The Arkansas Pharmacists Summer 2009

The

Arkansas

Pharmacist

Arkansas Pharmacists Association 2009 Summer Quarterly Edition

Jan Hastings, Pharm.D. President 2009 - 2010

Board of Directors

2008 - 2009 Officers

Area Representatives

President ......................................................Jan Hastings, Pharm.D., Benton President Elect..................................................Mike Smets, P.D., Fort Smith Vice President............................................Gary Bass, Pharm.D., Little Rock Past President ........................................Paul Holifield, Pharm.D., Batesville

Area 1 (Northwest)....................................Gary “Buzz” Garner, P.D., Mena Area 2 (Northeast) ..............................Dennis Moore, Pharm.D., Batesville Area 3 (Central) .............................Kenny Harrison, Pharm.D., Little Rock Area 4 (Southwest/Southeast) ......................Mike Stover, Pharm.D., Rison

Ex-Officio Members APA Executive Vice President ................................................................................................................................................ Mark Riley, Pharm.D., Little Rock Board of Health Member ...................................................................................................................................................................John Page, P.D., Fayetteville Board of Pharmacy Representative ..............................................................................................................................Charles Campbell, Pharm.D., Little Rock UAMS College of Pharmacy Representative (Dean)........................................................................................Stephanie Gardner, Pharm.D., Ed.D., Little Rock Harding College of Pharmacy Representative (Dean) ....................................................................................................Julie Hixson-Wallace, Pharm.D., Searcy UAMS College of Pharmacy Student Representative............................................................................................................................Collin Ward, Little Rock Harding College of Pharmacy Student Representative ..........................................................................................................................Celia Proctor, Little Rock

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District 1 Eddie Glover, P.D. U.S. Compounding 2515 College Ave. Conway, AR 72034

District 3 Danny Ponder, P.D. Ponder Economy Drug, Inc. 400 S College St, Mountain Home, AR 72653

District 5 Lynn Crouse, Pharm.D. Eudora Drug Store 140 S. Main St. Eudora, AR 71640

District 7 John Vinson, Pharm.D. Area Health Education Center 612 South 12th Street Fort Smith, Arkansas 72901

District 2 Brent Panneck, Pharm.D. St. Francis Pharmacy 210 Cobean Blvd. #10 Lake City, AR 72437

District 4 Laura Beth Martin, Pharm.D. Family Pharmacy 810 S. Main St. Hope, AR 71801

District 6 Michael Butler, Pharm.D. Village Health Mart Drug #1 4440 N. Highway 7 Hot Springs, AR 71909

District 8 Christy Campbell, P.D. Lowery Drug Mart #2 123 Central Ave. Searcy, AR 72143

APA’s Academy of Consultant Pharmacists

APA’s Academy of Compounding Pharmacists

President..........................................................Jim Griggs, P.D., Fayetteville President Elect ..................................................................To Be Announced

President ..........................................Gary Butler, P.D., Hot Springs Village President Elect ..................................................................To Be Announced

Arkansas State Board of Pharmacy

Arkansas Association of Health System Pharmacists

President ................................................Lenora Newsome, P.D., Smackover Vice President ....................................................Benji Post, P.D., Pine Bluff Secretary ..............................................................Marilyn Sitzes, P.D., Hope Member..........................................................Ronnie Norris, P.D., McGehee Member ..........................................................Steve Bryant, P.D., Batesville Member ..................................................Justin Boyd, Pharm.D., Fort Smith Sr. Citizen Public Member ..................................Ross Holiman, Little Rock Public Member............................................................Larry Ross, Sherwood

President ..............................................Maggie Miller, Pharm.D., Batesville President Elect............................................Jason Derden, Pharm.D., Benton Past President ............................................Justin Boyd, Pharm.D., Ft. Smith Executive Director................................Dennis Moore, Pharm.D., Batesville Treasurer ..............................................Sharon Vire, Pharm.D., Jacksonville Secretary ..................................................Paula Price, Pharm.D., Sherwood Member at Large......................................Brandy Owen, Pharm.D., Conway Member at Large ............................Jody Smotherman, Pharm.D., Batesville Member at Large ................................Jennifer Priest, Pharm.D., Little Rock

The Arkansas Pharmacist

Contents

Arkansas

Pharmacist The

Arkansas Pharmacists Association 417 South Victory Little Rock, AR 72201 501-372-5250 501-372-0546 Fax

The Arkansas Pharmacist (ISSN 0199-3763) is published quarterly by the Arkansas Pharmacists Association, Inc. It is distributed to members as a regular service paid for through allocation of membership dues ($5.00). Non-members subscription rate is $30.00 annually. Periodical rate postage paid at Little Rock, AR 72201.

Editorial Staff: Editor: Mark Riley, Pharm.D. Executive Vice President Art & Design Editor: Helen Hooks Communications Specialist Opinions and statements made by contributors, cartoonists or columnists do not necessarily reflect the attitude of the Association, nor is it responsible for them. All advertisements placed in this publication are subject to the approval of the APA Executive Committee.

POSTMASTER: Send address changes to The Arkansas Pharmacist 417 South Victory Little Rock, AR 72201.

Features 2009 Annual Convention Highlights ........................................................10 Arkansas Healthcare Access Foundation..................................................26 2009 District Meeting Schedule ..............................................................31

Departments From the President......................................................................................4 The Executive’s Perspective ......................................................................5 Compounders Report..................................................................................7 Rx and the Law ..........................................................................................8 Calendar of Events ....................................................................................9 In Memoriam ..............................................................................................9 Safety Nets................................................................................................19 Member Classified Advertising................................................................21 AAHP Report ..........................................................................................22 Harding Report ........................................................................................25 2009 Salary Survey ..................................................................................27 Medicaid Alert ..........................................................................................32 APA Board of Directors Minutes..............................................................33

Index to Advertisers Pace Alliance ............................................................................................6 Pharmacy Quality Commitment ..............................................................20 Arkansas Pharmacy Foundation Legacy ................................................23 Pharmacists Mutual ................................................................................24 Arkansas Pharmacy Support Group ........................................................32

APA Staff Office E-mail Address apasupport@arpharmacists.org Mark S. Riley, Pharm.D. Executive Vice President mriley@arpharmacists.org

Scott Pace, Pharm.D. Associate Executive Vice President scott@arpharmacists.org

Helen Hooks Communications Specialist hhooks@arpharmacists.org

Barbara McMillan Director of Administrative Services & Meetings bmcmillan@arpharmacists.org

Debra Wolfe Director of Public Affairs dwolfe@arpharmacists.org

Celeste Reid Administrative Assistant creid@arpharmacists.org

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From the President Our profession is a wonderful profession and I LOVE IT! I am very grateful for the opportunity you have given me to serve as President of our Association for the next year.

Didn’t we have an excellent convention? What an amazing time of learning, fellowship and networking! We are lucky to have very committed pharmacists in the state who take time out of their schedules to attend convention and I hope that you got as much out of it as I did.

As I mentioned in my acceptance speech, I read a book last fall that really hit home with me. The title is “How Full Is Your Bucket? Positive Strategies for Work and Life” by Tom Rath and Don Clifton. Let me share an excerpt from the book: “Each of us has an invisible bucket. It is constantly emptied or filled, depending on what others say or do to us. When our bucket is full, we feel great. When it is empty, we feel awful. Each of us also has an invisible dipper. When we use that dipper to fill other people’s buckets- by saying or doing things to increase their positive emotions- we also fill our own bucket. But when we use that dipper to dip from other’s buckets- by saying or doing things that decrease their positive emotions- we diminish ourselves.”

Jan Hastings, Pharm.D. Associate Professor UAMS College of Pharmacy

The book further states that if we don’t have a higher ratio of fills to dippers our bucket is ‘emptied’ and we are drained. This saps our energy and the result is that we become negative in our interactions, which causes stress in our jobs and in our personal relationships. The book even states that people whose bucket is emptied all the time have more accidents on the job. For pharmacists, this could translate to medication errors which could put our patients at risk.

I am a positive person and I tend to see my glass as half-full! At this time nationally we are in a discussion about health care reform and pharmacists have much to offer, not only to our patients but the health care system in general.

Pharmacy has many positives going for us as a profession. We are respected by our patients and other medical professionals for our wealth of drug knowledge.

The Gallup Poll each year shows that pharmacists are one of the most trusted professionals. We are accessible to our patients and that access has been proven to improve patient’s health. They come to us for advice on a myriad of subjects from ‘what can I take for my headache’ to ‘I’m having some chest pain. Do I need to go to the doctor?’ And we help them every day, in every way that we can. Pharmacists help their patients.

In addition, pharmacy is doing well financially. (Check out the UAMS Salary Survey in this issue.) Yes, I know we struggle with reimbursement issues and figuring out how to get paid for our services is paramount to our success in the future, but overall pharmacists are doing well financially no matter the practice setting. Salaries are high, benefits are good and life is great. Today’s students only need to dream their perfect employment situation upon graduation and they can probably make it happen!

I am not blind to the challenges we face- they are real and they will have to be faced. Reimbursement has to be fair and allow us to stay in business. We need less red-tape from the federal government when it comes to serving our patients. We need respect from employers that afford us basic human rights, like lunch and bathroom breaks. We need to be able to spend less time as ‘insurance’ agents and more time with our patients. But if we can somehow put a positive spin on all these issues- even if they don’t go away completely- at least our focus will be less negative and our patients will benefit from that positivity when we interact with them.

I guess I sound like a cheerleader and sometimes that’s how I feel. This year, when I come into your pharmacy as I travel across our state, I plan on trying to fill your bucket. I want you to feel better when I leave than when I arrived. When I represent you on the local, state and national levels I will try my best to present a positive viewpoint. The health care landscape is changing and pharmacy can have a tremendously positive effect. Help me this year to improve our recognition as a health care provider by using positivity to improve our profession, our patient’s lives and as a results our own lives.

Now, let’s get to work because you and I together can make 2009-2010 the most productive year our Association has ever known. Thank you!

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The Arkansas Pharmacist

The Executive’s Perspective Has it really been 16 years since the last time we had a national debate on health care? It’s hard to believe, but it was 1993 the last time our federal government took a serious look at overhauling the health care industry. Back in 1993, the U.S. spent a total of almost $700 billion a year on health care (among all payers, private and governmental). This year, the total expenditure is expected to reach almost $2.5 trillion. If we keep on the current trajectory, by 2016, we will be spending upwards of $4.3 trillion a year on healthcare. These numbers were staggering in 1993 and they are even more alarming in 2009. As a country, we now spend four times more on health care than we do on national defense. On the whole, the U.S. spends more money than any other industrialized nation on health care costs (including countries with universal coverage for all citizens), yet our health outcomes are lagging behind and we still have over 46 million Americans who are uninsured. The growth in the health care industry is unbelievable and, according to economists, is unsustainable; so the question is not ‘do we need to change the health care system,’ but ‘how do we best change the health care system.’ This is the multi-trillion dollar question.

This debate is now underway in Washington, with both the House and Senate crafting legislation that would extend coverage to most of the 46 million uninsured in the U.S. Much of the early focus in the health care debate has centered on ways to reduce health care expenditures through the management and reduction of chronic diseases. Pharmacists are featured prominently in early drafts of legislation that we have reviewed as the providers of medication therapy management (MTM) services for patients with chronic diseases, such as diabetes and asthma. However, the big unknown for the pharmacy community is what an outpatient prescription benefit would look like under any of the current reform plans.

Scott Pace, Pharm.D. Associate Executive Vice President

The APA supports the MTM initiatives that are being proposed, but the APA also believes that it is vital that any outpatient prescription benefit created under a health care reform plan should preserve the relationship between the patient and their local community pharmacist. Specifically, a health care reform plan must preserve the patient’s right to select the pharmacist of their choice, it must pay pharmacists fairly for their dispensing and cognitive services, and it should not incentivize or coerce patients to use mail-order pharmacies. Dr. Mark Riley, APA’s executive vice president, has taken this message to Washington three times in the last month, and he remains in constant communication with our representatives and senators as the health care debate moves forward.

Remember, the strength of the APA in every political debate, is the vigor and veracity of our pharmacists. I encourage each of you to stay informed and engaged as health care reform unfolds this summer. Call and e-mail your congressman and senators. Ask them to make sure that pharmacists are a vital part of health care reform.

The Arkansas Pharmacist

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The Arkansas Pharmacist

Compounders Report Pharmacy Compounding Subject to FDA Approval?

The Facts Just Don’t Fit, Part Two A continuation of the fact that show why the FDA should not have jurisdiction over Compounding Pharmacists. by: Gary Butler, President, APA Compounding Academy

Fact: The legislative history of the FDC Act shows that Congress did not intend to interfere with the practice of medicine. Depriving physicians and patients of access to compounded drugs at a time when there were no alternatives for most diseases would have caused an extraordinary disruption with medical practice, and would have been contrary to Congress’s intent.

Fact: There is absolutely no indication from the legislative history that anyone in Congress expected or intended for the FDC Act to turn compounding pharmacists into criminals. FDA says that this silence shows that Congress did not intend to confer an exemption upon pharmacists. In fact, the contrary was true no expressed exemption was needed because nobody every contemplated that compounding would be deemed illegal. Compounding had been practiced since the early colonial days. Under FDA’s theory, Congress fundamentally changed the health care delivery system without anyone in Congress saying, or even hinting, that they had just abolished compounding as a lawful activity.

Fact: As of 1938, every state permitted compounding. Pharmacists were licensed and trained to compound in every state. These state laws did not change after passage of the FDC Act. Compounding remained a state-sanctioned, state-licensed activity. Under FDA’s theory, every state was authorizing pharmacist to and often even requiring pharmacists to commit illegal acts.

Fact: As of 1938, pharmacy schools trained pharmacists to compound. Under FDA’s theory, these schools of pharmacy were teaching and have continued to teach illegal conduct.

Fact: The pharmacy groups were among the strongest supporters of the FDC Act. The President of the American Pharmacists Association (APhA) was persistent in supporting the bill, and praised Congress for passing the law. In fact, pharmacy groups wanted the law passed because they were already heavily regulated, and their competitors drug manufacturers were not. Under FDA’s theory, the pharmacy groups were supporting legislation that caused virtually every pharmacist in the United States to become criminals.

Fact: The United States Pharmacopeia (USP) contained monographs for compounded drugs in 1938. In fact, Congress gave the USP special status under the FDC Act. Under FDA’s theory, the USP monographs for compounded drugs established criteria for illegal products. In fact, since 1939 the USP has added monographs for new compounded drugs, and more recently, standards for compounding. Under FDA’s theory, each new monograph has represented another formula for another illegal product.

Fact: The United States government has long engaged in the act of compounding. Documents from the early 1940s give military pharmacists instructions on compounding. The Department of Defense has continued to support and utilize compounding. The U.S. Army offered formulas for pharmacists to compound drugs from bulk. Under FDA’s theory, every military pharmacist who compounds is breaking federal law. This would create a terrible dilemma for military pharmacists because filling an order to compound a drug would mean following an illegal order.

Fact: The federal government provides reimbursement coverage for compounded medications. Under FDA’s theory, the U.S. Government is paying for an illegal product.

Fact: The FDA itself did not take the view in 1938 that compounding is illegal. There is no evidence whatsoever that FDA, in the wake of the passage of the law, told pharmacists that their behavior was illegal. In fact, in subsequent publications for pharmacists talking about the FDC Act, FDA described multiple provisions of the law, but did not tell pharmacists that one effect of the law was that compounding had become unlawful.

The Arkansas Pharmacist

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Rx and the Law

PHARMACY MARKETING GROUP, INC

AND THE LAW

By Don. R. McGuire Jr., R.Ph., J.D.

This series, Pharmacy and the Law, is presented by Pharmacists Mutual Insurance Company and your State Pharmacy Association through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community.

JURISDICTION Because the United States has many different court systems, the law applied to your case can have a dramatic impact on the outcome. One important factor in any legal dispute is the jurisdiction. But what does that mean? Jurisdiction is defined as the power to hear and determine a case.1 Courts can have general jurisdiction or limited jurisdiction.

General jurisdiction courts can hear and decide almost all types of cases. An example would be the district or superior court in your county. In a typical situation where a pharmacist is sued by a patient, this would be the forum where the case would be heard. However, there are other situations where this would not be true.

Pharmacies that do a significant amount of business out of state and have registered as a non-resident pharmacy with that state’s board of pharmacy are probably subject to the jurisdiction of that state’s courts. Long Arm Statutes have been enacted in most states. These laws allow local courts to have jurisdiction over non-resident defendants in certain circumstances. If an error occurs on a prescription sent to another state and the patient is harmed, the pharmacy could have to defend the case in that patient’s locale. This can be inconvenient and expensive for the pharmacy, but it is a potential price the pharmacy would pay for doing business in that state.

Pharmacists could also end up in another state’s court due to a contract which they signed. Parties to a contract may agree to a particular jurisdiction in the contract.

Then in the event of a breach of that contract, the parties do not have to contest the proper jurisdiction because it has been agreed upon in advance. Pharmacies may enter into contracts with many different vendors, each of which may stipulate to a different jurisdiction. This 1 Barron’s Law Dictionary Second Edition; 1984; edited by Steven H. Giftis 8

could result in the pharmacy defending a breach of contract claim in a far away state.

Courts of limited jurisdiction are limited to hearing only certain subject matters. Examples of these would be a small claims court or a probate court. Patients could bring cases against their pharmacist in small claims court, but their ultimate recovery would be limited by the jurisdictional limit of the small claims court.

Interestingly, Federal courts are courts of limited jurisdiction. The structure of the Federal court system parallels the structure of most state court systems. While the trial courts in state systems are courts of general jurisdiction, the Federal trial courts are not. Federal court jurisdiction is limited to two types of cases. Federal Question jurisdiction consists of cases involving disputes arising under the U.S. Constitution or the laws and treaties of the United States. The other Federal jurisdiction is Diversity jurisdiction. This occurs when the opposing parties come from different states. Therefore, it is possible that the case described above where the pharmacist sent prescriptions out of state could be brought in Federal court if the jurisdictional amount was met. Diversity jurisdiction requires the amount in controversy to exceed $75,000. Smaller cases will be relegated to the state courts even though the opponents are from different states.

In either a general or a limited jurisdictional court, the court must have both subject matter and personal jurisdiction. That is, the court must have jurisdiction over both the subject of the case and over the parties involved. Most often, courts of limited jurisdiction are limited because of the subject matter of the case. A court’s jurisdiction over a person results from the person’s physical presence in the state, but jurisdiction over

The Arkansas Pharmacist

Calendar of Events a person can be expanded by the Long Arm Statutes previously mentioned.

If a party feels that the court doesn’t have the power to hear and decide the case, the party should file a motion asserting the lack of personal or subject matter jurisdiction (or both) with the court. The judge can also rule on the subject of jurisdiction on their own initiative. If a court does not have jurisdiction, then the judge should dismiss the case from that court’s docket. However, the plaintiff is then free to file the case in the proper court.

A court without jurisdiction over a case cannot issue a valid decision in that case. Any judgment issued by a court without proper jurisdiction is void.

In summary, most cases involving pharmacists or pharmacies will typically be heard in their local courts.

However, certain activities or contractual agreements could result in the pharmacist dealing with a case in a distant jurisdiction. The law in that jurisdiction may or may not have an impact on your case, but nonetheless the distance involved will make the case more bothersome.

© Don R. McGuire Jr., R.Ph., J.D., is General Counsel at Pharmacists Mutual Insurance Company.

This article discusses general principles of law and risk management. It is not intended as legal advice. Pharmacists should consult their own attorneys and insurance companies for specific advice. Pharmacists should be familiar with policies and procedures of their employers and insurance companies, and act accordingly.

Calendar of Events 2009 September 8 - 30, 2009 Arkansas Pharmacists Association District Meetings See page 31 of this issue for the complete schedule.

October 8 - 9, 2009 AAHP 43rd Annual Fall Seminar Holiday Inn Airport Little Rock, AR October 17 - 21, 2009 NCPA 111th Annual Convention and Trade Exposition Ernest N. Morial Convention Center New Orleans, LA

In Memoriam Dr. Jamie Gault Ward, AR

2010 June 24 - 26, 2010 APA Annual Convention and Trade Exposition Holiday Inn and Fort Smith Convention Center Fort Smith, AR The Arkansas Pharmacist

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2009 Annual Convention

2009 Convention Contributors AAHP AmerisourceBergen Cardinal Health Conexus Health Harding College of Pharmacy H & H Wholesale The Health Law Firm NASPA 10

Nonprescription Medicines Academy Pace Alliance Rx Systems, Inc. UAMS Alumni Association UAMS College of Pharmacy Vemco ZRT Labs

The Arkansas Pharmacist

Longest Drive

The Arkansas Pharmacist

Closest to the Pin

First Place Team

First Place Team

Third Place Team

Convention Golf

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Exhibitors

Registered Exhibitors H & H Wholesale Liberty Computer Service Walgreens RxMaster Pharmacy System Abbott Diabetes Care Meda Pharmaceuticals Merck & Co, Inc. PBA Health Roche Ark. Foundation for Medical Care U.S. Army Healthcare HCC Rexam Prescription Products Sagent Pharmaceuticals RPH on the Go Wyeth Pharmacists Mutual Southern Pharmacy Cooperative Takeda Pharmaceuticals Retail Designs, Inc. Member Health, LLC Cardinal Health Berry Plastics Corp.

Smith Drug QS 1 GlaxoSmithKline Harding University Dr. Comfort Morris & Dickson UAMS College of Pharmacy McKesson Corp.

Bio-Tech Pharmacal, Inc. Leadsonlabs Robert P. Potts & Associates AmerisourceBergen Top Rx Pace Alliance Arkansas Healthcare Access Foundation AAHP 12

The Arkansas Pharmacist

Wholesale Partner Appreciation Karaoke Party Left: Dr. Jan Hastings opens with the first song

Below: Ron Trusty of AmerisourceBergen serenades Becky Shinabery

Left: APA Past Presidents join together to entertain the crowd

Right: UAMS students and Dr. Anne Pace “rock the house”

Left: Brandy Cook with Smith Drug was awarded “Best Female Vocalist”

UAMS men’s trio

As Paul sings his way “out”, Jan sings her way “in” The Arkansas Pharmacist

Dr. Michael Smith of Russellville really sounds like Elvis 13

CE Sessions Pharmacists from all over Arkansas earned as many as 19 hours of continuing education credit at the 127th Annual APA Convention at the DoubleTree hotel in downtown Little Rock, June 11th – 13th. Convention attendees participated in educational sessions that covered a wide range of topics, such as: treating hospital-acquired infections, asthma, marketing your professional services, Arkansas pharmacy law update, osteoporosis treatment, and appropriate usage of methadone.

In addition, Rebecca Snead, executive vice president of the National Alliance for State Pharmacy Associations, gave a

fascinating keynote address entitled “Good to Great: Key Concepts to Transform Your Practice.” APA would like to extend our thanks to all of the speakers who helped to make this year’s convention CE so successful.

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The Arkansas Pharmacist

An Evening with the Presidents

APA Executive Vive President, Mark Riley presents the Guy Newcomb Legislative Leadership Award to Representative Allen Maxwell

Joe Baker of Pharmacists Mutual presents Dr. Sarah Frank with the “Distinguished Young Pharmacist” award

APA President, Paul Holifield presents the “Pharmacist of the Year” award to Dr. Tony Bari

Left: Dr. Eddie Dun is honored with the APA Community Leadership Award

Above: The APA President’s gavel is presented to Incomming President, Jan Hastings

Left: Senator Percy Malone is honored with the newly established Percy Malone Public Servic Award

Dr. Paul Holifield is honored as the Immediate Past President The Arkansas Pharmacist

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Awards Ceremony Dr. Lenora Newsome honors fifty year certificate holders

The Honorabel Marion Berry presents Dr. George Wimberly with a Lifetime Acheivement Award

Dr. Mike Scribner is honored as the UAMS Roche Preceptor of the Year

Pat Keller and Dr. Dan Spadaro of Arkansas Healthcare Access Foundation honor Dr. Kammy Krissel and Dr. Lisa Henson with the 2009 Spirit of Service Award

UAMS ASP President, Collin Ward is presented with the Charles M. West Leadership Award, sponsored by the Arkansas Pharmacy Foundation 16

Right: Dr. Paul Holifield is presented with the APA Outgoing Presidents Award Dr. Jan Hastings is presented with the NCPA Presidents Award The Arkansas Pharmacist

2009 APA Award Winners

Tony Bari, P.D. Pharmacist of the Year

Michael Thames, Pharm.D. Innovative Pharmacy Practice Award

Eddie Dunn, Pharm.D. Bowl of Hygeia and APA Comminity Service Award

Rep. Allen Maxwell Guy Newcomb Legislative Leadership Award

Sarah Frank, Pharm.D. Distinguished Young Pharmacist

Sen. Percy Malone Percy Malone Public Service Award

2009 Incoming Board Members

Left to Right: Collin Ward, UAMS ASP President; Dr. Jim Griggs, Consultant Academy President: Dr. Laura Beth Martin, District 4 President; Dr. Eddie Glover, District 1 President; Dr. Brent Panneck, District 2 President; Dr. Gary Bass, Vice President; Dr. Mike Smets, President Elect; Dr. Jan Hastings, President Not in Photo: Dr. Kenny Harrison, Area 3 Representitive The Arkansas Pharmacist 17

AP-PAC Luncheon Saturday's convention schedule featured the Arkansas Pharmacists Political Action Committee (AP-PAC) luncheon. Approximately 60 people attended. This luncheon is not only a fundraiser for our PAC, but also serves as a venue to dissiminate information about the political landscape to APA members who are dedicated to making APA successful in the political arena. Dr. Mark Riley reported on the 87th General Assembly and on national issues including the Health Care Reform debate. Dr. Randy Shinabery, Chairman of AP-PAC, wants to extend his sincere appreciation to those who attended this important event, and to all who contribute to our PAC.

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The Arkansas Pharmacist

Safety Nets

Dr. Jon Wolfe

Safety Nets

Dr. Eddie Dunn

We present a Safety Net that shows how a thoughtful pharmacist and a caring physician collaborated to promote both the comfort and the safety of a particularly vulnerable patient.

A pharmacist from Northwest Arkansas received the original prescription illustrated in Figure One. The prescription was for an 89 y/o female who had just been discharged from the hospital. The pharma-

Figure One

cist, who had filled prescriptions for this patient for many years, knew the patient was being treated for heart failure and coronary artery disease. Part of her drug regimen included high doses of nitrates for chest pain. The pharmacist also knew the patient was opioid naïve.

Upon questioning the patient’s caregiver, the pharmacist learned the patient had been prescribed morphine sulfate for chest pain because nitroglycerin was not relieving the chest discomfort as it once did. The caregiver went on the say the prescriber had instructed the patient to place the medication under her tongue in a manner similar to sublingual nitroglycerin. After this, the pharmacist handed the prescription to the pharmacy technician for entry into the computer.

The technician entered the prescription information as Roxanol® (morphine sulfate) Oral Solution (concentrate) 20 mg/mL, quantity 30 mL, with directions of “place ¼ to ½ teaspoonful under the tongue every four hours as needed for chest pain”. The same technician filled the prescription and placed it in line for verification and patient counseling.

As the pharmacist examined the filled prescription for accuracy, he became increasingly concerned about the morphine sulfate dose to be administered. If dispensed as written, the frail, opioid naïve, 89 y/o patient could have potentially received 50 mg of morphine sulfate every four hours. The pharmacist decided to telephone the prescriber to verify this extremely high morphine sulfate dose. After listening to the pharmacist’s concerns, the prescriber stated that he intended to write directions: Take “¼ to ½ mL every four hours” not “¼ to ½ teaspoonful”. After this, a corrected prescription label was affixed to the medication container and the patient’s caregiver appropriately counseled.

The prescription presented for study shows exactly how the problem occurred. The first point is actually the order for morphine itself. The prescription was written for “morphine SL”, which would point many pharmacists to a tablet. However, the following concentration expression steers the reader back to the right track. The second point is the use of “cc” in the concentration statement. The proper abbreviation is “mL”, a usage specifically indicating a liquid product. The “cc” as is copied here could be construed correctly (as 1 mL), or as a loosely-written symbol for fluiddrachm (fl). The third point is the use of avoirdupois notation (“tsp” for teaspoonful ≈ 5 mL) along with a fraction. Both sorts of notation are unofficial for prescription use.

The liquid volume must be expressed as mL in this case. The fraction of a mL must be expressed as a decimal fraction (in this case 0.25 – 0.5 mL). The prescription ends with use of “30 cc”, instead of “30 mL” to indicate the volume to dispense.

The above issues show the importance of adopting metric notation in prescriptions, and never wavering from its correct use. One can add the small concern that the Sig is also written in a common, but unofficial, format. The order, according to USP standards, should be written out fully as “every four hours as needed to relieve chest pain.”

The use of computer-generated prescriptions – even for CII drugs at some future time – ought to eliminate the temptation to write shortcut expressions such as “prn”, which is fairly safe, or “CP”, which can be interpreted in several ways.

This patient benefits from having a committed caregiver, who helped the pharmacist at the beginning. The patient also is well served by a physician who recognizes the need to relieve pain, and who understands that morphine provides life-enhancing value to the patient in the grip of cardiac pain. We can all hope for a future level of practice in which the notations of the past can no longer trip up good intentions for our patients.

The Arkansas Pharmacist

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The Arkansas Pharmacist

Member Classified Advertising FOR SALE Kirby Lester counting machine still in box $1,000.00. Contact Cliff Robertson at North Heights Pharmacy, Texarkana, Arkansas 870-774-3666.

NIGHT PHARMACIST NEEDED Washington Regional Medical Center 7 days on/ 7 days off. Hospital experience desired not required.

Contact Jonell Hudson, Ramona McLean, or Melissa Williams, Employment Manager Washington Regional Medical Center Office: 479-463-1066 Fax: 479-463-1297 m3williams@wregional.com 3215 N. North Hills Blvd.

Fayetteville, AR 72703 RELIEF PHARMACIST NEEDED Relief pharmacist needed for independent pharmacy in Van Buren.

We need someone for approximately 20 hours per week and 1 or 2 Saturdays per month. Please call 479-474-3431 or 479-806-4365 or email Elizabeth Morrison at etmorrison@sbcglobal.net.

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY Job Description Job Title: Hospital Experiential Director Rank: Assistant Professor (non-tenture track), Pharmacy Practice Individual being sought to oversee hospital/institutional component of UAMS College of Pharmacy Experiential Education Program.

Candidate will also contribute to the college’s service and scholarly missions. For more information contact: Schwanda K. Flowers, PharmD. Assistant Dean for Experiential Education Assistant Professor, Pharmacy Practice College of Pharmacy University of Arkansas for Medical Sciences 501-686-7920 office skflowers@uams.edu PHARMACIST NEEDED IN HOT SPRINGS Full-time overnight Pharmacist position open at St. Joseph's Mercy Health Center in Hot Springs. Position scheduled overnight and has 7 days on / 7 days off. We offer a competitive salary, overnight differential pay, excellent benefits including vacation (2 periods during the year with 21 days off in a row), sick leave, medical/dental/vision insurance, retirement and 401k plan.

Our pharmacy is state-of-the-art with automated dispensing cabinets and clincial services.

To apply go online at www.saintjosephs.com or contact the Lori Wozniak in Human Resources at lori.wozniak@mercy.net or 501-622-2127.

INDEPENDENT PHARMACIES WANTED Independent pharmacist interested in purchasing independent pharmacies in Arkansas. Pharmacies will remain independent after purchase. Purchaser has solid independent pharmacy background.

If interested in selling your pharmacy, please contact Vance at 870-897-1204 or via e-mail at VanPark@aol.com.

VOLUNTEER PHARMACISTS NEEDED Shepherd’s Hope Neighborhood Health Clinic is a ministry of Fellowship Bible Church and Oak Forrest United Methodist Church serving uninsured and indigent patients in the South Midtown area of Little Rock. The Clinic is located at 2404 Tyler Street (behind Oak Forrest). The hours of operation are 6:00 p.m. to 8:30 p.m. every Tuesday and Thursday night. Current needs are pharmacists willing to volunteer every 4 weeks. If you are available to volunteer and help with this ministry, please contact Bren May at 501-993-0729. Thank you!

IVANRX4U, INC., Pharmacist Relief Services, Career Placements.

Relief pharmacists needed - FT or PT. Based in Springfield, MO and now in Arkansas. Staffing in Missouri, Arkansas, Eastern Kansas and Oklahoma. We provide relief pharmacists for an occasional day off, vacations, emergencies -- ALL your staffing needs. Also seeking pharmacists for full or part-time situations.

Please contact Tracy Byrd, Marketing and Recruiting Director, or Mike Geeslin, President for information regarding current openings throughout Arkansas - temporary as well as permanent placements.

Let IvanRx4u help staff your pharmacy, call 417-888-5166. We welcome your email inquiries, please feel free to contact us at: Ivanrx4u@aol.com or Ivanrx4u-tracy@hotmail.com.

PHARMACIST IN CHARGE WANTED Competitive salary with up to 3 weeks paid vacation and major medical coverage plus 401K plan. Great schedule - Monday thru Friday, hours 9:00 a.m. to 6:00 p.m. Contact Alan Tweddell at 870-931-2881 or send resume to: Country Mart Pharmacy, 208 Lincoln Dr., Fredericktown, MO 63645 Positions to be filled in S.E. Missouri.

PHARMACISTS NEEDED Full time pharmacists needed in Mena. Competitive salary with excellent benefit package. No nights or Sundays. Contact Alvin Groves at 479-619-6343.

RELIEF STAFFING AVAILABLE THROUGH STAFF RPH, INC. We provide quality pharmacists and technicians that you can trust for all your staffing needs. Our current service area includes AR, TX, OK and TN. For more information call Rick Van Zandt at 501-847-5010 or email staffrph@comcast.net.

PHARMACISTS NEEDED Kroger is looking for part-time pharmacist in Hot Springs. Please contact Jamie Shoemaker at 501-650-1715 or Julie Dean at 901-765-4204.

PHARMACY FOR SALE In beautiful North Arkansas. Established in 1974. Family owned with exceptional reputation in dynamic community. Excellent schools, recreational & retirement center, golf courses, lakes, rivers, 2.5 hours from Little Rock, AR; Memphis, TN; and Springfield, MO. Pharmacy is ideally located: a) across from doctor’s complex and new treatment, diagnostic, and emergency facility, b) next door to ophthalmologist and optometrist. Contact Mike Sprague at 512-799-5265.

The Arkansas Pharmacist

21

AAHP Report

AAHP July 2009 Report by: Maggie Miller, President Fall Seminar 2009 The 43rd Annual AAHP Fall Seminar will be held October 8-9, 2009, at the Holiday Inn Little Rock Airport Conference Center. There will be over 11 hours of live continuing education provided.

Something new for the Fall Seminar this year is a Thursday night CE event that will provide 3 hours of live CE. You can register for those 3 hours even if you are unable to attend the entire seminar. Please check our website at www.aahponline.org for more information. Everyone is welcome to attend.

Listserver for AAHP Members AAHP in conjugation with ASHP is now offering a Listserve for AAHP members. To join the Listserver, visit our website at www.aahponline.org. Once you subscribe you will have ongoing contact with other Arkansas pharmacists. This will be a great opportunity to increase communication with our members and for members to share ideas and experiences with one another.

Residency Task Force AAHP has created a residency task force aimed at improving communication between students and residency providers. The task force is currently working on compiling a list of all the residencies offered in Arkansas along with the respective contact information and a brief description of the residency. This list will be available on the AAHP website www.aahponline.org once it is completed.

The task force will also do a needs-assessment throughout the state for institutions or retail pharmacies that have interest in participating in a residency program.

If you are interested in the task force please contact Lanita Shaverd, Pharm.D. by email Lanita.shaverd@va.gov.

Student Chapters The Harding College of Pharmacy has started a Student Society of Health-System Pharmacy (SSHP).

They recently learned that they received the 2009 American Society of Health-System Pharmacists (ASHP) Student Society Development Grant Program. The program is intended to encourage the development of student societies of health-system pharmacy in colleges of pharmacy.

The UAMS College of Pharmacy SSHP chapter has applied to be an ASHP Recognized Student Society.

In order to be recognized, the SSHP chapter has to meet specific criteria set by ASHP. This will reflect the “triad� relationship between, ASHP, AAHP, and SSHP, as well as provide a direct relationship between ASHP and SSHP. Congratulations AAHP would like to congratulate AAHP members Chris Duty, Pharm.D. at Arkansas Methodist Medical Center in Paragould for being awarded Employee of the Year and Jody Smotherman, Pharm.D. at White River Medical Center in Batesville for being awarded Preceptor of the Year from the UAMS COP graduating class of 2009.

Arkansas Association of Health-System Pharmacists (AAHP)

22

The Arkansas Pharmacist

Harding Report

Harding University College of Pharmacy Hosts First Annual Pharmacy Camp Nineteen high school students from ten states attended Pharmacy Camp at Harding University College of Pharmacy June 21-26. Students from Alabama, Arkansas, Florida, Illinois, Indiana, Louisiana, Missouri, Oklahoma, Tennessee, and Texas arrived on campus and began their journey into the profession of pharmacy. This program was funded in part by the Walgreens Diversity Foundation.

Students began the week by learning about the many career opportunities available to pharmacists. Camp sessions included preDr. Lana Gettman talks to the campers vention and treatment of diabetes and hypertension, trainabout treatment of diabetes. ing for the pharmacy technician license, pharmaceutics and compounding, professional shadowing, many pharmaceutical laboratory experiences including a simulated epidemic and DNA fingerprinting. These handson learning experiences taught by faculty from the College of Pharmacy and assisted by pharmacy students gave the campers an opportunity to envision themselves in this important health care role.

Throughout the week, campers worked in teams as they developed a health awareness poster which was presented to faculty judges on the last day of the 2009 Campers and camp. The poster presentation was included in the camp curriculum to improve Counselors the student’s ability to write in a scholarly manner, improve their oral communication skills, and to help develop leadership skills.

The week concluded with a banquet where certificates of recognition and awards were given to the students who participated.

Casey from Tennessee said, “All of the labs were great. Our counselors were amazing. This camp definitely increased my interest in becoming a pharmacist!”

Pharmacy Camp 2010 is tentatively set for June 20-25. Applications will be available on the College of Pharmacy website after January 1, 2010, and the enrollment will be limited to 30.

Ms. Carol Kell Director of Admissions

Dr. Dan Atchley and two campers discuss DNA fingerprinting.

Campers compounded lip balms and lollipops.

The Arkansas Pharmacist

25

Arkansas Healthcare Access Foundation

How would you like to help someone in your community who is in need?

Now you can – and it only takes a few minutes!

Arkansas Health Care Access Foundation (AHCAF) is working in conjunction with the Arkansas Pharmacists Association and other Arkansas organizations to provide non-emergency medical care to Arkansas’ uninsured and under-privileged population.

As we are all aware, the number of people without medical coverage is growing daily due to loss of jobs, companies cutting benefits, and our weakening economy. We want to do what we can to see that the low-income, uninsured people of Arkansas get the medical care they need before their health gets to a critical stage.

What YOU can do to help All we ask that you sign up with AHCAF as a volunteer pharmacy and fill prescriptions for our clients at no cost to them. You will then be reimbursed by one of the pharmaceutical manufacturers who work with us, or AHCAF will do a one-time purchase at cost of prescriptions, which are written by our volunteer doctors.

How it works for the client/patient A potential client fills out our application at their local DHS or Health Department. Once approved, they are given a yellow authorization sheet. When they need to see a doctor, they call us and we give them the name of the doctor at the top of the list.

The patient then calls the doctor’s office for an appointment and identifies themselves as an Arkansas Health Care Access client. When they visit the doctor’s office for their appointment, they must present their yellow authorization.

Following the visit, this doctor’s name then goes to the bottom of the referral list.

How it works for the pharmacy The doctor sees the patient free of charge. If prescriptions are needed, the doctor will attempt to write from a formulary of name-brand drugs provided by AHCAF. If the patient needs medications that are not on the list, we have a grant from the Attorney General’s Office with which we can do a one-time purchase of those medications for the patient, which the pharmacy agrees to provide to us at cost.

Currently, Pfizer, Johnson & Johnson, and Blansett Pharmaceutical Manufacturers donate approximately $414,822 a year in brand name medication through our volunteer pharmacies. We hope to be adding additional pharmaceutical manufacturers to our donor list in the near future.

What you get You get the satisfaction of knowing you helped someone in need by donating just a few minutes of your time! And you get undying gratitude from Arkansas Health Care Access Foundation for being part of our program!

To request further information or sign up, please contact Penny Boyer, Public Relations Specialist, at 501680-4424 or our office at: AHCAF Attn: Penny Boyer PO Box 56248 Little Rock, AR 72215 Phone: 501-221-3033 Toll Free: 800-950-8233 Fax: 501-221-7977 26

The Arkansas Pharmacist

2009 UAMS Salary Survey

UAMS College of Pharmacy 2009 Salary Survey Results Paul O. Gubbins, Pharm.D. Professor, UAMS College of Pharmacy

In the year since we conducted our last graduate salary survey to evaluate the marketplace and gather data on salaries being offered, the economy has tumbled to lows most of us have not seen in our lifetimes. Across the nation, the jobless rate and payment of unemployment benefits have skyrocketed. Despite the economic downturn, the demand for pharmacists has continued to increase and pharmacist salaries show continued growth.

Last year, our survey revealed that our graduates’ average salary was $104,328, a 6.9% increase over the previous year. For 2009 graduates, the trend continued but growth has slowed somewhat. The average salary this year was $108,896, a 4.4% increase. Increasing salaries indicate that demand remains high, which we predict will not change in the near future.

About the same percentage of students had loans (2008-88%, 2009-85%), but the average loan amount increased by 9% this year to $66,066.

Average Salaries Reported by UAMS College of Pharmacy Graduates since 2000

Paid vacations, health insurance, and retirement plans, and paid holidays continued to be ranked as the top four most important benefits. Sign on bonuses are also identified as part of the typical benefits package and the average bonus amount increased again this year. The mean bonus reported last year was $9,582, while this year it was $13,417.

2009

$108,896

2008

$104,328

2007

$97,552

2006

$93,555

2005

$88,197

Thanks to our graduates for providing this information each year and to Dr. Paul Gubbins for graciously agreeing to analyze and summarize the data. Best wishes to our new graduates as they enter the profession!

2004

$84,318

2003

$80,271

2002

$76,860

~ Dean Stephanie Gardner

2001

$73,347

2000

$65,279

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Summary • • • • • • • • •

91 UAMS COP P4 students completed the survey 96% have accepted a position 72 % believe the position opportunities available were excellent or good Over 50% have accepted a position in a community/retail setting 4 students have accepted a residency/fellowship position 24% will receive a sign-on bonus Approximately 55% will practice pharmacy in central Arkansas 13% of the students accepting positions will practice pharmacy out-of state Top benefits include: paid vacation, health insurance, retirement, and paid holidays which are the same as in 2008; 10% of graduates will receive APA membership dues paid by their employer • Average salary for a pharmacist (not residency) position is $108,896; an increase of $4,568 (4.4% increase) from 2008 • Approximately 13% plan to own a pharmacy in the future • Approximately 85% have student loans, with an average amount of $66,066

Table 1: Demographics Variable Ages

No. Students (%)

18-21 years old 22-25 years old 26-30 years old 31-35 years old 36 or greater

0 (0%) 48 (52.7%) 42 (46.2%) 0 (0%) 1 (1.1%)

Gender Male Female

32 (35%) 59 (65%)

Marital Status Single-no children Single, with children Married-no children Married-with children

50 (55%) 3 (3%) 30 (33%) 8 (9%)

Plan to Own Pharmacy in Future Yes No

28

12 (13%) 79 (87%)

The Arkansas Pharmacist

Table 2: Position Information* Accepted a position Yes No

87 (96%) 4 (4%)

Position requires moving to different city/state Yes No

22 (25%) 62 (71%)

Previous employment with employer* Yes, as intern Yes, during rotations No, have no working relationship

44 (51%) 17 (20%) 23 (26%)

Ranking of Position Opportunities Excellent-found exact position wanted Good-satisfied with opportunities Fair-wish there were more opportunities Poor-few opportunities Very poor-trouble finding position

23 (27%) 38 (45%) 20 (24%) 4 (5%) 0 (0%)

Table 3: Salary Information by Position Environment # Students N=85 12

Mean Salary Per Year $108,663

Salary Range $88,400-$125,000

Mean Number of Hours Worked Per Week 39

Chain (e.g., USA Drug)

16

$113,735

$104,000 - $124,000

40

Mass Market (e.g., Wal-Mart)

20

$117,588

$105,000 - $129,900

40

SuperMarket (e.g., Kroger)

6

$119,500

$111,000-$150,000

40

Hospital Pharmacy (includes outpatient pharmacies in institutions, VA system)

23

$95,467

$86,000 - $110,240

39

Nuclear Pharmacy

2

$110,250

-

Residency/Fellowship

4

$40,750

$40,000 - $43,000

Graduate School (e.g., MS or PhD program)

-

-

-

Sales

-

-

-

-

Home Health

-

-

-

-

Other

2

$82,000

-

-

For all students except those completing residencies

80

$108,896

$86,000- $150,000

40

Position Environment Independent

The Arkansas Pharmacist

42.5

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Table 4: Salary Information by Location in State* Number of Students Locating in the Area (n=79)

Mean Salary Per Year

Northwest AR (Fayetteville)

7

$111,228

North Central AR (Mountain Home)

4

$100,356

Northeast AR (Jonesboro)*

3

$106,667

West Central AR (Russellville)

2

-

Western Arkansas (Fort Smith)

2

-

Central AR (Little Rock)*

45

$104,000

East Central AR (Forrest City)

2

-

Southeast AR (Monticello area)

3

$111,360

Southwest AR (Hope)

1

-

Out of State

10

$112,370

Location

*does not include residency positions

Table 5: Benefits Rank 1 2 3 4 5 6 7 8 9 10

Benefit Paid Vacation (mean number of days = 13) Health Insurance Retirement Plan Paid Holidays (mean number of paid holidays = 7) Profit Sharing Paid Liability Insurance CE Expenses Paid by Employer Paid License Fees Sign-on Bonus (mean bonus = $13,417) Other Bonuses (e.g., tuition, bonus based on profit) Shift Differential 11 Moving Expenses 13 Arkansas Pharmacist Association Dues Paid by Employer 14 Other* *other includes gas/mileage, disability/dental insurance, overtime, parking, childcare, etc.

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The Arkansas Pharmacist

APA District Meetings

2009 District Meetings Schedule DATE

DISTRICT

TIME

Sept. 8 Tuesday

2

7:00pm

Sept. 9 Wednesday

2

Sept.10 Thursday

LOCATION

PRESIDENT

PHONE NO.

Jonesboro St. Bernard’s Auditorium

Brent Panneck

870-237-8215

7:00pm

Forrest City Forrest City Country Club

Brent Panneck

870-237-8215

8

7:00pm

Batesville Lyon College Ed. Dining Hall

Christy Campbell

501-268-1900

Sept. 14 Monday

6

Russellville 7:00pm Arkansas Tech University (East Banquet Room)

Micheal Butler

501-922-0777

Sept. 15 Tuesday

7

7:00pm

Fort Smith Hardscrabble Country Club

John Vinson

479-424-3166

Sept. 16 Wednesday

3

7:00pm

Rogers Embassy Suites

Danny Ponder

870-425-5145

Sept. 17 Thursday

3

7:00pm

Mt. Home Big Creek Golf and Country Club

Danny Ponder

870-425-5145

Sept. 21 Monday

4

7:00pm

Texarkana Park Place Restaurant

Laura Beth Martin 870-777-2263

Sept. 22 Tuesday

4

7:00pm

Camden Camden Country Club

Laura Beth Martin 870-777-2263

Sept. 23 Wednesday

5

7:00pm

Monticello Monticello Country Club

Lynn Crouse

870-355-2046

Sept. 24 Thursday

5

7:00pm

Pine Bluff Pine Bluff Country Club

Lynn Crouse

870-355-2046

Sept. 29 Tuesday

6

7:00pm

Hot Springs Clarion Resort on the Lake

Michael Butler

501-922-0777

Sept. 30 Wednesday

1

7:00pm

Little Rock Chenal Country Club

Eddie Glover

501-327-1222

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31

Medicaid Alert The use of antipsychotic medications to treat children has increased over the past few years. Unfortunately, there is very limited clinical data regarding the safety and effectiveness of these medications in children under 12 years of age.

The Arkansas Department of Human Services found that in fiscal year 2008, 11,404 Medicaid-covered children took atypical antipsychotics for more than 30 days, including 893 children under the age of 5 and 5,602 children between the ages of 6 and 12. Many preschoolers in Arkansas are prescribed atypical antipsychotics as an initial treatment intervention, often without diagnosis for a disorder for which such medications are first-line treatment.

Working with psychiatrists and pharmacists, the Arkansas Department of Human Services has developed a plan to monitor and limit the unnecessary prescribing of antipsychotics to vulnerable patients. Beginning in July 2009, DHS will require prior authorization for prescriptions of all antipsychotics for children under the age of 5. In addition, dose limits for the oral atypical antipsychotic agents, clonidine, and guanfacine will be put in place for children younger than 18 (see chart). Higher doses will require prior authorization at the time of sale.

The Medicaid Prescription Program point-of-sale (POS) system will also identify therapeutic duplications of antipsychotic drugs with overlapping days’ supply and will reject the in-process antipsychotic drug claims. Division of Behavioral Health Services child psychiatrists will serve as consultants to the College of Pharmacy Call Center staff to facilitate rational prescribing and minimize disruption in treatment. In addition, DHS is actively planning new efforts to expand the availability of psychosocial services in communities throughout the state.

All calls about prior authorization for all antipsychotic agents, clonidine and guanfacine for recipients under 18 years old should be directed to the PDL PA Call Center, 1-866-250-2518 or 501-526-4200 (fax 501-526-4188). To minimize response time, the PDL PA Call Center may need a copy of the patient’s medical records and progress Summary of oral atypical antipsychotic maximum daily doses for notes. age categories for recipients < 18 years of age The complete dosage chart and explanation of the therapeutic Drug <5y/o** 5-12y/o 13-17y/o duplication criteria may be reviewed on the Medicaid Web Abilify® 5 mg daily 30 mg daily 45 mg daily site, www.medicaid.state.ar.us, under Provider Information, then Prescription Drug Information.

Risperdal® 4 mg daily 6 mg daily 8 mg daily Invega®

3 mg daily

6 mg daily

9 mg daily

Seroquel®

150 mg daily

600 mg daily

1000 mg daily

Geodon®

40 mg daily

80 mg daily

160 mg daily

Zyprexa®

10mg daily

20mg daily

30mg daily

**PA required through manual review for recipients < 5 years of age.

Summary of oral clonidine and guanfacine maximum daily doses for recipients < 18 years of age Available Max Daily Dose Drug Name Max Daily dose Strengths Edit Clonidine tablets 0.1 mg, 0.2 mg 2 per day 0.4 mg Clonidine tablets Guanfacine tablets

0.3 mg

1 per day

0.4 mg

1 mg, 2 mg

2 per day

4.0 mg

This link https://www.medicaid.state.ar.us/Download/provider/pharm/PM090427.doc will provide you with the memorandum mailed in April to providers. The subject of the memorandum is as follows: Effective July 7, 2009: Antipsychotics oral agents, clonidine, & guanfacine therapeutic duplication edits, age edits, and quantity and dose edits in recipients < 18 years of age; manual review on all antipsychotic agents for recipients < 5 years of age; clinical edits on oral dissolvable tablets or liquids for atypical antipsychotics for all ages; quantity and dose edits for the following drugs: chloral hydrate liquid and capsules, Transderm Scōp® patch, Bactroban® nasal oint, Tyzine® nasal spray and drops; manual review for Milipred®; Effective July 21, 2009: ADD/ADHD medications listed for preferred and non-preferred status, addition of preferred medications, Strattera® clinical edits and manual review for recipients < 5 years of age; Effective August 11, 2009: Asthma medications listed for preferred and non-preferred status, edits for select non-preferred agents used in asthma; Singulair® clinical edits for asthma monotherapy or allergic rhinitis; Effective immediately: to prevent billing errors, dose and quantity edits on Moxatag ER 775 mg & Proquin XR 500 mg.

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The Arkansas Pharmacist

APA Board of Directors Minutes Minutes Arkansas Pharmacists Association Board of Directors March 22, 2009 Hosto Center – Little Rock Members Dr. Paul Holifield-presiding Dr. Maggie Miller Dr. Brandon Cooper Dr. Danny Ponder Dr. Buzz Garner Dr. Kenny Harrison Dr. Jan Hastings Dr. Stephanie Goodart-O’Neal Dr. Lynn Crouse Dr. Mike Stover Dr. Muncy Zuber

Dr. Gary Bass Dr. Dennis Moore Dr. John Page Dr. John Vinson Dr. Stephanie Gardner Dr. Mark Riley Dr. Cliff Robertson Dr. Mike Smets Ms. Celia Proctor Ms. Collin Ward

Guests and Staff Dr. Richard Hanry - treasurer Harold Simpson – legal counsel Dr. Scott Pace Barbara McMillan

CONSENT ITEMS President Paul Holifield called the meeting to order at 9:40 a.m.

President Holifield asked Dr. Richard Hanry to lead the invocation.

Dr. Buzz Garner made a motion to approve minutes. The motion passed.

President Holifield introduced Ms. Collin Ward and Ms. Celia Proctor as new board members from the UAMS and Harding Colleges of Pharmacy, respectively.

DISCUSSION ITEMS Upcoming Events and CE Meetings CE at the Races was held on Friday, March 20th at Oaklawn. The event was a great success.

The 2009 APA Convention will take place at the DoubleTree Hotel June 11-13th in downtown Little Rock. There will be 19.5 hours of live CE at the convention.

Arkansas Mission of Mercy free pharmacy and dental clinic will take place May 8th & 9th at the Holiday Inn NW located in Springdale, AR. Pharmacist volunteers are needed for this event.

Arkansas State Board of Pharmacy Report Dr. Mark Riley gave a brief update on recent happenings with the State Board of Pharmacy. An update on faxed prescriptions was given, and language is being changed.

Arkansas Academy of Health-System Pharmacists (AAHP) Report Dr. Maggie Miller reported that the AAHP Fall Seminar will take place in Little Rock at the Holiday Inn – Airport in October. AAHP is working with Harding to establish a student chapter. In addition, AAHP is conducting a survey on residencies.

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33

Arkansas Academy of Consultant Pharmacists Dr. Muncy Zuber reported that Dr. Hasam Kamel will be presenting the CE session for the Consultant Academy at the APA Annual Convention in June.

UAMS College of Pharmacy Report Dr. Stephanie Gardner reported that the new UAMS Hospital is now open and is phenomenal. Dr. Gardner reported that UAMS will soon get a new chancellor, Dr. Dan Rahn. Dr. Rahn is currently at the Medical College of Georgia.

Dr. Gardner also reported that the college is currently processing applications and conducting interviews for fall 2009 admission.

Dr. Paul Holifield then opened a discussion on the UAMS Pharmacy Camp. The Camp is open to rising high school juniors and seniors. Dr. Holifield suggested to the Board that the Association should consider sponsoring the camp.

Harding College of Pharmacy Ms. Celia Proctor reported that Harding just completed their most recent ACPE site visit.

Arkansas Board of Health Report Dr. John Page reported that because the cigarette tax passed that the state now has the money for a trauma system.

Dr. Page discussed the different designation levels that hospitals may choose if they want to be involved in the trauma system.

State Legislation Update Dr. Mark Riley reported on the 87th General Assembly. He reported that the PBM Bill will soon become law, and it will apply to all state-funded prescription programs. The Bill has been hard fought, but Dr. Riley thanked all of the pharmacists for their efforts.

Dr. Riley next discussed the possibilities of running legislation in the future that would codify the State Board of Pharmacy appointment agreement that has been in place for years.

Community Health Centers was the next topic of discussion. Some of the tobacco tax dollars were allocated to these centers. Pharmacy is concerned because many of the community health centers are obtaining pharmacy licenses and are competing with privately owned pharmacies. Dr. Riley is working on language to encourage community health centers to work with locally available pharmacies.

Dr. Riley reported that SB120, an update to the Arkansas Pharmacy Practice Act, passed the legislature. The new changes cleaned up language for the State Board and also allows for broader collaborative practice between pharmacists and physicians.

Medical Assistants Dr. Scott Pace reported that a bill passed the legislature that allows non-licensed, non-trained medical staff to be delegated the ability to administer medications. This includes the delegation of ability to administer immunizations. In light of this, the APA should encourage our Board of pharmacy to lessen the rigid training requirements that pharmacists must obtain before being able to administer medications.

Federal Legislation Dr. Pace reported that HR 616 and S511 have been filed that would exempt pharmacists from the Federal DME accreditation requirements. These bills are still pending, and as it currently exists, the accreditation is still schedule to go into effect on September 30, 2009.

34

The Arkansas Pharmacist

CCRx Dr. Riley reported that CCRx has fundamentally changed since their purchase by Universal American. Dr. Riley believes that the Board should revisit the original endorsement of the CCRx program. Dr. Holifield recommends that APA monitor the CCRx program over the next three months and to reconsider removing the endorsement at the June board meeting.

Misc.

Dr. Riley reported that APhA wants the APA to buy a paver in their stone walkway at their new building. The paver would cost $5000. The Board tabled this issue at this time.

Dr. Kenny Harrison asked if there is a way to consider lowering retired members’ annual dues.

ACTION ITEMS APA Elections Dr. Riley reported on the nominations that have been received thus far for APA Officers and Annual Awards, such as “pharmacist of the year”. The executive committee will make the award selections after the nominations close.

Financial Report Dr. Richard Hanry reported on the financials of the Association, and he stated that the merger of the APA Services Company into the Association is complete and makes managing the Association’s financial affairs much easier.

Dr. Jan Hastings made a motion to accept the financials as presented. It was seconded and passed.

Misc.

President Holifield then opened up discussion on the UAMS Pharmacy Camp. Dr. Robertson made a motion to support the Pharmacy Camp with $15,000 sponsorship, with any additional funding at the discretion of the executive committee. Motion was seconded by Dr. Danny Ponder. Motion passed.

CCRx Dr. Buzz Garner made a motion to cease APA’s support of CCRx. Motion was seconded. Discussion occurred.

Dr. Jan Hastings made a motion to table the previous motion to cease APA’s support of CCRx, pending Dr. Riley’s upcoming meeting with Mike Bukach from CCRx. Motion seconded & passed.

Adjournment A motion was made and seconded to adjourn the meeting at 1:47p.m. The motion passed.

The Arkansas Pharmacist

35

Show your pride on the The Arkansas Pharmacy Foundation is pleased to announce the beginning of our Pharmacy Walkway of Honor. The walkway will be composed of bricks on which the names of pharmacists, pharmacies, and other business-related companies (i.e. wholesale, drug, design, computer, etc.) can be placed to show appreciation for the profession of pharmacy. The walkway will be located outside the entrance to the Lester E. Hosto Conference Center. The Foundation will place the first brick in memory of Dr. Lester Hosto.

Please use the form below to personalize your brick(s). Make copies as necessary. Print the name and other information as you would like it to appear on your brick. You have a maximum of three lines per brick with up to 18 characters per line, including spaces.

Please use the ampersand (&) instead of â&#x20AC;&#x153;andâ&#x20AC;? and omit periods.

Personalize your brick here.

1 2 3 Name: ___________________________________________________________________ Address __________________________________________________________________ City ______________________ State ____________________ Zip _________________ Phone (_______)___________________________________________________________ I wish to order ________________ bricks @ $125.00 each for a total of $ ______________ Method of Payment _____ Check, payable to APF _____ Visa ______ Mastercard

_____ Discover _____American Express

Credit card number _____________________________________________________ Expiration Date _______________

Signature ____________________________________________

Your support is sincerely appreciated. Please mail to APF, 417 South Victory, Little Rock, AR 72201 or fax to 501-372-0546 or visit www.arpharmacists.org to order.

Proceeds will help provide funds to sponsor, support and conduct educational programs, thereby promoting the Foundation to efficiently perform the objectives for which it is organized.