ARRX 1st Issue 2022 by Arkansas Pharmacists Association

First Issue 2022 Award-Winning Quarterly Publication of the Arkansas Pharmacists Association

A Step Forward in APA's Headquarters Construction

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AR•Rx

THE ARKANSAS PHARMACIST

3/16/22 3:58 PM

Dear Colleagues, The Arkansas Pharmacists Ass ociation (APA) is your profess ional statewide organization we have been looking after the and for the past 138 years, interests of Arkansas pharma cists. Today, I want to person professional future by renewin ally invite you to invest in you g your APA membership in 202 r 2. 2021 was undoubtedly one of the most challenging years we will ever remember, and every been there to fight and advoca step of the way APA has te for our profession. Despite tragedies, hardships, and imm successful year and were rem ense challenges, we had a inded of an unshakeable truth – none of APA’s success wou 2021 brought its share of diffi ld be possible without you. Wh culties, it also brought huge adv ile ancements for the profession 2022 will be another spotligh of pharmacy and it is clear that t year for Arkansas pharmacist s. The key to success is your financial support, and profess continued membership in APA ional engagement through you , r valuable time and presence on your behalf. A few of APA’s so that we can keep advocating successes in 2021 include: • As the COVID pandemic con tinued to devastate Arkansas and the rest of the country and close of 2020 with the develop world, hope emerged at the ment of two COVID vaccines. APA worked with the Arkansas and Governor Asa Hutchinson Department of Health (ADH) to develop a vaccine partnership that included pharmacists on wide reach across the state, thei the front lines due to their r ability to adapt to health cris es with innovative solutions, and experts. As a result, Arkansas their role as medication was soon ranked in the top 10 states of vaccines administere received. Additionally, official d as a percentage of vaccines statistics from ADH showed that 72% of COVID vaccines (app were administered by commun roximately 2.5 million doses) ity pharmacists and 13% of vac cines (approximately 500,000 by health-system pharmacist doses) were administered s. • APA continued to serve as a central COVID-19 resource . Through our COVID webinar updates, we strove to keep our s, vaccine webpage, and ema members informed of the stea il dily changing flood of informa • As the year rolled on, APA tion. remained committed to providi ng our annual events on an online plat with social distancing require ments. Members enjoyed an form to keep in line ambitious schedule of events APA Summer Convention in Jun including the first dose of the e, online Regional Meetings in September, townhalls with Ark the second APA Excellence ansas pharmacy leaders, in Pharmacy Awards Show, student pharmacists’ pinning celebrations, and more. As vac ceremonies and graduation cines became more prevalent, we cautiously reintroduced limi including an unprecedented ted in-person meetings, hybrid meeting that allowed in-person attendees and virtu pharmacy presentations simulta al attendees to enjoy a day of neously. • In August, APA broke ground on the future home of Arkans as pharmacy as construction Pharmacists Association hea began on the new Arkansas dquarters. The new building feat ures updated office space for space ideal for meetings with staff, state of the art meeting legislators and the APA Board of Directors, dedicated worksp and guests, and a large confere ace for students, legislators, nce center designed not only for future APA meetings, but space to bring in additional non for use as a private rental -dues revenue. • APA supported state legislat ors in their efforts to improve pharmacy by donating from the known as AP-PAC. Each elec APA political action committee tion cycle, AP-PAC gives bet ween $50,000-$100,000 to sup that have helped pharmacist port legislative champions s. That money comes solely from generous APA member arkansas-pharmacists-pac if donations. Visits www.arrx.org you would like to donate today. / • APA staff and members wer e interviewed in countless new s feat ures the Arkansas Democrat Gazette by local news outlets such as Arkansas Business, , Talk Business & Politics, KAR K, KLRT, KAIT, KTHV, KHOG, • APA staff continued to sup and more. port the development of the Ark ansas CPESN (Community Pha Network), which officially laun rmacy Enhanced Services ched as a clinical integrated network with CPESN USA. Ove pharmacies are participating r 150 Arkansas community in the network. • APA continued to support its partnerships with the Arkansas Association of Health System Pharmacist Academy and Com s Pharmacists, APA Consultant pounding Pharmacist Academ y. • APA continued to provide exp ertise and facilitate conversatio ns with health plans about attr and paying for professional pha ibuting patients to a pharmacy rmacist enhanced services. • APA continued to provide dire ct, one-on-one consulting, pro blem solving, and professiona throughout the year. l expertise to our members We appreciate the opportunity to serve the pharmacists of Ark ansas. We are one of the stronge in the nation because of our mem st state pharmacist association bers and the passion they hav s e for improving the lives of thei pharmacy, but we can only mo r patients and the profession of ve forward in strength and pro gress with your active member ever thought about being a mem ship and engagement. If you’ve ber of APA, now is the time. Plea se do not hesitate to contact our 5250 if we can do anything to talented staff at 501-372serve you. We look forward to you continuing your membership in APA and to a great 2022! Warm regards,

John A Vinson, Pharm.D. Executive Vice President & CEO PO Box 3798 | Little Rock, AR 72203 | p 501-372-5250 | f 501 -372-0546 | www.arrx.org

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APA Staff John Vinson, Pharm.D. Executive Vice President & CEO John@arrx.org Nicki Hilliard, Pharm.D. Director of Professional Affairs Nicki@arrx.org

Marlene Battle, Pharm.D. Health Equity Coordinator Marlene@arrx.org Brandon Cooper, Pharm.D. Strategic Advisor Brandon@arrx.org Jordan Foster Director of Communications Jordan@arrx.org Susannah Fuquay Director of Membership & Meetings Susannah@arrx.org

Debra Wolfe Director of Government Affairs Debra@arrx.org Office E-mail Address Staff@arrx.org Publisher: John Vinson Editor: Jordan Foster Arkansas Pharmacists Association PO Box 3798 Little Rock, AR 72201-2923 Phone 501-372-5250 Fax 501-372-0546 AR•Rx 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. Current edition issue number 93. © 2022 Arkansas Pharmacists Association.

POSTMASTER: Send address changes to AR•Rx The Arkansas Pharmacist PO Box 3798 Little Rock, AR 72201-2923 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. Visit us on the web at www.arrx.org.

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CONTENTS

Celeste Reid Director of Administrative Services Celeste@arrx.org

6 Inside APA: Changing the Payment Model to Support Provider Status in the Real World 7 From the President: Looking Back at 2021 8 FEATURE: An Open Letter to Arkansas's Pharmacy Professionals and Our Patients 10 Member Profile: Kyle Hively 11 Legislator Profile: Representative Jim Wooten

20 APA Convention Save the Date 22 Consulting Academy Report: Antipsychotic Use in DementiaRelated Psychosis in Long-Term Care Settings 23 Compounding Academy: Closing the Engagement Gap 24 Photos: APA Beam Signing 26 Rx and the Law: Emergency Use Authorizations

12 FEATURE: Meet Beth Barrington

27 Financial Forum: Measuring the Value of a Financial Professional

14 Safety Nets: Where's the Sig?

28 2022 APA Awards Solicitation

16 New Drugs: Saddling Up for the 4th Quarter FDA Approval

29 Call for APA Board Nominations

17 Upcoming Pharmacy Events

ADVERTISERS

18 UAMS: 2021 - A Year in Review

19 Harding University: Looking Back and Looking Forward 20 AAHP: Hospital Value-Based Purchasing and Readmission Reduction Program

Pharmacists Mutual

13 UAMS College of Pharmacy 15 Biotech Pharmacal, Inc. 21 Retail Designs, Inc. 21 Arkansas Pharmacy Support Group 23 Law Offices of Darren O'Quinn 27 Pharmacy Quality Commitment

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INSIDE APA

APA Board of Directors 2021 - 2022 Officers President – Max Caldwell, P.D., Wynne President-Elect - Dylan Jones, Pharm.D., Fayetteville Vice President – James Bethea, Pharm.D., Stuttgart Past President – Kristen Riddle, Pharm.D., Greenbrier

Regional Representatives Region 1 Representatives - Kevin Barton, Pharm.D., Bentonville - John Hall, Pharm.D., Fort Smith - Spencer Mabry, Pharm.D., Berryville Region 2 Representatives - Erin Beth Hays, Pharm.D., Pleasant Plains - Jett Jones, Pharm.D., Jonesboro Region 3 Representatives - Brandon Achor, Pharm.D., Sherwood - Brittany Sanders, Pharm.D., Little Rock - Lanita White, Pharm.D., Little Rock Region 4 Representative - Betsy Tuberville, Pharm.D., Camden Region 5 Representative - Lelan Stice, Pharm.D., Pine Bluff At Large Representatives - Stacy Boeckmann, Pharm.D., Wynne - Rick Pennington, P.D., Lonoke Arkansas Association of Health-System Pharmacists HyeJin Son, Pharm.D., Little Rock Academy of Compounding Pharmacists Greg Turner, Pharm.D., Searcy Academy of Consultant Pharmacists Emily Holton, Pharm.D., Bentonville

Ex-Officio APA Executive Vice President & CEO John Vinson, Pharm.D., Benton AR State Board of Pharmacy Representative John Kirtley, Pharm.D., Little Rock Board of Health Member Marsha Boss, P.D., Little Rock UAMS College of Pharmacy (Dean) Cindy Stowe, Pharm.D., Little Rock Harding College of Pharmacy (Dean) Jeff Mercer, Pharm.D., Searcy General Counsel Nate Steel, J.D., Little Rock Treasurer Richard Hanry, P.D., El Dorado

John Vinson, Pharm.D. APA Executive Vice President & CEO

Changing the Payment Model to Support Provider Status in the Real World

he recent pharmacy news cycle at the end of 2021, well into year two of the COVID-19 global pandemic, continues to produce both positive pharmacist stories as well as challenging pharmacist stories at both the local and national level. Some of the negative press has included potential pharmacist strikes on the West Coast, large chain pharmacies cutting back store hours, pharmacies closing without warning, independent pharmacies shutting their doors in underserved communities, and patient safety and pharmacist wellbeing concerns related to understaffed pharmacy teams in community settings. All of these negative stories can be tracked back to Hobson’s Choice pharmacy benefit manager abuse to community pharmacies and inadequate or in some cases nonexistent payment models for cognitive services for pharmacists. Pharmacists have to work together either with payors and/or through the state legislative process to reform and build payment models that fairly compensate pharmacists for their enormous talents. The new clinical opportunities for expanded pharmacist services for vaccine prescribing and administration, vaccine administration for children, COVID-19 therapeutics prescribing and administration (monoclonal antibodies, antiviral therapy, and others), and clinical testing has dramatically increased demand for pharmacists, student pharmacists and pharmacy technicians in community and other practice settings. The new opportunities are working well for vaccines and cash based models, but dispensing fees for traditional dispensing models continue to be woefully inadequate through adhesion contracts (take it or leave it) from pharmacy benefit managers and payment for cognitive services through medical billing is not advancing quick enough for the expanded role of pharmacists. The future of pharmacy thriving depends on two major changes in the payment model for pharmacists.

1. The outpatient community pharmacy reimbursement for product and dispensing fees should not be determined by pharmacy benefit managers with inherent conflicts of interest, and rather it should be objective and independently determined. One successful example of a reformed payment model is the Arkansas Medicaid fee for service program’s reference based (NADAC) for the drug ingredient cost and a survey driven professional dispensing fee that reflects the estimated true costs of professional dispensing.The 8-0 victory in Rutledge (Arkansas) vs PCMA (PBMs) at the United States Supreme Court in December of 2020 is paving the pay for states to regulate and change this payment model for state regulated fully insured plans, state government funded plans, and other self-funded plans in the states. West Virginia is now leading the nation in community pharmacy dispensing payment reform with their recent passage of HB2263 of 2021 and statute §33-51-9: Regulation of pharmacy benefit managers. Their recently enacted legislation requires that pharmacy benefit manager may not reimburse a pharmacy or pharmacist for a prescription drug or pharmacy service in an amount less than the national average drug acquisition cost (NADAC) for the prescription drug or pharmacy service at the time the drug is administered or dispensed, plus a professional dispensing fee of $10.49: Provided, that if the national average drug acquisition cost is not available at the time a drug is administered or dispensed, a pharmacy benefit manager may not reimburse in an amount that is less than the wholesale acquisition cost (WAC) of the drug, as defined in 42 U.S.C. § 1395w-3a(c)(6)(B), plus a professional dispensing fee of $10.49. 2. Pharmacists should be compensated for their cognitive services through medical billing pathways just like physicians, nurse practitioners, licensed social workers and other healthcare providers. Pharmacists should be

UAMS COP Student Lindsey Worthington, Little Rock Harding COP Student 6 Hannah Ferguson, Searcy AR-Rx 1st Qtr 2022.indd 6

AR•Rx

THE ARKANSAS PHARMACIST

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INSIDE APA

compensated for both services provided (CLIA waived labs, administration of medications, procedures, etc.) PLUS appropriate office visit evaluation and management codes for in person (clinic or pharmacy), telemedicine, telephone or online assessments. For example, if a patient is evaluated by a physician and referred with a prescription for monoclonal antibody therapy for administration, the pharmacist should only bill the administration codes for treatment through a medical billing pathway. If instead, a pharmacist sees the patient, performs COVID-19 testing at the pharmacy, assesses the patient, writes the prescription for COVID-19 therapeutics (monoclonal antibody therapy), and then administers the monoclonal antibody therapy, the pharmacist should be eligible and appropriately compensated for billing and payment for both an office visit for assessment and management (cognitive payment) based on time (99203 or 99213 for example) as well as the billing for the actual administration of the therapeutic (the service or product). This also means that pharmacists need efficient pathways for medical billing credentialing for insurance and self-funded plans, and that state Medicaid and managed care Medicaid programs need to recognize and update policies to allow

these services by pharmacists as other licensed providers. Washington, Oregon and Ohio are three states to watch in 2022 for reform of the cognitive services payment models. Provider status is here to stay in all 50 states. Pharmacists are assessing, monitoring and prescribing medications related to COVID-19 in every state in the country. Our ability to transform and maintain these new practice norms with adequate labor to support these efforts depends on successful reform of the antiquated and broken payment models. States are the laboratories for change, and federal policy (Medicare etc.) often only changes after seeing success and innovation at the local level either in private plan design or through state legislative changes. Arkansas is making progress at the state level, but there is a lot of change needed in this state to accomplish the 2 major changes stated above. The Arkansas Pharmacists Association will need our members more than ever to understand, embrace and advocate for changing the payment model now and for years to come. With your help, Arkansas can become the key state to watch around the country in payment model reform for pharmacists. §

FROM THE PRESIDENT

Looking Back at 2021

hat a year 2021 was! It will go down in Pharmacy history as one of the most difficult - mentally, physically, and financially - in years that the profession of pharmacy has ever experienced. It's also been a very productive one on the political and business side. On the political side, 2021 was a year that had a large number of pharmacy bills that were passed through legislation and became law. COVID-19 definitely helped put the face of the profession in the public's eye, which proved to help us legislatively. Pharmacists in every part of the state did their part by administering COVID-19 vaccinations in their local pharmacies or in public vaccination clinics whether they would be in a drive thru or walk up clinics. This legislative session, every bill that was put forth to promote pharmacists passed, allowing pharmacists to practice at the top of their license. If you practiced in a pharmacy that only wanted to administer a small number of vaccinations, or a pharmacy that wanted to give thousands of vaccinations, or a pharmacy that administered vaccines and monoclonal antibody therapy, you had the choice to practice at the level you wanted to. When you see your legislators and the State Board of Pharmacy, please thank them for the opportunities they are giving pharmacists in Arkansas. With low reimbursements and high DIR fees, a lot of pharmacies would have had a difficult time making the financial obligations during this time. For the pharmacies providing the COVID-19 vaccinations and

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the monoclonal antibody therapy, the extra income this generated will make it easier to cover the financial Max Caldwell, P.D. obligations each store has. APA President As for the mental and physical aspect of it, 2021 has to be the hardest ever! I want to personally commend you for all you have done by providing COVID-19 vaccinations and monoclonal antibody therapy. Not only does this add extra time to administer, but all the paper work before and after adds even more time to the process. It was and still is a difficult time for clerks, pharmacy techs, and pharmacists with the extra work while still providing the great customer service in addition to the daily routine of filling prescriptions. As for the larger operations where each store has multiple pharmacists, the mental and physical fatigue is still there above what it normally takes to run your business. To all of the Arkansas pharmacists, whether working independent pharmacy, hospital pharmacy, or chain pharmacy, please be safe and stay healthy. If you feel like you cannot take the pressure of your job any longer, please reach out for help to a colleague or other individual. We at the APA office and the APA Board know that several pharmacies are short staffed and putting a lot of pressure on their pharmacists and employees to perform at a high duty with not enough help. §

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Dear Pharmacy Colleagues and those who we care for: Pharmacists and pharmacy technicians are trusted sources for advice and prescription medications in every county in Arkansas. We are pillars of our communities, key members of the healthcare team, and a comforting force in our patients’ darkest hours. However, in recent years pharmacy practice has had significant challenges, exacerbated by the COVID-19 pandemic. As a result, those same patients we have taken an oath to protect have seen unannounced pharmacy closures and longer wait times, including recent announcements by Rite-Aid that it would close 63 of its stores and by CVS that it will soon close 900 pharmacies, a staggering 10% of its stores nationwide.

conditions, including a pharmacist who had worked 14 days straight who had no idea when she would get a day off but stayed committed to keeping the pharmacy open. The tag-lines #shewaited and #pizzaisnotworking trending on social media platforms (due to a chain pharmacist succumbing to a heart attack) show the severity of this issue. Pharmacy professionals dedicated to ensuring patients receive the proper medication for the right reason now worry about their ability to safely care for their patients. We must ensure that we can take care of our patients and pharmacy professionals alike. State and federal government entities must initiate changes necessary to keep patients and pharmacy staff safe. The Centers for Disease Control and Prevention (CDC) and the Arkansas Department of Health rely on pharmacy

Like other health care settings and other industries, pharmacies lack key staff, both pharmacists and pharmacy technicians, due to shortages. This challenge is not new and existed before the pandemic. The pandemic has worsened staffing issues due to illness, childcare, school closures, and burnout. Pharmacy professionals have answered the public health call to help, providing millions of doses of COVID vaccines and boosters to Arkansans, in addition to monoclonal antibodies, COVID-19 testing, influenza vaccines, patient counseling, filling prescriptions, and more. Many pharmacies are even preparing to support oral antiviral therapy access as soon as they can. If all this wasn’t enough, supply chain challenges impact medication supply, resulting in worsening medication shortages than existed before the pandemic. The inability to recruit and retain skilled professionals is directly affected by a broken payment system. The prescription payment system controlled by pharmacy benefit managers (PBMS) no longer rewards safe and personalized care in the pharmacy. They have instead developed a smoke and mirrors system, broken promises that leave patients paying too much for medications, and pharmacies subsidizing healthcare, if they’re even able to stay in business to begin with. The convoluted system often underpays pharmacies, which results in pharmacies being unable to afford adequate staff while controlling costs. Although the pandemic has stretched on for almost two years, we know that this story has been developing for much longer. The stress on the pharmacy system and the reports of depression and suicide in pharmacy professionals nationwide have escalated at a frightening pace. We’ve heard story after story of appalling working

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An Open Letter to Arkansas's Pharmacy Professionals and Our Patients By Dr. Jenny Arnold, Dr. John Vinson, and Jordan Foster

professionals to increase access to care. We need other arms of government also to support this essential role. Recent action by the Arkansas legislature to allow Medicaid to cover six prescriptions per month, plus no limitations for medications to treat major disease states, will help to expand access to much needed medications for our patients. The same fair payment methods utilized in traditional Medicaid should also be expanded to include PASSE patients, where PBMs continue to chip away at declining profits. Tricare, the benefits for our military and their families, is one of the worst payers in pharmacies and further requires pharmacies to subsidize the care of our military. In late 2021, Tricare and their PBM Express Scripts abruptly ended a multi-year agreement allowing

AR•Rx

THE ARKANSAS PHARMACIST

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OPEN LETTER TO PHARMACY PROFESSIONALS AND PATIENTS

Walmart to serve as a pharmacy provider just days after signing it, leaving military families scrambling to find a new pharmacy provider, in some cases much farther away. Our members of the military and their families have made tremendous sacrifices, and they deserve better. CMS and Medicare continue to take an outdated and passive approach to pharmacy practice. Medicare has issued no clear support or directive to Medicare Part D plans to adequately support pharmacies providing life-saving access to COVID-19 antivirals in pharmacies.

clinical services, medication dispensation, and patient counseling. That should also involve an open and frank conversation between pharmacy team members and state boards of pharmacy to ensure that working conditions allow for the care that patients deserve. Finally, payment issues stemming from deceptive PBM business practices and Medicare’s refusal to recognize pharmacists as providers must continue to be aggressively addressed or else pharmacists will continue to experience grueling levels of work without adequate support.

Further, CMS discriminates against pharmacist providers in clinics and pharmacies, not permitting these highly trained professionals to be reimbursed like our other colleagues, such as physicians and nurse practitioners. This has forced health systems and clinics to subsidize the specialized care patients receive by pharmacists, including management of critical illnesses such as diabetes, transplants, cancers, and heart disease. It also means that pharmacists may not be reimbursed for diagnosing and prescribing essential antiviral therapy to tackle the pandemic in each community. CMS needs to urgently make pharmacists “eligible providers” to increase access to care, especially in underserved communities and for our most complex patients. Lastly, we need state and federal regulators’ and legislators' support to pass laws to regulate predatory and anti-competitive practices of PBMs.

While Arkansas is certainly not immune to the overwhelming wave of stress and strain that permeates pharmacies across the country, recent efforts by APA are giving hope to Arkansas pharmacists during a difficult time for the profession. PBM reform, a favorable SCOTUS ruling, new legislation, and new pandemic-created services are producing more demand, more job opportunities, and more opportunities to be paid this year than in previous years. All these combined have created an environment with stronger opportunities to step out on your own if you’re not happy where you are and be part of Arkansas’s strong history of pharmacy entrepreneurism. Whether it is through our networking opportunities, our legislative advancements, or our professional advocacy, the Arkansas Pharmacists Association is here to help you. APA is interested in continuing to hear from our members about current workplace conditions and will continue to push for payment reforms to help ease the burden of our hardworking professionals.

Recently, national pharmacy organizations have shined more light on these issues and expressed their unwavering support for America’s pharmacists. The American Pharmacists Association teamed up with the National Alliance of State Pharmacy Associations to create the APhA/NASPA Work Group on Pharmacy Workplace Issues, a collaborative group that is focused on three major projects: the Pharmacist’s Fundamental Responsibilities and Rights, the National Pharmacy Workplace Survey, and the Pharmacy Workplace and Well-Being Report. Additionally, the National Association of Boards of Pharmacy passed a resolution creating the NABP’s Task Force on Workplace Safety and Well-being and supporting APhA/NASPA’s Pharmacist’s Fundamental Responsibilites and Rights. The solutions to these issues will not come swiftly. Employers must listen and be open to genuine discussion with pharmacists about working conditions. As APhA recently wrote, “Signing bonuses and free pizza aren’t enough.” Pharmacists and pharmacy technicians deserve to work in an adequately and appropriately staffed pharmacy so they can safely and attentively provide

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Thank you to the outstanding pharmacy professionals in community pharmacies, hospitals, clinics, and long-term care settings who continue to work hard to take care of your patients and navigate complex systems to keep your patients safe. The Arkansas Pharmacists Association and our Board of Directors exist to support you in all that you do. Please reach out to us for support; we are here for you.

Links Links to the Pharmacists's Fundamental Responsibilities and Rights, the National Pharmacy Workplace Survey, and the Pharmacy Workplace and Well-Being Report can

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MEMBER PROFILE

Kyle Hively DIRECTOR OF CLINICAL OPERATIONS OUACHITA COUNTY MEDICAL CENTER Pharmacy/academic practice: Health-system pharmacy Pharmacy school and graduation year: Harding University College of Pharmacy, 2016

Years in business/years teaching: I have been in pharmacy

for 22 years now. I started in pharmacy in 1999 as a clerk and then technician. Early on I was fortunate to meet entrepreneurial pharmacists who allowed me to help build their nutritional supplement manufacturing and independent retail compounding pharmacy businesses. After graduating I was able to be a part of a dynamic team opening a new hospital. In 2018, I joined Ouachita County Medical Center in Camden as the Director of Pharmacy. Currently, I serve as Director of Clinical Operations for OCMC where I am responsible for pharmacy and laboratory services.

Favorite part of the job and why: My favorite part of my job as a pharmacist is the variety of opportunities to learn from other professionals and solve problems as part of a team. Pharmacists in the hospital are well positioned to help coordinate patient care with multiple providers, between different departments, and through transitions of care like admission and discharge. No other single department follows each patient individually for the duration of their encounter. I enjoy this unique opportunity for teamwork and learning from all of the wonderful and talented people I have been able to work with along the way. Least favorite part of the job and why: My least favorite

part of the job are the barriers that get in the way of my favorite parts. Notable examples include the red tape of complex regulations that are further convoluted by middle men like PBMs. In the last decade we have also seen how medication shortages can jeopardize patient safety. Lately I am hearing about an upcoming shortage of saline flushes!

What do you think will be the biggest challenges for pharmacists in the next 5 years? The payment of

pharmacists needs to be separated from the reimbursement of medications. This biggest challenge is also our greatest opportunity. Practice sites will not be able to effectively “reinvent the wheel” on their own; therefore, working together as a profession to implement new practice models and integrate regulatory changes will be essential to make the most of this opportunity.

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Oddest request from a patient/customer: There was an

order for HYDROmorphone entered by a physician in a free text field. Dilaudid was auto-corrected and resulted in an order for “delightful 1mg q4h prn”. There was also a patient with “twilight” documented in her list of medication allergies. But my favorite happened during the supply shortages in the spring of 2020, when the pharmacy was compounding hand sanitizer for the hospital. The shortages were so severe that even getting enough alcohol was a challenge. Late one night I got a call asking where I wanted to keep the moonshine that folks were dropping off at the hospital! With some Arkansas ingenuity, and the help of social media, our community demonstrated their commitment to supporting their hospital during our time of need!

Why should a pharmacist in Arkansas be an active member of the Arkansas Pharmacists Association? The

big picture reason that comes to mind for me is all the work APA does to advocate for pharmacy, Arkansas’ pharmacists, and our patients. I have seen over the years how much advocacy matters. The saying in politics “if you aren’t at the table, you’re on the menu” is the truth and as pharmacists, we are not always able to make the time to advocate for ourselves. Empowering APA to continue to work on our behalf is essential. The second reason I have to encourage all pharmacists in Arkansas to be active members of APA are the communication, resources, and networking opportunities that the association provides. As terrible as this pandemic has been, I could always count on APA to be three steps ahead of me to help with PPE shortages, regulatory changes, COVID-19 monoclonal antibody therapies, and all things related to COVID-19 vaccines. §

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THE ARKANSAS PHARMACIST

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LEGISLATOR PROFILE

Representative Jim Wooten BEEBE District: 45 Represents (Counties): Part of White County Years in Office: First term in 2018. Now serving my second term.

Occupation: Football consultant / real estate Your hometown pharmacist: Burrows Drug Store in Beebe What do you like most about being a legislator: Helping the constituents I serve and serving the public

Most important lesson learned as a legislator: Serving as a legislator has taught me patience

Advice for pharmacists about the political process and working with the AR Legislature: Communication and consistency

Your fantasy political gathering would be: Governor Ron DeSantis, President Donald Trump, Senator Rand Paul, and Governor Nikki Haley §

Hobbies: Golf Most admired politician: Mike Huckabee, George W. Bush

AAHP Board

Arkansas State Board of Pharmacy

Executive Director.............Susan Newton, Pharm.D., Russellville President...............................Hye Jin Son, Pharm.D., Little Rock President-Elect................ Kevin Robertson, Pharm.D., Little Rock Past President.................Kimberly Young, Pharm.D., Little Rock Treasurer.................................Andrea Boland, Pharm.D., Hector Secretary..................................Melissa Shipp, Pharm.D., Searcy Board Member at Large.............Gavin Jones, Pharm.D., Benton Board Member at Large.......Amber Powell, Pharm.D., Little Rock Board Member at Large........Ashley Wilson, Pharm.D., Little Rock

President............................Rebecca Mitchell, Pharm.D., Greenbrier Vice President/Secretary......Lynn Crouse, Pharm.D., Lake Village Past President............................Lenora Newsom P.D., Smackover Member................................Rodney Richmond, Pharm.D., Searcy Member.........................................Debbie Mack, P.D., Bentonville Member.............................................Brian Jolly, Pharm.D., Beebe Public Member...........................................Carol Rader, Fort Smith Public Member..............................................Amy Fore, Fort Smith

Technician Representative....BeeLinda Temple, CPhT, Pine Bluff

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Meet Beth Barrington by Jordan Foster

What’s your job title?

PBM Coordinator at the Arkansas Insurance Department

What sort of duties do you have at work?

Everything PBM: from Pharmacy MAC and NADAC complaints and licensing for PBMs / MEWAs. It is only me… for now.

Do you have any mentors in your professional life?

Booth Rand and Scott Pace for everything PBM and Allen Kerr

What was your first paying job?

My first job was at Juanita’s on Main street. I was the hostess for several years.

Fiction

Pharmacist Immunization Expansion Who inspires you?

What’s the best book you’ve read recently?

My husband and my sons! They inspire, challenge and The most recent best book I listened to is “Where the encourage me to be a better me! By Emily Wilson, Pharm.D. Crawdads Sing” by Delia Owens. Currently working on and John Vinson, Pharm.D. “American Gods” by Neil Gaiman.

What kind of music do you like?

At one point in my life, I managed the second largest music store in the Atlanta metro area. So, I love all types of music. What I like one day will vary from the next day.

What’s the best concert you’ve been to?

Sarah McLachlan with the Chieftains in Atlanta – it was amazing! Also, seeing Paul McCartney at Verizon was an excellent show too.

Do you like traveling?

Yes, I enjoy adventures near and far. Over Thanksgiving 2021, I was lucky enough to visit Ireland! At the end of summer 2021, we spent the weekend at Petit Jean enjoying the scenery and hiking.

What’s the best place you’ve traveled to?

Ireland! It was so beautiful and green! That was a trip of a lifetime for me!

Do you like reading?

If so, what genre of books do you like? I enjoyed reading before Audible. Now I listen to books more than reading. Action & Adventure, Fantasy, Historical Fiction, Literary

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What’s the most exciting part of your job?

I really enjoy working at Arkansas Insurance Dept. where we truly help Arkansans and our locally-owned business. I look forward to creating a PBM division. I enjoy helping pharmacies re-coup reimbursements.

Where did you work before this position?

For the past year, I worked at OneShare Health. Prior to last year, I was as the Executive Assistant to Insurance Commissioner and Chief Deputy Commissioner of Arkansas.

What’s your most-used productivity hack?

Copy / paste (lol) My goal is to get 8-9 hours of sleep every night. Also, I am a ‘to-do’ list maker.

What animal would you consider your spirit animal?

I do not know if this is my spirit animal, but I do like octopus. After watching “My Octopus Teacher” and “Octopus: Making Contact” I find them to be very interesting.

Do you have any vacations planned?

Yes, but not until 2023. After the tour to Ireland, we signed up for one to Germany in June 2023.

AR•Rx

THE ARKANSAS PHARMACIST

3/16/22 3:58 PM

MEET BETH BARRINGTON

What’s something you’re proud of?

I am very proud to be the daughter of Rev Paul R. Barrington and Joyce Dennehy plus my 3 brothers and my sister. I am proud of my upbringing which I hope shows in my integrity.

What’s your favorite food?

hometown is Bryant, Arkansas. I graduated from Ole Main … once again called NLR High School.

Are you a morning person or a night owl?

I am more of a night owl than a morning person. This is why I am very much a coffee person! My Nespresso machine is the best thing!

I cannot pick a favorite food as I enjoy so many! I do enjoy going out to eat and have several favorite restaurants: Ristorante Capeo, The Pantry, 42, Dizzy’s, Café Bossa Nova, La Terraza …. I could go on…

Are you a coffee or tea person?

What’s your favorite movie?

What’s something you find challenging about your work?

Do you have any hidden talents or hobbies?

What is one thing you would like pharmacists to know that would make your job easier and more beneficial for them?

Beetlejuice and Ferris Bueller’s Day Off are all-time favorites. I do love to go to all of the LR area theaters for all the productions. I am huge fan of the Opera in the Rock! I was surprised at how I enjoy their performances as I have never been to any type of Operas. My hidden talent is acting and performing on stage. I enjoy dancing, jogging/running and yoga.

Do you have any pets?

I have a cat that wants nothing to do with me… as long I feed her.

Are you a sports fan? Who are your favorite teams?

Coffee

Most challenging about my work is when I cannot fix something for a pharmacy. It makes me mad when a loophole is found.

For a MAC appeals, I need the complaint form, the invoice and the MAC appeal denial to submit. For a NADACs, I have spreadsheet that list all the information needed and no other forms are needed. Keep in mind it needs to be the NADAC price for the day the RX was filled. Things out of AID scope are: Federal plans, Medicaid Part D, EBD (Arkansas Employee Benefit Division), Long Term Care facilities and Hospice. §

All I know is Razorbacks! I grew up in Arkansas. My childhood

YOUR JOURNEY

BEGINS HERE!

pharmacy.UAMS.edu

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3/16/22 3:58 PM

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY

Melanie Reinhardt, Pharm.D. Eddie Dunn, Pharm.D.

Where's the Sig? This issue of Safety Nets examines potential hazards associated with electronic prescriptions. Thank you for your continued support of this column.

he electronic prescription illustrated in Figure One was transmitted from a prescriber's office to a community pharmacy in Southeast Arkansas. A pharmacy technician entered the Armour Thyroid® 90 mg tablet patient directions into the computer as "take 1/2 tablet by mouth daily along with a 30 mg tablet (total dose 75 mg)". This information - along with the prescription image - was transmitted from the input queue to the pharmacist verification queue of the computer. While examining the order, the pharmacist realized the prescribed directions instructed the patient to take 1/2 of a 90 mg tablet ".5 times a day" instead of once daily. Confused by this unusual dosing interval, the pharmacist telephoned the prescriber's office for clarification. The prescriber's nurse told the pharmacist the patient was to administer 1/2 tablet of Armour Thyroid® 90 mg (i.e. 45 mg) once daily. The pharmacist immediately asked "what about the additional 30 mg tablet?" The nurse said she had no idea why "daily with 30 mg tablet" was included in the order. After this, the prescription was correctly filled and the

Figure 1

patient appropriately counseled. Over the past several years, the prescription examples illustrated in Safety Nets have switched from traditional handwritten prescriptions to the more prevalent electronic prescriptions. The authors of Safety Nets recognize that electronic prescriptions do have certain advantages compared to handwritten prescriptions (i.e. illegible handwriting), but do not necessarily "improve medication safety along with prescribing accuracy and efficiency" (HRSA statement). In fact, ERx's have actually introduced new types of medication errors into the health care system that would be extremely unlikely - or even impossible – to occur with traditional handwritten prescriptions. In this case, the prescriber wanted the patient to receive 45 mg of Armour Thyroid® daily - a straightforward medication order. Incredibly, the ERx in this case does not contain these specific patient directions anywhere in the Sig! Rather, the Sig. contains the meaningless phrase ".5 times per day", along with the erroneous and potentially hazardous" daily with a 30 mg tablet". Fortunately, the errors contained in this order are so glaring the pharmacist was forced to contact the prescriber for clarification. In other electronic orders, the errors may be more subtle and harder to detect. In fact, the neatness and legibility of electronic prescriptions may reduce the level of scrutiny compared to handwritten orders.

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“Where’s the beef?” was the tagline of a funny commercial featuring a customer complaining about the lack of meat on a hamburger. Could this commercial be used to describe prescriber’s offices when transmitting electronic prescriptions that force pharmacists to have to look for key prescription elements including the Sig? In this case, the obvious answer is yes. It is definitely, however, not funny. §

STUDENT SPOTLIGHT

Medical Tragedies - Katie Angel I never thought prescription medications could cause medical tragedies, but that changed when it happened to my grandmother. In three months she went from living a healthy life to relying on life support. My grandmother was a double kidney transplant recipient which required her to take anti-rejection medications. Cyclosporine’s effectiveness was decreasing and it was time to search for a new treatment option. Her team decided to switch to sirolimus. Things went fine, but her health gradually began to decline. After reviewing her signs, symptoms, and chest x-ray, her physician diagnosed her with pneumonia and prescribed antibiotics. Her health continued to worsen. During the last months of her life, she showed one sign of improvement - when her medications were discontinued for a week during a hospital stay. Soon after she was sent home to restart all her previous medications. Unfortunately, this led to her death from sepsis caused by sirolimus. I knew something was wrong because she improved when her medications were stopped for a week. I read the list of potential sirolimus side effects, but I stayed quiet. What could a high school kid possibly know? Shouldn’t the doctors have noticed? This led me to pharmacy school. I want to practice in a rural community where I can be alert to my patient’s medication changes, monitor them for new problems and potential side effects, and make myself available at all times. I never realized pharmacists are the last line of protection for patients, yet we are the most important line. My grandmothers death could have been avoided, and I want to be the one to help prevent this from happening to others.

AR•Rx

THE ARKANSAS PHARMACIST

3/16/22 3:58 PM

WWW.ARRX.ORG

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3/16/22 3:58 PM

Saddling Up 4th Quarter FDA Approval

imilar to the popular television series, “Yellowstone”, the drug development field can be considered the wild west. Each drug company claims its stake on a certain territory. The fourth quarter did not disappoint with 10 medications reaching FDA approval, 4 of those focused on oncology efforts. Cancer is a battleground where companies have a shared enemy, and territories overlap. However, the benefits patients experience will hopefully keep these new drugs from being dropped off at the train station. If you are confused by this reference, ask Rip… Oncology: EXKIVITY™ (mobocertinib) is a kinase inhibitor of the epidermal growth factor receptor (EGFR) that irreversibly binds to and inhibits EGFR exon 20 insertion mutations. It is indicated for the treatment of adult patients with locally advanced or metastatic nonsmall cell lung cancer with these mutations, whose disease has progressed on or after platinum-based chemotherapy. TIVDAK™ (tisotumab vedotin-tftv) is a tissue factordirected antibody and microtubule inhibitor conjugate indicated for the treatment of adult patients with recurrent or metastatic cervical cancer with disease progression on or after chemotherapy. It works by identifying cancer cells to activate cell cycle arrest. It also mediates antibodydependent cellular phagocytosis and antibody-dependent cellular cytotoxicity. SCEMBLIX® (asciminib) is an ABL/ BCR-ABL1 kinase inhibitor indicated for the treatment of adult patients with: 1) Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML) in chronic phase (CP), previously treated with two or more tyrosine kinase inhibitors (TKIs), and 2) Ph+ CML in CP with the T315I mutation. Cytalux (pafolacianine) is an imaging drug intended to assist surgeons in identifying ovarian cancer lesions. The drug is designed to improve the ability to locate additional ovarian cancerous tissue that is normally difficult to detect during surgery. Cancer cells divide much faster than normal tissue. To do this, they need folate. Cytalux (pafolacianine) is essentially a folate compound tagged with a fluorescent dye. MISCELLANEOUS ORAL AGENTS: QULIPTA™ (atogepant) is a calcitonin gene-related peptide receptor antagonist indicated for the preventive treatment of episodic migraine in adults. LIVMARLI™ (maralixibat) is a reversible ileal bile acid transporter (IBAT) inhibitor indicated for the treatment of cholestatic pruritus in patients

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with Alagille syndrome (ALGS) > 1 year of age. It works by decreasing the reabsorption of bile acid salts from the terminal ileum. TAVNEOS™ (avacopan) is a complement 5a receptor (C5aR) antagonist that inhibits the interaction between C5aR and the anaphylatoxin C5a, and blocks C5amediated neutrophil activation and migration. It is indicated as an adjunctive treatment of adult patients with severe active anti-neutrophil cytoplasmic autoantibody (ANCA)associated vasculitis (granulomatosis with polyangiitis [GPA] and microscopic polyangiitis [MPA]) in combination with standard therapy including glucocorticoids. It does not eliminate glucocorticoid use. LIVTENCITY™ (maribavir) is a cytomegalovirus (CMV) pUL97 kinase inhibitor indicated for the treatment of adults and pediatric patients ( > 12 years of age and weighing at least 35 kg) with post-transplant CMV infection/disease that is refractory to treatment (with or without genotypic resistance) with ganciclovir, valganciclovir, cidofovir or foscarnet. MISCELLANEOUS INJECTABLE AGENTS: BESREMI® (ropeginterferon alfa-2b-njft) is an interferon alfa-2b indicated for the treatment of adults with polycythemia vera. Interferon alfa belongs to the class of type I interferons, which exhibit their cellular effects in polycythemia vera in the bone marrow by binding to a transmembrane receptor termed interferon alfa receptor (IFNAR). Binding to IFNAR initiates a downstream signaling cascade through the activation of kinases (JAK1 and TYK2) and transcription (STAT) proteins. Nuclear translocation of STAT proteins controls distinct gene-expression programs and exhibits various cellular effects. VOXZOGO™ (vosoritide) is a C type natriuretic peptide (CNP) analog indicated to increase linear growth in pediatric patients with achondroplasia > 5 years of age with open epiphyses. In patients with achondroplasia, endochondral bone growth is negatively regulated due to a gain of function mutation in fibroblast growth factor receptor 3 (FGFR3). Binding of VOXZOGO™ (vosoritide) to natriuretic peptide receptor-B (NPR-B) antagonizes FGFR3 downstream signaling. As a result, VOXZOGO™ (vosoritide), like CNP, acts as a positive regulator of endochondral bone growth as it promotes chondrocyte proliferation and differentiation. §

AR•Rx

THE ARKANSAS PHARMACIST

3/16/22 3:58 PM

NEW DRUGS

Drug

Indication

Route

Dosing

Exkivity™️ (mobocertinib)

Treat locally advanced or metastatic non-small cell lung cancer with EGFR receptor exon 20 insertion mutations

Every 48 hours

Tivdak™️ (tisotumab Treat recurrent or metastatic cervical cancer with disease progression on or after vedotin-tftv) chemotherapy

INJ

Daily

Qulipta™️ (atogepant)

Prevent episodic migraines

Daily Fexinidazole®

Livmarli™️ (maralixibat)

Treat cholestatic pruritus associated with Alagille syndrome

Daily

Tavneos™️ (avacopan)

Treat severe active anti-neutrophil cytoplasmic autoantibody-associated vasculitis in combination with standard therapy

Daily

Scemblix® (asciminib)

Treat Philadelphia chromosome-positive chronic myeloid leukemia with disease that meets certain criteria

Every 4 weeks

Besremi® (ropeginterferon alfa-2b-njft)

Treat polycythemia vera, a blood disease that causes the overproduction of red blood cells

INJ

Every 2 weeks

Voxzogo™️ (vosoritide)

Improve growth in children > five years with achondroplasia and open epiphyses

INJ

Daily

Livtencity™️ (marabivir)

Treat post-transplant CMV infection that does not respond (+ genetic mutations that cause resistance) to standard treatment

At end of each HD treatment

Cytalux (pafolacianine)

Identify ovarian cancer lesions

INJ

Weekly

Upcoming Pharmacy Events APRIL Date: TBD* Harding P3 Pinning Ceremony Searcy, AR

MAY May 6, 2022 Harding Class of 2022 Meeting Searcy, AR May 9, 2022 Arkansas Pharmacy Foundation Golf Tournament Mountain Ranch Golf Club Fairfield Bay, AR

WWW.ARRX.ORG

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May 7, 2022 Harding College of Pharmacy Commencement Searcy, AR May 19, 2022* UAMS Class of 2022 Meeting Little Rock, AR May 21, 2022 UAMS College of Pharmacy Commencement Little Rock, AR

* denotes dates subject to change

JUNE June 7-9, 2022 AR State Board of Pharmacy Board Meeting Virtually/In-Person Little Rock, AR June 8, 2022 APA Board Meeting Doubletree by Hilton Little Rock, AR June 9-10, 2022 APA Annual Convention Doubletree by Hilton Little Rock, AR

3/16/22 3:58 PM

UAMS SCHOOL OF PHARMACY

2021 - A Year in Review

think we each recognize that we had much to be thankful and grateful for in this past year, while at the same time having a sense of uncertainty just below the surface of each day. Collectively, we accomplished much. The Class of 2021 graduated and embarked on their professional journey, with first-time pass rates show that with your help in the practice setting we were able to deliver the same high level of education expected, even in a pandemic. Although the didactic curriculum in 2020-2021 was delivered primarily via remote technology with strategic face-toface activities, we put more effort into preparing student pharmacists with the same high expectations that you have come to depend.

Cindy Stowe, Pharm.D. Dean and Professor UAMS College of Pharmacy

With this accomplished, the Class of 2026 has started and completed their first semester on their way to becoming a pharmacist. As we moved through 2021, we were, all the while, trying to figure out the nuances of navigating our routine activities under pandemic-based restrictions designed to optimize COVID-19 disease free outcomes. My sincere appreciation to the students, staff, faculty, alumni, and pharmacy profession that helped us care for our communities while educating future generations of pharmacists, cannot be overstated. I cannot think of any time in my career when the life of the College and the Profession have been more in sync and connected than it has been since the COVID-19 vaccine made its arrival. The visibility of the pharmacy profession has never been this great! While working to continue our excellence in education, service, and research, we were also preparing for our report for renewal of accreditation. This is a required renewal, but amidst the pandemic, was an additional challenge for the College. The culmination of the 24-month process for the accreditation self-study occurred in late October with the Accreditation Council for Pharmacy Education (ACPE) virtual site visit. The normal accreditation cycle is 8 years, and our last site visit was in the fall of 2013. The ACPE site visit is conducted by peers from other colleges/ schools of pharmacy, a member of the ACPE Board of Directors, and an ACPE staff member. The site visit consists of meetings with college standing committees, a group of students, a group of preceptors, and individual student and faculty member interviews. The site visit serves to collect information ‘on-site’ to confirm the selfstudy report and make recommendations to the ACPE Board of Directors about the College’s compliance with the accreditation standards. The report of the ACPE site

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team and the College’s self-study report are provided to the ACPE Board of Directors to determine the College’s accreditation status. The preliminary verbal exit report and draft ACPE site visit team’s report were positive, and the College awaits the final ACPE Board of Directors Accreditation Report due after the January ACPE Board of Directors meeting. We are grateful for everyone’s time and input into this important process. Last year I talked about audible books and podcasts… So, as a follow-up this year was full of more ‘listening’. As if living through a pandemic was not enough, I found reading about the pandemic a sort of check on perspective to determine if while living through it I was not seeing it… Here are some highlights: • The First Shots by Brendan Borrell • A Shot to Save the World by Gregory Zuckerman • What Really Happened in Wuhan by Sharri Markson • The Premonition by Michael Lewis • The Plague Year by Lawrence Wright I did read, of course, The Great Influenza by John M. Barry and Spillover by David Quammen and if you’ve not read these, I would recommend it since these were written prior to the current pandemic. All of these books were influential in helping me understand this crazy dilemma in which we all find ourselves. I must admit, at this point, I’ve not expanded my podcast listening too much this year except to say I’ve found myself more interested in ‘travel’ podcasts in hopes that 2022 will provide the opportunity to do a little bit of traveling beyond a day’s drive this year. As we enter 2022, I look back on 2021 with a tremendous amount of gratitude for the efforts and commitment of the pharmacy profession in the delivery of care to our communities. My hope for you is that you show as much grace and care to yourself as you do all those around you and that you take time to reflect on the road that you have traveled. There has been a lot of ground gained through legislative efforts and Supreme Court findings in this past year to change the landscape of our profession. I am looking forward to our continued professional advocacy and how the fruits of much labor impact the day-to-day practice of pharmacy. I hope your 2022 is filled with much happiness and good health and that we get to see each other more often in person. §

AR•Rx

THE ARKANSAS PHARMACIST

3/16/22 3:58 PM

HARDING UNIVERSITY REPORT

Looking Back and Looking Forward

s I write this article, the fall semester is drawing to a close Jeff Mercer, Pharm.D. at Harding University’s College of Dean and Professor Pharmacy (HUCOP). Our students Harding College of Pharmacy are busy preparing for finals and anticipating a well-deserved holiday break before classes reconvene in the spring. There is a hint of Christmas and holiday cheer in the air as the University blooms with its annual festival of lights. I guess you could say it almost feels like a normal semester – and that is a wonderful feeling indeed. In the nearly two years since the COVID-19 pandemic began, I have grown to appreciate some of the simpler pleasures in life – pleasures that were always there but have since risen just above the surface of recognition. On any given day this semester, I have enjoyed interacting with our students in the hallways of our building, seeing our faculty stand before their classes to teach, and even the occasional search for an open parking slot on a busy weekday morning. It is sometimes said that you don’t fully understand what you appreciate until it is taken away. If these simple moments are any indication, I am reminded of the joy that is found in simply being together as a pharmacy family at HUCOP. One opportunity that I cherished this semester was a return to the classroom. As dean, I am often pulled in various directions, and at times I lose sight of the day-to-day happenings with our students. This was especially true before the pandemic began when travel and University responsibilities held my attention elsewhere. The recent change in travel requirements and increased use of virtual technologies has afforded me the opportunity to return to the classroom and to reconnect with my students. As the course coordinator for our PHA 6040 Pharmacy Practice Management course, I have found great joy in this dedicated time with students as we explore the wonderful profession of pharmacy. I’m appreciative to our second-year students who have participated in the class and to the many pharmacy practitioners, preceptors, and business

WWW.ARRX.ORG

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professionals that have given of their time to share insights as guest lecturers and panelists. It has truly been special and serves as a gentle reminder of the goodness that comes from simply being together. Another recent event held a particularly special meaning this year as an opportunity to celebrate being back together. “Friendsgiving” is an annual thanksgiving meal among friends that was founded by alumna Shannon Raney during her time as a student at HUCOP. What started in 2014 as a studentdriven, potluck-type meal has since become a grand tradition for everyone at HUCOP each November. The pandemic forced a cancellation of the event in 2020, so when Friendsgiving returned in 2021, it was a most joyous occasion for all. In response to this year’s Friendsgiving, Dr. Raney reflected on what makes the event special, saying it involves “teachers, students, faculty and staff, together enjoying a meal and wonderful fellowship! No worries or stresses. That’s truly the blessing I wished for this event!!” And that is what Friendsgiving has become - this shared meal continues to gather momentum as the signature social event each fall semester for all associated with the program as a celebration of our pharmacy family at HUCOP. If there is one thing I have learned over the last couple of years, it is the uncertainty of tomorrow. The pandemic fundamentally changed our routines and the overall pace of life, and many of us settled into a distressing and unsettled world. However, I have also realized that people are resilient, and the draw toward a sense of community is unyielding. Perhaps the real lesson learned in 2021 is the joy that comes from simply being together. As the holidays pass and we welcome a new year, I hope 2022 brings you peace, contentment, and the happiness that is found in being together again with friends and family. §

3/16/22 3:58 PM

ARKANSAS ACADEMY OF HEALTH-SYSTEM PHARMACISTS

Hospital Value-Based Purchasing and Readmission Reduction Program

ost of the hospitals in Arkansas serve significant patient volumes that are M e d i c a re beneficiaries. According to the Agency for Healthcare Research and Quality (AHRQ), the U.S. population has grown in the past decades, and the population of older adults has grown disproportionately. Projections show that one in five Americans will be 65 years or older by 2030. The Hospital VBP Program rewards acute care hospitals with incentive payments for the quality of care provided in the inpatient hospital setting. Based on the quality of care delivered, payments to hospitals are adjusted under the Inpatient Prospective Payment System (IPPS). The Hospital VBP Program is designed to make the quality of care and patient experience better for hospitals and patients. The Hospital VBP Program encourages hospitals to improve in clinical care, patient safety, patient experience, and efficiency and cost reduction. Clinical care domain includes mortality and complications and healthcare-associated infections. Each domain weighs 25%, and each hospital may earn 2 scores on each measure; one based on or achievement and the other for improvement. The final score awarded to a hospital for each measure is the higher of these 2 scores. These scores HyeJin Son, PharmD, BCPS AAHP 2021-2022 President

are used to compare hospitals against other hospitals as well as its own baseline performance designated by CMS. CMS monitors these measures to reward and penalize hospitals based on the quality of care provided to Medicare patients by withholding participating hospitals’ Medicare payments by 2%. In addition, readmission reduction program evaluates hospital 30-day, all-cause, risk-standardized readmission rate for several medical conditions such as acute myocardial infarction, pneumonia, total hip arthroplasty and total knee arthroplasty, chronic obstructive pulmonary disease, coronary artery bypass graft, and heart failure. This is a penalty only program where hospitals can face up to 3% reduction in medicare payments. These measures can affect Medicare payments by millions of dollars for hospitals that take care of a large portion of medicare patients, and incentivizes them to improve the quality of care. Hospital pharmacy departments have been involved in improving patient care in these areas for many years and are making a difference in patient care by being an active member of the patient care team, medication counseling, medication reconciliation, as well as meds-to-bed deliveries. https://qualitynet.cms.gov is a great resource for additional information. §

SAVE the

DATE! 2022 APA Convention

June 9-10, 2022 DoubleTree Hotel Little Rock

Join us in the heart of the capital city’s downtown district for the 2022 APA Annual

Convention June 9-10 at the Little Rock DoubleTree. APA will offer up to 12 hours of

live continuing pharmacy education (CPE) relating to pharmacy practices. Members and

guests will be able to learn about the latest product trends in pharmacy from more than 30 exhibitors who will showcase new products to potential customers while working to maintain and strengthen relationships with existing customers. Social events to

mingle with fellow pharmacists, colleagues, and friends are planned as well. Convention

registration will open shortly so stay tuned for more information through InteRxActions 20

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AR•Rx | THE ARKANSAS PHARMACIST and at www.arrx.org/annual-convention.

3/16/22 3:58 PM

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3/16/22 3:58 PM

CONSULTING ACADEMY REPORT

Antipsychotic Use in Dementia-Related Psychosis in Long-Term Care Settings

primary focus in recent years for the Centers for Medicare and Medicaid Services has been antipsychotic use in the longterm care (LTC) setting, which led to the launch of the National Partnership to Improve Dementia Care in Nursing Homes. The National Partnership calculates and tracks antipsychotic use in LTC settings, excluding residents that have a diagnosis of Huntington disease, schizophrenia or Tourette syndrome. Since the launch of the National Partnership, national rates of antipsychotic usage in nursing home residents have been reduced significantly, from 23.9% in 2011 to 14.5% in 2020. Arkansas, in particular, has seen a reduction from 26.1% in 2011 to 11.7% in 2020, ranking 6th in the nation for lowest antipsychotic usage in long-term care residents. (Source: CMS Quality Measure, based on MDS 3.0 data) Emily Holton, Pharm.D. Consulting Academy 2021-2022 President

lab results), medications (evaluating any new therapies since onset of symptoms that may be cause adverse events) and environmental factors (objects that trigger hallucinations) that might cause symptoms need to be ruled out. Next, nonpharmacological management strategies should be implemented, documented, and then evaluated for their effectiveness. Nonpharmacological therapies can include music therapy, increased social interactions, modification of the environment, physical exercise, and caregiver support/education for improving effective communication in residents with dementia.

Currently, the FDA has approved no drug for managing psychotic symptoms of dementia, so off-label use of psychotropic medications remains current practice. Black box warnings were placed on atypical and typical antipsychotics, in 2005 and 2008, respectively, for increased mortality in elderly patients Consultant pharmacists have with dementia-related psychosis. Consultant pharmacists have an integral role in determining if As a LTC consultant, initiation of an integral role in determining if antipsychotic use is appropriate or antipsychotic therapy requires a antipsychotic use is appropriate or inappropriate and monitoring for detailed evaluation to determine the inappropriate and monitoring for safety and efficacy in the LTC setting. appropriateness. Once exclusion safety and efficacy in the LTC setting. of other potential causes and nonDoing so is a main focus of reviewing Doing so is a main focus of reviewing pharmacological interventions are resident’s medications each month. resident’s medications each month. attempted, if the nursing progress A recent home study regarding notes/physician progress note and antipsychotic use specifically in management of dementia-related consultation with other medical team psychosis (DRP) summarized caregivers (psychiatric evaluations) recognizing characteristics of DRP, evaluating the need supports the need for antipsychotic initiation, an approved for initiation of an antipsychotic, and how to then initiate, CMS indication must be attached to that order and monitor, and taper therapy. documentation must support the diagnosis. Antipsychotics should be initiated using the lowest effective dose and Characteristics of DRP include delusions (false beliefs then tapered when symptoms have been stable for at least that the resident believes to be true) and hallucinations several months. Consultants need to be mindful of the (hearing or seeing things that are not present) that have increased risk for adverse effects that can be attributed been present, at least intermittently, for one month or to antipsychotic use (falls, sedation, worsening confusion, longer and are severe enough to pose a threat to the safety etc.). Recommendations for reductions should focus on of self or others. Hallucinations in DRP differ from those why that resident should have a reduction and include is schizophrenia in that they are often mainly visual. In an individualized approach citing specific nursing notes/ schizophrenia, hallucinations are mainly auditory and often documentation, or perhaps, lack thereof. involve voices. Accurate assessment of DRP depends on good communications with the resident, caregivers, staff Although reducing antipsychotic usage in LTC residents and health care team. Common primary diagnosis that are remains a primary focus, CMS acknowledges that often associated with DRP include: Alzheimer’s disease, circumstances exist where clinical indications for their use dementia with Lewy bodies, vascular dementia, Parkinson are present and does not expect the use will decrease disease dementia, frontotemporal dementia and traumatic to zero. However, the state survey process continues to brain injury. evaluate the antipsychotic use and consultant pharmacists are integral to the process to make sure antipsychotics are being used appropriately in our LTC residents. § Prior to initiating therapy with an antipsychotic, other medical conditions (uncontrolled pain or UTI, evaluation of

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AR•Rx

THE ARKANSAS PHARMACIST

3/16/22 3:58 PM

COMPOUNDING ACADEMY REPORT

Closing the Engagement Gap

he days of pulling the chain on the open sign and expecting business to come into your pharmacy are long gone. It is no longer as simple as getting the right pill in the right bottle. The complexities of navigating arbitrary hoops imposed by PBM’s, underwater reimbursements and a COVID 19 Pandemic can take their toll on staff and leadership alike. When pharmacy employees are taxed by poor processes, poor staffing or excessive patient volume, they tend to disengage and patient customer service falls quickly. In a time when employee engagement is more critical than ever, it is important to implement these 5 steps to closing that engagement gap and ensuring your staff is the absolute best for your patients. Based on the book Closing the Engagement Gap: How Great Companies Unlock Employee Potential for Superior Results by Julie Gebauer and Don Lowman. Greg Turner, Pharm.D. Compounding Academy 2021-2022 President

Know Them Understand their personal and professional goals and determine how you can help them attain their goals. Question: Do you have frequent one on one’s to discuss their goals and understand what is important to your employee? Or….. Do you have one on one’s when they need immediate coaching or only during year end reviews??

Reward Them Optimize appreciation. Show knowledgeable appreciation that is small and spontaneous as well as extravagant and expected. Whether a bell to ring, a star to wear or a Sonic drink, these small acknowledgments matter. This is especially true in an era of social media. When you acknowledge your employee on social media, more than just your staff are privy to this appreciation. Everyone from co-workers to family will recognize this performance accolade. Most will read this and say “ I used to do that or I do that…” etc.., etc.. Implementation to close the employee engagement gap must be planned and purposeful. You must implement all these steps with consistency, care and candor. You will be surprised to see a more engaged staff which will lead to creating WOW customer experiences and better patient outcomes. §

Grow Them Foster learning and help develop plans to improve their skills and capabilities. NCPA has several certificate programs available that can help you develop plans to grow and stretch your staff. Sometimes, your ROI will come more from the fact that your employee sees that you care about them than from what the actual certificate brings. Inspire Them Cultivate a culture of trust, mutual accountability, and pride. Focus on the importance and worthiness of their role. Although helping patients attain better health is important, sometimes in the heat of their day to day work load, employees can become callous to how important their role is in the healthcare system. Take time to strengthen appreciation for the many lives that your employees touch daily. Involve Them Inform them, gather their input, and encourage collaboration through transparent leadership. Utilize their knowledge to improve processes and workflow. Many times, your staff has the answers because they are on the front lines. Be sure to encourage an environment of open sharing of ideas to anticipate changes and prepare for the future.

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APA Beam Signing

hings. Are. Happening! Last August, the long road to APA's new headquarters began with the demolition of the old buildings and was quickly followed by the groundbreaking ceremony in September. For the next few months, construction c re w s worked on clearing the site, pouring the foundation, and building the retaining wall. However, progress came to a complete halt for more than two months when supply chain constrictions delayed delivery of the

steel beams. Finally, at the beginning of March the steel beams were delivered and construction ramped back up. To celebrate this major milestone, APA hosted a beam signing ceremony on March 13, two years to the day from when APA's former offices were shut down due to the pandemic. With the beams in place and construction moving full speed ahead, APA should be cutting the ribbon on the beautiful new headquarters before the end of the year!

CBM Construction Vice President Matt Gray and daughter

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APA Past President Kristen Riddle

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APA President Elect Dylan Jones

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

here have been a number of questions from pharmacists about the potential liability of administering COVID vaccines available under an Emergency Use Authorization (EUA) and how that status may impact their insurance coverage. What is the difference between an approved drug and one available under an EUA? An EUA may be approved by the Food and Drug Administration (FDA) to help make medical countermeasures available for use during public health emergencies. To be approved for an EUA, there must be no adequate, approved, and available alternative. At the beginning of the pandemic in early 2020, this was true. To apply for an EUA, the manufacturer must complete three phases of investigations. Phase 1 uses the vaccine on a small population of healthy patients. Phase 2 expands the number of patients in the trial to hundreds and includes a wider range of demographics and health statuses. Phase 3 expands to thousands of patients with broad demographic groups. This phase collects critical information on safety and effectiveness. By this point, tens of thousands of patients have been administered the vaccine (or a control) and monitored. Prior to submission to FDA, the manufacturer of the vaccine will submit their data to an independent Data Safety Monitoring Board for review. After submission, the data is also reviewed by the Vaccine and Related Biological Products Advisory Committee. Failure to receive high marks from either of these groups will likely lead to a denial of the EUA application. Three vaccines were authorized under separate EUA applications in late 2020 and early 2021. The EUA makes it legal to administer the vaccines in the United States. Most insurance policies for pharmacy professional liability contain an exclusion for acts in violation of pharmacy laws. Because these vaccines are legal for use under the EUA, this exclusion would not apply. Review your policy for any general vaccine exclusion or a specific COVID vaccine exclusion. Also review the policy language for any provision addressing the use of only approved drugs. Absent these, your policy should cover the administration of COVID vaccines under an EUA.

vaccine on January 31, 2022. To gain full approval, the manufacturer gathers additional safety and effectiveness data through continuing trials and monitoring of patients. Clinically, there is little difference between a product used under an EUA and one that has been fully approved. However, any "approved" language in your policy could be problematic for insurance coverage. Because there is little difference clinically, administration of COVID vaccines should be treated in a similar manner to other vaccines administered in the pharmacy. Use of a specific patient waiver beyond the normal consent form to try to avoid potential liability is not necessary and not likely to be legally enforceable. The professional responsibilities of the pharmacist under statutes and regulations were created to protect patients. Those responsibilities are placed on the pharmacist because of their education and experience. If the idea of a waiver or release like this was viable, every professional would use one with every transaction or encounter. Make sure to provide the required patient information and counsel the patient on important points as you would for any other vaccine. Legally, the administration or dispensing of a drug under an EUA is every bit as valid as administering or dispensing an approved drug. There is a difference however. When the public health emergency ends, the EUA is also extinguished. When that day comes, the two approved vaccines can continue to be used, but vaccines authorized under an EUA will not be legal to use in the United States any longer. Insurance coverage for administering vaccines under an EUA is likely included in your policy, but a quick review of your insurance policy should be able to verify that for you. § ____________________________________________________________________

© Don R. McGuire Jr., R.Ph., J.D., is General Counsel, Senior Vice President, Risk Management & Compliance 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.

This issue is slowly going away for COVID vaccines because FDA has now granted full approval for two vaccines, the Pfizer-BioNTech vaccine on August 23, 2021 and the Moderna 26

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Measuring the Value of a Financial Professional Findings suggest that these relationships can make a difference for investors

This series, Financial Forum, is presented by PRISM Wealth Advisors, LLC and your State Pharmacy Association through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community.

hat is a relationship with a financial professional worth to an investor?

A 2019 study by Vanguard, one of the world’s largest money managers, attempted to answer that question. Vanguard’s whitepaper, concluded that when an investor works with a professional and receives that level of investment advice, they may see a net portfolio return about 3% higher over time.1 How did this study arrive at that conclusion? By comparing self-directed investor accounts to this model, Vanguard found that the potential return relative to the average investor experience was higher for individuals who had financial professionals. 1 Vanguard analyzed three key services that a professional may provide: portfolio construction, wealth management, and behavioral coaching. It estimated that portfolio construction advice (e.g., asset allocation, asset location) could add up to 1.2% in additional return, while wealth management (e.g., rebalancing, drawdown strategies) may contribute over 1% in additional return. 1 Asset allocation is an approach to help manage investment risk. Asset allocation does not guarantee against investment loss. The biggest opportunity to add value was in behavioral coaching, which was estimated to be worth about 1.5% in additional return. Financial professionals can use their insight to guide clients away from poor decisions, such as accepting excessive risk in a portfolio. Indeed, the greatest value of a financial professional may be in helping individuals adhere to an agreed-upon financial and investment strategy. 1

financial advisor, the value of a relationship may be measured in both tangible and intangible ways. Many such investors are grateful they are not “going it alone.” § Citations: 1 - advisors.vanguard.com/iwe/pdf/ISGQVAA.pdf [2/19] ________________________________________________________________

Pat Reding and Bo Schnurr may be reached at 800-288-6669 or pbh@berthelrep.com. Registered Representative of and securities and investment advisory services offered through Berthel Fisher & Company Financial Services, Inc. Member FINRA/SIPC. PRISM Wealth Advisors LLC is independent of Berthel Fisher & Company Financial Services Inc. This material was prepared by MarketingLibrary.Net Inc., and does not necessarily represent the views of the presenting party, nor their affiliates. All information is believed to be from reliable sources; however we make no representation as to its completeness or accuracy. Please note - investing involves risk, and past performance is no guarantee of future results. The publisher is not engaged in rendering legal, accounting or other professional services. If assistance is needed, the reader is advised to engage the services of a competent professional. This information should not be construed as investment, tax or legal advice and may not be relied on for the purpose of avoiding any Federal tax penalty. This is neither a solicitation nor recommendation to purchase or sell any investment or insurance product or service, and should not be relied upon as such. All indices are unmanaged and are not illustrative of any particular investment

Of course, financial professionals can account for additional value not studied by Vanguard, such as helping clients implement wealth management strategies, which may help protect against the financial consequences of loss of income, and coordinating with other financial professionals on tax management and estate strategies. After years of working with a

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2022 APA Awards Solicitation AWARD NOMINATIONS Each year APA encourages members to submit the names of individuals who are deserving of special recognition for their professional activities during the past year. Any active APA member is eligible to nominate a person for the awards. Award recipients are chosen by an APA committee following a review of all nominees. Nominations are now being accepted for the following annual awards to be presented by the Association. Nominations will close at midnight on Wednesday, April 6, 2022. Please mark your nomination with an X. If you have more than one nomination, please feel free to copy this form.

Pharmacist of the Year _______

The Pharmacist of the Year Award was established in 1959 to honor an individual who “should possess professional standards beyond reproach, a record of outstanding civic service in the community, and as a member of the APA, who has contributed efforts toward the progress of the association.” Previous recipients include: 2021 Brenna Neumann, Fayetteville 2020 Brittany Sanders, Little Rock 2019 Duane Jones, Siloam Springs 2018 David Smith, Conway 2017 Laura Lumsden, Little Rock 2016 Keith Larkin, Fort Smith 2015 Wayne Padgett, Glenwood

Bowl of Hygeia Community Service Award _______

In 1958 E. Claiborne Robbins of the A.H. Robbins Company established the Bowl of Hygeia Award. The purpose of the award is to encourage pharmacists to take active roles in the affairs of their respective communities. Previous recipients include: 2021 Bob Hodge, Paragould 2020 Mike Smets, Ft Smith 2019 Max Caldwell, Wynne 2018 Cissy Clark, Earle 2017 Sue Frank, Little Rock 2016 Jon Wolfe, Little Rock 2015 Nicki Hilliard, Little Rock

Distinguished Young Pharmacist of the Year _______

The nominee must have an entry degree in Pharmacy, received nine or fewer years ago, and be a member of the APA. Nominee must be in the active practice of pharmacy in the year selected, and actively involved in the profession of pharmacy, displaying an interest in the future of the profession. Previous recipients include: 2021 Marco Middleton, Clarendon 2020 Victoria Hennessey, Springdale 2019 Brandon Achor, Maumelle 2018 Greta Ishmael, Cherokee Village 2017 Joshua Bright, Harrison 2016 Kevin Barton, Centerton 2015 Rachel Stafford, North Little Rock

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2022 APA Awards Solicitation (continued) Excellence in Innovation Pharmacy Practice Award _______

This award was established in 1993 by the APA in cooperation with the National Council of State Pharmacy Associations and DuPont Pharmaceuticals to recognize, annually, a pharmacist who has demonstrated a prominent spirit of innovation and entrepreneurship in the practice of pharmacy. Previous recipients include: 2021 Blake Torres, Benton 2020 Anne Pace, Little Rock 2019 Jett Jones, Jonesboro 2018 Whitney Bussell, Little Rock 2017 Jody Smotherman, Batesville 2016 Nikki Scott, Russellville 2015 Taylor Franklin, Fort Smith

Guy Newcomb Award _______

The APA Board of Directors created this award in 1997 to recognize individuals who, by their legislative influence and leadership, have distinguished themselves as political friends of Arkansas pharmacy. This award is named in memory of Dr. Guy Newcomb of Osceola. Dr. Newcomb was a pharmacy leader who understood, appreciated, and enthusiastically participated in the political process. Previous recipients include: 2021 Representative Brian Evans, Cabot & Representative Lee Johnson, Greenwood 2020 Leslie Rutledge, Little Rock 2019 Senator Kim Hammer, Benton 2018 Governor Asa Hutchinson, Little Rock 2017 Senator Jason Rapert, Conway & Representative Clint Penzo, Springdale 2016 Senator Ron Caldwell, Wynne & Representative Michelle Gray, Melbourne

Percy Malone Public Service Award _______

This award was established in 2009 by the Arkansas Pharmacists Association in honor of former state senator Percy Malone, P.D. The recipient must have made a contribution to public service by being elected to any public office and by displaying an interest in the people of Arkansas. Previous recipients include: 2021 Representative Vivian Flowers, Pine Bluff 2016 Representative Justin Boyd, Fort Smith 2015 Lenora Newsome, Smackover

Friend of Pharmacy Award _______

This new award honors someone that does not serve as a pharmacist but is a champion to the pharmacist community. 2021 Judge Shawn Johnson, Little Rock 2020 Joe Baker, Little Rock 2019 Dr. Jennifer Dillaha, Little Rock & Senator Jason Rapert, Conway

If interested in making an award nomination, please fill out the form at www.arrx.org/2022-awards. Nominations will close on April 6, 2022.

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Call for Board Nominations 2022-2023 Take advantage of the opportunity to give back by serving on the Arkansas State Board of Pharmacy or the APA Board of Directors. We are seeking nominations for enthusiastic and energetic individuals who want to make an important contribution to the pharmacy profession. APA’s Board of Directors is made up of 12 representatives spread out over five regions, including two at-large representatives. Each regional representative will serve a three-year term. For questions about term lengths, please contact Susannah Fuquay at 501372-5250. APA Board membership requires the flexibility to meet in Little Rock during the week and on two Sundays during the year.

APA Board of Directors Call for Nominations

Nominations are invited for each of the following positions on the Arkansas Pharmacists Association Board of Directors. Brief job descriptions follow.

Vice President of APA

Statewide (Serves four one-year terms as Vice President, President-Elect, President, and Past President, four total years as Board Member) • Attends all board and executive committee meetings • Serves on the executive committee • Assumes responsibilities of the chair in the absence of the board president or president-elect • Participates as a vital part of the board leadership

Regional Representatives

• Attends all board meetings and conducts the affairs of the association • Maintains knowledge of the organization and personal commitment to its goals and objectives • Appoints an executive committee and other committees and delegates to the executive committee power and authority of the board of directors in the management of the affairs of the association • Recruits new members; participates in APA membership drives

Region 1 – Northwest Arkansas: One Open Seat Northwest Counties: Benton, Boone, Carroll, Conway, Crawford, Faulkner, Franklin, Johnson, Logan, Madison, Marion, Newton, Pope, Searcy, Sebastian, Van Buren, Washington

Region 2 – Northeast Arkansas: No Open Seats Northeast Counties: Baxter, Clay, Cleburne, Craighead, Crittenden, Cross, Fulton, Greene, Independence, Izard, Jackson, Lawrence, Mississippi, Poinsett, Randolph, Sharp, Stone, White, Woodruff

Region 3 – Central Arkansas: One Open Seat Central Counties: Pulaski, Saline

Region 5 – Southeast Arkansas: No Open Seats Southwest Counties: Clark, Columbia, Garland, Hempstead, Hot Spring, Howard, Lafayette, Little River, Miller, Montgomery, Nevada, Ouachita, Perry, Pike, Polk, Scott, Sevier, Yell

Region 4 – Southwest Arkansas: One Open Seat Southwest Counties: Clark, Columbia, Garland, Hempstead, Hot Spring, Howard, Lafayette, Little River, Miller, Montgomery, Nevada, Ouachita, Perry, Pike, Polk, Scott, Sevier, Yell At-Large Representatives: One Open Seat

APA Officers and Board of Directors

The requirements for nominees of the APA Officers are as follows: Arkansas licensed pharmacist who has been a member of this Association in good standing for the past three (3) consecutive years. Board Members shall be limited to six (6) consecutive years as a Regional Representative, or six (6) consecutive years as an At-Large Representative. No member of the Board of Directors shall serve more than nine (9) years on the Board of Directors in any non-Executive Committee capacity. Reimbursement - Members of the Board of Directors don’t receive compensation but can be reimbursed for reasonable direct and indirect expenses related to attending meetings such as mileage and/or hotel costs. Board members receive a discount on annual convention registration. Board members who are on the program at Regional Meetings (president, regional representative) do not pay registration fees for those meetings. Removal from office - Directors may be removed for being absent without reasonable cause from any two consecutive meetings or any three meetings during a 12-month period. Meeting dates for 2022-2023 are likely to be: • • • •

Board Retreat: Early August (Thursday afternoon, all day Friday, Saturday 8 a.m. to 12 p.m.) December 2, 2023 (All day) in Little Rock March 2023 (Sunday 9 a.m. to 4 p.m.) in Little Rock APA Annual Convention Board Meeting, June 2023 (Wednesday morning before Convention)

If interested in nominating yourself or another individual, please fill out the form at www.arrx.org/apa-board-2022. Nominations will close on April 6, 2022. 30

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