ARRX - The Arkansas Pharmacist Winter 2017

WINTER 2017 Award-Winning Quarterly Publication of the Arkansas Pharmacists Association

Provider Status Takes Center Stage in 2017 Practical Tips for Pharmacists on Mumps Immunization

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AR•Rx

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THE ARKANSAS PHARMACIST

2/10/17 11:02 AM

Dear Colleague, As legislators, lobbyists, and concerned citizens flock to the state capitol to engage in the session of the General Assem 2017 regular bly, my thoughts are of you, your practice, and your patient advocate on behalf of your pat s. Every day you ients; I have the great privileg e and immense responsibility and our beloved profession. of advocating for you Every time I sit down with gov ernment leaders, lawmakers, and regulatory boards I am rem reputation the APA enjoys. Our inded of the strong team is actively working to leve rage this position to push for recognizes the vital role of pha legislation that rmacists and enhances our abil ity to provide care in every Ark ansas community.

In addition to political efforts, the APA continues to advocate for pharmacists through a range of the formation of the Commu services. Through nity Pharmacy Enhanced Ser vices Network, APA and the have launched a quality improv colleges of pharmacy ement initiative focused on inte grating community pharmacy to optimize coordination of hea enhanced services lth care services to patients and populations in our state and effort that affects all pharmacist communities – an s, no matter their practice sett ing.

APA continues to advocate for pharmacists through our exp anded media presence, increas exposure from six scheduled ing our television appearances in 2016 to more than 20 planned in 2017. We pharmacy through features ’ve also promoted in state-wide publications urg ing Arkansans to take advant medication expert. age of their local We also continue to offer and broaden our clinical programm ing. The award-winning Pharma Program provides immunizatio cists Immunization n and CPR training for APA members as well as free pro addition, more Arkansas pharma motional posters. In cists are offering Medication The rapy Management as we expand of MTM training. the availability The APA corresponds with our members regularly through Inte RxActions, a weekly e-news changes and trends, and the letter on industry award-winning AR∙Rx The Ark ansas Pharmacist, a quarterly features on topics affecting journal with in-depth the pharmacy world, in add ition to more than 20 hours Pharmacy Education with num annually of Continuing erous networking opportunitie s.

Membership in the APA connec ts you to a network of pharma cy leaders, practice innovato visionaries who not only want rs, and professional to see you thrive, but actively help you succeed. Buying into investment that will yield a gre this network is a small at return for your professiona l future and the future of the pro fession.

I know I speak for everyone in our office when I say it is an honor to serve on your behalf. trust you have placed in us to We appreciate the be your voice in Arkansas. Mo ving forward, I hope you con participate in the APA, beginni tinue to support and ng by joining or renewing you r membership in 2017. The eas online at www.arrx.org/join or iest way to renew is over the phone at (501) 372-52 50.

Please do not hesitate to con tact us if we can ever do any thing to assist you in your pra ctice Sincerely,

Scott Pace, Pharm.D., J.D. Executive Vice President & CEO 417 South Victory Street | Littl

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APA Staff Scott Pace, Pharm.D., J.D. Executive Vice President and CEO Scott@arrx.org

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John Vinson, Pharm.D. Vice President of Practice Innovation John@arrx.org Jordan Foster Director of Communications Jordan@arrx.org Susannah Fuquay Director of Membership & Meetings Susannah@arrx.org Celeste Reid Director of Administrative Services Celeste@arrx.org

Office E-mail Address Support@arrx.org Publisher: Scott Pace Editor: Jordan Foster Design: Gwen Canfield - Creative Instinct Arkansas Pharmacists Association 417 South Victory Street Little Rock, AR 72201-2923 Phone 501-372-5250 Fax 501-372-0546 AR•Rx The Arkansas Pharmacist © (ISSN 0199-3763) is published quarterly by the Arkansas Pharmacists Association, Inc. It is distributed to members as a regular service paid for through allocation of membership dues ($5.00). Non-members subscription rate is $30.00 annually. Periodical rate postage paid at Little Rock, AR 72201.

Current edition issue number 78. © 2017 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.

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CONTENTS

Debra Wolfe Director of Government Affairs Debra@arrx.org

6 Inside APA: Voters Across Arkansas

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APA Compounding Academy: FDA Releases New Guidelines

7 From the President: Friends On the

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APA Consultants Academy: It’s a Mab, Mab, Mab World

9 Member Spotlight: Jason Eakin,

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UAMS Report: Integrating Medication Therapy Management into the Workflow

10 FEATURE: Provider Status Takes

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Harding University Report: HUCOP and APA Host Legislative Town Hall

15 New Drugs: Congress Taking Steps

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AAHP: Advancing Pharmacy Practice through the Pharmacy Practice Initiative

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CPE In Paradise

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Member Classifieds

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Legislator Profile: Representative Douglas House

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2017 APA Awards Solicitation

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Call for Board Nominations

Approve Medical Marijuana Hill

Baptist Health Medical CenterConway Center Stage in 2017

to Speed FDA Drug Approval

16 2017 Calendar of Events 17 Safety Nets: Two Decades 18 Compliance Corner: Arkansas

Pushes Forward With Medical Marijuana

20 FEATURE: Practical Tips

for Pharmacists on Mumps Immunizations

DIRECTORY OF ADVERTISERS 4 8 8 14 19 19

Pace Alliance Retail Designs, Incorporated Arkansas Pharmacy Support Group Pharmacists Mutual EPIC Pharmacies Save the Date: APA Annual 2017 Convention

29 Wright, Lindsey, Jennings 30 Law Offices of Darren O'Quinn 35 UAMS 35 Pharmacy Quality Commitment Back Cover: APA Honors AmeriSourceBergen

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APA Board of Directors

INSIDE APA

2016 - 2017 Officers President - Eddie Glover, P.D., Conway President-Elect - Lynn Crouse, Pharm.D., Eudora Vice President - Stephen Carroll, Pharm.D., Arkadelphia Past President - Brandon Cooper, Pharm.D., Jonesboro

Area Representatives Area I (Northwest) Michael Butler, Pharm.D., Hot Springs Area II (Northeast) Darla York, P.D., Salem Area III (Central) Clint Boone, Pharm.D., Little Rock Area IV (Southwest/Southeast) Dean Watts, P.D., DeWitt

District Presidents District 1 - Denise Clayton, P.D., Mayflower District 2 - Max Caldwell, P.D., Wynne District 3 - Dylan Jones, Pharm.D., Fayetteville District 4 - Betsy Tuberville, Pharm.D., Camden District 5 - James Bethea, Pharm.D., Stuttgart District 6 - Yanci Walker, Pharm.D., Russellville District 7 - Lacey Parker, Pharm.D., Centerton District 8 - Rodney Richmond, P.D., Searcy Academy of Consultant Pharmacists Anthony Hughes, P.D., Little Rock Academy of Compounding Pharmacists Becca Mitchell, Pharm.D., Greenbrier Arkansas Association of Health-System Pharmacists Kendrea Jones, Pharm.D., Little Rock

Ex-Officio APA Executive Vice President & CEO Scott Pace, Pharm.D., J.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) Keith Olsen, Pharm.D., Little Rock

Harding College of Pharmacy Representative (Dean) Jeff Mercer, Pharm.D., Searcy Legal Counsel Harold Simpson, J.D., Little Rock Treasurer Richard Hanry, P.D., El Dorado UAMS COP Student Mary Elizabeth Bradley, Little Rock Harding COP Student Alyssa Stormes, Searcy

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Scott Pace, Pharm.D., J.D. Executive Vice President & CEO

Voters Across Arkansas Approve Medical Marijuana

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rkansas has become the first southern state to amend its constitution to allow the use of medical marijuana. It joins 27 other states and the District of Columbia as allowing some form of legalized marijuana for medical use.

Former Supreme Court Justice Louis Brandeis famously called states “laboratories of democracy” because of their ability to be nimble and to create their own social experiments at the state and local level. The issue of medical marijuana has certainly proven this statement true. Despite the large number of states that now allow medical marijuana, there does not appear to be a clear consensus on how it should be done, allowing states to create a model that works best for their citizens. These models currently range from marijuana cigarettes that are ingested to treat a medical condition (e.g. wasting, glaucoma, pain, Lou Gehrig’s disease, seizures, etc…) to cannabis oils that are highly purified to ensure purity, concentration and the ability to provide predictable and titratable dosages.

APA was a vocal opponent of medical marijuana during the election season.

However, once the people of Arkansas voted to support it, we have been hard at work advocating for treating the marijuana that is sold in Arkansas as much like other medications as possible. This includes advocating for the safest and most predictable methods of consuming marijuana in Arkansas. APA believes that the safest manner to consume marijuana is through the oil-based products.

As I previously mentioned, the oilbased products have a known purity, concentration and volume all which allow for predictable and titratable dosages to be calculated. The oils would be the most medical manner that marijuana could be treated and would follow the example of states such as Connecticut and Virginia.

Marijuana cigarettes, on the other hand, offer none of these important safety mechanisms. Having said that, APA is open to vaping as an alternative to marijuana cigarettes because the purity, concentration and volume will all be known.

The new constitutional amendment established a marijuana commission with five members appointed by Governor Hutchinson, Speaker Gillam and President Pro Tem Dismang. These three leaders made thoughtful selections of two physicians, a pharmacist, an attorney and a regulatory expert as the commissioners. The commissioners have been hard at work since being appointed in December to craft the rules, fees and quantity of grow facilities and dispensaries that will be allowed in Arkansas (certain parameters were mandated in the amendment). The legislature will also be actively involved in the coming weeks to make sure that implementation in Arkansas happens in a responsible manner.

Marijuana will be just one of the many issues that the Arkansas General Assembly discusses during the legislative session. The session began Monday, January 9th and will be in session through at least late April. Stay tuned to your weekly InteRxActions email for the latest happenings. §

AR•Rx

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THE ARKANSAS PHARMACIST

2/10/17 11:02 AM

FROM THE PRESIDENT

Friends on the Hill Eddie Glover, PD President

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He was elected House Republican harmacy has good things going at the start of the New Year on Capitol Hill. House Rep. Buddy Carter (R-GA) is the only Conference vice chair. It is encouraging to see pharmacy pharmacist in Congress. He is making waves for our profession advocates move into leadership positions. and is promoting quickly on the Hill. He was recently selected to serve on the influential House Energy and Commerce In December, as mentioned in the Compounding Academy’s Committee. This committee has jurisdiction over important column, FDA released final Compounding Office Use pharmacy legislation including DIR fees, MAC transparency, guidance. Unfortunately FDA retained the position that a 503A and any willing pharmacy. According to NCPA, Speaker of compounder must receive a valid patient specific prescription the House Paul Ryan (R-WI) was before the compound leaves the quoted to say, “Buddy’s insight pharmacy, therefore prohibiting will be extremely valuable to the office use. This is a real challenge I cannot stress enough the importance committee as the only pharmacist for situations where small batch of Arkansas pharmacists being in Congress. Since the day he sterile compounds are needed for a involved with both our state became a member of Congress, facility or when a non-sterile office legislators as well as our national he has wasted no time offering compound is needed in clinics. his unique health care expertise in hopes of creating a better system I cannot stress enough the for all patients.” In addition to Representative Carter there importance of Arkansas pharmacists being involved with are other “friends of pharmacy” members appointed to serve both our state legislators as well as our national legislators. on the committee as well. Rep. Michael Burgess (R-TX), a Nationally we have top notch Arkansas Senators and Texas physician and advocate for pharmacy compounding, Representatives serving pharmacists and our patients in was named Chairman of the Health subcommittee. Many Washington, DC. They are anxious to hear from you and want of our Texas pharmacy colleagues have a great relationship to help Arkansas patients get the best medical care possible.§ with Rep. Burgess. Many of us know the work Rep. Doug Collins (R-GA) has done on behalf of community pharmacy.

AAHP Board Executive Director . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Susan Newton, Pharm.D., Russellville President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Kendrea Jones, Pharm. D., Little Rock President-Elect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Brandy Owen, Pharm.D., Conway Past President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Rob Christian, Pharm.D., Little Rock Treasurer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Marsha Crader, Pharm.D., Jonesboro Secretary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Melissa Shipp, Pharm.D., Searcy Member-at-Large . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Erin Beth Hays, Pharm.D., Pleasant Plains Member-at-Large . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . David Fortner, Pharm.D., Sherwood Member-at-Large . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Joy Brock, Pharm.D., Little Rock Technician Representative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Holly Katayama, CPhT, Little Rock

Arkansas State Board of Pharmacy President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Stephanie O’Neal, P.D., Wynne Vice President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Tom Warmack, P.D., Sheridan Secretary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Kevin Robertson, Pharm.D., BCPS, Little Rock Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Steve Bryant, P.D., Batesville Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Debbie Mack, P.D., Bentonville Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lenora Newsome, P.D., Smackover Public Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Carol Rader, Fort Smith Public Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .James Burgess, DDS, Greenwood

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AR•Rx

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THE ARKANSAS PHARMACIST

2/10/17 11:02 AM

MEMBER SPOTLIGHT

Jason Eakin, Pharm.D Baptist Health Medical Center – Conway

Pharmacy/academic practice: Currently I am working at

Baptist Health Medical Center - Conway as the Director of Pharmacy. Prior to this I worked at Baptist Health Medical Center - North Little Rock where I was a Clinical Pharmacist and Pharmacy Supervisor.

Pharmacy school and graduation year: UAMS College of Pharmacy 2000

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

pharmacy for over 17 years. Worked for a small time in retail prior to starting with Baptist Health in April 2001.

Favorite part of the job and why: I like figuring out

solutions to our challenges within the hospital and health care. Whether it is my pharmacy staff, our patients, or other leadership it truly takes everyone working together to deliver the best possible care for our patients. With the opening of our new hospital in Conway, there have definitely been challenges and great opportunities to find and design solutions.

Least favorite part of the job and why: The amount of

What do you think will be the biggest challenges for pharmacists in the next 5 years? I believe it is the amount of change in health care, whether it is regulatory agencies or the political climate. Also, I believe pharmacogenomics will continue to evolve and how exactly pharmacists will play in the development of this area will be important.

Recent reads: The Wisdom of Faith by Bobby Bowden;

Fearless: The Undaunted Courage and Ultimate Sacrifice of Navy Seal Team Six Operator Adam Brown by Eric Blehm

Fun activities/hobbies: Spending time with my wife (Kris)

and my two sons (Kyle and Carter). I enjoy playing and coaching sports with my two sons. Also, going to DeGray Lake with family and friends in the summer.

Ideal dinner guests: John F. Kennedy, Babe Ruth, Dave

Matthews, and Will Ferrell

If not a pharmacist then…: I would like to have been

involved with baseball. Coaching, playing, or just doing something to be part of the game. §

challenges you encounter with the opening of a new hospital.

At times it was overwhelming but my pharmacy staff and our whole hospital team have been super to work with as we continue to grow our hospital here in Conway.

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PROVIDER STATUS Takes Center Stage in 2017

By John Vinson, Pharm.D., Krystalyn Weaver, Pharm.D, Jordan Foster

Do we truly understand the pharmacy profession’s goal of “provider status” and what will be the results? To learn more about this issue, we conducted an interview with Krystalyn Weaver, Pharm.D., vice president of policy and operations of the National Alliance of State Pharmacy Associations (NASPA). APA Vice President of Practice Innovation John Vinson, Pharm.D., visited with Krystalyn for AR∙Rx The Arkansas Pharmacist to focus on why federal provider status is important, what it will mean for pharmacists in Arkansas, and if it will ever happen.

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AR•Rx

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THE ARKANSAS PHARMACIST

2/10/17 11:03 AM

John: Across practice settings, provider status is seen as the answer for the future of pharmacy. So let’s start by defining the term: What is provider status, and why do we need it?

Krystalyn: That’s a great place to start. The term “provider status” really refers back to the fact that federally— specifically in Part B of the Social Security Act where health care providers and their services are identified for Medicare coverage— pharmacists are not included. So in this case, the exclusion of pharmacists on a list of providers means Medicare beneficiaries aren’t able to access pharmacists’ patient care services such as diabetes management, smoking cessation assistance, and others through their Medicare benefits.

Hence our goal of attaining federal “provider status." A pending step in that direction would be passage of the Pharmacy and Medically Underserved Areas Enhancement Act, aka H.R. 592 or S.109.

This legislation would allow Medicare to pay for pharmacists' services in medicallyunderserved areas. Believe it or not, this includes most of Arkansas.

The goal is to ensure that patients have access to pharmacists’ brains — not just the products we dispense.

Back to the term provider status. Medicare access is a major step, but it's only one step. The reality is that we need to approach ensuring patient access to pharmacists’ services from more than one angle. Though Medicare patients make up a huge population of those who would benefit from pharmacists’ knowledge and skills, there are many other patients who do not have Medicare coverage. Thus, when we attempt any effort to get patients access to these services, we tend to use the label “provider status” on it—even though the meaning of that term is more specific to the federal example. In fact, most states, including Arkansas, already define pharmacists as providers in at least one area of state law. But that doesn’t mean we already have ensured patient access to pharmacists’ patient care services in those states.

So "provider status" is broader. It encompasses any effort to get patients access to these services, which makes the meaning of that term somewhat complicated.

Doesn’t everyone support increased access to broader services?

Well, not every pharmacist wants to provide these services.

Often when I'm talking about integrating more patient-care services into our practices I get the inevitable comment: “I’m too busy in the pharmacy as it is. There is no way I can add

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As a practicing community pharmacist myself - although it’s only moonlighting - I can relate. Any pharmacist or consumer for that matter knows how busy a community pharmacy can be. It is, in fact, difficult to add to that workload in the world we live in now.

But that's the key phrase: in the world we live in now. It doesn't have to be this way.

I challenge my peers not to think of the current practice environment. When we're talking about broadening pharmacists' services, think of the future. Remember that the reason we aren’t already doing this is because our payment system is broken — it doesn’t recognize the full value that The goal is to ensure pharmacists are capable of providing. A that patients have core premise of the provider status push access to pharmacists’ is that we have to change our business brains — not just the model. We need to change the practice products we dispense. environment and make it feasible for our services to be delivered effectively.

But if you dig into the “why” of that objective, it's more than just about pharmacists. It's about the fact that patients benefit from the valuable services pharmacists can provide. We know that when pharmacists are on the healthcare team, outcomes improve and costs go down.

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even more activities to my day-to-day operations and still get prescriptions filled.”

So what's keeping Congress from passing it?

That’s a great question, but it assumes that policy decisions are always made with 100 percent reliance on facts and data.

The reality is that national policy is influenced by political pressures. And one of the biggest political pressures we're facing today is our national debt and the ever ballooning costs of entitlement programs. Adding pharmacists’ services to Medicare benefits will come at an added cost to the program, at least initially.

So rather than reflecting on why it hasn’t happened yet, I like to focus on why now is a good time. There has never before been more of an awareness on health policy in the larger policy environment. Policy makers are realizing that saving money is more than simply cutting costs — it's also critical to get the most value.

Pharmacists are pros at keeping people healthy and maximizing the utility of a critical healthcare resource: medications. We have plenty of data to show that. More people are realizing this, so not only do we have unprecedented collaboration among pharmacy associations, wholesalers, and national pharmacy chains, we are now seeing support from many outside organizations such as the Centers for Disease Control and Prevention, the National Governors Association, the Office of the Surgeon General, and others.

If Congress is so concerned about the price tag, hasn’t research demonstrated that the long-term savings from compensating pharmacists as providers is greater than the short-term costs? Won’t healthier patients and

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PROVIDER STATUS TAKES CENTER STAGE IN 2017

reduced hospital admissions save Medicaid and Medicare significant money?

Absolutely, there is plenty of data to show that pharmacists can save payers on the overall cost of healthcare in both the short and long term. Most of these studies demonstrate a range of 2 - 1 to 4 - 1 return on investment depending on the direct patient care service measured.

In some cases, the return on investment is as high as 12 to 1. Unfortunately, the way new federal bills are analyzed don’t usually account for these savings. The Congressional Budget Office assigns a “score” to bills that estimates the cost of the bill to the federal budget over the next 10 years. But that score doesn’t take into account cost savings as the result of an upfront investment — which doesn’t help our cause one bit.

You’ve mentioned that Congress needs to enact provider status and we support this in Arkansas. We also want pharmacists to be added to the Medicare list of providers, and we want pharmacists to have the same payment “status” as the other providers. But that’s at the federal level, what about at the state level?

There is a lot states can do to ensure patient access to and coverage for pharmacists’ patient care services.

Unfortunately, it isn’t as simple as the Arkansas legislature simply granting provider status. The state environment is different than the federal one. At the federal level, a somewhat simple change of definition in law results in a massive change in the payment structure for MANY patients across the country. At the state level this almost always isn’t the case.

There are several places in state laws where the term “provider” is defined to include pharmacists in the definition, each with a different degree of impact on patient access to pharmacists’ services.* Each of these state laws is important in its own way but does not have the broader national impact that a federal

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change would be for sustainable payment models for pharmacist provided direct patient care.

Additionally, it's at the state level where scope of practice is defined, and that's an essential factor in pharmacists’ ability to provide the care they want to provide. In recent years states have made improvements to laws regulating pharmacists: disease state management protocols, therapeutic substitution, emergency refills for maintenance medications, broadening immunization and collaborative practice agreements, medication administration, allowing pharmacists to prescribe travel medication, and promoting access to public health services through pharmacies, such as smoking cessation products, naloxone, and hormonal contraceptives.

And finally there are services that pharmacists can already do and already are doing that they aren't being compensated for. It won’t be as easy as just submitting a quick claim for services; we'll need to comply with the rules and regulations other providers comply with now — including credentialing, documentation, quality assurance, etc.

How do you think physicians will react to that? Does it change the physician –pharmacist relationship?

The examples we currently have of physician-pharmacist collaborations show that great creativity is required to make the relationship financially viable. But when we are able to find sustainable revenue streams to take *Arkansas state laws that already define pharmacists as providers:

Finally, states can influence local payers including Medicaid programs, state employee plans, and private payers through legislative or regulatory action, memorandums of understanding, or by simply working with those payers directly and sharing the business case with them for investing in pharmacist patient care services.

Example: 20-77-2202 (Healthcare Quality and Payment Policy Advisory Committee): “Healthcare provider” means one (1) of the following individuals or entities licensed by the State of Arkansas to provide healthcare services: … a pharmacist

So are we talking about expanding the role of pharmacists? Providing services under disease state management protocols, statewide protocols, or collaborative practice agreements with physicians? Or simply providing services that pharmacists can already do but currently aren’t being compensated for?

23-76-102 (Health Maintenance Organizations Definitions) 23-79-503 (Comprehensive Health Insurance Pool Act) 23-99-203 (Patient Protection Act of 1995)

All of the above. As we discussed before, state efforts often include work to align pharmacists’ scope of practice with their clinical ability — so patients aren’t missing out on pharmacists’ care because of outdated laws.

Protocols, disease state management and collaborative practice agreements can allow for increased collaboration and efficiencies in care delivery — unless the state laws and regulations are so restrictive that entering into an agreement becomes an administrative ineffective burden. *

AR•Rx

23-99-802 (Any Willing Provider Law) 16-114-201 (Actions for Medical Injury Definition) 23-79-149 (Prescription Drug Benefits) 4-88-1002 (Patient Rights Regarding Payment for Pharmacists Services Act)

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THE ARKANSAS PHARMACIST

2/10/17 11:03 AM

There has never before been more of an awareness on health policy in the larger policy environment. Policy makers are realizing that saving money is more than simply cutting costs — it's also critical to get the most value.

the strain off of the system, physicians often report favorably on working closely with pharmacists. I think physicians and other providers will embrace the presence of pharmacists on the health care team. Let’s face it — drugs are complicated and there are plenty of other things doctors, nurses, physician assistants, and nurse practitioners have to focus on. Having a medication expert on their side will make their job that much easier and allow them to provide care to more patients. But I think if we align the incentives appropriately — and build an infrastructure that allows pharmacists to access the patient health data they need — the system can be fixed to maximize pharmacists' skills and improve patient care.

Let’s talk about compensation. If, as providers, pharmacists could be compensated for a broader range of their services, what does that look like? What are the mechanics of it?

I don’t want it to sound like an easy, quick transition. We'll need to adjust workflows, reimagine how we use pharmacy technicians, implement infrastructure changes to allow pharmacists to plug into the information systems hospitals and doctors use, and learn how to do medical billing. And medical billing is VERY different than prescription billing, which is quick, automated and immediately tells you if a claim is covered.

In medical billing, a claim is submitted but the provider may not know for weeks if it will be paid by the insurer. Copays have to be collected at the time of service but are only estimates of what the patient’s cost share is — meaning you have to bill the patient after the fact as well. And if a claim isn’t covered, the dispute process can be lengthy and arduous. Obviously all of these challenges have been overcome by our colleagues in other health professions so they're not insurmountable, but they will be big changes for pharmacy.

Sounds like this is an issue pharmacists need to anticipate, so that when it’s enacted, our members are ready to take advantage of it on day one. So, as a last question, what should Arkansas pharmacists be doing now to prepare themselves, their practices, and their patients for these potential changes?

Pharmacists can get themselves ahead of the game by incorporating services into their current business model now.

Start small. Consider incorporating medication synchronization into your pharmacy. Incorporate other adherence interventions.

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Make sure to fulfill all of the Medicare Part D and private payer MTM opportunities that come your way. This will help you to get your workflow to a better place and start to change patient perceptions about the level of care pharmacists are capable of providing.

Build relationships in the community. Reach out to local physicians' offices, get to know the care managers in the local hospital and see if you can find a way to help them with medication reconciliation at discharge. Building relationships will also build a referral network. Yes, this will mean business when we are able to bill Medicare for medical services but it will also mean increased business now. If your local providers see you as the go-to pharmacy for optimal medication management, they will send their patients to you.

Try to understand the quality measurement landscape — and beyond Star Ratings. Physicians, ACOs, medical homes, and hospitals are all held to different quality metrics. Learn what they are, learn what the pressure points are and think of how pharmacists can help to achieve those metrics. Also get to know the billing codes that may be available to us through Medicare. These include CPT codes, chronic care management codes, G-Codes and more. The Medicare Learning Network is a great resource. Sign up for their email list and get information sent to you regularly.

And among the most important next step, be involved with APA. Support the Association’s efforts!

Thank you, John, for this opportunity to share my thoughts with pharmacists in Arkansas.

Thank you, Krystalyn. Excellent information. I would also encourage Arkansas pharmacists to consider joining the Arkansas Community Pharmacy Enhanced Services Network and to consider opportunities to provide pharmacist enhanced services for patients in patient centered medical homes and clinics participating in the CMS Comprehensive Primary Care Plus initiative.

Perhaps pharmacists will be able to form or join clinical integrated networks in the future as well. Clearly, there are many changes to come and those able to adapt will survive and flourish. §

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THE ARKANSAS PHARMACIST

2/10/17 11:03 AM

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Congress Taking Steps to Speed FDA Drug Approval This column, presented by the Harding University College of Pharmacy, aims to briefly highlight information on new molecular or biological entities, new indications, or significant new dosage forms recently approved by the FDA

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he FDA’s drug approval rate continued to move along blood glucose and automatically provide appropriate basal at a snail’s pace this quarter with only three new insulin doses in patients >14 years of age with type 1 diabetes molecular/biological entities gaining approval. However, mellitus. Significant new dosage forms that were approved in early December the U.S. Senate cleared a final hurdle this quarter include: Bonjesta® (doxylamine/pyridoxine, to passing broad legislation aimed at speeding up FDA extended-release tablet) for nausea/vomiting of pregnancy; approval of drug and medical-devices. The U.S. House Carnexiv™ (carbamazepine, IV injection) for seizures; had already overwhelmingly passed the legislation which Epaned™ (enalapril, oral solution) for hypertension; Flublok® is lauded by the drug industry but found objectionable by (quadrivalent recombinant influenza vaccine, injection) some consumer advocates. Overall the bill, which also recommended as an alternative for individuals with an egg increases federal funds for biomedical research, carries a allergy, it is a change from the previous trivalent version of the price tag of $6.3 billion including: $4.8 billion for the NIH only influenza vaccine fashioned through recombinant DNA over 10 years; $1 billion aimed at opioid technology; Kyleena™ (levonorgestrel, intrauterine system) for contraception; addiction prevention and treatment; and $500 million for new FDA programs. The Lucentis® (ranibizumab, pre-filled syringe In early December the measure is expected to be signed into law for ophthalmic intravitreal injection) for wet U.S. Senate cleared a

by President Obama before his term ends. age-related macular degeneration and final hurdle to passing macular edema after retinal vein occlusion; broad legislation aimed New Drugs: Lartruvo™ (olaratumab, IV Selzentry® (maraviroc, oral solution) for at speeding up FDA infusion), a platelet-derived growth factor HIV-1 infection; Vemlidy® (tenofovir, approval of drug and tablet) for chronic hepatitis B virus receptor-alpha blocking antibody, was medical-devices. granted accelerated approval to treat infection with compensated liver disease; soft tissue sarcomas in combination with Vermox™ (mebendazole, chewable doxorubicin. Approved for up to 8 cycles tablet) for roundworms and whipworms; this olaratumab will cost an average $5,900 per cycle.

Yospraia™ (aspirin/omeprazole, delayed-release tablets) Intrarosa™ (prasterone) is a new chemical entity formulated to decrease risk of gastric ulcer in patient taking chronic as a once-daily vaginal insert to treat women with moderatelow-dose aspirin; Xultophy® (insulin degludec/liraglutid, to-severe pain during sexual intercourse. Zinplava™ subcutaneous injection) basal insulin and GLP-1 analogue (bezlotoxumab, IV infusion) is indicated to reduce recurrence combination in a pen; and Soliqua™ (insulin glargine/ of Clostridium difficile infection in patients who are at high lixisenatide, subcutaneous injection) basal insulin and GLPrisk of Clostridium difficile recurrence. Bezlotoxumab is 1 analogue combination in a pen. not an antibacterial, and therefore not indicated for the treatment of Clostridium difficile, but rather should only be used in conjunction with antibacterial drug treatment. The cost is not known at this time, but bezlotoxumab is likely to encounter reimbursement obstacles due to a potentially high-price and its cost-benefit profile.

New Dosage Forms: Medtronic’s MiniMed 670G hybrid closed looped system, referred to as an “artificial pancreas,” became the first approved device that is intended to monitor

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2017 Calendar of Events FEBRUARY

SEPTEMBER

February 22-25 International Academy of Compounding Pharmacists Educational Conference San Diego, CA

Dates TBD* District Meetings Around the State

OCTOBER

October Date TBD* AAHP Fall Seminar Location TBD

February 24 CPE at the Races Oaklawn Park Hot Springs, AR

October 14-18 National Community Pharmacist Association Annual Convention Orlando, FL

MARCH

March 12 APA Board Meeting Hosto Center Little Rock, AR

October 26* APA Golden CPE Hosto Center Little Rock, AR

March 24-27 American Pharmacists Association Annual Meeting & Exposition San Francisco, CA

NOVEMBER

November 3-5 American Society of Consultant Pharmacists Annual Meeting and Exhibition Kissimmee, FL

APRIL

April 13* Arkansas Pharmacy Foundation Golf Tournament Location TBD

DECEMBER

Date TBD* American Society of HealthSystem Pharmacists Location TBD

MAY

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

December 9* APA Committee Forum Location TBD

JUNE

June 8-10 APA 135th Annual Convention Downtown Marriott Little Rock, AR

December * APA Board Meeting Location TBD *Dates have not been finalized.

AUGUST

Dates TBD District Meetings Around the State 16

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THE ARKANSAS PHARMACIST

2/10/17 11:03 AM

Safety Nets – Two Decades Welcome to another issue of Safety Nets. This issue of Safety Nets highlights the potential hazards associated with E-prescriptions. Thank you for your continued support of this column.

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he Arkansas Pharmacist first hosted Safety Nets twenty years ago this month. The authors were most fortunate to find strong support for the feature, and for the reason behind it, from the opinion leaders in Arkansas Pharmacy.

The support continues today and extends deeply into the fabric of the thoughtful practitioners who make up Arkansas Pharmacy. It has been an adventure.

Like all adventures, it had a start. That would be on the campus of Georgetown University, where the United States Pharmacopeia convened its Faculty in Medication Errors meeting in October, 1993. Jon Wolfe was chosen in order to have the insight of a hospital practitioner with expertise in sterile products. The ten participants spent most of a week reviewing the outline and content of a course meant to serve as a template for colleges of pharmacy and nursing. The result was to send Jon back to UAMS with course materials and a set of slides. (Remember classes taught with those?)

By 1995 Eddie Dunn had identified a compelling interest in teaching about best safe medication handling practices.

He and Jon gained faculty approval in the college for an elective course, Medication Error Reduction, which they cotaught. The course proved to be popular. Jon added material about safety in preparing and dispensing parenterals to his required IV Therapy course. Eddie did the same for nonsterile products in his required Dispensing course.

One rainy November afternoon, Jon visited Eddie’s office and asked him to partner in a radical project – publishing a column about prescription error reduction. His proposal was to talk about the topic that many avoided. This was in a time when many pharmacy leaders felt it preferable not to mention errors, in order to minimize the risk of lawsuits.

Eddie agreed with Jon. The two divided the World of Errors into two parts – Sterile Products and Non-Sterile Products.

Jon would cover the former and Eddie the latter.

The column was based on the NCCMERP (National Coordination Council for Medication Error Reduction and Prevention) error classification categories that have been featured so often, but that were radical and novel in 1995.

The authors went to Dean Milne, explaining that they would collect information only about Category A and B errors. That way, nothing would be in a college file that could adversely

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affect any pharmacist. These would all be success stories of how Arkansas pharmacists had successfully protected patients. Larry agreed.

Next they shopped the idea to Mark Riley, who strongly encouraged the project. Mark’s backing proved crucial in encouraging pharmacists to submit cases for publication.

Lester Hosto and the Board of Pharmacy also saw the merit in the idea, lending their endorsement. The first article announced the feature. It solicited reports of successful interventions.

You can see the result. The adventure has never faltered. APA members have provided more material, and more personal narratives of creative problem-solving than Eddie or Jon could have imagined. The remark: “You can’t make this stuff up!” has become a byword for them. These columns have also served as springboards for articles in journals that have introduced readers across all of pharmacy what excellent work is done daily in Arkansas.

Within a few years, the patient safety content of the old elective course had become part of required classes throughout the College of Pharmacy. At that point Jon and Eddie petitioned to drop the elective class. It seemed appropriate, for safety truly is not optional or elective. Over these twenty years Safety Nets has served as the basis for numerous continuing education courses. The students have ranged as far afield from pharmacists and technicians as insurers and hospital administrators. Indeed, it has proven impossible for the authors to attend any pharmacy event at which no one walks up and says: “I thought you guys must be making this stuff up – but the same error came into my store the day after I read your last column.”

It has been most rewarding to have been invited to participate in professional continuing education in this fashion. One of the most rewarding aspects is knowing that APA and the College intend for the column to continue indefinitely. To this end, the new Course Director for IV Therapy, Melanie Reinhardt, consented to take up the Sterile Products portfolio from Jon at his retirement. Her knowledge, insight and enthusiasm guarantee a continuing freshness to Safety Nets. The adventure continues. §

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2/10/17 11:03 AM

Arkansas Pushes Forward With Medical Marijuana

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here have been years of public discussion on both sides of the issue of medical marijuana in Arkansas.

This discussion coalesced into two separate measures on the ballot for the November 2016 election: the Arkansas Medical Marijuana Amendment of 2016 (AMMA) and the Arkansas Medical Cannabis Act (AMCA). In the months leading up to the November 2016 election, many members of the medical community, including the State’s Surgeon General, were opposed to both measures, chiefly due to concerns over treating marijuana as a medication.

Nevertheless, after the AMCA was removed from the ballot by the Arkansas Supreme Court, the AMMA still passed with 53.09% to 46.91% of the votes cast and became effective the very next day, November 9, 2016.

Since then, many pharmacists and other health professionals have had questions about the content, regulatory structure and timeline of the measure. The AMMA legalizes the use of marijuana by patients with “qualifying” medical conditions, as certified by a physician, but does not legalize the recreational use of marijuana.

It also allows for formal designation of “caregivers,” to assist patients with consumption of marijuana, including minors. It lists 12 medical conditions as sufficient to qualify a patient to have access to medical marijuana. In addition to the specific conditions, the AMMA also qualifies “pain that has not responded to ordinary medications, treatment or surgical measures for more than six (6) months.”

AMMA’s provisions all depend upon a qualifying patient making purchases from licensed dispensaries, which are in turn supplied by licensed cultivation facilities. So, a regulatory structure must be created to determine how patients become qualified, who should be licensed to serve as dispensaries and cultivation facilities and what rules those businesses will be required to follow in order to maintain their licensure. Three different state agencies each have been given 120 days, or until March 9, 2017, to promulgate new rules to implement their own areas of authority under the structure created by the Amendment.

The Department of Health, the Alcoholic Beverage Control Board and the Medical Marijuana Commission are in the early stages of drafting proposed rules to govern the patients and physicians, the dispensaries and the cultivation facilities.

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The Medical Marijuana Commission will govern the award of licenses to dispensaries and cultivation facilities and, likely also the additional types of licensure, if they are created by the legislature. The members of the Commission are: pharmacist Dr. Stephen J. Carroll, physicians Dr. Ronda Henry-Hillman and Dr. J. Carlos Roman, attorney Travis W. Story and lobbyist James Miller. It is remarkable that a five member commission includes three medical professionals and it is a great indication of the State’s commitment to patient care and safety.

We can also expect new laws from the General Assembly to implement, change or even perhaps reverse aspects of the Amendment. The legislature may not amend the sections authorizing use and possession of medical marijuana by a qualifying patient or designated caregiver or the number of dispensaries and cultivation facilities authorized. But all other aspects of the Amendment are open to revisions, so long as the laws are “consistent with its policy and purpose.”

Many expect some additional categories of licensure to be added by the legislature, as well as clarification of many of the employment-related aspects of the law. There has also been discussion about whether the legislature should consider requiring dispensaries and cultivation facilities to employ a pharmacist or other medical professional.

Under the current plan, Arkansas will likely begin taking applications for dispensaries and cultivation facilities in July, with the first sales taking place in 2018. § _______________________________________________________

About the author: Erika Gee represents clients in government relations, regulatory and compliance matters at Wright, Lindsey & Jennings LLP. She previously served as general counsel to the Arkansas State Board of Pharmacy for 6-1/2 years and as Chief of Staff and Chief Deputy Attorney General for Attorney General Dustin McDaniel. She uses her experience as general counsel for state agencies and licensing boards to assist clients to resolve regulatory and disciplinary disputes with state government.

AR•Rx

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THE ARKANSAS PHARMACIST

2/10/17 11:03 AM

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Join us in the heart of the capital city’s downtown district for the 2017 APA Annual Convention, to be held June 8-10 at the Little Rock Marriott. APA will offer up to 15 hours of continuing pharmacy education (CPE) relating to pharmacy practices.

Members and guests will be able to learn about the latest product trends in pharmacy from more than 40 exhibitors who will showcase new products to potential customers while working to maintain and strengthen relationships with existing customers.

Social events to mingle with fellow pharmacists, colleagues, and friends are planned as well as the annual golf tournament on Wednesday afternoon, June 7. Convention registration will open shortly so stay tuned for more information through InteRxActions and at www.arrx. org/annual-convention.

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SAVE THE DATE

June 8-10, 2017

2017 CONVENTION

Little Rock Marriott Little Rock, Arkansas

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2/10/17 11:03 AM

Practical Tips for Pharmacists on Mumps Immunizations

By John Vinson, Pharm.D.

The measles, mumps, rubella (MMR) vaccine effectiveness is very good, but it is not perfect.

• One dose of MMR vaccine is considered about 78% effective. Two doses are about 88% effective.

• Vaccine effectiveness is the measure of how well a vaccine protects a population, not an individual. Effectiveness is defined as (the attack rate in the unvaccinated minus the attack rate in the vaccinated) divided by the attack rate in the unvaccinated.

Keep it in perspective: The best way to avoid a vaccine preventable illness like mumps is to be properly vaccinated, even when the vaccine is not 100% effective.

• According to the CDC, before the U.S. mumps vaccination program started in 1967, about 186,000 cases were reported each year, and many more unreported cases occurred. Since the pre-vaccine era, there has been a more than 99% decrease in mumps cases in the United States.

• The rate of mumps infection within a vaccinated population is expected to be more than 9 times lower than in an unvaccinated population

The severity of illness is expected to be less for patients after being vaccinated.

• More severe symptoms of mumps include swollen testicles in males, infertility, deafness, encephalitis and death. The Arkansas Department of Health reported that doctors were seeing very few of these complications and instead were seeing milder symptoms with the mumps outbreak than would be expected in unvaccinated patients.

• A related and good example of this is with the shingles vaccine. The shingles vaccine is only reported to have

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The Arkansas Department of Health reported that most of the 2,000 people infected in the recent mumps outbreak in Arkansas were up-to-date on their MMR vaccination series. About 90 percent of the school-age children who were involved in the outbreak were considered properly vaccinated. How is this possible?

51% reduction in preventing new cases of shingles.

However, shingles vaccine is reported to be 66% effective in preventing post herpetic neuralgia (PHN), and is believed to lessen the severity of shingles acute symptoms and PHN symptoms if a person should develop shingles or PHN after vaccination.

Herd immunity (or “community immunity”) is when a high enough percentage of a community is immunized against a contagious disease to reduce the risk of an outbreak. The herd immunity threshold for mumps is about 86%.

• The American Academy of Pediatrics has a new tool that makes it easier to view child vaccination rates across the United States based in national immunization survey (NIS) data from the CDC. https://immunizations.aap.org/ • The CDC also makes the most current NIS data available through Vax View at https://www.cdc.gov/vaccines/ vaxview/ • According to 2014 and 2015 data, Arkansas had 89.1% and 90.2% MMR vaccination rates in kids age 19-35 months old. The data for this population is above the herd immunity or community immunity threshold (CIT) of 86% for mumps, and slightly below the needed 92-94% CIT for measles.

• Adults are more likely than kids to have vaccination rates that do not exceed the recommended community immunity threshold rates. Arkansas pharmacists can especially play a role in screening and vaccinating in this population. The Arkansas Department of Health reported that only 45% of the mumps infected adults during the outbreak were up to date on their MMR vaccine.

AR•Rx

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THE ARKANSAS PHARMACIST

2/10/17 11:03 AM

Mumps Immunizations: Other Tips to Consider 1. The current MMR vaccine is expected to provide good protection from the strain identified in the outbreak.

Mumps has 12 genotypes assigned letters A to N (excluding E and M). The Arkansas Department of Health was able to genotype at least 10 cases, and the 10 cases were all genotype G. This is the most common mumps genotype in the western hemisphere. As with all outbreaks, public health officials continue to study the strain to understand if the vaccine recommendations should be changed or remain the same for the future.

2. Measles, Mumps, Rubella (MMR) is a live vaccine.

The Immunization Action Coalition has developed well designed screening tools for vaccine contraindications. The two that you should consider using: Screening Checklist for Contraindications to Vaccines for Adults and Screening Checklist for Contraindications to Vaccines for Children and Teens. These tools can be downloaded for use at the IAC website at: http://www.immunize.org/handouts/screeningvaccines.asp Contraindications include: • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component (e.g., gelatin, neomycin) • Known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, or long-term immunosuppressive therapy or patients with human immunodeficiency virus (HIV) infection who are severely immunocompromised) • Pregnancy 3. MMR vaccine is available as MMR (3 vaccines in one) or as MMR in combination with varicella V (4 vaccines in one):

• The first MMR with 3 vaccines in one has been available since 1971 • The first MMRV with 4 vaccines in one has been available since 2005 4. Who can receive vaccines including MMR from Arkansas pharmacists?

• Adults age 18+: MMR vaccine can be provided and administered to adults 18 and over either through a generalized protocol with a physician or if the pharmacist receives a patient specific prescription with instructions to administer.

• Children age 7 to 17: if they received a patient specific prescription with instructions to administer. Currently, a generalized protocol can only be used for influenza in patients under 18.

• Tip: Children with health coverage through Arkansas Medicaid receive vaccines through the Vaccines For Children Program (VFC) and may most likely need a referral to a provider that participates in VFC or a local Arkansas Department of Health facility.

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MUMPS IMMUNIZATIONS

• Children age 0 to 6: Pharmacists are not allowed under current Arkansas law to administer vaccines to children aged 0 to age 6 years old. You should provide a referral to their primary care provider or a local health department if you determine MMR is indicated.

5. What are the CDC’s routine recommendations for mumps vaccine?

• Children should get 2 doses of MMR or Measles, Mumps, Rubella, and Varicella (MMRV) vaccine: • First Dose: 12-15 months of age • Second Dose: 4-6 years of age • Children ages 7-18 that have not been vaccinated should receive: • First Dose: as soon as possible • Second Dose: 4 weeks after the first dose • Adults who were born during or after 1957 who do not have evidence of immunity against mumps should get at least 1 dose of MMR vaccine.

• Adults who were born during or after 1957 who do not have evidence of immunity against mumps should get at least 1 dose of MMR vaccine.

• Tip: You may be able to find this information in the Arkansas Department of Health WebIZ online immunization registry, a previous employer or through their primary care provider health records.

• If unable to determine history of vaccination, a vaccination should be offered 6. Should the CDC recommendations be followed exactly or should some patients get a 3rd dose of MMR?

Most of the time, a 3rd dose is not recommended. However, The Arkansas Department of Health would work closely with outbreak areas to help guide these types of decisions.

• ADH has a specific webpage dedicated to Mumps communications: http://www.healthy.arkansas.gov/ programsServices/infectiousDisease/ CommunicableDisease/Pages/Mumps.aspx • The ADH Outbreak Response Section can be reached at (501) 537-8969 during business hours Monday-Friday 8:00-4:30. After hours please call the ADH Emergency Operations Center at 1-800-554-5738 and they will contact the on-call ADH physician or nurse, who will call you back.

• Ensure your pharmacists/pharmacy is signed up for the Health Alert Network (HAN) communications. ADH uses this network to send urgent notices to healthcare providers. http://www.healthy.arkansas.gov/programsServices/ preparedness/Pages/HAN.aspx • Example: The ADH recommended in 2016 that in impacted mumps outbreak areas, children under 4 years of age who have had at least 28 days since their first MMR vaccine can get a second shot early. These early vaccinations still counted towards ADH school requirements.

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APA COMPOUNDING ACADEMY

FDA Releases New Guidelines Becca Mitchell, Pharm.D. President

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n December 2016, FDA released final guidance entitled “Prescription Requirement Under Section 503A of the Federal Food, Drug, & Cosmetic Act” and this guidance affects almost all of the compounding pharmacies in Arkansas. Any pharmacy, including inpatient hospitals, that compounds medications is considered 503A unless it has elected to register with FDA as a 503B Outsourcing Facility.

FDA’s latest guidance outlines their “current thinking” on what 503A pharmacies are permitted to compound. If they inspect your pharmacy and find you not compliant with these requirements, they can deem you as being an unlicensed 503B facility and enforce cGMP compliance requirements.

The full guidance can be found by going to www.fda.gov and searching “UCM496286” but I will attempt to summarize the three key points: compounding after receipt of a prescription, anticipatory compounding, and compounding for office use.

FDA defines a valid prescription order as one written by a licensed prescriber or notation in a patient’s chart (inpatient setting). The specific patient for whom the prescription is written must be identified and clear. When the prescription is received before compounding occurs, there is no limit on the amount that can be compounded assuming it satisfies only that prescription.

The second item addressed is anticipatory compounding, which means the medications are compounded in advance of receiving prescriptions. Many pharmacies do this based on historical prescribing patterns and expected refills. FDA’s new guidance permits this practice in limited quantities, defined as no more than a 30-day supply of a particular compounded drug. FDA will expect pharmacies to produce reports showing the quantities they compound do not result in an inventory of more units than were dispensed in any 30-day period during the previous 12 months.

EXAMPLE 1: From July 15 to August 15, 2016 your

pharmacy received prescriptions totaling 500 progesterone 100mg SR capsules. You routinely compound this product in batches of #300 capsules. THIS IS ALLOWED – you can actually compound and have in inventory up to #500 of these capsules at any one time. If August 15 to September 15, 2016 your pharmacy receives prescriptions totaling 600 progesterone 100mg SR capsules, you can then increase the quantity you compound and hold in inventory to a total of 600 of those capsules.

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EXAMPLE 2: Your pharmacy compound progesterone

125mg SR capsules for Jane Doe, who uses #30 each month. You have no other patients currently on this strength of progesterone. You routinely compound 100 capsules per batch, which allows Jane Doe to get three refills per batch.

THIS IS NOW PROHIBITED - #100 is more than you have dispensed in a 30-day period, so you can only compound these #30 at one time.

The guidance also specifies that the patient specific prescription must be received prior to the compounded medication leaving your pharmacy.

FDA’s final topic in this guidance relates to office use compounding, which is the common term for providing compounded medications to practitioners or facilities without a specific patient prescription for that compounded medication to be administered to a patient in the office. FDA was petitioned by many stakeholders to permit a limited amount of non-sterile office use compounding by 503A pharmacies, but those appeals were ineffective. FDA’s position is that only 503B facilities can compound without a prescription for a specifically identified patient. FDA will likely continue to inspect 503A pharmacies and require evidence of patient specific prescriptions for all compounds dispensed.

It should be noted that this guidance applies only to compounds intended for human use – while FDA has indicated it intends to address compounding for veterinary patients, this particular guidance and its requirements are only applicable to compounded medications for human patients.

Understanding FDA’s expectations is a critical first step to compliance and to a satisfactory inspection when FDA inspectors arrive at your pharmacy. If that day hasn’t happened for you yet, rest assured it is coming and make sure you’re ready by staying up to date on these guidance documents.

Don’t let the constantly changing regulations discourage you from providing customized patient care through compounded medications. Finding innovative solutions to help patients is what we do best, so we will adapt and evolve to ensure we comply with the new guidance while serving our patients’ needs. §

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THE ARKANSAS PHARMACIST

2/10/17 11:03 AM

APA CONSULTANTS ACADEMY REPORT

It’s a Mab, Mab, Mab World

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e all know that the antigenantibody response is the fundamental process that protects us from foreign molecules, such as pathogens and their chemical toxins. In the blood, the antigens are bound by antibodies to form an antigen-antibody complex. This immune complex is then transported to cellular systems where it can be destroyed or deactivated.

Anthony Hughes, P.D. President

Antibodies that are produced within the host in response to an infection or foreign substance are known as polyclonal antibodies. This is because they are derived from multiple different parent cells, so that all the antibodies are not identical. Because of these differences they bind to numerous antigenic determinants, therefore, they are not suitable for specific targeted drug therapy.

Monoclonal antibodies are immunoglobulins that are produced outside the host from a single parent cell. These antibodies are homogenous and therefore are identical. That means all antibodies are able to bind to a specific section of an antigen (epitopes) where the immune molecule binds. This is beneficial because it allows the targeting of drug therapy to a specific entity such as the cardiovascular or immune system.

Monoclonal antibodies comprise one of the fastestdeveloping drug fields. It is an exciting new field where pharmacists could play a key role. If I asked you to explain how Monoclonal Antibodies (mAbs) are named what would you say?

“I was sick that day and missed class please call on someone else.”

Not surprisingly Monoclonal Antibodies are poorly understood by a large number of providers and pharmacists. My goal is to provide a simple explanation of the history and basic nomenclature guidelines if possible.

the plasma cells) to form immortal tumors(hybridoma) that allowed the cells to produce antibodies indefinitely.

Many of these failed because our immune systems saw them as non-human antibodies so they were rapidly cleared by the body. In addition they could even provoke an allergic reaction. To avoid this, parts of the antibody were altered by replacing certain areas with human amino acid sequences.

The resulting antibodies are called chimeric (xi).

Humanized monoclonal antibodies are built using multiple sequence segments derived from variable regions of unrelated human antibodies as building blocks (zu). Researchers have targeted the creation of a "fully" human antibody product, Human (u) , to reduce the possible side effects of humanized or chimeric antibodies. As of November 2016, thirteen of the nineteen synthesized human monoclonal antibodies were on the market The resulting product name consists of a Prefix, Substem A, Substem B, and Suffix (mab). The Prefix is the name, title or identification introduced by the manufacture Substem A - specifies the target of the antibody, such as a tumor or bacterial target, Substem B specifies the sequence, from which the monoclonal antibody was derived, The Suffix – mab is a common stem for all monoclonal antibodies.

This naming scheme may seem complicated, but it actually provides a lot of information about the monoclonal antibody.

Looking at Raptiva (efalizumab), for example, indicated for plaque psoriasis. The suffix -mab indicates that it is a monoclonal antibody, the substem B -zu- denotes that it is of humanized origin, the substem A –li- shows that it targets the immune system, and the prefix efa- is its individualized prefix by the manufacture. There are times when the resulting name is too hard to pronounce, and then one or more of the letters may be omitted or added to assist the pronunciation. §

Although the nomenclature may seem confusing, impossible, and even intimidating at first glance, it is actually very precise and easy to navigate, just like the Krebs Cycle, right?

First introduced in 1975, monoclonal antibodies were produced by isolating beta cells from immunized animals and fusing these cells with myeloma cells (cancer of

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UAMS REPORT

Integrating Medication Therapy Management into the Workflow

P

harmacies are generating Ph. D., professor, and Jeremy Thomas, Pharm. D., additional income, reducing associate professor, both in the college’s Department DIR fees and impacting PBM of Pharmacy Practice, mentored Scott in evaluating the reimbursement all within their impact of this practice innovation. Duane Jones, Harps existing workflow. How are they accomplishing this? pharmacy district manager, was instrumental in providing Medication Therapy Management (MTM) generates this the support to implement this program within the 35 infusion of income and reduced DIR fees that leads to pharmacies within the company. He said several other improved reimbursement. For every community pharmacy, training programs taught pharmacists about MTM but the higher your MTM completion rates, the higher your none of them adequately solved the problem of integrating Equipp scores and the more positive impact your it into a busy, retail pharmacy environment. That’s why so pharmacy has on PBM STAR ratings. MTM is beginning few pharmacies were successfully doing it. to turn the tide and change the face of pharmacy. Sadly enough the national average for MTM completion rates This program is receiving national recognition as the only are around 30%. I suspect this turnkey MTM training program is because pharmacists struggle complete with technician training, with incorporating clinical services manuals with protocols and all A $60 CMR is equivalent to forms necessary for prescriber into community pharmacy the net profit from filling 45 communication as well as a workflow. As stated by the prescriptions. website for ongoing support National Community Pharmacy and disease state guideline Association (NCPA) CEO B. updates. In discussion with Douglas Hoey in his Executive Update in December, "we must pharmacists and technicians who position ourselves to complete the MTM opportunities have implemented the program in their stores state that or lose them to a call center or worse, the patient is not attitudes for patient care have changed and they receive served at all." significant personal satisfaction in the performance of MTM. MTM The Future Today is now being promoted by During my many discussions with pharmacists over this UAMS and was offered Jan 26 in Little Rock and will also past year, I have heard some say that “MTM is just not be offered at the annual APhA2017 meeting on March 23 worth their time”. However the inherent and collateral value in San Francisco, CA. You can enroll for the continuing of MTM services extend far beyond the cognitive services education seminars at MTMTheFutureToday.com. This reimbursement, which in itself is impressive. Pharmacies training program with ongoing practice resources is the that have excelled in providing MTM services say that the only practical program available and endorsed by APhA $60 earned from a 30 to 45 minute CMR is equivalent to and UAMS College of Pharmacy. Dr. Nicki Hilliard from the net profit earned from filling 45 prescriptions in that the UAMS College of Pharmacy and Dr. Scott and Leslie same time frame. And CMR's often provide the opportunity Moore, Pharm.D. (Current UAMS-Harps Community to administer an immunization which is another revenue Pharmacy Resident) are working jointly to further develop, source. evaluate, market and teach the program.

Keith Olsen Pharm.D., FCCP, FCCM Dean and Professor

The key is implementing MTM into your daily workflow.I have also heard that community pharmacists that are frustrated with creating a clinical workflow and complain they cannot find an MTM training program that gives specifics of creating a clinical workflow. I am happy to say there is a program created in Arkansas that provides specifics and protocols of implementing clinical services workflow into community pharmacy practice. While she was completing a community pharmacy residency with Harps in 2015-2016, Nikki Scott, Pharm. D., a UAMS graduate and native Arkansan took on the project of creating a step-by-step protocol and training program for teaching MTM services and how pharmacists and technicians could put it into practice. Geoffrey Curran, 24

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These are exciting times for the pharmacy profession as we are finally being recognized for our value in improving adherence and minimizing medication errors. We have been advocating for payment for cognitive services for over two decades and it is refreshing to see it, albeit slowly, coming to pass. As we move to a pay for performance model, MTM services offer great opportunities to generate additional income while utilizing cognitive skills to impact patient care. If you are poised to integrate these clinical services into your daily workflow and utilize your technician staff to assist, you can achieve remarkable results. §

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HARDING UNIVERSITY REPORT

APA HOSTS LEGISLATIVE DAY JANUARY 28

HUCOP and APA Host Legislative Town Hall

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016 is a year that will no doubt be remembered for it’s highly Jeff Mercer, Pharm.D. Dean charged political discourse and election results that are sure to change the faces of policy and politics in the future. While most eyes were on the presidential and national legislative elections, it is important to remember that much of what shapes our profession day-to-day occurs at the state level and is the result of local legislators understanding the needs of their constituents.

In what has become a recurring event, the Harding University College of Pharmacy (HUCOP) recently hosted the Fall 2016 Pharmacy Legislative Town Hall Meeting, offered in conjunction with the Arkansas Pharmacists Association (APA) with continuing education approval from the Arkansas State Board of Pharmacy (ARSBP). This was the third meeting of its kind, dating back to the first held in the fall of 2012. Developed as an outgrowth and integral part of our Pharmacy Political Action elective course, each meeting has given an opportunity for interested students, faculty, local pharmacists, business-leaders and citizens to voice their opinions on various pharmacy practice issues and to interact with representatives in the Arkansas State Legislature.

Coordinated by HUCOP Associate Professor of Pharmacy Practice, Rodney Richmond, the work of our political action students has been historically significant in helping legislators understand and influence the important issues facing the pharmacists in Arkansas. Some may remember the work of our political advocacy students that collaborated with the APA to help gain passage of the therapeutic substitution law in August of 2013. The first legislative town hall convened in the fall of 2012 helped lay the groundwork for that legislation and the relationship that would develop between the students and successive state legislators. Sen. Jonathan Dismang (District 28), Rep. Mark Biviano (District 46), and APA President Dennis Moore served on the first town hall panel that included attendees totaling 45 pharmacists, university faculty/staff, and students. The second town hall was held in the Spring of 2013 following the passage of the therapeutic substitution law. The keynote speaker was Senator Percy Malone who is a well-known pharmacist in the state and former Chair of the Senate Public Health committee.

The most recent town hall was held on the evening of November 29, 2016, in the Cone Chapel of Harding’s American Heritage Conference Center. Four Arkansas legislators were our honored guests – they included Rep. Les Eaves (District 46), Rep. John Payton (District 64), Sen. Ronald Caldwell (District 23), and Rep. Michelle Gray (District 62). In addition, we were delighted to have two pharmacists make up the remainder of the panel – Dr. Max Caldwell, WWW.ARRX.ORG

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Pharmacist/Owner of Caldwell Pharmacy in Wynn and Chairman of the Board of Directors for the AR Community Pharmacy Enhanced Services Network, and Dr. Scott Pace, Executive Vice-President and CEO of the APA. With support from the HUCOP student chapters of NCPA and APhA-ASP, the most recent legislative town hall was a great success. Seventy-four attendees from eight central Arkansas counties were present. In addition to local pharmacists and business owners, a number of regional and statewide entities were represented, including Harding University, UAMS College of Pharmacy, and the Arkansas State Board of Pharmacy. Throughout the meeting, HUCOP P2 student Nathan Strange served as moderator and steered the conversation through various topics of discussion that included PBM issues from multiple perspectives, the recent statewide approval and subsequent steps for implementation of the medical marijuana law, and updates on the statewide enhanced pharmacy services network initiative for community pharmacies. Dr. John Kirtley, Executive Director of the Arkansas State Board of Pharmacy, attended the meeting and served as an excellent resource for issues that needed a legal context for discussion.

Following this year’s meeting, Sen. Ronald Caldwell stated that the town hall format “was a valuable experience, bringing pharmacists and legislators together to discuss important issues that need to be addressed in our state.” Similarly, Rep. Michelle Gray described the gathering as “an interesting forum that could be a model that is used around the state.”

As 2017 brings in a new political climate across the national landscape, it is comforting to know that we have a voice with those who influence and control state law. Being pharmacists, we are well aware of our capabilities as medication experts and the importance of moving the profession toward more progressive pharmacy practice. Communicating that knowledge to our state legislators and helping them understand the valuable role that we play in the healthcare system is vital to achieving adequate representation for our professional concerns.

At Harding, we are committed to providing opportunities for our pharmacy students to learn the importance of political advocacy. Our legislative town hall meetings provide real-life experiences for students to witness key relationships develop among local legislators and our community. With support from the APA and ARSBP, these events continue to grow and provide a refreshing reminder that we live in a wonderful state with local representatives who are responsive to our needs. §

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ARKANSAS ACADEMY OF HEALTH-SYSTEM PHARMACISTS

Advancing Pharmacy Practice through the Pharmacy Practice Initiative Kendrea Jones, Pharm.D. President

T

he Pharmacy Practice Initiative (PAI) formerly known as the Pharmacy Practice Model Initiative (PPMI) was developed in 2010 by ASHP and the ASHP Foundation to transform health-system pharmacy practice including ambulatory care settings. The initiative set a framework to increase pharmacy presence among healthcare teams, improve utilization of pharmacy technicians, promote pharmacy credentialing and training, enhance the use of technology to improve medication safety, and promote pharmacists as leaders in medication use (Figure 1). The PPMI was changed to the PAI

to reflect that the initiative is a national program intended to advance pharmacy practice in all settings.

Through the hospital and ambulatory care self-assessment tools, ASHP has developed key progress measures, ASHP measures progress of the PAI recommendations annually.

The self-assessment tools are a valuable resource to determine areas for practice advancement both at a state and national level. AAHP encourages facilities to complete the assessments annually to determine areas for improvement.

The assessment tools can be used to educate pharmacists,

Figure 1

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ARKANSAS ACADEMY OF HEALTH-SYSTEM PHARMACISTS

technicians, students, and residents regarding current practices and identify areas for change. Assessment tools can be found at www.ashpmedia.org/pai/index. Completion of the surveys will help AAHP identify additional areas and ways to support our members and state institutions through more education, tools, and networking.

AAHP has been diligently working to advance the PAI through its many different councils and educational programs. For over 3 years, our Programs and Education Council has provided a state-wide collaborative initially focusing on adverse drug reactions and most recently antimicrobial stewardship. The collaboratives have offered pharmacists an opportunity to network with other healthcare professionals and hospital administrators helping to promote the important role of pharmacy in improving patient outcomes. Additionally, through the council AAHP has offered numerous educational programming including our annual Fall Seminar and monthly webinars that support the PAI and help highlight best practices. For a list of upcoming webinars, see Figure 2.

AAHP continues to support technician advancement and training. Annually, an Arkansas technician is awarded a scholarship to support technician certification fees. AAHP has piloted tech check tech and continues to advocate for broader use of technicians. Our New Practitioner, Residents, and Students Council actively promotes residency training

to students and supports in-state programs through annual preceptor development programs, residency showcase, and webinars. The council is especially excited about its upcoming ASHP Visiting Leaders Program, April 18 – 19th.

Philip Schneider, MS, FASHP will be joining us to provide residents and preceptors opportunities for leadership growth and career-life guidance. Please follow our social media pages on Facebook and Instagram for information on upcoming AAHP events including networking opportunities.

Lastly, some of our members may have heard about the 2017 launch of the Arkansas Community Enhanced Services Network (CPSEN). This network will not just impact patient care and pharmacists within a community setting. The CPSEN will be a valuable tool for health-system pharmacists to ensure continuity of care especially for high risk and high costs patients. We are fortunate to have healthsystem pharmacists serving on the CPSEN development committees. AAHP will begin sharing more information on how health-system pharmacists will be able to collaborate within the CPSEN in the near future.

As we start a new year, I thank you for your continuing to support AAHP. For more information about our board and councils please visit http://www.arrx.org/aahp. §

Figure 2

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CPE In Paradise The Arkansas Pharmacists Association took over the Most Magical Place on Earth as pharmacists from across the state gathered at Disney World in sunny Orlando, Florida during APA's biannual event CPE in Paradise. Attendees were able to explore all four Disney World parks and earn eight hours of CPE during the five day adventure.

Special thanks to Jean nie Smith and Erin Beth Hayes for leading the continuing education sessions. Look for more information on our next CPE in Paradise in 2018.

Brandon Davis and Spencer Mabry

The Boardwalk Inn at Disney World

Greta Ishmael

Jeanie Smith

Erin Beth Hayes

Anne Pace, Karen Cree, and Mary Ann Weatherford

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Jake Rye and Justin Broadway

The Boardwalk Inn at Disney World

Magic Kingdom at Disney World

A rkansas pharmacies contend with regular and significant government regulation, and often need the assistance of attorneys with experience and relationships in this specialized area. Jay Shue provides pharmacy clients with strategic advice and counsel in federal and state government investigations, audits and enforcement matters. He can also help you identify gaps in compliance before they turn into an investigation.

Jay’s experience includes: · Serving as Arkansas’ first Medicaid Inspector General · Six years as the Deputy Attorney General of the Arkansas Attorney General’s Medicaid Fraud Control Unit · 20+ years as a prosecutor, litigator and attorney

JAY SHUE

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An Arkansas Resource for Arkansas Pharmacies

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Member Classifieds

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

Oncology Pharmacist position available at Ozarks Medical Center. The Oncology Pharmacist under general direction oversees or prepares (compounds and oral) commercially available and investigational antineoplastic drugs; assesses medication orders; assists with patient care activities including planning and implementing antineoplastic and antiemetic drug regimens; monitors patients' response to drug therapy and fluid and pain control medications; recommends changes or alternative therapy; compounds and dispenses medication; provides drug related information to patients, physicians, and nurses. Requirements: Bachelor's degree or PharmD from accredited college; Oncology or Pharmacotherapy Board Certification preferred. Contact Sherrie Lane at sherrie.lane@ozarksmedicalcenter.com or call 417-257-5837 if interested.

New Position Available at Cantrell Drug Company: Regulatory Affairs/Regulatory Compliance Leader. Experience required, please contact Human Resources at lwilson@ cantrelldrug.com Cantrell Drug Company in Little Rock is currently seeking applicants for our Pharmacist-in-Charge (PIC) position in our 503B Outsourcing Facility. The PIC will be responsible for the regulatory oversight for our 503B Outsourcing operations at Cantrell Drug Company.

The PIC will be involved in day to day manufacturing operations at the facility and performs the duties and responsibilities in a manner consistent with Cantrell Drug Company values and commitment to quality. For more information, please email lwilson@cantrelldrug. com. (12/16/16)

Cantrell Drug Company is looking to hire an aseptic compounding pharmacist. The candidate must demonstrate an awareness of operations of the pharmacy relating to the scope of compounding in which they participate and/ or supervise. This is a full time position working Monday through Friday 3 PM to Midnight and every other Saturday 10 AM to 6:30 PM. If you are interested, please send your resume to dconaway@cantrelldrug.com. (11/4/16) Wanted Rx Shelving sizes 36/7.5/84 and 48/7.5/84 Call 501 837 0080 (10/25/16) Marmaduke Family Pharmacy in Marmaduke, Arkansas has an opening for a Pharmacy Technician. This is a full-time position. We are looking for someone who is responsible, personable, organized and has an excellent work ethic. As a Pharmacy Technician, you must undergo an extensive background check. You may email your resume to eddingtonpharm@yahoo.com. You may also call Kellie (870-597-2911) to set up an appointment for an interview.

(10/25/16)

Advanced Pharmaceutical Consultants is currently seeking an experienced pharmacist in charge (35 hours/week, Mon - Fri, dayshift) to join our team at Riverview Behavioral located in Texarkana, AR. Previous behavioral health or hospital experience preferred. Data entry proficient is a must. Excellent communication skills needed. Detail oriented and organized. Immediate position. Please reply by sending current resume to Beth Patrick, recruiter for APC to bpatrick@apcpharm.com Cooperative Christian Ministries and Clinic in H.S. is in need of Volunteer Pharmacist. Our clinic hours are: 2nd Tuesday of EACH month, Time: 6:00-8:00 pm with supper available at 5:00pm.

EVERY Wednesday 9:00 - 1:00 1st and 3rd Thursday 9:00-1:00 ANY HOURS THAT YOU CAN Pharmacy for sale. Family owned for over 60 years.

Call 870-974-0292 (11/4/16) 30

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LEGISLATOR PROFILE

Representative Douglas House DISTRICT 40

Represents (Counties): North Pulaski and South Faulkner

Most admired politician: Theodore Roosevelt.

Years in Office: I have been in office 4 years. Starting my

Advice for pharmacists about the political process and working with the AR Legislature: Build a trusting

third term

Occupation: I am retired from the US Army. I enlisted as a Private in the National Guard and retired as a Colonel. I had 38 years of service, 24 active. I had about 10 years as an enlisted Soldier, 10 years as an Infantry Officer and 18 years as a Judge Advocate (Army Lawyer). I served a year and a half in Iraq.

Your hometown pharmacist: I use Julie Hejny at Family First Pharmacy in Jacksonville and the LRAFB when necessary.

What do you like most about being a legislator: I enjoy the tough challenges the best. Right and wrong are easy.

What's best or sometimes what is the lesser of evils really forces you to stretch your mind and work hard, doing your homework, reaching out to others.

friendship BEFORE the General Assembly convenes. After the session starts then be brief, truthful, and tell all sides fairly. We may agree with your position because we trust you, but we don't need to get blindsided by another point of view or undisclosed facts.

Your fantasy political gathering would be: Abe Lincoln,

George Washington, Franklin Roosevelt, and Winston Churchill as moderator. In their time each of these three men saved the United States while Churchill saved the U.K.

Toughest issue of the past session: The toughest issue last session certainly was the Arkansas Works appropriation.

Hobbies: I love to read, shoot, make grass grow and then cut it. My wife and I also love to travel. ยง

What do you like least about being a legislator: I dislike

having unverified information. Some people will tell you only what they want you to hear, and nothing is said under oath.

Verifying information is the biggest time eater.

Most important lesson learned as a legislator: The biggest lesson I have learned is that you can't please everybody, ever.

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2017 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 4:30pm March 31, 2017.

Please mark your nomination with an X. If you have more than one nomination, please feel free to copy this form.

Pharmacist of the Year _______

The Pharmacist of the Year Award was established in 1959 to honor an individual who “should possess professional standards beyond reproach, a record of outstanding civic service in the community, and as a member of the APA, who has contributed efforts toward the progress of the association.” Previous recipients include: 2016 Keith Larkin, Fort Smith 2015 Wayne Padgett, Glenwood 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: 2016 Jon Wolfe, Little Rock 2015 Nicki Hilliard, Little Rock 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: 2016 John Kirtley, Little Rock 2015 Aduston Spivey, Hot Springs 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: 2016 Kevin Barton, Centerton 2015 Rachel Stafford, North Little Rock 2014 Stephen Carroll, Arkadelphia 2013 Zach Holderfield, Fayetteville 2012 Clint Recktenwald, Gassville 2011 Cheryl Bryant, Little Rock

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2017 APA Awards Solicitation 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: 2016 Nikki Scott, Russellville 2015 Taylor Franklin, Fort Smith 2014 Marcus Costner, Fayetteville 2013 Lanita White, Little Rock 2012 Melissa Brown, Fayetteville 2011 Eric Crumbaugh, Benton

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: 2016 Senator Ron Caldwell, Wynne & Representative Michelle Gray, Melbourne 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: 2016 Representative Justin Boyd, Fort Smith 2015 Lenora Newsome, Smackover 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 Email: jordan@arrx.org Fax: 501-372-0546.

Please submit by 4:30pm March 31, 2017.

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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. Due to the redrawing of the membership map, APA has converted from using eight District Presidents and four Area Representatives to using 12 Regional Representatives covering five regions. APA Board membership requires the flexibility to meet in Little Rock during the week and on two Sundays during the year. Note: Regional representatives will normally serve three year terms but due to restructuring of election cycles, 2017 election winners may serve either one, two, or three years.

APA Board of Directors Call for Nominations

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

Vice President of APA

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

Regional Representatives

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

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

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

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

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

Region 3 – Central Arkansas – Three Seats Central Counties: Pulaski, Saline

At-Large Representatives – Two Seats

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. Board Members shall be limited to six (6) consecutive years as a Regional Representative, or six (6) consecutive years as an At-Large Representative. No member of the Board of Directors shall serve more than nine (9) years on the Board of Directors in any non-Executive Committee capacity.

Reimbursement- Members of the Board of Directors don’t receive compensation but can be reimbursed for reasonable direct and indirect expenses 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 Regional Meetings (APA president and regional representative) do not pay registration fees.

Removal from office- Directors may be removed for being absent without reasonable cause from any two consecutive meetings or any three meetings during a 12-month period. Meeting dates for 2017-2018 are likely to be: • • • •

August 3-5, 2017 (Thursday afternoon, all day Friday, Saturday 8 a.m. to 12 p.m.) Overnight stay required Early December, 2017 (Saturday 6 to 8 p.m. and Sunday 9 a.m. to 2 p.m.) in Little Rock March 11, 2018 (Sunday 9 a.m. to 2 p.m.) in Little Rock APA Annual Convention Board Meeting, 2018 (Wednesday a.m.) in Little Rock

If interested in nominating yourself or another individual, please contact APA Executive Vice President Scott Pace (scott@arrx.org) at 501-372-5250. Nominations will close at 4:30 p.m., March 31, 2017.

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