The Business of Pharmacy Podcast™
Nov. 21, 2022

Inner Workings of a State Pharmacy Board | Ned Milenkovich, PharmD, Atty, Much Law

Inner Workings of a State Pharmacy Board | Ned Milenkovich, PharmD, Atty, Much Law

Ned Milenkovich, PharmD, Atty, discusses his time spent on a state pharmacy board.


Pharmacy Boards Unveiled | Ned Milenkovich, PharmD, Atty, Much Law

Mike Koelzer, Host: [00:00:00] Ned, for those that haven't come across you online,

introduce yourself and let our listeners know what we're talking about


Ned Milenkovich, PharmD, Atty: My name is Ned Milenkovich.

 I am a pharmacist, and I am an attorney. I live in Naples, Florida, and I practice law nationally. but today we're focused on talking about my tenure and my career, as a pharmacist.

when I sat on the Illinois State Board of Pharmacy for nearly a decade.

Mike Koelzer, Host: Ned, was that something that you aspired to, was that even a thought of yours in the future when you went from pharmacy school and then I know you had maybe a little gap and then to PharmD and then a little gap into attorney. was that on your mind or was it like, Oh, you twisted my arm enough, I'll do it.

Ned Milenkovich, PharmD, Atty: Well, I think like many other people, I have multiple interests. one, I, if I had to cut it up into four quadrants, I would say that I was always interested in healthcare. [00:01:00] I was always interested in the law. I was always interested in media and publication. and I was also always interested in, government work

I had always aspired to do something with the government, not necessarily thinking in advance and strategically and calculating that I would be on the Board of Pharmacy, but when I saw an opportunity. where I could be a part of a board, in my capacity as a pharmacist, but also having the legal background and practicing in the drug and pharmacy law.

That's really where the rubber meets the road, in pharmacy laws and rules. So that was one of the reasons I had gone into that.

Mike Koelzer, Host: Was that something that they put a call out for, or did you have your ear to the ground thinking that you were gonna jump on the board at some point?

 I think all board members arrive at their position as a board member in different ways. I did not have anybody sponsoring me or backing me or promoting me. I'm a pharmacist and an attorney. I'm a partner in a law firm. so I learned that there was a [00:02:00] vacancy at the board. And so I applied for the position and, There's a whole application process that takes place.

 and somehow at some point you need to get the attention of the governor of your respective state. and it took a long time. Honestly, it took a long time for people to notice that I had this particular background and that I might be a good addition to the board. And then one day I got the call that I had been appointed by the governor and welcome to the club type thing.

Ned Milenkovich, PharmD, Atty: So that's how it worked.

Mike Koelzer, Host: It seems to me that that would be great. not just a feather in your cap or something to have on paper, like I think a lot of degrees, if I got a degree at my age, I would just do it for, a few, fancy letters behind my name. But it seems like being on the board would be a very important or a very valuable slice of the profession as you progress in your legal career to help pharmacists.

 [00:03:00] Once you've been on the government side, now you can approach things from so many different angles.

Ned Milenkovich, PharmD, Atty: Well, it's interesting, Mike, that you say that because, all the while when, and this is not just unique to me, but o other board members, when you are appointed to a board of pharmacy, you have a day job also. you don't get paid for that position. at least I'm not aware of any state that's going to

pay you and, and I wouldn't and didn't do it for the money, but,it's a very serious position and it's one that requires a great deal of, Independent thinking. you must put the state's interest before your own. you must put the public's interest before your own.

So any type of self dealing or self-serving decisions that you make,could be scrutinized. And one of the reasons that board members are held in such high regard in a perfect world is because they have that capability of wearing two hats. They go to work on the one hand and they do their day job, whether they be a pharmacist or in my case a pharmacist who went [00:04:00] to become an attorney. And on the other hand, they serve their respective state to administer the various laws and rules and discipline pharmacists and pharmacies and be open to new advancements within the profession. We see a lot of that these days with technology and, and other, new, methods of moving the profession forward while also taking into consideration, public safety at all times.

Mike Koelzer, Host: It seems like pharmacy, I guess like a lot of professions is rather interconnected. You know, when you think about it,you work for this company and there's vertical integration. Oh yeah, this pharmacy does own this pharmacy and , it seems like there's a web. Are there many times where you had to recuse yourself, on the board because of that?

You must have to look with a fine tooth comb when it comes to that to understand where all the connections are.

 It's a very important question that you're asking and, you know, ethics comes into place and you have to have the awareness to recognize when, uh, you might be conflicted and when [00:05:00] you might have to seek recusal if you're not sure. you certainly have resources at the, at the board, that could assist you in making that decision.

Ned Milenkovich, PharmD, Atty: But, I don't know that there's any board member that hasn't had to recuse themselves because of the interconnectedness that you describe. Now, there are a lot of stakeholders out there in the industry. You've got small independent pharmacies and pharmacists. You have mid-size pharmacies, you have very large corporations, and everything in between.

And,it's not just a pharmacy. I mean, you've got a long term care pharmacy, you've got mail order, you've got specialty, you've got retail, you've got home infusion. I mean, and the list goes on and on. and so in particular. I suspect it's happened from time to time, particularly since I had been in my capacity as an attorney.

We certainly get our fair share of clients coming through the door, and of course it can happen.

Mike Koelzer, Host: On the board, do they make it a point to have different representation? In other words, they want so many [00:06:00] independents and so many chain and so many, manufacturing and things like,

Ned Milenkovich, PharmD, Atty: So some state boards do not have a diversification of the various,professional, areas, while other states absolutely do, and they require it. They may require it by rule or even by statute. but, it, it really is, state by state. And it's interesting. I was having a conversation the other day with some of my clients and we were talking very much on the topic of boards, and I said, Don't take this the wrong way.

But, boards are like dogs. I mean, all the boards are dogs, but there's 50 types of dogs. And so each dog is a little different. And some are small, some are big, some are quiet, some are loud, some are aggressive. some don't talk or bark.

it's very interesting and you really should understand if you're gonna be going before a board of pharmacy, which we do all the time as lawyers, understanding, the dynamic of the board and the personality of the various people who are [00:07:00] on that board in order to, obtain,the type of results that people are looking for.

Ned Milenkovich, PharmD, Atty: And that could be trying to promulgate a new methodology that the board hasn't considered. it could be defending oneself against an allegation of wrongdoing, some sort of disciplinary hearing. So it's, it varies. And boards are all different.

Mike Koelzer, Host: Years ago, For about six years, and this is 15 years ago, I was on our city's civilian appeals board and there would be like eight of us on there. And once every quarter or so, we would go to the police department and have this meeting. And these were people that thought they were roughed up a little bit by the police, not treated well by the police, and they would bring things to our board.

And then what we would do is we would look at them, we would take a vote about whether we thought that they overstepped his or her boundaries, and then we would just [00:08:00] recommend it to the city manager. We didn't have a final say, but we would just recommend it to the city manager. It might have even been after the city manager already cleared it, but then someone didn't like the results, so they appealed it to our board. Our board often went the way of the majority of people if they saw themselves in it. So whether it was, sex or race or, religion or economic levels, things like that, we often saw the board vote along those lines, and I hated to see it, but it was the case.

 I sat in on it. That was where the question came from about the different people on the board. How many on the board? Usually every state is gonna be different. You're gonna have,for example, Illinois had seven. pharmacists and two public members, non pharmacists. you'd have to go state by state. I think some have five, some have 14. it [00:09:00] really varies. 

I'd love to go in front of a board with a bunch of old independent pharmacists on it, you know, but it, it would seem, they break it up on purpose a little bit. Not to have that narrow of a focus

Ned Milenkovich, PharmD, Atty: Yeah, I think that, um, that could happen, I suspect where you 

have several independents, on a board, but usually it's not the way it works. And they, even if it's not 

written in 

statute or rule, they still might. Look at it at the governor's level and say, we really probably want to have some chains, some independence, some for some in the hospital system,whatever they deem appropriate.

but your comment about, the, sort of the personal experiences that one individual may have had on your civilian or civil appeals board. Um, uh, I, I think there's some truth to that and I think that probably, I could probably draw some parallels within the pharmacy board. obviously it's, you're talking about two different things here.

Ned Milenkovich, PharmD, Atty: One is, you know, a a pharmacy [00:10:00] board and the other one is, you know, some, some sort of crime or, or 

I'm imagining it's a crime. Um, but I, I think that people 

tend to be, uh, predisposed to their own opinions and how they perceive things, and that 

could dictate their position on a particular issue. I think, I think people have to guard against that if they're sitting on a pharmacy 

board.they're, using your example of an independent pharmacy. I mean, there's a lot of things that Indys have a problem with when it comes to what some of the larger corporations are doing. And, I have seen where the independent pharmacist has been on a board, and this is not taking a position or a slight against one or the other because I 

represent both types of clients.

but they would, they would, simply, give a particular issue a thumbs down only because they perceive it. As being perhaps a threat to, to, to their business. In [00:11:00] generally, I think that's where the best board members are the ones who can look at a particular issue from different angles and not just through their own personal lens.

Mike Koelzer, Host: And Now I'm thinking about the board in terms of penalties and things like that. How much of the board sways on intent versus not intent? let's say, People did something wrong, both pharmacies and one guy you knew. They knew it. One guy you knew didn't know it, but there's no excuse for not knowing.

A big thing when it comes to, I want to ask even about law in general, but in this case, in the board stuff, you have a bigger heart for people that didn't know what the hell was going on?

 I would say to you that the person who was ignorant, or not informed about a particular law or a rule and broke it. Perhaps unknowingly is probably going to [00:12:00] be in a little bit of a stronger position than the individual who purposefully, knowingly, intentionally violated a law. the problem with both of them is that both broke the law and they both broke a rule,

Ned Milenkovich, PharmD, Atty: perhaps.

 When you're on the board and you are talking to an individual who is, ignorant of a particular law rule,you sort of have to hold them accountable and run them over the coals and, ask them, Why don't you know this? and for that particular individual, , in addition to whatever fines or penalties might accrue, I think it's more important that they get an education in what it is that they did wrong.

So you might send them back and have 'em do several hours of continuing education on a particular subject to help them get back up to speed on it. I've been in situations many times where my clients have broken the law and they didn't know that they broke the law. And, it's one of those things where you sort [00:13:00] of, you gotta fall on your sword and you gotta say, Mia Culpa, how can we fix this?

versus the guy who just decided that it was a good idea to let a bunch of Vicodin go out the back door. in terms of fines and heftiness of fines, gosh, I mean, I would say to you that a lot of that is driven by statute. How much you can find someone. I would say to you that the statute, in many cases, will give a lot of reign to the board.

Ned Milenkovich, PharmD, Atty: So if they want to hit you up with a huge fine and knock you out, knock you outta business or bankrupt you, they could probably do it. Not in all cases. I will name any states, but there's some states that have pretty, pretty nominal fines. but, generally speaking, I think the wisdom of the board has gotta be such that they weigh all of that before they, drop the hammer on you and say, pony up a pony up.

your primary residence or

Ned Milenkovich, PharmD, Atty: whatever the fines are not intended even though people think they are, to be, big time revenue generators for a state. Of course the state [00:14:00] makes money off of that. I mean, they have to pay their people, they have resources that they have to expend on all of this stuff.

 but it's more or less, hurting the individual in the pocketbook to wake them up and say, Look, you just broke the law. Personally, when I sat on the board and we had people come before us, I always tried to be fair. I always tried to be level with them. and, not necessarily give them the benefit of the doubt, but you can usually tell when you have somebody before you that really is trying to do the right thing versus somebody who's a little bit more smug, a little more daring, if you will.

Ned Milenkovich, PharmD, Atty: Someone who's gonna go out there and maybe do it again if you give 'em the chance or the 


Mike Koelzer, Host: You have to call a spade a spade. If somebody breaks a law, they broke it, whether they intended to or not. And as you said, the penalty phase is where you can be lenient or more strict, depending on maybe the intent that was in there.

 as a [00:15:00] board member or as a board, you have all kinds of levers to enforce against a licensee. I mean, you've got, fines, you've got probations, you've got, reprimands that you can hit 'em with. I mean, a more severe, arguably,and very damaging professionally would be a suspension.

Ned Milenkovich, PharmD, Atty: Of a pharmacist's license and God forbid, a revocation, where you lose it. So those are your, sort of, your tiers of, of discipline. and in Illinois we have and had, something called the non-disciplinary order where it never went on your record. And if you were fit for something of that nature, that was always a good way to go for a license because you didn't get a blemish on your record.

The fine was not called a fine, it was called an administrative fee that you had to pay. I, I don't know why more states don't go that route,for appropriate cases, but they

Mike Koelzer, Host: don't. I always think of a board as, being the things that we as pharmacists [00:16:00] have to be afraid of, how. Of the board energy, if you can think of percentages. Is it, 20%,people who have done something wrong, 20% looking into things for people that wanna do something right.

20% looking at new rules that people had ideas of, and you're seeing if it and the board seeing if they want to do it or not. How is the board divided in terms of tasks?

 every board, first of all, is going to be different, and a lot of boards will have created committees to deal with things such as rule making, disciplines. there's probably a bunch of different committees that could be formed and broken out so that the board isn't tasked 100% of the time with everything.

Ned Milenkovich, PharmD, Atty: And then the idea would be that the committee would report back to the full board what their recommendations are on a particular issue. There's definitely a good [00:17:00] amount of time that's dealt with disciplinary matters. There's a good amount of time that goes into it.

understanding the state of the law and the rules and how they can be improved to advance the profession while at the same time protect the health and safety of the public. there's probably a good amount of time spent on listening to stakeholder presentations, introductions of new ideas, concepts, initiatives.

Ned Milenkovich, PharmD, Atty: I mean, if you look at, for example, just rolling the clock back to P T C B, the technician group when they first came into play, people didn't really know what to think about that. Now, of course, there's all kinds of certifications for technicians. I'm a big believer in. , the advancement of laws and rules as a result of stakeholder initiatives.

[00:18:00] So the laws and the rules will remain arcane and old and applicable to today's society so long as they continue to be on the books. and, we have so much going on right now with technology, with telepharmacy with all of these initiatives out there. Are gonna make life easier for pharmacists and allow them to do more with their professional knowledge than just licking, sticking and pouring.

 There's a lot of things out there that are ready to happen, but then you look at the laws and the rules of a particular state, and they're nowhere near where they should be in order to accommodate this type of forward thinking 

and movement of the profession.

Mike Koelzer, Host: I Heard somewhere too, like when SCOTUS came down, the Supreme Court came down and chastised the PBMs in Arkansas and so on. A lot of states maybe weren't expecting that and didn't [00:19:00] even have rules that could take advantage of the new laws against the PBMs and the boards have to get caught up, get current, and then enforce it 

 I mean, some of the states, maybe pharmacists have been kind of downtrodden in thinking that there's not gonna be a good future, but it almost seems like you want to keep up on those laws when the time comes.

Ned Milenkovich, PharmD, Atty: I would say that that's probably true. I mean, when the Supreme Court came down with the Arkansas decision, they probably did catch a lot of people by surprise. Now, if a particular state had on the books a law that was sort of already sitting there dormant or however you wanna describe it, They probably through their legislature, passed the law in the, in somewhere that, that was akin to what the Supreme Court decision was.

well they probably had a little bit of a leg up in the whole process, but you still, many times have to go through what we [00:20:00] call. Notice of public rulemaking where, they promulgate a proposed rule and then it goes into, the register, the state register, or in the case of a federal law, it'd be the federal register.

Ned Milenkovich, PharmD, Atty: And then it's open up to public comment. and so then once that comment period ends, then the board goes back and they look at, Okay, here's what we have and here's what the public said. Do we wanna make any changes to this? If they're substantive 

changes, you go do another notice of public rulemaking.

If not, then you finalize the rule. But that process, that whole rule making process, it can happen very quickly if they really wanna make it happen quickly. But typically that's not how it works. It's gonna take six months a year, it could take two years. but yeah, I would say it's gonna take some time for all of those states who want to follow along.

, the Arkansas path and the Supreme Court path to,to put, to, to put something together. But we're seeing it. I mean, it's happening across the [00:21:00] country. It's just 

Ned Milenkovich, PharmD, Atty: taking a long time.

Mike Koelzer, Host: Who's tasked on the board to communicate upwards? I imagine the boards are all under this state board thing, and then they have to respond to the, this person and they go to the governor and so on. Who on your board is in a paid position that somehow takes your stuff upwards?

Ned Milenkovich, PharmD, Atty: So every board operates a little bit differently. And for example, in Illinois, we were always an advisory board and we're a part of a super agency called id. F P R Michigan has one, it's called lara. 

I believe Pennsylvania has one as well.

 How much time, energy, and effort a board member wants to put into providing inputs, upwards to the staff who works in the board full time.

This is their job, these are the employees. And the lawyers, I guess it depends on how much of a [00:22:00] voice you really have. I would say as a board member, you cycle in and you cycle out,

Mike Koelzer, Host: It seems that someone gets paid to oversee all the boards, and then that person is overseen by maybe the governor. What's the structure?

Who's in charge of the board?

Ned Milenkovich, PharmD, Atty: Well, it depends if the board is independent of a super agency or not. If you look at a state that has its own executive director, its own general counsel, it has its own assistant general executive directors, those people are typically overseeing the board immediately above them.

Is probably somebody who is a political appointee, meaning the governor. The governor wins the state. And so then, all the political people that were there in that position with the other governor, the one that lost, They got booted. They get kicked out, and the new people coming on the [00:23:00] block and then they oversee these, agencies, whether it be the board of pharmacy, the board of medicine, the dental board, the nursing board, the butcher board, the cosmetology board, all of those, because it goes well beyond pharmacy, right?

As you know. They got a board for everything these days. But who oversees them? It's gonna vary from state to state. But yeah, the board members, we're appointed, but we. I hate to say it this way, but it's always a little bit of, well, doesn't have to be, but there's always gonna be a little bit of tension between the board members and the staff.

maybe not in all cases, there has to be some sort of functional relationship between the two. otherwise, someone's gonna lose and, you're there as a board member, as an appointee. 

Ned Milenkovich, PharmD, Atty: tho those people are there and this is their career. I mean, they don't leave unless they get fired or they quit, which happens.

And sometimes those people get sideways with the political appointees that are above them, and [00:24:00] they get asked to. And, it's, and just simply that. And it could be over. I could be over whatever. I mean, it could be because of a statute or a rule. It could be because personalities don't jive together.

political views, who knows? 

Mike Koelzer, Host: How many paid positions, like for Illinois for example, how many paid positions are there that strictly do pharmacy board stuff? Is it zero? Is it a fraction of a position or does the pharmacy board pay a full-time, administrative assistant, a full-time, pharmacy director who only has the board underneath them?

How many people are involved? 



Ned Milenkovich, PharmD, Atty: there's a lot of people. In some cases they're full-time on the, focused on the Board of Pharmacy. In other cases, they may not be, they might be an attorney on the board who's got the pharmacy board, the medical board, and the dental board under their auspices.

There are a significant number of FTEs allocated, you know, either directly to the [00:25:00] board or, pieces, parts, you some of it is gonna be part of the pharmacy board and some is gonna be part of some other boards depending on, what your role is there and what the job description is.

Mike Koelzer, Host: In my state, I had this little tiny agreement. I didn't agree with the state, and I think they read a rule wrong, and they probably think I read it wrong, but I got this thing, it looked like they were sending me to the death penalty, you know, it it was like an official legal thing, with the headings and all the sections on it, and this and that, it certainly wasn't on the back of a napkin.


Ned Milenkovich, PharmD, Atty: I mean, some of these things they have already canned. It's not the first time that someone has violated something so they can pull it together. It's what we call a boilerplate language. Other times they have to draw it up from scratch depending on what the situation is. But, yeah, I mean it's, you get a,you gotta complain.

Mike Koelzer, Host: You got an accusation. And,when you get one of those,if you're not used to getting those types of things, it sends a little bit of a shock wave through you, you're like, , What did I do wrong here? Am I going to jail? And the state's gotta cover their tracks. I mean, they just [00:26:00] can't call you up and say something. They gotta have all that documented and so on. So I can see where the staff needs to be there. 

 You mentioned an advisory board. I remember years ago I was on the parochial school board, and we spent about three months in a.

Kind of quibbling back and forth which way this idea was gonna go and so on. And I think the fourth month our paid leader showed up. I think he was half cropped and, and he just said, no, and I wished like that would've happened four months ago.

So it's important to know if you're on an advisory board or not, and how that goes.

Ned Milenkovich, PharmD, Atty: Yeah, I'm a little bit jaded in that regard because

I feel like if the powers that be want to make a particular situation happen, it doesn't matter how much deliberation you're gonna have at the levels that they're asking you to do. And sometimes I [00:27:00] feel like they're putting you up to it because you're looking at all of this and you're like, weighing it.

Ned Milenkovich, PharmD, Atty: And so somehow vetting it out, vetting the process so that they have something to hang their head on, knowing full well what the outcome of it is gonna be ahead of time, they know what the outcome is gonna be. You don't, and, I've seen it, I've seen it happen many times, in my life. At the boards, at the associations,I've seen it happen in the workplace.

and I think sometimes that's just the way the cookie crumbles. but ultimately, yeah, it's like, why are we talking about this if we already know what the outcome is gonna be and why are we wasting resources? But yet here we are.

Mike Koelzer, Host: So you mean somebody has an idea and they're above the board and they want it to go, let's say the direction of A, They give it to the board, hoping the board will say a two to kind of cover their tracks, and then if the board says B, they say tough. We're gonna go a anyways

Ned Milenkovich, PharmD, Atty: Well, [00:28:00] if the board doesn't say, Hey, then it doesn't necessarily mean that they're gonna do it anyways. It just means that they're just gonna have to take another bite at the apple down the road. to get their tracks covered.

Yeah. And you know, these things are never really, I, I mean they're not set up to fail. so they usually talk to people or can talk to people who have interests that are aligned.

and this, this is not something that I would necessarily,I'm not sure thatI have. Right To say what I'm saying. And goes against what I was saying earlier about how you have to put the interest of the state before your interest. Well, I suspect you could probably put the state's interest before your own.

Ned Milenkovich, PharmD, Atty: and if you're aligned with the higher powers then, they get what they want and you're aligned with it. You know, they recruit the people who are gonna advocate for those positions. I mean, we've been dealing with a particular group,of all things, can you believe Flavorings, have always been a [00:29:00] part of the pharmacy practice when mom or dad comes. For a prescription for junior,and junior's not gonna want that medication unless they add some kind of bubble gum flavor or cherry flavor to it. There are interest groups out there, particularly in the compounding pharmacy arena, who would require the pharmacy in order to engage in adding a simple flavoring to undergo full US P 7 95 remodeling or stop doing it.

Okay. and we see this all the time, rearing its head, and then we have to go back and we have to talk sense into the board. And the board recognizes that, hey, this is stupid. Like, why are these people pushing this? But yet you got people out there who are continually driving at the same, Thing in order to achieve their result.

whether they're successful at it or not, I don't know,

Ned Milenkovich, PharmD, Atty: but we've certainly seen it come up several times.

Mike Koelzer, Host:  When you're dealing with the board, [00:30:00] what kind of people really get under your skin? like that guy's pulling that bologna. What would get under your skin?

Ned Milenkovich, PharmD, Atty: no, I'm just to clarify, we're talking about fellow board members or people who are on the staff 

versus the people of the public

Mike Koelzer, Host: Well now, Ned that you opened it up, we have to go with all three of 'em.

 I think the people who got under my skin a lot were. Uh, on the board were those individuals who had far outstayed their tenure, their statutory tenure, but never got replaced.

Ned Milenkovich, PharmD, Atty:  Meaning, you get two, five year terms and then you're supposed to be replaced by a new person.

I mean, that's the whole idea. It's a term limitation. Yet somehow these people managed to stay for far longer than what their statutory period was. You wonder how, how does that happen while all these other people are being [00:31:00] replaced? And those people incidentally are the same people who have close ties to the government, to the staff people.

and they're the ones that are, not necessarily always the most vocal publicly, 

Ned Milenkovich, PharmD, Atty: but they are behind the scenes vocal. Those people were a little bit tricky to deal with.

Mike Koelzer, Host:  That seems rather black and white to me, that you would just say, Hey, what the hell is Sally doing here? You know, this is her 11th year. It seems rather black and white. Why is it not?

Why isn't a stink made by the other members?

Ned Milenkovich, PharmD, Atty: well, because probably nobody would listen. And you would just hurt yourself. and so you don't say the things that are necessarily on your mind.  in the public, I'm not so sure that the public really got under my skin so much, to be honest.

 The ones that got under my skin were the ones that we were disciplining that were clearly breaking the law. and they would sit there and they would be argumentative with you over the fact that they [00:32:00] broke the law and didn't quite care.

 but yeah, those are the types of, those types of individuals and they know who they are. I mean, we can leave it at that.

Mike Koelzer, Host: With the state officials, would that be the same thing

 yeah, I think so. I think that there are definitely people on the state boards that are career people who have a lot of power and influence internally, and maybe rightfully so because they've been there for so long and they know the ins and outs of how everything works.

 I'm not even so sure that is, something that, that, that would bother me so much. but certainly there are, I guess it comes down to how one conducts themselves, right? I mean, if you're transparent,open minded and are able to communicate with people that which you are trying to achieve without trying to cloak it, I've got a lot of respect for that.

Ned Milenkovich, PharmD, Atty: I mean, if someone is out there and they're gonna champion a particular cause, I mean, Might not agree with them, but if they come out there and they say, Look, this is what we're gonna do, and it, and even if they give you an opportunity to voice your opposition to [00:33:00] it, because a lot of times what you'll find is if they're transparent and they want to do something which is not good for the profession, you can go out there and find yourself,your other fellow stakeholders who are going to stand up with you in opposition.

And not everybody can be wrong. I mean, so at least you have a forum to vet out your opposing viewpoints you still might lose at the end of the day.

But I think people are really smart in the profession. I mean, pharmacists are not dumb people 

and they're critical thinkers.

 I think they're smart enough to recognize when they don't know something and they're smart enough to recognize when you don't know something. I think keeping that level of decorum and professionalism and transparency provides a medium for good things to happen for the profession, regardless of how people react and behave with each other.

but yeah, that was one of my pet peeves [00:34:00] peeves . You'd see people there and they would, uh, they would dance around and prt around and act like they're, just like everybody else. And you knew darn well that they were. Not like you. they were getting by on, on some kind of favors and

Ned Milenkovich, PharmD, Atty: I don't know what those favors are 

Mike Koelzer, Host: is there anything natural when it comes to 


Ned Milenkovich, PharmD, Atty: So there is what we call the A B P, which is the National Association of Boards of Pharmacy, which is a non-governmental association. And, that association.

While it's not a state agency, it certainly bands together the various boards of pharmacy through engagement of those boards, in various activities and task forces.

there's an annual meeting. There are district meetings,and that association you become, [00:35:00] an automatic life member once you sit on a board. So it's, it provides a wonderful medium in many of my colleagues and friends who I. Come to know over the years,I knew them or know them as a result of going to these meetings and you establish,friendships for a

Ned Milenkovich, PharmD, Atty: lifetime. I know a lot of people in a lot of different states, both current and former board members, current and former executive directors. And,it's a great opportunity to exchange ideas. they will get behind all kinds of initiatives. Whether it's, diversion issues, which was a big issue, has always been a big part of the association. or, technology or, I mean, the issues are numerous and widespread. It's not just those two things, but just by way of example, I would say that those are, areas that, that have been an area of focus 

Mike Koelzer, Host: when you talk about them getting behind, they don't Bond [00:36:00] together and do a letter of recommendation to the present or something from the national board that's more support from below.

Ned Milenkovich, PharmD, Atty: So they make themselves available and have all sorts of resources for the various boards of pharmacies. There, there's various accreditations that you can get, as a pharmacy. Sometimes, for example, boards don't have the bandwidth and they don't have the number of inspectors necessary to re-up a pharmacy license.

And the state will turn around and say, Well, you can go pay N A B P to do your inspection. And then we'll, will honor, honor 

whatever an inspection report comes from there. That's just one example. I know that they also have backbone, state, Board of pharmacy newsletters that come out.

if you've ever seen those from your individual state board and they'll help. put content in the newsletters that come forward. a also, you know, at least when Carmen Catone was executive secretary, he certainly, had a lot of contacts [00:37:00] in, in, in relationships with both the FDA and the dea, and has, on more than one occasion, Gone to, the federal agencies in Washington I don't know if there were any congressional hearings, I'm sure there were, where, as a subject matter expert, they would bring him out there and he would talk about particular issues,that were on the table.

not a naive and simple organization, to say the least on the contrary, certainly a force to be dealt with. and they know all the boards, so it doesn't, they're to get a message out. they can pull together, messaging very quickly and get opinions, to come together.

Mike Koelzer, Host:  If there was a shifty state board, if you could look at a state and say, That's shifty, would that be, again, not Illinois, I'm talking way out on the West Coast. Of course. As far as, as far as we can go, how could you imagine a board being shifty?

Would it be payments under the table? [00:38:00] Would it be, uh, you know, having certain, bigger pharmacy companies having seats on the board where you kind of scratch your head and say, Why is this part of that? 

Ned Milenkovich, PharmD, Atty: I'm not sure it's necessarily you. Pay to play or anything like that where a particular board gets remuneration or money under the table, for something. But, power is, is probably more, shifty the more of the shifty stuff than the money. I mean there, there have been boards that, again, not speaking about any particular board, but there have been boards where, seemingly people who should not be controlling the independent and final decision making of a particular board, are doing so.

 And the one, area or one state that I'm thinking of,the lawyer, the general counsel of the board, had a tremendous amount of influence [00:39:00] over the board's decisions. And it's like, this makes no sense. 

 He should be making recommendations to the board, 

but he should be deferring to the board, not telling them what to do. and when he's on the one hand, prosecuting a licensee or, or undergoing some sort of administrative complaint against a licensee, whether it be a pharmacist or a pharmacy, and then he is turning around and telling the board, how they 


Well, that's judge, jury and execution are all, all on one. And lately I've been reading that there's been some new public scrutiny of these individuals and what they've been doing, and they're gonna find themselves in trouble. and I think, I think it's interesting because, we can talk about shifty boards, and shifty actors, but those people aren't long for this world.[00:40:00] 

Sooner or later, someone's gonna ring the bell and they're gonna get caught, and it may not happen overnight. My feeling is that boards, Should be, or they tend to be transparent. professional, fair. I'm not saying that's gonna be the case all the time, but I think maybe I'm naive, but I think that they try to be good actors.

and, there's always gonna be people who are gonna push the envelope on a particular system and try to get away with things 

Mike Koelzer, Host: I think the internet has done so much to help things. A little bit, not shady, but just a little bit in the dark. What average pharmacist is gonna read all the board stuff or something? If it's, you know, in a book. The online stuff is easier.

I'm sorry to say this, but I've got three people I've talked to in my life who I'm pretty sure have all fibbed about war [00:41:00] medals, One Bronze Heart, and two people on their Purple Hearts. And I thought about that and I thought years ago you could tell anybody that you earned a Purple heart.

What's someone gonna do? Go to Washington and look up on the Purple Heart list, But now you can pretty much look up somebody on the internet and I think that just helps. Even when it comes to boards and things like that, it brings stuff to the light that wasn't hidden on purpose.

Mike Koelzer, Host: It was just hard to find stuff when it's not online.

Ned Milenkovich, PharmD, Atty: Certainly, Things are more verifiable these days, with the use of the internet. you could do background checks on people. You could do criminal checks on people, You can find out where people live, what their phone number is, how old they are. I mean, you know, all kinds of things are out there now, and I'm not so sure it's necessarily a good thing that everybody knows your business.

I mean, but, but I would agree with you that. You could verify things. [00:42:00] Although, I think a lot of this has sort of become perverted also with this fact checkers. You gotta wonder if the fact checker knows this fact

Mike Koelzer, Host: What's one thing you would tell pharmacists about the boards?

Ned Milenkovich, PharmD, Atty: I would say to the pharmacist that you have to remember that these people are pharmacists also. and they are professionals. just like you are in a given situation, whether it be one where you're being disciplined or being accused of doing something or whether you're going before the board to push for a new type of fantastic technology or automation or, those continuing education programs or processes that previously didn't exist.

You have to remember that we are a self-governing profession. Pharmacists are governing each other and so, you know, you have to keep in mind that, they. Their point of view, while it may not be the same as yours, has a common [00:43:00] thread, and going before a particular board of pharmacy or talking to a board of pharmacy shouldn't intimidate you.

but you should be prepared to have an open and healthy dialogue with the board, because they will receive you much better if you are able to go before them in a positive, constructive way, and turn a potentially adversarial situation into a win-win. I always want to hear what their thought process was. And if you keep yourself open minded as that licensee and are able to advocate why you believe something or why you did something or why you didn't do something,and recognize that you might not be right in the end.

Mike Koelzer, Host: Well, Ned golly, that was interesting. I think a lot of us, when we see the cop in our rear view mirror or hear about the board and so on, we [00:44:00] get a little bit tensed up.

 So it was really cool to get that information. I think the more information you get sometimes, the green curtain comes down . So very cool stuff. Thanks for coming on.

Ned Milenkovich, PharmD, Atty: Well, thanks Mike, and I really appreciate you taking the time with me today and,and sharing some of our collective thoughts with your listening Congratulations on a very successful program that you have, and I'm sure we'll be hearing more and more about your program as it grows in popularity

Mike Koelzer, Host: Thanks so much, Ned. I look forward to keeping in touch.

Ned Milenkovich, PharmD, Atty: Thank 

Mike Koelzer, Host: Thank you.