ARRx - The Arkansas Pharmacists - Winter 2015 by Arkansas Pharmacists Association

AR•Rx

THE ARKANSAS PHARMACIST

Dear Arkansas Pharmacist, As your statewide professional organization, the Arkansas Pha rmacists Association (APA) is after the interests of Arkansas looking pharmacists. We invite you to invest in your professional futu joining as a member in 2015. re by Here are just a few examples of how APA has worked on you in 2014. r behalf We are excited about the 2015 General Assembly. APA is a res pected voice on pharmacy and care issues at the Capitol. We health look forward to continuing to push for legislation that enh the vital role that pharmacist ances s play in the health care team and legislation that shines ligh complex pharmacy benefit. We t on the have a great legislative team assembled and we look forw being your voice at the Capitol ard to ! APAâ&#x20AC;&#x2122;s clinical programs were also successful in 2014. The award -winning Pharmacists Immuni Program continued to provide zation immunization and CPR trainin g for APA members and provided free promotional posters encouragi ng patients to receive their flu, pneumonia, shingles, and wh cough vaccines from their pha ooping rmacist. APA continued to garner gre at airtime with our public rela tions and marketing campaign, aired radio ads, published new which spaper editorials, and made countless television appearanc encourage patients to visit the es to ir local pharmacist. In order for APA to continue wo rking on pharmacistsâ&#x20AC;&#x2122; behalf, we need your support! Please APA in 2015. You can join onl join the ine by visiting www.arrx.org/joi n with your username and pas (located on your membership sword dues statement). We appreciate the opportunity to serve the pharmacists of Arkansas. Please do not hes contact our staff at 501-372-5 itate to 250 if we can do anything to serve you. We look forward joining the APA and to a great to you 2015! Sincerely,

Mark S. Riley, Pharm.D. Executive Vice President & CE O

417 South Victory Street | Little

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Rock, AR 72201-2923 | p 501-37 2-5250 | f 501-372-0546 | ww w.arrx.org

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

CONTENTS 3 Letter from APA’s Mark Riley

6 Inside APA: APA Implementing New

Strategic Plan

Harding Report: Harding Implements Successful College-Community Collaboration Efforts

Arkansas Academy of Health-System Pharmacists: AAHP offers N.O.W. (Networking Opportunities that Work)

AAHP 2015 Award Winners

APA Compounding Academy: Let’s See What 2015 Brings for Compounding

15 FEATURE: Riley Honored for NCPA

APA Consultants Academy: Cimetidine for Dementia-Related ISB

16 RX and the Law: Law vs. Ethics

2014-2015 APA Board of Directors

17 Safety Nets: Beginning Our 19th Year

APA 2015 Awards Solicitation

19 FEATURE: Representative Boyd Goes to

APA 2015 Annual Convention Preview: Little Rock Rocks for 2015 Annual Convention

7 From the President: Time to Start

Building Relationships with New Legislators

9 COVER: PCMH Evolves in Arkansas 14 Member Spotlight: William Hammill, Searcy

Presidency

the Capitol

21 New Drugs: 2014 New Drugs 23 Clinical Programs: Pneumococcal

Conjugate Vaccine in Adults

25 APA 2015 Calendar of Events 26 UAMS Report: Patient and Family

Centered Care a Partnership

Member Moment: Lauren and Stephen Carroll

Call for 2015 Pharmacy and APA Board Nominations

Member Classifieds

Susannah Fuquay Director of Membership & Meetings Susannah@arrx.org Celeste Reid Director of Administrative Services Celeste@arrx.org Debra Wolfe Director of Government Affairs Debra@arrx.org Office E-mail Address Support@arrx.org Publisher: Mark Riley Editor: Eileen Denne Design: Gwen Canfield - Creative Instinct Arkansas Pharmacists Association 417 South Victory Street Little Rock, AR 72201-2923 Phone 501-372-5250 Fax 501-372-0546 AR•Rx The Arkansas Pharmacist © (ISSN 0199-3763) is published quarterly by the Arkansas Pharmacists Association, Inc. It is distributed to members as a regular service paid for through allocation of membership dues ($5.00). Non-members subscription rate is $30.00 annually. Periodical rate postage paid at Little Rock, AR 72201. Current edition issue number 70. © 2014 Arkansas Pharmacists Association.

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

DIRECTORY OF ADVERTISERS 4 Pace Alliance 8 Arkansas Pharmacist Support Group 8 Pharmacy in Arkansas Print 12 Bell & Company 13 Pharmacists Mutual Insurance 18 WRetail W W .Designs, A R R X . OInc. RG

18 UAMS Alumni Association 22 EPIC Pharmacies 30 Law Offices of Darren O'Quinn 34 First Financial Bank 39 Pharmacy Quality Commitment Back Cover: APA Honors Cardinal Health

APA Board of Directors

INSIDE APA

2015- 2016 Officers

INSIDE APA

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

APA Implementing New Strategic Plan

Area Representatives Area I (Northwest) Michael Butler, Pharm.D., Hot Springs Village Area II (Northeast) Brent Panneck, Pharm.D., Lake City

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

Area III (Central) Clint Boone, Pharm.D., Little Rock

Area IV (Southwest/Southeast) Lynn Crouse, Pharm.D., Eudora

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

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

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

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

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

Find the APA on Facebook, or visit our website at www.arrx.org 6

s I sit at my computer writing this article a couple of days before the holidays, I begin to think about why this association exists and what an acceptable performance level is for the membership it represents. Of course, I always fall back on advocacy as our primary responsibility; advocacy with governing entities, elected officials, state agencies, other associations, private businesses, various healthcarerelated interests (including other professions), and patients. While advocacy is, I believe, the cornerstone of our work, there are many other aspects to an association’s interaction with its members and others. Our staff has evolved over time as a group of dedicated individuals that work as a team that have very specific individual duties that are essential to our members as benefactors. Eileen Denne is primarily responsible for communications – within and without; Celeste Reid for interaction with those that call on our association as well as handling the specifics of our financial dealings; Susannah Fuquay for coordination of all things related to our meetings and for membership retention and growth; Debra WolfeSheppard for government affairs (no small task with the huge turnover of elected officials in a term-limited legislature); Eric Crumbaugh with immunizations and Medication Therapy Management (and other practice related issues); and Scott Pace oversees the daily operation of all of these functions as well as handling specific pharmacy-related member issues.

I am charged to lead in setting the direction laid out to me by the board of directors. My responsibilities are largely relational with those inside and outside of our profession. I say all of this to make the point that to function as a “well-oiled machine,” there has to be organization and planning to produce effective direction from the board. We don’t just “show up and see what happens today.” I am extremely proud of our board of directors and our staff for the development of our second fouryear strategic plan. Many hours were spent in staff training and planning before the August board of directors retreat where the directors spent two days focusing on the vision, mission, goals, and objectives – a strategic plan - that this association will follow in representing you as its members. Staff then followed up to put together a document for board approval that was very clear in establishing work objectives for staff and an accountability for me, the CEO, to see that every effort is put forth to accomplish the directives. The final document was adopted by the board at the December meeting. The complete strategic plan is available to you on our website at www.arrx.org/strategic-plan. Feel free to take a look at it and make suggestions to your board representatives. This is a living, breathing document that can change, as necessary, as the landscape dictates. It is intended to give us a framework and to remind us of the substantial amount of work that needs to be done.

AR•Rx

THE ARKANSAS PHARMACIST

FROM THE PRESIDENT

I continue to be amazed at the way pharmacists go about their daily routines in order to provide health care to their patients in a caring and unselfish way. Even with all of our challenges, we must stay focused on making a difference by addressing those things that are being inflicted upon us that are wrong (for us and patients) and to look to

the future and make changes that move the profession forward. Thanks for allowing me to lead this organization for almost 12 years. It seems like just yesterday… §

FROM THE PRESIDENT C

Time to Start Building Relationships with New Legislators

ovember brought a political change in Arkansas. New constitutional officers, big margins in the House and Senate for the Republicans, a new U.S. Senator, and two new U.S. Congressmen. With power comes great responsibility, and I am confident that the newly-elected leaders of our state will use their new power to continue to improve the great state we call home. Those newly elected into the majority party now have the daunting task of working with the other side to pass legislation, while at the same time appeasing the base of those groups that put them into office. Likewise, those in the minority face the proposition of working with the new majority party and persuading their fellow legislators to do what they feel is best for the state. Either way, the practice and delivery of health care in Arkansas stands to change dramatically over the next few years. What kind of role do we want pharmacy to play in the upcoming legislative session? The APA has always prided itself on being very proactive in trying to advance the profession of pharmacy in this state, and has been very successful in doing just that. A large portion of these successes can be attributed to the relationships the staff and members have built with legislators from both parties who have become true “friends” of pharmacy. This year, we gain a giant “friend of pharmacy” in the legislature as APA member Justin Boyd, owner of Coleman Pharmacy of Alma, now represents District 77 in the Fort Smith area in the Arkansas House. Congratulations to Representative Boyd, we are excited to work with you! (Read more on Rep. Boyd on page 19.) Now more than ever it is of utmost importance to start building new relationships with many of the newcomers to the state legislature, while at the same time maintaining the great working relationships we’ve had with those who suddenly find themselves in new governmental roles. I urge you once again to reach out to your local representatives and introduce yourself, if you haven’t done so already.

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The best lobbying tool we have as Brandon Cooper, Pharm.D. pharmacists are the relationships President we have with people. The grassroots efforts which were so successful in the past can be directly attributed to our ability to connect with our patients, our employees and coworkers, other healthcare providers, and the people we interact with on a daily basis in our communities. One other strong selling point is that most, if not all, of the legislation we support and promote in each legislative session can be directly tied to promoting and advancing healthcare by helping to take care of the needs of our patients. Many times the APA staff is asked why we promoted certain legislation, since we stand to gain very little monetarily by passage of a certain bill. The answer is simple: because it was the right thing to do for our patients. It’s hard to argue with that, especially when the other side cannot make the same argument. Each one of us can advocate on behalf of our profession in different ways, but it is easy to do when we have strong relationships with those that can help to make a difference. No matter what our political affiliation is—Democrat, Republican, Liberal, Conservative, None-of-the-above, or Somewhere-in-between—we must remain committed to working together to solve the problems that can and will affect the practice of pharmacy and our patients. Our job as an association has always been to work with those elected officials to help make healthcare more affordable and produce better outcomes using the medication expertise of the pharmacist. We will continue to work toward this goal. Congratulations to Gov. Hutchinson, Lt. Gov. Griffin, Attorney General Rutledge, and all of the newly-elected members of the General Assembly; and congratulations to Senator Cotton, Congressman Hill and Congressman Westerman who represent Arkansas in Washington. APA looks forward to working with all of these leaders to help serve our patients, our profession and to make Arkansas an even better place to live! § 7

AR•Rx

THE ARKANSAS PHARMACIST

Patient Centered Medical Home Evolves in Arkansas By Eileen E. Denne, APR

atient Centered Medical Home has different meanings for healthcare professionals, but for one pharmacist doing innovative work in this area, it boils down to getting all healthcare providers to communicate, collaborate and fairly compensate one another for the roles they provide in patient care. For Jeremy Thomas, Pharm.D., Pharmacy Practice, University of Sciences (UAMS), PCMH is a bottom-line concept. “It boils down to saving money in health care. Pharmacists need to see it as adding revenue. It’s an effort by primary care offices such as physicians in internal, family, and pediatrics practices to provide more proactive team-based care for patients. PCMH addresses ongoing chronic conditions and preventative care.”

Alison Gray, Pharm.D., clinical pharmacist at Little Rock Family Practice, counsels patient.

the PCMH models and gets them implemented throughout state.

Full-time pharmacist at Little Rock Family Practice Clinic

One of his successes was the addition of Alison Gray, Pharm.D., to the staff of the Little Rock Family Practice Clinic last August. Gray is a clinical pharmacist at the Associate Professor, practice. She graduated from University of Maryland Arkansas for Medical School of Pharmacy in 2013 and completed a year-long residency at Midwestern University in Downers Grove, Illinois. After I find lots and lots of problems that, Gray said, “I was looking for with people’s medications; an ambulatory care position. Little Rock came up and it was exactly many don’t have an accurate what I was looking for.” list and we generate one that

they can share with their other providers. I find lots of errors, especially in those who have just been discharged from the hospital. I am really serving as a liaison between Saline Memorial Hospital and community pharmacists.

Her position is partially funded through the Centers for Medicare and Medicaid’s (CMS) Comprehensive Primary Care Initiative (CPCI). Thomas describes CPCI as a laboratory of innovation that produces business and patient care models for PCMH, and seed money. He helped to develop the job description for the Little Rock Family Practice position.

Thomas has a unique perspective on PCMH due to his role as consultant pharmacist for Nexus Cindy Martindale, P.D. Clinical Solutions, a medical home transformation company that assists physician offices to According to Gray, the physicians become a medical home. Since March 2014, Thomas has at the practice researched what pharmacists can do spent 50 percent of his time as a consultant pharmacist before they started the application process. When she for Nexus and 50 percent at UAMS. He works to develop interviewed, they asked “How can you help us?”

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PCMH EVOLVES IN ARKANSAS

If pharmacists are concerned about sustainability of pharmacy and profit margins, PCMH is another avenue of professional service we can provide that has a financial model attached to it. Jeremy Thomas, Pharm.D.

“I am passionate about ambulatory care pharmacy because it is very valuable. I don’t think a lot of other physicians or healthcare providers understand the benefits of getting patients motivated to make the changes necessary to improve their health. Medicine is not always about just telling patients what they need to do. I think [my position] is a great position for a pharmacist so we can talk to patients and educate them.”

CPCI supports pharmacist counseling at Benton practice

Another pharmacist in Central Arkansas agrees with and practices Gray’s philosophy. Fully funded through a CPCI grant, Cindy Martindale, P.D., works in her husband’s physician practice, Saline Med-Peds in Benton. She focuses medication management on patients at the highest risk and all transitions of care, whether coming out of hospital or rehab, and on patients who see multiple doctors or are having problems with their medication.

Dr. Jeremy Thomas talking about Patient Centered Medical Home during the 2014 APA Annual Convention.

“I have been able to develop my own service from the ground up,” Gray said. “That means I’ve had to write my own protocols and outline exactly what I will be doing. I’ve been working on three protocols including: 1) warfarin therapy management; 2) medication therapy management; and 3) diabetes. And I plan to expand and do some other disease state protocols in the next few months.” The protocols provide a written agreement with the physicians allowing Gray to adjust certain medications. She described one of the biggest obstacles as getting physician buy-in. She only sees patients when the physicians refer them to her. “The benefit of the protocols is that it gives the doctors a better understanding of what I’m capable of and my knowledge base.” Gray said. “Having them trust and understand what I do may take a while.” She is working to try to increase revenue through reimbursement at the practice so that she can cover her own salary. Private insurers are not willing to reimburse for her services yet, she said, but at Little Rock Family Practice they are working on it “pretty feverishly” so that she can be reimbursed for all services.

“I have also focused on the diabetes population and trying to reduce A1Cs. We invite patients to a luncheon and class taught by a Certified Diabetes Educator. We’ve had 25 to 30 patients take the class just in the last six months and always have a waiting list. It has been very successful in educating our patients and lowering blood sugars. We may start other classes related to hypertension.” She has a unique arrangement with Saline Memorial Hospital to share patient medication lists electronically and her patients can also pull their medication lists from the Saline Med-Peds portal. Martindale feels that what she does is a great help to people. “I find lots and lots of problems with people’s medications; many don’t have an accurate list and we generate one that they can share with their other providers. I find lots of errors, especially in those who have just been discharged from the hospital. I am really serving as a liaison between Saline Memorial Hospital and community pharmacists including Smith- Caldwell and Finley Pharmacies in Benton. I fax medication lists to them to reconcile so that they are aware of what meds our patients are supposed to be on.”

Pharmacists can help better manage patients

Thomas sees the work that Gray and Martindale are doing as a way to help physicians better manage patients. “Look at all the things physicians are now held accountable for in these new payment models,” Thomas says.” Three programs in Arkansas include: Medicaid’s PCMH; CPCI CMS grant (Medicare, Medicaid, ABCBS, Humana and QualChoice); and, not finalized yet is Medicaid expansion Private Option – ABCBS, Ambetter, QualChoice. The majority of these are evaluating physician performance in

AR•Rx

THE ARKANSAS PHARMACIST

PCMH EVOLVES IN ARKANSAS

the areas of diabetes, hypertension, cholesterol, smoking cessation, and immunizations, plus hospital admissions and readmissions for heart failure, and COPD. These are all areas where, when involved in the patients’ care, pharmacists have been shown to have a positive impact in collaboration with the healthcare team.” Pharmacists have had positive impact on clinical outcomes and some have shown a positive impact economically by saving the health system money. Beyond the impact on patient outcomes, another reason to become better educated about PCMH, Thomas says, is that pharmacists are relying less and less on profit margins from dispensing only.

Payors looking at pay-for-performance versus fee-forservice

“If pharmacists are concerned about sustainability of pharmacy and profit margins, PCMH is another avenue of professional service we can provide that has a financial model attached to it. These new payment models are built around quality of care and safety. Payors are looking at pay-for-performance versus fee-for-service. Physicians hear those words a lot.” “We look at AWP and MAC pricing and dispensing fees – that’s our fee-for service. Now pharmacists are beginning to look at Medicare Star Ratings. That’s our version of payfor-performance. Physicians are being held accountable for very similar things. Partnering with a PCMH can be beneficial for both the physician and pharmacist.”

services but there have been many barriers in place such as time, space, resources and personnel. Plus, the payment models themselves have been lacking therefore few have taken advantage of it. However, if we look at the profit margins on dispensing now versus 30 years ago we have to ask ourselves, if we rely on dispensing alone where will our profession be in the next 30 years, he asks. Community pharmacist Zach Holderfield, Cornerstone Specialty Pharmacy in Fayetteville, says of PCMH, “It is an emerging practice model that will offer current and future pharmacists opportunities to serve as the medication experts responsible for optimizing drug therapy, improving therapeutic outcomes, and promoting wellness and further disease prevention. But, the PCMH model is not clearly structured yet and we must understand its challenges from an operational standpoint, make sure we push for the best pharmacist integration model, and are able to be reimbursed for services provided.”

The benefit of the protocols is that it gives the doctors a better understanding of what I’m capable of and my knowledge base. Having them trust and understand what I do may take a while. Alison Gray, Pharm.D.

Financial incentives, Thomas says, are changing. He wonders whether pharmacy as a profession will look at PCMH as an opportunity to engage in advanced professional activities or allow this to pass us by and let someone else take advantage of it. “Physicians will compensate pharmacists for better care. Payors need to compensate the physician practice,” Thomas explains. “If there are savings, the physician has ability to share in the savings. If they meet clinical quality indicators, they get a bigger piece of the pie. They, in turn, pass those along to the pharmacist. It is a business arrangement between physician and pharmacist. Right now several have partnered with local hospital pharmacists to help with medication management in Jonesboro, Batesville, and Fayetteville.” PCMH is still new to many community pharmacists and it is not on the radar screen for most. If it is, they are likely to have many more immediate and daily concerns impacting their businesses. Thomas acknowledges that over the years community pharmacists have explored various mechanisms for compensation for cognitive

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Pharmacist Alison Gray at Little Rock Family Practice Clinic on University Avenue in Little Rock.

Hospital pharmacists familiar with PCMH

Several hospital pharmacists, on the other hand, are already familiar with PCMH. Health systems are currently accountable for readmission rates. The two biggest areas are in medication adherence and transitions of care. If you look at readmissions, Thomas says, many are medication-

PCMH EVOLVES IN ARKANSAS

related; medications are not managed well or the patient has an adverse effect. “That is a huge area for pharmacists to become involved. There are more hospital pharmacists engaged in medical homes now in Arkansas than community pharmacists. It should be the other way around because patients have more access to community pharmacists than they do hospital pharmacists.” Maggie Williams, director of pharmacy at White River Medical Center in Batesville, and chair of APA’s Professional Affairs and Ethical Practices Committee, thinks PCMH will help with decreasing readmissions and increasing patients’ education on their own disease state. White River has a partnership with Batesville Family Practice and assists with patients by appointment at their clinic. “I think [PCMH] will have a positive impact on patient health overall and decreasing their need for emergent medical care. It is originating in home physician offices. Batesville Family Practice is a medical home but there are lots of physician offices in town not practicing. It is just in the beginning stages. We are participating [in PCMH] but we’re not seeing the impact on hospitalizations yet.” Thomas would like to help connect more physician offices with pharmacists. PCMH is only going to continue to grow based on payment models, he says. “Pharmacy will be engaged to extent that pharmacy decides to be engaged.”

If pharmacists are interested, he can look to see if there are physician offices in their towns that are participating and if they are willing to partner or if there are offices two counties over that they could partner with for pharmacy consultation. He suggests that pharmacists can provide services over the phone, internet and through technology and need to go to payors and physicians and say ‘here is what I can offer and here is what I do best.’ Thomas is confident that pharmacists will eventually want to get involved in PCMH. “The healthcare landscape is a continually changing environment and we have to look at ourselves as healthcare professionals who can solve medication-related problems and look for opportunities to do that in various models of care, not just the pharmacy.” Pharmacists, he says, first need to know that PCMH is there and that this physician-centered program comes with an expectation to provide proactive as opposed to reactive care. “As pharmacists we have the ability to engage the community in order to help and assist physicians in their outcomes. They are incentivized to spend money wisely to keep patients healthy year-round. For pharmacists, if reimbursement doesn’t pay the bills anymore, we have to look somewhere else. It’s not easy because people don’t like to change.” §

AR•Rx

THE ARKANSAS PHARMACIST

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MEMBER SPOTLIGHT

William Hammill, Pharm.D. — LOWERY DRUG MART #1, SEARCY Pharmacy Practice: Independent retail pharmacy. Pharmacy School & Year: University of Arkansas for Medical Sciences, 1996. Years in business: 18. Favorite part of the job: Knowing my knowledge and experience benefits those who are seeking the advice of my profession. Least favorite part of the job: Politics and constant struggles with PBMs while fighting to keep my profession from becoming extinct.

Recent reads: Decision Points by President George W. Bush; "IT WORKED FOR ME In Life and Leadership" by Colin Powell. Fun Activities: Anything with my family, duck hunting, golf, and camping. Ideal Dinner Guests: Ronald Reagan, Abraham Lincoln, Stevie Ray Vaughn, Levon Helm, and Nash Buckingham. If not a pharmacist then..: A cement finisher and farmer like my Dad. §

Oddest request from a patient: I had a patient request that I stop by the grocery store and pick them up a gallon of milk and deliver it along with their prescriptions after I closed one Saturday.

AR•Rx

THE ARKANSAS PHARMACIST

APA EVP and CEO Mark Riley Honored for NCPA Presidency RILEY NAMED FOR ENDOWED SCHOLARSHIP TO UAMS COLLEGE OF PHARMACY

NCPA Arkansas delegation, Sunday, Oct. 19, 2014, Austin Hilton Hotel, Austin, Texas.

As he concluded his year as National Community Pharmacists Association (NCPA) President at the NCPA Annual Convention and Exhibition in Austin, Texas, APA’s Executive Vice President and CEO Mark Riley, Pharm.D., was surprised to learn that he was the recipient of an endowed scholarship. More than 60 pharmacists contributed to “The Mark S. Riley, Pharm.D. Endowed Scholarship,” which was presented to Riley at the 2014 NCPA President’s Reception on Sunday, Oct. 19. The endowment was created at his alma mater, the University of Arkansas for Medical Sciences (UAMS) College of Pharmacy. Riley’s son Chad and daughters-in-law Lana and Stacy are also graduates of UAMS COP. The endowing contributors included 30 APA Past Presidents, current APA Board Members and special friends. The endowment was kept secret until the presentation on Sunday night. The scholarship recognizes Riley’s service to the profession of pharmacy in Arkansas and across the United States. APA’s COO Dr. Scott Pace presented the plaque to Riley. Tery Baskin, Percy Malone, Becky Snead, Charles West, and Doug Hoey all rose to share their own personal tributes to Mark. Riley concluded his year as NCPA president on Oct. 22, 2014.

APA COO Scott Pace makes presentation.

Mark and Brenda Riley listening to remarks.

Lonny Wilson, Oklahoma, and Tom Meningham of APhA.

NCPA Executive Vice President Doug Hoey comments.

APA’s Mark Riley and Scott Pace.

Mark with sons Chad (L), and Clay Riley (R).

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PHARMACY RESIDENCES

Law Vs. Ethics 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.

recently attended a conference which had some very Ibilled thought-provoking sessions. While the conference was as a pharmacy law conference, ethical issues kept

percolating to the surface. What is the difference between law and ethics? Why should I care? What impact can ethics have on pharmacy practice? We should care because law and ethics work together to maintain our society. Law is a rule of conduct that is formally recognized by a society as binding and is enforced by that society. Ethics on the other hand is less structured and less formal. As a professional, pharmacists must use their professional skills for the benefit of their patients. Ethics involves the decision-making process required to treat patients. Many times the choices faced are not dealt with directly by laws. Some commentators view laws as the baseline for professional conduct. This must mean that there is some advanced mode of practice that exceeds the requirements of the law. For example, if a pharmacist is required to undergo an annual skills assessment, there would be nothing to prevent the assessment being done every six months if it was thought that it provided better care for the patient. It still complies with the requirement set by law. The cost/benefit analysis and the decision-making process that ensues to decide if every six months is warranted is where ethics comes into play. Some pharmacists don’t believe that ethical questions will affect them. They follow the law every day and that will suffice. However, there is a limitation on the effectiveness of the law. Law tends to be reactionary, not proactive. Law deals with yesterday’s problems, not tomorrow’s. Also, law is limited. There are not laws to address every single issue that comes up in today’s society. If there were, our code books would be enormous. This is why lawyers are always talking about the “reasonable person.” What would a reasonably prudent pharmacist have done in your situation? This is the measuring stick for situations where black and white laws don’t exist, which is most of the time. These situations make pharmacists nervous because there may not be one “right” answer. Most likely there will be a best answer. Many people wish that more laws were simple right or wrong choices, but the reality is that our society is

too complicated for such laws. Changing one little factor in a scenario may drastically change your conclusion. Look at this list of issues if you think that pharmacists aren’t faced with ethical decisions: • Should pharmacists be involved in the dispensing of Medical Marijuana? • Should pharmacies sell alcohol or tobacco products? • Should pharmacists take part in executions by lethal injection? • Should pharmacists have the right to refuse to dispense drugs based on their personal morals? • Should pharmacists dispense drugs for assisted suicide? Depending on your state, most of these activities are legal. If following the law is your only criteria, then there is little to debate here. But, ethical questions can arise because of a number of different reasons. It could be a conflict between the pharmacist’s moral values and the law. It could be competing laws that don’t coincide leaving the individual to try to reconcile the two different laws. They might also arise when there is no applicable law at all. Ethical questions might also arise when a patient’s needs cannot be met within the legal guidelines. Chances are that we are all going to be faced with these types of choices at some point in our professional lives. Take time to prepare before you are faced with an urgent decision. There are plenty of references available that explain the principles of ethics and the decision-making process. When you are better prepared, the challenges are easier to handle. The ostrich approach is not going to prepare you well. Pharmacists are required to study the applicable laws. They should also study ethics because law and ethics work hand in hand. Neither alone is sufficient for pharmacists’ practices in the 21st Century. §

_________________________________________________________ © 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

PHARMACY RESIDENCES

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY

UNIVERSIT Y OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY

Beginning Our 19th Year

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

ather than provide our 73rd usual installment of Safety Nets, we want to step back for perspective. Many of our columns have concluded by saying how powerful it is for pharmacists and technicians reading about these cases to take time to discuss safety and to reflect on their own work. The same process is important for columnists, too.

college to swift communications with pharmacists across Arkansas has proven vital to sustaining the column. We cannot remark on the college’s role without also noting that access to our Arkansas Poison Control and Drug Information Center has allowed us quick access to the facts needed to retain focus.

It has been 18 years since AR•Rx The Arkansas Pharmacist hosted its first installment of Safety Nets. Since January 1996, when your authors were still junior faculty members at the College of Pharmacy, we have enjoyed a genuine welcome on these pages. We also have found ourselves and our interest in patient safety welcome in APA meetings for continuing education, and in every pharmacy we have visited. In return, we offer this New Year’s reflection.

Third, of course, among our stay ropes is the Arkansas Pharmacists Association. The executive directors, the staff and the board members have believed in the value of our work. The magazine space has been provided without charge. The APA has met any request that we have made for information. Moreover, the staff publishing AR•Rx The Arkansas Pharmacist have lent us technical support and personal encouragement. We particularly appreciate their fidelity in reminding us of deadlines!

Every safety net features a fine enough mesh to catch the falling. In Arkansas’s case, the fine mesh resides in the dedication and skills of pharmacists in every sort of practice. Over 18 years this state has seen remarkable creativity among pharmacists in pioneering new practices, and in focusing existing practices closely on specific patient needs. Safety nets have been a constant feature of these entrepreneurial exercises. A proper safety net also needs strong anchoring cables that hold it always in place, always ready to meet unexpected needs. We have been blessed with such reliable anchors since we first proposed this column. Every pharmacist in Arkansas can agree with us about this, and about how truly fortunate our profession is that they exist. First we would list the Arkansas State Board of Pharmacy. The executive leadership and the members of the Board welcomed our idea to write a column about protecting patients from harm due to medication errors. The idea to discuss this issue seemed controversial nearly 20 years ago. The Board has always stood with us, regularly applying solid principles of patient safety practices in its regulatory work. Now we can all be pleased that study of errors has become a requisite part of continuing professional development. Second, the College of Pharmacy has provided a reliable anchor point. Our Deans and our department chairs never questioned the time devoted to this work. They, too, saw the value of bringing a once controversial topic in to the light of study and publication. Indeed, our access through the WWW.ARRX.ORG

Our fourth strong support has come from the United States Pharmacopeia. The resources of our unique national pharmacopeial body have multiplied our local sources of information. Our inquiries have always been filled quickly. Our requests for publications have been turned around faster than we could imagine. Our work with USP constantly reminds us and challenges us to uphold the example of inquiry and reporting established here in Arkansas over 50 years ago by Bill Heller and his pharmacy staff at University Hospital. At this turning of a year let us all take a moment away from business and reflect on what has sustained nearly two decades’ of shared work. We can all agree how fortunate we are to practice pharmacy in a state where practitioners, regulators, teachers and association work together seamlessly. What is true of this column and its work to improve health outcomes through safer patient care is true of every aspect of our profession. We all need refreshment, if we are to continue our engagement in answering the challenges that we know must come. Taking time to look back, to study and to evaluate is proper at this time of year. It is also proper to express thanks for what we have received, and your authors of Safety Nets begin this 19th year in these pages with a genuine “Thank You.” Your constant backing has anchored our Safety Nets. In the process Arkansas has provided a service unique among pharmacy associations in the country. §

AR•Rx

THE ARKANSAS PHARMACIST

Representative

Justin Boyd

(District 77)

Goes to the Capitol By Eileen E. Denne, APR

n a cloudy day last December, newly-elected Representative Justin Boyd, Pharm.D., was in Little Rock for freshman orientation. APA member Boyd, University of Arkansas for Medical Sciences (UAMS) college of pharmacy Class of 2000, and co-owner of Coleman Pharmacy of Alma, now represents District 77 in the Fort Smith area in the Arkansas House. Former Senator Percy Malone, P.D., was the last pharmacist who served in the legislature, from 1995 to 2013. “It is very humbling to sit in a seat and be able to serve the citizens of this state,” Boyd said when asked how it felt to come to the Capitol as a member of the Arkansas House of Representatives. He had just concluded a tour of the capitol and media training that included a video interview and some pointers on posture. “They suggested that we stick to no more than three points, and no more than 9 seconds,” Boyd said. Boyd’s three points include meaningful work, quality of place and education for members of his District. “We are in an environment where people want good jobs and need to feel secure. People want something to do after work – places to fish or hunt, or to have the right social opportunities. We want the best for our kids – education which will lead to opportunities for our children.” “I plan to focus on funding and ensuring that we’re investing the state’s dollars in the right place to receive the best outcomes in those areas.”

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Prescription Drug Abuse on Agenda

Asked what his agenda might be on pharmacy issues, Boyd said, “Beyond my focus on jobs and the economy, it is prescription drug abuse. As a state board of pharmacy member for five years and as a pharmacist, prescription drug abuse is one of the challenges this state faces. As a legislator, I plan to work with other state representatives and senators to identify what the state is doing currently, what the state can do going forward and what might be useful as a last resort to help the state find the right balance between adequate pain control for our patients and prescription drug abuse.” He continued, “Education for patients, prescribers, pharmacists and other health care practitioners will be the cornerstone of the current epidemic so we’ll need to look at ways to identify and fund those opportunities. And, as a last resort, we need to look at enhancing our laws or current rules and regulations regarding prescription drugs.”

Reserving Judgment on Private Option

Boyd is reserving judgment on which direction the state might go with the health insurance private option until later in the legislative session. As we begin to understand Governor Hutchinson’s priorities, he said, then he may see opportunities to influence the state’s priorities. “I have one of the largest hospitals in the state, Sparks Hospital, in my district. The private option provides important funding to two of the largest employers in Ft.

Boyd in his office and at pharmacy counter at Coleman Pharmacy of Alma.

Smith: Sparks and Mercy Ft. Smith Hospitals that each employ about 1,500 people. So the vote on the private option will have an impact on those people as well as thousands of patients in Sebastian County.” Boyd brings unique pharmacy experience to his role as a legislator. After graduation, he did a year-long residency at UAMS in Jonesboro. He worked in hospitals from 2001 to 2009 then became co-owner of Coleman Pharmacy of Alma in 2009. The store went through a complete rebuild in fall 2011. He decided in 8th grade to become a pharmacist. “There was a short time when I considered becoming a microbiologist but I soon realized that being a pharmacist was my true calling.”

Justin with daughter Mora.

Justin with wife Lori.

What is Boyd looking forward to most in his role as a legislator? “I look forward to working closely with the APA on its legislative priorities. The Arkansas Pharmacists Association has worked hard to develop positive relationships and it follows through with what it says it is going to do. I am also looking forward to getting to know my fellow legislators and developing lifelong friendships.” He anticipates that being away from his family will be the most challenging part of the job of legislator. Boyd’s wife Lori is a doctor of audiology. They have three daughters: Mora, age 8; Olivia, age 6; and Amelia, age 4. The girls are involved in dance. Boyd likes to go deer and turkey hunting when he has time. §

Justin with daugher Amelia.

AR•Rx

THE ARKANSAS PHARMACIST

2014 Brings New Drugs

ith the year coming to a close, it has been a surprisingly slow quarter at the Food and Drug Administration (FDA) with only seven new entities approved. However, it was still a productive year because more new entities were approved by August 2014 than in all of 2013. Several drugs received new indications, including: Otezla® (apremilast; plaque psoriasis), Humira® (adalimumab; juvenile idiopathic arthritis and Crohn’s disease in children >6 years), Eylea® (afibercept; all forms of macular edema after retinal vein occlusion), Lemtrada™ (alemtuzumab; relapsing forms of multiple sclerosis), Velcade® (bortezomib; mantle cell lymphoma), and Ozurdex® (dexamethasone intravitreal implant; diabetic macular edema). The imaging agents Lumason™ (echocardiography) and Lymphoseek® (solid tumors) also received approval. Diabetes/Weight-Management: Trulicity™ (dulaglutide) is a once-weekly injectable GLP-1 agonist approved for type II diabetes mellitus. It was studied as monotherapy or combination therapy, but comes with a REMS strategy and carries a contraindication for patients with certain cancers. New diabetes product formulations include: Bydureon® (exenatide preassembled pen), Xigduo™ XR (dapagliflozin/ metformin combination), and Iluvien® (fluocinolone 3-year intravitreal implant for diabetic macular edema). For chronic weight management the new combination Contrave® (naltrexone/bupropion) extended-release was approved for adults with BMI >30 kg/m2 and at least one weightrelated comorbidity in conjunction with diet and exercise. Contrave® is contraindicated in patients with seizure disorders or uncontrolled hypertension.

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Opioid-Related: Hysingla™ ER is a new high-dose hydrocodone product (20-120 mg/tablet) with an abusedeterrent formulation, but unlike Zohydro™ ER, is taken every 24-hours. For complications of opioid therapy, Relistor® (methylnaltrexone) is newly indicated for opioid-induced constipation, and Movantik™ (naloxegol) was approved as the first once-daily peripherally-acting mu-opioid receptor antagonist to treat opioid-induced constipation. Movantik™ is classified as a Schedule II controlled-substance because of its similarity to noroxymorphone, but a petition has been submitted to the Drug Enforcement Agency (DEA) to deschedule the drug. Driven by demand and lack of competition, nasal naloxone doubled in price from $20 to $56 making it more costly for nonprofit organizations to distribute. Pulmonary: Esbriet® (pirfenidone) and Ofev® (nintedanib) were approved for the treatment of idiopathic pulmonary fibrosis. The FDA granted both drugs a fast track, priority review with orphan product and breakthrough designations. Esbriet® carries warnings for patients with severe liver disease, end-stage kidney disease or those requiring dialysis, concomitant CYP1A2 inhibitors, and may cause patients to sunburn more easily. Ofev® is not recommended in patients with moderate-to-severe liver disease and carries the potential for embryofetal toxicity (e.g. birth defects, stillbirth). New pulmonary product formulations include an inhalation spray version of tiotropium (Spiriva® Respimat®) for COPD that delivers a metered-dose in a slow-moving mist in a way that does not depend on the how fast air is breathed in from the inhaler. Infectious Diseases: Approval was granted to the third drug in a year to treat Hepatitis C. Harvoni® (ledipasvir/sofosbuvir) is the first drug combination approved and does not require administration with interferon or ribavirin. In clinical trials the hepatitis C virus was eradicated in >90% of participants within

NEW DRUGS

12-weeks, and fatigue and B-cell precursor acute headache were the most lymphoblastic leukemia. More new entities were approved by common adverse effects. Blincyto™ carries a boxed August 2014 than in all of 2013. Several Tybost® (cobicistat; integrase warning for cytokinedrugs received new indications. inhibitor) and Vitekta™ release syndrome and (elvitegravir; protease neurological toxicities and inhibitor) were approved as requires a Medication Guide. single-entities for HIV-1 infection. Both must be used as Akynzeo® (netupitant/palonosetron) was approved to part of a cocktail and are not expected to have a major prevent acute and delayed chemotherapy-induced effect on clinical practice. Tybost® is a boosting agent nausea/vomiting. Akynzeo® must be used cautiously used to increase blood levels of the protease inhibitors with CYP3A4 substrates and avoided in severe hepatic Reyataz® or Prezista®. Trumenba® was approved as and renal impairment. § the first vaccine against invasive meningococcal disease Contributing Author: Timothy K. Cheum, Pharm.D. Candidate, Harding caused by Neisseria meningitides serogroup B, with 82% University College of Pharmacy of trial participants seroconverting after a 3-dose series. Oncology: Blincyto™ (blinatumomab) was granted a priority review with orphan product and breakthrough designation to treat Philadelphia chromosome-negative

Rodney Richmond, RPh, MS, CGP, FASCP, is Associate Professor, Pharmacy, at Harding University College of Pharmacy in Searcy.

AR•Rx

THE ARKANSAS PHARMACIST

CLINICAL PROGRAMS COLLEGES OF PHARMACY

Prevention of Pneumococcal Disease in Adults: New Recommendations By Eric Crumbaugh, Pharm.D.

rkansas pharmacists have been fielding lots of questions pertaining to the “new” pneumococcal vaccine. This article will help to answer these questions and recommend the appropriate vaccine or vaccines for patients to prevent pneumococcal disease. The “new” vaccine people are referring to is the pneumococcal conjugate vaccine (PCV13) or Prevnar©. PCV13 and a different version of this vaccine called PCV7 have actually been used in the pediatric population since 2000. Starting in 2012, this vaccine was recommended for use in adults with immunocompromising conditions, asplenia, cerebrospinal fluid leaks, and cochlear implants. Technically, the vaccine is not new, it is just recommended for more people.

The third group of patients is those under 65 years of age that are at the highest risk for pneumococcal infections. This includes patients who have chronic renal failure, nephrotic syndrome, chronic liver disease (including cirrhosis), alcoholism, cochlear implants, cerebrospinal fluid leaks, asplenia, and immunocompromising conditions including patients taking immune system suppressing medications. These patients will first receive a dose of PCV13, then 6 to 12 months later a dose of PPSV23, followed by a booster dose of PPSV23 five years later. PCV 13 and PSV23 should NEVER be administered at the same time. All patients who have an indication for the PCV13 and the PPSV23 vaccine should first receive the PCV13 followed by PPSV23. Spacing of doses for patients

When discussing pneumococcal vaccine recommendations with adults, pharmacists must consider three groups of patients who will receive pneumococcal vaccinations. The first group is ALL patients over age 65; second is patients under age 65 with a high risk of pneumococcal infection; and third is patients under age 65 at the highest risk of pneumococcal infection. In September 2014, the Advisory Committee on Immunization Practices (ACIP) recommended all patients over 65 years of age should receive a dose of PCV13 in addition to the pneumococcal polysaccharide vaccine (PPSV23) or Pneumovax©. They recommend the patient first receive the PCV13, and then 6 to 12 months later receive the PPSV23. The minimum interval between doses is 8 weeks but 6 to 12 months is preferred. All patients over age 65 will now receive two different doses of the pneumonia vaccine that are separate, distinct formulations. This recommendation will be reevaluated in 2018 and revised as needed. The next group is patients under age 65 that are at high risk for pneumococcal infections. This includes patients who have chronic lung disease (including COPD, emphysema, and asthma), chronic cardiovascular disease, and diabetes. All of these patients will receive two doses of the PPSV23 in their lifetime, one before age 65 and one after 65. The minimum interval between these two doses should be 5 years. In addition, these aforementioned patients will also receive a single dose of the PCV13 after they turn 65. WWW.ARRX.ORG

CLINICAL PROGRAMS

who have not previously received, or who have received the PPSV23 vaccine are summarized in the graphic below. This new recommendation for routine use of PCV13 in adults over age 65 created several reimbursement issues which as of February 2, 2015 have been resolved. Previously, Medicare Part B would only cover annual flu vaccinations and one pneumococcal immunization after age 65 at no cost to the patient. CMS has updated the Medicare coverage requirements to align with the updated ACIP recommendations. This change will allow for one PCV13 AND one PPSV23 vaccination to be paid at a zero dollar copay for all Medicare beneficiaries 65 years of age and older retroactively effective to September 19, 2014. An initial pneumococcal conjugate vaccine (PCV13) should be administered first to all Medicare beneficiaries who have never received a pneumococcal vaccine and who are over age 65. A different, pneumococcal polysaccharide vaccine (PPSV23) should be administered 12 months after the conjugate vaccine was given. The “interval” between the two different pneumococcal vaccines to be eligible for Medicare Part B reimbursement must be 11 or more months, not 8 weeks or 6 months as in the ACIP recommendations. We do not know what the considerations were for the CMS timing decision, but it is possible that this was the most direct/expeditious way to execute the payment for the

second dose. More information regarding the updates in reimbursement can be found at http://www.cms.gov/ Regulations-and-Guidance/Guidance/Transmittals/2014Transmittals-Items/R3159CP.html. Both these vaccines protect patients from the bacteria Streptococcus pneumonia which remains the leading cause of infectious cases of serious illness, including bacteremia, meningitis, and pneumonia among older adults in the United States. Serotypes of this bacteria covered in both of these vaccines have also been found to be resistant to antibiotics such as penicillin, macrolides, cephalosporins, and others. Only about 20 percent of the high and highest-risk population between 18 and 64 years of age and only 60 percent of people over 65 years of age are vaccinated against pneumococcal pneumonia. All healthcare providers including pharmacists should strongly recommend and administer the pneumococcal vaccine(s) if appropriate and document all patients’ vaccinations. APA members who need help setting up or expanding immunization services can use the online immunization toolkit found at www.arrx.org/immunizations or by contacting the APA office at 501-362-5250. § Graphic source: http://www.cdc.gov/mmwr/preview/mmwrhtml/ mm6337a4.htm

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

Arkansas State Board of Pharmacy President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lenora Newsome, P.D., Smackover Secretary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Stephanie O’Neal, P.D., Wynne Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Steve Bryant, P.D., Batesville Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Tom Warmack, P.D., Sheridan Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Kevin Robertson, Pharm.D., BCPS, Little Rock Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Percy Malone, P.D., Arkadelphia Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Joyce Palla, Arkadelphia Public Member. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sheila Castin, Little Rock

AR•Rx

THE ARKANSAS PHARMACIST

2015 Calendar of Events CALENDAR OF EVENTS

FEBRUARY

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

MARCH

March 8* APA Board Meeting Hosto Center Little Rock, AR March 27-30 American Pharmacists Association Annual Meeting & Exposition San Diego, CA

APRIL

April 9* Arkansas Pharmacy Foundation Golf Tournament Location TBD

MAY

May 12-13 National Community Pharmacists Association Legislative Conference Washington, D.C.

OCTOBER

October 10-14 National Community Pharmacists Association Annual Convention Gaylord National Harbor Washington, DC October 20* APA Golden CPE Hosto Center Little Rock AR October 30-November 1 American Society of Consultant Pharmacists Annual Meeting and Exhibition Las Vegas, NV

DECEMBER

December 6-10 American Society of HealthSystem Pharmacists Midyear Clinical Meeting and Exhibition New Orleans, LA December 5-6 APA Committee Forum and Board Meeting Holiday Inn Airport Little Rock, AR * Dates have not been finalized.

JUNE

June 6-10 American Society of HealthSystem Pharmacists Summer Meeting Denver, CO June 11-13 APA 133rd Annual Convention Embassy Suites Little Rock, AR

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UAMS REPORT

Patient and Family Centered Care a Partnership

s I was contemplating the topic for this column, I thought about the activities scheduled for the day. My lunch hour was blocked for a presentation from faculty and staff from across the UAMS campus who had participated in the UAMS Leadership Institute over the past year. This group focused on the UAMS initiative to ensure that Patient and Family Centered Care is provided throughout the hospital and clinics in the State. Stephanie Gardner Pharm.D., Ed.D. Dean

Patient and Family Centered Care (PFCC) sounds like something that would be so obvious that it wouldn’t need to be a topic of concern for healthcare institutions across the country. But, it isn’t as obvious as the name might imply. Focusing on the patient has been something that we have taught pharmacy students for as long as I can remember. But today, we are spending more time emphasizing that the patient and those individuals that they identify as “family” should be considered as integral members of the healthcare team. There should be a partnership between the patient, his or her family, and the practitioners to ensure that decisions respect patient’s wants, needs, and preferences regarding their own care. Patients should feel

UAMS’ Jonell Hudson, Pharm.D., BCPS, and Marshallese child.

UAMS pharmacy student with Marshallese family. 26

empowered to express their opinions and they should be expected to participate in their own care, rather than merely be the recipient of procedures, tests, and medications that someone else orders. The core concepts of patient and family centered care are respect and dignity, information sharing, participation, and collaboration. Pharmacists and other health care providers should listen to and honor the patient’s perspectives and choices and should be willing to incorporate the patient’s values and beliefs into the planning and delivery of their care. The health care team should provide complete and unbiased information in a timely manner that allows patients to effectively participate in decision-making. And this concept must be applied more broadly; patients and family members should serve on committees that help improve the patient experience and ultimately improve health outcomes at the institutional level. Patients and families should also be allowed to collaborate with the health care leaders when new policies, programs, facilities, or professional education opportunities are planned. Community pharmacies have provided patient and family centered care for many generations. The corner drugstore has been seen as an accessible place where patients and their families can talk to someone they trust about concerns regarding their health. In the current environment pharmacists are challenged to deliver on this concept fully secondary to limited time for patient education, incomplete information regarding the patient’s medical history, and a lack of information regarding the individuals that a patient would identify as their family. Some of these barriers are expected to lessen over the next few years. Pharmacists will likely have more access to individual patients’ health records as electronic health information becomes more cohesively connected. By having this data in an electronic form it should be easier to link patient and family information. Certainly efficient access and the ability to contribute to patients’ health records is important but the game changer is a reimbursement model focused on patient outcomes that will result in pharmacists spending their time with patients and families to maximize patient outcomes. As these changes occur, our educational programs will focus on preparing future pharmacists to not only possess the therapeutic knowledge to impact patient outcomes but to also emphasize the skills and attitudes that facilitate the inclusion of patients and families within the healthcare team. We are asking patients to share their stories in the classroom and we are including them on college and hospital committees. Thanks to all the preceptors who are helping advance this model of care and who are encouraging students to demonstrate the core concepts of patient and family centered care. § AR•Rx

THE ARKANSAS PHARMACIST

HARDING UNIVERSITY REPORT

Harding Implements Successful CollegeCommunity Collaboration Efforts

he fall semester was a busy one at Harding University College of Pharmacy (HUCOP). In addition to the routine of classes and exams, our students and faculty have completed several other exciting projects. Between the White County Fair and Get Down Downtown (a Searcy city festival), over 800 members of the community received free blood pressure, glucose, and cholesterol screenings as well as information on tobacco cessation. The participants were counseled about the importance of getting vaccinated against the flu and were provided a schedule of the flu clinics to be held in White County by the Health Department. P1 students also presented posters from their Patient Centered Care class and talked with people about various health topics. Late in September, pharmaceutical sciences faculty member Dr. Kaci Bohn organized the third drug take back event in cooperation with local law enforcement. The event was affiliated with the Texas Tech Medication Cleanout program (www.medicationcleanout.com) which not only endeavors to assist the public in returning unused medications to prevent poisonings, abuse, and misuse but also involves a research component through which more information regarding types of medications returned and regional patterns can be obtained. The event involved a drive-through drop off where participants did not even have to leave their cars to turn in their old medications. Forty-five participants completed the event survey and returned over 200 pounds of medications including 5.2 pounds of controlled substances. It was another very successful college-community collaboration effort! In October, HUCOP’s chapter of SSHP won an Outstanding Professional Development Project Award from the American Society of HealthSystem Pharmacists (ASHP) for their collaboration with the ASU-Beebe pharmacy technician training program. The project involved providing pharmacy technician certification exam review sessions for pharmacy technicians across the state. These sessions were held in hospitals as well as during the APA annual convention and AAHP fall seminar. So far, all the technicians who participated in the review sessions and who have sat for the examination have passed. We’re very proud of this activity that is assisting in ensuring a strong pharmacy technician workforce

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Julie Hixson-Wallace in Arkansas. The students Pharm.D., BCPS presented their project in Dean December in Anaheim during the Student Society Showcase at the ASHP Midyear Clinical Meeting and received their award.

In November, attention turned to immunizations. Pharmacy practice faculty member Dr. Jeanie Smith organized flu shot clinics for the faculty, staff, and students in the physician assistant and pharmacy programs at Harding that allowed them to receive the 2014 flu vaccine at no out-of-pocket cost. In addition to the continued service of providing travel vaccines to groups planning out-ofcountry trips, Dr. Smith also established immunization clinics to assist students with maintaining their required vaccines as well as to meet the needs of faculty, staff, and the community. HUCOP obtains and administers vaccines in a convenient setting and at a very low cost. In December, pharmacy practice faculty and students completed an HPV public service announcement funded by an American Association of Colleges of Pharmacy Student Community Engaged Service Award of $15,000. The PSA will soon be appearing on media outlets throughout the state to encourage an increase in HPV vaccination rates with the goal of reducing the cervical cancer rate in Arkansas. We are pleased to be part of this important community outreach involving a serious public health problem for our state. From the HUCOP family to all of you, best wishes for a wonderful new year! §

(L to R) HUCOP SSHP P4 students Elizabeth Scott, Brandon Green, and Yoon Lee at the ASHP Mid-Year Clinical Meeting with poster "Student-Led Pharmacy Technician Certification Initiative" that received the Outstanding Professional Development Project Award from ASHP. 27

ARKANSAS ACADEMY OF HEALTH-SYSTEM PHARMACISTS

AAHP offers N.O.W. (Networking Opportunities that Work) Marsha Crader, Pharm.D. President

ave you ever wondered how to stay connected with peers around the state or who has an answer for the specific question that you are dealing with at work? The Arkansas Association of Health-System Pharmacists (AAHP) offers you networking opportunities designed with your professional needs in mind. There are multiple avenues for networking within AAHP. Currently, AAHP board or committee service, Arkansas Health-System Pharmacists Adverse Drug Event

After the recent visit by ASHP’s Chief Executive Officer, Paul Abramowitz, Pharm.D., Sc.D. (Hon), FASHP, he provided very kind words regarding our organization. “…your members are very active and motivated.” “…I am very impressed with AAHP’s leadership.” “You all are doing many great things in pharmacy in Arkansas. Keep up the exceptional work!” Reduction Collaborative (AHSPARC), and the annual Fall Seminar are some of the opportunities for you to network with fellow colleagues. Fall Seminar is a great time to network because of the opportunities to meet with the following: • Continuing education speakers and pharmacists interested in operational, clinical, or quality practice areas. • Pharmacy directors and clinical coordinators. • Residents, residency preceptors, and residency directors. AAHP is excited that we will have even more opportunities for networking in 2015. The organization has purchased software that enables us to provide networking opportunities as well as live continuing education. Membership will also be surveyed to ask if they would like their contact information to be available for member only interest groups (e.g., information technology, antimicrobial stewardship, etc.) Finally, AAHP will be collaborating with the Arkansas Hospital Association again regarding a statewide antimicrobial stewardship initiative. Please look for more communication regarding these new opportunities in the upcoming months at http://www.arrx.org/aahp. 28

AAHP is not only keeping you connected at the state level but at the national level as well. Your AAHP executive director and presidential officers participate in ongoing opportunities at the national level with the American Society of Health-System Pharmacists (ASHP). AAHP leadership has the opportunity to learn and share best practices with all the ASHP state affiliates. AAHP continues to be a leader in our efforts as a state organization. After the recent visit by ASHP’s Chief Executive Officer, Paul Abramowitz, Pharm.D., Sc.D. (Hon), FASHP, he provided very kind words regarding our organization. “…your members are very active and motivated.” “…I am very impressed with AAHP’s leadership.” “You all are doing many great things in pharmacy in Arkansas. Keep up the exceptional work!” We are very proud of the AAHP relationships that have been established and continue to be built with ASHP leadership and staff. Through these efforts, we have been able to bring you national networking opportunities at the Fall Seminar annually since 2008. I would like to recognize some of the outstanding pharmacy team members that provide exceptional patient care in Arkansas. These pharmacists and technician were recognized during our 2014 Fall Seminar Awards Banquet. • Louise Pope Award (outstanding lifetime service): Dennis Moore, Pharm.D. • Manager of the Year: Kevin Robertson, Pharm.D., BCPS • Clinician of the Year: Jennifer Perry, Pharm.D. • Staff Pharmacist of the Year: Larry Yancey, Pharm.D. • New Practitioner of the Year: Andrew Hodge, Pharm.D. • Residency Preceptor of the Year: Niki Carver, Pharm.D., CPPS • Technician of the Year: Holly Katayama, CPhT Thank you to the current and previous award recipients that have made a difference in patient care at the bedside, pharmacy department, or professional organization level. Through AAHP members’ hard work and dedication to working together as a profession, we continue to make a difference in Arkansas. If you have not taken the chance to engage in AAHP’s N.O.W., please take the time to do so. We want you to be a part of the exceptional work that AAHP continues to provide. §

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AAHP 2014 Award Winners

Clinician of the Year: Jennifer Perry, Pharm.D., with AAHP President Marsha Crader, Pharm.D.

Louise Pope Award for Outstanding Lifetime Service: Dennis Moore, Pharm.D., with AAHP Executive Director Susan Newton, Pharm.D.

Residency Preceptor of the Year: Niki Carver, Pharm.D., CPPS, with AAHP President Marsha Crader, Pharm.D.

New Practitioner of the Year: Andrew Hodge, Pharm.D., with AAHP President Marsha Crader, Pharm.D.

Staff Pharmacist of the Year: Larry Yancey, Pharm.D., with AAHP President Marsha Crader, Pharm.D.

Manager of the Year: Kevin Robertson, Pharm.D., BCPS, with AAHP President Marsha Crader, Pharm.D.

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Technician of the Year: Holly Katayama, CPhT, with AAHP President Marsha Crader, Pharm.D.

APA COMPOUNDING ACADEMY

Lee Shinabery, Pharm.D. President

Let’s See what 2015 Brings for Compounding

appy New Year everyone! I hope everyone had a great 2014 and that your 2015 is all you want it to be.

Last year left compounding pharmacy with some big changes. Some of the changes are good and some may take some time to see which side of the road they land on, good or bad. In my opinion, one of the good things is the Food and Drug Administration (FDA) learning from Congress that compounding prescriptions for individual patients will be

There are still many areas of the regulation the FDA will need to clear up and no one knows when, if ever, that will happen. The big question with this regulation is will these facilities be able to handle the compounded injectable medication needs of the physicians.

of us in Arkansas have not been able to see this. These high reimbursements across the nation have caused several insurance companies to stop paying for compounds. We as a group need to work on educating employers and the insurance companies to the therapeutic advantages and the cost savings with reasonable reimbursement offered by compounded prescriptions. Many doctors will not consider writing compounded prescriptions due to no insurance coverage (because of the increase in office staff work due to the need of a different medication). With insurance company recognition and reimbursement more doctors may be inclined to write compounded prescriptions. I believe compounding is stronger now in the medical world than it has ever been. We must continue to educate ourselves, our patients and, especially, our physicians on the overwhelming benefits we provide to the medical community. §

governed by the individual state boards of pharmacy. For us in Arkansas this is a good thing. We have a very proactive pharmacy board. They have always worked well with our APA office and our pharmacists, and I see no reason why that would change in the future. This relationship has and will let us stay among the states leading the way in doing what is right for pharmacy, compounding and our patients. One of the “wait and sees” is the creation of the 503B compounding pharmacy or better known as an Outsourcing Facility. These facilities will be allowed to ship office stock sterile injectables across state lines. The facilities making the decision to register with the FDA to supply medical offices with these compounded medications will be required to meet the rigorous Good Manufacturing Practice (GMP) standards. There are still many areas of the regulation the FDA will need to clear up and no one knows when, if ever, that will happen. The big question with this regulation is will these facilities be able to handle the compounded injectable medication needs of the physicians. One area compounding pharmacy must continue to fight for is recognition by the insurance industry. The bulk of insurances in Arkansas do not reimburse for compounded medications at all. Many compounders throughout the country over the last few years enjoyed some very good reimbursements for their compounded medication but most 30

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APA CONSULTANTS ACADEMY REPORT

Cimetidine for DementiaRelated ISB

ome studies estimate that 15% of patients diagnosed with dementia will express inappropriate sexual behavior (ISB) as part of the disease manifestation, which can be traumatic for loved ones and troubling for staff in the skilled nursing facility. After nonpharmacological interventions have been attempted and failed, the best approach medication-wise may not always be clear. I have recently seen an increase in the usage of cimetidine as an intervention for dementia-related ISB in several of my practice sites. Not knowing what might be

One such case study had success in decreasing the incidence of sexually inappropriate behavior in 14 of 20 patients who were treated with cimetidine alone with few adverse reactions1.

considered an adequate dose for this type of off-label indication, I decided to do some research. I found mostly level III evidence from case studies that described small successes with cimetidine. Currently, no randomized, controlled clinical trials have been published to evaluate the effectiveness of this medication (or any others) for dementia-related ISB. In the literature I read cimetidine doses ranged from 400mg/day to 1600mg/ day with a response time of 1 to 8 weeks. One such case study had success in decreasing the incidence of sexually inappropriate behavior in 14 of 20 patients who were treated with cimetidine alone with few adverse reactions1. In the other 6 patients, they had success with the addition of either ketoconazole or spironolactone to the medication regimen. I most commonly see doses of cimetidine 200mg TID initially with titration to an effective dose. In spite of some successful case studies, there are several limiting factors of this therapy to consider. Cimetidine is an H-2 receptor blocker that also competitively inhibits binding of DHT to androgen receptors. This weak anti-androgen effect may explain why it is effective in treating ISB in some cases, but with it comes a risk of gynecomastia development in men. This adverse reaction is highly dose dependent and is most prevalent at doses of >1000 mg/day for 7-12

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Rachel Hardke, Pharm.D. President

months2 though it can occur as soon as one month after treatment initiation. Another factor to consider is the inclusion of H-2 receptor blockers in the Beers Criteria as a potentially inappropriate medications for patients with dementia or delirium, the very population we are treating for ISB. H-2 receptor blockers, particularly cimetidine, have been shown in some cases to worsen delirium in this population. Lastly, cimetidine is a weak inhibitor of many of the CYP450 isozymes (1A2, 2C19, 2D6, and 3A4) resulting in a variety of potential drug interactions. Knowing these patients as we do (and the average number of medications they may be taking), the odds of a significant drug interaction are high. Cimetidine is contraindicated with dofetilide and thioridazine, and can decrease clearance of hepatically metabolized drugs with narrow therapeutic windows, such as theophylline, carbamazepine, and phenytoin. Monitor INR closely at therapy initiation as cimetidine may cause INR to increase in some patients. Use is cautioned in patients with hepatic or renal dysfunction. Decrease the dose by 50 percent in patients with a CrCl < 30 mL/min. If cimetidine is initiated, careful consideration of the whole patient is clearly necessary. There are many different pharmacologic therapies that have been attempted for ISB in dementia including antipsychotics, antidepressants, anticonvulsants, antiandrogens, estrogens, and others. Lacking established clinical guidelines for treatment when pharmacologic intervention becomes necessary, many of our current therapies are a result of trial and error. Cimetidine may be another option to help alleviate one manifestation of this very complicated disease and avoid adding an antipsychotic that carries with it a serious black box warning for this patient population. As always, we must use our best clinical judgment to evaluate if our patients are receiving the greatest benefit from their medication therapy while minimizing risk. § _________________________________________________ Wiseman S V, McAuley J W, Freindenberg G R, et al. Hypersexuality in patients with dementia: possible response to cimetidine. Neurology2000;54:2024. 2 García Rodríguez LA, Jick H. Risk of gynaecomastia associated with cimetidine, omeprazole, and other antiulcer drugs. BMJ : British Medical Journal 1994;308(6927):503-506. 1

2014-2015 APA Board of Directors

President Brandon Cooper, Pharm.D.

President-Elect John Vinson, Pharm.D.

Vice President Eddie Glover, P.D.

Past-President Dana Woods, P.D.

Area I Representative Michael Butler, Pharm.D.

Area II Representative Brent Panneck, Pharm.D.

Area III Representative Clint Boone, Pharm.D.

Area IV Representative Lynn Crouse, Pharm.D.

District 1 President Denise Clayton, RPh

District 2 President Kristy Reed, Pharm.D.

District 3 President Chris Allbritton, Pharm.D.

District 4 President Lise Liles, Pharm.D.

District 5 President H. Dean Watts, P.D.

District 6 President Stephen Carroll, Pharm.D.

District 7 President C.A. Kuykendall, P.D.

District 8 President Darla York, P.D.

Hospital Academy President Marsha Crader, Pharm.D.

Compounding Academy President Lee Shinabery, Pharm.D.

Consulting Academy President Rachel Hardke, Pharm.D.

Board of Health Member Gary Bass, Pharm.D.

UAMS College of Pharmacy Stephanie Gardner, Pharm.D., Ed.D.

Harding College of Pharmacy Julie Hixson-Wallace, Pharm.D., BCPS

UAMS Student Member Brett Bailey

Harding Student Member Meredith Mitchell

State Board of Pharmacy John Clay Kirtley, Pharm.D.

Legal Counsel Harold Simpson, J.D.

Treasurer Richard Hanry, P.D.

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

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2015 APA Awards Solicitation AWARD NOMINATIONS Each year APA encourages members to submit the names of individuals who are deserving of special recognition for their professional activities during the past year. Any active APA member is eligible to nominate a person for the awards. Award recipients are chosen by an APA committee following a review of all nominees. Nominations are now being accepted for the following annual awards to be presented by the Association. Nominations will close at 4:30 p.m., April 3, 2015. 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 â&#x20AC;&#x153;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.â&#x20AC;? Previous recipients include: 2014 Michelle Crouse, Lake Village 2013 Carl Collier, Fayetteville 2012 Charles Born, Little Rock 2011 Don Johnson, Little Rock

Bowl of Hygeia Community Service Award _______

In 1958 E. Claiborne Robbins of the A.H. Robbins Company established the Bowl of Hygeia Award. The purpose of the award is to encourage pharmacists to take active roles in the affairs of their respective communities. Previous recipients include: 2014 Eric Shoffner, Newport 2013 Vicki and Karrol Fowlkes, Little Rock 2012 Sparky Hedden, Sheridan 2011 Tom Warmack, Sheridan

Cardinal Health Generation Rx Award _______

This award honors a pharmacist who has demonstrated outstanding commitment to raising awareness of the dangers of prescription drug abuse among the general public and among the pharmacy community. The award is also intended to encourage educational prevention efforts aimed at patients, youth, and other members of the community. Previous recipients include: 2014 Denise Robertson, Little Rock 2013 Lelan Stice, White Hall 2012 Dennis Moore, Batesville

Distinguished Young Pharmacist of the Year _______

The nominee must have an entry degree in Pharmacy, received nine or fewer years ago, and be a member of the APA. Nominee must be in the active practice of pharmacy in the year selected, and actively involved in the profession of pharmacy, displaying an interest in the future of the profession. Previous recipients include: 2014 Stephen Carroll, Arkadelphia 2013 Zach Holderfield, Fayetteville 2012 Clint Recktenwald, Gassville 2011 Cheryl Bryant, Little Rock

Excellence in Innovation Pharmacy Practice Award _______

This award was established in 1993 by the APA in cooperation with the National Council of State Pharmacy Associations and DuPont Pharmaceuticals to recognize, annually, a pharmacist who has demonstrated a prominent spirit of innovation and entrepreneurship in the practice of pharmacy. Previous recipients include: 2014 Marcus Costner, Fayetteville 2013 Lanita White, Little Rock 2012 Melissa Brown, Fayetteville 2011 Eric Crumbaugh, Benton

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2015 APA Awards Solicitation Guy Newcomb Award _______

The APA Board of Directors created this award in 1997 to recognize individuals who, by their legislative influence and leadership, have distinguished themselves as political friends of Arkansas pharmacy. This award is named in memory of Dr. Guy Newcomb of Osceola. Dr. Newcomb was a pharmacy leader who understood, appreciated, and enthusiastically participated in the political process. Previous recipients include: 2011 Johnny Key, State Senator, Mountain Home 2009 Allen Maxwell, State Representative, Monticello 1999 Larry Teague, State Representative, Nashville 1998 Tim Hutchinson, U.S. Senator, Bentonville

Percy Malone Public Service Award _______

This award was established in 2009 by the Arkansas Pharmacists Association in honor of former state senator Percy Malone, P.D. The recipient must have made a contribution to public service by being elected to any public office and by displaying an interest in the people of Arkansas. Previous recipients include: 2011 Gene Boeckmann, Wynne 2009 Percy Malone, Arkadelphia Name of Nominee________________________________________________________________________________________ Address_________________________________________________________________________________________________ City/State/Zip ____________________________________________________________________________________________ Phone___________________________________________________________________________________________________ Reasons for selecting nominee: Attach one page with description of reasons and/or the individual nominee’s resume. Nominator’s Name: __________________________________Phone____________________________Date________________ Fax or email written nomination form and material to: Awards Committee, Arkansas Pharmacists Association; eileen@arrx.org; Fax 501-372-0546. Please submit by 4:30 p.m., April 3, 2015.

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Save the Date! LITTLE ROCK ROCKS FOR 2015 ANNUAL CONVENTION

An aerial view of the Little Rock Skyline at dusk.

Photo Credit: Little Rock Convention and Visitors Bureau

Join us in Little Rock for the 2015 APA Annual Convention, to be held June 11-13 at the Embassy Suites Hotel on Financial Parkway. Once again, APA will offer 15 hours of continuing pharmacy education (CPE). The 2015 CPE will be divided into theme blocks relating to pharmacy practices based on members’ suggested topics. Members and guests will be able to learn about the latest product trends in pharmacy from more than 40 exhibitors. Exhibitors will showcase their new products to potential customers while working to maintain and strengthen relationships with existing customers. APA is planning several special social events as well as the traditional golf tournament on Wednesday afternoon, June 10. Convention registration will open shortly. Stay tuned for more information through InteRxActions and www.arrx. org/annual-convention.

Member Moment APA members Stephen and Lauren Carroll welcomed twin boys on July 1, 2014. William and Jacob Carroll were born at 12:04 p.m. and weighed 6 lbs 5 ounces and 6 lbs 15 ounces, respectively. The Carrolls live in Arkadelphia. Stephen is the Chief Operating Officer and Lauren is a staff pharmacist at AllCare Pharmacy. Do we have two future pharmacists on hand?

Send us your news!

We want to celebrate our members and their moments! Send us your news of weddings, babies, awards, volunteering, accomplishments, graduation, etc… anything that you are proud of. Email a little description of your moment and a picture in the moment! Submit your moments to Susannah@ arrx.org so that you can be featured in the next AR•Rx The Arkansas Pharmacist.

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Call for Board Nominations 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 Board membership requires the flexibility to meet in Little Rock during the week and on two Sundays during the year.

Arkansas State Board of Pharmacy Elections

APA Bylaws: Article IV- Nominee and Delegates Section 1: BOARD OF PHARMACY NOMINEES. Only Arkansas registered pharmacists primarily engaged in an active practice of profession in Arkansas for the past five (5) years and who for the past five (5) years shall have been an active member in good standing in the Arkansas Pharmacists Association shall be eligible as a candidate for Association nomination to the Arkansas State Board of Pharmacy for a six (6)-year term. Candidates for the State Board election shall be nominated from the statewide APA membership and elections for each position shall be on a statewide basis. APA will submit the names of the three nominees receiving the most votes to the Governor for his consideration. Governor Beebe will evaluate the nominees recommended by APA and make the appointment to the Arkansas State Board of Pharmacy. If interested in nominating yourself or another individual, please contact APA Executive Vice President and CEO Mark Riley (mark@arrx.org) at 501-372-5250. Nominations will close at 4:30 p.m., March 13, 2015. _____________________________________________________________________________________________________

APA Board of Directors Call for Nominations

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

Vice President of APA

Statewide (One-year term as Vice 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.

Area IV Representative • • •

Attends all board meetings and conducts the affairs of the association. Maintains knowledge of the organization and personal commitment to its goals and objectives. Recruits new members; participates in APA membership drives.

Area IV – Southwest and Southeast Districts (Four-year term) Southwest District - Calhoun, Columbia, Dallas, Hempstead, Howard, Lafayette, Little River, Miller, Nevada, Ouachita, Sevier and Union Counties. Southeast District- Arkansas, Ashley, Bradley, Chicot, Cleveland, Desha, Drew, Grant, Jefferson and Lincoln Counties.

District President • • • • • •

Holds meetings and make recommendations to the Board as deemed necessary by the District. Attends all board meetings and conducts the affairs of the association. Maintains knowledge of the organization and personal commitment to its goals and objectives. Serves as master-of-ceremonies for the APA District Meetings. Serves as board liaison to an APA committee as designated by the president. Recruits new members; participates in APA membership drives.

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CALL FOR BOARD NOMINATIONS IN 2015-2016

District 1 President

Central District (Two-year term) Central Counties: Faulkner, Lonoke, Prairie, Saline, Pulaski and Monroe.

District 2 President

Eastern District (Two-year term) Eastern Counties: Clay, Craighead, Crittenden, Cross, Green, Lawrence, Lee, Mississippi, Phillips, Poinsett, Randolph and St. Francis.

District 4 President

Southwest District (Two-year term) Southwest Counties: Crawford, Franklin, Logan, Polk, Scott and Sebastian.

District 5 President

Southeast District (Two-year term) Southeast Counties: Arkansas, Ashley, Bradley, Chicot, Cleveland, Desha, Drew, Grant, Jefferson and Lincoln.

APA OFFICERS AND BOARD OF DIRECTORS Requirements- 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. No elected member of the APA Board of Directors shall serve for more than eight (8) consecutive years or more than two (2) consecutive terms in the same capacity. Reimbursement- Members of the Board of Directors donâ&#x20AC;&#x2122;t receive compensation but can be reimbursed for reasonable direct and indirect expenses relating 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 District Meetings (president, district presidents) 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 2015-2016 are likely to be: Aug. 6-7, 2015 (Thursday 9 a.m. to 8 p.m. and Friday 8 a.m. to 12 p.m.) in Little Rock Dec. 5-6, 2015 (Saturday 6 to 8 p.m. and Sunday 9 a.m. to 2 p.m.) in Little Rock March 6, 2016 (Sunday 9 a.m. to 2 p.m.) in Little Rock June 22, 2016 (Wednesday a.m.) in Hot Springs

If interested in nominating yourself or another individual, please contact APA Executive Vice President Mark Riley (mark@arrx.org) at 501-372-5250. Nominations will close at 4:30 p.m., March 27, 2015.

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Member Classifieds Pharmacy Manager opening with Albertsons in Texarkana, AR. Must have a college degree in Pharmacy & have valid AR Pharmacist license. Must be Immunization/CPR Certified or willing to become certified. Email tahara.coleman@ albertsons.com. (1/20/15) Pharmacy for sale in small town in south Ark. New building is 5 years old with gift shop, soda fountain, and Rx dept, 4000 sq ft. Upstairs storage and grandkid room, one block from school, one US 167. Open 4 days a week, volume about 130 to 140 average. (870) 924-4018. (1/19/15) Seeking friendly, energetic, pharmacist for employment in Paris, Ozark, or Booneville. Candidate must possess excellent people skills. If interested, please call Robert Woolsey (479) 6677338. (1/14/15) Pharmacist needed at Cantrell Drug Company in Little Rock. We are growing again! Cantrell Drug Company needs to fill 1 pharmacist position during the evening shift (3:30 pm - 12 am). The position is non-retail and is full-time with a great benefit package. Work responsibilities will be devoted to compounding of intrathecal syringes, supervision of dayto-day compounding activities, and batch record verification checks. The successful candidate will want to work in a lab-type environment while demonstrating strict attention to detail, documentation, and a focus on quality. Preference will be given to candidates with experience and past leadership responsibility. Please send your resume to chutts@cantrelldrug.com (1/13/15). Pharmacist available in Texarkana. Pharmacist in Texarkana licensed in Arkansas, Texas and Louisiana. I am immunization and diabetes certified. Can work in retail or hospital. Contact Joe Michalls, Pharm.D., (903) 824-5093, michallsj@me.com. (1/13/15) Residency-trained pharmacist can deliver diabetes education and/or management. Pharmacist in the Little Rock area looking for part-time work (832h/mo). If interested, please call (773) 443-6454 or email navant2@att.net. (1/13/15) Independent pharmacy in Van Buren is seeking friendly, personable, efficient pharmacist. Duties will include the normal

Member Classifieds are free to APA members and $65 per issue for non-members. Contact eileen@arrx.org for more information.

staff pharmacist duties as well as helping with MTM consulting, immunizations, etc. Store hours are Monday-Friday 9 a.m.-6 p.m. and Saturday 9 a.m.-1 p.m. Send resume to kbarlow@pharmacyexpressvb. com or fax to (479) 474-3131. (1/13/15) Part-time Pharmacist in Warren area. Looking for relief or fill-in pharmacist, possibly one day a week and vacations. If interested contact doloresfamilypharmacy@hotmail.com. (1/13/15) Part-time/Full-Time pharmacist wanted in Fort Smith. Independent pharmacy in Ft. Smith seeking Licensed Pharmacist for one to two nights a week and one weekend a month. Competitive salary, benefits. Send resume to 700 Lexington Ave. Fort Smith, AR 72901, email Anderson.1@live. com or call (479) 782-2881. (1/13/15) Regulatory & Quality Administrative Assistant at Cantrell Drug. Cantrell Drug Company needs to fill a position relating to regulatory coordination and quality assurance documentation. The shift is Mon.-Fri., 8 am - 5 pm. The position is non-retail and is full-time with a great benefit package. Work responsibilities will be devoted to facilitating licensure applications, state board communication, maintaining internal drug and product development databases, assistance in gathering information from peer reviewed databases, etc. The successful candidate will want to work in a professional office environment while demonstrating strict attention to detail, documentation, and a focus on quality. Preference will be given to candidates with experience, college degree, and information technology aptitude. Please send your resume to chutts@cantrelldrug.com (1/9/15). Experienced Relief Pharmacist Available. Experienced relief pharmacist (retail/hospital/IV) available in Central Arkansas. Willing to travel reasonable distances. Fred Savage (501) 350-1716; (501) 803-4940; fred.savage47@yahoo. com. (1/8/15) Pharmacy Director. Valid Arkansas Pharmacist license. Graduate of an ACPEaccredited school of pharmacy. Five years of acute care experience with at least three years in management role. Apply online at: www.NationalParkMedical.com. (12/16/14)

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Experienced Relief Pharmacist Available. Experienced relief pharmacist (retail) NW Arkansas (Fayetteville, Bentonville Area). Certified for immunizations. Looking for 1 to 2 days a week. Contact Jim Davis (479) 619-6597 or jim@ bluegrassbanjo.org. (12/5/14) Looking for Pharmacist wanting to grow. One of the fastest growing FDA-registered pharmaceutical companies in the United States desires to hire a pharmacist that wants to grow professionally and financially. Highly specialized training will be provided in a very unique and innovative setting in Central Arkansas. If you are interested in learning new pharmaceutical skills, possess a strong work ethic, and are a team player, send your resume to: pwike@scausa.net. (12/1/14) Pharmacist available for employment. Pharmacist with 30 years experience in both hospital and retail seeks PT/FT work. Contact at alfaromeo@centurylink.net or (501) 231-1130 (12/1/14) STAFF RPH, Inc. Pharmacist and Technician Relief Services. We provide quality pharmacists and technicians that you can trust for all your staffing needs. Our current service area includes AR, TX, OK and TN. For more information call Rick Van Zandt at (501) 847-5010 or email staffrph1@att.net. IVANRX4U, Inc., Pharmacist Relief Services, Career Placements. Relief pharmacists needed - FT or PT. Based in Springfield, MO and now in Arkansas. Staffing in Missouri, Arkansas, Eastern Kansas and Oklahoma. We provide relief pharmacists for an occasional day off, vacations, emergencies -- ALL your staffing needs. Also seeking pharmacists for full or part-time situations. Please contact Christine Bommarito, Marketing and Recruiting Director, for information regarding current openings throughout Arkansas, including temporary as well as permanent placements. Let IvanRx4u help staff your pharmacy, call (417) 888-5166. We welcome your email inquiries; please feel free to contact us at: ivanrx4uchristine@centurylink.net. Â§

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