NPC's John O'Brien Delivers 2024 Hooding Ceremony Address at Washington State University

REMARKS AS PREPARED FOR DELIVERY

Thank you very much Associate Dean Willson.

And thank you Dean Leid and Chancellor DeWald, and of course, Associate Dean Julie Akers, for inviting me here.

I also want to thank Jenny Arnold, CEO of the Washington State Pharmacy Association, for being here today to administer the oath to the next generation of pharmacists.  

And thank you Peter, Zach, and Sergio for your thoughtful reflections. 

It’s an honor to be here with all of you.

Congratulations to all the graduates on your remarkable accomplishments! Let’s take a moment and recognize all the family, friends, and faculty who are here today.

You see, education is often a family enterprise and a team effort — especially when one’s education starts to stretch toward two decades in length. 

It has been about that long since I graduated with my PharmD. When I think back on that day, there are two things I remember. 

First, Florida Governor Jeb Bush was our main speaker. He said he was nervous, so he asked his Mom, Barbara, what he should speak about. She said, “Speak about ten minutes, Jeb.” So, I’ll try to follow the former First Lady’s advice.

However: the most memorable speaker that day for me wasn’t Governor Bush. It was Michael Jackson.  

No, not THAT Michael Jackson. THIS Michael Jackson was the executive vice president of the Florida Pharmacy Association. 

Michael administered the Oath of the Pharmacist that Jenny will lead you in later today. When his deep voice slowly boomed through the auditorium — “I will embrace and advocate change that improves patient care” — I thought he was talking directly to me. I might have even teared up a little bit. 

You see, the call to advocacy resonated with me for two reasons. One, because all my mentors during my pharmacy education were heavily involved in pharmacy associations — either as elected leaders or hired staff.  And two — well, I’ll tell you the second one later.

When Governor Bush handed me my diploma and asked “what’s next,” I proudly told him I was going to Washington, D.C. as ASHP’s next executive resident, and hoped to work for his brother, the president, someday. 

Well, I didn’t get to work for President Bush, but I DID get to work for the next TWO Presidents, one from each party. 

This would be a perfect segue to tell you about being a pharmacist in a senior policymaking role and how I made a difference. But I’m not gonna do that. 

That’s because I hardly need to tell you how that works. We’re in Washington State, where pharmacists become legislators, and pharmacists and pharmacy students have worked so effectively within their state association to change laws.  It must be contagious because just across the river, my friend Alex Adams became Idaho’s Secretary of Health and Human Welfare. Pharmacists being involved in advocacy ISN’T novel — but it IS making a difference.

Nine years ago, Governor Inslee signed a first-in-the-nation piece of legislation that recognized pharmacists should be paid not just for dispensing drugs, but also as providers in their own right, within their scope of practice.  

Just last month, he signed a law increasing pharmacy choice and medication access to patients — while establishing greater oversight of pharmacy benefit managers. And if Jenny and Julie get their way, he should just keep his pen in his hand because they're just getting started.

You already KNOW how political and policy advocacy works. You don’t need to hear my stories about working for a Secretary of Health and Human Services who hosted pharmacists at the White House for the signing of a bill that banned pharmacy gag clauses for good and who helped give pharmacists and pharmacy students authority to administer lifesaving vaccines that were discovered and developed by pharmaceutical scientists. That authority, by the way, relied heavily on the work of former Albertson intern, and your professor, Dr. Kim McKeirnan. So they say all policy is local.

I will say, though, those jobs were pretty cool. Being a senior government official is something that I won't forget. If you have even the SLIGHTEST interest in government service after graduation, find me at the reception, find me on LinkedIn, and we can talk about how to get there. 

But here’s my message to ALL of you, regardless of where you’re headed next: You don’t need to work in the White House or the State House to embrace and advocate change that improves patient care. You can be advocates for change wherever you work. 

The diverse experiences we heard about earlier and that you’ve had during your education have already begun to prepare you. Today’s PharmD graduates worked during the pandemic with local health departments or in nursing homes on testing and other COVID-19 activities. The PhD graduates here today had to adapt to the strange new world of doing lab research in a highly restricted COVID environment.  

The class of 2024 has proven its resilience. You’ve seen dramatic change in our healthcare system in just the last few years. You’ve adapted. You’ve improvised. You’ve overcome. So what’s next, and what role can you play? 

First, I’ll take a step back: As Associate Dean Willson mentioned, I lead the National Pharmaceutical Council, a health policy research organization in Washington D.C. I lead a team of pharmacists — but none of us work behind a counter. Instead, we do policy-relevant research related to the value of innovative medicines and patients’ access to them — and we communicate it with impact.  

If I had to sum up the research we do right now, I’d say we know three things, which all of us can probably agree on. 

First, we’re in a golden age of biomedical innovation. The treatments and cures you’ve studied were unimaginable to me 25 years ago and those you will go on to develop and help patients use are unimaginable to me now.

Second, innovative drugs improve health outcomes and lower healthcare costs, especially when a pharmacist is part of the patient care team. 

And third, the deep problems in our current reimbursement system threaten to blow up this whole thing. All the work you’ll do to discover new drugs — or help patients use them to get well and stay healthy — is worth nothing if patients can’t access their medicine. 

The problem isn’t just that our system of financing and drug supply chains is perverse, opaque, and puts the patient last. It’s also that these flaws have seriously harmed the experience of the pharmacist behind the counter and their ability to interact with patients.  

To understand how we got here, and to advocate for changes that improve patient care, you have to understand the incentives in the broader system you face. The research is clear — pharmacists helping patients use medicines lowers the total cost of health care. But too many big players in the healthcare system see pharmacy as a place to claw back funds to increase short-term profits, instead of investing in pharmacists to improve patient care and achieve long-term savings.

These are the same entities that negotiate rebates — large discounts off the list price of a medicine — that don’t reach the patient at the pharmacy counter who actually uses the medicine.

The pharmacy counter is the one place in American healthcare where what you owe as a patient isn’t calculated based on discounts that an insurer has negotiated, like it is with a hospital or doctor’s office.

Instead, what a patient pays is often based on a drug’s list price, and the payers who receive most of these rebates can use them to lower overall premiums, cover additional services, pay their executives, put a new fountain in front of their headquarters—whatever they want.  

One report found that about half of drug spending in 2020 went to an entity other than the drug company that made the medicine — and it certainly didn’t go to the patient. In some circumstances, the net price a payer pays for a medicine can be lower than the payment your patient pays at the pharmacy counter.  

We can do better — and here’s how you can make a difference.

First, stay engaged with your professional associations and their advocacy activities, and walk your talk by providing high-quality care and contributing to innovative drug development strategies that push the healthcare system forward. Every patient you see is a potential advocate for a system that relies on you more instead of paying you less.

Second, seek or create practice settings that use pharmacists on care teams to improve long-term outcomes and lower total costs. When I worked for a health plan I saw physician practices hire pharmacists to provide direct patient care. Why? Because these physicians have contracted with Medicare or private health plans to provide better care at a lower cost. When savings and quality bonuses are on the line, they know that using pharmacists to optimize medication regimens is an important part of that equation.

And third, conduct or participate in the research that measures the success of these models – and translate it into the language that health plans and employers understand. Healthcare’s future is NOT more fee-for-service reimbursement, prior authorization, or clawbacks — it IS value-based care models that reward those who slow the growth of healthcare spending while improving the care patients receive.

I don’t want to pretend this will be easy.

Healthcare consolidation has created giant conglomerates where three or four companies will be involved in nearly every prescription a patient receives. But these companies all work for employers of all sizes who are becoming increasingly frustrated with the current system, and the Medicare program has committed to a value-based future. Embrace and advocate change that improves patient care — and help healthcare’s real purchasers realize the value of their prescription medicines.

The second reason I teared up when I took the Oath and heard that line is that everything I’ve shared with you today is deeply personal to me.

Preparing these remarks helped me reflect on a career journey that has far surpassed my wildest expectations. I deserve zero credit for it. I didn’t choose this career — it chose me.

Seriously! I wanted to be a sports broadcaster when I grew up.

But then my mom got sick, and I became fascinated by prescription medicines. She fed my curiosity with a 1984 PDR and a subscription to the Encyclopedia of Science and Innovation.

And if you’ve ever cared for someone with a chronic illness, you quickly learn the importance of health insurance and fighting for access.

Changes in my family’s circumstances showed me how the care you received and the medicines you get can be more about the card in your wallet — not the pharmacist behind the counter.

Those lessons were reinforced by a community pharmacist named Charlie who taught me the business side of pharmacy practice, and how laws and regulations made hundreds of miles from his pharmacy affected his ability to provide care. Charlie’s teachings were reinforced by county pharmacist association leaders who encouraged me to join the Florida Pharmacy Association and APhA-ASP.

Before I knew it, I was traveling to our state capitol and then Washington D.C. For conventions, for internships, for clerkships, and ultimately, as the American Medical Student Association’s Washington Health Policy Fellow.

You see, a dean I had never met, of a medical school I wasn’t enrolled in, told me to apply for a summer health policy experience for medical students. When I told him there was a mistake and that I wasn’t a medical student, he said “You just apply.” And somehow in the summer of 1996, I joined 14 medical students in Washington D.C. to learn health policy. My key takeaway that summer was that I spoke the language of pharmacy — and patients, doctors, insurers, drug companies, and members of congress all spoke a different language.

What IF I learned to speak those languages? Could I do a better job helping my Mom? Could I do a better job helping the patient at the pharmacy counter?

As it turns out, it’s allowed me to write or shape health care policies that affects patients millions at a time.

But that journey began as kid worried about his mom, and continued with the realization that even though I was training to be an expert in prescription medicines, I knew very little about how drugs were developed, priced, reimbursed, and valued by a healthcare ecosystem I barely knew existed.

My challenge to you is that when the excitement of this ceremony is over, after you’ve posted the pictures to Instagram and added the word "PharmD" to your LinkedIn profile, that you think quietly about what REALLY motivates you.

What is YOUR calling? Is it changing the way that immunizations are delivered across this country like Dr. McKeirnan? Or is it finding a cure for a rare disease to which there is no treatment and putting that next man on the moon?

The education you received is valuable, but your passion and your calling is priceless — and it will ultimately be the catalyst from having a job to making a difference. Pay attention for that next tap on the shoulder.

Today’s hooding ceremony is not just a well-deserved honor. The hood you receive represents both your academic achievements and the profession you’ll swear an oath to uphold. 

Whether you’re serving patients directly, are a researcher advancing care models, or working at a health plan, or employed at any business that says we want lower costs and better health, you’re a pharmacist or pharmaceutical scientist with an opportunity to improve patient care.

It was once said that the best way to predict the future is to create it. So, I leave you with this parting thought: Be the future you want to create, and it will be here more quickly than you could have imagined.  And if you do that, you’ll have some pretty cool stories to tell the class of 2050. 

Thank you very much for having me today. Congratulations, graduates! And Go Cougs!