May 4, 2021

Drug Topics®: How do other states, and then these pharmacies in these states, deal with language barriers and ensure that their patients are able to effectively understand their medication instructions?

Lee: Yeah, so as I said, there are federal requirements about not discriminating based on language or national origin. This goes all the way back to Title VI of the Civil Rights Act of 1964.

And then, in 2000, Bill Clinton signed this Executive Order 13 166, which requires that every federal agency must have a policy in place to address LEP patients. And so, if any pharmacy takes federal funds, that’s Medicaid or Medicare, which every pharmacy does, they are required to provide this service.

Now, the challenge there is because this is not at the State Board of Pharmacy level, it's kind of nebulous how they do it. It doesn't have direct number of languages or how they should do signages or standardizing labeling. So even though they are required in these other states, there is no direct guidance for how they should do that.

So that's what the benefit of the state requirements is. They require the State Board of pharmacies to come up with these rules that the pharmacies need to follow.

Drug Topics®: And on the practical side of this, will setting up this capability be a heavy lift for pharmacies, particularly local and community, and what kind of costs and requirements are involved here?

Lee: Yeah, so when this legislation first came into place, a lot of pharmacies, especially the chains, felt that there's going to be a huge cost to them. And after - especially the New York law - after it was implemented, there was a follow-up study that found that every pharmacy system that they studied was able to provide the service.


So, therefore, there are these national vendors of pharmacy management systems and labeling systems. And if they can do it in one state, there's no rationale that they couldn't propagate this into another state, there is no reasoning to go across state lines. So as the technology gets better and more languages are required, I think this will be a benefit to every pharmacy across the country.

Drug Topics®: And pharmacies are considered to be some of the most accessible health care professionals positioned to be a really valuable resource for patients. But when a lot of pharmacies aren't equipped to educate a sizable share of patients that don't speak English, there leaves a pretty big gap in patient care. Just how big of an issue do you consider this to be? And what do you envision the effect the Oregon law having on language barriers to patient education?

Lee: One of the groups of pharmacies that seem to want to address their community are the independent pharmacy. So, they're the ones that are least likely to afford some of these major integration systems and efforts.

By being able to drive down the cost and making this part of a standard package of labeling software or from the vendors, we can reach out to those independent pharmacies that are actually serving the population that are struggling with this.

And the other thing that we noticed is that when we did talk to pharmacies that are providing these types of service, they saw this as a competitive advantage. If they can draw the patients that are going to the major chains to their local pharmacies, then they can get more business instead of going to these larger commercial pharmacy chains. So, there are there are economic advantages to this as well.

Drug Topics®: And before we finish up today, what do you see as the most important takeaways on this important topic?

Lee: I know we've already seen some interest in other states as well. When I was talking to a lot the advocates that were in Oregon, they've already said that folks in Nevada and Texas have already contacted them.

And they have actually put together – so one of the challenges for a community advocate is, how do you go about getting organizations involved? How do you get people behind you? How do you talk to a legislator?

One of the things that the Oregon folks have done is they're putting together a toolkit that teaches people how to pass this type of legislation and get them in through their system and passed to the very end. I think that is one of the great things about what Oregon has done, is not just thinking about what they've done internally within the state, but how can they make this easier for other states to use that as a role model for passing these other rules and regulations as well. I thought that was really a positive impact of this.