Mark Riley started dating his future wife at the age of 16. He decided to pursue a career in pharmacy about that same time. "I've always been one of those people who needs to know what they're doing."
"I don't like to live with indecision."
Today the Pulaski County native leads pharmacists across Arkansas and the nation, and not even he can be sure where that journey will take them. Changes in the way they're paid, the growth of pharmacy chains and emergence of mail-order pharmacies have all altered the landscape of the profession Riley loves.
Last fall, he was picked for a one-year term as president of the National Community Pharmacists Association, representing more than 23,000 independent pharmacists in the United States. He's also executive director of the Arkansas Pharmacists Association, working for more than 2,000 pharmacists of all stripes in his home state.
People who know him say he's well-suited for the roles, a consensus-builder by nature and an expert on the intricacies of his industry who just may possess a photographic memory.
"He's probably the most knowledgeable person in America about PBMs," pharmacist and former state legislator Percy Malone said, using an industry acronym for the pharmaceutical middlemen that some pharmacists view as their biggest threat.
More important than that, Malone said, is Riley's dedication to the profession and its clients.
"Even though he does represent the pharmacists, he's a strong advocate for consumers. Take care of the patient and the community pharmacy will survive."
Riley likes to cite a 2013 Gallup poll that ranked pharmacists second only to nurses in how the public views the honesty and ethics of numerous professions.
"That carries a lot of responsibility with it. It becomes more than just a professional relationship," said Riley, who has owned East End Pharmacy in the Saline County community of that name since 1983. "I've had people come in and ask me what kind of car should they buy?"
Riley, 61, grew up off Dixon Road just south of Little Rock. His father worked for the Coca-Cola bottling plant and his mother was a homemaker and grocery store clerk. Riley was valedictorian, a class officer and what he calls a "decent athlete" at Mills High School, playing basketball and baseball.
Riley said he settled on the idea of becoming a pharmacist because "everybody liked the local pharmacist" and because the idea of being in medicine and business appealed to him.
It certainly wasn't because of any overfamiliarity with prescription drugs. Back then, he said, his family's medicine cabinet contained three over-the-counter products -- camphor, Vicks Formula 44 and Pepto-Bismol.
"If those three didn't cut it, that was it."
Riley earned his pharmacy degree from the University of Arkansas for Medical Sciences in 1976, working throughout college at a box factory and at Landmark Pharmacy. He'd married his high school sweetheart, Brenda, four years earlier, attracted in part by what he terms "brutal honesty."
"She always says what she believes to be the truth. That's a rare quality and because of that I developed tremendous trust in her. Of course, I didn't always want to hear it."
After college, Riley stayed on at Landmark as a pharmacist and manager. He says three men encouraged him to get more involved in his profession: Landmark's owner, Jerry Stephens, who helped start a political action committee and cooperative buying group for independent pharmacists; Lester Hosto, then director of the Arkansas State Board of Pharmacy; and Charlie West, Arkansas Pharmacists Association executive director who also had a leadership role in the National Community Pharmacists Association.
"My image of pharmacists was to be involved, because all my mentors were very involved," he said.
Guest lecturer
He joined the Arkansas Pharmacy Association board of directors in 1978. He opened East End Pharmacy and served as APA president in 1984-85. He has been a guest lecturer and preceptor at UAMS and was appointed by then-Gov. Mike Huckabee to the Arkansas State Board of Pharmacy, serving from 1999-2003.
Riley stopped practicing as a pharmacist in 2003 when he took the job as APA's executive director. As the association's top staff person, Riley speaks and advocates for state pharmacists, representing their interests to legislators, the state pharmacy board, Arkansas Medicaid and other state agencies, consumers and businesses.
"I didn't get bored, but I just felt I needed to do more," Riley said of his decision to switch gears, adding that one of his son's reactions was different. "He said, 'I thought you were going to slow down a bit.'"
Not quite.
A few years after taking over at the state association, Riley started working his way up the leadership ladder at the national association as well.
Riley is considered a national expert on pharmacy benefit managers, or PBMs, as the go-between in the pharmaceutical business are known. He gained that knowledge by working for a Little Rock-based PBM from 1993 to 2003.
"I knew where all the skeletons were hidden," he said.
PBMs have been on the rise since the late 1980s. Riley said PBMs are useful in providing an electronic processing system for coverage and payment of prescription drugs, similar to what a credit card company does. The downside, he says, is that PBMs determine how much pharmacies get paid for the drugs they dispense, and they may charge payers such as employers and insurance companies more than they remit to the pharmacies, pocketing the difference as a "spread."
In 2009 testimony before Congress, Riley said he'd helped an Arkansas company determine whether its PBM had been using spread prices on prescriptions for its employees. Riley found the company was being charged an average of $22.55 extra per prescription, and in one instance had been charged more than $100 extra for a cholesterol-lowering drug. Riley and the national pharmacy association have opposed, unsuccessfully, mergers of PBMs.
THE LIFELINE
Riley has also decried the impact of mail-order pharmacies on traditional pharmacies, lobbied against "preferred pharmacy" health plans that restrict patients' choice of a pharmacy and criticized the current system of reimbursement for generic drugs covered under Medicaid.
"Pharmacy payments are incredibly complex," said Doug Hoey, chief executive officer of the National Community Pharmacists Association, which is based in Alexandria, Va. "Mark, he can go deep and explain all the complexities, but he's also able to simplify it and put it in terms his audience can understand."
Hoey said Riley frequently speaks to pharmacist groups around the country as well as lawmakers and government officials. For instance, when the U.S. Department of Defense decided to use mail-order pharmacists exclusively, Hoey said, "We asked Mark to come with us to explain that that's a really bad idea, and he was able to do that."
He said Riley's presentation led to a "modification" of the military's decision, although nothing close to a reversal.
After watching him in action, Hoey says he has come to suspect that Riley has a photographic memory. "If he doesn't, it must be very close," he said. "He can remember trivia, statistics. If I was going to be on Who Wants to Be a Millionaire, he'd be my 'lifeline.'"
Riley says the transition to head of the national association wasn't too difficult because he'd been working on its issues for years as an officer, and because of his experience in Arkansas politics. The two posts -- one representing independent pharmacists alone, the other working for pharmacists in all settings -- requires him to wear "multiple hats," Riley said. "I have to learn when I'm wearing each, politically."
Malone said Riley has worked for the good of all Arkansans on "issues that don't have anything to do with pharmacists' pocketbooks."
Those include helping set up the state's prescription monitoring program, which is designed to curtail the abuse of controlled substances, and its pseudoephedrine laws, which restrict access to the over-the-counter nasal decongestant used in the illegal manufacture of methamphetamine.
"We never claimed that we stopped meth, but it has stopped the local production or severely slowed it," Riley said.
The Arkansas association has opposed the most recent proposed legislation to legalize medical marijuana because it would bypass pharmacies as dispensaries.
A NICE COUNTRY TENOR
Riley faced a health care crisis in 2002 when he was diagnosed with lymphoma. He underwent chemotherapy and says the cancer has not reappeared.
The experience had a profound effect on him. Even though he'd been trained to be empathetic as a professional, he said, "it changed how I looked at people's disease."
"More than once, when people would come in [to the pharmacy] and I would realize they had been diagnosed, we would go outside and cry together," he said. "After you've been through it, you understand what people are going through. Some of those people made it, some of those didn't."
Nearly 30 years ago, Mark and Brenda bought a woodsy piece of property in East End, not far from the little Lorance Drive Church of Christ that Riley has attended since 1965. Free weekends are often spent at a cabin on Greers Ferry Lake. Riley hunts and fishes. For years he was youth baseball commissioner at East End.
But his real passion is music. He picked up the guitar at age 12. Since 1980, he has played it and today sings in a band called Drugstore Cowboys. The group of pharmacists from central Arkansas performs a couple of times a year at industry events, fundraisers, class reunions or private parties. Riley has a nice country tenor voice -- and a couple dozen of Fender Telecaster guitars. The room where they're stored is lined with the covers of Riley's favorite record albums, from Johnny Cash and Merle Haggard to the Eagles and John Denver.
Riley said he can still remember where he was when he heard Denver's 1974 hit "Rocky Mountain High" for the first time -- in a car driving along Gum Springs Road.
"That's one that changed my life. I've always thought music was my poetry."
misses the profession
Riley says he misses working as a pharmacist, a profession which has turned into quite a family tradition. His younger son, Chad Riley, and both of his daughters-in-law are pharmacists. His older son, Clay, is an orthopedic surgeon. No word yet on whether three grandchildren have health caregiving proclivities.
Colleagues voted Mark Riley Arkansas Pharmacist of the Year in 1988. Harding University in Searcy, home of the only college of pharmacy in the state besides UAMS, named its NCPA student chapter after him.
But the honor he remembers best was bestowed on him by an elderly woman, a longtime customer, who came in to his pharmacy one day to tell him she'd seen an article about him in the newspaper.
"She said 'I cut it out and keep it in my Bible.' I thought, 'What better compliment can you get?'"
High Profile on 06/01/2014