The Quality Corner show reunites with Veronica Vernon, PharmD, BCPS, BCACP, MSCP, and Assistant Professor and Vice Chair of Pharmacy Practice at Butler College of Pharmacy and Health Sciences for a newsworthy update on contraception access at the pharmacy level.
Vernon chats with podcast host Nick Dorich, PharmD, PQS Associate Director of Pharmacy Accounts about medical terminology for contraception, pharmacy prescribing at the state level, and the recent announcement of the OTC norgestrel pill, Opill.
Vernon first appeared on S3 EP23
Addressing Healthcare for the LGBTQIA Community - Roundtable Discussion
The Quality Corner show reunites with Veronica Vernon, PharmD, BCPS, BCACP, MSCP, and Assistant Professor and Vice Chair of Pharmacy Practice at Butler College of Pharmacy and Health Sciences for a newsworthy update on contraception access at the pharmacy level.
Vernon chats with podcast host Nick Dorich, PharmD, PQS Associate Director of Pharmacy Accounts about medical terminology for contraception, pharmacy prescribing at the state level, and the recent announcement of the OTC norgestrel pill, Opill.
Vernon first appeared on S3 EP23
Addressing Healthcare for the LGBTQIA Community - Roundtable Discussion
00:00:01:05 - 00:00:05:23
Nick Dorich
Who is the target patient audience for these products as OTC?
00:00:06:00 - 00:00:29:21
Veronica Vernon
That's a great question, Nick. These will be patients. The good thing is progestin only contraception has very few medical contraindications or reasons where somebody couldn't use it. Breast cancer is a big one. No hormones with breast cancer. But the good thing is a lot of reasons that folks are concerned about hormonal birth control is typically due to the estrogen component, due to the increase for stroke, potentially for blood clots.
00:00:29:23 - 00:00:47:21
Veronica Vernon
We don't see that to the same extent with our progestin only contraception. So this is going to be available for a lot of folks who may not be candidates for estrogen therapy or may not be able to get in to see a provider, but can take a pill every day. And they want to take a pill every day.
00:00:47:23 - 00:01:12:23
Introduction
Welcome to the Pharmacy Quality Solutions Quality Corner show where quality measurement leads to better patient outcomes. This show will be your go to source for all things related to quality improvement and medications and health care. We will hit on trending topics as they relate to performance measurements and find common ground for payers and practitioners. We will discuss how the platform can help you with your performance goals.
00:01:13:00 - 00:01:46:12
Introduction
We will also make sure to keep you up to date on pharmacy quality news. Please note that the topics discussed are based on the information available at the date and time of reporting. Information or guidelines are updated periodically and we will always recommend that our listeners research and review any guidelines that are newly published. Buckle up and put your thinking cap on the Quality corner show starts now.
00:01:46:14 - 00:02:07:00
Nick Dorich
Hello Quality Corner Show listeners. Welcome to the PQS podcast, where we focus on medication, use, quality improvement and how we utilize pharmacists to improve patient health outcomes. I'm your host Nick Dorich. We are again trying our podcast in the video format, so hopefully you're watching on YouTube because then you'll be able to see both myself but also our guest for today's show.
00:02:07:05 - 00:02:25:00
Nick Dorich
And she is a returning guest for the show but previously was part, was here as part of a roundtable discussion. Here she is by herself owning all the content by herself. So without further ado, I'm going to jump right into today's episode and I'm going to introduce everyone to Doctor Veronica Vernon. Veronica, welcome back to the show. And how are you doing today?
00:02:25:02 - 00:02:28:03
Veronica Vernon
Great, thank you, Nick. I'm so excited to be back.
00:02:28:05 - 00:02:42:15
Nick Dorich
Excellent. Well, I know you and some of our guests who have asked some of our listeners excuse me, who had previously listened to the show, they might know you, but do you mind? Give us an introduction. You know who. Who are you? Where is your practice? What is it that you do in the world of pharmacy?
00:02:42:17 - 00:03:03:11
Veronica Vernon
Definitely. I am an assistant professor and vice chair of pharmacy practice at Butler University in Indianapolis, Indiana. I started my career as a gynecology pharmacist with Veterans Health Administration at the Indianapolis VA, where I prescribe birth control, manage menopause, and worked with a very collaborative and fantastic gynecology team.
00:03:03:13 - 00:03:27:12
Nick Dorich
Excellent. Well, that kind of that introduction description also does tell our audience a little bit about what our topic for today's conversation is going to be and today we're going to be talking about pharmacists and we're going to be talking about pharmacists and specifically birth control and contraception. It has been a very popular topic and there's been a lot that's been happening in this world, at least here in the United States, in the last couple, couple of years.
00:03:27:12 - 00:03:43:12
Nick Dorich
A lot of movement that's been on this topic. I know that this is something where you are a regular speaker, a regular guest speaker, guest lecturer on this sort of topic. So, I'm excited to have you provide an update for us today on what do our pharmacists need to know, what do our patients need to know and what do we need to be considering for the road ahead?
00:03:43:14 - 00:03:48:18
Nick Dorich
So we're going to get into that conversation here in just a moment.
00:03:48:20 - 00:04:13:07
Breakdown
Now it's time for the breakdown as Quality Corner Show Host Nick Dorich asks three main topic questions. Our guests will have a chance to respond and there will be some discussion to summarize the key points. This process will repeat for the second and third questions, which will wrap up the primary content for this recording. After that, I expect to end on a closing summary, usually containing a bonus question.
00:04:13:09 - 00:04:21:00
Breakdown
Now that we have described the process, let's jump into the questions.
00:04:21:02 - 00:04:40:18
Nick Dorich
All right, Veronica, we're ready to jump into our conversation for it for today's topic. And we are going to be talking about pharmacists and we're gonna be talking about birth control, contraception, whether it's just prescribing management or of course, now as well, OTC, which we'll get into the timing of this in just a second. Normally I jump right into our first question and, you know, getting into all the nitty gritty.
00:04:40:18 - 00:05:05:02
Nick Dorich
But before we do that, I wanted to actually ask you a housekeeping item, because I've already used a couple of different terms here: birth control, contraception. There's a number of other terms that may be used. So from the standpoint of the pharmacy community and from the medical community, how or what should we what's the terminology that we should use that is current acknowledging that this is going to be current as of beginning of March 2024.
00:05:05:04 - 00:05:10:01
Nick Dorich
Current terminology. It may change in the future, but how would you have us refer to it?
00:05:10:03 - 00:05:30:01
Veronica Vernon
That's a great question, Nick. I think it's important to know who your audience is when speaking with other health care providers. I use the term contraception or hormonal contraception or non-hormonal contraception, depending on what I'm talking about. But when I'm talking with patients, I like to use birth control because they understand what that is. Contraception may not be a term they're quite as familiar with.
00:05:30:03 - 00:05:38:13
Veronica Vernon
So knowing if you're speaking to other health care providers or patients is important to discern or consumers, individuals that are looking for something over the counter.
00:05:38:15 - 00:06:11:01
Nick Dorich
Excellent. Okay. Important question for us to ask and just knowing with this topic and myself, you know, having been a pharmacist and I'm not behind the counter working in that kind of position now or counseling patients with that. But the terminology can be important, especially as you talked about for this patient population, especially as we talking to certain patient populations, it can be birth control and contraception, but these medications may be used, especially younger women for needs or for therapy outside of just the reproductive aspect of it.
00:06:11:01 - 00:06:22:23
Nick Dorich
So anything further there, you just want to kind of confirm or clarify as well for people where, hey, this may be used or this could be used as it relates to maybe perhaps skin to skin conditions or other medical aspects.
00:06:23:00 - 00:06:51:08
Veronica Vernon
Definitely. Birth control and contraception can be a misnomer at times because there are many different approved and off label uses for these products. We use them, like you said, for acne, for endometriosis, for painful periods, for heavy periods to help stop bleeding, a multitude of reasons that we can use it. And I think it's important to always ask our individuals coming to the pharmacy or coming to see you as a pharmacist what they're looking for, what are their goals?
00:06:51:10 - 00:07:25:00
Veronica Vernon
Never make the mistake of just assuming they're using it to protect against pregnancy. They may not be sexually active or in a sexually active relationship with an individual that could cause them to get pregnant. They could be in a same sex relationship. And I think it's important that we're making sure we're being as inclusive as possible and also avoid using gendered language, saying that this is for women or this is for women or individuals who have a uterus might be a better way to say it, or individuals who are looking to use a form of contraception.
00:07:25:00 - 00:07:36:09
Veronica Vernon
And I think it's also important that we not just focus on hormonal contraception, but realize there are a variety of methods out there and trying to determine which is best for our patients is the best way to go.
00:07:36:11 - 00:07:53:20
Nick Dorich
Excellent. So like many of these conversations, it's and when we're any time we as a pharmacist are managing a medication for a patient or maybe it's not even to that stage where they're taking a medication, but it should come down to what is your goal with the therapy? What is it that you're looking to treat to manage? What is your goal that you would like to experience?
00:07:53:20 - 00:08:15:17
Nick Dorich
Why are you talking with the health care provider and focusing on that aspect of it as the primary purpose here? So, Veronica, great conversation for us to get started with here. And I think here we as we've got that part covered, we can use birth control, we can use contraception here. So good on the terminology piece. Now getting us into our actual conversation, I've got three questions or three main topics that I want to hit pin on for us today.
00:08:15:19 - 00:08:46:17
Nick Dorich
The first thing that I want to talk about and it's something where I know you have a wide range of experience, whether it's from a legislative side of things, whether it's related to a practice side of things. But I want to talk about pharmacist prescribing or managing of these medications. This is a topic where, especially in recent years, maybe perhaps due to what we've seen from pharmacies being able to interact with patients after the COVID experience, more and more states are looking at an expanding pharmacy scope of practice to be able to prescribe or manage patients for these medications.
00:08:46:17 - 00:08:59:08
Nick Dorich
So what does that currently look like? Are there certain restrictions? Are there certain common commonalities that we're seeing across states? What can you tell us about this update? Again, at time of recording? We're in March 2024.
00:08:59:10 - 00:09:26:00
Veronica Vernon
This is one of my favorite topics to talk about because it combines gynecology and advocacy, which are two of my very favorite things in the world and are near and dear to my heart as I do teach pharmacy law at Butler and are reproductive health topics. We started back in 2013. If we rewind time, California was the first state to pass a policy that said pharmacists can furnish contraception, and that's without a prescription from an individual practitioner.
00:09:26:02 - 00:09:47:14
Veronica Vernon
Then we added on states like Oregon, New Mexico, Hawaii, Colorado, and now we're up to over 30 states that have some policy in place. Some of these policies are laws have been passed that allow pharmacists to have a collaborative practice agreement with an individual practitioner to prescribe or some are broader and allow a statewide protocol or stating our order.
00:09:47:14 - 00:10:09:24
Veronica Vernon
The statewide protocol is usually approved by the Board of Pharmacy and allows individual pharmacies to prescribe contraception where standing order is typically authorized by the state health official. And then you have other states like Idaho that have what we call standard of care prescribing where they don't explicitly say pharmacies can prescribe contraception, but it's permitted because pharmacists can prescribe, period there.
00:10:10:01 - 00:10:43:00
Veronica Vernon
What it's important to know is every state is very different. And I think this is unfortunate because in terms of scalability for some of these policies across pharmacies that have footprints in multiple states, it can be challenging. Some states have an age restriction of 18 and older. My state of Indiana, we passed that policy last year in 2023, and that can be a barrier for our teen age individuals who are 15, 16, 17 looking for contraception, whether it's to regulate their cycles or to protect against pregnancy and don't have a lot of other options.
00:10:43:02 - 00:11:09:23
Veronica Vernon
We also see what's permitted. What pharmacist are actually allowed to prescribe does vary widely from states. Some states say all self-edit ministered hormonal contraception, which includes the combined hormonal contraception, the patch pills and rings that contain estrogen and progestin. The progestin only pills and even depo medroxyprogesterone acetate also known as Depo-Provera the injection, because off label that can be self-administered.
00:11:10:00 - 00:11:31:04
Veronica Vernon
Other states say it's just pills. Other states say it's pills and patch. It really varies widely and I think it's important to be as broad as we can. Also ensuring that we're allowing emergency contraception is something pharmacies can prescribe. Some states, my state's included Indiana. We excluded Ulipristal . Unfortunately, that's something I wasn't really a fan of.
As Ulipristal, when it comes down to emergency contraception can be more effective than Plan B or the Levernogesterol, one tablet. If individuals weigh over 165 lb or have a BMI over 25, or we're getting into that 72 to 120 hours post unprotected intercourse. So some states have excluded things that really should be included. And I think it's important, too, that we're also including non-hormonal methods of contraception so pharmacies can prescribe condoms, external, internal condoms or other methods, especially if they're covered by insurance.
00:12:03:12 - 00:12:21:15
Veronica Vernon
We see this a lot with our Medicaid population, where a prescription is required for something to be covered by Medicaid in the states. And so there's quite a variety. There's also variety in training, what pharmacies have to do to be able to use this law or to use this policy. Some states say, you don't have to do any training.
00:12:21:15 - 00:12:39:24
Veronica Vernon
You just decide based off of your experience, education and training, are you able to do this, which every other health care provider does this. I like to give the example that my husband's a surgeon. Nowhere in law does it say how many years of training he has to do to be able to do surgery on a patient. He went through the training.
00:12:39:24 - 00:13:07:09
Veronica Vernon
He's competent. He's been able to prove that through his credentialing process with this hospital that's outside of the legal system. Now, if he were trying to do surgery and didn't go to a surgical residency and do a fellowship, that could be questionable. But it doesn't specifically say in law, I always like to use a example for my friend Jada Adams in Idaho that nowhere in law does it say a surgeon has to take the sponges out of a patient when they're done operating on them.
00:13:07:11 - 00:13:26:05
Veronica Vernon
That's just inferred. And so I think we need to start getting to a standard of care approach in pharmacy where we are saying that pharmacists need to determine for themselves what training they need. Some states say one hour, some say four. Indiana, we had to put training in there to get it passed through the General Assembly. We just said training approved by the board.
00:13:26:05 - 00:13:48:20
Veronica Vernon
And then I went to the board of Pharmacy and I said, Can you just to prove anything that's from an ACPE accredited provider? And they said, “Sure,” I would have liked to have just left it up to individual pharmacist to determine what they need. Some are going to need more training. Some aren't. My students who are just coming out and graduating, they already have this built into our curriculum and we give them simulations and we give them real world experiences.
00:13:48:20 - 00:14:19:17
Veronica Vernon
We let them practice on mock patients and standardized patients and we give them APPE experiences. So there's just such a variety across all the states. It's working with individual countries almost to an extent. But what's exciting is that pharmacists prescribe contraception is one of the broader policies that we see nationwide after immunizations and naloxone, where we have that available in all 50 states by pharmacist, then it's hormonal contraception, which I think is exciting from a public health perspective.
00:14:19:17 - 00:14:22:09
Veronica Vernon
This is a huge victory.
00:14:22:11 - 00:14:48:12
Nick Dorich
So, Veronica, a quick follow up question before going to our next topic on this. And as we talk about different states, it's you know, with these instances, the pharmacist can prescribe or manage a patient for this medication or for its use. Do states typically require or set anything around what would be determined for reimbursement or payment, i.e., if a pharmacist is prescribing, are they getting paid for the time spent as that as a medical service, if you will?
00:14:48:12 - 00:15:06:06
Nick Dorich
Because if a patient goes to their, you know, whether it's their gynecologist or whether it's even if it's a nurse practitioner, for example, or a pay in a gynecologist office, there's a office fee that goes to that right, service admin, etc., that goes into that supporting that because, you know, the pharmacist, they may be dispensing the prescription. Yes.
00:15:06:08 - 00:15:17:15
Nick Dorich
But if they're spending that time as a service to a patient, does that typically get reimbursed? Is that up to the to that particular health plan? How does that differ against across different states? What does that look like?
00:15:17:17 - 00:15:38:22
Veronica Vernon
That's a great question, Nick, and I'm glad you asked it. When we saw our early states, California, Oregon, really starting to implement contraception prescribing. What helped Oregon was that they had payment built in that they said pharmacists have to be recognized as medical providers and be able to submit a medical claim for the time that you're spending counseling and assessing that patient for their contraceptive method.
00:15:38:24 - 00:16:03:09
Veronica Vernon
We haven't had problems typically getting the actual product covered, but that's what we're good at in pharmacy. We're good at getting products covered, which now we can argue that's becoming a really significant issue. But paying for our cognitive services, our direct patient care services, that's where things get sticky. Some states have said, yes, pharmacists are now medical providers, at least through our state plan.
00:16:03:09 - 00:16:23:00
Veronica Vernon
So state Medicaid or state employee plans and any other plan that's regulated under the state, which unfortunately isn't a majority because there's a lot of those self-funded plans. Those are what a majority of insurance coverage is going to be, and that's under the federal government. But some states have tried to make some waves and say, yes, you must pay.
00:16:23:00 - 00:16:43:13
Veronica Vernon
Pharmacist Initially, we just saw this in states typically on the West Coast, but now it's starting to go across the country. We're starting to see it around the Midwest, the Northeast, which is really exciting. Pennsylvania just announced that pharmacies can enroll as providers in Medicaid recently, I believe it was March 1st and Wisconsin did it at the same time.
00:16:43:15 - 00:17:06:00
Veronica Vernon
When Indiana, when we were crafting our policy, I told legislators, we have to have payment, we have to have payment for Medicaid. That has to be part of this bill or it's going to be really tricky to implement. Now, pharmacies can charge cash-based service, and I encourage folks to do that, but that can be really hard for our patients to find palatable when they're used to using their insurance card to get drugs covered at the pharmacy.
00:17:06:06 - 00:17:29:02
Veronica Vernon
Now we're asking them to pay $50, $75, $80 to do a visit with us, which that covers our time, If you think about the time to take it would take to do a contraception visit takes anywhere from 20 to 30 minutes. Typically, some are going to be a little bit faster, some are going to take more time. And you think if you're not getting paid for that 20 to 30 minutes that you're pulled away from your other activities, it's not sustainable.
00:17:29:04 - 00:18:01:21
Veronica Vernon
You're not going to be able to sustain the service. So I think it's important that we do talk about payment and find out how to empower pharmacies to have those conversations with payers, how to use our state associations and our national associations to leverage some of those conversations to say, look at how much you're saving with contraception. We use some of the data out of Oregon when we were talking with our state Medicaid in Indiana and said, “Look, Oregon showed within the first two years they saved the state over $1.6 million by avoiding 51 unintended pregnancies in their Medicaid population.”
00:18:01:23 - 00:18:28:09
Veronica Vernon
And I think that's important to note. And we need more data. We need more implementation science to show how this is working and where pharmacists are having a significant impact, because sometimes for payers, it's hard to see how you're saving the money right now this month with this claim, but showing them it's preventative service, it's public health. Contraception, for the most part is covered under the Affordable Care Act, and you pay any other provider that does the service a fee.
00:18:28:10 - 00:18:38:02
Veronica Vernon
They're allowed to bill you through the medical benefit. And so pharmacists should be able to do that too. And we need to be doing this. We can't be giving away our services for free.
00:18:38:04 - 00:19:00:12
Nick Dorich
Certainly not, Veronica. And actually, as a as it relates to this topic or conversation, and I'm going to move us head to our second topic, because access is important both for the patients, but then also the need to have the interaction with the provider. So when it does come to birth control and contraception, there's also another big update which, as you and I were messaging this morning ahead of this episode, big breaking news here.
00:19:00:12 - 00:19:19:20
Nick Dorich
So I am sure and Veronica, you may have a disclaimer as well that what we share out this next part here, what you share in this next part may be subject to change, but we are expecting and preorder has now actually been announced for the really the first over-the-counter birth control contraceptive medication that's there. So, you know, what does this, what do we know?
00:19:19:20 - 00:19:35:03
Nick Dorich
Currently, again, we're recording this episode the first week of March, and it was literally just the preorder details were just announced this morning. So we're expecting a lot more information. But Veronica, high level or right from the start, what do pharmacists need to know? What do patients need to know about this OTC medication?
00:19:35:05 - 00:20:01:01
Veronica Vernon
In July 2023, the FDA approved the first over the counter hormonal contraception outside of Plan B, So this really was a huge victory. We've been waiting and waiting to hear when it's going to be available on the market. We kept hearing early 2024. Well, today we're recording this early March, the manufacturer announced that pre-sales begin today. This is going to be for the product called OPill Norgestrel.
00:20:01:01 - 00:20:34:02
Veronica Vernon
It's a progestin only contraception and one pack is going to cost $19.99. Three packs will cost $49.99 and a six month supply will cost $89.99. The exciting part about this is I still think that could be a significant cost barrier for patients who may not have $19.99 to even get a pack or sustain that. The manufacturer is going to be in the coming weeks announce a program to help offset that cost for individuals who are uninsured or underinsured or may not otherwise have access to this, which is a step in the right direction.
00:20:34:02 - 00:20:54:09
Veronica Vernon
We still have a long way to go, but this is exciting. I love to talk about pharmacists prescribe contraception, but over-the-counter access is equally important to discuss because this removes barriers we're removing the need for an appointment. People can go in, they can self screen, they can look at the label and see if it's appropriate for them. So it will be available in the coming weeks.
00:20:54:09 - 00:21:12:18
Veronica Vernon
Maybe by the time you're listening to this podcast, if you're listening to it a few weeks after we've recorded it, you will be able to get it. So some stores are starting preorders now. The rest is going to be rolling out in the coming weeks, where it will be available on the shelves. The important thing to note, I was going to say the important thing to note with this is norgestrel.
00:21:12:18 - 00:21:35:09
Veronica Vernon
According to the labeling that was approved by the FDA is it has to be taken at the same time, every day there is a three hour window that someone has to take the dose every single day. So, if they're more than 3 hours late, they're going to need to use a backup method of contraception if they are able to get pregnant and sexually active with a partner that has male anatomy for at least two days.
00:21:35:09 - 00:21:52:03
Veronica Vernon
So that's a big thing to tell patients if you happen to see them in the OTC aisle. But this should be available everywhere. I was at a meeting last week and we were talking about when can we get it into vending machines and make it readily accessible. But this is something reproductive health advocates have been working for decades.
00:21:52:05 - 00:21:54:19
Veronica Vernon
So it's a very, very exciting day.
00:21:54:21 - 00:22:23:07
Nick Dorich
Yeah. And so, Veronica, a couple of things on this real quick, because we've on this show have covered different medications being switched from prescription to OTC, which in theory sounds great. But even, I think last summer we talked about naloxone and some of the other medications, right. For opioid use disorder that that can be going to change to OTC status just because it becomes over-the-counter or even moving to a behind the counter type product doesn't necessarily mean that it's easier for patients to access if they're certain requirements.
00:22:23:07 - 00:22:57:06
Nick Dorich
If there's a cost part to it, that becomes key. So good details there as a starting point. The other part, you know, just as it goes generally to this, let's talk about it from the pharmacist perspective right. These medications or at least this initial product moving or being available as OTC, are there specifics or is there do we have any kind of information, perhaps a decision tree or guide as to, well, hey, these are the patients that maybe are best suited for it as an OTC medication versus, hey, no, if you're in a state where they can talk and get it prescribe for them from the pharmacist or the provider.
00:22:57:06 - 00:23:05:08
Nick Dorich
But I guess my question in the most straightforward way that I can ask, who is the target patient audience for these products as OTC?
00:23:05:10 - 00:23:29:07
Veronica Vernon
That's a great question, Nick. These will be patients. The good thing is progestin-only contraception has very few medical contraindications or reasons where somebody couldn't use it. Breast cancer is a big one. No hormones with breast cancer. But the good thing is a lot of reasons that folks are concerned about hormonal birth control is typically due to the estrogen component, due to the increased for stroke, potentially for blood clots.
00:23:29:09 - 00:23:45:03
Veronica Vernon
We don't see that to the same extent with our progestin only contraception. So this is going to be available for a lot of folks who may not be candidates for estrogen therapy or may not be able to get in to see a provider, but can take a pill every day. And they want to take a pill every day.
00:23:45:03 - 00:24:03:07
Veronica Vernon
I think the important thing to notice what is your patient want? Are they comfortable with knowing this has to be taken within the same three-hour window every single day and they can do that? Great. If not, perhaps. Let's talk to them about some of our other options, especially if you're in a state where you can prescribe contraception and you're able to do that.
00:24:03:09 - 00:24:21:23
Nick Dorich
Right. And the reminder for and we as the pharmacist or those in pharmacy that are listening to this episode know this point, but saying it as a point of reinforcement or if there's any patients or caregivers that are listening to this just because there is a medication or even an herbal or supplement that's OTC, that does not mean it comes without risks or side effects.
00:24:21:23 - 00:24:41:04
Nick Dorich
Definitely. That's a key item as it goes to OTC use is that they still buy the medication, the OTC products. It still comes with the directions for use, it still comes with this notes of contact your pharmacist or your provider if you experience X, Y, Z, or if symptoms worsen anything else that comes to it. So it just being OTC, I think that is great.
00:24:41:10 - 00:25:09:24
Nick Dorich
It's great for access for patients. But again, that doesn't mean that it's just, hey, it's out there, you're going to get the effect that you want and you don't need to monitor it or anything. That's not true. So remember, as you go through this, talk to your pharmacist, folks. That's the important takeaway. I guess this final question for you as the pharmacist and as our expert here for for this topic, we've talked about, okay, This is generally about improving access for patients, for birth control, contraception and contraceptive methods that are there.
00:25:10:05 - 00:25:32:07
Nick Dorich
You've talked about pharmacists can prescribe now in over 30 states medication moving to OTC. I guess the, my question, final question here for today is what's next? Like, what's that next thing on your wish list? As someone who has worked in this space, what's the public health item that folks are saying, hey, you know, maybe this isn't being seen in states yet or maybe it's just being seen in a state like Oregon or California that's leading the way.
00:25:32:07 - 00:25:34:18
Nick Dorich
But what's the next step in this phase?
00:25:34:20 - 00:25:53:22
Veronica Vernon
I think I'm going to wear my reproductive health advocate hat here and say it's going to be providing more wraparound services in the pharmacy with referrals for OB-GYNs, for prenatal care, making sure that we're getting individuals where they need to be in our communities, whether it's, hey, we need to connect with some social workers so we can meet some social determinants of health needs.
00:25:53:24 - 00:26:30:20
Veronica Vernon
I would love to see that and figure out the payment structure, what that looks like, making sure that all pharmacists are credentialed and contracted as medical providers and have systems set up in place to do medical billing. I think it's really important that we're ensuring we're doing medical billing and not trying to find a workaround through our PBM systems that we're doing medical billing, but providing those wraparound services where we really are getting people connected and have referral systems in place and networks in place where it's very easy for me to send a patient from my pharmacy to the OB-GYN or the federally qualified health center down the street, and they can receive that information.
00:26:30:22 - 00:26:53:06
Veronica Vernon
I think what we're seeing now is just pharmacies being able to use the full extent of their education, training and expertise and moving towards that standard of care model where pharmacist are determining, hey, this is what I'm trained to do. I am a primary care and ambulatory care trained pharmacist. I am not going to treat oncology patients, but I can take care of your diabetes and your reproductive health needs.
00:26:53:10 - 00:27:14:01
Veronica Vernon
I'll refer you to my colleague who's in oncology pharmacist to talk about your oncology needs and the oncology team at the hospital down the street. But I think that's really important as we start thinking about instead of saying, Well, I want pharmacist to do X, Y and Z, how can we be broader with that and just allow pharmacies to determine what they're trained to do?
00:27:14:03 - 00:27:36:17
Veronica Vernon
I feel like as an educator, I have to say that I am really proud of how we train our students and what my students are able to do, and I get calls for them saying, Hey, I'm pretty frustrated. I can't do everything that you train me to do in school because state law limits my scope of practice and how can we bust through that ceiling and really allow pharmacies to have more of the same regulatory model that medicine and nursing have?
00:27:36:19 - 00:27:58:02
Nick Dorich
I think it's also just an important aspect for for patients, right? Because we live, work, breathe in this space every day. Right. Or at least 40 hours a week or whatever. You know how much time it is you spend working. But patients are they're going and trying to figure it out when they have a question or when they have a new diagnosis or when they have something else that they want to address in their life.
00:27:58:02 - 00:28:16:03
Nick Dorich
So the more that this causes and it doesn't necessarily need to be all in the same, that would make things easier. Much like provider starts when we talk about provider status be a lot easier if Medicare just did it because then it applies to all 50 states in U.S. territories. Same thing here. It'd be great if there is some alignment that's that's there across state boundaries.
00:28:16:05 - 00:28:37:15
Nick Dorich
But Veronica said that I had two final questions. But just as I think about this, and if you're a pharmacist looking to understand what's applicable in your state or hey, if you need to expand things in your state, do you have any recommended resources, you know, where people go to learn about what is effective, what's allowed in their state, or if they want to expand opportunities in their states, where should they go to find out more information?
00:28:37:17 - 00:28:55:08
Veronica Vernon
I always like to give a plug for the National Alliance of State Pharmacy Associations, because if you don't know if your state has a state association, start there. They also have a lot of resources where you can see what policies have been effective. And then if you're looking to get started with contraception, there's a multitude of resources out there.
00:28:55:10 - 00:29:24:12
Veronica Vernon
There are resources through the American Pharmacist Association, through the National Community Pharmacy Association, through birth control pharmacists, lots and lots of resources there really endless Oregon Health Sciences University. Anything you could want is available. But I do really advocate for the importance of connecting with your state pharmacy association and also finding colleagues in other states. I am happy to tell you what not to do when you're crafting legislation, because we've learned the hard way in Indiana when it comes to implementation.
00:29:24:12 - 00:29:45:22
Veronica Vernon
And I think it's important that we share those stories of where we mis-stepped or where we had to concede in a law during the lawmaking session to try to get a policy passed. And then we realized, OOPS, that concession we made basically made those policy un implementable. And so I think that's important that we share those stories and NASPA is a great way to do that.
00:29:46:02 - 00:29:49:07
Veronica Vernon
But also national pharmacy associations.
00:29:49:09 - 00:30:10:14
Nick Dorich
Great. Well, Veronica, I appreciate it. And we could spent I don't know how long we've been going 20, 30 minutes already talking about this. And we could spend a whole lot more time. But this has been meant to be that kind of high-level conversation, discussion with an expert like yourself about this, about this topic. At the end, we'll get to, you know, where people can find you and how to contact you to learn more about this and whether it's from the practice side or the advocacy side.
00:30:10:14 - 00:30:34:04
Nick Dorich
Because again, you are very experienced in both those areas. But we are going to wrap up our primary conversation discussion for today's episode. So thank you for this discussion and really updates. I think this was a good part for me to confirm what I know or didn't know as it. There's a lot of states that have different approaches right now about how they are approaching or what they are allowing pharmacies to do in this space of birth control and contraception.
00:30:34:04 - 00:30:54:06
Nick Dorich
So great information. And I think it's a great topic for us because we're seeing many pharmacies actively become more involved with this as a service opportunity. So I think it's also very timely from that. But now we're going to move to our set of questions at the end. This is meant to get to know our guests a little bit differently, and it's not necessarily going to relate to health care, but it can be peppered in.
00:30:54:06 - 00:30:57:05
Nick Dorich
So are you ready for our rapid fire questions, Veronica?
00:30:57:07 - 00:30:59:02
Veronica Vernon
I can't wait.
00:30:59:04 - 00:31:06:22
Nick Dorich
Okay. Question number one, what makes you most thankful to be working in the pharmacy profession and working with patients?
00:31:06:24 - 00:31:10:13
Veronica Vernon
My students, absolutely. They're the future.
00:31:10:15 - 00:31:12:04
Nick Dorich
That's easy enough.
00:31:12:06 - 00:31:15:23
Veronica Vernon
They're amazing. They're the reason I do my job and why I love teaching.
00:31:16:00 - 00:31:32:06
Nick Dorich
Excellent question. Number two, what fictional character would you want to work with in your pharmacy experience? Who would be best suited to be your the Batman to, you know, to to your or sorry, the Robin to your Batman, if you will, here?
00:31:32:08 - 00:31:45:17
Veronica Vernon
I'm going to go with Wonder Woman because she's amazing and she is someone I admired since I was a little girl. And I just think it'd be awesome. Use her lasso of truth and we would get a lot done.
00:31:45:19 - 00:32:09:02
Nick Dorich
That's immediately where my mind was going. Whether it's you're having a conversation with a patient about, Hey, did you take your medications or you're experiencing as you're trying to call a help desk for something that's there. But last up, truth I find could be very, very helpful. Our next question is what's your what's one personal case? I'm sure you have many, but what's one personal recommendation for living a happy and healthy life?
00:32:09:04 - 00:32:30:07
Veronica Vernon
That's a great question. I think mine is to always do something for yourself every week. Sometimes it's hard to say every day, but even 5 minutes. But every week doing something fun for me, it's planning on where I'm going to travel next. I don't travel every week, but doing regular traveling for me is something that brings me a lot of joy, even if it's just going the next town over and just breaking up the routine.
00:32:30:07 - 00:32:34:18
Veronica Vernon
But planning where I'm going next brings me immense joy in life.
00:32:34:20 - 00:32:56:21
Nick Dorich
Yeah, And then you get the experience of getting to actually go and do that trip, which it allows you to kind of double down on that. And then after that, you want to travel all over again. So it's just like the cycle of happiness. That's how I think about that topic. Last question here for this section. What game show or reality TV show would you want to appear on as a guest or competitor?
00:32:56:23 - 00:33:16:06
Veronica Vernon
Probably Jeopardy, which I know is not very exciting, but I grew up watching it and I still love Jeopardy. I'd like to see something more exciting like Survivor, but I would be a terrible survivor. I just I don't do well roughing it at all. But Jeopardy! I can handle answering trivia questions. I'm there.
00:33:16:08 - 00:33:25:02
Nick Dorich
There you go. At some point in the future, Veronica, I believe, will probably see a TV show where it is a Jeopardy and Survivor crossover, where it's on the island. That's the challenge.
00:33:25:02 - 00:33:27:10
Veronica Vernon
Maybe consider that.
00:33:27:12 - 00:33:47:04
Nick Dorich
There you go. All right. Well, great choices, great selections there. Appreciate getting to know you a little bit and in the inside for these these questions. But Veronica, we're going to wrap up today's episode. And again, appreciate you coming on the show to talk about birth control, contraception, pharmacist prescribing related to those OTC status, because, again, we're recording this in early March.
00:33:47:09 - 00:34:05:03
Nick Dorich
And so by the time you get to hear this episode, there's going to be there is going to be we have a disclaimer at the beginning of the episode about make sure you check your latest information. There's a lot that's happening on this topic, so check out NASPA resources as Veronica referenced, and talk with other pharmacists that are, you know, involved in this space.
00:34:05:03 - 00:34:12:10
Nick Dorich
That's perhaps the best way to do so. But, Veronica, if folks want to hear from you directly about this topic, how can they contact you? Where can they find you?
00:34:12:12 - 00:34:31:09
Veronica Vernon
Yeah, you can find me on LinkedIn. That's an easy way to reach me. I'll also give you my email. It's vvernon@butler.edu. I find that the easiest I'm on X but I am more of a lurker than a poster. I don't check it all the time, but I'm @vronpharmD.
00:34:31:11 - 00:34:47:16
Nick Dorich
Excellent. Well, Veronica, again, thank you. Appreciate having you on the episode today to talk about this topic. And with that audience, we have wrapped up another episode of The Quality Corner Show. We thank you for joining us today and we hope you will star our next episode. Before we go, we have one final message from the PQS team.
00:34:47:18 - 00:35:09:07
Outro
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00:35:09:09 - 00:35:31:12
Outro
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