Season 1 #4 – A Prescription for Independence and Safety

Welcome to NFB News Live. Tennessee presents the show that keeps you informed on blindness issues, up to date on innovations, and brings you engaging stories from people like you. Now on with the show.

Today, who and what we are presenting is Loretta Roberts, and she's going to be talking all about the. I say the, because it's my favorite, the accessible labeling system, script talk. That's s c R I P T a l K. So, Miss Loretta, take it away. Awesome.

Thank you so very much for having me, everybody. I'm going to start by giving a little bit of background about Envision America, because I just love to do that. And then before I talk about script talk, that's going to be the very last one I talk about. I'm going to tell you about all of the accessible labels that we offer, because script talk is not the only one, and a lot of people don't know that. So Envision America started back in 1996, and the cornerstone of Envision America was built on a single premise, and that was to provide people with visual impairments equal access and greater independence through technology. And we accomplish this by focusing on accessible medication labeling. All right? And the best part is by making it free through participating in pharmacies. What I'm going to do is I'm going to start by talking about all the different type of labeling that we have. The first one I'm going to talk about is our braille. And the braille labeling is just a clear strip that goes all the way around the legal label. It will depend on the type of prescription names, and that type of information will be how much the pharmacist can fit on that prescription. But we did just enlarge those. So most of the information is on there for you, and it goes right across the top of that legal link. Now, the second most common of our accessible labels that I want to talk about is our script view large print. And with our script view large print, this allows the pharmacy to program on this label all the way up to a 20 font. And it comes in a booklet attached to the bottle. It would be adhered to the bottle with a clear rubber band so you can easily pick it up. Once you take that rubber band off that is also still attached to the bottle, then the little booklet opens up, and you'll just turn each page and it'll have every piece of information that's on that legal label in this booklet. Now, also with participating pharmacies, because not all pharmacies do this yet large print can also be available in dual language. So for the large print dual language for every line where there's a sentence in English right under that will be the language of choice for the dual language. We do also have what's called a script view mobile app for iPhones and Android. They are equal to the iPhone seven or higher. If you have the script view app on your phone. On the very last page of the booklet is a QR code. If you use your camera to scan that QR code, then it will pick up all the information on this booklet and it can read it to you. Once you're done with it, you just put the blue clear rubber band back over the booklet and it adheres it back to the bottle so that you can safely and easily pick that bottle up. Now, something else that we do offer is called our CSS labels. These are our controlled substance safety labels labels. And what these are, these are available for all controlled substance, and they include links to safety videos that can help you manage these types of medications independently and safely. Now, our most common of all of our labels is called our script talk audible labels. Now, the script talk audible labels, they're great. And the way that they work is the pharmacy is going to program all of your prescriptions into what's called an RFID tag. So it's going to look like a little sticker on the bottom of all your prescriptions bottles, and it's actually going to say RFID on them. What that stands for is radio frequency identification. Okay, now this is a label that once you are set up, the pharmacy will automatically put these on all your prescriptions. So all you have to do is pick up your prescriptions as normal, and then you're going to set your prescription bottle on top of the prescription reading device that we will load out to you and we loan them out to you with the understanding that as long as you're using a participating pharmacy, you can always keep that device. If at any time you're no longer able to use a participating pharmacy, then at that time we would send a return label so that it can be returned and eventually loan to somebody else that can use it. So what you would do is place this RFID prescription bottle on top of the device anywhere once it's turned on, and then you're going to hit push and release the read button and it's going to read everything off to you. What I want to do now is kind of describe and explain the device to you. Now, the device can be held in one hand. It's a half moon shaped size. I always like to tell people when I'm talking to them on the phone. If anybody remembers the old CD Walkman players from back in the eighties, it's kind of that shape, you know, that small thickness and everything. So it's easily held in one hand. But if you set the device down on a table with the three rubber buttons on the top closest to you, that's how I'm going to describe the device. All right, so the three buttons on the top, there's going to be a down triangle, which is the next button, an oval button with a dot, which is your read button. And then on the other side of that oval button is an arrow button that faces up. That's the previous button. Now, these three buttons are going to work differently depending on what mode you have the device set. All right, so now when you turn the device on on this model that I've got in my hand, which is script talk one, and we did just recently come out with a script talk two, which is identical to it except for on the one, the backside is more straight across like a half moon, where the two is more of a rounded. And the buttons are the same, the three buttons on the top, but the toggle button on the one is if you put your fingers on the top of the device and go down the front, the toggle buttons right there on the front, and you'll toggle it all the way to the left. When you toggle it all the way to the left, you're going to hear a long faint beep. You're going to hear a script talk station ready? And then two ds. Once you hit that hear that second d, you take your prescription bottle, you set it on top of the device anywhere, and you push and release that read button. You do not want to hold the read button down. If you hold the read button down, it's going to take you into the instruction modes. Once it's in the instruction mode, if you touch those two arrow buttons, the next and the previous, you're either going to speed the voice all the way up to where you're not going to be able to understand what it's saying or you're going to slow it all the way down into spell mode where it's going to literally spell every single word out to you. So if you ever have this in the instruction mode, you want to be very careful that you don't hit those two arrow buttons, only the middle one to turn it off, which is your read button as well. Okay, so now when you're in the read mode, you push and release it and it starts telling you about the prescription. If you missed something, you're going to hit the right arrow button, which is your previous, and it'll take you back to what you missed. If you, if you want to skip past something and get to what you want to hear, say, for instance, the prescription number, then you're going to hear hit the next button until you get to what you want to hear. So that's how those buttons are used. Now, like I said, the script talk one and the script talk two are identical, except for that toggle button one. The toggle buttons on the front of the device. Script talk two, the toggle button is on the right hand side, so you'll toggle it towards you to turn it on and back to turn it off. You always want to make sure you hear it click off if you use the batteries, because if you don't, you won't run those batteries down and the device will beep, beep, beep, beep beep until you turn it off. The other difference between the script talk one and the script talk two, script talk one is female voice. Script talk two is male voice. Some people that say they can't understand the one when they have it, we send them a replacement with the two, and because it's a male voice, they can hear it a little bit better, and vice versa, there's some that couldn't hear the two and we send them to one and they can hear it. So, you know, depending on what you get will depend on, you know, what we have to send you if you can't hear it. So for right now, I'm just going to go with the script talk one, and I'm going to toggle this button all the way to the left. And you're going to hear a long, faint beep. You're going to hear script talk. Section ready? And then two more dings after that second ding, I'm going to put the bottle on top of the device, and then I'm going to push and release the read button so you can hear what's on the prescription bottom. This is what you would hear if it was one of your prescriptions.

Split top station ready.

Okay, so now I'm taking that bottle, putting it on top, push and release the read button.

John J. Smith Medication Alloxicillin 250 milligram capsules instructions take one capsule three times daily. 30. Prescription Day 10 20 23 expiration January 10, 2024 refills remaining zero. Prescriber Doctor Ben Casey, Scriptability Pharmacy to reorder this prescription, dial 808 901180 prescription 123456 warning. Finish all this medication unless otherwise directed by prescriber. Warning. Medication should be taken with plenty of water.

All right? So once it's done, you just take that bottle off, you toggle it all the way to the right until it clicks and it turns off. And that's how the device works. Now, we also have available the other way you can listen to these, these labels is the script talk mobile app. So the script Talk mobile app, a lot of people really love this feature, but with the mobile app, you're going to see on the top left hand corner, full scan. Top right hand corner is a quick scan. Now, full scan, you're going to hear everything you just heard on that device, including side effects. If you hit the quick scan, you're only going to hear the name of the medication and milligram. Now I'm going to go ahead and let you hear the quick scan, since we already know what the full scan is going to give you for iPhone seven and higher, the NFC, which is the near field communication, which is what's going to read this RFID tag is on the front, up by where the ear is, where you listen when you're on a call. So we're going to click quick scan. We're going to put the bottle up.

Here into it registers it, amoxicillin, 250 milligrams, capsules.

So that's all you're going to hear, the name of the medication and the milligram. Now, the other really good thing about the app is down on the bottom. First thing is it's very good with voiceover. So it does work with voiceover. And if you have an Android, it does work with talkback as well. On the bottom, there's three big blue buttons. The very first big blue button says my meds. If you click on the my meds, we all know that when you go to urgent care doctor or a new doctor or the hospital, first thing they ask you is what medications are you on? If you click on that, it's going to bring you to a screen that's going to give you a list of the name, milligram, time and date of every prescription you've scanned. So that's a very good feature to have on there. The next one down is called find a pharmacy. If you click on find a pharmacy, it's going to bring you to the page where it says find a pharmacy using phone data or by putting in a zip code. If you put in by zip code, you'll put your zip code in, and then you'll hit either five, it's going to ask you for a mile radius. So either it goes from five all the way to 150, then you'll hit search, and then it's going to bring a list of any pharmacies that participate in your area. Now, after you get past that, it's going to bring you to all mail order pharmacies that participate with script talk. So there's a list of all of those on there as well. How do you know which pharmacies will do this? There's several different ways you can find out. One is you can just call us and any agent that answers, we'll be able to look up your area and let you know. We also have a team that will work to try. If you have, if you're using a pharmacy that doesn't participate, we do have a team that will try to help get them set up. We do get pharmacy set up almost daily. Most of your mail orders participate and you can have more than one pharmacy. I have some people that have like three or four pharmacies because they get different meds at different pharmacies because of the cost. So as long as that pharmacy offers it, you can have multiple pharmacies, but you can call us, you can go on the Envision America website and hit find a pharmacy. It's right at the top of the page. Put in your zip code and put your mile radius, and it'll give you a list of all of them there. If you have the app, you can look on the app.

How long have you been with Envision America in doing this?

I've been with Envision America for four years. I, my first year I was here, I started out as a regular customer service representative. But once I was there after a few months, I was just so passionate about helping people. And they didn't have anybody that worked directly with advocates, so we had advocates that were, hey, can we have Zoom meetings? Can we do this? Can we, you know, talk to my whole work coworkers to try to get this spread? And I just started, yeah, sure. Let me, let me see if I can get that done for you. And it just, it broke off from there. This is the first. I'm the first person to ever have this position as an affidavit outreach specialist with this company. They've never had it prior to me. The three years I've been doing it, it's grown so much. We've gotten so many people set up. I send all of my advocates a forum that's called. Let us do the work for you. And I tell them all, if you have anybody that needs help getting set up, fill this form out. I will call both the patient and the pharmacy. I'll do all the work to help get them set up. You don't have to do any of it. Just give me that form. I keep track of those forms so I know who's helping the most get people set up.

Loretta, thank you very much. And before we close, would you give your email and the script talk phone number in case anybody listening would like to contact you to help get their pharmacy and get Envision America products in their pharmacy?

Absolutely. You can reach us by calling 1808 901180. My email address is L. Roberts. That's Roberts at Envision with an e america.com.

Loretta, thank you again for joining us on NFB Newsline Tennessee presents. You've been a great presenter.

Thank you so very much. It's my pleasure.

You and me, NFB, let's dream together. NFB.

You and me lives on forever. You will see.

Presenting the second part of accessible prescription labeling. We're talking to someone I've interacted with for a few years now, ever since we thought about doing a bill for accessible prescription labeling. Her name is Charlotte Glass and she works for Envision America. Hi, Sharla, and welcome.

Hi. Thank you for having me. I'm excited to be here and talk about your, your law going into effect.

It was great when we first started communicating, you know, she told me about how, you know, Envision America does more than the labeling systems. They pretty much cover it all, and they work with states and they work through legislation. On March 14, 2024, the board of pharmacy in Tennessee came down with the laws. But first we had to get the bill passed. That was a wonderful experience. Now let's hear from Sharla to talk about what's happened at the board of pharmacy and how all this happens and comes into place and what the rules are.

Yeah, so kind of the way that just backtracking a little bit with the legislation. So during the legislative process, the board of pharmacy and the pharmacy associations in Tennessee were at the table. They had an opportunity to express their concerns, and that is, you know, they helped to amend the bill. So it got to a point where they were comfortable with it. And so the Tennessee bill is not as specific as some of the other states bills. And the rule then also reflected that. But I would say the board of pharmacies rule is, you know, they just decided to leave it as vague as possible so that pharmacists could do basically whatever they wanted as far as accommodation, like work with patients and, you know, ask them what their accommodation needs are and then work with that. So the rule that they ended up passing, they basically already had this rule written before anybody else could provide any public feedback. The rule they wrote was all reasonable accommodations for individuals who are blind, visually impaired, or otherwise print disabled shall be made. So, again, kind of vague, but it does mean that they have to provide all reasonable accommodations. I know that the Tennessee NFB and myself had expressed to the board that what we thought maybe it could have a little bit more specificity as guidance to the pharmacists, but they really felt like keeping it open ended, like that was better. So this is what we have. This is what's, in effect. I think it's really important for everyone to know that since it is that vague, that you have to be specific about what you consider is a reasonable accommodation and ask for exactly what you want, because the board didn't, you know, provide specific examples. So whether it's script talk or large print labels, braille, you know, a QR code that goes to an app or any other thing that you need, you know, you just have to make a case that you believe it's reasonable and they shall make it. So I would just encourage people to go ahead and ask their pharmacist for whatever accommodation they want. And, you know, if they say they don't think it's reasonable, then that's when people can go back to the board of pharmacy and be like, okay, well, we think it's reasonable. They think it's not, and then have the board of pharmacy determine whether it's reasonable or not. So to further define it, I'm excited because, you know, bills and rules like this open the door for conversation, and they make it possible for patients to, you know, ask for the accommodations they need, and it makes it possible, you know, it gives us a reason to call them and. And to educate the pharmacists and provide more information about, you know, being more equitable and accessible. So that's kind of where. Where we're at right now. And I am happy to answer any other questions that people have about what's happened in Tennessee or what's happening around the nation, because there's eight other states this year that have introduced similar legislation, and Virginia's just passed this week. The governor signed it. So we got at least one more this year.

From talking to people from Memphis to Bristol, Tennessee, and from Chattanooga to the borders of Kentucky, I have found that script talk is the favorite of everyone. Do you have any selling points, maybe for the script talk system for, like.

When you're talking to your pharmacist?

Yes.

Yeah, yeah. I think the first thing is that you can. You can point them to the us access board to best practices. That would be, you know, the federal standards. Federal standards are not mandated, but they are, you know, they're listed by the federal government what the standards for accommodating line and low vision patients are. And then you can say, you know, script talk and the scriptability system, our labels are the only ones that match all of those best practices. We're the only solution that actually matches all of those. Another thing is that our software is already integrated with most of the major pharmacy chains. Just this year, we finished the integration with McKesson, which is actually the largest pharmacy software system. And so what integration means is that it. It can be easily worked into their current workflow, which makes filling a lot easier. Cause it's already. It can be already built into their existing software system that pulls in the data for them so they don't have to retype any patient information, you know, which, of course, is also safer when it's just pulling information already in. And that had to be retyped. And we have all those options available. I guess that's the third point, is, you know, they can pick and choose what solutions are going to best meet their patients needs. And we also provide translation in 25 different languages, so, you know, we can help them also meet those civil rights, you know, language access needs as well, for both sighted and vision impaired patients, no matter what language they speak, you know, we really focus on making the pharmacist job easier and patients safer.

Have you found that it's harder to get them on board than it is the bigger chain stores?

Well, we have most of the big chain stores except for Walgreens. We're working with most of the big chain stores. So I'm going to say, yeah, but whether that's just because there's more of them or because there's more financial barriers somewhere in between there. Some of the independent pharmacists really pride themselves on the personalized care that they give their patients. And they, when they learn about this, they happily jump on board. They're excited about it. You know, they're doing community outreach as part of their pharmacy practice already, and so they don't feel they are not daunted by the little bit of extra work because they consider community outreach part of their practice. But some of the. Some of the other independent pharmacies, again, especially ones that feel overworked or that are in places where they're really not getting the reimbursements that they need to stay afloat. So when I say that, I mean there are going to be pharmacies that are in lower income areas where a majority of their patients are Medicaid or Medicare, and the government's not really reimbursing them. Sometimes they even lose money on filling a prescription because the reimbursements do not cover the cost. So they're less likely to provide script talk because they're going to lose further money. So I think it kind of depends on geographical location as well. So geographical location and then their practice philosophy, I guess, are the two contributing factors there.

For someone who is totally blind or very low vision, that does not know braille, audio really is their only option for accessibility for something like this. And if a pharmacist says, well, we don't want to do script talk, are there other options that they can choose from? And I know some of the other ones there are, but they're not as well done as script.

I mean, there is like Walgreens does the talking pill reminder. I think Amazon provides the Tel RX device. I have heard, I haven't seen it demonstrated, but I have heard of other pharmacies having a QR code that your phone can read aloud, which we have a QR code on our large print labels that can do the same thing. So if our pharmacy is only doing the large print label, they can still have that QR code on there for an audible option. So I think the QR code is probably the easiest for pharmacies because you can create a QR code on lots of different platforms. And so if your phone has voiceover, then it can read that text. I'm actually kind of surprised more pharmacies haven't started utilizing that. The downfall is, though, a QR code can't hold as much information as our RFid tags, so you're not going to get, you know, all the information, but at least it could give you some. And there's also the HIPAA thing, like, you know, a script talk. You at least have to have the app know about the app or have the device in order to read the RFID tag, which is a secure RFID tag. So only our app and only our device will read it. But with a QR code, anybody with a phone can read it. So you have a little bit, but then again, with a printed label, anybody who can read can read it.

So, anybody else have any questions for Sharla?

Hey, Sharla, it's Robin.

Hi, Robin.

Hi. I just wanted to tell this group I attended three meetings this week, all of which turned out to be extremely positive. And I was happy to be able to add Tennessee to the past dates. And all the representatives that I spoke to today are so eager to make this happen in New York. We can add to that within a year or so. But it's looking good, Sharla. It's looking good.

I think it's just so beautiful what, you know, all these NFB and ACB chapters are able to accomplish. You know, I just see this snowball rolling and I just tell everybody, every conversation is bringing us closer to entire nation of, you know, accessibility.

I know the regulations are coming into effect. Does it, does it include every type of pharmacy, for example, the ones in hospitals? Those are the ones I was thinking of that you can, you know, while you're in the hospital, you can sometimes get your, your prescriptions filled. Or is it more the, you know, Kroger's, Walgreens and then the state ones as well?

The law itself says the board of pharmacy shall promulgate rules necessary to ensure that an individual who is blind, visually impaired or otherwise print disabled has appropriate access to prescription labels, bag tags and medical guides. In the law, it does not say anything about what kind of pharmacy in the rules. It says if you're dispensing a label for medical or prescription order, they must bear at least all these things and all reasonable accommodations for individuals who are blind, visually impaired or otherwise prince disabled shall be made. This rule shall not apply to medical and prescription orders dispensed by an institutional pharmacy or long term care pharmacy for administration to inpatients of that institutional facility or long term care facility, except when medications are dispensed to patients residing in assisted care. So, no, if it's, if it's for you to take home, they need to do it. But if it's just for, like, when you're in the pharmacy, when you're in the hospital, they don't, okay, there is.

Going to be room for improvement. And that's where, you know, our first few years are going to tell, you know, how things are going with the way it's written. If we're going to need, you know, amendments.

I have a question.

How can we get word out there to other visually impaired and blind folks.

That are not members of the NFB or ACB that could really use this?

I would say some usual means would be like, hey, a letter to the editor. You know, like, this rule, this law was passed. Nobody's really talked about it. You should know about it. That could be one way, because I know a lot of people still get the information, you know, post it on the blogs and the things that the social media that you're a part of. You know, every October we have medication safety awareness a month, and we really promote people to do it then, because, like, all of us together, we're going to do it this. In this month and inundate people with this idea. And. But of course, you don't have to just do it in October. And, you know, if you have different chapters of the NFB, maybe your chapter could put out a press release and send it to all your local news stations and stuff and invite them to come and do a story. You know, like, hey, I can do demo. This. This pharmacy would love, you know, talk to your pharmacist. Maybe they would be happy to have a little extra promotion by having, you know, a news station or a newspaper do include them in the article or in the, you know, do an interview.

That's what I'm working on with my pharmacist. To do that I did a blog is what we.

I work at a sil for people with disabilities. So we did a blog and just posted it on our website about the legislation and the. The wonderful press release that y'all helped us do.

So.

Awesome.

And I've sent, you know, information out to all of the independent living counselors here in Tennessee. And so there's, like, lots of little ways to get the information out.

And I will say that the Nashville chapter of the NFV, we've recently created an outreach and engagement committee. We're wanting to target doctor's offices, clinics, diabetes clinics, maybe some senior living facilities. And I think, yeah, maybe, like, pharmacies and stuff would be a great way to not only let them know that we're here, and if they come across a patient, you know, here's some business cards you're welcome to. You know, we can leave them on your counter or whatever, you know, if you happen to know somebody that could benefit from knowing us. But while we're there, we can also provide them information that might be helpful for their facilities to better serve our population.

Yeah, I think along with.

Oh, sorry, go ahead.

I was gonna say, especially if your city has an accessibility council or something like that.

I think the other part, when you're doing outreach, you know, you can talk about this piece of legislation, but often, you know, when you're talking about prescriptions and you know, the equipment needs to be accessible, it's all well to give me an accessible prescription. But if I can't use the surrender, don't know how or I don't have access to an accessible glucometer, however you say that, right? Glue commuter. You know, so educating, educating. You know, not only you have to educate social workers and doctors, is there.

A place where we could check on.

The status of them?

The best place to go, because I try and keep this blog up to date, is stay safe. Rxdev.org dot. There's a list on there of like in the tools section, there's a list, there's a timeline, but then there's also the model bill language and all the bills that have ever been introduced.

What about the people? Like all of us really old people that don't see well anyway, those are their clients. I mean their patients. So what do they say about that?

I mean, I don't think they say much. Anybody can ask for the accommodation, though. When pharmacists say, I don't think I have any patients, I'm like, what? You have no patients over the age of 65 with diabetic retinopathy.

I just realized something. You were reading, you know, the law and then you read the board of pharmacy rules. I don't believe there's anything in there that specifically states proof of blindness.

Nothing? Nothing.

Sweet.

Well, that's, that's generally how. I mean, I hate to say this, but. Or not hate to say this, but I mean, that's generally how the ADA works. It's about self identification. Do you have, and I don't mean like the disability. I mean, it's about functionality, right? You have something that limits major life function.

Sharla, thank you for coming and visiting with us this evening. It's been great having you on NFB newsline Tennessee presents. And you presented very well.

I enjoyed it very much. Thank you for allowing me to share my passion and have this opportunity to be with you guys tonight.

All of you who participated tonight, thank you. Thank you for coming and taking the time to listen and for engaging in the conversation. Thank you all for joining me. And it's been great visiting with you again. Remember to go to Newsline. Look up articles, look up stories, read your local newspaper, delve into some of the magazines that NFB Newsline has to offer. And if you haven't signed up for NFB Newsline, you can go to nfbnewsline.org and sign up there, or you can contact me at the NfV newsline tnf tn.org DoT thank you all for joining me on another great edition of NFV Newsline Tennessee presents.

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