ARRx - The Arkansas Pharmacists - Fall 2014 by Arkansas Pharmacists Association

Fall 2014 Award Winning Quarterly Publication of the Arkansas Pharmacists Association

Prescription Drug Abuse Becomes Epidemic of This Generation Candidates Vie for State Races

APA Staff Mark S. Riley, Pharm.D. Executive Vice President and CEO Mark@arrx.org Scott Pace, Pharm.D., J.D. Chief Operating Officer Scott@arrx.org Eileen E. Denne, APR Senior Director of Communications Eileen@arrx.org

4 Inside APA: Be Proactive as Healthcare

Marketing Your Brand: Telling Your Brand’s Story 27 APA District Meetings in Pictures 26

Changes

5 From the President: Getting the

Message Out

7 COVER: Prescription Drug Abuse

Becomes Epidemic of This Generation

12 FEATURE: Candidates Vie for State

Races

18 RX and the Law: Marijuana – Medical

Clinical Update: APA Partners on Medication Adherence

AAHP Report: AAHP Membership… What can it mean to you?

APA Compounding Academy: Let’s Work Together to Keep Compounding Viable

Or??

19 Safety Nets: Propafenone and

Cheratussin AC®

20 Member Spotlight: Clay Morris, Red

River Pharmacy

21 New Drugs: FDA Approves New Drugs

and Biologicals

23 UAMS Report: Survey Details

APA Consulting Academy: Pharmacogenetics in the Skilled Nursing Facility

Member Classifieds

2014-2015 Calendar of Events

USPS Statement of Ownership

Prescription Drug Monitoring

24 Harding Report: Why it’s Great to be at

Harding!

DIRECTORY OF ADVERTISERS Pace Alliance Arkansas Pharmacy Support Group First Financial Bank Law Offices of Darren O’Quinn, PLLC Bell Pharmacists Mutual Life Insurance Retail Designs AR•Rx

Susannah Fuquay Director of Membership & Meetings Susannah@arrx.org Celeste Reid Director of Administrative Services Celeste@arrx.org

CONTENTS

2 6 6 6 10 11 22

Eric Crumbaugh, Pharm.D. Director of Clinical Programs Eric@arrx.org

25 36 36 38 39

UAMS Alumni Association EPIC Pharmacies "Walkway of Honor" Brick Advertise in AR•Rx Pharmacy Quality Commitment

Back Cover: APA Honors Morris & Dickson

THE ARKANSAS PHARMACIST

Debra Wolfe Director of Government Affairs Debra@arrx.org Office E-mail Address Support@arrx.org Publisher: Mark Riley Editor: Eileen Denne Design: Gwen Canfield - Creative Instinct Arkansas Pharmacists Association 417 South Victory Street 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 69. © 2014 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 the APA Executive Committee. Visit us on the web at www.arrx.org.

APA Board of Directors

INSIDE APA

2014-2015 Officers

INSIDE APA

President - Brandon Cooper, Pharm.D., Jonesboro President-Elect - John Vinson, Pharm.D., Fort Smith Vice President - Eddie Glover, P.D., Conway Past President - Dana Woods, P.D., Mountain View

Be Proactive as Healthcare Changes

Area Representatives Area I (Northwest) Michael Butler, Pharm.D., Hot Springs Village Area II (Northeast) Brent Panneck, Pharm.D., Lake City Area III (Central) Clint Boone, Pharm.D., Little Rock Area IV (Southwest/Southeast) Lynn Crouse, Pharm.D., Eudora

District Presidents District 1 - Vacant District 2 - Kristy Reed, Pharm.D., Jonesboro District 3 - Chris Allbritton, Pharm.D., Springdale District 4 - Lise Liles, Pharm.D., Texarkana District 5 - Dean Watts, P.D., DeWitt District 6 - Stephen Carroll, Pharm.D., MBA, Arkadelphia District 7 - C.A. Kuykendall, P.D., Ozark District 8 - Darla York, P.D., Salem

Academy of Consultant Pharmacists Rachel Hardke, Pharm.D., Carlisle

Academy of Compounding Pharmacists Lee Shinabery, Pharm.D., Jonesboro

Arkansas Association of Health-System Pharmacists Marsha Crader, Pharm.D., Jonesboro

Ex-Officio APA Executive Vice President & CEO: Mark Riley, Pharm.D., Little Rock Board of Health Member: John Page, P.D., Fayetteville AR State Board of Pharmacy Representative: John Kirtley, Pharm.D., Little Rock UAMS College of Pharmacy Representative (Dean): Stephanie Gardner, Pharm.D., Ed.D., Little Rock Harding College of Pharmacy Representative (Dean): Julie Hixson-Wallace, Pharm.D., Searcy Legal Counsel: Harold Simpson, J.D., Little Rock Treasurer: Richard Hanry, P.D., El Dorado UAMS COP Student: Brett Bailey, Beebe Harding COP Student: Meredith Mitchell, Joplin, MO

Find the APA on Facebook, or visit our website at www.arrx.org 4

Mark Riley, Pharm.D. Executive Vice President & CEO

ith the conversation about the changing landscape of health care, we are excited about the opportunities for pharmacists to get more involved in nondispensing, direct patient care. At the association, we are working hard to educate decision makers at all levels about what pharmacists can bring to the table to improve quality and lower costs to the system. But you also have to be proactive at the local level because opportunities may vary in different practice locales. At District Meetings and other venues I have discussed the importance of communicating with local businesses, state agencies, and other payers about how pharmacists can address their needs. I have been reminded of this lately by an issue concerning a group of mental health clinics. They considered employing a mail order pharmacy/management company to address legitimate issues that affect the patients that depend on those clinics for their care. I met with the director of this particular group and talked through the issues with her. Medication adherence, patients’ lack of transportation, barriers created by pre-authorizations to patients getting meds, and a few other issues, caused her to listen to the pitch from this company. Local companies changing pharmacy benefit design and moving patients to mail order service has long been a problem. Addressing issues BEFORE the company has made decisions that disadvantage local businesses is much more productive than trying to reverse a decision.

I promise you that regardless of your practice setting, other interests are coming after your business and your patient relationships. While many of those offerings are simply self-serving and won’t deliver the promised savings and service, some are addressing legitimate needs by making the process more efficient and effective for those affected. While I always think solutions are better achieved locally, you and I need to be proactive in making it clear about what you can do for those entities before someone else beats you to the punch. I continue to offer to help you talk to local payers whenever my schedule permits. But, please let’s do this together and preemptively before there is a crisis. Payers will work with those who can address quality and cost issues but they don’t always know where to look and tend to go with recommendations from consultants and others that call on them. They don’t know what they don’t know. Please take a few minutes to think about situations in your area where you can make your services available and indispensable to those payers and patients around you. If you do, everyone local wins. §

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FROM THE PRESIDENT

Let's Get the Message Out Brandon Cooper, Pharm.D. President

home, by looking to see how our professional message is being translated in our workplaces.

Like me, many of you may be cherishing that moment simply for the fact that we can enjoy a morning drive or evening at home without being bombarded by mudslinging, accusations, lies, and distortions from political advertisements that fill up every last second of radio and TV broadcasts. Unsubstantiated or not, we can’t deny the power that these few-second snippets of information have over the course of an election season.

One thing we may have trouble doing as pharmacists is to “toot our own horn.” In the past, when reimbursement rates were halfway decent, pharmacists were content to provide the needed services that many people take for granted today. Think about all the steps it now takes to actually fill a prescription or provide a medication review. Do your pharmacy patrons or patients know what goes on behind the counter? What about all the steps taken to avoid a potentially life-threatening medication error or drug interaction in a hospital or clinical setting?

y the time this magazine reaches you, we will only have a matter of weeks to determine the next elected leaders of our communities, counties, Congressional districts, and state.

Most of us were taught from an early age not to rely on the information we may see or hear until we have researched the issue ourselves. Even in pharmacy school, the importance of “evidence-based” research was ingrained in our psyche. Never would that seem more beneficial than in the political process, since the people we put into office can have so much influence over decisions that could affect our careers and the delivery of health care for many years to come. This is further proof of just how important it is to make sure our message, as pharmacists, gets translated in the right manner. Several years ago the APA Board of Directors decided to undertake a massive public relations campaign throughout the state to help promote the benefits of our profession. Since then, the APA “brand” image has grown by leaps and bounds throughout the public arena. While we could look to the measured successes of impressions (the number of times a message has been seen, heard, watched, or read), what we can’t measure are the benefits or impact that our messages will have in the future…simply by having pharmacists at the forefront of people’s minds. This will be especially beneficial when that message reaches the right people, the legislators and business leaders that can help us advance our profession by taking needed action.

Sure, we will continue to practice at the top of our license when we are given the chance, but if we truly want to have the kind of impact in the ever-changing landscape of health care we desire, then we have to start telling our stories. Start letting people know what you’ve done behind the scenes; involve them in the discussion of issues that you feel are detrimental to patient care and the ability to perform your job; and add value to what they have always perceived as just an ordinary part of what a pharmacist does. When the time comes for that all-important phone call or meeting with a legislator, or other health care stakeholder, you’ll then find it easier get your message to the forefront of the discussion. As you look through the political candidate profiles in this issue, it is my hope that you’ll make a concerted effort to see where the candidates stand on issues that will impact the future of pharmacy practice. Mudslinging and dirty politics can only go so far if you’ll educate yourself on current issues. Likewise, the messages that the legislators hear from us must be filtered through the correct channels of communication during the upcoming legislative session. Start now by telling your story and activate a grassroots effort of your own. §

We could discuss the merits of our statewide campaign at length, but let’s bring public relations one step closer to

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Prescription Drug Abuse Becomes Epidemic of This Generation By Eileen E. Denne, APR

APA’s COO Scott Pace explains how Arkansas is handling prescription drug abuse.

hen speaking to community groups, Rotary Clubs or legislative committees, APA’s Chief Operating Officer Scott Pace, Pharm.D., J.D., calls prescription drug abuse in Arkansas the drug epidemic of this generation.

described the scope of the problem to the Arkansas State Legislature’s Joint Drug Task Force on September 23, and talked about possible solutions. Both are described in this article.

“Every day, 2,500 kids ages 12 to 17 experiment with “We know that illegal drugs like marijuana, cocaine and prescription pain killers for the first time,” Pace said in a heroin used to be the drugs of choice for kids, but now recent interview. “Arkansas averages a death a day from they are getting high on drugs they can find in their parents’ unintentional prescription drug overdoses. By the time kids or grandparents’ medicine cabinets.” Pace said. “The get to high school, one in five will have more we can educate ourselves, kids, abused prescription medication. Forty parents and grandparents about this percent of those will have gotten their epidemic, the more likely we are to put Fifty Americans die a day medications from a family member.” the brakes on the abuse.” from prescription drug The Department of Justice shares these alarming statistics: 1

overdoses, and more than 6 million suffer from prescription drug abuse disorders.

• 1 in 7 teens admit to abusing prescription drugs to get high in the past year. Sixty percent of teens who abused prescription pain relievers did so before the age of 15. • Fifty-six percent of teens believe that prescription drugs are easier to get than illicit drugs. • 2 in 5 teens believe that prescription drugs are “much safer” than illegal drugs. And 3 in 10 teens believe that prescription pain relievers are not addictive. • Sixty-three percent of teens believe that prescription drugs are easy to get from friends’ and families’ medicine cabinet. On behalf of pharmacists, Pace advocates increasing awareness of the problem and decreasing illegitimate access to prescription medication in Arkansas. He

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Arkansas 25th highest drug overdose mortality

According to a 2014 report, Prescription Drug Abuse: Strategies to Stop the Epidemic, Arkansas has the 25th highest drug overdose mortality rate in the United States, with 12.5 per 100,000 people suffering drug overdose fatalities. The number of drug overdose deaths - a majority of which are from prescription drugs in Arkansas almost tripled since 1999 when the rate was 4.4 per 100,000. From 1999-2009, prescription drug overdose deaths in the U.S. increased by over 130 percent, from 16,000 to 37,000. A report by the nonprofit Trust for America’s Health calls prescription drug abuse a top public health concern, as prescription drug related deaths now outnumber those from heroin and cocaine combined, and drug overdose deaths exceed motor vehicle-related deaths in 29 states and Washington, D.C. Misuse and abuse of prescription

PRESCRIPTION DRUG ABUSE BECOMES EPIDEMIC

Source: www.cdc.gov

painkillers alone cost the country an estimated $53.4 billion a year in lost productivity, medical costs and criminal justice costs. The report also notes that, currently, only one in 10 Americans with a substance abuse disorder receives treatment. The Centers for Disease Control and Prevention (CDC), says that nationally, sales of prescription painkillers per capita have quadrupled since 1999 - and the number of fatal poisonings due to prescription painkillers has also quadrupled. Enough prescription painkillers were prescribed in 2010 to medicate every American adult continually for a month. "Fifty Americans die a day from prescription drug overdoses, and more than 6 million suffer from prescription drug abuse disorders. This is a very real epidemic - and warrants a strong public health response," said Andrea Gielen, ScD, Director of the Johns Hopkins Center for Injury Research and Policy. "We must use the best lessons we know from other public health and injury prevention success stories to work in partnership with clinical care, law enforcement, the business community, community-based organizations, and other partners to work together to curb this crisis."2

Positive steps to curb abuse

Arkansas has taken a number of steps in the past five years to help curb abuse including participation in Drug Enforcement Agency (DEA) Drug Take-Back Days, launching the Prescription Drug Abuse Summit and creation of the Prescription Drug Monitoring Program (PMP). The Prescription Drug Abuse: Strategies to Stop the Epidemic report finds that Arkansas meets six out of 10 possible indicators of promising strategies to help curb prescription drug abuse including: the existence of a Prescription Drug Monitoring Program; doctor shopping laws; support for substance abuse treatment services; prescriber education required; a physical exam requirement for prescribing a controlled substance; and a lock-in program under the state’s Medicaid plan where individuals suspected of misusing controlled substances must use a single prescriber and pharmacy.

Monitor, Secure and Dispose

In 2010, a coalition led by former Arkansas State Drug Director Fran Flener, Attorney General Dustin McDaniel and both of Arkansas’s U.S. Attorneys launched an ongoing educational program to encourage everyone to “Monitor,

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PRESCRIPTION DRUG ABUSE BECOMES EPIDEMIC

Secure and Dispose” of their prescription medications. The coalition planned Arkansas’s participation in the U.S. Drug Enforcement Administration’s National Prescription Take Back Initiative with collection events each spring and fall.

“For years pharmacists have been industry leaders in disposal of non-controlled substances,” he added. “We counsel our patients on the best options for their expired and unused prescription medications. We now will have that same option when it comes to the disposal of controlled medications.” Counseling patients has been one of the themes for an educational program offered to Arkansas pharmacists during the past three years.

Prescription Drug Summit Grows In April 2014 Americans turned in over 780,000 pounds, or 390 tons, of prescription drugs. Since its first National Take Back Day in September of 2010, DEA collected more than 4.1 million pounds, or more than 2,100 tons, of prescription drugs throughout all 50 states, the District of Columbia, and several U.S. territories.3 The final Take-Back Day was held on Sept. 27, 2014. While Drug Take Back Days were a good way to get expired or no-longer-needed prescription medications out of medicine cabinets, the DEA is finalizing the regulations pertaining to the Secure and Responsible Drug Act, which offer consumers additional options for disposal of controlled substances.

Pharmacies can now take back

The Final Rule authorizes certain DEA registrants (manufacturers, distributors, reverse distributors, narcotic treatment programs, retail pharmacies, and hospitals/clinics with an on-site pharmacy) to modify their registration with the DEA to become authorized collectors. All collectors may operate a collection receptacle at their registered location, and collectors with an on-site means of destruction may operate a mail-back program. Retail pharmacies and hospitals/clinics with an on-site pharmacy may operate collection receptacles at long-term care facilities. The public may find authorized collectors in their communities by calling the DEA Office of Diversion Control’s Registration Call Center at 1-800-882-9539.3 “The DEA’s final rule on controlled substances return programs is a positive development for our patients who can more easily dispose of unwanted medications that may have potential for abuse. Each pharmacy will review the DEA policy and decide which, if any, of the allowed disposal options for controlled substances are feasible at their particular pharmacy, taking into account the community in which they practice,” said Pace.

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In 2012, the Arkansas Department of Justice, DEA and Arkansas State Board of Pharmacy partnered to create a Prescription Drug Summit to call attention to prescription drug abuse. Taking advantage of free Continuing Education credits, health care providers, students and other interested individuals have participated in the day-long program in increasing numbers. The State Board of Pharmacy said that in 2012, 373 attended. In 2013, attendance rose to 512. And in 2014, the State Board estimates that close to 600 participated.

For years pharmacists have been industry leaders in disposal of non-controlled substances. We counsel our patients on the best options for their expired and unused prescription medications. We now will have that same option when it comes to the disposal of controlled medications.

Prescription Drug Monitoring Program points to abusers

Another important program that helps health care professionals and law enforcement monitor prescription drug abuse is the Prescription Drug Monitoring Program. The Arkansas General Assembly passed Act 304 of 2011 to create the program, which is housed within the Arkansas Department of Health. Pharmacist Denise Robertson directs the program. Pharmacies were required to report the data beginning on March 1, 2013 and they became eligible to query the database around June 1, 2013. There are strict querying requirements for all potential users. Healthcare and law enforcement providers are registered in the PMP in the following numbers.

Lookup Users of the PMP4 Type of User

Number Registered

and May 2013, DEA found 114; and from Dec. 2013 to Feb. 2014, 31. From March 2013 to March 2014, law enforcement made 125 queries, resulting in 16 arrests and two convictions. Twenty one of the 125 queries led to the opening of additional cases. Starting this fall, the PMP will be sending an alert to certain pharmacies and prescribers saying there is evidence of activity on certain patients and to check patient records. If a pharmacist at a store isn’t signed up, the alert will go to the pharmacistin-charge. If not signed up, the PMP will e-mail them a letter saying “you have an alert on one of your patients.” From the beginning they will set parameters and do threshold reports.

The first 12 months of PMP data provide a baseline for awareness and prevention of prescription drug abuse. Between September 1, 2012 and August 31, 2013, more than 7 million controlled prescriptions were filled in Arkansas. The average number of units per prescription was approximately 60. Upwards of onehalf billion units of controlled drugs were dispensed during first 12 months of program tracking, or around 168 units for every Arkansas citizen.

Early results indicate PMP working

The PMP staff has identified a number of chronic doctor and pharmacy shoppers since the PMP began. Between March

With pharmacists participating in prescription drug disposal and monitoring, and continuing to be educated on the scope of the problem in the state, Arkansas has the potential to see reductions in the numbers of abusers. APA’s Pace thinks that pharmacists are key to helping address the problem. “We’re the medication experts who are highly accessible and care for our patients. I don’t know of any other health care providers who can offer better guidance and solutions to help our patients. Pharmacists have demonstrated that they care about important issues such as prescription drug abuse.” § 1 http://www.drugfreecommunity.com/documents/FactSheet.pdf

2 http://healthyamericans.org/newsroom/releases/?releaseid=291 3 http://www.justice.gov/dea/divisions/hq/2014/hq092314.shtml 4 Prescription

Drug Monitoring Program 2014.

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Candidates Spotlight 2014 In anticipation of the upcoming November elections, ARâ&#x2014;?Rx asked the candidates in the Governor, Attorney General and U.S. Senate races to tell us about themselves and their vision for pharmacy in the future.

Governor

Asa Hutchinson Hometown: Rogers. Occupation: Attorney/Consultant. Your pharmacist: Ron Smith, Central Discount Pharmacy. What are three primary objectives you want to accomplish while in office: As governor, my top priorities will be to create jobs, improve education and lead Arkansas in dynamic economic growth. What do you expect to like most about office: Promoting Arkansas, its people and its future. What do you expect to like least about office: Absolutely nothing. Most admired politician: Ronald Reagan. Advice for pharmacists about the political process: Stay engaged and don't give up! Your fantasy political gathering would include: Thomas Jefferson; Abraham Lincoln; Martin Luther King and my mom! Toughest political issue: Funding more highway infrastructure investment in Arkansas. What's your vision for pharmacy in the future of healthcare? That pharmacists never lose their passion and opportunity to provide personal guidance and service to the public. What do you do for fun: I enjoy playing basketball and backpacking. I enjoy everything I do with my wife Susan of 41 years and my children and grandchildren.

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CANDIDATES SPOTLIGHT 2014

Governor

Mike Ross Hometown: Born in Texarkana; raised in Prescott, Emmet and Hope; live in Little Rock. Occupation: Self-employed. Your pharmacist: My wife, Holly Ross. What are three primary objectives you want to accomplish while in office: First, I’ll grow the middle class and create more and better-paying jobs by cutting taxes, reducing government regulations, strengthening our schools, renewing our focus on career technical training and making quality pre-kindergarten education accessible to every 4-year-old in Arkansas. Secondly, I’ll strengthen our equal pay laws to ensure women earn equal pay for equal work. Finally, I’ll immediately begin tackling domestic violence in Arkansas – a major problem facing our state – by building support for my “Protecting and Empowering Survivors of Domestic Violence Act.” What do you expect to like most about office: I’m running for governor to help people, so when I’m elected, I expect that’s the part I’ll like most. I love Arkansas, and I want to make it an even better place to call home. What do you expect to like least about office: I have no doubt the long hours, extensive travel and demanding work will be exhausting parts of the job to being governor, but it will most definitely be worth it. Most admired politician: President John F. Kennedy. He called on us to serve our country and the world around us like no president had done before. Advice for pharmacists about the political process: Never give up and to continually work to achieve your goals. I’m also inspired by this quote by Margaret Mead: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.” Your fantasy political gathering would include: John F. Kennedy; Dr. Martin Luther King, Jr.; Abraham Lincoln; Margaret Thatcher; Benjamin Franklin; Harriett Tubman; Sir Winston Churchill; and, Bill Clinton. Toughest political issue: The toughest political issue I’ve dealt with so far on the campaign trail has been domestic violence and child abuse – especially when you see how domestic violence affects an entire family for several generations. What's your vision for pharmacy in the future of healthcare? Pharmacists play a critical role in health care. I know first-hand because my wife of 31 years, Holly, is a practicing pharmacist. I want pharmacists to have a more inclusive and active role in patient care and work inter-professionally with a patient’s overall health care team. We need more collaborative practice agreements (CPA) between pharmacists and health care providers, so we can reduce fragmentation of care, lower overall health care costs and improve health outcomes. In fact, studies have shown that patient health improves significantly when pharmacists work with physicians and other providers to manage patient care. What do you do for fun: I enjoy spending time with my wife, Holly, and spending time with our children, who are now grown. I also really enjoy hunting and fishing.

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CANDIDATES SPOTLIGHT 2014

Attorney General

Leslie Rutledge Hometown: Batesville. Occupation: Attorney. Your Pharmacist: Jeremy in Little Rock. What are your three primary objectives you want to accomplish while in office? 1) I want to use my prosecutorial experience to protect Arkansans. Whether the threat is a hardened criminal, a business trying to defraud them, or an overreaching federal government, the state of Arkansas needs a Chief Legal Officer ready to protect and defend on day one. 2) I want to advocate for a predictable, fair regulatory atmosphere that promotes a prosperous state. When government doesn’t overstep its bounds and businesses are in a market-friendly atmosphere, Arkansas’s economy will thrive. 3) I believe the Office of Attorney General must serve the people with honesty and integrity. Public trust in officeholders is essential. Without uncompromising ethical standards, the people of Arkansas are not being served. Arkansas deserves public leaders who will put the state's interests first. What do you expect to like most about the office? The opportunity to have a direct, positive impact on the lives of every day Arkansans. What do you expect to like least about the office? Learning about the struggles of Arkansans but knowing that time and resources will make it difficult to address every issue as quickly as I would prefer. Most admired politician? Ronald Reagan. Advice for Pharmacists about the political process? As with anyone else, always stay informed and express your opinions in the ballot box. Pharmacists are in a unique position of interacting with a broad stretch of community members of all socioeconomic levels. They should proactively reach out to their local elected leaders about issues in the community, and not only about health issues. A pharmacist once told me the best pharmacists are on a first name basis with the people who they serve. Pharmacists have a great perspective on their local communities and should use that to help make a positive change. Your fantasy political gathering would include: Ronald Reagan, Margaret Thatcher, James Madison, George Washington and Winston Churchill. Toughest political issue? Addressing the overreach of the federal government. What’s your vision for pharmacy in the future of healthcare? I hope pharmacies continue to grow in importance for local communities because pharmacists speak with their individuals with health needs and concerns on a regular basis. Pharmacies, when operated by responsible and caring pharmacists, are critically important points of care in local communities. What do you do for fun? Cooking and reading.

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CANDIDATES SPOTLIGHT 2014

Attorney General

Nate Steel Hometown: Nashville. Occupation: Attorney/State Representative. Your pharmacist: Mike Pinegar and Loy D. Dildy, Nashville Drug. What are three primary objectives you want to accomplish while in office: 1) Make AR a better place to live and raise a family by 2) expanding drug courts and other treatment alternatives to prison so we can 3) slow prison growth and preserve room in prison for violent offenders and child predators. That way, we will lower our crime rate and make our communities and neighborhoods safer. What do you expect to like most about office: Following through on promises made and reforms sought through my time as a legislator and candidate. What do you expect to like least about office: Nothing. Most admired politician: My grandfather, Congressman Buddy Tackett. Advice for pharmacists about the political process: Know your elected officials at all levels, especially local. Your state representatives and senators need to understand your issues on a personal level. Your fantasy political gathering would include: President Theodore Roosevelt, Attorney General Bobby Kennedy and President Harry Truman. Toughest political issue: Balancing privacy rights with law enforcement. Prescription Drug Monitoring is a good example. What's your vision for pharmacy in the future of healthcare? I would like to see the personal pharmacist and customer relationship preserved in the future. While other areas of health care are becoming more the automated, I hope that pharmacies like Nashville Drug in my hometown continue to have the freedom and opportunity to work with their customers in a personal way. What do you do for fun: I love to golf, run, and hunt - not necessarily in that order.

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CANDIDATES SPOTLIGHT 2014

U.S. Senate

Tom Cotton Hometown: Dardanelle. Occupation: U.S. Representative, Arkansas’s 4th Congressional District. Your pharmacist: My family and I have used Rose Drug and Berry Drug in Dardanelle for years. What are three primary objectives you want to accomplish while in office: 1) Stop the harm that Obamacare is doing to our healthcare system and our economy by repealing Obamacare and starting over on patient-centered healthcare reform that empowers individuals and families, not politicians and government bureaucrats. 2) Balance our budget and address the unconscionable level of debt we are burdening future generations of Arkansans with. 3) Get Arkansans back to work by reducing the disincentives to work, including higher taxes, excess regulation, and federal bureaucracy. What do you expect to like most about office: The continued opportunity to work with and help individuals from all across Arkansas. It has been an honor to work with individuals to fix problems they have with the federal government, and I look forward to working with people across the entire state if chosen to represent Arkansas in the Senate. What do you expect to like least about office: The continued gridlock and unwillingness to compromise we have seen from President Obama, as well as politicians who are more concerned about maintaining the status quo over finding solutions to the problems facing our nation. Most admired politician: Abraham Lincoln. Advice for pharmacists about the political process: Get involved. My office has been lucky to be advised by Mark Riley, Executive Vice President of the Arkansas Pharmacists Association and the current President of the National Community Pharmacists Association. His advice, and that of individual pharmacists I have met across the state, has been instrumental in bringing issues to my attention. I’ll continue to rely upon on their advice if elected to the Senate. Your fantasy political gathering would include: Abraham Lincoln, Winston Churchill, and George Washington. Toughest political issue: Under President Obama, our military budget has seen drastic cuts, and I’m working to restore those cuts and rebuild our military so that we can always remain a free and secure nation. I never thought I would encounter so much opposition from other members of Congress on this issue. That being said, once you’ve fought overseas and had Al-Qaida try to shoot at you and blow you up, that puts today’s political skirmishes in perspective. What's your vision for pharmacy in the future of healthcare? Pharmacists have always played a vital role in providing medication and advice to people across Arkansas, and I see that role continuing, but we must also work to strengthen it. My mom and dad receive a lot of important information from their local pharmacist in Dardanelle, and I’ve heard from several pharmacists who are worried that declining reimbursements and Pharmacy Benefit Managers are squeezing these relationships. There are steps Congress should take to protect that relationship. What do you do for fun: I’m a newlywed, and I enjoy getting to spend time with my wife Anna. Anna and I also enjoy running. I picked up running when I was training for the Army, but it has become a hobby for me. I have run eleven marathons and still try to run most days, although that is sometimes hard to do when you’re traveling the state campaigning across 75 counties.

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CANDIDATES SPOTLIGHT 2014

U.S. Senate

Mark Pryor Hometown: Little Rock. Occupation: Senior U.S. Senator from Arkansas. Your pharmacist: Smith's Country Club Drug Store. What are three primary objectives you want to accomplish while in office: The number one issue facing Arkansans today is jobs and the economy. I’ve always worked in a bipartisan way to make sure we can grow the economy from the middle out. That’s why I’ve developed the “American-Made Strong” jobs package to bring jobs back to the U.S. and end the tax loophole companies get for shipping jobs overseas. I’m also a big believer in cutting red tape so businesses can grow and thrive. Another priority of mine is protecting Social Security and Medicare benefits for our seniors. Hardworking Arkansans deserve the dignity of a secure retirement, and in our state most folks aren’t sitting on a big nest egg when they reach 65. For hundreds of thousands of Arkansans, they have two things: Social Security and Medicare, and I’m going to protect those benefits so long as I’m in the Senate. For too long Arkansas has lagged behind the nation on college accessibility. Too few of our young people are going to college and too many who do aren’t finishing. The biggest barrier is the cost. I’ve supported Pell Grants and the federal student loan program to make higher education more affordable, and I think we need to expand those programs to make it easier for students to go to college and stay until they complete their degree. What do you expect to like most about office: The best part of my job is getting around our state and listening to Arkansans. Many of the bills I’ve introduced and passed into law came from conversations with constituents or letters that folks write to my office. That’s how I heard, for example, about the military widow in Greenwood who was denied her family’s benefits after her husband passed away, all because of a ridiculous loophole. We got her benefits reinstated, and I passed a law to ensure that would never happen again to any other families. I’ve always seen my role as being a bipartisan bridge-builder to find responsible solutions that benefit Arkansans. What do you expect to like least about office: It’s never fun being away from Arkansas and my family. That’s why for the last 12 years, anytime the Senate finishes up for the weekend or a congressional recess, I’m on the first flight home. Most admired politician: My father, David Pryor. He taught me one of my life’s most valuable lessons that Arkansas always comes first. In fact, on my desk in Washington, I have a sign that my dad gave to me that reads, “Arkansas Comes First.” It’s the same sign that sat on his desk when he served in the Senate. That’s what guides me every day, and that’s my commitment to Arkansans if I’m given another six years in the U.S. Senate. Advice for pharmacists about the political process: Don’t be a stranger. My door is always open to hear your ideas, observations and concerns about what needs to be done in Congress. I value your expertise and experience. Your fantasy political gathering would include: Any of the founding fathers, especially James Madison. Toughest political issue: Fighting to protect Arkansas seniors’ retirement security. I never thought I’d have to introduce a bill like the Medicare Protection Act, which would make it harder for irresponsible politicians to turn Medicare over to the insurance companies, cut benefits and raise the eligibility age to 70. Those proposals would hurt the nearly 600,000 seniors in Arkansas who depend on Medicare. What's your vision for pharmacy in the future of healthcare? Pharmacists are vital health care providers in Arkansas. I know that pharmacists have significant interaction with patients on a regular basis, and I think they should be fully empowered to help Americans live healthier lives. I’ve cosponsored a bill to help expand Medicare patients’ access to medication therapy management services and to ensure pharmacists can be compensated for providing important services that make our health care system work better. I believe pharmacists should be empowered to practice medicine within their appropriate scope of practice, and I am willing to support legislation to fully recognize pharmacists as health care providers under Medicare. What do you do for fun: I like fishing and watching the Razorbacks. AR•Rx

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PHARMACY RESIDENCES

Marijuana – Medical Or?? 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.

arijuana, medical and otherwise, has certainly been M in the news for the last several months. As more states legalize marijuana, for medical or recreational use,

pharmacists are presented with a unique legal challenge to balance patient needs and legal requirements. It is beyond the scope of this article to examine the literature and clinical research that would support or refute a medical use for marijuana. We will assume there is a legitimate medical use for marijuana, or its components, while we look at the legal question. Some states have passed various laws to address the use of marijuana within their borders. There is not a universal approach. In many states, pharmacists are not involved in the dispensing of medical marijuana. If you were presented with the opportunity to do so, what should you consider? The main question is: how legal is legal? Marijuana remains a Schedule I drug under Federal law. Schedule I drugs are deemed to have no legitimate medical use and have a high potential for abuse. A state has no power to lower this classification. The U.S. Constitution provides that Federal law is supreme to state law. Generally, states may enact laws that are more stringent than Federal laws, but not more lenient. For example, a state can move a Schedule III up to a Schedule II or move a non-controlled drug into Schedule IV within their borders. But a state is unable to move a Schedule II down to Schedule III. This is a basic tenet in the relationship between Federal and state laws. If this is so, how are the states legalizing marijuana? The answer is a concept called enforcement discretion. This occurs when an agency responsible for the enforcement of a law decides to not enforce that law. An earlier example of this concept was the importation of prescription drugs from Canada. The Food & Drug Administration (FDA) stated that all importation was illegal, but it exercised its discretion and would not prosecute those bringing in these drugs for their own use. In essence, the activity is still illegal, but we choose to do nothing about it. The caveat here is that the agencies always have the ability to change their minds.

The Drug Enforcement Administration’s (DEA) current position is that it has enforcement priorities for marijuana. They are: 1) prevent distribution to minors; 2) prevent revenue from the sale from going to criminal enterprises; 3) prevent diversion from states where it is legal under state law to those states where it is not legal; 4) prevent state-authorized marijuana activity from being used as a pretext for trafficking other illegal drugs or other illegal activity; 5) prevent violence and the use of firearms in the cultivation and distribution; 6) prevent drugged driving and the exacerbation of other adverse public health effects; 7) prevent the growth on public lands; and, 8) prevent possession or use on Federal property. The DEA will not take any action in states that have legalized marijuana if the states agree to help with these priorities. Therefore, individuals who possess marijuana for personal use on private property in those states will not face DEA prosecution at this time. Because they do not possess it for personal use, a pharmacist dispensing marijuana is not covered by this exception. A pharmacist would also have to be diligent to make sure their dispensing did not violate one of these enforcement priorities. The DEA has made it clear that it will change its stance if it believes a state is too lax in assisting with enforcement priorities. So how legal is legal? It is definitely not a rock solid legal foundation. Depending on your point of view, it could be seen as temporarily solid or merely illusory. The uncertainty of this foundation may keep a number of pharmacists from engaging in the dispensing of marijuana. For those who decide to proceed, one would hope that the medical benefit for their patients would far outweigh the risk to the patient and the legal risks for the pharmacist. The actual outcome remains to be seen. §

_________________________________________________________ © 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.

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PHARMACY RESIDENCES

UN N I V EE RR SS II TT YY O OF ARKAN U N SS A A SS FF O ORR M MEEDDIICCAALL SSCCI IEENNCCEESS CCOOL LLLEEGGEE OOFF PPHHAARRMMAACCYY

Propafenone and Cheratussin AC® Welcome to another issue of Safety Nets. This column illustrates the potential hazards associated with illegible prescriber handwriting. A community pharmacist from Central Arkansas reports the following potentially lifesaving intervention. Thank you for your continued support of this column, and to the pharmacist who shared this interesting case with our readers.

he prescription illustrated in Figure One was electronically transmitted from a prescriber's office to a community pharmacy in Central Arkansas. The pharmacist who examined the prescription immediately questioned the dosing interval (i.e. every two hours) for the antiarrhythmic propafenone (Rythmol®). While the pharmacist was still examining the prescription, the patient arrived at the pharmacy. The pharmacist asked the patient if the prescriber had explained how Figure One to administer the medication. The patient said "I think he said one tablet in the morning and one in the evening." The pharmacist decided to telephone the prescriber's office for clarification. After listening to the pharmacist's Figure Two concerns, the nurse verified the dosing interval was actually every 12 hours, not "every two hours". The nurse then apologized for entering the wrong patient directions into "our system." After this, the prescription was correctly filled and the patient appropriately counseled. The prescription illustrated in Figure Two was electronically transmitted to a community pharmacy in Northeast Arkansas. The patient was a 3-year-old boy. The pharmacist who initially examined the prescription performed the required checks for accuracy and released the prescription to be filled as Cheratussin AC® (codeine phosphate 10 mg/5mL, guaifenesin 100 mg/5 mL), quantity 180 mL, with directions of "take 12.5 mL by mouth every four hours as needed for cough." The prescription was filled and placed in line for verification and counseling. During the counseling session, the pharmacist began to question the appropriateness of a 12.5 mL dose for this 3 year-old patient. The pharmacist asked the patient's mother if the prescriber had instructed her how to administer the medication. The mother could not remember the prescriber's instructions. At this point, the pharmacist decided to telephone the prescriber to confirm the Cheratussin AC® dose. The prescriber's nurse confirmed the patient directions were wrong. She said the patient was to receive one-half teaspoonful (2.5 mL) per dose, not 12.5 mL as indicated on the prescription. She then said "I guess we picked the wrong directions." After AR•Rx

THE ARKANSAS PHARMACIST

this, a corrected prescription label was generated and the patient's mother appropriately counseled. These medication orders illustrate the potential hazards associated with electronic prescriptions. They offer clear proof that data processing equipment and the software that drives it cannot be perfected. These systems are of human invention, and will always be as error-prone as the writers and the users. While E-prescriptions may reduce the incidence of certain types of errors, their use does not guarantee errorfree prescriptions. In fact, the legibility of electronic prescriptions may actually increase the risk of an error reaching a patient compared to a handwritten order which may be more carefully examined by the pharmacist. The inconsistencies that these careful pharmacists immediately detected provided the means to prevent these harmful overdoses from reaching two patients. In the one case, the pharmacist showed no hesitation in perceiving 12.5 mL as an unusually large dose for a 3-year-old child. The likely explanation was a numeral “1” where it should not have been. The difference between 12.5 and 2.5 is 500% — not a trivial matter. In the other case, the propafenone prescription’s instruction to dispense 60 tablets, with 11 refills would almost certainly show a year’s prescription to be dispensed monthly. A Sig of 12 tablets/ day (2,700 mg of propafenone) represents three times the maximum recommended dose (900 mg) of propafenone. This, again, is clearly hazardous territory. Such a dose would almost guarantee the emergence of arrhythmias. Both pharmacists not only detected these problems, but quickly resolved them without alarming the patients or their families. In both cases the parties contacted confirmed the correct doses, and acknowledged the errors. This speaks for excellent practice habits and for good communication with other caregivers. Finally, these two pharmacists have benefitted us all by sharing the experiences in a spirit that encourages learning. §

Member Spotlight

Clay Morris, Pharm.D. — RED RIVER PHARMACY, TEXARKANA Pharmacy practice: Compounding, nuclear, homeinfusion, community pharmacy.

with roundworms. We treated the entire family with a compounded product to prevent crossover infection.

Graduate pharmacy school and year: University of Arkansas for Medical Sciences College of Pharmacy 2007.

Recent reads: Same Kind of Different as Me, Boys Should Be Boys, Storey’s Guide to Keeping Honey Bees.

Years in business: Seven.

Fun activities: Woodworking, photography, hunting/ fishing.

Favorite part of the job: The people I work with and the people we serve. Making a difference through hospice and compounding. Least favorite part of the job: Pharmacy Benefit Managers.

Ideal dinner guests: Cal Ripken Jr, Bo Jackson, Paul the Apostle, any WWII Veterans. If not a pharmacist then…: A free spirit living on a boat in St John, USVI. §

Oddest request from a patient/customer: A family had a pet raccoon that ended up getting infected

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FDA Approves a Wide Range of New Drugs and Biologicals this Quarter Halfway through 2014 it was another productive quarter at the Food and Drug Administration (FDA) with the approval of 11 new molecular or biological entities. Meanwhile, a number of drugs are on-schedule to lose patent protection this year, including Nexium®, Actonel®, Boniva®, Celebrex®, Evista®, Exalgo®, Exforge®, Intuniv®, Nasonex®, Restasis®, and Trilipix™. Making the Rx to Over-the-Counter (OTC) switch so far this year are Nasacort® (allergic rhinitis) and Nexium® (GERD), with Flonase® to follow in 2015. Controlled-Substances: The Drug Enforcement Administration (DEA) stole the headlines in this category with their rescheduling of all hydrocodone products to Schedule II effective October 6, 2014. Previously, hydrocodone was in Schedule II as a single-entity, but that was of little consequence until the approval of Zohydro™ER since hydrocodone was only available as a combination product. Effective August 18, 2014, tramadol was moved to Schedule IV, something that had been done legislatively in 10 states. Newly approved controlled-substances included: Targiniq™ER (oxycodone/naloxone, C-II), an abuse-deterrent extended-release formulation for severe pain requiring around-the-clock, long-term treatment; Bunavail™ (buprenorphine/naloxone, C-III), a buccal film for maintenance treatment of opioid dependence; and Belsomra® (suvorexant, C-IV) a first-in-class sleep agent. And potentially blazing new trails, sources report the FDA has taken up a DEA request to evaluate the medical evidence related to the safety and effectiveness of marijuana, a move that could result in the drug being “weeded” out of Schedule I.

or indications include Jardiance® (empagliflozin), the third drug approved in its class for adult, type II diabetes, and Eylea® with a new indication for diabetic macular edema. New formulations include Invokamet™ (canagliflozin/ metformin) and Levemir® FlexTouch® (pen design). Infectious Disease: Jublia® (efinaconazole) and Kerydin™ (tavaborole), both first-in-class once-daily antifungal agents, were approved for onychomycosis of the toenails. Jublia® is administered through a built-in flow-through brush applicator, while Kerydin™ is applied with a dropper. Sivextro™ (tedizolid) and Orbactiv™ (oritavancin), fasttracked as Qualified Infectious Disease Products, are new antibacterial agents approved to treat acute bacterial skin and skin structure infections, including MRSA. Orbactiv™ is given as single-dose while Sivextro™ is 6-day course. Triumeq® was approved as a once-daily, fixed-dose combination of the antivirals dolutegravir, abacavir and lamivudine to treat HIV in adults. Hematology/Oncology: Zydelig™ (idelalisib) is a much anticipated first-in-class treatment for relapsed chronic lymphocytic leukemia and two types of lymphoma. Zydelig™, granted accelerated approval and designated as a breakthrough therapy and orphan drug, carries a boxed warning and is approved with a Risk Evaluation and Mitigation Strategy. Beleodaq™ (belinostat), also receiving accelerated approval as an orphan drug, is intended to treat peripheral T-cell lymphoma in patients who have relapsed or are refractory to other treatments. Keytruda™ (pembrolizumab) is the first programmed death inhibitor

Diabetes: The insulin market is heating up as biosimilars and newer forms emerge. Basaglar™ (insulin glargine, biosimilar) was tentatively approved, subject to a 30-month stay in the wake of pending patent infringement litigation. Afrezza®, an ultrarapid acting powder insulin delivered through the whistlesized Dreamboat inhaler, hopes to succeed were Exubera® failed. Other new diabetic drugs

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NEW DRUGS

approved to treat advanced melanoma. Keytruda™ also received accelerated approval with breakthrough therapy and orphan drug designation. Approved for new indications are: Avastin® (bevacizumab) as combination treatment for patients with persistent, recurrent or late-stage, metastatic cervical cancer; and Promacta® (eltrombopag, PO) for severe aplastic anemia that fails to adequately respond to immunosuppressive therapy. Specialty Drugs: Plegridy™ (peginterferon β-1a), available in prefilled syringes, was approved for adults with relapsing forms of multiple sclerosis. Plegridy™ is a pegylated formulation of interferon β-1a which extends its half-life and allows for less-frequent dosing. Genzyme received approval for Cerdelga™ (eliglustat) for long-term treatment of Type 1 Gaucher’s disease, a rare genetic glucocerebrosidase enzyme deficiency that causes fatty materials to collect in the liver and spleen. Cerdelga™ is a hard gelatin capsule usually taken twice-daily which makes it more convenient than available infusion treatments.

Pulmonary: Striverdi® Respimat® (olodaterol) is another once-daily, long-acting beta agonist bronchodilator inhaler used for maintenance treatment of COPD. Striverdi®, which carries a boxed warning related to the risk of asthma-related death, may produce paradoxical bronchospasm and should not be used for rescue therapy. Arnuity™ Ellipta® (fluticasone) is a once-daily, dry powder corticosteroid inhaler approved as maintenance treatment of asthma in patients aged 12 years and older. § ____________________________________________________ Contributing Authors: Tim Cheum, Pharm.D. Candidate and Kejal Patel, Pharm.D./MBA Candidate, Harding University College of Pharmacy _________________________________________________ Rodney Richmond, RPh, MS, CGP, FASCP, is Associate Professor, Pharmacy Practice, at Harding University College of Pharmacy in Searcy.

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COLLEGES OF PHARMACY

UAMS

Survey Details Prescription Drug Monitoring Usage

was very pleased to hear that this issue of the APA Journal would be focused on prescription drug abuse. It is critical that healthcare professionals know how to help patients who need pain medicines get the treatment that they need. We also want to ensure that future practitioners can recognize the signs and symptoms of addiction. Stephanie Gardner Pharm.D., Ed.D. Dean

Throughout the Fall of 2013, UAMS and Harding college of pharmacy students assisted in signing up pharmacists attending the Arkansas Pharmacists Association District Meetings to become users of the Prescription Monitoring Program (PMP). Pharmacists in attendance who were already registered users of the PMP (337 total) completed a questionnaire regarding their experience with the PMP to date.

Figure 1. Sum of respondents from respective three digit zip codes.

The PMP goals are to enhance patient care, curtail the misuse and abuse of controlled substances, combat illegal trade in and diversion of controlled substances, and lastly enable access to prescription information to authorized individuals. Among the 337 pharmacists, 62% best described their primary practice work environment as independent community, 34% community chain pharmacy and 4% as hospital or other. Figure 1 illustrates the geographical diversity of the pharmacists polled in the survey from across the state based on the first three digits of their zip codes.

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The majority of pharmacists (80%) stated that querying the PMP is not mandated by their job and that a query takes less than 5 minutes (79%). (Figure 2) Seventy percent stated that the PMP was very easy or easy to navigate. Pharmacists were asked how information from the PMP affects their decision to fill a prescription: 56% call the physician’s office to report the information, 22% return the prescription to the patient but note the finding on the prescription so that the next pharmacy will see the information, 17% return the prescription to the patient unaltered, and 5% reported “other.”

Figure 2. Pharmacists asked how many minutes accessing the PMP added to fill a prescription.

Seventy percent of pharmacists express that having PMP delegates, either licensed technicians or pharmacy interns, would be helpful to their practice. Over 100 pharmacists provided written comments regarding their use of the PMP. Comments included: PMP should be promoted more to prescribers, would be helpful if the program was faster, would be helpful if data were uploaded daily instead of weekly, would be helpful if system was incorporated into employer’s software system so that logging in is not necessary each time, it is a surprise to the patient, and this is an excellent program that has definitely positively impacted my practice.

COLLEGES OF PHARMACY

The UAMS College of Pharmacy has long provided education about substance abuse unique among American colleges and schools of pharmacy. Looking back to the leadership of the late Lester Hosto, the College of Pharmacy has been a partner in the truly successful Impaired Practitioner Program. The lives and careers salvaged have a worth beyond measuring. A solution to prescription drug abuse will require consistent and nonjudgmental guidance for patients. That guidance can only emerge from a profession refreshed

by its commitment to care for impaired practitioners, and informed by evidence-based care of those who become victims of this scourge. I invite every reader to consider how the College may assist in your own community. I hope that you will then share your insights with me, so that the entire strength of our College – students, faculty and alumni – may be focused on this long-unmet public health need. §

HARDING UNIVERSITY

Many Reasons Why It's Great to be at Harding!

s another round of APA District Meetings conclude, I thought I’d share with you some of the reasons we say, “It’s Great to be at Harding!” In the Harding University College of Pharmacy (HUCOP), our mission is to graduate pharmacists who accept the responsibility of improving the spiritual and physical wellness of the world by providing patient-centered care that ensures optimal medication therapy outcomes delivered through the highest standards of Christian service. The values we employ as we daily strive to accomplish this mission are captured in the acronym ACCTIONS, which stands for advancement, Christianity, collaboration, trustworthiness, innovation, outreach, nurturing, and service. We’ve had a wonderful year filled with what we believe are worthy examples of our mission and values in ACCTION. In July at the American Association of Colleges of Pharmacy Annual Meeting in Grapevine, Texas, a HUCOP research team was recognized with one of four 2014 Student Community Engaged Service Awards, sponsored by TEVA Pharmaceuticals. The student team, including Brantley Underwood, Ellen Jones, Parisa Khan, and leader Katy Jang, submitted a proposal for their ongoing work entitled Development of a Pharmacist-Driven CommunityBased Initiative to Reduce Cervical Cancer Rates in White County, Arkansas: Meeting the Needs of an Underserved Population. Dr. Rayanne Story serves as the faculty advisor to the group. The project began in the fall of 2009 and has been handed down to subsequent students who have continued the work. The grant award of approximately $18,000 will

allow the project to incorporate new Julie Hixson-Wallace media outlets such as television Pharm.D., BCPS public service announcements Dean highlighting HPV disease burden and encouraging prevention through vaccination. Also in July we learned that Dr. Ashley Earley, assistant professor of pharmacy practice, was selected by the National Association of Chain Drug Stores (NACDS) Foundation as a participant in the foundation’s 2014-15 Faculty Scholar’s Program. Earley was one of eight faculty members from pharmacy schools and colleges across the nation chosen for the program, which is in its third year. The program is designed to educate faculty at pharmacy schools and colleges of pharmacy about effective and meaningful community pharmacy-based patient care research. Earley has interest in exploring reasons for patient non-adherence and how community pharmacists can positively influence adherence. Both of these honors demonstrate ways in which Harding students and faculty are collaborating to provide outreach to the communities we serve. Several students completed both introductory and advanced pharmacy practice experiences internationally during 2013-14. Seven completed IPPEs in four different countries including Honduras, Panama, Haiti, and parts of South America; eleven completed APPEs in three different countries including Haiti, Nicaragua, and parts of South America. The experience completed in parts of South

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COLLEGES OF PHARMACY

America involved one IPPE student and one APPE student who spent two weeks traveling down the Amazon River collecting plant specimens from the rain forest and learning about medicines that are derived from natural sources. Since returning home, the students are incorporating their new knowledge into both a didactic elective course and a required health and wellness APPE. Associate professor of pharmacy practice, Dr. Debbie Waggoner, took her research along with her and the group of students who participated in the experiences in Nicaragua. Dr. Waggoner is evaluating the effectiveness of a novel wound healing gel and was able to share this new compound with populations that would not otherwise have access to its beneficial effects. Related to the APPEs completed in Haiti was a project involving an invention known as a zeer which is a pot-in-pot evaporative cooling device. In preparation for their international travel, students researched the zeer system at home in Arkansas and subsequently deployed it in Haiti where it is being used to provide non-electrical refrigeration of insulin in order to improve diabetes control. Projects like this allow our students to experience classroom and experiential learning while advancing innovation by leaving behind tools which can be used in these underserved communities long after they have gone.

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Finally, class of 2012 alumnus, Dr. Jake Blair and his wife Jaclyn (a physician assistant who also graduated from Harding), are moving to Peru as part of a group of families pursuing full-time vocational ministry. They will be planting a church while using their roles as health care providers to financially support their mission work. This is a penultimate example of carrying out the Christian mission of HUCOP. Similarly, Dr. Shawn Turner, a class of 2013 HUCOP alumnus, is putting his pharmacy education into vocational ministry by returning to Harding to serve as a faculty member in the College of Pharmacy. Shawn comes back to us following completion of a residency program at Texas Tech in collaboration with the Dallas VA Medical Center. As Shawn’s return to Harding and these other items demonstrate, we believe we are following our mission and values. I appreciate your collaborations as preceptors and in so many other ways that make it possible for us to achieve these goals! §

MARKETING IDEAS

Telling Your Brand's Story Marketing Ideas from Pharm Fresh Media By Liz Tiefenthaler

wo months ago I was teaching a marketing class to a group of pharmacy owners and I asked the question, “Is there anyone here who can tell me what their brand is?” Almost instantly a hand shot up in the middle of the room and a young man said “Sunmark!” After a confused couple of seconds, I realized what he meant and replied, ”That is what you sell not who you are.” This young man is not alone in his confusion over being able to define his brand. Unfortunately, most of us define our brand by what we do or what we sell rather than by why we do what we do. Learning to tell our story to consumers is key to attracting new customers. In order to truly tell our story, we need to start with figuring out our brand based on why and not what.

This is where your leadership is so important. As you build your brand so that you have a strong story to tell a target group of people looking for what you have to offer, make employee buy-in a #1 priority. I had an owner tell As you build your brand so that you me once that his store didn’t have many people signed up for have a strong story to tell a target his sync program because one group of people looking for what you of his pharmacists didn’t like to offer, make employee buy-in a #1 do it. Really? Should a person priority. stay on as an employee who is poisoning the brand? Not in my If your brand is going to tell an pharmacy.

authentic story about how much you care about patient health and how you will help patients reach their goals of feeling better, then you will need a "We" commitment from everyone.

Simon Sinek is a brilliant leadership trainer. (Check out his blog on his website StartWithWhy.com.) He stresses the important point that “people don’t buy what you do, they buy why you do it.” People buy passion and the human side of a business over offerings. As much as we need a logo, consistent brand colors and a good website, these are just things that we create to help promote our brand. A real brand comes from something authentic that emerges from your pharmacy culture. A real brand story is told with feeling.

Let me give you an example using adherence as a brand offering. We all believe in adherence and understand that it is better for the patient and for the pharmacy, yet why do some people sign up hundreds of patients while others have perhaps 20 or 30 patients involved? The successful pharmacies are those where the commitment to adherence and a passionate commitment to patient health, is so prevalent that every employee embraces

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this as a brand attribute. It doesn’t matter whether it is a tech or a pharmacist or your driver. In a successful brand, every single person is committed to the WHY and not just the WHAT.

If your brand is going to tell an authentic story about how much you care about patient health and how you will help patients reach their goals of feeling better, then you will need a “We” commitment from everyone. Start with a clear understanding of who you are and why you do what you do and then have a company culture where everyone embraces this. Asking yourself “why” will allow you to tell your brand story in a big way. § About Liz Tiefenthaler: Liz is the President of Pharm Fresh Media, a marketing services company serving Independent pharmacy. She is a columnist for America's Pharmacist and Drugstore Canada as well as a frequent presenter for NCPA.

A RA•RR•xR x| T |H ET H A ER KAARNKSAANSS A PH TIST S APRHMAAR C MIAS C

APA District Meetings in Pictures Little Rock

Hot Springs

Camden

(L to R) Denise Clayton, Paige Ballard and Tonya Robertson.

Area 1 Representative Michael Butler in Hot Springs.

District 4 President Lise Liles.

(L to R) Phillip Way, Tim Eubanks and Eric Horras.

HUCOP and UAMS COP Deans Julie Hixson-Wallace and Stephanie Gardner.

District 4 Meeting attendees.

Area 3 Representative Clint Boone.

APA President Brandon Cooper.

UAMS’ Schwanda Flowers.

APA’s Executive VP and CEO Mark Riley.

(L to R) Steve and Aduston Spivey and Jackie and Jimmy Buck.

AR State Board Vice President Lenora Newsome.

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APA District Meetings in Pictures Russellville

(L to R) Ashley Rector and District 6 President Stephen Carroll.

Fort Smith

Bentonville

(L to R) Charles Wimberly and Amy Avlos from Smith Drug.

HUCOP’s Todd Brackins.

By Eric Crumbaugh, Pharm.D.

HUCOP’s Jeff Mercer and UAMS COP’s Scott Warmack.

AR State Board Asst. Director Brenda McCrady.

(L to R) Peggy Thomas, Taylor Franklin and Donna Curry.

Mountain Home

AR State Board Executive Director John Kirtley.

(L to R) Wayne Schulte and Brian Erickson.

(L to R) Leo Ziebert and Scott Bryant.

(L to R) Bryan Persen, Billy Newton and Taylor Burgess.

District 7 Meeting with District President CA Kuykendall.

Past President Dana Woods leading District 3 Meeting.

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Searcy

Jonesboro

(L to R) Jason and Rhonda Barr.

(L to R) Cheyenne Smith and Blair Thielemier at District 2 Meeting.

(L to R) Daniel Dallas and Joe Vincent.

UAMS’ Kat Neill at District 8 Meeting.

(L to R) Julie Walker and APA District 2 President Kristy Reed.

(L to R) Larry Holcomb, Loy Jackson and Faith Ashley.

Monticello

(L to R) Nancy Showalter and Stacy Featherston.

(L to R) Sam McHaney and Lee Shinabery at District 2 Meeting.

UAMS’ Seth Heldenbrand.

(L to R) William Hamill, Sue Helms, Kathryn Sanders, Amber Miller and Christy Campbell.

(L to R) Lisa Blanton, Sara Massey and Max Caldwell.

District 5 Meeting attendees.

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APA District Meetings in Pictures APA DISTRICT MEETINGS IN PICTURES

Stuttgart

(L to R) Carol Weiland, Roxie Wilson and Beth Williams.

District 5 President Dean Watts addresses members.

(L to R) Karen Watts, Jacque Charles and Brandyn England.

Harding University COP’s Tim Howard.

(L to R) Norris Ragan and Lisa Black.

AR State Board Member Tom Warmack.

AAHP Board Executive Director . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Susan Newton, Pharm.D., Russellville President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Marsha Crader, Pharm.D., Jonesboro President-Elect. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Rob Christian, Pharm.D., Little Rock Past President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lanita S. White, Pharm.D., Little Rock Treasurer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sharon Vire, Pharm.D., Jacksonville Secretary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Wendy Jordan, Pharm.D., Jonesboro Member-at-Large . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Maggie Williams, Pharm.D., Batesville Member-at-Large. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Niki Carver, Pharm.D., Jonesboro Member-at-Large . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .James Reed, Pharm.D., Conway Technician Representative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Janet Liles, CPhT, Searcy

Arkansas State Board of Pharmacy President. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Larry Ross, B.A., M.S.Ed, Sherwood Vice President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lenora Newsome, P.D., Smackover Secretary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Stephanie O’Neal, P.D., Wynne Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Steve Bryant, P.D., Batesville Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Tom Warmack, P.D., Sheridan Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Kevin Robertson, Pharm.D., BCPS, Little Rock Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Percy Malone, P.D., Arkadelphia Public Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Joyce Palla, Arkadelphia

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THE ARKANSAS PHARMACIST

CLINICAL UPDATE

APA Partners on Medication Adherence By Eric Crumbaugh, Pharm.D. Pharmacist and owner Marci Peoples of Pleasant Grove Pharmacy in Texarkana discusses adherence with APA’s Director of Clinical Programs Eric Crumbaugh.

any studies have shown that patients’ health is to increase patient’s medication adherence through improved when they take prescribed medications synchronization. Through this program, the pharmacist regularly and do not allow prescriptions to lapse. Poor identifies non-adherent patients using an online platform medication adherence costs the healthcare system $290 that is populated with information from the pharmacy’s billion, according to the health policy dispensing software. The pharmacist institute Network for Excellence then selects an anchor medication in Health Innovation. Sixty-nine (normally the most costly drug) Poor medication adherence percent of medication-related and sets up the refills of all other costs the healthcare system hospital admissions are due to poor medications to be filled the same day $290 billion. adherence for patients with chronic each month. diseases such as congestive heart failure, diabetes, and hypertension. A week prior to the fill date, the online platform generates a preMedicare STAR ratings The Centers for Medicare and Medicaid recorded call to the patient to prompt measure health and Services (CMS) has made adherence them to let their pharmacist know if drug service plans that a key focus for pharmacies and any part of their drug therapy has help to assess patient plan sponsors by creating Medicare been changed. Then one day prior, health; manage chronic Part D STAR ratings, a system that another call is automatically made conditions; offer drug plan measures patient adherence at the reminding the patient to pick up their customer service; address pharmacy level in several key areas. medication. member complaints, Medicare STAR ratings measure health member experience and and drug service plans that help to Currently there are approximately 70 satisfaction; accuracy of assess patient health; manage chronic pharmacies participating in this study drug pricing. conditions; offer drug plan customer with 7,000 patients enrolled. The service; address member complaints, goal is to get up to 7,500 patients. member experience and satisfaction; The study period will end in February ensure patient safety and accuracy of 2015 and the data will be analyzed drug pricing. by the University of Arkansas for Medical Sciences College of Pharmacy Pharmaceutical Evaluation and APA, along with National Community Pharmacists Policy. For more information about this program contact Association and Pfizer, have partnered together to Eric Crumbaugh or go to www.arrx.org/adherence. § launch a pilot program with Arkansas pharmacists

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THE ARKANSAS PHARMACIST

ARKANSAS ASSOCIATION OF HEALTH-SYSTEM PHARMACISTS

AAHP Membership…What can it mean to you?

an you believe the fall season is already upon us? Before we know it, a new year will begin. This means colder weather, New Year’s resolutions, and deciding which organizations to continue membership or join for the first time. The Arkansas Association of HealthSystem Pharmacists (AAHP) would like you to know what membership can mean to you whether you are a pharmacist, student, or technician. AAHP is a state affiliate of the national organization, American Society of Health-System Pharmacists (ASHP), and an academy of the Arkansas Pharmacists Association (APA). Our collaborations with these two associations help our organization impact pharmacy efforts on the state and national level. Both AAHP and its Student Societies of HealthSystem Pharmacists (SSHP) at Harding and University of Arkansas for Medical Sciences (UAMS) have been recognized for their efforts. SSHP at both colleges of pharmacy in Arkansas recently received continued official recognition from ASHP for 2014-2015. Recognition was based on their efforts in promoting membership, stimulating interest in health-system pharmacy careers, and encouraging career development and professionalism.

glycemic agent ADEs by 2%. The next AHSPARC meeting is October 21, 2014, in Little Rock. For more information go to www.arrx.org/aahp.

Marsha Crader, Pharm.D. President

If you are a pharmacist, including new practitioners and residents, AAHP offers you many educational and networking opportunities. Our annual Fall Seminar is a great event that offers continuing education, professional research posters, and an exhibitor showcase. This is in addition to specific networking opportunities for directors and clinical coordinators. If you have residency-specific interests, we also have a residency showcase and resident roundtable at Fall Seminar. The Residency Taskforce continues to provide programming outside of Fall Seminar, with its 2014-2015 UAMS COP SSHP Officers and members. most recent offering in May 2014 that provided ASHP Residency Learning System (RLS) training to Arkansas residency directors and preceptors. AAHP also plans to offer new virtual pharmacist educational opportunities through technology in the upcoming year. This will allow pharmacists to obtain education in the convenience of their own home, pharmacy, or office.

Faculty advisors for the SSHP For students looking for a way to Harding University COP 2014-2015 SSHP members. organizations are Tiffany Dickey, learn more about the profession and Pharm.D., Catherine O’Brien, to become involved, AAHP and SSHP Pharm.D., and Rayanne Story, Pharm.D. AAHP was are the right fit for you. AAHP provides student tailored also highlighted in the Arkansas Hospital Association’s education at Fall Seminar which includes residency (AHA) spring 2014 journal for its efforts with one of the information and the annual UAMS and Harding Jeopardy Hospital Engagement Networks (HEN). AAHP members, game. Each SSHP organization is involved in professional including Niki Carver, Pharm.D., CPPS, are leaders in the service projects, and the winner of each college’s annual Arkansas Health-System Pharmacists Adverse Drug Event clinical skills competition competes at the ASHP Midyear Reduction Collaborative (AHSPARC). The pharmacists Clinical Meeting. These groups have been involved with involved with this AAHP and AHA collaborative have projects such as technician training for the Pharmacy helped reduce adverse drug event (ADE) rates throughout Technician Certification Board (PTCB) exam and providing Arkansas. Opioid ADEs have been reduced by an health education to medically underserved populations. astounding 48.2%, warfarin ADEs by 25.5%, and lastly

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THE ARKANSAS PHARMACIST

COMPOUNDING ACADEMY

AAHP knows that technicians are a vital component of the health-system pharmacy team, and we continue to provide opportunities for you as a technician. Fall Seminar offers specific technician programming, including its recent addition of a review course for the PTCB exam. Additionally, technician certification is promoted through our pharmacy technician certification scholarship. AAHP is continually assessing the needs of the organization and its membership. In the near future you will receive a

survey asking you about the current membership benefits that you value, as well as benefits that you would like AAHP to provide in the future. Please take the time to fill out this survey, so we can better meet your membership needs. On behalf of AAHP, I ask you to continue your membership with us if you are already a member, and if you are not currently a member, I ask that you consider AAHP membership and what it can mean to you. §

COMPOUNDING ACADEMY

Let’s Work Together to Keep Compounding Viable

s most of you are aware, the compounding world is ever changing. I have been compounding for over 14 years now. And in that time compounding has changed a lot. And the one thing I know for sure is more changes will come in the future. Only by us standing together and working to help one another for the betterment of our patients and our profession will we continue to be a viable asset to our patients and doctors. In the past compounders would get together to share ideas and the new things they were doing for their patients. This sharing is where I learned the most. Sharing has changed now with compounders shipping all over the US. Most compounders now are very guarded about sharing things because they are unaware of who their competition might be. We need to get back to helping each other to ensure medications are made properly and the patient is well taken care of.

very big asset for all of us in Lee Shinabery, Pharm.D. the future. The accreditation President process is not an easy one and there are many things involved with getting accredited. This column is not nearly long enough to cover all the things needed to become accredited. But there is one I have heard has tripped up many pharmacies trying to become accredited. It involves your pharmacy software.

An area that has seen major changes is insurance billing of compounds. When I started in this business, everyone talked about how you should not take insurances and/ or compounds that were not covered by most insurance companies. Then a few years ago several insurance companies started covering compounds and they reimbursed very well. Now, because of the high prices, we are seeing insurance companies go back to not covering compounded medications. Most had hoped there would just be a correction in the AWPs, but insurance companies just went back to the way it was and used the same excuse others have (not a Food and Drug Administration approved medication).

As I am sure most of you are aware, with compounding medications you have to be able to track where each medication goes by its lot number. Software systems made for compounding do this very easily. But systems made to do retail pharmacy do not accomplish this very easily or even at all. Why does this matter? Mostly, because it is the law. Also, the Pharmacy Compounding Accreditation Board (PCAB) inspector will ask you during his or her in-store inspection to perform a recall of a medication from its lot number. If you cannot perform this task you will not pass to become PCAB Accredited. Most all pharmacy software systems have the capability to tie a lot number to a prescription. The biggest problem comes when you have to enter more than one lot number for the medication to fill a prescription. I have not found a system other than the ones made especially for compounding that can do this. So, make sure your software can track a medication by lot number and for whom it has been filled. Hopefully, you can get this done now so it is not a problem later. You may have to contact your software vendor and ask how this can be done. If it cannot you need to inform them that you must have it added as soon as possible.

Another area of change is the ability to accredit your compounding pharmacy. I believe this will become a

Let’s work together to help keep compounding medications a viable option for the years to come. §

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THE ARKANSAS PHARMACIST

CONSULTANTS ACADEMY REPORT

Pharmacogenetics in the Skilled Nursing Facility

rug seeker. This was the label applied to one nursing facility resident by her physician, because despite periodic increases in her codeine dose, she continued to complain of pain. Unfortunately, many of us may have jumped to the same conclusion due to the escalation of prescription drug abuse. This particular resident, however, was fortunate enough to be living at a facility that decided to look at medication management differently. There are 2.2 million serious adverse drug events (ADE) every year making it the fourth leading cause of death in the U.S. It is also estimated that 75 percent of the population have genetic variations that increase the likelihood of an ADE. To help combat the rehospitalization of their residents due to ADEs and treatment failures, several nursing homes across the state have started offering DNA testing to residents who are considered “high risk” depending on the number or class of medications they are taking. These residents would also qualify to have their testing paid for by Medicare Part B. A simple cheek swab and approximately 10 days later, the results are analyzed and uploaded to a secure website for review by the healthcare team. The software that I have experience with was written by and is supported with pharmacists. It allows the pharmacist and prescriber to view potential drug-gene and drug-drug interactions based on the resident’s current medications, ranking each by

severity. Consultant pharmacists are in a unique position to Rachel Hardke, Pharm.D. influence prescribing choices President by advising on those residents whose results show an altered metabolism of certain medications based on cytochrome P450 isozymes. Taking a look back at our “drug seeker,” her results showed she was a poor metabolizer of CYP2D6. Codeine, a prodrug, is a substrate of CYP2D6. As a poor metabolizer, our resident had no CYP2D6 activity, therefore codeine was not converted into its active metabolite, morphine. Increasing the dose was not providing her with the expected pain relief. As a consultant pharmacist, I find this testing to be a unique opportunity to be an even more integral part of the medication management team. Being that this is a new initiative in nursing facilities, there are still some questions surrounding the application of this information. How it will affect the survey process, what kind of liability issues may arise, and other concerns have not all been answered. Hopefully, they will be addressed quickly as more and more homes are opting into genetic testing. Personalized medication therapy can reduce adverse drug events, hospitalizations, treatment failures and may even increase adherence. All will help us achieve our goal of improved outcomes for our patients. §

Member Classifieds Parata RDS PT-050 for Sale. Parata machine was purchased new approximately 5 years ago. Machine has been in use until about 2 months ago when it was decided that the pharmacy did not need it anymore. Fully operational and only needs upgraded software. Contact Randy Kassissieh at Baker Drug Pharamcy at 501-945-3264 or 501-772-1123 for more information. $10,000 or best offer. (9/29/14)

looking for experienced Certified Pharmacy Technicians (CPhT) with retail and longterm care (LTC) operational knowledge to continue to better serve our growing patient base. Positions open include medical/dental benefits, paid vacations and holidays, as well as 401k participation. For additional information or to submit your resume, please call 479-270-7800. (9/24/14)

Full-Time Health System Pharmacist Position in Central Arkansas. Current opening for motivated, experienced, Staff pharmacist. Fully automated Pharmacy environment including Pyxis, Pyxis Connect, Bedside barcode scanning, & CPOE. Hospitalist model. We offer Integrated clinical pharmacy services 7 days a week. Interested applicants please apply on-line at www.saintmarysregional.com or contact Susan Newton 479.964.9272. (9/26/14)

Clinical Pharmacist Faculty – Family Medicine, UAMS Regional Programs, UAMS West (Fort Smith, AR). Applications are invited for a non-tenure-track, faculty position at UAMS West (Fort Smith, AR) with a primary appointment in the Department of Pharmacy Practice in the UAMS College of Pharmacy. Excellent communication, interpersonal, and patient care skills are essential. Candidates must have an earned Pharm.D. with a residency or equivalent experience, and must be eligible for licensure in Arkansas. Practice experience in a family medicine environment is preferred. Rank and salary are negotiable

Full-Time Pharmacy Technician Opportunities in NW Arkansas. Growing community pharmacy in NW Arkansas is 34

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and commensurate with experience. The position is available immediately. Interested individuals should submit a curriculum vitae, a list of three references, and a letter of intent to: Don Heard, EdD, MBA, Director, UAMS West, 612 South 12th Street, Fort Smith, AR 72901/ Phone: 479-4243172. Email: Hearddona@uams.edu.The University of Arkansas for Medical Sciences is an Equal Opportunity/Affirmative Action Employer. (9/8/14) Seeking pharmacy technician for independent retail pharmacy in North Little Rock. Experience preferred. Please email resume to pharmacy1777@gmail. com. (9/2/14) Pharmacist available for employment. Pharmacist with 30 years of experience in both hospital and retail seeks PT/FT work. Contact at alfaromeo@centurylink.net or 501-231-1130 (Cabot area). (8/27/14) Part-time Pharmacist in Warren area. Looking for relief or fill-in pharmacist, |

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possibly one day a week and vacations. If interested contact doloresfamilypharmacy@hotmail.com. (8/25/14) Part-time Pharmacist in North Little Rock. Part-time Pharmacist needed for outpatient clinic in North Little Rock (NOT RETAIL). This is 5-10 hours per week with VERY Flexible scheduling. Email resume to: stocktonmed2014@gmail.com or fax (501) 666-2366. (8/19/14) Hiring pharmacy technicians in Little Rock - New independent retail pharmacy in Little Rock looking to hire pharmacy technicians ASAP. Monday - Friday Hours. Email tgardner@pharmetricsrx.net if interested. (8/14/14) Part time/Full Time pharmacist wanted in Fort Smith. Independent pharmacy in Ft. Smith seeking Licensed Pharmacist for one to two nights a week and one weekend a month. Competitive salary, benefits. Send resume to 700 Lexington Ave. Fort Smith, AR 72901, email Anderson.1@live.com or call (479) 782-2881. (7/21/14) Seeking part-time pharmacist in DeQueen. Harris Drug and Gifts, an independent pharmacy in SW AR is looking for a part-time licensed pharmacist. Store hours M-F 8 a.m.-5:30 p.m. and S 8 a.m.12 p.m. Please send resume to Harris Drug 205 DeQueen Ave. DeQueen, AR 71832 or send via email to harris.drug@yahoo.com. This position will be for 2-2 1/2 days a week. (5/27/14) Pharmacy for sale in Strong. Only pharmacy in small town and has been in business for 36 years. The building is 3000-square- feet. There is a clinic with a doctor in town. The closest competition is 30 miles away. Residents can take advantage of The El Dorado Promise which provides graduates of El Dorado High School with a scholarship covering tuition and mandatory fees that can be used at any accredited two- or four-year, public or private educational institution in the US. For more information, please call 870-951-0534 or e-mail newsomjf@sbcglobal.net. (5/22/14) Pharmacist needed in Sherwood. Pharmacist-In-Charge needed for Sherwood, Monday thru Friday, 9 a.m. to 6 p.m. Self-motivated, friendly, trustworthy need apply. Send resume tosrice@unitedpaincare.com. (5/22/14)

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Independent pharmacy in Van Buren is seeking friendly, personable, efficient pharmacist. Duties will include the normal staff pharmacist duties as well as helping with MTM consulting, immunizations, etc. Relief Pharmacist hours available as well, to cover vacations and Saturdays. Store hours are Monday-Friday 9 a.m.-6 p.m. and Saturday 9 a.m.-1 p.m. Send resume to kbarlow@pharmacyexpressvb.com or fax to (479) 474-3131. (5/22/14) Opportunity to open pharmacy in north central AR. Great opportunity to own your own business. Small town in north central Arkansas currently has no pharmacy. Large population draws from surrounding communities. Land owner will build and design to suit pharmacy. Option to have graduated rent until business established. Building site overlooks and is walking distance to Bull Shoals lake. If interested contact Jeff or Pat Dell at 870-436-5405 or ccr@southshore.com. (5/20/14) We are seeking a friendly, energetic, pharmacist for possible employment in a leadership position within our company. Candidate must possess excellent people skills. If interested, please call Robert Woolsey 479-667-7338. (5/15/14) Seeking pharmacy techs in Conway. US Compounding Pharmacy in Conway is seeking pharmacy technician applicants. Please send resume and request application from lwilson@uscompounding. com. (5/12/14) Chicot Memorial in Lake Village seeking pharmacist. Chicot Memorial Medical Center is seeking a dynamic, engaged Pharmacist to manage the Pharmacy Operations of our critical access hospital. We are a collaborative, patient centered, learning organization focused on improving patient outcomes, patient satisfaction and patient education. Our Pharmacy Director will serve in a key position in helping us achieve our goals. We offer a very competitive compensation and benefits package. Please apply athttp://www. chicotmemorial.com or call 870-265-9395 for more information. (5/2/14)

Charitable Clinic Needs Service Minded Pharmacists- Want to be thanked dozens of times a day? Tired of dealing with insurance? Join our team at River City Charitable Clinic in North Little Rock. We are looking for volunteer pharmacist to take an active role in the healthcare of low income, uninsured, unassisted patients. Volunteer(s) are needed specifically for a new "refill clinic". You can pick your ideal clinic time on Monday, Wednesday, or Thursday. Staff it weekly or share with a friend. Interested pharmacists can contact Pam Rossi at PRRossi@uams.edu or call Anne Stafford, RN Medical Manager at 501-376-6694. (2012) Experienced Relief Pharmacist Available- Experienced relief pharmacist (retail/hospital/IV) available in Central Arkansas. Willing to travel reasonable distances. Fred Savage 501-350-1716; 501-803-4940; fred.savage@sbcglobal.net. (5/7/12) IVANRX4U, Inc., Pharmacist Relief Services, Career Placements- Relief pharmacists needed - FT or PT. Based in Springfield, MO and now in Arkansas. Staffing in Missouri, Arkansas, Eastern Kansas and Oklahoma. We provide relief pharmacists for an occasional day off, vacations, emergencies -- ALL your staffing needs. Also seeking pharmacists for full or part-time situations. Please contact Christine Bommarito, Marketing and Recruiting Director, for information regarding current openings throughout Arkansas, including temporary as well as permanent placements. Let IvanRx4u help staff your pharmacy, call 417-888-5166. We welcome your email inquiries, please feel free to contact us at: ivanrx4uchristine@centurylink.net. (2011) STAFF RPH, Inc.- Pharmacist and Technician Relief Services. We provide quality pharmacists and technicians that you can trust for all your staffing needs. Our current service area includes AR, TX, OK and TN. For more information call Rick Van Zandt at 501-847-5010 or email staffrph1@att.net. (2011) ยง

Northwest Arkansas Free Health Center in Fayetteville looking for pharmacy volunteers. We provide health and dental care to low income and uninsured individuals. Our pharmacy hours are Wednesday 1-3 and Thursday 6-8. Contact Monika Fischer-Massie at mfischerm@nwafhc.org or call 479-4447548. (12/12/12)

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THE ARKANSAS PHARMACIST

2014-2015 Calendar of Events

CALENDAR OF EVENTS

2014

2015

OCTOBER

FEBRUARY

October 18-22 National Community Pharmacists Association Annual Convention Austin, TX October 28 APA Golden CPE Hosto Center Little Rock AR

NOVEMBER

February 25-28 International Academy of Compounding Pharmacists Educational Conference Fort Lauderdale, FL February 27* CPE at the Races Oaklawn Park Hot Springs, AR

November 5-7 American Society of Consultant Pharmacists Annual Meeting and Exhibition Orlando, FL

MARCH

Nov. 8-15 CPE in Paradise RUI Palace Resort Costa Rica

March 27-30 American Pharmacists Association Annual Meeting & Exposition San Diego, CA

DECEMBER

APRIL

December 7-11 American Society of Health-System Pharmacists Midyear Clinical Meeting and Exhibition Anaheim, CA December 6-7 APA Committee Forum and Board Meeting Holiday Inn Airport Little Rock, AR

March 8* APA Board Meeting Hosto Center Little Rock, AR

April 9* Arkansas Pharmacy Foundation Golf Tournament Location TBD

MAY

Dates TBD National Community Pharmacists Association Legislative Conference Washington, D.C.

JUNE

June 11-13 APA 132nd Annual Convention Embassy Suites Little Rock, AR * Dates have not been finalized.

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THE ARKANSAS PHARMACIST

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