators about issues that pertain to their future profession.

In December 2018, student advocacy efforts led to pharmacy interns in New York getting limited privileges to immunize patients, and we are still advocating for legislation that will provide immunization expansion to all CDC-recommended adult vaccinations. It is critical that we, especially students, continue to push for advances in legislation that will improve public health.

Immunization expansion, Clinical Laboratory Improvement Amendments (CLIA)—waived testing, and comprehensive medication management (CMM) were some of the key policy issues that we discussed at PLAID in December 2019. State senators, legislative directors, and more than 120 first-year pharmacy students and members of the executive board from the Student Pharmacists’ Association of Western New York were in attendance.

Legislators came with talking points in hand, as well as their opinions about the subject, ready to educate our students on the legal system. Students came prepared with questions and opinions on the current laws, ready to explain our stances in person to legislators who may not fully understand issues facing the pharmacy profession.

Currently, the law allowing student pharmacists in New York to immunize has a sunset clause; immunization expansion legislation will make the law permanent. Unless that happens, interns could lose the ability to administer immunizations. Expanded legislation will also allow pharmacists to administer all CDC-recommended vaccinations and approve a statewide standing order.

CLIA-waived testing and CMM bills are both scope-of-practice issues. CLIA-waived testing would allow pharmacists to perform routine clinical laboratory tests without invasive modalities, to expedite treatment for influenza, strep throat, and diabetes. CMM would authorize a physician to refer patients to a pharmacist for medication service for treating chronic conditions, such as diabetes, asthma, high cholesterol, and high blood pressure, through established written protocols.

These laws, if passed, could reduce emergency department visits and improve chronic disease monitoring, while advancing public health goals.

ADVOCATING IS LEARNING: CHANGE STARTS WITH GRASSROOTS AND LOCAL EFFORTS

After PLAID, our executive board of students organizes other opportunities for students to augment their skills as advocators and interns. We plan grassroots efforts and schedule visits to local legislators’ offices with groups of students and pharmacists to reiterate points we made at PLAID. We also travel to our state capital, Albany, for Pharmacy Day. There students split into groups, hold appointments throughout the day with state senators, and discuss bills we are advocating and how they affect pharmacy students.

While in school, pharmacy students learn about the laws affecting their future practice, but rarely do they get involved with changing those laws because they are busy focusing on didactic work and other requirements. However, the passing of laws today will affect how we practice as pharmacists in the future. This is why I think it is crucial for students to get involved in legislative advocacy and reform and to let their voices be heard. There is no better time to take advantage of our opportunities to strengthen the future of pharmacy.

In The Lorax, Dr Seuss wrote, “Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not.” It is important that pharmacy students educate our legislators on how laws can benefit the general public in terms of safety and health care. No one besides us will advocate for our issues.

KIRA VOYER is a 2021 PharmD candidate at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences in New York.