Academic Pharmacy Now: 2021 Issue 3 by AACP

Academic Pharmacy

The News Magazine of the American Association of Colleges of Pharmacy

NOW

Volume 14 2021 Issue 3

The Price Is…

Complicated Patients want transparency about prescription costs and are turning to pharmacists as a trusted source to help them navigate. 20

Also in this issue: Confronting Implicit Bias 7 Rooting Out Racism in Healthcare 14

Pharmacists Help People Live Healthier, Better Lives.

who we are @AACPharmacy

Academic Pharmacy The News Magazine of the American Association of Colleges of Pharmacy

Pharmacists Help People Live Healthier, Better Lives.

1400 Crystal Drive, Suite 300 P Arlington, VA 22202 703-739-2330 P www.aacp.org

Founded in 1900, the American Association of Colleges of Pharmacy is the national organization representing the interests of pharmacy education. AACP comprises all accredited colleges and schools of pharmacy, including more than 6,600 faculty, approximately 63,800 students enrolled in professional programs and 4,800 individuals pursuing graduate study.

NOW

CEO & Publisher

Lucinda L. Maine Editorial Advisor

Lynette R. Bradley-Baker

Editorial Director

Maureen Thielemans Managing Editor

Jane E. Rooney

Letters to the Editor

We welcome your comments. Please submit all letters to the editor to communications@aacp.org.

About Academic Pharmacy Now

Academic Pharmacy Now highlights the work of AACP member pharmacy schools and faculty. The magazine is published as a membership service.

Editorial Assistant

Kyle R. Bagin

Communications Advisor

Stephanie Saunders Fouch

Change of Address

For address changes, contact LaToya Casteel, Member Services Manager, at lcasteel@aacp.org. ©2021 by the American Association of Colleges of Pharmacy. All rights reserved. Content may not be reprinted without prior written permission.

Art Director

Tricia Gordon Digital Designer

Sean Clark

AACP’s Professional Supporter Program

Freelance Writer

Joseph Cantlupe

Promotion Supporter

Freelance Writer

Emily Jacobs

Freelance Writer

Athena Ponushis

Academic Pharmacy NOW  2021 Issue 3

Volume 14 2021 Issue 3

@AACPharmacy a look inside

campus connection

Networking During (and After) a Pandemic

A recent AACP webinar explored tools and tips for virtual networking as well as what to expect when inperson interactions resume.

Bringing Bias to Light Microaggressions— manifestations of implicit bias—can be harmful to student pharmacists, but schools can take action.

community impact

Mitigating Mistrust

As calls increase to correct longstanding inequities in healthcare, pharmacists are exploring ways to improve training and practice to better serve marginalized groups.

The Price Is... Complicated Patients want transparency about prescription costs and are turning to pharmacists as a trusted source to help them navigate.

@AACPharmacy

When Two Pandemics Collide Pharmacy schools continue to engage with their communities to fight the national opioid crisis.

Take Two: See What’s New at 2021 #VirtualPharmEd Virtual Pharmacy Education 2021 promises to deliver another high impact conference with pharmacy educators and practitioners from around the globe.

AACP Annual Meeting P July 19–22, 2021

Academic Pharmacy NOW  2021 Issue 3

community note publisher’s impact

Dear Colleagues: Aren’t vaccines the most wonderful tool in our toolboxes? While there are still so many uncertainties associated with our individual and collective behaviors in month 16 of the global pandemic, I personally have found that the increasing percentage of the eligible population to have received at least one dose of available vaccines very reassuring, even liberating. AACP is pleased to be contributing to efforts to bolster vaccine confidence in our partnership with the American Pharmacists Association. APhA received a contract from the Centers for Disease Control and Prevention to amplify pharmacists’ voices to mitigate vaccine hesitancy. We are targeting five pilot communities in areas where data from earlier this year exposed higher rates of hesitancy based on myriad surveys. Schools in or near these target markets are collaborating with a wide variety of community partners in unique and creative ways between June and September. A program featuring these examples is part of AACP’s 2021 Virtual Annual Meeting. We hope that the ideas presented will stimulate more schools to partner with other community organizations so that cities, counties and states across the U.S. will achieve herd immunity by late summer. This is so essential to fulfill our desire to get our learners back in school from K-12 through professional degree programs this year. The articles in this issue of Academic Pharmacy Now highlight the opportunities pharmacists have in both public health and direct patient care in a variety of contexts. Pharmacists play key roles assisting patients, families and other clinicians to appreciate the complex issues of prescription drug prices and to advocate for affordability and promote adherence to therapy. Pharmacists, as the most accessible health professionals, have equally important roles to play in addressing deficiencies in our communities that perpetuate health inequities and disparities in minoritized populations. That being said, those quoted in these articles identify that we as an academic community must look critically at the Pharm.D. curriculum and ask the hard questions about whether areas such as pharmacoeconomics, systemic racism, cultural humility and engagement with diverse populations are currently adequately covered in our very full curricula and accreditation standards. Attracting underrepresented learners has long been a priority of AACP yet analyses reveal that we have collectively moved the needle only slightly. Insufficient numbers of students of color restrict our ability to also achieve diversity in our faculty and administrative ranks. AACP’s 2021–24 strategic plan pending approval by the delegates to the 2021 House of Delegates elevates our work on academic innovation and diversity, equity, inclusion and anti-racism to new levels of priority. We look forward to working in partnership with all of our members on these efforts. Together, I know we can make progress and in turn achieve our vision of creating a world of healthy people. Sincerely,

Lucinda L. Maine, Ph.D., R.Ph. CEO and Publisher

Academic Pharmacy NOW  2021 Issue 3

campus connection

Networking During (and After) a Pandemic A recent AACP webinar explored tools and tips for virtual networking as well as what to expect when in-person interactions resume. By Emily Jacobs Although networking has changed significantly during the COVID-19 pandemic, it remains vital at every career stage. From first-year students to top-ranking experts, networking allows individuals to share knowledge, gain experience and make connections that can lead to new professional opportunities. “Networking always comes up as the one thing you should do when it comes to career journeys and adventures,” said Dr. Roshni Rao, director of PHutures, a new office for professional development at Johns Hopkins University. “But the word ‘networking’ can rack up mixed emotions.” The term often implies “working the room” to interact with as many people as possible. This can be unappealing and even inauthentic for shy or introverted individuals. Inexperienced students may be uncertain how to

start networking. For busy professionals, networking can seem like a burden on their time. Less technically savvy individuals may be uncomfortable with expanding virtual networking options. A person’s feelings about networking may be based on perception, but they also may come from real experiences. In a recent AACP webinar, Rao discussed how to use networking in a more authentic, helpful way. The first step for effective networking, she said, is to reframe any incorrect or unhelpful beliefs a person may have. For example, rather than worrying about meeting a lot of people, focus on building a few relationships at a time. Busy students or professionals can dedicate as much or as little time to networking as they want. Introverted individuals can choose networking methods that suit their individual preferences.

Online platforms offer possibly the most flexible networking environment. Users can easily interact with people one-on-one, with fewer distractions. Professionals can send or respond to messages at their leisure. Social media profiles can be updated with information that portrays an individual in a professional yet authentic way.

Social Media Options As networking has moved almost exclusively online during the COVID-19 pandemic, social media has become more important than ever for making professional connections and participating in industry conversations. “These platforms aren’t going anywhere,” Rao said. The number of social media options can be overwhelming. Rather than trying to juggle multiple profiles on Twitter, LinkedIn, Clubhouse and TikTok, individuals might want to choose a single platform that “matches [their] professional and personal values,” she advised. A person’s profile image and content should also create a persona that matches the “professional story” the individual wants to tell. For specific industries, such as pharmacy, social media search features are an essential networking tool. Twitter has numerous hashtags for pharmacy topics. LinkedIn users can search for specific

Academic Pharmacy NOW  2021 Issue 3

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“What is here to stay, what we should have learned from the pandemic, is to be a more effective networker. Send shorter messages, have more impactful conversations within the time limit, learn to start and end on time, be respectful of a person’s time.” —Dr. Roshni Rao

organizations, groups or individuals related to pharmacy. On the newer platform Clubhouse, searching for pharmacy topics also yields a list of ongoing conversations. Users can find a wide variety of individuals to connect with and topics to discuss.

Connecting in a Post-COVID World

tendance or discourage handshaking. Increased empathy and courtesy for others’ time could play a bigger role in scheduling and conducting online meetings.

The COVID-19 pandemic has undoubtedly changed networking as we know it. Events like conferences and workshops “What is here to stay, what we should moved to virtual spaces. This crehave learned from the pandemic, is to ated challenges as people adjusted to be a more effective networker,” Rao newer technologies. Connecting online When contacting an individual onsaid. “Send shorter messages, have makes it more difficult to judge body line, it is important to be courteous more impactful conversations within language and facial cues. Many people but specific about your intentions. For the time limit, learn to start and end on are also becoming weary of online-only example, you may want to schedule a time, be respectful of a person’s time.” interactions and frequently complain of brief meeting to discuss their career Perhaps most significantly, virtual “Zoom fatigue.” path or ask about job openings at their networking has broken down many company. Be brief and respectful of the The stress of health concerns and figeographical barriers and expanded recipient’s time. Once you have made a nancial struggles during the pandemic opportunities. Student pharmacists connection, make an effort to maintain have taken a toll on careers, relationare better able to not just connect but that relationship. This does not have ships and well-being. Many households have conversations with experts in to be time-consuming or aggressive; a have found it difficult to juggle multiple their chosen field from all over the quick note every few months is often obligations, such as remote working globe. Recruiters are not limited by sufficient. and online learning. Because the panlocation when contacting candidates. Because the best relationships are never demic has affected almost everyone in Organizations can interview, vet and some way, Rao noted that this has creone-sided, it is also important to “pay even hire more candidates from a wider ated more empathy and respect for oth- geographical area. it forward” when it comes to networkers’ time. As a result, organizations are ing. This often means making genu“I’m able to connect with a lot more more inclined to keep online meetings ine recommendations or helping to people around the year and enjoy and events on-topic and on-schedule. connect other professionals when you connecting more in-depth with the can. “Networking is more about adding Many changes that reshaped networkpeople I talk to,” Rao pointed out. “The value to others,” said Rao. “If you’re ing during the past year may remain pandemic year has sort of streamlined not looking for a job or you don’t need long after the pandemic has ended. For anything, still network…you can always example, companies looking to cut costs that process. Now I’m able to actually build relationships and to do that more help people connect to other people, may encourage employees to attend frequently, while at home, with people and then you’re an excellent networker, events virtually rather than paying for across the world. Networking in the because you’re making connections for transportation and hotels. Lingering pandemic has meant fewer barriers to other people.” concerns about viral exposure may meeting people.” P prompt event organizers to reduce at-

Emily Jacobs is a freelance writer based in Toledo, Ohio.

Academic Pharmacy NOW  2021 Issue 3

campus connection

Bringing Bias to Light Microaggressions—manifestations of implicit bias—can be harmful to student pharmacists, but schools can take action. By Athena Ponushis

Dr. Nicole Avant wanted to give her students a space to share their stories of microaggressions. She had students write down the indignities they had experienced: classmates laughing at accents; a professor asking, ‘Can I touch your weave?’; another professor publicly asking Asian students about ‘Asian flush’ when discussing alcohol metabolism; one student choosing the username ‘Syrian refugee’; and other hurtful remarks, such as, ‘You’re a token minority’; ‘How did you come here?’; ‘I don’t care about slavery.’ Avant, former chief diversity officer and faculty member at the University of Cincinnati College of Pharmacy, posted these examples on her office door. She saw students navigating microaggressions every day, while trying to excel academically, and she wanted to give them a place to release the harm. “They can’t hold these indignities in their bodies. They have to be able to release them, so I dedicated my office door to capture their experiences and amplify their voices,” Avant said. “I also created affinity groups, so students could come together and talk to externalize these experiences. I wanted my students to know, ‘This is not you. Do not internalize these violent experiences as there is nothing innately wrong with you.’”

microaggressions are the manifestations of implicit bias, attitudes and beliefs that influence a person’s perception, actions and decisions in an unconscious manner. Microaggressions are so commonplace that psychologists compare them to death by a thousand cuts, as the accumulation of these everyday indignities can have consequences on a victim’s mental and physical health, though due to their “normalized” nature, perpetrators of microaggressions are generally unaware of the negative effects of their actions. In the microaggression workshop she leads, Avant has attendees write down indignities they have either experienced directly, witnessed or heard. Sharing these stories, anonymously,

Working as the founder, owner and lead consultant of the Avant Consulting Group, Avant has continued to collect stories and hold a mirror up to microaggressions, commonplace indignities that communicate hostile, derogatory or negative slights to marginalized individuals or groups. Oftentimes,

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participants start to notice patterns—who was harmed, what was the harm, did anyone interrupt the microaggression and bring the harm to light? If schools of pharmacy are committed to equity and to eliminating racial and ethnic health disparities, then they must facilitate such transformative exercises. They must comb through their curriculum and see where racism might be reinforced, challenge it, put it in context and thread that context throughout the curriculum to educate student pharmacists on how racism leads to health disparities, Avant said. They must establish affinity groups where students can gather to hear and support each other so they do not internalize racism, sexism and other inequities and question their abilities or intrinsic worth. In its ongoing work to eliminate health disparities, AACP has designated ‘leading diversity, equity, inclusion and antiracism (DEIA) efforts’ as a key priority in its new strategic plan. AACP will advocate for schools to integrate DEIA topics throughout their curricula and enhance co-curricular activities to increase student awareness of racism, sexism and ageism, expanding their world view. AACP will also endeavor to make DEIA workshops and training available to all stakeholders, including faculty, staff, students, board of directors and external partners. Dr. Robert E. Braylock, a licensed pharmacist who owns BHK Consulting, LLC, led the unconscious bias training at AACP’s recent leadership forum, where he asked leaders to do what schools will be asking students to do: diversify the voices they have in their lives. The point he wanted to emphasize about combatting implicit bias was the consequence of not doing it. “If we are not having these conversations with our students, if we are not encouraging them to participate in culturally diverse experiences and consider other perspectives, then they are not leaving college with a more culturally diverse perspective. If anything, they are leaving having solidified the monolithic and ethnocentric perspectives they may have come into college with, because we have not challenged that.”

Mitigate Inequities to Mitigate Bias At the Equity, Diversity and Inclusion Institute last January, Avant gave a presentation, “‘Not to Exclude You, but …’: Uncovering and Mitigating Bias in Academic Pharmacy,” based on her manuscript that describes microaggressions that student pharmacists are experiencing. She wanted attendees to understand how microaggressions show up in academic pharmacy and see their complicity in that.

Academic Pharmacy NOW  2021 Issue 3

She read an exemplar from her research, in which a white college woman shares how she was sexualized through inappropriate jokes: “At my IPPE last Tuesday, they had me watch a surgery. I was in the operating room, which was all guys, so one, two, three, four, five, six guys and they just kept messing with me the whole time, like making jokes, and I think they were trying to be funny…but it was stressing me out. And I don’t know why they were doing that, they were giving me a hard time and joking, I guess being typical guys. I don’t know how else to describe it, just being goofy. They kept asking me questions and they wanted me to say some weird stuff. They were doing a replacement, actually, and they were putting the cement in, and they let me play with the cement. So, I noticed as it was solidifying it was getting hot, it was getting hard, and he’s like, ‘Do you know what we say? We tell the doctor I want it hot and hard,’ and then the one guy prompted me to say it, and I didn’t really want to say it but he kept on to get me to say it, so I said it.” Avant and her colleagues interviewed students at a college of pharmacy and three themes arose from their content analysis. Microaggressions left students with feelings of “otherness,” based on their race, religion, gender, sexuality, socioeconomic status and age. Students expanded on the power, pain, pollution and pervasiveness of microaggressions—the power speaking to the invisibility and duplicity of microaggressions (because they are normalized, perpetrators may not realize they are causing harm); the pain speaking to how much it hurts to be repeatedly insulted, invalidated and dismissed; the pollution alluding to how microaggressions disrupt learning environments; and pervasiveness revealing how ubiquitous microaggressions are (sometimes disguised as jokes). The third theme revolved around the responsibility of faculty, staff and administrators to mitigate microaggressions. Faculty, administrators and staff become complicit when they are unaware of microaggressions. “Unawareness is a privilege in itself, to be able to exist and thrive in academic pharmacy without any understanding of the violence students at the margins experience,” Avant said. “When confronted with bias, the very least institutions can do is be accountable. They also must create environments where minoritized faculty and students can thrive as their authentic selves and not be forced to assimilate.” Microaggressions show up in academic pharmacy in interpersonal ways. For example, when someone assumes students of color are there because of their race and not on

campus connection

Dr. Nicole Avant dedicated her office door as a space where students could share their stories of microaggressions.

Academic Pharmacy NOW  2021 Issue 3

campus connection

merit, or when non-Christian students are required to complete coursework on their holidays, or when female students are judged more on dress code than their male counterparts. Microaggressions can also appear environmentally (e.g., the exclusion of marginalized identities in photographs on the walls and the statues on the grounds). And what may be most perilous to public health, racial microaggressions show up in the curriculum. “Schools need to change their curriculum. They need to unpack how they perpetuate racist attitudes when describing racial differences in health. Narrowly focusing on personal choices and ignoring larger harmful oppressive structures to describe

the Black-white health chasm cultivates systems of inculpability,” Avant emphasized. “One of the ways pharmacy can undo the harm that they have historically caused and continue to contemporarily cause is to modify their curriculum to ensure they are graduating pharmacists who can unpack racist attitudes and who are aware of how racism operates, how racism harms and how racism kills. If schools of pharmacy are not doing that, they are causing immense harm to communities of color.” The students in Avant’s study stated they would like to see longitudinal cultural competency in the curriculum, but Avant wants to see more of a focus on structural competency. She feels cultural competency can oversimplify cultures and reinforce stereotypes. “I would rather see schools teach how structural inequities (e.g., slavery, 13th amendment, Jim Crow, GI bill) impact the distribution of the social determinants of health; prospective pharmacists can then be trained to create structural interventions to dismantle systems of power to improve health.” Bias impacts lives and clinical and non-clinical encounters, but at the root of bias lies structural inequity. “Awareness and mitigation of bias related to race, class, gender, body type, sexuality, age, nationality, religion and ability are important. However, knowledge expansion regarding social, economic and political structures that facilitate differential outcomes is necessary. Without the appropriate historical and contemporary context, our brains internalize differences as natural. The U.S. has cultivated a society where not everyone has access to opportunity, power, wealth, income, housing, education, transportation, freedom, safety, food stability, healthcare; all these things that we know allow individuals to thrive. Because not everyone is given a solid, fertile foundation, some of us get to grow tall and strong while some of us are left struggling to survive,” said Avant, alluding to A Gardener’s Tale, by Dr. Camara Jones, an allegory on race and racism. “When we see these differences in growth, our brains start to internalize, ‘This group must be superior and this group must be inferior,’ but we are ignoring historical insults. We as pharmacists do a good job teaching about racial and ethnic health disparities, but we don’t really do a good job of discussing the true root causes: structural inequities. Dismantling structural inequities will eventually mitigate biases, because we won’t have any differences to internalize.”

Academic Pharmacy NOW  2021 Issue 3

campus connection

“Developing awareness of bias helps us create structures to better inform us. We should always strive to use data rather than opinion to make the best possible decisions for ourselves, our institutions and our patients.” —Dr. Stuart Haines

Race as a Social Construct, Not a Biological Determinant When Avant was in pharmacy school, she was trained to think of race as a biological construct. “I remember being taught in pharmacy school that Black-white health disparities in hypertension were due to a salt-sparing genetic variant in African descendants. Biology and behaviors were often used to explain the root causes of health inequities instead of oppressive systems jeopardizing the health of communities of color,” she pointed out. “Now that I realize that race is a sociopolitical construction, I realize the school was perpetuating racist attitudes regarding Black bodies and blaming them and not racist systems for differences in health. That racist narrative and those like it need to be eliminated. The real reason we have differences in hypertension and other supposed racial diseases is due to navigating racism and other inequities, shame, stigma and discrimination, and I do not see that being taught.” AACP President-Elect Dr. Stuart Haines, professor and director of pharmacy professional development at the University of Mississippi School of Pharmacy, agrees that schools must prudently examine how they are presenting race in their curriculum. “In our past training of health professionals, we have implicitly talked about race as if it was a biological variable that should be considered when making treatment decisions, when in fact race is a social phenomenon, a social construct,” Haines said. “As health professionals, we have to take a step back and say, why are health outcomes different for different groups of people? In most cases those differences are related to social variables, meaning how our society is structured rather than biological differences between people that make them more prone to certain diseases or health outcomes, and I think that’s a key message our students need to hear.”

Haines would also like administrators, faculty and students to remember that we all have biases. It’s human nature, but it must be acknowledged, and as scientists, pharmacists must remain objective and question if their actions are being influenced by bias or data. “That comes to all sorts of decisions we may be making—hiring decisions, admission decisions, even when grading student papers, to do it in a blinded way,” he said. People can become aware of their biases by taking a Harvard implicit association test, by being cognizant of what messages they consume and by listening to other people. When someone makes another person uncomfortable, focus on the impact, not the intent. Schools must acknowledge implicit bias and adopt strategies to mitigate it. “Developing awareness of bias helps us create structures to better inform us. We should always strive to use data rather than opinion to make the best possible decisions for ourselves, our institutions and our patients,” Haines noted. Giving an example of how bias affects all aspects of life, Haines points to biomedical journals. As a journal editor, Haines has seen what studies have shown: When authors come from lesser-known schools or universities, their papers are less likely to be accepted, and when authors come from prestigious universities, their papers are more likely to be accepted. In experiments, when the names of the authors and institutions have been changed on the papers, the outcome of the publication decision always favors those from prestigious universities, thus confirming the bias. “That just shows you how bias affects all sorts of judgements we make in our lives,” he explained. One way to mitigate bias in academic pharmacy is to encourage extracurricular or co-curricular activities for students. “There are things we can do within our curriculum to teach our students about bias and how it impacts us, but there are also co-curricular experiences that students can have

Academic Pharmacy NOW  2021 Issue 3

campus connection

“Schools need to change their curriculum. They need to unpack how they perpetuate racist attitudes when describing racial differences in health. Narrowly focusing on personal choices and ignoring larger harmful oppressive structures to describe the Blackwhite health chasm cultivates systems of inculpability.” —Dr. Nicole Avant

that expand their world view and help them mitigate bias,” Haines said. “That’s one of the great things about going to college, you get to learn from people who are different from you.” Service events like health fairs, or student pharmacists tutoring high school students, can improve the quality of instruction at underserved schools and expose future pharmacists to underserved communities. Interacting with high school students as mentors or role models could lead to inspiring those students to pursue pharmacy as a career, simultaneously aiding another AACP goal, to attract a more diverse student population. “We need a more diverse faculty, too,” he continued. “The pipeline is a long one because it takes time to train people to become faculty members, so if we don’t have enough students graduating from our schools who come from underrepresented communities, then we’re certainly not going to have enough faculty members who come from underrepresented communities. We need to make an effort. We need to encourage our graduates to consider advanced degrees beyond their doctor of pharmacy degree so they can consider becoming faculty members someday.”

Diversifying Perspectives and ‘Primary Voices’ In his unconscious bias trainings such as the one he led at the leadership forum, Braylock sometimes shows a video of the Terence Crutcher police shooting in Tulsa, Okla., where you see a Black man with his arms up and hear police officers in a helicopter say, “That looks like a bad dude.”

Academic Pharmacy NOW  2021 Issue 3

“I don’t think they even meant anything bad by it, but in my opinion, that naturally flowed from them, which is really the heart of implicit bias, this unintentional and unconscious tendency to be able to discriminate against people in situations without you even knowing about it,” Braylock said. He brings up intention in regard to academic pharmacy because the racial diversity of pharmacists continues to underrepresent the racial diversity of society. “If there’s not an intentional effort to change that then it will stay the same,” he said. Braylock believes recruitment can transform pharmacy as a healthcare profession and transform the health and wellness of the nation, by investing in Black and Brown children as early as kindergarten. “Going to the beginning of that student’s development and providing them with rich learning experiences, is that a quick remedy? No. Is it sustainable and meaningful? Yes, it should be, because you are not putting Band-Aids on situations, you are addressing the root cause.” In the meantime, Braylock agrees that requiring students to participate in culturally diverse co-curriculars will help them become more well-rounded healthcare professionals and individuals. Embedding social determinants of health into all courses will help mitigate bias. Schools should at least have one required course that focuses extensively on the issue. “In pharmacy, we can be systems-oriented when it comes to patients, but I don’t think we are systems-oriented when it comes to students,” Braylock noted. “As objective as we are about patient lab values and blood pressure and A1C levels,

campus connection

we need to be just as objective about the strides that we want to make in this arena. We don’t say, ‘Oh, yeah, your A1C can be whatever,’ or ‘Oh, yeah, your blood pressure can fluctuate. That’s fine.’ We give specific targets because we know that it matters and we can’t be lackadaisical or unintentional about the health and wellness of our patients, especially with blood pressure, when we know that it can and does lead to kidney disease and stroke and so many other things. And so, just as intentional and objective as we are about that, we also need to be intentional and objective about combatting racism and ethnocentrism and making sure that we are advancing, very aggressively, unity, equity and justice.” More than anything, Braylock would like administrators, faculty and staff to do what he asked attendees at the leader-

ship forum to do: Diversify their intake of news, literature and music. Look at the creators of that material, who are those voices of influence, and intentionally diversify those “primary voices,” a term coined by Daniel Hill, author of “White Awake: An Honest Look at What It Means to Be White.” “I encourage academic pharmacy to diversify their primary voices,” he emphasized. “Whether those voices are the researchers and academics who you are engaging to find out what the best practices are and things of that nature, whether those voices are your mentors, or whether those voices are the students you are engaging with to find out what their experiences are, there desperately needs to be a diversification of the voices we all have in our lives.”P Athena Ponushis is a freelance writer based in Ft. Lauderdale, Florida.

Academic Pharmacy NOW  2021 Issue 3

community impact

Mitigating Mistrust As calls increase to correct longstanding inequities in healthcare, pharmacists are exploring ways to improve training and practice to better serve marginalized groups. By Joseph A. Cantlupe

While discriminatory practices in healthcare settings have existed for decades, the COVID-19 pandemic further revealed inequities rooted in the longstanding unequal treatment of minorities in this country. Academic pharmacists are committing to racial justice, beginning with changes to improve minority enrollment at colleges and universities and by seeking to boost minority faculty numbers. They also say there should be significant curriculum revisions to address inequities, and new language and cultural opportunities in pharmacy schools to better serve the health of diverse communities. Pharmacy schools can help lay the groundwork for needed changes within the profession to improve outreach and care to patients in minority groups.

“The same things that occurred in the past continue. We now have some rules and laws that protect us, but it has not removed the barriers,” she continued, referring to systemic and structural racism against the Black community and other minority groups, which are reflected inside and outside the classroom.

Lack of Diversity Campbell coauthored a 2016 study that showed that enrollment within most colleges of pharmacy did not reflect the racial and ethnic diversity of the counties in which they are located. The report found that Asian students were overrepresented in most colleges of pharmacy, while Black and Hispanic students were underrepresented, she said. Since then, the situation hasn’t changed.

These issues were raised in a recent AACP webinar, “Mistrust in the U.S. Healthcare System Among Marginalized “To meet the healthcare needs of an increasingly diverse population, each institution should establish a strategic Groups,” which included a panel of academic pharmacy plan for increasing diversity and evaluating and adopting leaders representing minority groups who challenged best practices,” Campbell wrote. Pharmacy schools must leaders within the profession and elsewhere to overcome discriminatory practices. Pharmacists have been doing more encourage students of color to go into the pharmacy and “remove any barriers, policies or procedures that we have to provide innovative practice models and services that in place that might be a huge obstacle to a marginalized directly engage the patient in ways that will decrease health community member.” disparities, said Dr. Hope Campbell, associate professor of pharmacy practice at Belmont University College of Dr. Carmen “Skip” Clelland, senior public health advisor Pharmacy, but “you still have individuals experiencing to the federal Health Resources & Services Administration racism that is baked into the system.” (part of the Department of Health and Human Services), said pharmacy schools must address myriad issues, among During the pandemic, pharmacists have helped expand them “the role of pharmacy and the training of pharmacists, access and increase public education about the vaccines, the general impact of drug therapy and the social she said. “They became more involved in public health, determinant of health impacts on populations.” Among ran mobile clinics, did contact tracing, collaborated with other things, the country lacks effective data collection local authorities and nonprofits.” Over the years, however, systems to measure inequities, he said. decisions, policies and procedures have led to disparate outcomes. “We have this historical reference that has carried “There are challenges with the health data measurement over and we do see the fallout of that today,” Campbell said, specifically within the minority community,” noted Clelland, specifically noting discrimination against Blacks beginning a member of the Cheyenne and Arapaho Tribes. “There are with slavery, Jim Crow laws and racist healthcare policies.

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community impact

unique differences you might see in the general population as far as race or ethnicity. There is the Black population and that may be mixed with American Indians. And part of an American Indian tribe may not be of a singular race. We have to identify and collect data that is meaningful.” It is important to consider genotypes and phenotypes, for instance, in clinical decision making and possible adverse outcomes of medications.

He noted that American Indians and Alaska Natives have suffered inequities related to discriminatory practices. As those unfolded over the years, many people lost faith in the government and the healthcare system, Clelland said. As a result, minority groups must deal with trust issues that impact their healthcare. “I think a lot of the mistrust, especially among American Indian and Alaska Natives, has to do with prior mistreatment by the federal government. That

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community impact

“We have a long way to go to ensure that we have that data and what it looks like within different populations. In pharmacy education, what I often see is in terms of silos, you’ll learn about a community and check it off, then learn about Hmong and check that box, or learn about the LatinX community and check that. But you will meet the patient and there’s not one checkbox, there may be multiple identities there.” —-Dr. Kajua Lor

had a negative impact on the general lifespan of American Indians as well as social status and economic conditions.”

Curriculum Changes Needed Expanding curricula that opens the door for more minority students is essential to provide potential academic pharmacy advances in equity, Campbell said. Academia can step up to address inequities through various curriculum changes, such as expanding anti-racism education and focusing on social determinants of health, structural racism and cultural competency.

Dr. Kajua Lor, associate professor, chair of the Department of Clinical Sciences at the Medical College of Wisconsin Pharmacy School, speaks Spanish and also worked in a LatinX community where many of her patients believe she is Chinese, although she is of Hmong ancestry. The Hmong are members of an ethnic group in Southeast Asia that have not had a country of their own. During the Vietnam War, Hmong “It’s important to educate ourselves about implicit in Laos partnered with American forces to fight Southeast and explicit bias, structural systematic racism, social Asian communists but were left behind after the U.S. pulled determinants of health and the impact that these have out of Laos, forcing many to flee or be killed. on the care we deliver,” Campbell said. And that doesn’t stop with clinicians. “Educate patients about their care Lor pointed out that Asians are sometimes lumped into one in a culturally and linguistically competent manner.” category in calculations of their health needs during data Collaborations should be established with “trusted collection, which ignores people from individual countries and different communities in Asia. Academia should lead the community partners, respected figures and NGOs in marginalized communities to extend our reach.” way in collecting and synthesizing data that would reinforce the needs in each country, said Lor, who echoed Clelland’s concerns about data collection flaws. “I do think aggregating data is necessary,” Lor said. In some states, there may be areas where, in a manner of speaking, “Asian Americans are all healthy, with no chronic disease and no issues with cancer,” but that belies the truth hidden in each community, she explained. “We have a long way to go to ensure that we have that data and what it looks like within different populations. In pharmacy education, what I often see is in terms of silos, you’ll learn about a community and check it off, then learn about Hmong and check that box, or learn about the LatinX community and check that. But you will meet the patient and there’s not one checkbox, there may be multiple identities there.”

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Clelland added that part of the expectation for student pharmacists is that they have the training to ensure they can prescribe the right drug for the right person, yet curriculum can be expansive in its reach into population health and the social determinants of health, “and what is the overall larger impact of looking at pharmacy’s accessibility,” he said. Pharmacy schools can better prepare students to differentiate the needs of populations, which is a true reflection of Americana, he said, such as in downtown Atlanta compared to its suburbs, or in the needs of the Hopi Tribe in Arizona compared to residents in New York City. “You rarely hear about pharmacy engaged in population health. When you come out of school, you are rarely prepared for that. Populations in different communities may not have the same needs or challenges.”

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Too often, there has been a “recognition that the way we have been doing things in the past has always reflected what we should be doing,” Clelland pointed out. “The same thing happened when women were left out of the conversation and the questions were posed: how do we make sure women are added to research and are we addressing the community of women and getting them interested in research.”

Campbell said language needs within a local community should be evaluated and be taken up by a local university or college. They may “need to add medical Spanish or other languages if a large immigrant population is served by graduates,” she said. Institutions can expand offerings such as dual degree programs that allow students to earn a master’s in public health and social justice.

Lor said she seeks to overhaul cultural competency training in pharmacy schools, “where learners are taught one culture and/or population at a time. This segmented training creates learners who lack the proper skills to develop structural humility and also allows for the perpetuation of racism, generalizations and stereotypes in patient care,” she said. Such a changed “structural competency framework” is needed with a shift that “emphasizes cross-cultural understandings of individual patients.”

Underrepresented Minorities

Lor is involved in a project called “Invisible Identities: Reimagining Cultural Competency Training for Health Professionals.” Those identities include veterans, people with disabilities, members of the LGBTQ community and people who self-identify as Hmong or other southeast Asian ethnic minorities. “We anticipate that our project will illuminate the impact of intersectionality and provide the skills to work with marginalized and invisible populations,” she said. Another area that may improve outreach and thwart inequities is through language instruction. Lor is evaluating the ongoing and historical framework involving communication between pharmacists and Spanish-speaking populations, in which barriers remain and continue to lead to inequities. Health information through pictures and videos tailored to certain languages can play a vital role in opening up pharmacies to more diverse communities, she indicated, and those elements can be included in pharmacy instruction. A pharmacist can wear a rainbow pin, for instance, to signify being open to LGBTQ+ communities, or another pin that “indicates the languages that you speak, such as ‘Hablo español’ (I speak Spanish) or ‘Kuv paub hais lus Hmoob’ (I speak Hmong), or even tailor the artwork in the clinic or pharmacy where you work,” she said. Pharmacists can also ask whether a patient prefers Spanish or English instead of making assumptions about language preference. “For invisible minorities like the Hmong, translation of labels is not enough, as many Hmong do not read and write in the Hmong language. Culturally tailored health information through pictures and videos is of utmost importance when words like ‘cancer’ do not exist in the community you are working with,” Lor emphasized.

Based on Census Bureau projections in 2018, the U.S. should have reached a point sometime within the past year when more than half of the nation’s children represented an ethnic or racial minority. However, Blacks, Hispanics and Native populations are underrepresented in health service professions such as medicine, dentistry, nursing and pharmacy. Of the total number of students enrolled in first professional degree programs for fall 2019, 17 percent were underrepresented minority students. White Americans received almost 50 percent of first professional degrees conferred in 2018-19. Asian Americans received 25.6 percent of the first professional degrees, according to the American Journal of Pharmacy Education. The AJPE report indicated that nearly 15 percent of degree recipients were underrepresented minorities (Black or African American, 8.5 percent; Hispanic or Latino, 5.7 percent; Native Hawaiian or Other Pacific Islander, 0.3 percent; American Indian or Alaska Native, 0.3 percent). The pharmacy Academy has also lagged in hiring minority faculty, Campbell said. Pharmacy has been more successful than medicine and dentistry in recruiting Black faculty but falls behind dental schools in their representation of Hispanic faculty. New schools and religious-affiliated institutions include more Black and Hispanic faculty members. In 2013, Blacks comprised 13.2 percent of the U.S. population yet only 4.7 percent of pharmacy faculty. Hispanics were the largest minority group in the country at 17.1 percent, but they constituted only 2.9 percent of pharmacy faculty, Campbell’s study revealed. Unfortunately, gaps exist in tracking the details of student populations in pharmacy programs, such as the number in residency programs, Campbell said. Although there is a distinct “paucity and scarcity of color” among people in residency programs and also an apparent lack of residency program directors, “we don’t collect that data,” she added. Attempts have been made to secure the data that would pinpoint specific breakdowns but they have been unsuccessful. An AACP report on affirmative action and diversity released in 2000 noted the need to track the number of minority

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“It’s important to educate ourselves about implicit and explicit bias, structural systematic racism, social determinants of health and the impact that these have on the care we deliver. Educate patients about their care in a culturally and linguistically competent manner.” —Dr. Hope Campbell

students in fellowships and residences, but 20 years later this goal still hasn’t been met. “If it’s not measured, it is not important and we don’t know the impact. It is my goal to track students of color. It’s tough being the only [Black student] in a class or group. We need to make sure that faculty is as diverse as can be. There needs to be a wide net cast to catch a diverse class. Black faculty aren’t being utilized.” Schools have a chance to open the door for more minority enrollment, Campbell emphasized. This past year, first professional student pharmacist enrollments were down 2.9 percent compared to fall 2018. Minority-serving institutions continue to provide a significant number of pharmacists of color to serve the U.S. population. “They continue to produce what they were designed to produce— underrepresented minorities in the profession,” she said. The webinar speakers laid out a broad role for pharmacists and educators to overcome racial and ethnic disparities. Clelland referred to the Department of Health and Human Services’ Healthy People initiative 2030 that provides a measurable framework and objectives to improve healthcare over the next decade, in which pharmacists can play key roles. “Pharmacists have a primary seat at the public health

table,” Clelland said. “We should be the most successful public health providers out there. We’re the most accessible.” Campbell added, “The fight for our patients must take us out of the pharmacy and into the streets, boardrooms and policy meetings. We need to influence the decisions that are being made that negatively affect our patients. Pharmacy must work to expand where they have influence and use their seat at the table for the good of their patients or leave the table.” She said she uses the acronym DECLARE when she thinks about how pharmacy can move forward on diversity issues: Diversity, Educate, Collaborate, Leadership, Advocate, Research and Empower. “Self-awareness and understanding our own racial identity and implicit biases are key to grow in this space,” Lor concluded. “The pharmacy community should take a look from the balcony and examine the structures and policies that impact the communities we serve to truly address inequities. Growth in cultural and structural humility takes time and heart.” P Joseph A. Cantlupe is a freelance writer based in Washington, D.C.

To read the full AJPE report referenced in this article, “The Pharmacy Student Population: Applications Received 2018-19, Degrees Conferred 2018–19, Fall 2019 Enrollments,” visit https://www.ajpe.org/content/84/7/ajpe8207.

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The Price Is… Patients want transparency about prescription costs and are turning to pharmacists as a trusted source to help them navigate.

Complica By Jane E. Rooney

Prescription drug spending reached almost $370 billion in the United States in 2019, according to National Health Expenditure data from the Centers for Medicare & Medicaid Services. A Mayo Clinic study in 2013 revealed that almost 70 percent of Americans take at least one prescription medication—a number that has certainly risen in the past several years. In his April address to Congress, President Biden noted that the United States pays the highest prescription drug prices of any country in the world. The national conversation about healthcare spending includes discussions about how to control those costs. 20

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Where do pharmacists fit into that conversation? Evidence suggests that during the pandemic, more patients relied on pharmacists for information about payment options and cheaper alternatives to their prescribed medications. According to a March 9 Forbes article, more than two thirds of pharmacists surveyed reported taking on new job responsibilities over the past year, including helping patients find ways to save money on prescriptions. ASHP’s recently released National Trends in Prescription Drug Expenditures and Projections for 2021 indicates that the pandemic had a significant influence on U.S. spending for prescription drugs last year.

“Pharmacists play a critical role in helping patients navigate drug pricing,” said Dr. Annesha White, associate dean for assessment and associate professor, the University of North Texas Health Science Center College of Pharmacy. “We are at the forefront of healthcare, especially community pharmacists. There’s a community pharmacy every five miles. That exposure is there, that interaction is there. Patients are coming in asking questions about pricing. Because of the access—there was a recent study in JAMA showing that pharmacists are even more accessible than primary care physicians—it’s the pharmacist interacting with patients on a day-today basis.” White predicted that the trend toward pharmacists taking on increased responsibility in this area will continue. “I think that pharmacists are equipped to take on that role because they have the training, not just the medication knowledge but also an understanding of formularies, managed care and drug pricing,” she explained. “Bringing those skillsets together lets pharmacists take a lead role in explaining to patients and helping them understand and become more adherent. That’s a critical outcome we’d like to achieve. It’s definitely an opportunity to step up and take those lead roles in many pharmacy settings.” Drug pricing is set by manufacturers and is based on several factors, including R&D costs, competition, market forces and proprietary information. While pharmacists have no direct influence on pricing, they can help patients navigate the system and can influence policy as well as formulary deci-

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“Pharmacists are in a unique position. They have the knowledge about the drugs and how the insurance is covering things, PBMs, Medicaid, but they are also at the cash register. MTM services are mostly focused on the clinical side. That role is going to expand. This is where pharmacists can make their mark. They can advise patients on the clinical and also the cost-effective side.” —Dr. Varun Vaidya

sions. Price is only one element of pharmacoeconomics—the study of costs and consequences of a drug to society and the healthcare system—and although it does not address why drug prices are so high, pharmacoeconomics provides a foundation for understanding issues such as cost per successful outcome or adverse event and costs of direct and indirect medical care. Pharmacy school faculty discuss how pharmacoeconomics fits into the curriculum, what the drug pricing landscape will look like going forward and the ways that the pharmacy community is stepping up and preparing student pharmacists to get involved in advocacy at the state level.

Kickstart the Cost Conversation White has seen an increase in the number of topics taught related to pharmacoeconomics, which is emphasized in the curriculum at the University of North Texas Health Science Center College of Pharmacy. “I tell my students that when I was in school, there were very few hours in the curriculum dedicated to pharmacoeconomics topics and now many of these topics are included in Chapter 1 of major textbooks. It continues to be needed,” she said. “We’ve heard it from faculty and students and also from patients. Why are drug prices so high? Why aren’t health outcomes improving given the high cost of healthcare? The majority of schools do cover pharmacoeconomics topics but there is room for improvement. A lot of schools are teaching it later in the program years, the P3 year as opposed to P2 or even the first year. It’s never too early to introduce these topics. Customers are coming into retail settings and asking why isn’t a drug covered or why are prices so high?” Given that coverage of pharmacoeconomics varies from school to school, White sees a need to develop a standardized approach to teaching this in the curriculum. “We

definitely need to increase the number of hours spent on these topics. Don’t wait until the third year because it’s too late,” she added. “I’m an advocate for introducing these topics early on in the curriculum. Some schools may not have faculty that have this as a specialty area and they don’t have the students who are as interested in it. That is a concern, because if you have no pharmacoeconomics in your curriculum, that really is an issue in terms of preparing a student for the future.” Student organizations are one way to get those conversations going. White suggested that pharmacoeconomics can be integrated into an introductory pharmacy course. If schools don’t have faculty who have a pharmacoeconomics background, guest speakers can be brought in to keep students up to date. At the University of Toledo College of Pharmacy and Pharmaceutical Sciences, this content is addressed in a P3 course that covers pharmacoeconomics principles, pricing, cost and quality issues, said Dr. Varun Vaidya, professor, Division of Pharmaceutical and Policy Sciences. “Every college in some shape or form is delivering [this content to meet accreditation standards] but most Pharm.D. students don’t think of this as core material. They are more focused on the clinical side,” he noted. “The board [exam] is heavily focused on therapeutics. The exam isn’t testing them extensively on pharmacoeconomics. It’s part of ACPE’s accreditation requirements but I don’t know how much importance student pharmacists see in this. The pharmacy Academy can work on improving that.” Vaidya offered an example of how he explains to students the ways in which pharmacists can help patients consider cost and improve their health outcomes. “In my class I

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discuss a new generation of anti-coagulants. The price difference is $400-$500 a month. From an efficacy standpoint all of these drugs are almost equal,” he explained. “The only benefit is convenience. If this is being laid out and patients are educated on the options, they can choose to pay the extra cost. But if it’s someone who cannot afford it, they should be given the alternative. That’s just one example. We can make these recommendations at the patient level that would not only save money for the patient but also the PBM. It is in the PBM’s interest to have pharmacists trained and be compensated for that.” He believes pharmacists should be trained to understand how we value the cost effectiveness of drugs and make that investment to learn to provide these services and get compensated. “These recommendations will save money and that’s a great value that pharmacists can add,” he continued. “Pharmacists are so accessible. When it comes to reimbursement for MTM services, the insurance companies’ perception is it’s overlapping with what they get from the physician’s office. Pharmacoeconomics in practice settings is a niche area that pharmacists can take advantage of.” Vaidya supports pharmacists being more involved in discussions with patients about pricing and cost effectiveness. “Pharmacists are in a unique position,” he pointed out. “They have the knowledge about the drugs and how the insurance is covering things, PBMs, Medicaid, but they are also at the cash register. MTM services are mostly focused on the clinical side. That role is going to expand. This is where pharmacists can make their mark. They can advise patients on the clinical and also the cost-effective side. The clinical often gets covered at the physician’s office or with nurse practitioners or with other healthcare providers. For certain medications, such as diabetes and for some chronic conditions, prices have gone up significantly. More patients are turning to pharmacists and I hope they are asking these questions— why are these drugs costing so much, what can be done, what are the alternatives?” White agreed that the focus will continue to be on decreasing costs without reducing quality of care. “Pharmacists have such an opportunity right now to take a lead role in this area. We have to step up to the plate and really share with different stakeholders in terms of the best ways to navigate this changing landscape of healthcare,” she said. “When you look at AI increasing, big data…at the core of it is still going to be the fact that transparency is lacking in terms of pricing. Patients are telling their stories about outrageous drug costs but pharmacists need to be able to communicate why those

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prices are high and be more transparent in sharing data across settings. We know that people want transparency and want to understand why prices are so high, so we need to be proactive to answer these questions.”

Advocacy Around Affordability Efforts to address drug pricing issues are gaining momentum at the state level and some pharmacy faculty are getting involved. In Maryland, a first-of-

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land School of Pharmacy, was chosen as one of the five board members for her expertise in data analysis, health economics and outcomes research. “We have several tools available to consider—there are multiple options from a policy standpoint to lower costs,” Onukwugha said. “The initial work we are tasked to do in the first year is to get a better understanding of the drug supply chain before getting to the stage of considering appropriate measures to reduce the cost burden. That work is ongoing and is key to gaining more clarity. What’s important is making sure we are evidence based and we are getting a sense of the stakeholders throughout our review of the supply chain. What we think about is the burden—both clinical and economic—families are feeling related to affordability concerns. We are approaching it holistically to think about medical care, not just prescription drugs. We attend public forums and listen to the public at these forums. Individuals and families are making tradeoffs in some cases and forgoing taking their medications. Price is one component but there are other dimensions to it. We want to understand that more fully before thinking about recommendations.”

its-kind Prescription Drug Affordability Board was created in 2019 to take action to make drugs more affordable for state residents; board members were selected in 2019 (four members) and 2020 (one member) based on their expertise in the space as well as strong research and policy backgrounds. Dr. Eberechukwu Onukwugha, associate professor, executive director, Pharmaceutical Research Computing, Pharmaceutical Health Services Research, University of Mary-

The board’s executive director, Dr. Andrew York, who is a pharmacist, said the aim is to take a comprehensive look at what affordability means for residents in Maryland. “We are looking at reducing costs, but just as importantly, we are looking at improving access. We are trying not to get tied up on things like ‘price,’ which is a loaded term,” York explained. “There are so many metrics that can be said to be the ‘price,’ but they seldom reflect what anyone in the supply chain actually pays. Instead, we hope to develop a report that is a comprehensive study of the pharmaceutical payment and distribution system. We have decided to take a broad view, and we hope to look at every aspect of the supply chain and look at every opportunity to make drugs more affordable. We are working on understanding the issues by the end of this year. Then, we plan to make recommendations and take action that will materially improve patients’ lives by making their prescription drugs more affordable. We are thinking about the interventions that would make the most impact.” York added that pharmacists are in a great position to help patients navigate affordability issues at the point of patient/ caregiver interaction. “The prescribers may not even know these are issues for the patients. It’s a huge opportunity for pharmacists to help patients by providing the necessary information to the healthcare team and to let them know that they need to take cost into consideration when prescribing,” he said.

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Drug affordability is an issue for all states, and York and Onukwugha hope the board’s approach can be translated outside of Maryland. “There’s been a lot of research already conducted to describe and document barriers to healthcare utilization and the impact of the cost burden,” Onukwugha noted. “We aren’t always fully aware of what’s already been studied and documented. It’s important to understand the literature. Something for those who are looking to do more in this space is data-oriented work—study your own populations with surveys or patient interviews.” Dr. Marta Brooks, chair and associate professor, Department of Pharmacy Practice, Regis University School of Pharmacy, sees an opportunity for pharmacy faculty to play an advocacy role. The school has representation within the Colorado Pharmacists Society to provide perspective from the educators’ side of the equation on policy issues. The Colorado legislature is considering forming a prescription drug affordability review board, which would have the authority to cap the price of certain high-cost drugs.

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“The impact on the pharmacy community—there is a lack of understanding of what it could do to individual providers,” Brooks said, explaining opposition to the bill. “We’re more concerned with the lack of availability of certain prescription drugs to Coloradans. Right now it’s not a feasible bill so we’re strongly opposing it.” Strategies that the pharmacy community supports, she continued, include redesigning drug rebate practices, advocating for easier substitutions of biologics and making biosimilars more available to patients. “We’re looking for greater transparency on drug prices from PBMs and pricing information being shared with consumers when drug manufacturers market their medications directly to the public. Pharmacists are continuing to do what they do, which is identify less costly options. We are actively working to address prescription affordability. We don’t want pharmacists to be caught in the middle.” Dr. Karen Smith, a professor at Regis in the Department of Pharmacy Practice, noted that pharmacists want the best health outcomes for patients, so it is a concern when drug pricing and insurance availability and coverage impact ac-

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“Financial health is often a corollary of general health. Those conversations aren’t traditional in the delivery of care but we are creating space for those conversations because patients want to talk about their options and their concerns. With pharmacists being on the front lines and seeing patients more often, there’s a unique opportunity to engage patients around this topic and at least be a resource.” —Dr. Eberechukwu Onukwugha

cess and adherence. “I think pharmacists will always try to maximize adherence and affordability of drugs. We can try to navigate the system for patients and try to find the drug and improve outcomes, but pharmacists do get caught in the middle of pricing and while they want to be an advocate for patients, it is difficult to be in that position.” Smith said Regis offers a survey course in the first year called Pharmacy and the U.S. Healthcare System that addresses pricing and what’s involved in developing a new drug. “We look at how the pharmaceutical industry prices their drugs and we also address the patient cost side by looking at those who would be non-insured, different levels of insurance, HMO government insurance and what is the patient responsibility from that perspective,” she explained. “In the second year, we have a pharmacoeconomics course. That looks at the value of drugs in terms of population benefits— how drugs are valued in society and different methods used to value them. We look at examples of cost-benefit analysis and cost-utility analysis.” Smith and Brooks emphasized that the best use of pharmacists’ time and expertise is direct patient care rather than talking about pricing, but Smith said pharmacy schools need to be realistic about the kinds of cost issues that will arise in practice settings. “It’s important to introduce student pharmacists to how legislation works and how they can advocate for the profession and for patients,” she said. Brooks added, “As a university we believe in producing a well-rounded pharmacist who is principled and taking care of the whole patient. As we try to foster some non-traditional career paths, I hope that those pharmacists that go into industry will bring that whole-person approach to population management and help change the tide.”

A Foundation for Future Pharmacists Frequent interactions with patients put pharmacists in a position to understand cost burdens and know what questions to ask patients. “Financial health is often a corollary of general health. Those conversations aren’t traditional in the delivery of care but we are creating space for those conversations because patients want to talk about their options and their concerns,” said Maryland’s Onukwugha. “With pharmacists being on the front lines and seeing patients more often, there’s a unique opportunity to engage patients around this topic and at least be a resource.” York added, “One thing I wish I’d learned in pharmacy school is more directly how the payment system works, considering how much time pharmacists spend on this. They have to work through wholesalers and insurance reimbursement. That’s a major part of what pharmacists do. It is critical to understand how the payment system works and how to advocate for yourself and your patients.” Onukwugha has observed expansion in recent years around population health and healthcare system courses but believes there are creative ways to more formally integrate pharmacoeconomics into the curriculum such as rotation opportunities in different settings. Maryland has seen more interest from faculty and students in interprofessional education. “The [goal is having] the pharmacist interact as part of a team, provide an important perspective to those discussions and hear from others about whether they see cost considerations coming through. I see opportunity for teams to talk more about cost considerations,” she said. “More students are seeing opportunities to bring that knowledge to the counter. They will ask more questions about a patient’s ability to pay or whether they have any concerns related to their ability to pay.”

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Smith emphasized, “I think that introduction to PBMs, how formularies are created, how pricing comes to be and how legislative decisions come to practice…those are very important to pharmacists. Including those in education helps us get to that well-rounded, involved pharmacist who can take care of patients no matter what specialty they go into. They have a foundation to benefit patients in the pharmacy world.” Brooks agreed, adding, “As we develop pharmacists who are leaders, that is how we will be able to evolve the narrative on prescription drugs and hopefully the [drug review] board won’t lead to healthcare professionals being caught in the middle.” Toledo’s Vaidya said pharmacy faculty should embrace the idea that this is an area where pharmacists can make a difference. “For student pharmacists, their heroes are often their clinical professors. For years the emphasis has been on the clinical side,” he pointed out. “The belief has been that as long as you know therapeutics, that’s what you need to know. That messaging has to change a little bit. Yes, the clinical side is important—that’s the foundation—but where we’re heading it’s important that students are not only taught to think about cost issues but how this is going to add value to the profession. That should be covered in the curriculum through an independent course. Academia needs to take it seriously.” He said faculty must convey that pricing is a key topic. For example, pharmacy faculty at Toledo educated students about a gag order in Ohio that prohibited pharmacists from advising patients on drug options that would cost less. “If we take a three-pronged approach where faculty give students the right tools, we promote the message that we can make a difference in this area and then from an accreditation standpoint we give it a push [through the board exams], it would create a much larger impact. The other thing I’m strongly in favor of is having fellowship programs,” he continued. “I would like to see student pharmacists specifically looking into the cost-effectiveness side of drugs. They should be given specialty training through pharmacoeconomics fellowships. Then they can be trained in this specialization so they can make a larger impact. That should be a sustainable model.” P Jane E. Rooney is managing editor of Academic Pharmacy Now.

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Predict student academic performance Ensure you’re recruiting the best candidates! We understand there are several factors affecting why schools may adopt test-optional admission policies — especially in these challenging market conditions. However, those factors are not necessarily about the predictive value of quantitative measures such as the PCAT. The PCAT remains one of the most reliable predictors of student academic performance in pharmacy programs. Why risk it? Let’s work together to ensure you’re recruiting the best candidates! Visit PearsonAssessments.com/PCATvalue to read the white paper Test-Optional Admission Policies and the Value of Quantitative Measures or speak to a consultant at 800.622.3231 800-622-3231

The upward trend of the pharmacy industry Pharmacy retains a moderate future employment outlook despite challenging market conditions. Pharmacist Wages & Employment Trends* Median wages (2019) $61.58 hourly, $128,090 annual Employment (2018) 314,300 employees Projected job openings (2018-2028) 15,300 Top industries (2018) Retail Trade, Health Care and Social Assistance

PearsonAssessments.com/PCAT

*Source: Retrieved from O*Net on October 15, 2020. Original source: Bureau of Labor Statistics 2019 wage data and 2018-2028 employment projections. Copyright © 2020 Pearson Education, Inc. or its affiliates. All rights reserved. Pearson and PCAT are trademarks, in the US and/or other countries, of Pearson plc. CLINA23931 MJL 10/20

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@AACPharmacy

When Two Pandemics Collide Pharmacy schools continue to engage with their communities to fight the national opioid crisis. By Morgan Carson-Marino, M.S., Pharm.D. Candidate, University of Florida College of Pharmacy, AACP APPE Student May–June 2021 and Thomas Maggio, MBA, AACP Public Affairs and Engagement Manager It’s no secret that opioids can lead to dependence. Opioid use can increase a patient’s risk of respiratory depression, fatal and nonfatal overdose. During the COVID-19 pandemic, prescription and non-prescription opioid misuse or opioid use disorder has become a pressing public health emergency. There is a significant stigma associated with use of opioid analgesics and medications for opioid use disorder (OUD). The COVID-19 pandemic has negatively impacted the opioid crisis. The public stigma of OUD also contributes to the national opioid public health crisis, such as reluctance to seek or provide treatment by patients and providers, respectively. AACP has led efforts in collecting and publicizing opioidrelated activities by colleges and schools of pharmacy. To date, the Association has more than 450 activities recorded by 114 academic pharmacy institutions from 45 states, the District of Columbia, and Puerto Rico in its Opioid-Related Activities Database. Education and research activities comprise the majority of activities. Activities related to service, practice, and advocacy have also been reported, but not as widely adopted as education and research activities. Therefore, clinical practice and patient advocacy initiatives within

pharmacy programs can expand opioid-related activities in the university-wide community. Below is a snapshot of opioid-related activities that are taking place at AACP member schools. The University of New Mexico (UNM) College of Pharmacy and the Massachusetts College of Pharmacy and Health Sciences (MCPHS) serve as key examples of successful co-curricular opportunities.

University of New Mexico College of Pharmacy The University of New Mexico (UNM) Substance Use Research & Education (SURE) Center has approached barriers to communication and broader discussion about substance use disorder (SUD) by increasing the use of non-stigmatizing language when speaking with providers, patients, and the public. Person-centered language alternatives is an evidencebased principle of communication which can decrease public stigma surrounding OUD. Discriminatory communication practices, such pejorative language, can appear to endorse negative social norms and present barriers to effective treatment for patients with

Since 2018, AACP has recorded a variety of opioid-related activities from schools and colleges of pharmacy to link the profession of pharmacy with opioid-related health initiatives in the university-wide community. The AACP’s opioid-related activities database (www.aacp.org/opioid) continues to accept institution submissions related to advocacy, education, practice, research, and service. AACP encourages submissions of opioid-related activities to its database and is especially interested in learning more about activities related to service, practice, and advocacy.

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OUD. UNM pharmacy education and experiential training integrates stigma-reducing strategies to communicate about OUD and harm reduction strategies for people who might be at risk of overdose. Strategic approaches in communication (e.g., use of terminology) during patient-provider interactions can help decrease harmful stigma and combat ideological barriers that are simultaneously perpetuating the opioid crisis during COVID-19. The goal of both destigmatizing language and person-first terminology aims to improve outreach during the COVID-19 pandemic in university-wide and rural communities. UNM College of Pharmacy faculty developed and disseminated an outreach intervention program to increase pharmacy-based naloxone dispensing to patients at risk of opioid-related breathing emergencies. The program primarily focuses on pharmacists’ and pharmacy technicians’ self-efficacy and communication skills and integration of opioid-related breathing emergencies prevention and naloxone counseling in community pharmacies. Emerging results indicate that this targeted educational outreach led to better identification of patients at risk of opioid-related breathing emergencies and increase in naloxone dispensing in rural areas. In addition, Dr. Ludmila Bakhireva, director of the SURE Center, and Dr. Amy Bachyrycz shared their experience working with rural/under-served and special populations, such as pregnant women and young children, affected by the opioid crisis. UNM SURE Center leads several prospective cohort studies examining the effect of prenatal opioid exposure on infant. The College of Pharmacy faculty also participate in a number of clinical trials focusing on novel interventions for OUD conducted within the NIDA Southwest Clinical Trial Network (CTN) Node.

Boston, and delivered numerous naloxone training sessions across Boston. Student pharmacists have also been involved in a pilot program at a local healthcare facility—the Newton-Wellesley Hospital. Drug disposal packets, instructions, and a survey are provided to post-surgery patients with an opioid prescription for acute pain. The goal of this program is to assess the efficacy of a simple intervention provided to patients in the hopes they will remove unused opioid prescriptions from their homes. Previous research at MCPHS has evaluated community pharmacists’ training and understanding about naloxone products and barriers to prescribing buprenorphine. The study discovered that community pharmacists did not have sufficient understanding to properly counsel patients about naloxone products. Therefore, there is a need for increasing substance abuse education and training in pharmacy school and after graduation in professional practice. In addition to his activities at MCPHS, Melaragni works with a local non-profit organization and launched the Opioid Epidemic Network (www.opioidepidemicnetwork.com) to highlight front-line responders’ efforts, and to involve student pharmacists in ongoing efforts to address the opioid epidemic during COVID-19.

Massachusetts College of Pharmacy and Health Sciences (MCPHS)–Boston Dr. Frank Melaragni, associate professor in the School of Pharmacy, has been instrumental in MCPHS University’s opioid-related activities and community outreach. As part of these efforts Melaragni has worked with student organizations such as Generation Rx and organized regular training session on how to recognize and respond to an opioid epidemic. This has results in over 5,000 MCPHS students, staff, and faculty learning about the opioid healthcare crisis and learning how to administer naloxone to those who have an opioid-related breathing emergency. Melaragni also initiated an MCPHS with the Public Health arm within the City of Boston to assist in reaching community members who wanted to learn about helping others with naloxone. Pharmacy students have received special training by the City of

Successful SUD Activities During COVID-19 It is difficult to fully understand the concurrent yet additive effect of SUD during the COVID-19 pandemic. The social stigma of OUD may add to a person’s reluctance to seek help. Food and Drug Administration (FDA) approval of KLOXXADO®, an 8 mg high-dose naloxone nasal spray, fits a timely

Academic Pharmacy NOW  2021 Issue 3

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community-based health need; it is expected to improve outcomes of opioid-induced overdose during the COVID-19 recovery phase. Risk reduction and risk management programs, in concert with COVID-19 vaccination efforts, will improve clinical practice and health outcomes while decreasing the potential of opiate-related emergencies. Non-opioid, tamperresistant or abuse-deterrent formulations of prescription medications also dissuades potential for drug misuse. Increased access to and education about naloxone products directly combats opioid-involved overdose. Research findings have shown how pharmacists and pharmacy technicians can benefit from high-impact education and practice training in overdose emergency response and naloxone administration. Changing from a stigmatizing to destigmatizing communication strategy, like adoption of person-first language with patients, is a data-based approach to reduce harm at both the patient and population level. Other strategies include clinical risk assessment tools and opioid tapering protocols. Opioid stewardship programs may be yet another avenue for student learning, community engagement, and healthcare practice. Student experiential learning opportunities in SUD and addiction can improve the skill set for future pharmacists.

Academic Pharmacy NOW  2021 Issue 3

Successful piloting and implementation of opioid-related activities during the COVID-19 pandemic are critical opportunities for students to learn more about substance abuse prevention and treatment. These activities, however, are likely to require an array of strategic planning efforts including recovery-oriented language, patient advocacy, and community outreach to increase access and quality care. Study abstracts that will be presented during AACP’s annual Virtual Pharmacy Education 2021 present another opportunity to learn more about opioid-related research being conducted in the United States and worldwide. Opioid-related abstract topics include pharmacist-delivered counseling methods and opioid screening, mitigation, and tapering strategies. All 2021 meeting abstracts will be published online by the American Journal of Pharmaceutical Education (AJPE).

References 1. Phuong Duong., et al. “Understanding the Barriers to Prescribing Buprenorphine in Massachusetts”. Acta Scientific Pharmaceutical Sciences 4.12 (2020): 22-29. 2. Melaragni F, Levy C, Pedrazzi J, Andersen M. Assessing pharmacists’ readiness to dispense naloxone and counsel on responding to opioid overdoses. J Am Pharm Assoc (2003). 2019;59(4):550-554.e2. doi:10.1016/j.japh.2019.04.012

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Take Two: See What’s New at 2021 #VirtualPharmEd AACP Annual Meeting P July 19–22, 2021 For a second year, AACP’s Annual Meeting returns to a computer near you. Virtual Pharmacy Education 2021 promises to deliver another high impact conference with pharmacy educators and practitioners from around the globe. Lights, Camera, Action! That’s what meeting speakers will hear when they deliver their sessions live, July 19-22, as they present dynamic and timely content to help you excel in your career. More than 120 educational sessions will be delivered in real-time, addressing critical topics such as adapting experiential activities to virtual settings, promoting well-being and resilience in student pharmacists, and the role of pharmacists in addressing COVID-19 vaccine hesitancy. Check out some of the Virtual Pharmacy Education 2021 highlights: ɋɋ

Shorter Schedule: Four days of main programming, from July 19–22, means you can focus on your professional development while still being flexible with your time.

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Most Sessions Delivered Live: Join in the exciting atmosphere of attending and participating in live sessions presented by the speakers. There are also 12 pre-recorded sessions that can be viewed on-demand throughout the conference.

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Pressing Pause to Recharge: Reset your mind and body during scheduled screen breaks, wellness activities and mindfulness exercises.

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Varied Session Lengths: Build a daily agenda that’s convenient for you with a mix of 10-, 30- or 60-minute sessions.

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Trending Topics: More than 120 presentations will address critically important topics that are relevant to your work in pharmacy education and practice right now.

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Continuing Education: Attendees can earn up to 19 hours of live CPE credit the meeting and up to 7.25 hours of live CPE credit for the Teachers Seminar.

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Scholarly Research at Your Fingertips: With one click you’ll have access to more than 500 posters in the Online Poster Gallery. Search by author name, poster category, section and title.

www.aacp.org/pharmed2021

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Low Rates, High Value Members pay just $225 for access to Virtual Pharmacy Education 2021 programming and can watch sessions on-demand for up to three months post-conference. Visit www.aacp.org/pharmed2021 to register today.

New Ways to Network Missing those hallway conversations with peers from across the country? Interested in talking to speakers after the session is over? There are several new opportunities at Virtual Pharmacy Education 2021, to connect with colleagues. ɋɋ

Video Chat Using Wonder: Mingle in our “virtual lobby” by using the social networking platform Wonder. Enter the Virtual Pharmacy Education 2021 room and connect with others in a group or one-on-one. You can participate in designated areas focusing on a specific topic, such as “AJPE” or “Session Discussions,” or talk with colleagues anywhere in the room, about any topic you find interesting.

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Session Chat in Zoom: Share your ideas and ask questions of the speakers in real time using the Zoom chat feature. No need to wait until the session concludes— start dynamic discussions throughout the presentation!

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Social Media Sharing: Use the hashtag #VirtualPharmEd across your social media platforms to engage with other attendees, and post your thoughts, highlights and reactions during sessions.

Academy Accolades This year, AACP will recognize award recipients from 2020 and 2021 during two special award presentation sessions which will include a rich dialogue between the honorees and attendees.

Volwiler Research Achievement Award and Paul R. Dawson Award for Excellence in Patient Care Research Presentation Monday, July 19, 1:15 p.m.–2:15 p.m.

Robert K. Chalmers Distinguished Pharmacy Educator Award and Lawrence C. Weaver Transformative Community Service Award Presentation Wednesday, July 21, 11:15 a.m.–12:15 p.m.

Distinguished Teaching Scholar and Lifetime Achievement Award Presentation during the Opening General Session Monday, July 19, 10:00 a.m. –11:30 a.m.

Distinguished Service Award and Rufus A. Lyman Award Presentation during the Closing General Session Thursday, July 22, 4:00 p.m. –5:30 p.m.

Visit www.aacp.org/pharmed2021 to learn more! 34

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Sound On: Keynote Speakers Ready to Educate and Inspire Attendees at Virtual Pharmacy Education 2021 will have a front-row seat to this year’s lineup of expert speakers. You won’t want to miss this rare opportunity to interact with industry thought leaders. Take a look at the top-notch speakers at #VirtualPharmEd:

Opening General Session

Closing General Session

Combatting Anti-Science Thinking

The How of Happiness: Boosting Well-Being Through Kindness, Gratitude, and Connection

Monday, July 19, 10:00 a.m.–11:30 a.m.

Thursday, July 22, 4:00 p.m.–5:30 p.m.

Moderator: Mary Woolley CEO & President, Research!America

Dr. Sonja Lyubomirsky, Ph.D. Distinguished Professor and Vice Chair of Psychology at the University of California, Riverside and author of The How of Happiness and The Myths of Happiness.

Panel: Georges C. Benjamin, M.D. Executive Director American Public Health Association Bruce Gellin, M.D., M.P.H. Chief of Global Public Health Strategy The Rockefeller Foundation In this session, Mary Woolley, CEO & president of Research!America, will lead a conversation with Georges C. Benjamin, executive director of the American Public Health Association and Bruce Gellin, chief of global public health strategy at The Rockefeller Foundation. The panel will address the disturbing trends in anti-science thinking and ongoing efforts within their organizations to address it. The panel will share specific ways colleges and schools of pharmacy, their faculty, and students can join with efforts to combat the anti-science movement.

During both normal times and challenging circumstances like today, most people around the world report wanting to be happy. Happiness not only feels good, however; it is good. Relative to their less happy peers, happy people are more creative, productive, and helpful; have more stable marriages and higher incomes; and boast stronger immune systems. Fortunately, decades of research suggest that individuals can deliberately increase their own happiness by creating and maintaining new habits. In this talk, Dr. Lyubomirsky will introduce the “positive activity model,” which describes the “how” and “why” of happiness—that is, the conditions under which such practices as gratitude or kindness work “best” and how small and simple activities can transform people into happier, healthier, more connected, and more flourishing individuals.

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Save the Date

Virtual Digital Health Institute: Preparing Future Pharmacists for the Digital Era

October 6–8, 2021

The Virtual Digital Health Institute is designed for institutions that seek to introduce or strengthen digital health concepts in their pharmacy programs. Participating institutional teams will not only learn how digital health is transforming the delivery and consumption of healthcare, but also hear how other colleges across the country have addressed the need to incorporate digital health in their pharmacy programs, identify opportunities to integrate digital health education in both didactic and experiential education curricula, and determine the best strategy to develop one or more digital health champions in their college.

Registration opens in August.

Who Should Attend: • Curriculum committee chairs and members • Skills lab directors • Experiential education leaders • Department chairs and those who support faculty development • Faculty with an interest in digital health • Deans