ARRX - First Quarter 2020

First Quarter 2020 Award-Winning Quarterly Publication of the Arkansas Pharmacists Association

The Road to SCOTUS:

Pharmacy Case Takes Detour

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THE ARKANSAS PHARMACIST

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Dear Colleagues, The Arkansas Pharmacists Ass ociation (APA) is your profess ional statewide organization and been protecting the interests of for the past 137 years we hav Arkansas pharmacists. Today, e I want to personally invite you by supporting APA as a member to invest in your professional futu in 2020. re

2020 continues to be a challen ging time for Arkansas pharma cists but offers a bright hope APA has been there to fight and for the future. Every step of the advocate for our profession. In way 2018, APA and the pharmacy fight a broken system for taxpaye community stood side by side rs, patients and our profession to that we love. Despite legislative succes attention, APA moved forward ses that garnered national in the 2019 general session to address more issues that aros had a successful year despite e and threatened our profession. the immense challenges, and We we learned more than ever that The key to success is your con it would be impossible without tinued membership in APA, fina you . ncia l sup port of our political action com legal defense fund, and profess mittee and new legislative/ ional engagement through you r valuable time and presence.

A few of our successes include : • APA worked with the Arkans as legislature and Governor Hut chin son to pass and sign additional licensure legislation during the pharmacy benefit manager 2019 legislative session. This legislation prohibited spread pric ingredient cost payments, requ ing, sets a payment floor for ires quarterly rebate reporting

by PBMs to the Arkansas Insu what is passed through to com rance Department (including munity pharmacies), and mor e.

• APA supported state legislat ors in their efforts to improve pharmacy by donating from the known as AP-PAC. Each elec APA political action committee tion cycle, AP-PAC gives betw een $50,000-$100,000 to sup have helped pharmacists. Tha por t legislative champions that t money comes solely from gen erous APA member donations. up, AP-PAC is looking to raise With an election year coming at least $50,000. Visit www.arrx.o rg/ap-pac-donation-form if you • APA continues to support the would like to donate today.

Attorney General’s (AG) office as they prepare to present oral Court in a landmark case ove arguments at the US Supreme r the legality of Arkansas Act 900, the 2015 MAC pricing law Circuit Court of Appeals decisio that was overturned by an 8th n on the preemption of self-ins ured plans by ERISA. This mon widespread repercussions cap umental case could have able of changing the pharmacy landscape for pharmacists, pati another example of why pharma ents, and employers. It also is cists across the country look to Arkansas as one of the nati To support our efforts during onal state association leaders. this pharmacy milestone, APA has established the Legislative www.arrx.org/LDF to donate and and Legal Defense Fund. Visi support the work being put into t the Supreme Court case and • APA staff and members part future legislative battles. icipated in dozens of live tele vision interviews. APA staff wer news articles in Arkansas Bus e also interviewed for publish iness, the Arkansas Democra ed t-Gazette, Talk Business & Poli and national news organization tics, and countless other stat s. e • APA staff continues to sup port the development of the Arkansas CPESN (Communit Network), which officially laun y Pharmacy Enhanced Service ched as a clinical integrated netw s ork with CPESN USA. More than pharmacies are participating in 120 Arkansas community the network.

• APA continues to support its partnerships with the Arkansas Association of Health System Pharmacist Academy and Com s pharmacists, APA Consultant pounding Pharmacist Academ y.

• APA continues to provide exp ertise and facilitate conversatio ns with health plans about attr and paying for professional pha ibuting patients to a pharmacy rmacist enhanced services.

• APA continues to offer netw orking and relationship building opportunities for its members regional meetings in 11 different at educational conferences and cities across Arkansas.

We appreciate the opportunity to serve the pharmacists of Ark ansas. We are one of the stronge in the nation and have emerged st state pharmacist association as a national leader but will only s remain that way with your acti Please do not hesitate to contact ve membership and engagemen our talented staff at 501-372-5 t.

250 if we can do anything to serve supporting the APA and to a grea you. We look forward to you t 2020!

Warm regards,

John A Vinson, Pharm.D., JD Executive Vice President & CEO

417 South Victory Street | Littl

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CONGRATULATIONS

2020 SCHOLARSHIP WINNERS

Pharmacists Mutual is proud to support students who are interested in serving in an independent or small chain community pharmacy or an underserved geographic or cultural community. Each student listed received a $2,500 scholarship.

AMNA PARACHA University of Maryland Eastern Shore

MASON SYKES Samford University

BENJAMIN HIGHTOWER University of Georgia

MORGAN PLATTA University of Wisconsin–Madison

BROOKE HENRIKSEN California Health Sciences University

LESLIE VO University of Texas at Austin

JADA JENSEN University of Wyoming

ROBERTO NAVA University of California-San Diego

EMILY BRUNSON University of Texas at Austin

NEVIN RADECHEL Drake University

LAUREN BREWER University of Georgia

RAEANN KILGORE University of Missouri–Kansas City

JOHNNY ALEXANDER University of Texas at Austin

SARAH HENDERSON Virginia Commonwealth University

JULIA ANNIS University of Rhode Island

STEPHANIE MARTIN Drake University

KAYLA LELAND Washington State University

STEPHANIE LUKEVICH South University

MICHAEL DANILOV University at Buffalo

BRIANNA SMITH William Carey University

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October 1, 2020 - December 1, 2020 https://www.phmic.com/scholarship/

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APA Staff John Vinson, Pharm.D. Executive Vice President & CEO John@arrx.org Jordan Foster Director of Communications Jordan@arrx.org

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Susannah Fuquay Director of Membership & Meetings Susannah@arrx.org Celeste Reid Director of Administrative Services Celeste@arrx.org Emily Wilson, Pharm.D. Executive Fellow emily@arrx.org

Office E-mail Address Support@arrx.org Publisher: John Vinson Editor: Jordan Foster 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 89. © 2020 Arkansas Pharmacists Association.

POSTMASTER: Send address changes to AR•Rx The Arkansas Pharmacist 417 South Victory Little Rock, AR 72201 Opinions and statements made by contributors, cartoonists or columnists do not necessarily reflect the attitude of the Association, nor is it responsible for them. All advertisements placed in this publication are subject to the approval of the APA Executive Committee. Visit us on the web at www.arrx.org.

Editorial Note: This issue of ARRX was set to be published shortly before the coronavirus pandemic swept through the United States. Due to contractual obligations with the United States Postal Service and our valued advertisers, the issue is being published with as many updates to content as possible.

Please visit www.arrx.org for APA news and updated information on scheduled APA events.

CONTENTS

Debra Wolfe Director of Government Affairs Debra@arrx.org

6 Inside APA: Challenges Facing Health-

27 AAHP: Challenges Facing Health-

8 From the President: Goodbye 2019,

28 Consulting Academy Report: A Day in

System Pharmacy Welecome 2020

29 Compounding Academy:

15 Legislator Profile:

30 Financial Forum: Why Do You Need A Will?

Pharmacy Case Takes Detour

Representative Vivian Flowers

16 Rx & the Law: Controlled Substances 17 Safety Nets: Student Spotlights 18 Member Spotlight:

Updates from USP

31 2020 APA Annual Convention Update 32 2020 APA Awards Solicitation 34 Call for Board Nominations 2020-2021

Kyeshia Ward Pharm.D.

19 New Drugs: The FDA Enters the New

Year with “2020” Vision

20 FEATURE: Q&A with UAMS College of

Pharmacy Dean Cindy Stowe

24 UAMS: Next Generation Pharmacy

Curriculum – the UAMS Advantage Compounding Academy Looking Forward

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the Life of A Consultant Pharmacist

10 FEATURE: The Road to Scotus:

25 Harding University: Looking Back, WWW.ARRX.ORG

System Pharmacy

ADVERTISERS 4 Pharmacists Mutual 8 Retail Designs, Incorporated 9 Biotech Pharmacal, Inc. 13 Arkansas Pharmacy Support Group 21 Law Offices of Darren O'Quinn 23 Smith Drug Company 26 UAMS College of Pharmacy 26 EPIC 35 Pharmacy Quality Commitment

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INSIDE APA

APA Board of Directors 2019- 2020 Officers President – Dean Watts, P.D., DeWItt

States’ Rights vs Strong Central Government

President Elect – Kristen Riddle, Pharm.D., Greenbrier Vice President – Max Caldwell, P.D., Wynne Past President – Stephen Carroll, Pharm.D., Benton

Regional Representatives Region 1 Representatives - John Hall, Pharm.D., Fort Smith - Dylan Jones, Pharm.D., Fayetteville - Spencer Mabry, Pharm.D., Berryville Region 2 Representatives - Greta Ishmael, Pharm.D., Cherokee Village - Jett Jones, Pharm.D., Jonesboro Region 3 Representatives - Brandon Achor, Pharm.D., Sherwood - Brittany Sanders, Pharm.D., Little Rock - Lanita White, Pharm.D., Little Rock Region 4 Representative - Betsy Tuberville, Pharm.D., Camden Region 5 Representative - James Bethea, Pharm.D., Stuttgart At Large Representatives - Stacy Boeckmann, Pharm.D., Wynne - Rick Pennington, P.D., Lonoke Arkansas Association of Health-System Pharmacists Erin Beth Hays, Pharm.D., Pleasant Plains Academy of Compounding Pharmacists Andrew Mize, Pharm.D., Springdale Academy of Consulting Pharmacists Denise Robertson, Pharm.D., Little Rock

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

Harding COP Student Brittany Petty, Searcy 6

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John Vinson, Pharm.D. APA Executive VP & CEO

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atrick Henry was one of many great leaders in early America. He was well educated, a lawyer from Virginia, and was an American patriot who is best known for his quote, “I know not what course others may take; but as for me, give me liberty, or give me death!" He believed in liberty so much that he declined to attend the Constitutional Convention in Philadelphia in 1787 where the first Constitution of the United States was drafted. He opposed the new Constitution because he believed it did not give states rights or any rights or freedoms for individuals and that it would promote a corrupt federal government between the three branches competing for more power. Henry believed that states and the people needed more rights, and the central government should be severely limited to an organizational role to support the collective states.

Henry’s opposition to a strong central government led to compromise and the first 10 amendments known as the Bill of Rights were written and ratified. The 10th amendment is the powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

One specific area that Henry and other anti-federalists opposed was Article 6 of the Constitution - the Supremacy Clause. This is interpreted to mean that when a federal law and a state law are believed to conflict or disagree, the federal law overrides or preempts the state law.

Almost 200 years later, Congress passed the Employee Retirement Income Security Act (ERISA) in 1974. The motivation for passing this law was a desire to protect employees from mismanagement of employee benefit plans in the private sector that left them at risk for the unexpected loss of promised employee benefits, like their retirement pension. In section 514 of ERISA law, Congress included an express preemption (based on the Constitutional Supremacy Clause) for certain provisions of the law to supersede any and all state laws so far as the state laws “relate to” any employment benefit plan.

On January 10, 2020, the United States Supreme Court granted certiorari to the state of Arkansas and Attorney General Rutledge in a landmark case that will decide if the ERISA express preemption applies or does not apply to state regulatory authority over pharmacy benefit managers (PBMs), specifically related to Arkansas Act 900 of 2015. Of note, only a single PBM existed in the late 1960’s and the PBM industry remained largely unheard of until online realtime drug claims processing began in 1987.

Even today, as PBMs have morphed into a $500 billion industry, with mega mergers and vertical integration, much of Congress and the general public either have never heard of PBMs or do not fully understand what PBMs do.

In section 514 of ERISA law, what does the phrase “relate to” mean? Did Congress really mean to take away states’ rights from protecting their citizens from an evolving industry that has inserted itself into the middle of patient care where today’s PBM business practices can cause life or death to a patient? Ironically, the very thing that ERISA was trying to protect, employee benefits, are often severely limited by the PBM in ERISA plans, eroding patient freedom of choice with plan designs that force patients to utilize pharmacies owned and operated by the PBMs often at a higher cost.

The Arkansas Pharmacists Association has been extremely active in both educational and legislative PBM reform efforts. Arkansas became and remains a national leader for PBM exposure and reform going back to the late 1990’s and early 2000’s. Act 900 of 2015 was a powerful law and struck a nerve with PBMs, especially the prohibition of deceptive selfdealing and higher pay by PBMs to itself in the marketplace. This is an indefensible PBM business practice that drives up costs and drives out competition.

Legal Defense Fund: The fight is an

expensive one in terms of both time and legal fees. The Arkansas Pharmacists Association needs your financial help in

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supporting our APA Legislative and Legal Defense Fund (LDF), as we support the final battle at the Supreme Court. Pharmacists all over the country are drawing a line in the sand and helping fight PBMs at the highest court in the land.

AP-PAC: We also need your help more than ever raising dollars for

our 2020 APA Arkansas Pharmacists – Political Action Committee (AP-PAC). We still need to raise about $40,000 to maintain a healthy pool of dollars to support statewide political candidates that support Arkansas pharmacists as we move into an election year. Arkansas will also be redistricting all state and federal legislative district maps after the 2020 census. Redistricting all 135 state legislative offices will create quite the shakeup in state legislative races, and we will need a healthy PAC to be effective in our jobs to support pharmacist friendly campaign efforts through the 2022 elections. The AP-PAC

is just as important if not more important than the Legal Defense Fund for Arkansas pharmacists to help us effectively utilize our states’ rights as Patrick Henry and Thomas Jefferson envisioned.

The dollars raised here almost exclusively come from Arkansas pharmacists and pharmacies.

Thank you for your continued support. The Arkansas Pharmacists Association is depending on you. 2020 will be the year where we get a clear vision into legality for PBM regulation between pharmacies and PBMs for patients who utilize employer sponsored health benefit plans. § Editor's Note: Since this article was written, several changes have affected the Supreme Court case. See the article on page 10 for more information.

Comparison of Current Advocacy and Legal Fundraising at the Arkansas Pharmacists Association Arkansas Pharmacists Association Legislative and Legal Defense Fund (LDF) Why? To fund legal expenses related to SCOTUS case and other legal expenses Who can give? Individuals or corporate donations are accepted What is the maximum that can be donated? No limit Tax deductible? Ask your accountant Check made out to: APA Legislative and Legal Defense Fund, mailed to 417 Victory St, Little Rock 72201 Donate Online: www.arrx.org/LDF

Arkansas Pharmacists Political Action Committee (AP-PAC) Why? To support Arkansas political candidates who support pharmacy. There are 135 state legislators, and multiple offices in the Executive branch and constitutional officers (including Governor, Arkansas Attorney General, Lieutenant Governor, etc.)

2020 is both an election year and is a redistricting year for the 2022 election.

Who can give? Individuals and/or corporations.

What is the maximum that can be donated? $5000 per year Tax deductible? Ask your accountant Tax credit eligible for Arkansas state income tax? Yes. Arkansas law allows for an individual (not corporate) income tax credit of up to $50 per taxpayer ($100 for a joint return) for cash contributions made by the taxpayer in a taxable year to a state political action committee (PAC). The tax credit form is called AR1000TC and the contribution taken on a tax return must be made by April 15 of the following year.

Check made out to: APA AP-PAC, mailed to 417 Victory St, Little Rock 72201 Donate Online: www.arrx.org/arkansas-pharmacists-pac

Individual Arkansas Political Candidates What? Financial contribution directly to a pollical candidate from a pharmacist or pharmacist/pharmacy supporter or other pharmacy employee Who can give? Individuals ONLY, not corporations What is the maximum that can be donated? $2800 per election (primary, general and run-offs are all separate elections) How? Usually directly between the pharmacist / pharmacy supporter and the candidate Tax credit eligible for Arkansas state income tax? Yes. Same rules as PAC above, but not in addition to PAC. Only one tax credit per year is allowed.

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FROM THE PRESIDENT FROM THE PRESIDENT

Goodbye 2019, Welcome 2020 Dean Watts, P.D. President

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any questions arise at the beginning of every new year and 2020 is no different.

• What changes in third party plans will we discover only after we attempt to bill the first claims of the year?

• Have reimbursements changed?

• Are we a preferred provider or even a provider at all?

• Did we complete credentialing and FWA training to each plan’s satisfaction?

$50,000 for violating Arkansas’s PBM laws. Our hope for 2020 would be that Express Scripts would be somewhat humbled and decide to conduct business in a fair manner. Instead, the first action we hear about is Express Scripts decision to force Medicare patients to get their medicine from Express Scripts’ mail order pharmacies…AFTER the annual sign-up period is over! This practice is in the federal oversight space, therefore Arkansas’s regulations to protect patients’ relationships with their pharmacists do not apply…YET.

As I write this column, shortly into the new year, we haven’t seen the drastic cuts in reimbursement that we saw in 2018, but my gut tells me that we must continue to be vigilant and monitor each plan’s profitability. By the time this article is published, we should have enough data to determine the profitability of the “market basket” we have drawn for each plan.

As expected, in January we got the announcement from the US Supreme Court that they will hear the appeal from the 8th Circuit Court regarding the right of a state to regulate business practices of parties in the federal Medicare space and ERISA plans. Depending on the outcome of the decisions, 2020 could shape up to be extraordinary.

Late 2019 saw the first action taken by the Arkansas Insurance Commissioner as he fined our friends at Express Scripts

Here’s wishing us all a happy and groundbreaking year. §

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THE ROAD TO SCOTUS:

APA Goes to Washington

By Jordan Foster APA Director of Communications

Arkansas Attorney General Leslie Rutledge and her office have been the legal defenders of Act 900 and will continue the fight at the US Supreme Court in Washington, DC.

On January 10, the pharmacy world stood still. What could have been any other Friday became a day of waiting, clock watching, and internet refreshing as pharmacists throughout the state and across the nation waited to hear two words – “petition granted.”

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he long and winding road that lead to January 10 was lined with passion, heartache, celebration, and frustration. Now that road leads to one final stop that could have massive ramifications for pharmacists and patients nationwide – the US Supreme Court.

While the fight against PBMs started long before 2015, this story begins during the legislative session of that year as the Arkansas Pharmacists Association worked with key legislators to craft bills that would be productive, protective, and practical. For many legislators, the concept of a pharmacy benefits manager was a foreign one. Within a few years, that would change drastically.

Act 1025 of 2015 addressed two major issues patients were experiencing in Arkansas: forced changes in providers without consent and negative remittances, also known as claw backs. Championed through the chambers by lead sponsors Sen. Jason Rapert and Rep. Dan Douglas, Act 1025 required a patient’s express consent before a health or pharmacy benefit plan required a change in providers, addressing the issue of patients being told that their benefits would be terminated at their pharmacy of choice unless they opt-out of their plan design. Additionally, it prohibited PBMs from forcing a pharmacist to collect a copay from a patient that is greater than what the pharmacist is allowed to keep for providing the service, commonly referred to as a clawback.

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Act 900 of 2015 amended the existing MAC law to ensure that pharmacies in Arkansas were able to compete on a fair playing field to serve their patients and their communities by: • preventing a PBM from paying an Arkansas pharmacy less than it pays its own pharmacy, • requiring a PBM to provide pharmacies access to its MAC list, • requiring a PBM to update its MAC pricing within seven days for any product with a 10+ percent increase in pharmacy acquisition cost, • allowing a pharmacy or pharmacy service administration organization (PSAO) to file an appeal to the PBM, • and allowing a pharmacist to decline to provide a service if the MAC price paid to the pharmacy is less than the pharmacy acquisition cost.

Along with a third law introduced in 2015 – Act 689 that amended the definition of “third-party administrator” in Arkansas to include PBMs and required them to register and be overseen by the Arkansas Insurance Department – the bills introduced by APA received overwhelming support, with all members of the House and Senate voting to approve at least one of APA’s pieces of legislation. Many supported all three. In April 2015, Governor Asa Hutchinson signed all three bills into law. In a perfect world, the story ends here, PBMs

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APA GOES TO WASHINGTON

atone for the destructiveness of their business practices, and pharmacists across the state are able to serve their patients in a sustainable way. Reality, as we know, is far from perfect and the warm glow of victory would not last long.

August 2015 - Pharmaceutical Care Management Association

(PCMA), a national trade association representing the eleven largest PBMs in the country, sued the state of Arkansas in US District Court – Eastern District of Arkansas over Act 900 on five claims: • Act 900 is preempted by ERISA (Employee Retirement Income Security Act of 1974), • it is preempted by Medicare Part D, • it violates the Commerce Clause of the US Constitution • it violates the Contract Clauses of the US Constitution and the Arkansas Constitution, • and it is so vague that it violates the Due Process Clauses of the US Constitution and Arkansas Constitution.

February 2017 – PCMA told the court of a similar law in Iowa

that was struck down by an Iowa district court order ruling that the law was preempted by ERISA. They also pointed out that the 8th US Circuit Court of Appeals agreed with the lower court’s order, implying that if the Arkansas court ruled against PCMA, the 8th Circuit Court would subsequently reverse that decision.

March 2017 – In his ruling, US District Court Judge Brian Miller acknowledged the effects of the PBMs and their bad practices, while only subtly connecting the two. “Independent community pharmacies have had to eliminate employees during the last 5 to 10 years due to the financial hardships they have faced. The Arkansas legislature passed and amended Arkansas Code Annotated section 17-92-507 in an attempt to address this issue.”

definitions writ of certiorari (Latin for “to be more fully informed” or “to be made certain”) –

an order for a superior court to review a lower court’s decision amicus curiae brief (Latin for “friend of the court”) – a brief filed by groups who are not parties in the case but have strong interest, expertise, or insight regarding issues of a case

the 8th Circuit Court of Appeals had issued their decision, ruling that not only was Act 900 preempted by ERISA, it was preempted by Medicare Part D as well, reversing the ruling from the US District Court and ripping away an early victory from Arkansas pharmacists. Down but not out, APA leaders in conjunction with the Attorney General’s office had one final option that would turn out to be a milestone in the state’s history.

them from the US District Court, both Arkansas and PCMA appealed to the US 8th Circuit Court of Appeals in St. Louis, Missouri – Arkansas appealing the lower court’s decision that Act 900 is preempted by ERISA and PCMA appealing the decision that Act 900 is not preempted by Medicare Part D.

October 2018 - Arkansas Attorney General Leslie Rutledge filed a petition for a writ of certiorari with the US Supreme Court, citing split circuit court decisions regarding ERISA preemption of PBM laws in the 1st Circuit, 8th Circuit, and DC Circuit, resulting in “confusion and uncertainty about state power to regulate drug prices.” The US Supreme Court invited the US Solicitor General to submit a brief called a “Call for the Views of the Solicitor General” (CVSG) providing the position of the United States regarding the case. According to the Attorney General’s office, this is the first time in the state’s history that the US Supreme Court has granted Arkansas’s request to hear a case.

June 2018 – Five months later and in the midst of the 2018

December 2019 - US Solicitor General Noel Francisco

He denied PCMA’s motion for summary judgment on four of its five claims but agreed with the PBM association that Act 900 is preempted by ERISA, crippling the Arkansas law’s most powerful function.

January 2018 – With each party handed a ruling against

APA Annual Convention in Rogers, then APA CEO Scott Pace received news of the worst-case scenario from the Arkansas Attorney General’s office. A three-judge panel at

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submitted his brief stating that the 8th Circuit Court of Appeals erred in ruling against the state and recommending the US Supreme Court accept Attorney General Rutledge’s

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ERISA Explained Passed in 1974, the Employee Retirement Income Security Act was established in response to public support for pension reform after several nationally high-profile instances of pension plan mismanagement and abuse

by American companies and unions. Today, the complex law is intended to protect people who participate in their employer’s retirement and health insurance plans at any private company.

APA CEO John Vinson, flanked by APhA CEO Tom Menighan and NCPA CEO Doug Hoey, take to the steps of the US Supreme Court, battleground for the upcoming pharmacy case Rutledge v Pharmaceutical Care Management Association.

petition to hear the case and overturn the appeals court decision.

January 2020 – The US Supreme Court

accepted the states petition to hear the case Rutledge v Pharmaceutical Care Management Association.

February 2020 – The Supreme Court announced April 27, 2020 as the date for oral arguments.

March 2020 – APA, along with partners

NCPA, APhA, NASPA, and 51 state pharmacy associations, filed an amicus brief supporting Arkansas's petition.

Additionally, 46 state attorneys general united to submit an amicus brief, signifying widespread bipartisan support across the country.

However, due to the coronavirus pandemic, the Supreme Court announced in mid-March that it would shut its doors to the public over concern for public health. Days later, the Court announced it would postpone its March cases to a later date. At press time, there has been no announcement about April cases, including Rutledge v PCMA. To support our entire advocacy operation for the Supreme Court case and beyond: research, lobbying, attorneys, communications, the entire

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operation, the Arkansas Pharmacists Association has established the APA Legal Defense Fund. The better funded the Legal Defense Fund, the more resources and influence we can put toward accomplishing our goals at the Supreme Court, defending the practice of pharmacy in key litigation, and getting priority legislation passed.

Please consider making a donation to the Legal Defense Fund by visiting www. arrx.org/LDF

While the law states “the provisions of [ERISA] shall supersede any and all State laws [that] relate to any employee benefit plan,” the Attorney General argues that a law regulating third-party administrators whose customers happen to include ERISA plans is not the same as a law directly affecting ERISA plans, and that Act 900’s operation is not dependent on the involvement of ERISA plans.

Since the passage of Act 900 in 2015, a movement has been growing among Arkansas pharmacists. That force swelled in 2018 and 2019 at the Arkansas State Capitol and today it is positioned to create a monumental change at the US Supreme Court for the pharmacy profession. APA wishes to thank all those involved with this journey including Governor Hutchinson, Senators Ron Caldwell and Jason Rapert, Representatives Dan Douglas and Michelle Gray, all of our members, pharmacists, patients, and allies who have joined the fight. Though the journey to where we are now may have seemed slow and tedious, remember the African proverb: “If you want to go quickly, go alone. If you want to go far, go together.” §

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Coincidentally, three Congressional bills in the 1960’s laid the foundation for what would ultimately become the initial guidelines of ERISA, including a bill filed by former US Senator John L. McClellan of Arkansas following his investigation into a union leader’s misuse of $4 million of union benefit funds.

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2020 Calendar of Events

APRIL ———————————

April 16, 2020 - Postponed Arkansas Pharmacy Foundation Golf Tournament Tannenbaum*

April 27, 2020 - Date Highly Likely to Change Rutledge v PCMA Oral Arguments & Pharmacist Rally United States Supreme Court Washington, D.C.

MAY ——————————— May 1, 2020 Harding P3 Pinning Ceremony Harding Campus Searcy, AR

May 8, 2020 Harding Class of 2020 Meeting Searcy, AR May 9, 2020 Harding College of Pharmacy Commencement Searcy, AR May 15, 2020 UAMS Class of 2020 Meeting Little Rock, AR

JUNE ———————————

OCTOBER —————————

June 10, 2020 APA Board Meeting Doubletree by Hilton Little Rock, AR

October 17-20, 2020 National Community Pharmacists Association Annual Convention Nashville, TN

June 11-13, 2020 APA 138th Annual Convention Doubletree by Hilton Little Rock, AR

October 29, 2020* APA Golden CPE Hosto Center Little Rock, AR

AUGUST ——————————

NOVEMBER —————————

Late August – September 2020 APA Regional Meetings Around the State

*Dates have not been finalized.

June 6-10, 2020 American society of Health-System Pharmacists Summer Meeting Seattle, WA

August 6-7, 2020* APA Board Retreat and Committee Chair Orientation TBA

October 8-9, 2020 AAHP Fall Seminar Wyndham Riverfront North Little Rock, AR

November 12-15, 2020 American Society of Consultant Pharmacists Annual Meeting and Exhibition Gaylord Palms Resort Kissimmee, FL

SEPTEMBER ————————

APA & COVID-19

Late August – September 2020 May 16, 2020 APA Regional Meetings UAMS College of Pharmacy Around the State Information is changing rapidly throughout the coronavirus pandemic.

Commencement for updated information you can use in your pharmacy and share with Little Rock, AR

Visit www.arrx.org/COVID your patients. The Arkansas Pharmacists Association is still working hard through this public health emergency. We can be reached by calling us at 501-372-5250 or by emailing a staff member. Please contact us with any questions or concerns. We are here to help you help your patients.

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LEGISLATOR PROFILE

Representative Vivian Flowers JEFFERSON COUNTY District: 17 Represents (Counties): Jefferson Years in Office: 5 (3rd term) Occupation: Former COO for UAMS Center for Diversity Affairs. Currently an Entrepreneur Your hometown pharmacist: Clifford Flowers What do you like most about being a legislator:

I’m really grateful for the opportunity to make a difference in the lives of people and I LOVE LOVE LOVE engaging young people!

What do you like least about being a legislator: The human limitations of addressing the enormous need, injustice and greed that exists.

Most important lesson learned as a legislator:

To divorce myself from the outcomes and stay focused on the purpose God called me to serve.

individually and collectively; use it! Legislators’ constituents are your patients, so don’t forget to leverage your influence on that level as well.

Most admired politician: Shirley Chisholm

Your fantasy political gathering would be: Shirley Chisholm,

Advice for pharmacists about the political process and working with the AR Legislature: We work for you, so hold us accountable. Your voice is stronger than you know,

Maynard Jackson, FDR, Ron Brown, Dale Bumpers, and Paul Wellstone

Hobbies: Writing, cooking, movies and design. §

AAHP Board

Arkansas State Board of Pharmacy

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

President.......................................Debbie Mack, P.D., Bentonville

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Vice President/Secretary.........Lenora Newsome, P.D., Smackover

Member..........................................Steve Bryant, P.D., Batesville Member................................Lynn Crouse, Pharm.D., Lake Village

Member..........................................Brian Jolly, Pharm.D., Beebe

Member..........................Rebecca Mitchell, Pharm.D., Greenbrier Public Member........................................Carol Rader, Fort Smith Public Member............................................Amy Fore, Fort Smith

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Controlled Substances 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.

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he opioid crisis has brought a lot of attention to the prescribing and dispensing of opioids. This attention has also extended to the prescribing and dispensing of all controlled substances.

I recently attended a seminar which contained a number of sessions on opioids and controlled substances. One of these sessions suggested that every pharmacist should read the DEA's Pharmacist's Manual. That suggestion caused me to ask myself when was the last time I had read it. One human trait is that we tend to forget details over time and our memory becomes a little less sharp. There have been a number of times when I was sure what a contract provision said, only to go back, read the document, and find that what it stated was slightly different from my memory.

This same phenomenon applies to the Pharmacist's Manual. The manual is about 80 pages, but it is much more readable than the actual statute and regulations.

The speaker at the seminar explained that many pharmacists feel their duty is to make sure that a controlled substance prescription isn't forged or altered. While that is true, the duty is much broader.

For a controlled substance prescription to be valid, it must be issued for a legitimate medical purpose in the usual course of the prescriber's professional practice. The law does not require a pharmacist to dispense a questionable prescription. The DEA has provided some red flags that may indicate diversion.

Those are discussed in 2018 decision and order. Corresponding Responsibility is a topic that requires its own forum so I won't delve more deeply into it now.

The Pharmacist's Manual contains information on a number of topics. Besides a basic introduction to the Schedules, there is a lot of practical information in the manual. There is a section on the transfer and disposal of controlled substances. This covers transfer to another pharmacy, the original manufacturer, or a reverse distributor. There are numerous reminders to use the triplicate DEA Form 222 to transfer Schedule II substances. Another reason to refresh our memories periodically is that requirements change and if we rely only on our memories, we may not be current. The DEA recently announced the phase out of the triplicate form over the next two years.

The DEA Form 222 is also mentioned in the section of the manual on ordering of controlled substances. Topics here include how to order the Form 222, who is authorized to sign the forms, and what to do if the forms are lost or stolen. The manual also contains useful information on what to do when controlled substances are stolen or lost. The DEA must be notified, in writing, within one business day of the discovery of the theft or loss. Completion of the DEA Form 106 in this situation can be made easier by using the biennial inventory and prescription records because you can use these records to determine how much product was stolen or lost. There is also an entire section of recordkeeping requirements. While many pharmacies are using a perpetual inventory system today, 16

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that does not replace the required biennial inventories. Physical inventories are required for a new registrant (either opening a new pharmacy or taking over an existing one) and for products that are newly added to a schedule.

The manual also contains helpful information for the review and dispensing of controlled substance prescriptions. It provides what information is required to be on the prescription itself and the information required to be on the prescription label. Partial fill situations are addressed as is the dispensing of controlled substances without a prescription. The record of over the counter sales of controlled substances is required to be kept in a bound record book. These types of sales must be made by a pharmacists and cannot be delegated to a non-pharmacist. While the manual contains a lot of practical information, there are some uncommon provisions also. Sometimes these less common situations are problem-prone because we aren't as familiar with the situation.

Suppose one of your patients has a valid prescription for a C-IV medication and requests that you send a refill to their vacation home in Bermuda. Can you send that refill to a foreign country?

Not unless you are registered with the DEA as an exporter and have obtained the necessary permits or submitted the necessary declarations for export. The pharmacist might assume it is permissible to send the refill because there is a valid prescription on file. This is an example where a seemingly reasonable conclusion is incorrect.

The periodic review of the DEA's Pharmacist's Manual is a good risk management tool. During my years of practice, none of my employers recommended or required that I review it. My working knowledge of the DEA regulations was what I drew from my pharmacy law class and any updates that I may have read and retained. Given the scrutiny that is currently being given to the dispensing of controlled substances, an annual review of the Pharmacist's Manual is an excellent risk management tool to help the pharmacist and pharmacy avoid a potential problem brought on by foggy memory of the requirements. In addition, a review of your state statutes and regulations should also be done because your state may have more restrictive standards which you are required to follow. § ________________________________________________________________ 1 https://www.deadiversion.usdoj.gov/pubs/manuals/pharm2/pharm_ manual.pdf 2 https://www.deadiversion.usdoj.gov/fed_regs/actions/2018/fr0220_4. pdf#search=red%20flag%20diversion © 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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THE ARKANSAS PHARMACIST

3/27/20 12:43 PM

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY

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

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

The first Student Spotlight was published in the 2018 Spring issue of The Arkansas Pharmacist. Since that time, our Student Spotlight feature has been published quarterly in conjunction STUDENT SPOTLIGHT

Serving Others - Jonathan Hardage

I used to be a pharmacy student who thought more about studying for a big exam than I did about volunteering to help others. But one day, I learned there was more to serving others than just pharmacy-related activities. I came to this realization after a brief encounter with a stranger.

Several weeks ago, I started volunteering at a food pantry. I wanted to volunteer for some time and finally decided to sign-up. However, as soon as I began preparing meals and stocking shelves, I felt like I was wasting my time. “Who will benefit from this,” I thought. “A pharmacy student should be doing something pertaining to pharmacy.” I was so wrong.

One afternoon, I held the door open for a gentleman entering my apartment building who was carrying a big box. After thanking me, the gentleman told me the box contained food from the food pantry where I volunteered. He said he wanted to open the box and show me the food he received. I was surprised to notice the meals inside were ones I had prepared just days earlier. He said he was grateful for the food pantry, and even offered to help me get in touch with the pantry, so I could also get some food.

It turns out I had helped someone after all. Did I count any tablets? No. Did I counsel about a medication?

No. Had I even been inside a pharmacy? No. However, I learned I could serve others outside of a pharmacy setting. Being a pharmacist doesn’t mean you only dispense medication or provide counseling. Being a pharmacist also means serving others at every opportunity.

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with Safety Nets. The response from our UAMS student pharmacists has been so overwhelmingly positive, this issue of Safety Nets is solely dedicated Student Spotlights. § STUDENT SPOTLIGHT

I Never Get the Flu; I Don’t Need the Shot - Marissa Johnston

I always knew one day I would be taking care of my parents. That is what children are expected to do. However, I never anticipated that day would come so soon. I watched his blood sugar skyrocket to over 500, while his pulse was almost undetectable.

My Dad has Type 2 diabetes, and last year, he refused to get vaccinated for the flu. He said, “I never get the flu; I don’t need the shot.” He would come to regret those words. I know, in that moment, he wished he had been vaccinated. Unfortunately, 5 months later he was diagnosed with influenza. His condition deteriorated so rapidly that we had to call an ambulance to transport him to the hospital. It was heartbreaking watching the EMTs place him on the stretcher in our living room. Upon our arrival to the hospital, he was immediately admitted to the intensive care unit. At this point, the medical team stated it was too late for standard influenza treatment. They were forced to treat current symptoms and attempted to keep him comfortable. My Dad is my hero, the man I look up to, and someone I couldn’t imagine losing.

No one, especially daughters, should have to watch their Dad go through so much pain, pain that could have been completely prevented.

After 7 days in the ICU he was finally released. It was several more weeks before he fully recovered.

My Dad is stronger and better than ever. This year, my Dad told me that “no one is getting the flu shot before him.”

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MEMBER SPOTLIGHT

Kyeshia Ward Pharm.D. Dean’s Pharmacy #3 Marianna

Pharmacy/academic practice: Community Pharmacy

Favorite activities/hobbies: My favorite activity is working on

Years in business/years teaching: 1st year

my nonprofit H.E.L.P.- Helping Everyone Learn Possibilities. It is a nonprofit to help youth in my community gain exposure to places and activities outside of Phillips County. It also exposes the youth to healthcare occupations both clinical and nonclinical.

Favorite part of the job and why: My favorite part of my job

Ideal dinner guests: Ideal dinner guests would be Ellen

Pharmacy school and graduation year: Harding University, Class of 2019

is working with patients daily. From answering OTC questions to completing medication reviews, each of my patients is different and allows me to serve them.

Least favorite part of the job and why: My least favorite part

of the job is dealing with insurance. It is hard to tell a patient a medication is not covered by insurance or the patient has to pay a large amount of money for life saving drugs. It is also hard when the pharmacy loses money due to insurance, but it is medicine that the patient must have.

What do you think will be the biggest challenges for pharmacists in the next five years? In the next five years, the biggest problem will be dealing with unfair insurance pricing. So many pharmacies struggle when they are being paid below cost for drugs. Prayerfully, this will change with upcoming hearings and legislation.

Oddest request from a patient/customer: The oddest

request I have had from a patient is for a medication to increase stomach acid. The patient thought that her omeprazole had eliminated too much acid and caused her stomach discomfort.

Degeneres and the Obamas. Ellen is so giving and honest and I would love to talk to her about all of the charity work she does. The Obamas are two educated individuals who have been in one of the highest positions in the country. I would love to personally speak to them about lessons learned from the experience.

If not a pharmacist then…: I would be a teacher. Before

attending pharmacy school, I was a high school chemistry teacher. I love assisting the community and being a teacher is a great way to give back to my community as well as help shape the minds of the youth.

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

The Arkansas Pharmacists Association allows pharmacists across the state to network. On my first rotation of P4 year, I had the opportunity to work the APA convention and meet many pharmacists from all over the state. During this time, I was able to meet and network with Dean & Karen Watts who are my current employers. §

Recent books read: The last book I read was Nineteen Minutes.

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THE ARKANSAS PHARMACIST

3/27/20 12:43 PM

The FDA Enters the New Year with “2020” Vision

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his past quarter was another banner period during which 24 unique drugs or biologics were approved, along with approval for several new formulations as well as significant new indications which are beyond the scope of this column.

F508del mutation in cystic fibrosis. Vumerity™ (diroximel fumarate), similar to dimethyl fumarate (Tecfidera™) was approved for relapsing forms of multiple sclerosis. Xcopri® (cenobamate) received approval to treat partial-onset seizures.

Biologicals: Ervebo® (Ebola Zaire, live), through a tropical

Acute Care: Fetroja® (cefiderocol) is the only antibiotic

disease priority review and breakthrough therapy designation, is the first vaccine for the prevention of Ebola virus disease.

Jynneos™ (smallpox and monkeypox, live, non-replicating) received priority review as the first vaccine to prevent monkeypox and the first of its type indicated to prevent both infections, and has been included in the Strategic National Stockpile. Beovu® (brolucizumab) is a vascular endothelial growth factor inhibitor indicated to treat wet age-related macular degeneration.

Givlaari™ (givosiran), through priority review with orphan drug status, was approved as a once-monthly SQ injection to treat acute hepatic porphyria as an interfering RNA. Vyondys 53™ (golodirsen) is the first treatment for Duchenne muscular dystrophy and uses exon-skipping technology in patients with a confirmed mutation amenable to exon 53 skipping.

Hematology/Oncology: Two drugs were approved to treat

sickle cell disease. Adakveo® (crizanlizumab-tmca) was approved as an orphan drug through priority review by inhibiting selectin which contributes to RBC stickiness leading to vasoocclusive crisis. Oxbryta™ (voxelotor) received accelerated approval as a deoxygenated sickle hemoglobin polymerization which is the central abnormality in sickle cell disease. Reblozyl® (luspatercept-aamt) received fast-track approval as an orphan drug to treat beta thalassemia by reducing the number of blood transfusions that poses a risk of iron overload. Brukinsa™ (zanubrutinib) is a kinase inhibitor receiving accelerated approval as an orphan drug for second-line treatment of mantle cell lymphoma. Enhertu® (fam-trastuzumab deruxtecan-nxki) was granted a breakthrough therapy designation through fasttrack review as a HER2-directed antibody and topoisomerase inhibitor conjugate indicated to treat unresectable or metastatic HER2+ breast cancer. Padcev™ (enfortumab vedotin-ejfv) was granted priority review with breakthrough therapy designation as a first-in-class agent directed against cell adhesion nectin-4 and indicated to treat advanced or metastatic urothelial cancer.

Chronic Care: Aklief® (trifarotene) is the first new retinoid

cream approved in 20-years to treat acne vulgaris. Ibsrela® (tenapanor) is a minimally-absorbed NHE3 inhibitor approved for irritable bowel syndrome with constipation. Trikafta™ (elexacaftor, tezacaftor and ivacaftor) received fast-track, breakthrough, and orphan drug designation as the first triple combination therapy approved to treat the most common

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approved this quarter and is a cephalosporin indicated to treat gram-negative complicated UTIs. Two oral therapies were also approved to treat acute migraines with/without aura. Reyvow™ (lasmiditan) works as a serotonin 1F receptor agonist, while Ubrelvy™ (ubrogepant) acts as a calcitonin gene-related peptide receptor antagonist. Finally, Scenesse® (afamelanotide) is a melanocortin-1 receptor agonist and the first treatment to ease phototoxic reactions in patients with erythropoietic protoporphyria.

Diagnostic Aids: ExEm® Foam (air polymer-type A) is an

ultrasound contrast agent indicated to help assess fallopian tube patency. Fluorodopa F 18™ (xxx) is a radioactive diagnostic agent for use with PET indicated to assess Parkinsonian syndromes. Ga 68 DOTATOC™ (xxx) is a radioactive diagnostic agent for use with PET indicated to assess somatostatin-positive neuroendocrine tumors. TissueBlue (Brilliant Blue G ophthalmic solution) is a disclosing agent indicated to selectively stain the internal limiting membrane on the surface of the retina.

New Dosage Forms: Significant new dosage forms approved

this quarter include: Abrilada™ (adalimumab-afzb, SQ injection) a biosimilar to Humira®; Absorica LD™ (isotretinoin, capsules) for severe recalcitrant nodular acne; Amzeeq™ (minocycline, topical foam) for acne vulgaris; Aralzo™ (tazarotene, lotion) for acne vulgaris; Biorphen™ (phenylephrine, ready-to-use) for hypotension in acute care; Bonsity™ (teriparatide, SQ injection) for osteoporosis; Exservan™ (riluzole, oral film) for amyotrophic lateral sclerosis (Lou Gehrig’s disease); Gvoke™ (glucagon, auto-injector) for hypoglycemia; Hemady™ (dexamethasone, 20mg tablet) for multiple myeloma; Katerzia™ (amlodipine, oral suspension) for hypertension and CAD; Nouress™ (cysteine HCl, injection) for neonatal TPN; Ozobax™ (baclofen, oral solution) for spasticity; Quzyttir™ (cetirizine, injection) for acute urticaria; Reditrex™ (methotrexate, SQ injection) for rheumatoid arthritis and psoriasis; Riomet ER™ (metformin, extendedrelease oral suspension) for type 2 diabetes; Rybelsus® (semaglutide, tablet) for type 2 diabetes; Secuado® (asenapine, transdermal patch) for schizophrenia; Slynd® (drospirenone, tablet) to prevent pregnancy; Talicia™ (omeprazole, amoxicillin, and rifabutin, delayed-release capsule) for Helicobacter pylori infection; and Ziextenzo™ (pegfilgrastim-bmez, SQ injection) a biosimilar to Neulasta®. §

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Q&A with UAMS College of Pharmacy Dean

Cindy Stowe

Pharmacist Immunization Expansion Wilson, Pharm.D. How did you decide on pharmacy By as Emily a career?

I’m a first-generation college student, and my parents made it clear that I was going to college, but they didn't push me in one direction or another. No one in my family is in pharmacy so I didn’t really have it on my radar specifically. I knew that I wanted to do something in the healthcare field. I enjoyed math and science, and pharmacy seemed to be the right fit.

When I was younger, I worked for the city park and each Saturday we would meet our supervisor at the local pharmacy which was a gathering point in my community, so I was frequently in the pharmacy. It still serves as a reminder to me of how integral pharmacies are to communities.

What drew you to the academic side of pharmacy?

As a kid I always thought I would be a teacher, and as I got older, I had additional interests that came into focus.

I remember when I was writing my application letter to pharmacy school, I wrote about how I envisioned providing pharmacy services in front of the counter or outside the physical pharmacy. When I got to pharmacy school, I recognized I could match my teaching interest and my pharmacy interest.

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What area(s) of pharmacy are you most passionate about?

The simple answer to that question is that I’m most passionate about being a pharmacist in any and all settings – I believe more than ever that no matter where we each practice, we are more alike than different – we are pharmacists. I think it’s the beauty of the profession – we are problem solvers and stay focused on improving the health and wellness of our patients.

Early on I chose the residency pathway that allowed me to provide pharmacy service in institutional practice, specifically pediatric pharmacy practice. In this role I found myself more energized by working with other healthcare providers on interprofessional teams and envisioning new roles for pharmacists that served to get pharmacists out of the physical pharmacy to provide direct patient care services.

With students in the practice site, I always wanted to know what area of practice they wanted to pursue, and I worked to figure out how could I provide learning experiences that would translate to their desired practice site.

As I moved out of the practice setting into the dean’s office,

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THE ARKANSAS PHARMACIST

3/27/20 12:43 PM

UAMS COLLEGE OF PHARMACY DEAN CINDY STOWE

I’ve stayed true to my belief that pharmacists are necessary members of the healthcare team, but I’ve become more focused than ever on those transferable skills that make us all pharmacists.

You joined the staff at UAMS in 1995 and left in 2014 to become dean of Sullivan University College of Pharmacy and Health Sciences. What made you decide to come back to Arkansas?

What drew me back to Arkansas is the same thing that brought me here in 1995: the people at UAMS, the Arkansas profession of pharmacy, and the people of Arkansas. When I travel around the country and talk to my colleagues at other colleges and schools of pharmacy, it’s clear what has happened and is happening here in Arkansas – it is special.

We have a strong working relationship between the Colleges, Board, the Association and profession at-large. There is a visible impact of pharmacists in each community making a difference and a clear focus on advocacy for our profession.

There’s a legacy of leadership within the profession that comes out of Arkansas and influences and affects national issues and leadership in national organizations like NCPA, APhA, and NABP. These things make Arkansas incredibly visible in ways that I’m not sure are always obvious when we’re dealing with the day-to-day work around us.

Finally, transitions take an incredible amount of energy and commitment. I have always been someone who embraces change as an adventure. I love what I get to do each day and recognize that some days are difficult. I stay focused on learning and being a better person each day. I’ve been on a steep learning curve these past six months, but it’s been enjoyable. I’m happier today about my decision to come back to Arkansas than I was yesterday, and I’m sure it will only get better!

What’s your philosophy for the role of dean?

I feel like the role of a dean is to stay focused on the people, help solve problems, build trusting relationships, and remove barriers and align resources so that students, staff, and faculty can be successful. As dean I have to be clear about the interconnected nature of the profession and the College – we cannot just peacefully co-exist, but we must inform and advance each.

A huge part of what makes UAMS so connected to the profession is that we not only educate the next generation of pharmacists and scientists but we leverage the research mission to help advance the profession and improve the health

What challenges did you face transitioning to the role of UAMS dean?

I think the challenges I’ve faced transitioning to the role of UAMS COP dean is a mix between a leadership transition from within and external. For me, the transition I faced moving to Sullivan University entailed taking on a new role as an outside candidate, so there was a significant amount of time invested in getting to know everyone within Sullivan. Back in Kentucky, I got to reconnect with my roots and enjoyed being back within the state where I was educated.

Coming back to UAMS to be dean at the place that I developed as a pharmacist educator has been easy in some ways – I know my way around the campus, Little Rock, and the State but things have changed. I’ve been meeting with stakeholders of the College within and external to the College and the University. Getting back in time to attend all the APA Regional Meeting this past year was a real benefit.

The Regional Meetings allowed me to get out and visit with many people. As I compare the job of dean at UAMS versus Sullivan, the job at UAMS is bigger in many ways than at Sullivan; internally there’s a broader research mission and externally as the flagship public institution there’s a high expectation across the State and Nation.

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UAMS COLLEGE OF PHARMACY DEAN CINDY STOWE

and wellness of patients. The two departments of the College work to fulfill the research mission. Our Pharmaceutical Sciences Department and Radiation Health Division focus on drug discovery and optimizing radiation and chemotherapy treatment for cancer patients. The Pharmacy Practice Department, with the Center for Implementation Research and the Division of Pharmaceutical Evaluation and Policy, focuses on helping advance the practice of pharmacy by leveraging population data to inform implementation of new and advanced pharmacist-delivered services with a focus on community-based practice. Additionally, we benefit from the Evidence-Based Prescription Drug Program and Arkansas Poison Control and Drug Information Center as outwardly facing population and public health service units of the College.

What is your vision for “the Stowe years?”

I believe the next 5-10 years will be the ‘tipping point’ years for the profession. What I mean by that is that I think this will be the time when, as a profession, we will turn the corner on payment models that recognize pharmacists-delivered services as well as the product. The College’s role will be to educate the workforce (both pharmacists and scientists) and to help advance the evidence, processes, and tools to accomplish payment for pharmacists delivered services in all healthcare settings. The College will have a new transformed professional curriculum that will set the standard among colleges and schools of pharmacy and allow our graduates to be leaders within the workforce ready to meet the challenges of the next fifty years.

Cindy Stowe and friends at University of Kentucky football game

Colleges of pharmacy across the country are reporting smaller class sizes as less students are considering pharmacy as a profession, a result that’s been attributed to the struggles of community pharmacy (underpayments, DIR fees, PBMs, etc.). How do you energize the incoming students when a lot of what they see and hear can be less than optimistic?

I believe the people who want to be pharmacists right now are truly the people who want to be pharmacists. I told the first year students (Class of 2023), that you’re here because you’re passionate about the profession and you are purposeful and intentional about it. It’s not just “Oh, I saw this, and I might be interested.” The students of today are those who have a real, core commitment to the profession of pharmacy. When times are difficult, the people that rise to the surface are the ones invigorated by challenges instead of inhibited by them. These are the people that we want and need to be pharmacists of the future. §

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UAMS College of Pharmacy Dean Cindy Stowe and University of Kentucky College of Pharmacy Dean Kip Guy

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UAMS COLLEGE OF PHARMACY

Next Generation Pharmacy Curriculum – the UAMS Advantage Cindy Stowe, Pharm.D. Dean

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elcome 2020! As we begin a new year and a new decade, it is a great time to think about where we are going and where we have been including the forces that have shaped us and the new challenges that lie ahead. As an academic leader, I have found myself reflecting on the those forces that have shaped the education of pharmacists over my career. The transition from the Bachelor of Science to the Doctor of Pharmacy as the single entry level degree has been one of the most impactful.

Now that we are about 30 years out from that transition at UAMS, it is worth a look at the changes that have occurred within education and practice.

At UAMS the first all-PharmD graduating class was the Class of 1993. Nationally, the number of graduates with a PharmD degree exceeded the number of BS graduates for the first time in 2000. The fall semester of 2000 was also the first year that all students across the US enrolled in the PharmD pathway.

It is hard to believe that’s been twenty years ago! Since 2000 the number of licensure eligible graduates has doubled (7260 graduates in 2000 to 14,905 graduates in 2018).

Within colleges and schools of pharmacy, the composition of the faculty has changed with the transition to the PharmD as the only entry level degree. A driver of this change was the expansion of experiential education within the PharmD curriculum as compared to the BS degree. To provide enough preceptors in a diversity of health-system settings, colleges and schools of pharmacy increased the number of pharmacy practice faculty in institutional based practice settings and helped start pharmacy residency programs.

Now, the gap between health-settings and community-based practice is being narrowed with more pharmacists entering the ambulatory care settings from both the community and institutional practices.

The size of pharmacy faculty has grown to accommodate these needs. Nationally, for the first time in 2008, the number of PharmD faculty outnumbered PhD faculty members. The most recent data available (academic year 2019) shows that PharmD faculty members represent the majority of the faculty within colleges and schools of pharmacy (PharmD 52%, PhD 41%, other 7%). At UAMS (academic year 2020), the distribution is similar (PharmD 56%, PhD 42%, other 2%).

Currently, of the 3822 AR licensed pharmacists (active license residing in AR), 64% hold a PharmD with or without a BS in Pharmacy and 36% hold a BS in Pharmacy only. In addition, the number of residency program positions continue to increase; quadrupling in Arkansas over the preceding 15 years (2005 = 10 residency positions and 2020 at least 43 positions).

Practice trends offer greater opportunities for specialization,

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and credentialing examinations continue to increase. The changing credentials of the practicing pharmacists in healthsystem settings after the conversion to the PharmD-only entry level degree is helping usher in the next generation curriculum transformation and focused efforts for colleges and schools of pharmacy to help advance community-based practice.

Now that most practicing pharmacists in Arkansas were formally educated within the first iterations of the professional curriculum, it is time to take the next step. The new next generation pharmacy curriculum will have similar topical content as the current curriculum but delivered in a more active delivery technique that integrates the foundational science and therapeutics and equips graduates with practice management skills to solve patient problems and optimize health and wellbeing. The composition of colleges and schools of pharmacy have changed progressively over the thirty years becoming more diverse in the disciplines and backgrounds of the faculty members while the practice environment has become more sophisticated and advanced in the healthsystem settings.

At UAMS we are strategically developing and maximizing areas of research expertise in radiation health, drug discovery, pharmaceutical evaluation and policy, and implementation science. These research areas of expertise have allowed us to develop an excellent graduate program. Additionally, the Department of Pharmacy Practice along with the services units of the College are well positioned to focus on helping advance community-based pharmacy practice now more than ever. Our diversity of faculty talent will allow us to develop and implement a uniquely UAMS next generation PharmD curriculum that will produce excellent pharmacist practitioners that will fully realize the vision of the entry-level PharmD curriculum. We value your support in educating the next generation of pharmacists through your time and talent as preceptors and donors, and I wholeheartedly encourage you to challenge us to make this next generation PharmD degree to be the envy of the nation! § Footnotes • University of Arkansas for Medical Sciences College of Pharmacy internal data.

• American Association of Colleges of Pharmacy Institutional Research.

2019-2020 Tuition & Fees at U.S. Colleges and Schools of Pharmacy. https://www.aacp.org/research/institutional-research Last accessed 2020January09.

• Arkansas Board of Pharmacy internal data.

Editorial Note: This article was written before the coronavirus pandemic and some information may have changed.

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HARDING UNIVERSITY COLLEGE OF PHARMACY

Looking Back, Looking Forward Jeff Mercer, Pharm.D. Dean

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’ve heard it said that time seems to pass more quickly the older you get. Well, that’s certainly true for me these days. This past December marked my thirteenth year as a member of the Harding University College of Pharmacy (HUCOP). I can hardly believe it, but I can truly say that my time at HUCOP has been the pleasure of my professional life.

I’m thankful to be part of a college that is rooted in mission and community. I’m grateful for faculty and staff that come to work every day with a focus toward student-centered teaching.

At the beginning of each new year, I take some time to reflect on the successes and opportunities of the past. This year seemed especially meaningful, and I want to express my appreciation to all who have been a part of Harding’s place in the world of pharmacy education. I’m thankful to be part of a college that is rooted in mission and community. I’m grateful for faculty and staff that come to work every day with a focus toward student-centered teaching. God has richly blessed us over these many years with a highly qualified faculty, capable students, and a bevy of preceptors, alumni, and friends that support our program in so many ways.

With each new year also comes the opportunity to look forward and set goals and objectives for where we are going.

Our new HUCOP Strategic Plan began in 2019. Now a full year into that 5-year plan, we are already seeing the fruit of our work, especially in regard to student development and readiness for graduation and practice.

This year, we are implementing a number of curricular enhancements designed to increase student readiness for graduation. The most substantial changes involve our experiential curriculum, where we have expanded the breadth and depth of our introductory and advanced pharmacy practice experiences (IPPE and APPEs) to further complement classroom learning. Students are tasked in both operational and clinical aspects of community, institutional, and ambulatory care settings necessary for today’s advancing roles of contemporary pharmacy practice.

Beginning Summer 2020, the fourth-year curriculum will expand to include an additional APPE requirement, bringing

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the number of APPEs required from 9 to 10 per student. In total, today’s students will spend upwards of 1900 hours in experiential and co-curricular learning settings outside of the classroom.

Other curricular plans are intended to address our students’ preparedness to enter the workforce. Beginning this summer, fourth-year students will enroll in a new 3-part course series entitled “Professional and Career Development.”

These courses will run longitudinally alongside the APPE curriculum. Students will benefit from board exam preparation assessments, interpersonal development exercises, professional portfolio requirements, and various other professional and career development activities. This course series will directly engage students in career planning and goal setting as graduation approaches.

This year, we are implementing a number of curricular enhancements designed to increase student readiness for graduation.

These are among the more immediate enhancements that are occurring with our program at Harding, but they represent only a small portion of our overall plans for the future. On the horizon, new degree pathways and focused educational tracks will offer students more opportunities to diversify and personalize their pharmacy education. It’s all very exciting and promises to make 2020 a signature year for us.

As I mentioned at the outset, the occasion of a new year brings about a time of reflection and planning for the future.

Harding has been blessed with an established place in pharmacy education that allows us to serve our students and the profession of pharmacy. Knowing that has helped shape our new strategic plan in preparation for the future. A new decade is upon us, and perhaps it’s telling of my age, but my fourteenth year at Harding sure feels a lot like the first.

I’m excited for what’s to come and wish you and your family a Happy New Year. § Editorial Note: This article was written before the coronavirus pandemic and some information may have changed.

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ARKANSAS ACADEMY OF HEALTH-SYSTEM PHARMACISTS

Challenges Facing HealthSystem Pharmacy Erin Beth Hays, Pharm.D. AAHP President

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here are many challenges drugs and high cost drugs. It’s important that a health-system a ff e c t i n g health-system have processes in place to receive and account for all pharmacy and these challenges are not temporary. While medication coming into the facility and recognize purchasing these challenges affect our day to day operations within the and usage patterns. Technology is also a great tool in helping walls of the pharmacy, the ultimate effect is on the patient. identify potential diversion, but don’t forget to also develop These challenges affect patients directly and indirectly. Drug relationships with co-workers so that unusual behavior can shortages can delay care to a patient or cause them to get be identified and investigated. a different course of therapy than would have otherwise been prescribed. Drug diversions can affect supply but also the type of care a patient may be getting if the diversion Drug Utilization: affects the actions of the one providing or administering the Drug utilization is impacted by so many factors including medication. Drug utilization can be impacted by shortages prescribing trends, drug costs, and drug shortages. Having a or costs, and how we utilize the systematic approach to identifying medications we have affects medications that need to be reviewed for utilization patterns the patient and their outcomes.

Whatever the challenge is, Three major challenges in healthis important in a health-system. we need processes in place to system pharmacy are drug One way of identification is using help identify the extent of these shortages, drug diversion, and 80/20 reports from wholesalers challenges and to address the to find high cost medications drug utilization. or high volume medications. challenges. In each of these Other strategies may be to look challenges, communication is Drug Shortages: at the current drug shortages key to all the stakeholders across This is often the most disruptive and analyze how the shortage the continuum of medication challenge we face as many times is affecting utilization or simply delivery to the patient: provider, we don’t see it coming and we reviewing the use of a medication pharmacist, pharmacy technician have to react quickly to meet the after a certain time frame of it patients’ needs. While stockpiling being added to the formulary. and nurse. or outsourcing the medication can make us feel more secure Whatever the challenge is, we in getting through the shortage, these are not a fail proof need processes in place to help identify the extent of these challenges and to address the challenges. In each of these way of surviving shortages. It is important that the healthsystem have plans and processes in place to address these challenges, communication is key to all the stakeholders shortages. The processes don’t just involve the pharmacy across the continuum of medication delivery to the patient: buyer but also informatics to help with redesigning the EMR provider, pharmacist, pharmacy technician and nurse. I during this time so that shortages can be communicated challenge each health-system in Arkansas to review what to the provider. Communication is key among several processes they have in place to address these challenges stakeholders in the process of getting the medication to the in the next year. § patients, including ordering providers, pharmacists verifying Editorial Note: This article was written before the coronavirus the order, pharmacy technicians fulfilling and delivering the pandemic and some information may have changed. mediation, and nursing staff administering the medication.

Drug Diversion:

Drug diversion can include controlled substances such as opioids and benzodiazepines. But it can also involve lifestyle

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CONSULTING ACADEMY REPORT

A Day in the Life of A Consultant Pharmacist Denise Robertson, P.D. Consulting Academy President

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harmacy conversation frequently focuses on independent pharmacy, PBMs and academia. You don’t hear much about the consultant side of pharmacy. Fortunately, we do have the APA Consultants Academy and this journal space.

Today, I want to share a typical day in the life of a consultant pharmacist.

and destruction. Narcotic usage is closely scrutinized for count and documentation accuracy in order to prevent and detect diversion. The consultant pharmacist assists the facility in setting and maintaining policy and procedure when it comes to medication handling. An integral part of the monthly site visit is personal interaction with the staff and residents. Time spent with the DON and Administrator reviewing current findings is vital to maintaining solid relationships. And time spent visiting with the residents is rewarding beyond explanation.

Coffee. I know I don’t have to elaborate on this one. Second up, checking email and phone messages from colleagues or client facilities. I could be working from home or on site today. Consulting used to be strictly on site. Every resident A monthly comprehensive report is sent to each facility addressing all findings from the DUR and site visit. chart must be reviewed for irregularities and adherence to state and federal regulations. Gone were the achy legs Communication letters to the attending physician or APN from standing all day in retail. are included that indicate matters The trade-off was a sore neck of attention. These can range from and shoulders from lifting 70-80 lab and dosing recommendations We share novel ways of approach to addressing drug interactions or heavy charts full of paperwork. to solving old problems and contraindications.

And let’s not forget the sore collaborate on addressing ever thumbs from popping hundreds changing rules and regulations. We of pills out of blister packs in I have laid out just a snippet of assist other healthcare organizations preparation for destruction. A what consulting is all about. There and professionals in keeping up with typical day was usually around will be the occasional phone call changes in pharmacy.

8 hours but could easily stretch from a facility when problems into 9 or 10 hours if narcotics arise or state surveyors show up were missing or documentation for an annual visit. Collaboration was questionable. with fellow consultants is constant. We share novel ways of approach to solving old problems and collaborate on Consulting has become more streamlined since the addressing ever changing rules and regulations. We assist development of EHR technology. A consultant can log into other healthcare organizations and professionals in keeping any facility EHR at any time using an ID and Password via up with changes in pharmacy. The recent Arkansas Nursing a secure portal. I am able to quickly run several reports that Home Nurses Association regional meeting focused totally on pharmacy updates. We were able to get Board approval simplify my Drug Utilization Review (DUR). Navigating a for six live pharmacy credit hours. I hope many of you were resident record involves a few clicks here and there. It puts lab able to attend! § results and progress notes within easy access. The resident drug regimen is reviewed for accuracy, interactions and conformity to state and CMS regulations. Any discrepancy I have long practiced pharmacy in retail, consulting and that requires immediate attention can be communicated to government. I have to say that consulting is my passion. It is a rewarding practice that I believe anyone with even a slight the Director of Nursing (DON) through instant messaging. interest should look into as a full time or part time career. § I am able to monitor a mix of disease states including Diabetes, Heart Disease, Parkinson’s and Cancer. We also Editorial Note: This article was written before the coronavirus track antimicrobial stewardship and psychotropic drug use. pandemic and some information may have changed.

It’s clinical pharmacy at its best!

There are still aspects of consulting that require being on site.

These include monitoring medication storage, administration

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COMPOUNDING ACADEMY REPORT

Updates from USP

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n September 23, 2019, the USP Expert Committee on Compounding announced that it would be postponing the updates to USP Chapters <795>, <797>, and the new chapter, <825>, indefinitely. This decision was based on the USP’s own bylaws and their appeals process, which allows those that had previously submitted appeals to request further review.

Andrew Mize, Pharm.D. Compounding Academy President

What this essentially means is that the previous version of these chapters are in effect until further notice. In the case of <795> this means the last revision in 2014 is still in effect, and for <797> the 2008 version still applies. USP <825>, being a new chapter on Radiopharmaceuticals, does not apply, but instead the section in <797> on Radiopharmaceuticals is applicable.

to the practice of compounding concerning these chapters.

The Board has instead adopted a “wait and see” approach to the enforcement of USP <800> to allow the chapter to be implemented in other states and then determine the proper course of action for Arkansas.

Even though these chapters have been delayed, a pharmacy may choose to early adopt them if they wish. At a minimum, a pharmacy should be aware of the differences in previous versions of chapters <795> and <797> and the revised versions.

With regards to USP <800>, I Revisit your Risk Assessment. Think would encourage you to implement about your practice objectively and what you can. Revisit your Risk identify areas where employee safety Assessment. Think about your can be improved. Update your SOPs practice objectively and identify to reflect these changes to your areas where employee safety practice. Train your staff. Document can be improved. Update your SOPs to reflect these changes the training. to your practice. Train your staff.

Document the training.

You can download a copy of the previous versions for free at: http://go.usp.org/l/323321/2019-05-31/2dfgwl.

On December 16th, USP announced public hearing dates for the affected USP chapters. A hearing for USP <795> and <797> will be held on January 21st. The appeal for these chapters is with regards to the BUD provisions set forth in each respective chapter. A hearing for USP <825> will be held on January 22nd and will address the framework and BUD provisions within the chapter.

The most that will change in the current review of <795> and <797> will be the BUDs, as nothing else is being appealed.

Once these chapters are implemented, USP <800> will be applicable as well. Don’t continue to wait hoping that these issues will go away. They will not. Be proactive and make the changes necessary to improve your practice, the safety of your staff, and the health of your patients. § Editorial Note: This article was written before the coronavirus pandemic and some information may have changed.

The appeals process has two potential outcomes: 1) the appeals are denied and a new implementation date is set a minimum of six months out or 2) the appeal(s) is/are granted and the applicable standards are referred back to the appropriate Expert Committee for further evaluation.

This further review would also include additional stakeholder input.

Until the appeals process and subsequent steps are completed and the chapters are implemented, USP <800> is somewhat in the air as well. Since, there are no other USP chapters that reference <800> the chapter is informational and is not applicable as part of the compounding standards.

However, enforcement agencies such as the Arkansas State Board of Pharmacy, the FDA, and OSHA may make their own determinations on enforceability of USP <800> while <795> and <797> are being appealed. The State Board of Pharmacy has not adopted USP <800> or written any regulation changes

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Why Do You Need A Will?

It may not sound enticing, but creating a will puts power in your hands.

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

According to the global analytics firm Gallup, only about 44% of Americans have created a will. This finding may not surprise you. After all, no one wants to be reminded of their mortality or dwell on what might happen upon their death, so writing a last will and testament is seldom prioritized on the to-do list of a Millennial or Gen Xer. What may surprise you, though, is the statistic cited by personal finance website The Balance: around 35% of Americans aged 65 and older lack wills.1,2 A will is an instrument of power. By creating one, you gain control over the distribution of your assets. If you die without one, the state decides what becomes of your property, with no regard to your priorities. A will is a legal document by which an individual or a couple (known as “testator”) identifies their wishes regarding the distribution of their assets after death.

A will can typically be broken down into four parts:

1. Executors: Most wills begin by naming an executor.

Executors are responsible for carrying out the wishes outlined in a will. This involves assessing the value of the estate, gathering the assets, paying inheritance tax and other debts (if necessary), and distributing assets among beneficiaries.

It is recommended that you name an alternate executor in case your first choice is unable to fulfill the obligation.

Some families name multiple children as co-executors, with the intention of thwarting sibling discord, but this can introduce a logistical headache, as all the executors must act unanimously.2,3

2. Guardians: A will allows you to designate a guardian for your minor children. The designated guardian you appoint must be able to assume the responsibility. For many people, this is the most important part of a will. If you die without naming a guardian, the courts will decide who takes care of your children.

3. Gifts: This section enables you to identify people or

organizations to whom you wish to give gifts of money or specific possessions, such as jewelry or a car. You can also specify conditional gifts, such as a sum of money to a young daughter, but only when she reaches a certain age.

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4. Estate: Your estate encompasses everything you own,

including real property, financial investments, cash, and personal possessions. Once you have identified specific gifts you would like to distribute, you can apportion the rest of your estate in equal shares among your heirs, or you can split it into percentages. For example, you may decide to give 45% each to two children and the remaining 10% to your sibling.

A do-it-yourself will may be acceptable, but it may not be advisable. The law does not require a will to be drawn up by a professional, so you could create your own will, with or without using a template. If you make a mistake, however, you will not be around to correct it. When you draft a will, consider enlisting the help of a legal, tax, or financial professional who could offer you additional insight, especially if you have a large estate or a complex family situation.

Remember, a will puts power in your hands. You have worked hard to create a legacy for your loved ones. You deserve to decide how that legacy is sustained. § Citations 1 - https://news.gallup.com/poll/191651/majority-not.aspx [4/24/18] 2 - https://www.thebalance.com/wills-4073967 [4/24/18] 3 - https://www.nolo.com/legal-encyclopedia/naming-more-oneexecutor.html [12/3/18] ________________________________________________________________ Pat Reding and Bo Schnurr may be reached at 800-288-6669 or pbh@ berthelrep.com. Registered Representative of and securities and investment advisory services offered through Berthel Fisher & Company Financial Services, Inc. Member FINRA/SIPC. PRISM Wealth Advisors LLC is independent of Berthel Fisher & Company Financial Services Inc. This material was prepared by MarketingLibrary.Net Inc., and does not necessarily represent the views of the presenting party, nor their affiliates.

All information is believed to be from reliable sources; however we make no representation as to its completeness or accuracy. Please note investing involves risk, and past performance is no guarantee of future results. The publisher is not engaged in rendering legal, accounting or other professional services. If assistance is needed, the reader is advised to engage the services of a competent professional. This information should not be construed as investment, tax or legal advice and may not be relied on for the purpose of avoiding any Federal tax penalty. This is neither a solicitation nor recommendation to purchase or sell any investment or insurance product or service, and should not be relied upon as such. All indices are unmanaged and are not illustrative of any particular investment

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2020 APA Convention Update STAFF SPOTLIGHT: ELISABETH MATHEWS

As we are all aware, the past weeks have brought massive changes to pharmacists and patients throughout the country. Just as we all adjust to these changes as a profession, the Arkansas Pharmacists Association is making adjustments based on the recommendations of Governor Asa Hutchinson, President Donald Trump, and the federal COVID-19 Task Force.

Due to the imminence of the upcoming APA Annual Convention and the many questions surrounding COVID projections, APA staff is postponing an in-person convention to a date in early fall, with more details to come. In the meantime and in addition to the fall convention, APA will be offering a one day virtual conference with an expected eight hours of CE offered. The CE will be a live teleconference, but will also be recorded and made available to complete at your own pace. During this difficult time, APA is committed to being as flexible as we need to be to help our members complete their CE requirements.

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2020 APA Awards Solicitation AWARD NOMINATIONS Each year APA encourages members to submit the names of individuals who are deserving of special recognition for their professional activities during the past year. Any active APA member is eligible to nominate a person for the awards. Award recipients are chosen by an APA committee following a review of all nominees. Nominations are now being accepted for the following annual awards to be presented by the Association. Check APA InteRxActions email for details on the closing date for nominations.

To submit your nominations online, visit www.arrx.org/2020-awards. Alternatively, you can fax (501-372-0546) or email (awards@arrx.org) this written nomination form and any supporting materials. Please mark your nomination with an X. If you have more than one nomination, please feel free to copy this form.

Pharmacist of the Year _______

The Pharmacist of the Year Award was established in 1959 to honor an individual who “should possess professional standards beyond reproach, a record of outstanding civic service in the community, and as a member of the APA, who has contributed efforts toward the progress of the association.” Some previous recipients include: 2019 Duane Jones, Siloam Springs 2018 David Smith, Conway 2017 Laura Lumsden, Little Rock 2016 Keith Larkin, Fort Smith 2015 Wayne Padgett, Glenwood 2014 Michelle Crouse, Lake Village

Bowl of Hygeia Community Service Award _______

In 1958 E. Claiborne Robbins of the A.H. Robbins Company established the Bowl of Hygeia Award. The purpose of the award is to encourage pharmacists to take active roles in the affairs of their respective communities. Some previous recipients include: 2019 Max Caldwell, Wynne 2018 Cissy Clark, Earle 2017 Sue Frank, Little Rock 2016 Jon Wolfe, Little Rock 2015 Nicki Hilliard, Little Rock 2014 Eric Shoffner, Newport

Distinguished Young Pharmacist of the Year _______

The nominee must have an entry degree in Pharmacy, received nine or fewer years ago, and be a member of the APA. Nominee must be in the active practice of pharmacy in the year selected, and actively involved in the profession of pharmacy, displaying an interest in the future of the profession.

Some previous recipients include: 2019 Brandon Achor, Sherwood 2018 Greta Ishmael, Cherokee Village 2017 Joshua Bright, Harrison 2016 Kevin Barton, Centerton 2015 Rachel Stafford, North Little Rock 2014 Stephen Carroll, Arkadelphia

Excellence in Innovation Pharmacy Practice Award _______

This award was established in 1993 by the APA in cooperation with the National Council of State Pharmacy Associations and DuPont Pharmaceuticals to recognize, annually, a pharmacist who has demonstrated a prominent spirit of innovation and entrepreneurship in the practice of pharmacy. Some previous recipients include: 2019 Jett Jones, Jonesboro 2018 Whitney Bussell, Little Rock 2017 Jody Smotherman, Batesville 2016 Nikki Scott, Russellville 2015 Taylor Franklin, Fort Smith 2014 Marcus Costner, Fayetteville 32

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2020 APA Awards Solicitation (continued) Excellence in Innovation Pharmacy Practice Award _______

This award was established in 1993 by the APA in cooperation with the National Council of State Pharmacy Associations and DuPont Pharmaceuticals to recognize, annually, a pharmacist who has demonstrated a prominent spirit of innovation and entrepreneurship in the practice of pharmacy. Some previous recipients include: 2019 Jett Jones, Jonesboro 2018 Whitney Bussell, Little Rock 2017 Jody Smotherman, Batesville 2016 Nikki Scott, Russellville 2015 Taylor Franklin, Fort Smith 2014 Marcus Costner, Fayetteville

Guy Newcomb Award _______

The APA Board of Directors created this award in 1997 to recognize individuals who, by their legislative influence and leadership, have distinguished themselves as political friends of Arkansas pharmacy. This award is named in memory of Dr. Guy Newcomb of Osceola. Dr. Newcomb was a pharmacy leader who understood, appreciated, and enthusiastically participated in the political process. Some previous recipients include: 2019 Kim Hammer, Benton 2018 Governor Asa Hutchinson, Little Rock 2017 Senator Jason Rapert, Conway & Representative Clint Penzo, Springdale 2016 Senator Ron Caldwell, Wynne & Representative Michelle Gray, Melbourne 2011 Johnny Key, State Senator, Mountain Home

Percy Malone Public Service Award _______

This award was established in 2009 by the Arkansas Pharmacists Association in honor of former state senator Percy Malone, P.D. The recipient must have made a contribution to public service by being elected to any public office and by displaying an interest in the people of Arkansas. Some previous recipients include: 2017 Representative Justin Boyd, Fort Smith 2016 Representative Justin Boyd, Fort Smith 2015 Lenora Newsome, Smackover 2011 Gene Boeckmann, Wynne 2009 Percy Malone, Arkadelphia

Friend of Pharmacy Award _______

This award honors someone that does not serve as a pharmacist but is a champion to the pharmacist community. Previous recipients include:

2019 Senator Jason Rapert & Dr. Jennifer Dillaha Name of Nominee_____________________________________________________________________________________________ Address______________________________________________________________________________________________________ City/State/Zip ________________________________________________________________________________________________ Phone________________________________________________________________________________________________________ Reasons for selecting nominee: Attach one page with description of reasons and/or the individual nomineeâ&#x20AC;&#x2122;s resume.

Nominatorâ&#x20AC;&#x2122;s Name: _____________________________________ Phone____________________________ Date______________

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Call for Board Nominations 2020-2021 Take advantage of the opportunity to give back by serving on the Arkansas State Board of Pharmacy or the APA Board of Directors. We are seeking nominations for enthusiastic and energetic individuals who want to make an important contribution to the pharmacy profession. APA’s Board of Directors is made up of 12 representatives spread out over five regions, including two at-large representatives. Each regional representative will serve a three-year term. For questions about term lengths, please contact Susannah Fuquay at 501-372-5250. APA Board membership requires the flexibility to meet in Little Rock four times per year for Board meetings and to participate in three to four conference calls per year.

APA Board of Directors Call for Nominations

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

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

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

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

Region 4 – Southwest Arkansas: No Open Seats Southwest Counties: Clark, Columbia, Garland, Hempstead, Hot Spring, Howard, Lafayette, Little River, Miller, Montgomery, Nevada, Ouachita, Perry, Pike, Polk, Scott, Sevier, Yell

Region 2 – Northeast Arkansas: One Open Seat Northeast Counties: Baxter, Clay, Cleburne, Craighead, Crittenden, Cross, Fulton, Greene, Independence, Izard, Jackson, Lawrence, Mississippi, Poinsett, Randolph, Sharp, Stone, White, Woodruff

Region 5 – Southeast Arkansas: One Open Seat Southeast Counties: Arkansas, Ashley, Bradley, Calhoun, Chicot, Cleveland, Dallas, Desha, Drew, Grant, Jefferson, Lee, Lincoln, Lonoke, Monroe, Phillips, Prairie, St Francis, Union

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

At-Large Representatives: No Open Seats

APA Officers and Board of Directors

The requirements for nominees of the APA Officers are as follows: Arkansas licensed pharmacist who has been a member of this Association in good standing for the past three (3) consecutive years. Board Members shall be limited to six (6) consecutive years as a Regional Representative, or six (6) consecutive years as an At-Large Representative. No member of the Board of Directors shall serve more than nine (9) years on the Board of Directors in any non-Executive Committee capacity.

Reimbursement- Members of the Board of Directors don’t receive compensation but can be reimbursed for reasonable direct and indirect expenses related to attending meetings such as mileage and/or hotel costs. Board members receive a discount on annual convention registration. Board members who are on the program at Regional Meetings (president, regional representative) do not pay registration fees..

Removal from office- Directors may be removed for being absent without reasonable cause from any two consecutive meetings or any three meetings during a 12-month period. Meeting dates for 2020-2021 are likely to be: • • • •

Late July / Early August (Thursday afternoon, all day Friday, Saturday 8 a.m. to 12 p.m.)

December 5, 2020 (Saturday 9 a.m. to 6 p.m.) in Little Rock March 2021 (Sunday 9 a.m. to 4 p.m.) in Little Rock APA Annual Convention Board Meeting, June 2021 (Wednesday a.m. before convention)

If interested in nominating yourself or another individual, please fill out this form www.arrx.org/2020-board-nominations.

Check APA InteRxActions email for details on the closing date for nominations.

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