Shannon Brenkendorff: Advocating for Expanded Pharmacist Scope in Colorado

Shannon Brenkendorff returns to share his firsthand experience testifying on pharmacy legislation in Colorado. He breaks down what the hearing process actually looks like, how pharmacists are advocating for expanded care access, and why “test and treat” laws matter for patients. The conversation highlights the real-world impact of policy decisions, the role of technology in supporting pharmacists, and how advocacy can directly influence outcomes. It’s an inside look at how legislation evolves and why pharmacists need a seat at the table.

Learn how to be reimbursement-ready on day 1 for ECAPS at our knowledge hub for pharmacy industry professionals: https://www.workflowservices.com/ecaps

Transcript

Introduction

SPEAKER_00 0:04

Hello and welcome back to the ECAPS Watch podcast. I'm Kevin Ulhan, CEO at Workflow Services, and I'm excited to be joined again. Shannon, you're our first repeat guest by Shannon Brankendorf, uh the VP of Technical Solutions here at Workflow Services on our team. How's it going today, Shannon?

Welcome Back

SPEAKER_01 0:22

Yeah, thanks, Kevin. Happy to participate today. And it is a Friday, so it's a good day for a podcast. And look forward to talking to you today.

SPEAKER_00 0:30

It's a Friday in the spring here in Wisconsin, and my uh seasonal allergies are killing me. So I'm struggling through, but feeling okay, but probably sounding a little bit stuffed up. That's what's going on with me. But Shannon, I I was excited to have you back on because you had some interesting um events that you were able to participate in a couple of weeks ago. And I haven't talked to you that much about it, but I thought it would be great for you to share with me and some of our viewers and listeners about what's been going on. So you had the opportunity to participate um in some of the process around expanding legislation for pharmacy scope in Colorado. Uh tell me what's up. What happened?

Colorado Bill

SPEAKER_01 1:10

Yeah, there was uh House Bill 26136 uh that was being reviewed by uh uh human and health services committee in Colorado. And I was asked to participate in some of the testimony uh to kind of push that uh bill forward uh in Colorado by Emily Zadborney, the CEO of the Colorado Pharmacy Society. Uh, and it was just a really interesting experience to participate in in the advocacy for um you know pharmacy services, especially in my home state where I live. I'm in Aurora, Colorado. Um, and great to great to you know sit alongside a lot of the pharmacies that are our partners today and and certainly help Emily because we've had a um a long kind of uh history of working together uh to further services specifically in Colorado.

SPEAKER_00 2:07

Yeah, we know Emily, she's a friend of the podcast, so it's great to have those names come up again. You know, one of the things that I was really interested to hear from you is a lot of the folks that we've talked to on the podcast talk about the power of advocacy. And so you you kind of got to do that in real life in the in the lawmaking process. So what was it like? What happened that day? What did you do? What was the point of the hearing you were at?

SPEAKER_01 2:35

Yeah,

Advocacy Experience

SPEAKER_01 2:36

it was, I mean, it was pretty exciting to participate, right? We have kind of a solution to help pharmacies deliver services and get paid for those services, and all of that is predicated by their ability to um deliver services, and that's kind of scope law, and then also uh payment opportunities through the uh Medicaid and commercial plans, and that's commonly referred to as provider status. And the the interesting thing, Colorado has had some good legislation. Um, and in fact, in in 2021, they passed some legislation that provided um some scope increase and also payment opportunities through commercial plans. And this bill, this uh House Bill 26136, uh, was uh really just some cleanup from those past bills. And so I was excited to participate. One, because it was kind of a full circle moment for me and just knowing how scope and payment opportunity is uh is so critical to you know pharmacists expanding and and really um solidifying themselves as healthcare hubs in their community. Uh so it was it was great to be uh able to help my fellow pharmacists uh in in Colorado here. And it was an interesting day for me because I had never participated in that, but I got to see it uh sort of firsthand. And I'm I'm happy to talk more about that. Um but yeah, it was it was it was a great experience uh for me personally.

Why It Matters

SPEAKER_00 4:05

So I want to hear about that personal experience from you, but first, just for a second, is it um does it show the value of pharmacy scope that this is happening in Colorado as a follow-up from some of the legislation that happened a couple years ago? I mean, does that suggest that that that made a difference and it's important and we're we're still working to refine it rather than just ignore it? Oh, absolutely.

SPEAKER_01 4:32

And I I think there's a lot of states that are sort of ahead of the game here. This this bill, which is all around increasing access to pharmacy services, was is not really necessarily a scope expansion, uh, but really a cleanup. And so today in in Colorado, pharmacists can test a treat for individuals um ages 12 and over, right? And so part of this bill kind of reduced that age to five. That doesn't mean a pharmacy has to, but they can decide um if they want to, you know, provide test and treat services for uh, you know, younger, younger patients. Uh the interesting thing is that there's over 20 states that include test to treat services and they have no age requirement. So um this bill was is interesting because it just kind of lowered uh you know that age requirement. And then it also cleaned up some other aspects of the original bill, which provided which offered provider status at the commercial plan level by um ensuring that you know plans wouldn't necessarily um prohibit um a pharmacist from actively participating in the plan, right? And so um what we saw in the the past legislation is that you know it ensured that pharmacists could get paid, um, but they can't get paid if a commercial plan won't enroll the pharmacist. And so this legislation ensures that the plan can't discriminate against a pharmacist if they want to provide services that are within the scope and what they're able to do based on the current law.

SPEAKER_00 6:15

Yeah. Well, so it sounds like we put some legislation in place to increase access to care in the pharmacy and realize that that was valuable. And so let's drive that even a little bit farther and get more folks access to care in the pharmacy. So that's the kind of thing I don't know. I love to hear that sort of thing. And I think there's a ton of opportunity, but you know, it an iterative approach is always a great way to go on to keep keep showing success.

SPEAKER_01 6:38

Definitely always moving forward. Yep.

SPEAKER_00 6:41

Yeah. So for you personally, what did you do? Were you were you answering questions or sharing your thoughts or what happened?

SPEAKER_01 6:49

Yeah, yeah,

Inside Hearing

SPEAKER_01 6:50

it was it was pretty fun. I mean, I I went downtown Denver. I've never I've been by the Capitol many times, I've never been inside there. So I found parking, walked into the Capitol, um, and found you know, Emily Zed Vorney and and some of the other pharmacists that were um preparing for the um in-person testimony. There was a lot of virtual testimony as well. And so it was what I learned is that it's a lot of hurry up and wait. And so we were hanging out, um, you know, just uh chatting about the legislation and you know what we're planning to say. And uh most folks that joined had, you know, written out things um to prepare and speak on during the testimony. Uh interesting thing is like when you're talking to the uh human and health services uh committee there, right? You're talking to local uh representatives, and in fact, uh in Aurora, my representative was on uh the committee, which was uh super cool to see. Uh, but you only get two minutes to talk, right? And so there's uh there's basically different phases where you know each uh proponent of the bill and then uh the folks that are against the bill get a chance to talk. And I think I was in maybe the the third or or fourth panel, and so I got to hear a lot of you know what um you know why we were supporting the bill from other individuals, and then I got my chance to to speak as well. But the the cool thing was that a lot of the individuals that were talking uh kind of against the bill, um, and this included, you know, some um some of the folks from not necessarily not necessarily the AMA in this case, but pediatric um doctors who thought it was um you know not a great idea, and and you know, they were against it because um of the challenges, you know, providing care to uh you know younger individuals, for example. And some of that was also some of the things that they also mentioned was the fact that pharmacists might not have access to uh the health record or the same information that um you know a doctor in a health system or in a in a pediatric office might

Addressing Concerns

SPEAKER_01 9:10

have. And so I was hearing a lot of this testimony and just being that I was a vendor in the space, providing solution that actually um involves technology that integrates with the health information exchange. I was sort of like re-assessing what I was going to say. Um and so I was able to kind of talk to how the technology that exists today um actually supports the pharmacists. And in some cases, they might have more information available at their fingertips uh from um a patient's healthcare perspective than a doctor because of some of the ways that our technology works. So it was pretty cool to sort of um factor in a rebuttal into the the two minutes that I had to to present. But two minutes goes very fast, and I feel like I could have could have talked for a whole half hour.

Bill Outcome

SPEAKER_00 10:06

So the point of the hearing was to help the lawmakers make a decision about whether or not to support the bill.

SPEAKER_01 10:13

Yeah, and whether to move the bill forward. So it was so what's gonna happen? Um what's gonna happen now is it's gonna this committee, uh, they voted 10 to 3, so they in support of the bill, which was great. Um, a few of the committee me members actually said that the testimony changed their opinion. And so they were came in um, you know, knowing and understanding the bill, and they were gonna vote no against it. Um, and they voted yes. So we we actually swayed a few of the committee members' opinions, um, which was terrific. The bill itself was sponsored by it was had bipartisan sponsorship. The unique thing about the sponsorship was that we had um a house representative from um a Democrat from the urban uh in urban uh area, and we also had um a Republican um House representative representing in a rural area in Colorado, which we actually have a couple pharmacies um in that area using our technology. So it was great to see that bipartisan support for a bill such as this, which is increasing access to services, um, even in the uh from the urban to the rural uh area. Um but yes, we pat it it got passed there, and now it's gonna go to the greater house uh for uh review. And if it if it passes there, it's gonna go to uh the Colorado Senate. Um so it was the we won the battle, but um the the war rages on.

SPEAKER_00 11:55

Do you get a do you did you get a sense of the the lawmakers who changed their mind due to some of the thoughts that were shared? Did you did you get a sense of what they thought before and and what helped them change their mind and what the new thinking was?

SPEAKER_01 12:10

Yeah,

Changing Minds

SPEAKER_01 12:11

I think it you know there was just some great there's some great testimony uh based on access and ensuring that um you know a a patient, specifically a child, um and after hours or on a weekend can can get the care that they need, right? And so I think they they really saw the benefit of access outweighing, I think, what um, you know, the the folks that were voting against or or testifying against the bill. Um they thought access sort of outweighed uh you know some of the potential risk, I guess. Um and the potential risk I don't I think is un is not really there because of the fact that you know pharmacists are trained um and they're they're participating in providing these services based on the level of their their education and they're already doing it for most, right? Uh 12 and older. And um and they have you know, if this thing passes, then they they have a decision whether they want to support, you know, um children with test to treat as well, which is just which is great. There was a lot of testimony related to the scope and access. Um, and I think that was really what won them over. I was there when I kind of testified, I was speaking on our technology and and really just highlighting the the other component of the bill, which was um ensuring that you know commercial plans can't um prohibit a a pharmacist from enrolling with them. Yeah. Um because the reimbursement is the most important thing, also, right, in in terms of being able to deliver the service in a sustainable way. Um can't do these things for free.

SPEAKER_00 14:09

So did you hear any cool stories about access? Like, did anyone have a narrative or an example that they came in talking about how access?

SPEAKER_01 14:18

Yeah, I think um, you know, one of our pharmacists in a in a rural community um just mentioned, you know, like uh a patient that that came in that was under 12 that he couldn't provide test to treat services on, right? But that patient had access to telehealth services. So a provider that doesn't know the patient or couldn't take vitals or you know, assess the patient in any way uh that you can do face-to-face, right? Acquiring blood pressure, temperature, these sorts of things, was able to basically write a script for the patient. Yeah. And and that just seems like very odd considering that this pharmacist knows that patient knows the family. Um the family, no, you know, a mom or dad knows their child and and knows whether they need to go to the emergency room or they can, you know, go to the the local pharmacy, for example. And so that was uh I think that was great testimony where I was like, wow, that that makes a lot of sense. And certainly, you know, telehealth services exist and exist and and provide value in in certain areas. And in this case, uh the pharmacist, right? The one that's local and and knows the patient could provide a better service, but just was not able to because of you know their the the the limits of the legislation that exist today.

SPEAKER_00 15:44

Yeah. What's the most surprising thing about the experience for you personally?

Personal Takeaways

SPEAKER_01 15:52

Uh the most surprising thing, um I was, you know, I I've been kind of working the Colorado market and and other pharmacy markets just to help pharmacies with you know delivering services, and um there was a lot of testimony from community pharmacies, and and we had some, you know, of the the big box chains also participate, but um virtually all of our community, all of the community pharmacists that provided testimony are using our technology, and I just was like I was really happy about that and also happy to participate. And that was surprising to me. I thought, you know, we would uh there would be others engaged in the discussion, but I pretty much knew everybody, and uh that was that was pretty cool for me personally.

SPEAKER_00 16:46

Yeah, it kind of makes you proud, right? And I think there's a few things for me in that. One is it feels like a lot of times as this scope evolves and legislation evolves and the market evolves, and access to care evolves in the pharmacy space, it feels like we are in the position of just trying to navigate sometimes like what can be confusing rules from the outside. And that's a big part of what we do, right? We see this over and over from customer to customer in a variety of states. And so we, you know, we like to think of ourselves as a trusted advisors to customers. But it's cool to see that there's a path that is not just navigating what's there, but also helping to show the folks who make laws that this is a positive thing and that those laws can change and the path can actually get a little bit straighter and easier. Um, you know, and to think back, we've been doing this quite a number of years now, and to think back to the beginning, the idea that we would play a role in helping actually expand the scope of the pharmacy, I just never would have guessed. And it's cool that we've had so much experience. And, you know, you talk about a lot of those pharmacies that were um sharing their thoughts that that we've worked with and our ability to support them and and make it so that they can successfully provide access to their customers, which is a cool thing to see it, like you said, kind of come full circle where where we're not just like subject to what's going on, but we can actually help to paint the future a little bit. It's pretty neat.

SPEAKER_01 18:19

Yeah, it was uh it was it was great to have an opportunity to participate with Emily and Jess Engelson and and some of the other folks from CPS who we've had a standing relationship with and just know that man, they went through this years ago, right? Yeah when they were on sort of the forefront of pushing some of this legislation uh forward and and now we're we're continuing to do that, and I get to I get to help. So yeah, definitely a full circle moment for me.

SPEAKER_00 18:50

Well, also a weird coincidence, another member of our team, Zach, uh at the exact same time that you were participating, was participating in a similar thing in another state. So he's gonna be on uh a future episode coming up here soon, talking about his experience as well. Um, is there any uh do you have any thoughts coming out of it that might be useful to folks in other states? Like, is there anything seeing that experience, you'd say, oh my gosh, I didn't realize that like this was possible or this is the way to approach it, or this is a thing to be careful of, or anything like that.

SPEAKER_01 19:26

I think pharmacists in general know that they have to be engaged uh, you know, to kind of uh further, you know, their you know, what they're doing uh and and their practice. And so I think a lot understand that they have to be engaged uh at some degree in the legislative effort. And so um I hope they continue to be engaged. And if there are those that that aren't, um definitely work with your your state pharmacy association and and get in get involved. You know, that's probably what I would say.

SPEAKER_00 20:04

I it seems like the the pharmacy community is pretty strong. Um, we see it kind of in almost every state. Um, it sounds like you had a special thing there where you had both support from rural regions and urban regions. So maybe there's something in there. Um, if you're if you're a pharmacist and you're trying to drive legislation forward in your state, find another pharmacist that's in a different kind of demographic area and partner up with them. So you can, you know, it's cool that that was the case where you had sponsors that were able to kind of explain look, this is for all of us, it's not just for people in the city or people in the country.

SPEAKER_01 20:42

Yep. Right.

SPEAKER_00 20:44

Yeah. Awesome. Absolutely. Well, thanks for doing it. I saw uh maybe we can link to a couple pictures or something like that, a couple pictures of you there. And I was super proud to see it and glad that you were there and glad you had a cool experience. Uh, I've never done that. Uh sounds like it was a sort of a fun and interesting day, one that you'll remember. So thanks for being there and you know, fighting the good fight and spreading the word and making it happen.

SPEAKER_01 21:09

Absolutely. Thanks for supporting me in that and and the opportunity to talk about it here with you and uh the rest of the folks listen tuning into this.

SPEAKER_00 21:19

Yeah. Well, we're gonna continue the conversation. Like I said, hopefully we'll get Zach on here quickly to talk about his experience, and we're gonna keep talking to folks in the industry and keep um sharing stories about the value of increasing access to care in the pharmacy.

SPEAKER_01 21:33

Awesome. Thanks so much, Kevin.

SPEAKER_00 21:35

Yeah, until then, uh join us on our next episode of the ECAP Plus Podcast.