State Senator Jeff Stone tackles PBM reform, reimbursement rates.
Forty pharmacists in 26 states won elections in November, including four in statewide or federal races.
In California, State Sen. Jeff Stone, PharmD, won reelection to his second term in the 28th District, which stretches from southwest Riverside County across the Coachella Valley to the Arizona border.
Stone opened the Temecula (CA) Pharmacy in 1983 and became involved in local politics as a small business owner and a champion of the business community.
During his rise through positions in Temecula’s government, county board positions, and eventually the state senate, he has supported legislation to reduce regulations imposed on large and small businesses, which he says are the backbone of California’s economy. He has been an outspoken supporter for the pharmacy profession and a public health advocate throughout his career.
For his advancement of the profession and public health in California, Stone will be recognized as the Pharmacist Planning Services Inc. (PPSI) Distinguished Person of the Year in March. He will receive the award at the annual meeting of the California Pharmacists Association.
PPSI is a nonprofit public health advocate that has helped organize The Great American Smoke Out, National Condom Week, and programs on birth control, hepatitis C, and medicinal cannabis.
Stone continues to own and operate a local business, Innovative Compounding Pharmacy, in La Quinta, CA.
DT: Community pharmacists are often driven by the people they serve. Was this mentality part of what drove you to public service?
Stone: When I opened my first pharmacy in 1983 in Temecula, I never imagined running for public office. It was only when I saw the impact that graffiti was having on my community that I decided to get involved in 1992.
I ran for City Council because I wanted our city to crack down on vandals who were responsible for graffiti, and the voters in that election agreed. I’m proud to say I won handily and the City of Temecula still has the strongest anti-graffiti ordinance in the country. I quickly realized the common denominator between being a pharmacist and an elected official is helping people.
DT: What are some of the hallmarks of pharmacy practice that helped prepare you for public service?
Stone: Being a pharmacist comes with many attributes, including the ability to study and retain complex health-related issues. What does that have to do with being an elected official? In order to be an effective elected official, one must have the discipline to study and understand new issues in order to then mitigate the problems or improve situations. As an independent pharmacy owner, I know firsthand the impacts of government regulations that can help or hurt my business. As the owner of the pharmacy, I need to understand accounting, workers compensation, insurance, employee laws, etc., hence making me more sensitive to the governmental mandates and unneeded bureaucracy.
Understanding these laws helps make me a better elected official. Having a medical background gave me a strong foundation as a county supervisor with a county hospital and helps me now as a state senator serving as vice chairman of the Senate Health Committee.
DT: As small business owners, how important is it for independent pharmacists to engage with state and local governments?
Stone: If members of our profession do not get elected to state legislatures or federal office, then we succumb to bad laws authored by people that do not fully understand what we do and the challenges we face. As one of the most educated, but underutilized healthcare professionals, we need people in office who can help expand our scope of practice in accordance with our exceptional educational attributes.
DT: What advice would you give pharmacists who are considering public service? Is there a process for preparing yourself or methods that you’ve identified as essential to be successful?
Stone: Public service comes in many forms. It isn’t just running for public office. I would encourage those with a passion to serve to become involved in their local Chambers of Commerce, their local Rotary Club, and to serve on various city boards and commissions. It is truly amazing how much a person can get done to change the way things are run if they just step up and get involved in a meaningful way.
My best advice can be summed up easily-get interested, get involved, show up, and work to change the things you believe need changing. You would be surprised how effective you can be if you just do these few simple things.
DT: What are your top priorities for this term?
Stone: I will be once again attempting to pass legislation that expands the scope of pharmacists to independently treat disease in cooperation with a physician, as a way to ease the burden on our healthcare system. Additionally, I will be working with several of my colleagues to enact strong regulations over how pharmacy benefit managers operate in California.
PBMs are the least regulated part of the healthcare delivery system, and they should not be allowed to force pharmacies to lose money when filling prescriptions or to automatically claw back payments previously authorized. In addition to pharmacy-related legislation, I will also focus on economic development, public safety, and issues affecting taxpayers across the State of California.
DT: How is California dealing with the opioid crisis? Are there new initiatives being discussed or implemented? What is the role of pharmacists in what many are calling a public health emergency?
Stone: We have a statewide and national crisis over opioid addiction and overdoses. Fentanyl has burst onto the scene as a major killer of people who have become addicted to these dangerous drugs, and I am working with my colleagues on both sides of the political aisle to come up with a solution to stop the illicit importation of drugs like fentanyl.
One solution we are looking at involves improving the CURES database in California, to make it accessible to pharmacists on a real-time basis so pharmacists will know if patients are filling prescriptions at multiple locations. If we can bring this database into the 21st Century and make it accessible to physicians and pharmacists, we can save lives.
DT: Drug prices, gag clauses, direct-to-consumer advertising, and pharmacy reimbursements have been thrust into the national debate. What role should pharmacists play as these discussion progress? How should we articulate the balance between price and innovation? How will this debate play out at the national level?
Stone: This is an issue that is particularly troubling to me as both a pharmacist and a state senator. The issue over gag clauses and reimbursement rates prompted me to successfully request a legislative audit of a local health system in California that has been slashing reimbursement rates to below acquisition costs to local independent pharmacies, presumably as a way to force patients to begin using the preferred PBM’s mail order services.
This issue was raised by a local pharmacist, and legislators and public policy leaders need to hear more from individual pharmacists to teach decision makers about the ramifications of so-called “cost cutting” measures that ultimately put patients at risk by reducing access to quality care.
DT: California Governor Gavin Newsom’s first executive order directed the state’s health department to negotiate drug prices directly with pharmaceutical companies, and he took steps to enable states to manage a single-payer system. How would these initiatives affect pharmacists in the California? Do these changes have the potential to deliver on their intent?
Stone: I am looking closely at the governor’s order, but I am greatly concerned that having the state involved in drug price negotiations will severely reduce patient access to quality pharmacy services. Having the state be in charge of purchasing drugs directly poses many challenges to physicians, pharmacists, and patients by potentially limiting the availability of necessary medications in many special circumstances.
Also, having the State of California function as a “super PBM” would likely force hundreds of pharmacies to close because it will certainly result in a rapid growth of mail-order pharmacy services, which might be fine in many circumstances, but these services do not necessarily work for patients needing specialized individual care and treatment.