Steven C. Anderson, IOM, CAE
NACDS President and Chief Executive Officer

Recently, NACDS provided a summary of the 2014 mid-term elections, with an emphasis on the federal level. As promised, this memo includes an overview of the state elections, which will shape the operating environment on pivotal state issues.

2014 State Legislature Elections: Increase in Republican Control and Divided Control of State Governments
Many individuals characterized the results of the 2014 mid-term elections as a Republican wave – and if that term is appropriate for the federal elections it also pertains to results at the state level. It also is worth noting that the last two midterm elections have reflected the historical trend that the party not in control of the White House made gains in the state legislatures and in the U.S. Congress.

This year’s midterm elections have resulted in significant Republican gains in state legislatures, with three state legislatures moving to Republican control. Due to this shift, Republicans now control 30 state legislatures, Democrats control 11, eight legislatures are divided, and Nebraska is unicameral.

The elections also produced an increase in the number of states in which one party does not have control of the entire state government.

2014 Governors’ Races: Republicans Boost Margin
Republicans will hold at least 31 of the country’s 50 governorships next year, including gubernatorial offices previously held by Democrats in Arkansas, Illinois, Maryland and Massachusetts. In Alaska, Independent challenger Bill Walker defeated incumbent Republican Governor Sean Parnell. The governors’ race in Vermont remains undecided. In Vermont, the election will go to the state legislature for it to decide in January because no candidate was backed by a majority of the voters.

State Leadership: Organizing in the Aftermath
With 11 new governors to date, control of three state legislatures shifting to the Republicans, and a total of 19 state governments under divided control, efforts in the states turn toward the build-up of gubernatorial transition teams and action to determine chamber leadership positions and committee chairs.

Although some states are making progress in the interim, many states with changes in party control will have a slower start in the New Year as they inaugurate new governors, and as legislators work to organize new chamber and committee leadership. Also of interest are key vacancies in state agencies, such as recent departures of state Medicaid Directors in Iowa, Minnesota, Nebraska and Wisconsin.

Pharmacists Serving in Legislatures
In the recent federal election analysis, NACDS noted that a former Georgia State Senator, pharmacist and pharmacy owner, Earl Leroy “Buddy” Carter (R), won his bid for the U.S. Congress. In other good news, beginning in 2015, 47 pharmacists will serve in 25 state legislatures across the country – including 37 Republicans and 10 Democrats. Georgia and Mississippi have the most pharmacists serving in the state legislatures, with four each. Newly elected pharmacists include Justin Boyd (R) of Arkansas, Jeff Stone (R) of California and Paul Chace (R) of Maine. Incumbent pharmacists, Maryland Delegate Donald B. Elliott (R) and North Carolina Representative Tom Murry (R), lost their bids for re-election. Also unsuccessful were newcomers Brian Caswell (D) of Kansas, Mike Seiber (D) of Kentucky and Tim McMenamin (R) of Oregon. Texas State Senator Leticia Van de Putte (D), a pharmacist, lost her bid for Lieutenant Governor, but will continue to serve in the State Senate.

Individual State Results

From Governor Robert Bentley`s (R) decisive victory to other races on the ballot, Republicans defeated challengers with relative ease, and maintained control of every statewide office. Constitutional amendments supported by the Republican-controlled Legislature were approved or appear on their way to ratification. Notably, Governor Bentley stated last week that the state`s General Fund budget will be the biggest problem before lawmakers next year. The state will have a deficit of at least $200 million in the budget when a fiscal lifeline expires. Voters in 2012 approved of taking money from a state trust fund to support the budget, but that bail out expires this year.

Governor-elect Bill Walker (I) ran as the Independent challenger and won. With the election of Governor Walker, it is expected that there will be a substantial shift in staff. Specifically, Health and Social Services Commissioner Bill Steuer, who oversees Medicaid, will be leaving. NACDS members operating in Alaska have faced various problems with the current Medicaid program. NACDS’ major issue focus for 2015 will be enhancing the ability of our members to immunize patients.


The Governor’s office, the House and the Senate remain under Republican control. NACDS’ major focus during the 2015 legislative session will be immunization policy.

Republicans swept the Governor’s office and all statewide Constitutional offices. The Republican Party now claims supermajorities in both the House and the Senate.

Although the Democrats lost their supermajorities in both houses, California remains a Democratic majority state. The Democrats retained large majorities in the House and the Senate, as well as control all of the statewide Constitutional offices. Incumbent Governor Jerry Brown, Jr. (D) was easily re-elected to his fourth term.

Governor John Hickenooper (D) was re-elected by a slim margin. Elections were also close in both houses; several races came down to several hundred votes, or less. In the Senate, the Republicans took control for the first time in a decade, now with an 18-17 majority lead. Democrats, although still in control, lost ground in the House, losing 3 seats resulting in a 34-31 majority. Colorado state law requires an automatic recount of all votes for any state races with a .5% margin or less. As such, several of these key races will trigger automatic recounts.

Governor Dannel P. Malloy (D) defeated Republican challenger Tom Foley by a larger margin than he did four years ago. The Senate Democrats lost one seat, but still remain the majority. New leadership is needed in the Senate, as President Pro Tempore Donald E. Williams, Jr. (D) has retired. The new President Pro Tempore will be Martin M. Looney (D) and the Majority Leader will be Bob Duff (D). The House Republicans picked up 10 seats bringing them to 64 seats, their highest membership in the House since 1994. Only 12 moderate Democrats are now needed to join with Republicans to create a majority and defeat liberal measures on the House floor. The additional 10 Republicans also play a huge part in the committee process. Although Democrats will still be in power (87 members), the increased Republican numbers will have an impact, especially when legislators are absent from committee votes. New leadership is also needed in the Republican Caucus. Representative Themis Klarides (R) will be the new minority leader, as Representative Lawrence F. Cafero, Jr. (R) has retired.

While the Democrats retain a majority in the Senate, they lost their supermajority. In the House, the Democrats retain control; however, the Republicans were able to pick up two seats.

Incumbent Governor Rick Scott (R) defeated Charlie Crist (D) by a very narrow margin, 48.2% to 47%. The Senate maintained all of its members, meaning that Republicans have maintained control with Senator Andy Gardiner (R) as the incoming President. In the House, Republicans picked up six seats creating a supermajority. The House will be led by incoming Speaker Steve Crisafulli (R). Speaker Crisafulli, on potential Medicaid expansion in Florida, has stated, “

[w]e’ll wait and see what the federal government does, but we believe we stand firm with where we are right now, and that’s without expansion.”

Incumbent Governor Nathan Deal (R) defeated State Senator Jason Carter (D), the 39-year-old grandson of former U.S. President Jimmy Carter, after extensive campaigning. Both the House and the Senate remain under Republican control. Governor Deal’s focus will remain on Georgia’s public education system and bringing more jobs to the state. Georgia currently has some of the highest unemployment rates throughout the country. Monday, November 17, 2014 marked the unofficial start of Georgia’s 2015 legislative session, as pre-filing of bills begins.

Democrats maintained control throughout the state with the incoming Governor-elect David Ige (D), as well as an overwhelming majority in both the House and the Senate.

Republicans maintained statewide control with the re-election of incumbent Governor Butch Otter (R), the Senate with a 28-7 majority and the House with a 56-14 majority. NACDS’ greatest legislative concern in 2015 will be working toward the Legislature’s confirmation of the adoption of the Board of Pharmacy rules regarding biosimilars, as both the manufacturers and payers are lobbying against it.

For the first time in 14 years, a member of the Republican Party, Bruce Rauner (R), won the Governor’s seat. Although it has been newsworthy, as Illinois is President Obama’s home state, meaningful power remains with the Democratic legislative leaders. Democrats maintained control of the Senate, led by Senate President John Cullerton (D), and continue to enjoy a veto-proof supermajority in the House of Representatives led by Speaker Michael Madigan (D). Senate President Cullerton has already begun to test Governor-elect Bruce Rauner (R) by stating his chamber will let the temporary state income tax increase sunset. Cullerton’s maneuver will put the new Governor in a position of needing to ask for a tax increase in his 2015 budget address or to propose budget cuts accordingly. In a budget cutting scenario, Medicaid is a likely source for reductions and, as such, pharmacy reimbursement could be at risk.

The Republicans swept the state elections. All three statewide offices on the ballot – Secretary of State, Auditor, and Treasurer – were retained by Republicans and the Legislature remains in solid Republican control. In the state Senate, the GOP added three seats to their majority and will control the upper chamber, 40-10, when the 2015 legislative session begins in January. Republicans in the House of Representatives saw a net gain of two seats and now have a quorum-proof 71-29 supermajority. The Republican margin the House is the largest in 40 years and the margin in the Senate is the biggest in at least 60 years. Both of the state’s pharmacist legislators, Senator Ron Grooms (R) and Representative Steve Davisson (R), won re-election.

The chambers remain the same, with a slim Democratic majority in the Senate and a strong Republican majority in the House. Having lost in the Governor’s election to incumbent Governor Terry Branstad (R), Senator Jack Hatch (D) will no longer hold a Senate seat and therefore step down as Chairman of the Senate Health and Human Service Appropriations Subcommittee, a key group of lawmakers for pharmacy issues. Chain pharmacy has enjoyed an effective working relationship with Senator Hatch, so that is a potential loss. With Governor Branstad’s re-election, we may see a new Medicaid Director appointed sooner than if a challenger had won. Meanwhile, pharmacist John Forbes (R) was re-elected to a second term in the House.

After one of the more controversial election seasons for Kansas, the political landscape appears to remain relatively unchanged. Governor Sam Brownback (R) barely won re-election, the Senate remains with a Republican Majority at 32-8, and the House Republicans increased their majority to 98-27. Two pharmacists will continue to serve in the Legislature, Representative Don Hill (R) and Senator Vicki Schmidt (R). Along with KACDS , the main focus of NACDS’ 2015 effort will be to get e-prescribing adopted and work on legislation on medication synchronization, biosimilars, and patient identification.

Kentucky is divided, as the State Senate remains in Republican control and State House Democrats retained the majority. Republicans increased their numbers in the Senate to 26, leaving them with a 26-12 majority. The elections resulted in a status quo in the State House, 54 Democrats to 46 Republicans. The Governor’s seat will be open for election in 2015, as current Governor Steve Beshear (D) will reach his term limit.

While no state elections were held, a key runoff election will happen December 6th for the Senate seat currently held by Mary Landrieu.

In a surprise for some, Governor Paul R. LePage (R) was re-elected. In the Legislature, the House gained a pharmacist with newly elected Representative Paul Chace (R). While Republicans gained 10 seats in the House, the Democrats retained their majority. Republicans have a narrow majority in the Senate. The divide in the Legislature and the re-election of Governor LePage should prove beneficial towards pro-patient advocacy efforts.

Republican gubernatorial candidate Larry Hogan beat Democratic Lt. Governor Anthony Brown and will become only the second Republican to govern Maryland in 40 years. State Senator Brian Frosh (D) was elected Attorney General. Capitalizing on a Republican surge nationally, Maryland Republicans picked up nine seats in the General Assembly – two seats in the Senate and seven seats in the House. The net gain of seven seats in the House will allow the Republicans a veto-proof majority.

Post-election, the breakdown in the Senate is 34 Democrats and six Republicans. Republicans picked up the open seat of retiring Senate President Therese Murray (D) and defeated Senator Richard T. Moore (D), the Senate Pro Tempore and recognized expert on healthcare. The Senate will also have a new leadership team in January as Senator Stanley C. Rosenberg (D) becomes the new President. In the House, the Democrats control 126 seats and the Republicans 34, which is a gain of five for the Republicans. Speaker Robert DeLeo (D) will be entering his last two-year term as Speaker. He lost a great deal of his team through retirements last year, forcing a revamp, including the need for a new chair of the Committee on Health Care Financing. Both chambers still maintained supermajorities that allow them to override the Governor`s vetoes. Governor-elect Charles Duane “Charlie” Baker, Jr. (R) is a former Secretary of Administration and Finance and Secretary of Health and Human Services. It is anticipated that he will seek to reform government operations. His expertise is healthcare, as he spent ten years as CEO of Harvard Pilgrim Health Care.

Republicans retained control over both chambers, but community pharmacy lost some stalwart supporters in the legislature. Senate Appropriations Chairman Dr. Roger Kahn, M.D. (R), a graduate of the Michigan Pharmacists Association’s “candidate school” and a strong supporter of pharmacy, was term-limited. Senator Bruce Caswell (R), who sponsored a successful MAC pricing bill in 2014, did not seek re-election. In the Executive Branch, the continuity of Governor Rick Snyder’s (R) re-election may prove helpful on collaborative practice agreement issues, including those related to point-of-care testing. Governor Snyder’s “blueprint” for reforming Michigan’s healthcare system has been useful in highlighting the important role of pharmacies and pharmacists in modern benefit designs. In addition, one of Governor Snyder’s earliest agenda items was to streamline regulation, which was helpful as NACDS navigated the technician regulation issue (SB 92).

The Republicans gained control of the House in the most recent elections, while the Senate and Governorship remain Democratic, resulting in a divided Legislature. Community pharmacy lost an ally with the exit of Representative Jim Abeler (R). During an unsuccessful Republican primary bid for the U.S. Senate, Abeler chose not to seek re-election to the state Legislature. With the re-election of Governor Mark Dayton (DFL), a new Medicaid Director may be appointed soon.

No state elections were held.

Republicans now have a veto-proof majority in both chambers. Republican candidate Travis Fitzwater (R) won the Missouri House 49th District seat with about 62% of the vote. He is the son of Missouri Pharmacy Association Chief Executive Officer Ron Fitzwater, and he himself is the Chief Operating Officer. NACDS member and pharmacist Lynn Morris (R), owner of Family Pharmacy, and Dr. Keith Frederick (R), a pharmacist, were easily re-elected to their House seats. Meanwhile, Senator David Sater (R), a pharmacist, remains in office. In the Senate, Rob Schaaf (R) was easily re-elected, and he is an opponent of pharmacy’s efforts to advance prescription monitoring program (PMP) legislation. Beyond the Republican supermajorities, Governor Jay Nixon (D) will be negatively impacted by Amendment 10 to the Missouri Constitution, which was approved by voters on November 4. Among its provisions, the Legislature may now override gubernatorial withholding of line items in the state budget. Governor Nixon has used this prerogative liberally. Community pharmacy can expect a more rancorous budget process moving forward. Although Governor Nixon continues to advocate for Medicaid expansion, his chance for success is slim.

The Legislature will remain in Republican control with the House holding a 59-41 majority, and the Senate with a 29-21 majority; one Senate seat has yet to be claimed in Missoula due to a recount. Democrat Governor Steve Bullock stated he looks forward to working with elected officials and his agenda will include Medicaid Expansion, Pre-K Education and various other priorities outlined in his budget. The Legislative leadership was chosen November 14th— the President of the State Senate is rancher Debby Barrett ( R ) of Dillon and the Speaker of the House is attorney Austin Knudsen (R) of Culbertson. Pharmacy issues on the 2015 agenda include e-prescribing for all controlled substances and immunization expansion.

One of Governor-elect Pete Ricketts’s (R) top two priorities is to address cost and inefficiency in the state’s Department of Health and Human Services. Perhaps due to having an outgoing Governor, the state has operated without a Medicaid Director for many months. The appointment of a new Medicaid Director may bring clarity to important issues for community pharmacy, including addressing the AMP-based FULs and carving-in the pharmacy benefit to managed care. In the unicameral Legislature, it is notable that Senator Steve Lathrop (D), sponsor of the problematic prescription monitoring program (PMP) bill last year that ultimately resolved favorably for community pharmacy, was termed out.

For the first time since 1929, Republicans control both the House and the Senate, in addition to the Governor’s seat. Governor Brian Sandoval led (R) captured more than 70% of the votes. State Senator Michael Roberson (R) became Majority Leader after the Republicans gained two seats. In the Assembly, State Representative Pat Hickey (R) became the Majority Leader after the Republicans picked up 10 seats. All statewide Constitutional offices were also claimed Republicans.

New Hampshire
First-term incumbent Governor Maggie Hassan (D) defeated Republican challenger Walt Havenstein to earn a second two-year term. Going into the election, the Republicans controlled the Senate 13-11. While one race is still very close, the Republicans will definitely control the Senate with at least a margin of 14-10. It is clear the Republicans will take back control of the House’s 400-member body, although the final numbers are not in for all races.

New Jersey
No state elections were held.

New Mexico
The Republicans have majority control in the House for the first time in more than 60 years. Democrats remain in control of the Senate. Governor Susana Martinez (R) was easily re-elected to serve a second term.

New York
In New York, all three major statewide Democratic incumbents won re-election, including Governor Andrew Cuomo, Attorney General Eric Schneidermann and Comptroller Thomas DiNapoli.
Assembly Speaker Sheldon Silver (D) will return to Albany with a significant Democratic majority in the Assembly, which when all votes are counted, is expected to mirror the current Democratic Majority (100 Democrats out of the 150 total members). The New York State Senate will be under Republican control with the addition of State Senator Simcha Felder (D), who currently conferences with Republicans. Senate Republicans are expected to continue some kind of Alliance with five Independent Democrats; details are being ironed out now.

North Carolina
In North Carolina, the Senate will once again be controlled by a 36-16 Republican supermajority when the North Carolina General Assembly reconvenes on January 14, 2015. Republicans added one seat in Senate District 25, despite some projections in favor of the Democrats. In the House, Republicans maintained their supermajority of 74-46. As the pharmacy community faces a variety of issues in the state related to Medicaid, drug take back, prescription only pseudoephedrine and biosimilars, they will do so without several legislators who were defeated while seeking re-election, including House Commerce Chairman Tom Murry (R), a pharmacist, House Regulatory Reform Committee Chairman Tim Moffitt (R) and Representative Mike Stone (R), a grocer.

North Dakota
Republicans maintained control of both chambers of the Legislature. While gaining a seat in the House the Republican majority became 71-23; in the Senate, Republicans lost two seats, however maintained a majority of 31-16. Meanwhile, the pharmacy ownership law will remain in place, with Statutory Measure #7 losing by an approximate margin of 59% to 41%. The referendum would have removed the requirement that pharmacies be majority-owned by registered pharmacists.

Incumbent Governor John Kasich (R) defeated Democratic challenger Ed Fitzgerald, by almost 64%. Incumbent Attorney General Mike DeWine (R) easily won re-election gaining more than 60% of the vote. The Ohio Senate Republicans maintained its majority of 23-10 and the House Republicans added five seats to their current 60 seat majority for a new majority of at least 65-34.

Incumbent Governor Mary Fallin (R), the first woman to be elected governor in Oklahoma, was re-elected. The Republican Party maintained control of both the House and the Senate.

Democrats had overarching success throughout Oregon. Incumbent Governor John Kitzhaber (D) won re-election, while the Democrats hold majorities in both the Senate and House of 18-12 and 34-25 (with one seat undecided), respectively. The Oregon Community Pharmacy Council has not yet met to discuss 2015 legislative action, but NACDS anticipates a biosimilar bill to include insulin and extend the sunset provision on reporting to prescribers.

York businessman and former Secretary of Revenue Tom Wolf (D) won the race for Governor against incumbent Governor Tom Corbett (R) – the first time in Pennsylvania history that an incumbent Governor has been defeated. In the Legislature, House Republicans picked up eight seats, increasing their majority to 119-84. The Senate Republicans picked up three seats, strengthening their majority to 30-20. Following the elections, Leadership elections were held in all four caucuses, with the most notable changes in both Republican caucuses. Former Appropriations Chair Jake Corman replaced Dominic Pileggi, who held the position since 2006, as Senate Majority Leader. Senator Pat Browne was elected Appropriations Committee Chair. Joe Scarnati remains President Pro Tempore. In the House, former Majority Leader Mike Turzai ascended to Speaker replacing Sam Smith upon his retirement and former Policy Committee Chair Dave Reed is the new Majority Leader. Bill Adolph remains House Appropriations Chairman.

Rhode Island
The Democrats retain control in the Governor’s Office, in addition to both the House and the Senate.

South Carolina
As expected, the Republicans dominated in South Carolina. Governor Nikki Haley (R) and the statewide Republican candidates won by large margins across the board. In the House, retirements from a few long-time serving representatives opened up the opportunities for pickups on either side. The only seats to change hands were Democrat Mary Tinkler, who won former Republican Speaker Bobby Harrell’s Charleston seat, and Richard Yow (R), who won retiring Democrat Ted Vick’s seat. No incumbents were defeated, making the Republican majority 78-46. State Senators were not on the ballot this year and the Republican majority in the upper chamber remains 28-18.

South Dakota
In addition to the re-election of incumbent Governor Dennis Daugaard (R), control of the Legislature remains with the Republicans. In the House, Republicans increased their majority by five seats, making it a 57-12 hold over Democrats. In the Senate, Republicans maintained their majority despite losing one seat, now having a 27-8 advantage over Democrats. Meanwhile, in what could potentially be a precedent for other states, Initiated Measure 17 was successfully passed to require insurance companies to accept any willing healthcare provider. The measure was authored by the state’s Attorney General.

Governor Haslam (R) won re-election in a landslide and the Republicans have gained supermajorities in both chambers of the Tennessee General Assembly. Governor Haslam has made it clear that he has no interest in expanding traditional Medicaid; however, he has indicated a willingness to pursue a “Tennessee Plan” for expanding federally subsidized health insurance for uninsured Tennessee workers, similarly to efforts in Indiana, Iowa, Michigan, and Pennsylvania. After a 2014 session that saw the passage of collaborative practice and a compromise on pseudoephedrine, NACDS was pleased to see pharmacist Representative David Shepard (R) narrowly defeat his opponent, Michael Curcio (D), by a margin of 16 votes.

Every statewide Constitutional office has been held by Republicans for more than two decades, and the trend continues. Republican remain in control of both houses, and more than half of the legislators will be serving their first or second term in office. There will be a special election on December 6th to fill the seat vacated by Senator Glenn Hegar (R), who was elected to serve as Texas Comptroller of Public Accounts.

Republicans maintained control of the Senate with a 24-5 majority. In the House the Republicans maintained a majority of 60-15 with the Democrats picking up one seat. House and Senate leadership races are complete; the Senate results were as expected, however there were many changes in the House. Greg Hughes (R) won the speakership, Jim Dunnigan (R) as Majority Leader and Francis Gibson (R) filling the Whip position. NACDS has great relationships will all of these new leaders. The Utah Food Industry Pharmacy Committee will be fighting the extension of the sunset on reporting for biosimilars. NACDS will also be engaged on physician dispensing and employer clinics.

The Legislature will need to elect the next Governor, as no candidate received more than 50 percent of the vote. While the Democrats remain in the majority in both the house and the Senate, the Republicans were able to pick up seats. In the Senate, the Republicans picked up two seats and now occupy nine of the 30 seats. In the House, the Republicans also picked up several key seats, most notably defeating House Health Care Committee Chair Michael Fischer (D).

No state elections were held.

The Republicans have taken control of the Senate with a 25-24 majority. In the House the Democrats will continue its majority but not by a more narrow margin. During the 2015 legislative session, NACDS plans to work closely on biosimilar legislation and patient medication simplification/medication synchronization.

West Virginia
In a history-making election and a subsequent party change by a Democratic Senator, Republicans took control of the Senate and the House of Delegates, ending an 80-year reign for Democrats. The GOP now controls the House of Delegates by a 64-36 majority. On election night, Republicans also picked up seats in the Senate, bringing the tally to a 17-17 split. However, the following day, Senator Daniel Hall switched his party affiliation to Republican, clearing the GOP’s way to a 18-16 majority. Given the shift in both chambers, the state will have a Democratic Governor and a Republican-controlled legislature, as well as new Committee Chairs for both Health Committees. Governor Earl Ray Tomblin (D) will face re-election in 2016.

In addition to Republican Governor Scott Walker’s (R) re-election, Republicans continue to control the Senate and further widened their control of the House. Governor Walker’s strong win will potentially embolden his Presidential aspirations, and pundits are expecting a more conservative legislative agenda. Of potential concern to community pharmacy, cost-savings measures such as carving-in the fee-for-service pharmacy benefit may become more likely. With Governor Walker’s re-election, a new Medicaid Director may be appointed soon.

Incumbent Governor Matt Mead (R) was re-elected. Republicans also maintained control of both the House and Senate with supermajorities. The Board of Pharmacy is supporting some additional “clean up” legislation related to pharmacy that the Wyoming Retail Association is currently looking into.

Advocating for Patients, the Profession and the Industry in the States
NACDS will continue to advocate in a bi-partisan way on behalf of patients, the profession and the industry in state capitals across the country. We will continue to promote the role and value of pharmacy in the nation’s healthcare system, particularly in delivery system reform efforts occurring at local and state levels. Positioning pharmacists as one of the most accessible healthcare providers in neighborhoods across the nation, NACDS will seek bi-partisan support for legislation that will enable pharmacists to provide the highest level of pharmacy care while fully utilizing their education and training. We will continue to oppose efforts that, if enacted, would limit the ability of pharmacists to provide quality, cost-effective pharmacy care working collaboratively with other healthcare providers. We will also support public health initiatives, particularly those directed at medically underserved areas and populations and among those most in need of care. NACDS believes that individuals with a higher level of knowledge of and experience with pharmacy services are more likely to support policies that are essential to pharmacy care. NACDS, in collaboration with coalition partners, will reach out to the key newly elected and returning state legislators to educate them about pharmacy services.