ARRX 3rd Quarter 2020

Third Issue 2020 Award-Winning Quarterly Publication of the Arkansas Pharmacists Association

Stronger Together Kristen Riddle, Pharm.D. 2020-2021 APA President Chokehold on U.S. Drug Supply Chain The Cost of Outsourcing API Production

APA Staff John Vinson, Pharm.D. Executive Vice President & CEO John@arrx.org

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Lynn Crouse, Pharm.D. Director of Pharmacy Practice Lynn@arrx.org Nicki Hilliard, Pharm.D. Director of Professional Affairs Nicki@arrx.org Jordan Foster Director of Communications Jordan@arrx.org Susannah Fuquay Director of Membership & Meetings Susannah@arrx.org Celeste Reid Director of Administrative Services Celeste@arrx.org Debra Wolfe Director of Government Affairs Debra@arrx.org Office E-mail Address Staff@arrx.org Publisher: John Vinson Editor: Jordan Foster Design: Gwen Canfield - Creative Instinct 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 90. © 2020 Arkansas Pharmacists Association.

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

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CONTENTS 4 Inside APA: Remember the Name 5 From the President: Bringing the Pieces Together 6 FEATURE: Stronger Together Kristen Riddle, Pharm.D. 2020-2021 APA President 10 Legislator Profile: Representative Jimmy Gazaway 13 Safety Nets: Gabapentin 14 Member Spotlight: Kendrea Jones, Pharm.D. 15 New Drugs: Brisk Drug Approval During the COVID-19 Pandemic 16 FEATURE: Chokehold on U.S. Drug Supply Chain 19 AAHP: Modified AAHP Fall Seminar 2020 is Going Virtual 20 UAMS & Harding University: 2020 UAMS and Harding Colleges of Pharmacy Salary Survey

24 Consulting Academy: Readjusting My Sails 25 Compounding Academy: Recommendations on Compounded Bioidentical Hormone Therapy 26 2020 APA Award Winners 28 2020-2021 New APA Board Members 29 USPS Statement of Ownership 30 Arkansas Pharmacy Phoenix Movement ADVERTISERS 2 Pharmacists Mutual 9 Biotech Pharmacal, Inc. 11 Retail Designs, Incorporated 11 Arkansas Pharmacy Support Group 12 Bowl of Hygeia Award Recipients 17 The Law Offices of Darren O'Quinn 23 UAMS College of Pharmacy 23 EPIC 31 Pharmacy Quality Commitment Back Cover: APA Honors AmerisourceBergen

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APA Board of Directors 2020 - 2021 Officers President – Kristen Riddle, Pharm.D., Greenbrier President-Elect - Max Caldwell, P.D., Wynne Vice President – Dylan Jones, Pharm.D., Fayetteville Past President – Dean Watts, P.D., DeWitt

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 - Greta Ishmael, Pharm.D., Cherokee Village 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 Kim Young, Pharm.D., Little Rock Academy of Compounding Pharmacists Brooks Rogers, Pharm.D., Little Rock Academy of Consultant Pharmacists Denise Robertson, Pharm.D., Little Rock

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 UAMS COP Student Ashlyn Tedder Ward, Little Rock

INSIDE APA

Remember the Name

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hen I am not advocating for Arkansas pharmacists, I really enjoy spending time with family. My wife Sarah and I have two children, Sam and Lily, who are ages 16 and 14. Like many other kids, they have been very involved in activities growing up. Sarah and I both have volunteered for all kinds of roles over the years and met many wonderful people and been part of many fun adventures and projects.

My daughter spent several years playing club volleyball and I was asked by the head coach to be an assistant coach for their team. One of our most memorable tournaments, was held north of Conway, at a venue close to Greenbrier called the Hangar at Cornerstone. It was memorable because we survived a tornado warning and an incredible rainstorm that tournament. It was also memorable because the family that owns this venue are entrepreneurs and have a heart for kids and community.

The wonderful owners are Jeremy and Kristen Riddle, a pharmacist and your current Arkansas Pharmacists Association President.

More recently, I have found myself, at least prior to the COVID-19 pandemic, spending considerable time volunteering at both USA and high school sanctioned swim competitions. I am looking forward to swim competition resuming. My son has been competing since age 9 and is now preparing for his junior year in competition. I had the privilege last year volunteering as the announcer for all of the home meets for Bryant. It’s a fun job because you get to know the kids, their favorite events and you have the most amazing seat in the house. At USA meets, we often have preliminary and finals formats where only the swimmers with the fastest times make finals, similar to Olympic competition. At these events, the fastest time in each heat for each event gets to select a “hype” song, or their favorite song to walk out on the pool deck as I announce the competitors and their lanes. One of the most played hype songs is Remember the Name by

Fort Minor.

This song John Vinson, Pharm.D. was recently APA Executive named by Vice President & CEO the Bleacher Report as a top 20 of all-time hype song for pregame pump-up for fans and athletes at sporting events.

The song title and the beat resonate with me in how our team at APA has recently turned up the volume on our mission focused activities as the “Voice” for pharmacists in Arkansas to be successful in their business and professional endeavors. Yes, we have a building to rebuild on top of normal operations, but we have not lost a beat on carrying out our mission including communicating with state law makers, our federal delegation, the Executive branch, state agencies, and others. Our team has also been working hard to pivot to online ACPE approved educational programs, our first ever virtual awards presentation, and other innovations in association activities. We are connecting with incoming student pharmacists at both Harding and UAMS, as well as connecting with our pharmacists and other APA members and friends of our association. We conducted Regional meetings virtually this year with four Zoom style meetings, one for each region, on each Thursday in September.

We are also quickly planning and finalizing strategies to best represent our APA pharmacists, APA student pharmacists and other APA members in the upcoming 2021 state legislative session, hot on the heels of the October 6th oral arguments at the US Supreme Court in the Arkansas vs PCMA lawsuit.

As the Voice of Arkansas Pharmacists, we are continuing to ensure that our stakeholders “Remember the Name”, Arkansas Pharmacists!

My challenge to you is to continue through this pandemic and beyond to be great ambassadors to our profession not only through innovations in your professional practice but also by supporting your state and national

Harding COP Student Aritney Cooper, Searcy

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pharmacist associations and serving in your communities.

Giving back some of your time, talent and finances make a huge difference in ensuring the viability and growth of the profession of pharmacy for the future. Be like Mike (Smets) and get involved in leadership for local parks and recreation, serve on the school board like Jason Finley, host informative radio shows like Alvin Simmons, or host volleyball tournaments in your back yard like Kristen Riddle. Be like Brittany Sanders,

Rodney Richmond, Sparky Hedden, Blake Torres and Josh Bright and jump headfirst into advocacy by volunteering to tell your story to local community leaders and law makers. Make a difference, leave a legacy of service and continue making sure that local communities “Remember the Name” of local pharmacists as irreplaceable key members of vibrant and healthy communities. §

FROM THE PRESIDENT

Bringing the Pieces Together

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y husband, Jeremy, and I toured a historic church in Boston while attending NCPA Annual meeting in downtown Boston a couple years ago. I was fascinated by all the ornate stained glass along each wall of the church which was built in 1875. Amazing...it was so beautiful, and each picture started as broken pieces of various colors of glass carefully brought together to tell a story for all. As pharmacists we have a similar situation. We have many broken pieces of glass in various colors. Several alone are not harmful but others have sharp edges and are dangerous such as decreased access to networks, dangerously low reimbursements, mandatory mail order, and health professional burnout. As the medication experts and professional problem solvers we must work together in our medical arts to bring these broken pieces together for something valuable to our patients and the medical community. In many areas our healthcare system is broken. We are the link in a world of siloed medical care.

We know our patients, their caregivers, their medications, their circumstances, their PCP and their specialist. We have the canvas for collaborative care for our patients.

Another example of using something broken to make something of value is Chard Art. Recently, our family went to a Chard Art Studio and each had the opportunity to make a piece of art out of broken glass, broken dishes, broken seashells, etc. We started with a blank canvas and layered the broken pieces to make a beautiful picture. That's what we do in pharmacy practice - our hospital pharmacists help our patients once they're admitted and our community pharmacists are usually the first to know the patient was discharged when the patient or caregiver walks in with their discharge medication list. We are the profession perfectly trained and positioned for collaborative care for our patients.

With pharmacists working in the transition of care and chronic care management we are building the valuable picture the patient needs. As pharmacists we are problem solvers and commonly help pick up the broken pieces for our patients.

Unfortunately, the patient is the one that ultimately suffers when there is decreased access or decreased communication

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between their healthcare professionals. Pharmacists have the skill set and training to solve healthcare challenges.

Kristen Riddle, Pharm.D. APA President

Now as Arkansas Pharmacists we have the chance to pick up the broken pieces and help build the picture for fair reimbursement and patient access across the nation. We have had decades of strong leadership in Arkansas which has impacted our nation! As Arkansas Pharmacists we have been chosen to be a part of something bigger than ourselves. 2020 is our year! 2020 has no doubt been a challenge. There are still many challenges ahead. We have the opportunity to use our challenges to make change. We can’t always control our circumstances both personally and professionally. But we can control how we respond to the circumstance. In Arkansas, we pick up the broken pieces and make a beautiful, world-changing picture! §

My daughter, Sydney, making chard art

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Stronger Together KRISTEN RIDDLE, RIDDLE, Pharm.D. 2020-2021 APA President

By Jordan Foster APA Director of Communications

“Competition makes us faster; collaboration makes us better.”

- Author Unknown

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veryone’s got an opinion about the year 2020. It’s been a year of fear, courage, loss, progress, anxiety, resolve, division, unity, despair, and hope. It was the best of times, it was the worst of times. And while it may be the only year to deserve its own wing in the National Museum of American History, a lesser known effect of “the year that never ends” is a renewed appreciation for the art of collaboration.

Online collaborations through teleconference platforms like Zoom gave Americans the opportunity to communicate, share ideas and develop new strategies while still being mindful of social distancing. Businesses like Ford, Xerox, and Hanes collaborated with healthcare leaders to manufacture critical PPE and medical supplies when the country was facing a shortage. And APA teamed up with national pharmacy organizations NCPA, APhA, and NASPA to publicize the most important pharmacy-related US Supreme Court case in history.

Now, as Kristen Riddle steps up to lead APA as President, she hopes to harness the power of collaboration that permeates the global workforce as APA and the profession of pharmacy face a year of big challenges and big changes.

Strong Foundations

With such a well-known pharmacist like Eddie Glover for a father, it should come as no surprise that pharmacy played a prominent role in Kristen’s life from a very young age. Along with her younger brother, she would spend her days after school behind the pharmacy counter with her dad, cleaning up fallen stickers, picking up boxes, and organizing vials. It was during this time that she learned just how connected and essential pharmacists are to their communities. “I remember when I was growing up, 6

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APA PRESIDENT KRISTEN RIDDLE

the pharmacy that my dad worked at was open on Christmas Eve,” Kristen said. “As a family, we would work at the pharmacy together on Christmas Eve and then we would come home and open presents as a family afterwards. That was a tradition for many, many years for us and as I grew older, I started to realize how that wasn’t really a normal experience for most families, but we had patients that were counting on us to be there for them, even on Christmas Eve.” In her senior year at Conway High School, Kristen’s dad bought his first store (College Pharmacy) where she was able to cultivate a strong sense of professional collaboration APA Past President Dean Watts swears in Kristen as the 2020-2021 APA President while working for him as a clerk and pharmacy technician. After earning a degree in dietetics from UCA and have a lot of support from my dad and his business partners. marrying her husband Jeremy, she set her sights on the Whether it was the Wellness Center or a skincare line, I would UAMS College of Pharmacy to follow in her dad’s footsteps. come up with ideas and they would allow me to explore and After graduation, Kristen’s pharmacy career led her down a fascinating path full of unexpected opportunities. She returned to College Pharmacy in Conway and used her degrees in pharmacy and dietetics to establish the College Pharmacy Wellness Center, a CLIA-waived facility that performed cholesterol testing, bone density testing, body fat analysis, patient counseling, and more. In 2005, the compounding element of College Pharmacy was spun off to create US Compounding. “When that happened, when we separated the two and you could have a focus on the traditional pharmacy and then a focus on the compounding side of things, both of those pharmacies had more room to grow and both pharmacies were able to accomplish things we never would have been able to do without giving them that space.”

During her time at US Compounding, Kristen coupled her passion for nutrition and wellness with the company’s compounding capabilities to create a collaboration of science and skincare. “Working in women’s health and compounding for years, I would see women that were experiencing mild to severe skin issues and I knew, scientifically, we had the ingredients that could provide relief.” With Kristen’s leadership, the company launched Rx Skin Therapy, a science-based line of clinical skincare products sold in hundreds of pharmacies across the country. She attributes the success of both the cosmeceutical venture and the wellness center to hard work, knowing your value as a pharmacist, and the support of her mentors. “As I was starting my career, I was really fortunate to

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develop them within the company. It was a really wonderful group to have as mentors, especially so early in my career.

And now I'm fortunate to own a pharmacy, American Home Pharmacy in Clinton, with some of those same mentors who are now my partners.”

In 2019, Kristen transitioned to a new role as community clinical pharmacist at Stanley Compounding after 14 years at US Compounding, once again combining her passion for wellness and nutrition with patient problem-solving. “I do a lot of collaborative care with the physicians and patients, doing consultations, reviewing labs, and counseling patients and consulting with them on symptoms, nutrition, supplements, vitamins, and overall hormone therapy.” Although she cherishes the time she spent at US Compounding, Kristen says she knew Stanley Compounding would be a great fit for her. “I’ve always had a lot of respect for this team at Stanley because of their high standards. Even when I was at US Compounding and we were considered ‘friendly competitors,’ I would refer patients to them, and they would do the same for us. When they approached me to see if I would consider coming on board, it was a difficult decision to leave US Compounding, but it was an easy decision to say yes to joining Stanley.”

Leading the Way

There’s no question the last few years at APA are memorable ones: 2018’s reimbursement crisis brought pharmacy front and center and 2019 saw sweeping legislative changes at the state level. However, Kristen assumes the role of APA

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Why Kristen calls her dad Eddie:

“I was a young pharmacist just out of school, and I was counseling a patient about her prescriptions. I turned around and said ‘Hey, Dad’ to ask him a question and immediately she was done with me. She only wanted to talk to him. From that day on in professional settings, I always called him Eddie.”

Timing is Everything:

“At the end of my third year of pharmacy school I was pregnant with our first son and on the first day of finals, I was waiting for the bus with some friends to take us over to the UAMS campus from the parking lot. While we were waiting, I kept experiencing this very uncomfortable feeling that had begun the night before. I felt like something just wasn’t right. I ended up having to skip my finals and head to the hospital. As it turns out, I was in pre-term labor. I wasn’t due for another six weeks and this was my first child, so I wasn’t sure what to expect, but I certainly didn’t expect to go into labor on the first day of finals. Fortunately, I was able to finish up my finals and get started on my rotations over the summer.”

Kristen and Jeremy Riddle with their kids Payton, Sydney, and Preston

President in a year that has brought a huge SCOTUS case, a deadly pandemic, and a devastating fire. Yet through the highs and the lows, the victories and the setbacks, Kristen says she’s never shied away from leadership roles because it’s woven into the fabric of being a pharmacist.

“As a profession, pharmacists are problem solvers. We solve problems for our patients every single day, whether they walk into our pharmacy, whether we’re calling them to consult with them, or whether we’re in the hospital. I’ve always told everybody, as a pharmacist you are a leader. You may not have a manager nametag, but you are a leader in that role and people look to you and depend on you.”

Kristen is in the unique position of serving at a state and national level – in addition to being APA President, she serves on the NCPA Board of Directors and over the next few years will have the opportunity to ascend to the role of president of the national pharmacy organization.

Serving in this dual role brings its own challenges, but she believes the benefits outweigh the increased responsibilities. “Collaboration is a huge part of my leadership style and being able to serve on both boards

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simultaneously fits that perfectly.

The best ideas rise to the top when you surround yourself with smart, successful, passionate pharmacists, on a state and national level, to openly discuss the issues we are facing every day.”

Perseverance:

“While I was at UCA, I took Chemistry 1 and I got a C. When I got my final grade, I thought ‘Well, that’s it. I guess I can’t be a pharmacist anymore.’ So I changed directions and pursued a different major, but I couldn’t let go of this aspiration I had to be a pharmacist. Finally, I told myself ‘I know I can do this and I’m going to do it.’ I talked to Dean Fowlkes, he gave me some great advice, and the rest is history. I like to share that story with high school and college students to remind them (and myself) that challenges are part of the experience. Don’t let something derail you from doing the things you really want to do.”

By the time Kristen ends her year as APA President in June 2021, some of the biggest issues of her presidency could look very different: the Supreme Court will have handed down its decision on Rutledge v PCMA, a COVID-19 vaccine will possibly be available to the general public, and construction could begin on the APA offices. But where some see closure, Kristen sees catalyst.

“We have to continue to push forward and take on the challenges that pharmacy faces with the same passion and fervor that has put Arkansas pharmacy in the national spotlight because, long after the SCOTUS decision or the COVID vaccine, there will still be efforts to control, diminish, or eliminate a pharmacist’s ability to serve their patients. It’s truly an honor to serve behind the leaders we’ve had here in Arkansas who have brought us to where we are. We must continue that trajectory and we must keep telling our story.” §

APA’s Impact:

“It’s nice for me to be able to step outside of our state and look at other states that don’t have such a strong association. It’s rare that a state has community pharmacy, hospital pharmacy, clinical pharmacy, consultants, everyone working together on the same board.

We must continue to work together, that’s what makes us strong. It’s how we pass the bills that we pass. It is why we have other states that look to Arkansas to see what we are doing.”

Staying Busy:

Between being APA President, serving on the NCPA board, and being a full-time pharmacist, Kristen's schedule stays full but that's not all that keeps her busy. She and her family live on a working farm, they own a transportation company led by her husband Jeremy, and they've converted a 15,000 square foot building on their property into a community center for their friends and neighbors.

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LEGISLATOR PROFILE

Representative Jimmy Gazaway PARAGOULD

District: 57 Represents (Counties):

Part of Greene (which includes the city of Paragould, Oak Grove Heights, and south along the Paragould/Jonesboro corridor to the Greene/Craighead County line)

Years in Office:

Running for my third two-year term in November 2020

Occupation: Attorney

Your Hometown Pharmacist:

Jeremy Hancock, who is also my cousin

What do you like most about being a legislator?

The legislative process. From starting with a general idea, to reducing it to writing and putting it in bill form, refining the language, working with colleagues, presenting the bill in committee and on the House floor, and then seeing it through the Senate and to the Governor’s desk. I really enjoy working through that process.

What do you like least about being a legislator?

The balancing act of maintaining a private law practice, spending time with family, and being in Little Rock when necessary

Most important lesson learned as a legislator:

Advice for pharmacists about the political process and working with the Arkansas Legislature:

Be involved. Get to know your State Representative and Senator personally. Sit down with them one-on-one outside of the legislature and explain to them what is important to you, your profession, and your patients. And then when the legislature is in session, contact them personally and let them know your opinions and how you would like for them to vote.

It really will make a difference.

Your fantasy political gathering would be:

JFK, Bobby Kennedy, Winston Churchill, Abraham Lincoln, and Ronald Reagan

Hobbies:

Music, traveling, history, politics, and Memphis Grizzlies basketball

Relationships are so important. To be successful, a legislator needs to build strong relationships with members of both parties and with members in both the House and the Senate.

Most admired politician: Robert F. (Bobby) Kennedy

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UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY

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

Gabapentin This issue of Safety Nets illustrates the potential hazards associated with poorly handwritten prescriptions. Thank you for your continued support of this column.

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he e-prescription illustrated in Figure One was transmitted from a prescriber's office to a community pharmacy in Southern Arkansas. The technician entered the gabapentin patient directions into the pharmacy computer as "take three capsules by mouth once daily." This information - along with the prescription image - was transmitted from the input queue to the pharmacist verification queue of the computer. While verifying the accuracy of the order, the pharmacist realized this E-prescription actually contained three separate patient directions: 1. Three capsules once daily 2. One capsule in the morning and two at night 3. Two capsules every morning and two every evening

Figure 1

Who entered the order information into the electronic prescription software? Were they a health care professional or support personnel? Did the prescriber review the order before transmission to the pharmacy? If not, why not?

All pharmacists must be diligent in scrutinizing every prescription, whether electronic or handwritten. We must not allow ourselves to be lulled into a false sense of security based on the neatness and legibility of E-prescriptions. § STUDENT SPOTLIGHT

Diet & Exercise: It Works!

- Isabelle Reaves

The first two Sigs. are contained in the "Directions" section of the order, while the third is contained in the "Notes" section.

Confused by these discrepancies, the pharmacist telephoned the prescriber's office for clarification. The prescriber's nurse confirmed the patient was to administer two gabapentin 300 mg capsules every morning and two every evening. The nurse had no explanation as to why the intended Sig. was contained in the "Notes" section of the order rather than the traditional "Directions" section. She also had no explanation as to why the two incorrect Sigs. were contained in the "Directions" section.

After this, the prescription was correctly filled and the patient appropriately counseled.

Today, approximately 80% of all prescriptions are transmitted electronically. Accordingly, most Safety Nets now focus on the hazards associated with electronic prescriptions. This seems at odds with the Health Resources and Services Administration (HRSA) statement "compared to paper prescriptions, e-prescribing improves medication safety along with prescribing accuracy and efficiency". E-prescriptions do have certain advantages over handwritten prescriptions such as reducing the number of SALAD (sound-alike, look-alike drugs) mix-ups.

On the other hand, electronic prescribing has introduced new types of medication errors into the health care system. Many of these new types of errors would be extremely unlikely - or even impossible - with traditional handwritten prescriptions.

In this case, would ANY prescriber intentionally or unintentionally handwrite a prescription containing three separate, contradictory, Sigs? Of course not. Clearly, this E-prescription does not "improve medication safety along with prescribing accuracy and efficiency". Certain questions about this order are appropriate.

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One afternoon, a patient came to our pharmacy to pick up her diabetes and cardiovascular medications. During checkout, she mentioned her prescriber wanted to add an additional medication to her diabetes regimen. She asked me, “How can I get off some of these medications? I’m tired of taking them.” I told her simple lifestyle changes – specifically eating healthier and increasing her physical activity – can often make a big difference in one’s health. She was skeptical and responded, “That’s a lot of work and I don’t have time for all that.”

A few days later, she came back to the pharmacy and asked me to help her create a diet plan and shopping list tailored to her monetary means. I created a meal plan including lean protein and vegetables with an occasional cheat meal. I also created an exercise plan focusing on 15-minute intervals of brisk walking at specific times throughout the day. Finally, I encouraged her to come back once a week and keep me posted on her progress.

Over the next few months, whenever she returned to the pharmacy, we would discuss her diet and exercise regimen. After one of her physician appointments, she came to the pharmacy and told me she had lost 40 pounds and her prescriber had discontinued one of her cardiovascular medications. Along with her physical transformation, I also noticed she had improved selfconfidence and self-esteem. I am proud I made a difference in this patient’s life. In my opinion, counseling patients about living a healthy lifestyle is equally as important as counseling about their medications.

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MEMBER SPOTLIGHT

Kendrea Jones, Pharm.D. Arkansas Children's Hospital Little Rock, AR

Pharmacy/academic practice: Health-system pharmacy Pharmacy school and graduation year: UAMS College of Pharmacy, 2005

Years in business/years teaching: Wow, it's hard to believe

but I have been a pharmacist now for 15 years! After completing 2 years of residency, I joined the faculty at the UAMS College of Pharmacy where I had a clinical practice site in the Arkansas Children’s Hospital (ACH) Burn Center for 12 years. In June 2019, I moved into the position of Operations Manager for the ACH Pharmacy Department and most recently was promoted to Director of Pharmacy.

Favorite part of the job and why: The variety of pharmacy

and other healthcare professionals that I get to work with to improve patient care for Arkansas Children’s Hospital patients.

I absolutely love working with team members to solve problems.

Ideal dinner guests:

The extent of regulation in pharmacy and keeping up with all the requirements and changes that occur; it can be challenging at times to feel like an expert in all areas. I will say my other least favorite part right now is leading in the middle of a pandemic; I clearly missed that lecture or course.

My deceased paternal grandmother and maternal grandfather and Michelle Obama. I would love to hear words of wisdom from my grandparents on how they would manage and navigate current times. Several years ago, Michelle Obama served as the keynote speaker for ASHP Midyear. She was so down to earth and I would love to be in her presence, go to Target and hear more about what she has learned from her previous experiences.

What do you think will be the biggest challenges for pharmacists in the next five years? It’s the challenge we

If not a pharmacist then…: If I were not a pharmacist, I would

Least favorite part of the job and why:

have been facing for some time, obtaining provider status and reimbursement for the services we provide both associated with medications and beyond. I think we are all called on to work with our state and national associations to continue to push for provider status and appropriate reimbursement. Continuing to find ways to demonstrate the need for appropriate resources and compensation for the expertise we bring to patient care is pivotal.

Specifically, for health system pharmacy navigating specialty pharmacy services, drug shortages, continued concerns about 340B and stability of the program, and having resources available to adequately apply data analytics to optimize patient care are all continued challenges.

Oddest request from a patient/customer: I was once asked

if I could go to the local liquor store and bring in whiskey for a patient since our hospital only stocked beer and this patient was refusing beer.

Recent books read: I am currently listening to “The 4 Disciplines of Execution” and recently re-read “The Hate You Give”.

Favorite activities/hobbies: I love binge watching older shows

probably have pursued a career in computer engineering. I enjoy thinking about how you can utilize technology to solve problems.

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

I see my involvement in APA and AAHP as my way of preserving a career that I love. Now more than ever, pharmacists in all areas are faced with a number of challenges in which we all have to work together and be united in advancing our profession. My membership in APA and serving on the board of AAHP directly supports that advancement. It gives me a voice at the table to help make an impact on our current profession and its future.

You were named to the APA Phoenix Committee, which will make key decisions about the future of APA’s headquarters. What’s it like being part of a group that will be making such long-lasting decisions for APA’s future? I was honored to be asked to participate in the APA Phoenix Committee; it is so much more than planning a building.

It is exciting to have a voice in setting the long-term strategic plan for growth of the association and its academies. §

on Netflix and spending time with my family.

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Brisk Drug Approval During the COVID-19 Pandemic

D

uring the COVID-19 pandemic, the FDA has worked to protect and promote public health through activities ranging from the acceleration of development for treatments for COVID-19, maintaining and securing drug supply chains, providing guidance to manufacturers, advising developers on how to handle clinical trial issues, to providing conservation strategies for personal protective equipment, expediting authorization of medical products to address public health emergencies, drafting policies and guidance to support rapid response to COVID-19, and generally keeping the public informed. Despite being engaged in these essential COVID-19 activities, they managed to approve 22 new drugs and biologicals through the first part of 2020.

Acute Care: Artesunate, through priority review as an orphan

drug after having been available through an FDA and CDC expanded access program, became the only drug approved in the U.S. since quinine to treat severe malaria. Barhemsys® (amisulpride) was approved for the prevention or treatment of postoperative nausea and vomiting. Nurtec™ ODT (rimegepant) was granted priority review as a calcitonin gene-related peptide receptor antagonist for the treatment of acute migraine.

Chronic Care:

Isturisa® (osilodrostat) received orphan drug designation for the treatment of Cushing’s disease where pituitary surgery is not an option or has not been curative. Nexletol™ (dempedoic acid) was approved to treat heterozygous familial hypercholesterolemia or for additional lowering of LDL-C in patients with established atherosclerotic cardiovascular disease. Pizensy™ (lactitol) is a simple monosaccharide sugar alcohol that works as an osmotic laxative to treat chronic idiopathic constipation. Vyepti™ (eptinezumabjjmr) a calcitonin gene-related peptide antagonist indicated to prevent migraines. Tauvid™ (flortaucipir F18) received fasttrack breakthrough therapy review as a radioactive diagnostic aid indicated for PET imaging to estimate the brain density and distribution of tau neurofibrillary tangles in patients being evaluated for Alzheimer’s disease. Ongentys® (opicapone) is a COMT inhibitor approved as adjunct treatment to levodopa/ carbidopa in Parkinson’s disease. Tepezza™ (teprotumumabtrbw) is an insulin-like growth factor-1 receptor inhibitor that received fast-track breakthrough review as an orphan drug to treat rare thyroid eye disease. Zeposia® (ozanimod) is a sphingosine 1-phosphate receptor modulator indicated to treat relapsing forms of multiple sclerosis.

Oncology: Seven kinase inhibitors received priority review

and orphan drug status as breakthrough therapies. Tukysa™

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(tucatinib) became the first drug approved under Project Orbis, an international regulatory collaboration program, and is indicated for metastatic HER2-positive breast cancer. Ayvakit™ (avapritinib) was approved for gastrointestinal stromal tumors harboring a platelet-derived growth factor receptor alpha exon 18 mutation. Koselugo™ (selumetinib) was approved to treat plexiform neurofibromas in pediatric patients with the rare disease neurofibromatosis type 1. Qinlock™ (ripretinib) was approved through the real-time oncology review process as 4th-line treatment of advanced gastrointestinal stromal tumor.

Pemazyre™ (pemigatinib) became the first treatment approved for advanced cholangiocarcinoma with fibroblast growth factor receptor 2 fusion. Retevmo™ (selpercatinib) is indicated for RET (mutant or fusion) non-small cell lung, medullary thyroid, and other types of thyroid cancers. And Tabrecta™ (capmatinib) became the first therapy approved for non-small cell lung cancer with MET exon 14 skipping. Also receiving approval was Cerianna™ (fluoroestradiol F18), a radioactive agent used with PET imaging to detect estrogen receptor-positive lesions as an adjunct to biopsy in breast cancer. Sarclisa® (isatuximab-irfc), a CD38-directed cytolytic antibody, was approved as an orphan drug to treat multiple myeloma. Tazverik™ (tazemetostat), a methyltransferase inhibitor, received accelerated approval as an orphan drug to treat advanced epithelioid sarcoma. Trodelvy™ (sacituzumab govitecan-hziy) is a Trop-2-directed antibody and topoisomerase inhibitor that received priority review and orphan drug status as a breakthrough therapy to treat metastatic triplenegative breast cancer.

New Dosage Forms: Significant new dosage forms approved

this quarter include: Anjeso™ (meloxicam, injection) NSAID for moderate-to-severe pain; Bynfezia Pen™ (octreotide, SQ injection) for acromegaly, carcinoid tumors, or vasoactive intestinal peptide tumors; Durysta™ (bimatoprost, implant) for reduction of intraocular pressure; Elyxyb™ (celecoxib, oral solution) for acute migraines; Fensolvi® (leuprolide, injectable kit) for pediatrics with central precocious puberty; Jelmyto™ (mitomycin, pyelocalyceal solution) for upper tract urothelial cancer; Milprosa™ (progesterone, vaginal insert) to support embryo implantation and early pregnancy; Monoferric® (ferric derisomaltose, IV) iron deficiency anemia; Procysbi® (cysteamine, delayed-release capsules and oral granules) for nephropathic cystinosis; Trijardy® XR (empagliflozin/ linagliptin/metformin, extended-release tablets) for type 2 diabetes; Twirla® (levonorgestrel/ethinyl estradiol, patch) for contraception; and Valtoco® (diazepam, nasal spray) for acute treatment of seizure clusters and repetitive seizures. §

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Headquarters of Changchun Changsheng Life Sciences Ltd. in Changchun, Jilin province.

Credit: ChinaImages/DepositPhotos.com

Chokehold on U.S. Drug Supply Chain

By Brandon Van, Harding College of Pharmacy Pharm.D. Candidate, Wade Weaver, UAMS College of Pharmacy Pharm.D. Candidate, and John Vinson, Pharm.D.

The capability to treat a simple infection or high blood pressure in the United States may soon become compromised, frankly due to our country’s position at the mercy of foreign active pharmaceutical ingredient (API) manufacturers. APIs are the components of a medication that perform the intended drug action. Dosage forms, such as tablets and capsules, contain APIs and other inactive ingredients that are brought together to form a final drug product. Over the past 30 years, the manufacturing of these active pharmaceutical ingredients has become an increasingly global enterprise.

Beginning in the 1970s, industry moved away from the mainland United States, first to Puerto Rico in response to tax incentives, and then to Europe and developing nations such as China and India. Overseas countries have virtually monopolized the global market of ingredients required to manufacture critical medications, posing public safety issues farther reaching than many may realize. The Food and Drug Administration (FDA) now reports that approximately eighty percent of activeingredient manufacturers are located outside the United States, and for some key drugs, China is the only supplier.

Notably, the Department of Commerce found in a recent study that ninety-seven percent of all active ingredients required to

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make antibiotics and blood pressure medications came from China. Such a non-diversified supply chain inevitably creates a fragile situation which lacks sustainability in the face of political dissension, natural disasters, or a worldwide pandemic.

The COVID-19 pandemic is one such example of a threat to our critical drug supply chain that has caused significant disruption in both the manufacturing and delivery of medical products throughout the United States. The problem for the industry has been compounded by the fact that much of Chinese drug raw material production is concentrated in Hubei, whose capital is Wuhan, the epicenter of the coronavirus outbreak.

Amidst the pandemic and a worldwide shutdown, there has been a surge in drug shortages over the last several months including antibiotics, insulin, and anesthesia that are vital for hospital and dental procedures. An April study by the National Community Pharmacists Association (NCPA) found that ninety percent of neighborhood pharmacies have experienced drug shortages since March 1, 2020 as a result of COVID-19.

Drugs in short supply have included albuterol inhalers, hydroxychloroquine, azithromycin and other drugs in high demand since the outbreak. With Chinese drug manufacturers reopening, drug stores are being replenished, but with the

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THE ARKANSAS PHARMACIST

CHOKEHOLD ON U.S. DRUG SUPPLY CHAIN

absence of staff due to quarantines and problems with transport, the amount of drug manufacturing is still limited. Chenghaw Wu, manager of Zhejiang Guobang Pharmaceutical stated “Resuming work does not mean resuming production.” Although the supply chain is improving, it still remains in some sort of disarray.

Furthermore, political agendas undoubtedly play a major role in the United States’ healthcare system and our ability to secure critical medications. In a time of rampant instability and international conflict, we as a nation cannot afford to become fully dependent on any single foreign entity for any goods, much less pharmaceutical ingredients. As China and India maintain their chokehold on the manufacturing of APIs, we are unnecessarily at risk of these countries viewing our massive import of vital medications as pressure points, which then grants them leverage against the United States. As Rosemary Gibson, a senior advisor at the Hastings Center, recently testified, “If China shut the door on exports of medicines and their key ingredients, U.S. hospitals and clinics would cease to function within months, if not days.”

This presents a compelling need to safeguard the world’s supply of medicines from the vulnerabilities inherent in relying on any one region for a significant proportion of essential raw drug materials. China’s ability to bring the world to its knees should they stop production or export of pharmaceutical ingredients presents a dire problem that should be viewed as a matter of national security.

Map of Wuhan in the Hubei Province of China

Credit: DepositPhotos.com

Perhaps an even more alarming concern comes into play when we consider that medications that we massively import into the United States are oftentimes either ineffective or contaminated. In the summer of 2018, Changchun Changsheng Biotechnology, one of China’s largest vaccine manufacturers, sold at least 250,000 substandard doses of vaccine for diphtheria, tetanus, and pertussis. The company has since had their license revoked and fined $1.32 billion by the Chinese government. Furthermore, the FDA has largely blamed a specific Chinese pharmaceutical company for the recalls on valsartan products that likely contain the N-nitrosodimethylamine (NDMA) carcinogen. The FDA has issued multiple urgent drug recalls related to other NDMAcontaminated medications including losartan, ranitidine, and one of the most widely used antidiabetic drugs, metformin.

As depicted in Figure 3, the FDA has seen an exponential increase in the foreign facilities designated as official action indicated

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CHOKEHOLD ON U.S. DRUG SUPPLY CHAIN

(OAI) upon inspection since 2006. Official action indicated is a designation meaning regulatory and/or administrative actions will be recommended, which could lead to an import alert or product seizure.

It comes as no surprise that utilizing developing countries, such as China and India, for the manufacturing of drug materials provides cost savings to pharmaceutical companies because of their lower labor, energy, and transportation costs.

However, these countries also have less stringent (FIgure 3) Concurrence rates on foreign drug inspections designated OAI 1996 to 2019. Credit: U.S. Food & consumer protection laws Drug Administration and weaker environmental Act of 2020. This bill would ban the use of federal funds regulations than more for the purchase of drugs manufactured in China, require developed countries. The unnecessary risk that these the Secretary of Health and Human Services to create a variables put on consumers in the United States is evident registry of all drugs and corresponding APIs that are produced in the contaminated and subpar medications that have outside the U.S., and provide incentives for moving medical recently come to light. As China and other countries continue manufacturing to the U.S. Thus far, this bill was referred to to monopolize the world’s supply of medications, we are the Committee of Finance. The FDA has also put together presented with the threat of a major public health crisis that a series of recommendations that we cannot afford to come to fruition. include implementing a rating system to incentivize drug manufacturers Domestic manufacturing capacity of Our nation must demand better to invest in mature manufacturing APIs is essential to prevent supply for the American healthcare quality systems. Recent legislative disruptions. Ideally, the United States consumer and must be prepared efforts are certainly a step in the right needs to begin to move towards to provide for itself in the event direction and a partnership between complete independence of foreign our foreign drug supply chain is healthcare professions could push drug manufacturers. Although this cut off, especially when it comes the needle farther to solving the is likely easier said than done, the to life-saving medications. issues of dependence on foreign drug issue is now gaining traction within manufacturers and protecting our the FDA and Congress, with at least country’s drug supply chain. ten separate bills proposed. In March 2020, Representative French Hill of Arkansas introduced Maintaining healthcare affordability is of utmost importance, H.R. 6399 - SAVE Act of 2020, which aims to decrease our and while outsourcing API production may produce a nation’s reliance on foreign countries for medical supplies by cost-advantage, it is imperative that a patient’s right to amending the Defense Production Act to include our medical safe, effective, and readily accessible medication not be supply chain, our vaccines, and our primary ingredients for compromised in the process. While proponents of outsourcing pharmaceuticals. The bill also includes a key provision that from foreign countries believe that the financial benefits requires the president’s administration to develop a strategy outweigh the safety risks, it is evident that these decisions on how to diversify drug supply chains. Hill commented on have an alarming potential to cause public harm. Our nation the bill, stating, “This will ensure that during times of a public must demand better for the American healthcare consumer health emergency, like we are experiencing right now, we have and must be prepared to provide for itself in the event our the supplies we need to keep Arkansans and Americans safe.” foreign drug supply chain is cut off, especially when it comes to life-saving medications. § Arkansas Senator Tom Cotton recently introduced S.3537 - Protecting our Pharmaceutical Supply Chain from China

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ARKANSAS ACADEMY OF HEALTH-SYSTEM PHARMACISTS

Modified AAHP Fall Seminar 2020 is Going Virtual Kim Young, PharmD AAHP President

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all Seminar is going to look very different this year due to the COVID pandemic. This year Fall Seminar will be an evening virtual event on Thursday, October 8, 2020. Unlike previous years, this year's event will not be associated with any CE credit. The evening event will consist of a presentation from Barbara Nussbaum, ASHP Vice President for Research and Education on the Pharmacy Forecast for 2020. We will also recognize the outgoing AAHP Officers and Presentation of Awards.

The ASHP Pharmacy Forecast has been developed for the past 7 years to focus on key opportunities for practice leaders within the next five years. This year’s report focuses on patient-centered care, pharmacy education and workforce, pharmaceutical supply chain, healthcare reform, among other topics.

For the awards, we want to recognize the extraordinary work of our pharmacy professionals across the state. The following awards will be presented.

Manager of the Year

This is an annual award established by AAHP to recognize the accomplishments of a pharmacist in a purely management position. It recognizes the exceptional work of the recipient during the last 12 to 18 months.

Clinician of the Year

This is an annual award established by AAHP to recognize the accomplishments of a pharmacist in a clinical pharmacy position who provides an innovative approach to pharmaceutical care, has made outstanding contributions to clinical pharmacy, and serves as a role model for fellow clinicians. It recognizes the exceptional work of the recipient during the last 12 to 18 months.

Residency Preceptor of the Year

This is an annual award established by AAHP to recognize the accomplishments of an Arkansas pharmacy residency preceptor who has demonstrated exceptional mentorship in developing residents by serving as a role model with passion for knowledge sharing. It recognizes the exceptional work of the recipient during the last 12 to 18 months.

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New Practitioner of the Year

This is an annual award established by AAHP to recognize a pharmacist who has been active in the practice of pharmacy for 7 years or less and displays leadership, professionalism, and dedication to the future of health-system pharmacy. It recognizes the exceptional work of the recipient during the last 12 to 18 months.

Staff Pharmacist of the Year

This is an annual award established by AAHP to recognize the accomplishments of a staff pharmacist who has exhibited interest and incentive in the practice of the profession of pharmacy above the level required in a staff position. This award recognizes work accomplished within the past 12 to 18 months and is open to frontline staff pharmacists.

Technician of the Year

This is an annual award established by AAHP in 1995 to recognize the contributions and achievements of a career technician who works to advance the practice of pharmacy and help promote opportunities for patient focused care. It recognizes the exceptional work of the recipient during the last 12 to 18 months.

Even though this year’s Fall Seminar will not offer CE credit, AAHP is offering free monthly ACPE CE in conjunction with UAMS for AAHP members. APPE students are providing the CE under direction of his or her preceptor. Monthly emails are sent announcing the upcoming CE and shared on social media. Thank you to all the preceptors, students, UAMS for allowing AAHP to offer this service to our members.

Another learning opportunity that AAHP is offering is a monthly virtual journal club. This however is not associated with CE credit. This journal club is led by residents from various health systems across the state. There is a new trial presented each month, if you have an article you would like a resident to review, please email Cody Null (Cody.Null@ baptist-health.org).

We are also planning on a virtual poster presentation and a virtual residency showcase as well. More information will be sent out on these events as we work out the details.§

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UAMS SCHOOL OF PHARMACY & HARDING UNIVERSITY REPORT

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

Jeff Mercer, Pharm.D. Dean and Professor Harding University College of Pharmacy

2020 UAMS and Harding Colleges of Pharmacy Salary Survey

Results Compiled by: Sarah Griffin, Assistant Dean for Academic Affairs (HU COP); Lanita S. White, Assistant Dean for Student Affairs (UAMS COP), Jeff Mercer, Dean (HU COP), Cindy D. Stowe, Dean (UAMS COP)

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n behalf of the UAMS and Harding University Colleges of Pharmacy, we offer our sincere congratulations to the Arkansas Pharmacy Classes of 2020. As they take the NAPLEX and start their new jobs or postgraduate work, we certainly wish them all the best.

As in previous years, we appreciate the students’ willingness to complete a salary survey, especially during the COVID-19 pandemic and the unprecedented changes initiated to combat the spread of the coronavirus. The response rate of the survey was 89% (144 of 162). As collected prior to commencement, the information indicates the job market for our 2020 Arkansas pharmacy graduates has held steady from 2019, despite the ongoing pandemic.

Overall, the average hourly salary for accepted pharmacist positions prior to graduation was $54.55 (n=39), a slight decrease from 2019’s $56.36 per hour. Of the 144 students who completed the survey, 58% had already accepted a position – down from 65% in 2019 but still stronger than the 50% rate in 2018. Additionally, 78% of respondents characterized the opportunities for employment as fair, good, or excellent, compared to 65% in 2019.

Trends in practice setting from previous years have also seen changes. This year, 51% of the students who accepted a position did so at a practice setting where they had served as an intern or spent time during an experiential assignment as compared to 42% of the Class of 2019. Fifty-two percent of graduates who accepted a position prior to graduation are doing a residency/fellowship while 40% (n=33) of graduates who accepted a position will be working in a community/ retail setting. Fifteen percent of respondents plan to own a pharmacy, unchanged from 2019 and the highest percentage since 2015.

Graduates who have student loans make up 88% of the group completing the survey with an average amount of debt of $178,070 per student.

In summary, our graduates enter the workforce at one of the most demanding times in recent history. The faculties of UAMS and Harding Colleges of Pharmacy are confident that our graduates are well prepared to conquer the challenges ahead and begin successful careers as pharmacists. §

Summary • 144 Arkansas graduating pharmacy students completed the survey • University of Arkansas for Medical Sciences (n=97) • Harding University (n=47) • 86% of respondents completed at least 3 years of pre-pharmacy education with 7% earning an associate’s or master’s degree prior to admission • 58% of respondents accepted a position prior to graduation • The average salary for graduates (excluding residency) is $54.55/hour • Overall 64% of graduates who accepted positions will practice in Arkansas, with the majority settling in central Arkansas. Excluding residency positions, 15% percent will practice pharmacy outside of Arkansas with the majority going to Tennessee and Texas • 40% of graduates (excluding residency) who accepted a position did so in a community setting (chains, independent, mass-market, specialty pharmacies, consultant, etc.)

• Forty three respondents (52%) are completing a PGY1 residency or fellowship; mean salary is $46,453 • Sixty-seven of 86 respondents (78%) believe positions opportunities are fair, good, or excellent • Approximately 15% plan to own a pharmacy in the future and 27% are undecided • According to respondents, the most sought-after job characteristics are good working conditions, fair pay, and interesting work • Top benefits offered by employers: health insurance, paid vacation, and retirement plan • 88% of graduates have student loans with an average of $178,070 and totals ranging from $12,000 to $370,000

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Graduate Demographics

Position Information

Salary Information by Position

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2020 UAMS AND HARDING COLLEGES OF PHARMACY SALARY SURVEY

Position Location Information

Employer Benefits by Rank

AAHP Board

Arkansas State Board of Pharmacy

Executive Director...................Susan Newton, Pharm.D., Russellville President................................Kimberly Young, Pharm.D., Little Rock President-Elect............................Hye Jin Son, Pharm.D., Little Rock Immediate Past President..Erin Beth Hays, Pharm.D., Pleasant Plains Treasurer..................................Kendrea Jones, Pharm.D., Little Rock Secretary.........................................Melissa Shipp, Pharm.D., Searcy Board Member at Large................Chad Krebs, Pharm.D., Little Rock Board Member at Large.............Amber Powell, Pharm.D., Little Rock Board Member at Large....................Gavin Jones, Pharm.D., Benton Technician Representative...........BeeLinda Temple, CPhT, Pine Bluff

President................................Lenora Newsome, P.D., Smackover

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Vice President/Secretary....Rebecca Mitchell, Pharm.D., Greenbrier Past President...............................Debbie Mack, P.D., Bentonville

Member................................Rodney Richmond, Pharm.D., Searcy

Member.................................Lynn Crouse, Pharm.D., Lake Village Member.............................................Brian Jolly, Pharm.D., Beebe Public Member...........................................Carol Rader, Fort Smith

Public Member..............................................Amy Fore, Fort Smith

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YOUR JOURNEY

BEGINS HERE!

pharmacy.UAMS.edu

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CONSULTING ACADEMY REPORT

Readjusting My Sails Denise Robertson, P.D. Consulting Academy President

“It is not a failure to readjust my sails to fit the waters I find myself in.”

- Mackenzi Lee

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have recently taken up sailing again, so this quote is quite timely. It also applies to navigating changes in pharmacy practice during this Covid-19 pandemic.

We find ourselves continuing to meet customer needs in spite of closed retail lobbies and drug, staff and PPE shortages.

Consultant Pharmacists have had to address the challenge of serving their nursing home residents and facilities during the no visitation mandate that started on March 13th.

Communication has been the critical factor in managing these challenges. The APA board and staff have worked tirelessly in keeping its pharmacy members informed on issues of PPE procurement, Pharmacy Board directives and ways to navigate changing business protocol. The Arkansas Health Care Association (AHCA) has been essential in keeping long-term care facility owners, staff and contract personnel informed through weekly conference calls and updates. Each call provides the most recent governor’s update on Covid-19 statistics. Communications from the Office of Long-term Care are discussed, as well as those from other state and federal agencies. Changes in PPE protocol, family visitation protocol, staffing challenges, lab screening recommendations, required lab result reporting and CARES Act funds distribution are all addressed. AHCA was also essential in the coordination of the Governor’s

mandate to test all nursing home residents, staff and contract workers in June.

The restriction of nursing home entry to essential staff in order to protect our most vulnerable population was our main hurdle. Contract personnel such as nutritionists, physical therapists, medical directors and consultant pharmacists were not allowed in the facilities. Each group mentioned had to change the way they served their clients.

Consultant pharmacists collaborated with each other early on as to how they would proceed. Face to face meetings were replaced by virtual meetings and conference calls.

Facility owners were consulted on their new protocols and precautions. We had to figure out how to continue to meet state and federal rules and regulations while committed to the protection of ourselves, residents and staff. Those facilities that use electronic health records were able to adjust well.

Pharmacists were still able to do their medication regimen reviews off site. For those facilities that did not use electronic health records, it was more of a challenge. Monthly site visits were abbreviated or suspended depending on the presence of positive Covid-19 cases in the building. As a result, many phone calls were made with administrators and directors of nursing to address any issues that pertained to the usual site visit such as narcotic documentation, drug destruction and surrender, medication stock and glucometer maintenance.

The following are additional changes that were implemented during the pandemic. Routine pharmacy deliveries and reconciliations were conducted outside the facility. As restrictions eased and residents/staff tested negative, some pharmacists conducted “drive by” visits so that required documents could be signed outside the facility using proper PPE protection. Some facilities set up work stations outside their buildings so that contract workers would have access to the needed documents. As visitation restrictions eased in July for those facilities with negative resident/staff test results, the pharmacist site visit now involves screening at entry, washing of hands and masking up. Some facilities even require wearing full PPE as part of their protocol. Ever try to page through mounds of paperwork wearing gloves?

Strict adherence to policy and procedure recommended by officials from our state and federal agencies is significantly reducing the rate of Covid-19 spread amongst nursing home residents. We must keep doing our part. We must remain adaptable and readjust to fit the waters we find ourselves in.

Stay Safe! §

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COMPOUNDING ACADEMY REPORT

Brooks Rogers, Pharm.D. Compounding Academy President

Recommendations on the Safety, Effectiveness and Use of Compounded Bioidentical Hormone Therapy

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s I begin my tenure as the APA Compounding Academy President, I wanted to begin by introducing myself. I am a 3rd generation pharmacist at Don’s Pharmacy in Little Rock alongside my Dad, brother, cousin and uncle. Our store has grown into a hybrid of sorts. We are a combo pharmacy that services retail and long-term care patients, while we also have a non-sterile compounding lab. Our front end is primarily focused on DME, wound care and surgical supplies.

I was born and raised in Little Rock. I did my undergraduate at the University of Arkansas (during ‘the Bobby Petrino era’), and graduated from the UAMS College of Pharmacy in 2014.

My wife and I have two boys, ages 3 and 1.

• Recommendation 3:

In my first article, I wanted to draw your attention to a study that was recently published by the National Academies of Science, Engineering, and Medicine (NASEM) titled “The Clinical Utility of Compounded Bioidentical Hormone Therapy: A Review of Safety, Effectiveness and Use.” I want to share the conclusions released by NASEM with the membership because if you’re a compounding pharmacy, I am certain you compound bioidentical hormone therapy (BHT). BHT is a big deal for compounding pharmacies, but more importantly for the patients we serve.

• Recommendation 5:

The study concludes with 6 recommendations in regards to BHT safety, effectiveness, and use.

• Recommendation 1:

Restrict the use of BHT preparations. Prescribers should limit BHT preparations to patients with a known allergy or a required dosage form other than what is commercially available. Also, they recommend that compounded BHT doses should not exceed those of FDA-approved hormone therapy products.

There should be an increase in education for prescribers and pharmacists who market, prescribe, compound, and dispense BHT preparations. For prescribers, the committee recommends they receive a certification at the state level if they are want to begin or continue prescribing BHT compounds. For pharmacists, the committee recommends more in depth training on BHT compounds.

• Recommendation 4:

Further federal and state oversight is needed to improve public health and clinical concerns regarding the safety and effectiveness of BHT. All conflicts of interests should be gathered and released. Conflicts of interest should be open to the public in a publicly available source maintained by state licensing boards.

• Recommendation 6:

Evidence of the safety, effectiveness and use of BHT compounds needs to be strengthened and developed.

I share these conclusions with you to ensure compounding pharmacies are conscious that they are always under fire.

Keep in mind, this is just the latest study of many to have targeted BHT over the years. It may or may not have much weight and perhaps very little effect on your compounding business, but it’s certainly something to be aware of in the ever-changing compounding pharmacy landscape. As we say at Don’s Pharmacy, “it’s always something.” §

• Recommendation 2:

The Pharmacy Compounding Advisory Committee should examine certain BHT for the FDA’s Difficult to Compound List: estradiol, estrone, estradiol cypionate, estriol, dehydroepiandrosterone, pregnenolone, progesterone, testosterone, testosterone cypionate, and testosterone propionate.

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2020 APA Award Winners Brittany Sanders, Pharm.D. was awarded the 2020 Pharmacist of the Year Award.

This award was established in 1959 to honor an APA member who possesses professional standards beyond reproach, has a record of outstanding civic service in the community, and has contributed his or her efforts toward the progress of the profession through the state association.

Pharmacist of the Year Brittany Sanders, Pharm.D.

Dr. Sanders has been incredibly active in the past few years in her roles as pharmacist and advocate. A native of Hot Springs, she worked in retail pharmacy for 12 years and is now the co-owner of the Pharmacy at Wellington in west Little Rock. She chose pharmacy because she wanted to be involved in patient care and it is that dedication to her patients that drove her to appear before the Arkansas legislature in 2019 to testify in support of bills that would help Arkansas patients and pharmacists.

For her continued dedication to her patients and her active role in advancing the profession of pharmacy, Dr. Sanders is recognized as the 2020 APA Pharmacist of the Year.

She is a graduate of the University of Arkansas Fayetteville and the UAMS College of Pharmacy. She and her husband Chad have two children and one foster son.

Victoria Hennessey, Pharm.D. was awarded the 2020 Distinguished Young Pharmacist Award. The APA Distinguished Young Pharmacist Award is given annually to an outstanding young pharmacist who has been out of pharmacy school less than ten years and who has demonstrated leadership among his or her peers.

With less than a decade under her belt since graduating from pharmacy school, Victoria Hennessey has packed a lot of experience into such a short time. In the last few years, she split her time between filling prescriptions at a Springdale independent community pharmacy and serving in an ambulatory setting, working side by side with physicians in team-based care for low income patients in an underserved area. In July, her work in leadership positions in the pharmacy world pushed her to purchase the same store where she previously filled prescriptions.

Distinguished Young Pharmacist Victoria Hennessey, Pharm.D.

Victoria is a graduate of UCA and UAMS College of Pharmacy. She and her husband have two kids and own Community of Pharmacy of Springdale.

Mike Smets, P.D. was awarded the 2020 Bowl of Hygeia Award. The Bowl of Hygeia Award is sponsored by the American Pharmacists Association Foundation and National Alliance of State Pharmacy Associations, with premier support from Boehringer-Ingelheim. This award was established to honor pharmacists who have compiled an outstanding record of community service.

Bowl of Hygeia Award Mike Smets, P.D.

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Dr. Smets grew up in the Fort Smith area spending a lot of time in community pharmacies as his father and grandfather were both pharmacists and independent pharmacy owners in Van Buren and were a great influence on him becoming a pharmacist. Community service is close to his heart as he serves on the boards of the Fort Smith Parks Commission, the Sebastian County Red Cross, the Artists, Audiences, and Community organization, and he now serves as President of Park Partners of Fort Smith.

He is a graduate of the University of Arkansas Fayetteville and the UAMS College of Pharmacy and is the pharmacist in charge at Coleman Pharmacy in Fort Smith. He and his wife Bonnie have one daughter and two grandchildren.

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2020 APA Award Winners Anne Pace, Pharm.D. was awarded the 2020 Excellence in Innovation Award.

This award was established in 1993 by the APA in cooperation with the National Alliance of State Pharmacy Associations to annually recognize a pharmacist who has demonstrated a prominent spirit of innovation and entrepreneurship in the practice of pharmacy.

NASPA Excellence in Innovation Award Anne Pace, Pharm.D.

Dr. Pace is a pharmacist who strives to be on the cutting edge. In her previous role as a UAMS College of Pharmacy Associate Professor, she was able to share with future pharmacists her love of being an expert in an area of healthcare and still being able to interact with patients on a daily basis. After buying a community pharmacy with her husband in 2013, she innovated their store by building a robust immunization and compliance packaging practice and most recently by becoming one of the first pharmacies in the country to offer rapid COVID antigen tests onsite.

Anne is a graduate of Drake University College of Pharmacy in Des Moines, Iowa.

She and her husband Scott have two kids and own Kavanaugh Pharmacy in Little Rock. She is a member of APA and NCPA and is a preceptor for the UAMS College of Pharmacy.

Joe Baker was awarded the 2020 Friend of Pharmacy Award. This new award, created in 2019, symbolizes the leadership, dedication, passion, and contribution to the pharmacy profession from an individual who isn’t in a traditional pharmacy role.

Joe is a native of Emerson, Arkansas and holds a Bachelor of Business Administration from SAU and a Master’s of Business Administration from UCA. He’s a familiar face to many Arkansas pharmacists after working for Pharmacists Mutual and teaching personal finance courses at UAMS and Harding Colleges of Pharmacy. Since retiring, he’s authored a book on personal finance entitled Baker’s Dirty Dozen Principles for Financial Independence, available later this year.

Friend of Pharmacy Award

Joe was the Arkansas representative for Pharmacists Mutual Company for 28 years providing insurance and financial services for Arkansas pharmacists. He and his wife Brenda live in Little Rock and have two daughters.

Joe Baker Arkansas Attorney General Leslie Rutledge was awarded the 2020 Guy Newcomb Award. The APA Board of Directors created this award to recognize individuals who, by their legislative influence and leadership, have distinguished themselves as political friends of Arkansas pharmacy.

Attorney General Rutledge has been a fierce advocate for pharmacists in Arkansas through her leadership in the Act 900 court cases of the past few years. In 2014 she became the first woman and the first Republican in the state’s history to be elected Arkansas Attorney General. She has led her team as they’ve defended Act 900 in lawsuits appearing before the US District Court and the 8th Circuit Court of Appeals and this fall, she’ll continue that trajectory at the U.S. Supreme Court.

Guy Newcomb Award

She is a graduate of the University of Arkansas Fayetteville and the UALR William H. Bowen School of Law. She and her husband Boyce have one daughter.

Attorney General Leslie Rutledge WWW.ARRX.ORG

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2020 APA Award Winners Charles M. West, P.D. was awarded the 2020 APA Lifetime Achievement Award. This award honors a pharmacist who has devoted his or her life and career to improving the field of pharmacy and has made an impact that affects healthcare at a local, state, and national level.

Lifetime Achievement Award Charles M. West, P.D.

Dr. West is a legend in the pharmacy world not just in Arkansas but all across the country. He previously owned Kavanaugh Pharmacy in Little Rock before joining the Arkansas Pharmacists Association staff as CEO. His passion for pharmacy extended from state level to a national platform when he became volunteer leader on the executive committee of the National Association of Retail Druggists, now known as the National Community Pharmacists Association. In 1984, he elevated to the role of Executive Vice President and CEO of the organization for 12 years and later served on the NCPA Foundation Board of Trustees, capping off an esteemed career of leadership and advocacy.

Dr. West attended Texarkana Junior College and Southern State College for prepharmacy requirements and graduated from the UAMS College of Pharmacy. He and his wife Becky have three children and ten grandchildren.

2020-2021 New APA Board Members

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DYLAN JONES, PHARM.D.

KEVIN BARTON, PHARM.D.

VICE PRESIDENT

REGION 1 REPRESENTATIVE

FAYETTEVILLE

BENTONVILLE

LELAN STICE, PHARM.D.

ERIN BETH HAYS, PHARM.D.

REGION 5 REPRESENTATIVE

REGION 2 REPRESENTATIVE

PINE BLUFF

PLEASANT PLAINS

BROOKS ROGERS, PHARM.D.

KIM YOUNG, PHARM.D.

COMPOUNDING PRESIDENT

AAHP PRESIDENT

LITTLE ROCK

LITTLE ROCK

ARITNEY COOPER

ASHLYN TEDDER WARD

HARDING COLLEGE OF PHARMACY

UAMS COLLEGE OF PHARMACY

STUDENT REPRESENTATIVE

STUDENT REPRESENTATIVE

SEARCY

LITTLE ROCK

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THE ARKANSAS PHARMACIST

Statement of Ownership, Management, and Circulation (All Periodicals Publications Except Requester Publications)

1. Publication Title

2. Publication Number

3. Filing Date

5. Number of Issues Published Annually

6. Annual Subscription Price

94 4_720

ARRX, The Arkansas Pharmacist 4. Issue Frequency

Quarterly

10/1/2020

$5.00

4

7. Complete Mailing Address of Known Office of Publication (Not printer) (Street, city, county, state, and ZIP+4 ®) Arkansas Pharmacists Association 417 S Victory St Little Rock, AR 72201-2923

Telephone (Include area code) 501-372-5250

Arkansas Pharmacists Association 417 S Victory St Little Rock, AR 72201-2923 9. Full Names and Complete Mailing Addresses of Publisher, Editor, and Managing Editor (Do not leave blank) Publisher (Name and complete mailing address) John Vinson 417 S Victory St Little Rock, AR 72201-2923

14. Issue Date for Circulation Data Below

ARRX, The Arkansas Pharmacist 15. Extent and Nature of Circulation

a. Total Number of Copies (Net press run)

Contact Person Jordan Foster

8. Complete Mailing Address of Headquarters or General Business Office of Publisher (Not printer)

(1) Mailed Outside-County Paid Subscriptions Stated on PS Form 3541 (Include paid distribution above nominal rate, advertiser’s proof copies, and exchange copies) b. Paid Circulation (By Mail and Outside the Mail)

John Vinson 417 S Victory St Little Rock, AR 72201-2923 10. Owner (Do not leave blank. If the publication is owned by a corporation, give the name and address of the corporation immediately followed by the names and addresses of all stockholders owning or holding 1 percent or more of the total amount of stock. If not owned by a corporation, give the names and addresses of the individual owners. If owned by a partnership or other unincorporated firm, give its name and address as well as those of each individual owner. If the publication is published by a nonprofit organization, give its name and address.)

Full Name Complete Mailing Address 417 S Victory St Little Rock, AR 72201

Full Name

2020

2182

1510 429

618

(3)

Paid Distribution Outside the Mails Including Sales Through Dealers and Carriers, Street Vendors, Counter Sales, and Other Paid Distribution Outside USPS®

0

(4)

Paid Distribution by Other Classes of Mail Through the USPS (e.g., First-Class Mail®)

0

(4)

Free or Nominal Rate Distribution Outside the Mail (Carriers or other means)

2800

0 0 1939

0

0

0 0

0 0

100

50

100

50

f. Total Distribution (Sum of 15c and 15e)

2900

1989

g. Copies not Distributed (See Instructions to Publishers #4 (page #3))

141

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h. Total (Sum of 15f and g)

3041

2020

96

97

e. Total Free or Nominal Rate Distribution (Sum of 15d (1), (2), (3) and (4))

i. Percent Paid (15c divided by 15f times 100) 11. Known Bondholders, Mortgagees, and Other Security Holders Owning or Holding 1 Percent or More of Total Amount of Bonds, Mortgages, or x None Other Securities. If none, check box

3041

Mailed In-County Paid Subscriptions Stated on PS Form 3541 (Include paid distribution above nominal rate, advertiser’s proof copies, and exchange copies)

d. Free or (1) Free or Nominal Rate Outside-County Copies included on PS Form 3541 Nominal Rate Distribution (2) Free or Nominal Rate In-County Copies Included on PS Form 3541 (By Mail and Free or Nominal Rate Copies Mailed at Other Classes Through the USPS Outside (3) (e.g., First-Class Mail) the Mail)

Managing Editor (Name and complete mailing address)

10/01/2020 Average No. Copies No. Copies of Single Each Issue During Issue Published Preceding 12 Months Nearest to Filing Date

(2)

c. Total Paid Distribution [Sum of 15b (1), (2), (3), and (4)]

Editor (Name and complete mailing address) Jordan Foster 417 S Victory St Little Rock, AR 72201-2923

Arkansas Pharmacists Association

13. Publication Title

* If you are claiming electronic copies, go to line 16 on page 3. If you are not claiming electronic copies, skip to line 17 on page 3.

Complete Mailing Address

12. Tax Status (For completion by nonprofit organizations authorized to mail at nonprofit rates) (Check one) The purpose, function, and nonprofit status of this organization and the exempt status for federal income tax purposes: Has Not Changed During Preceding 12 Months Has Changed During Preceding 12 Months (Publisher must submit explanation of change with this statement) PS Form 3526, July 2014 [Page 1 of 4 (see instructions page 4)] PSN: 7530-01-000-9931

PRIVACY NOTICE: See our privacy policy on www.usps.com.

Statement of Ownership, Management, and Circulation (All Periodicals Publications Except Requester Publications) 16. Electronic Copy Circulation

Average No. Copies Each Issue During Preceding 12 Months

No. Copies of Single Issue Published Nearest to Filing Date

PS Form 3526, July 2014 (Page 2 of 4)

*Once per year, APA is required to publish a Statement of Ownership and file it with the United States Postal Service.

a. Paid Electronic Copies b. Total Paid Print Copies (Line 15c) + Paid Electronic Copies (Line 16a) c. Total Print Distribution (Line 15f) + Paid Electronic Copies (Line 16a) d. Percent Paid (Both Print & Electronic Copies) (16b divided by 16c Í 100)

I certify that 50% of all my distributed copies (electronic and print) are paid above a nominal price.

17. Publication of Statement of Ownership x

If the publication is a general publication, publication of this statement is required. Will be printed in the 10/10/2020 issue of this publication.

18. Signature and Title of Editor, Publisher, Business Manager, or Owner

Publication not required.

Date

10/1/2020 I certify that all information furnished on this form is true and complete. I understand that anyone who furnishes false or misleading information on this form or who omits material or information requested on the form may be subject to criminal sanctions (including fines and imprisonment) and/or civil sanctions (including civil penalties).

PS Form 3526, July 2014 (Page 3 of 4)

WWW.ARRX.ORG

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Arkansas Pharmacy Phoenix Movement www.arrxphoenix.com

O

n June 1, many of us watched live television coverage as a fire ripped through the APA office shortly before midnight, engulfing the lobby into flames and causing extensive damage. Within moments, the foundation of APA’s history and institutional progress was reduced to mountains of smoldering ashes and oceans of murky water, leaving only charred reminders and memories of an organization whose passionate members have always united enthusiastically during times of great challenge. Now the Arkansas Pharmacists Association must set its sights forward to the future of APA’s home.

The APA Building Committee is hard at work and will soon share more information about the APA campus.

Until then, we have set up an initial opportunity for anyone who would like to make a donation to the Arkansas Pharmacy Phoenix Fund – a reserve created to prepare for the inevitable construction costs of the building repairs.

Our hope is that this fire is remembered not for the destruction of the APA office but as a spark that reenergized and reinvigorated our organization and ushered in a new era for the Arkansas Pharmacists Association.

Now is the opportunity for APA to rise from the literal ashes to become a stronger, more influential and more robust organization for all of Arkansas’s pharmacists. Please consider making a donation to the future home of the Arkansas Pharmacist Association!

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WWW.ARRX.ORG

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WWW.ARRX.ORG

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