ARRX 2nd Issue 2022

Second Issue 2022 Award-Winning Quarterly Publication of the Arkansas Pharmacists Association

ARRX 2nd Quarter 2022.indd 1

5/16/22 5:03 PM

Protect your Tomorrow with VISTA

Our VISTA business package policy protects your tomorrow with: • Commercial Liability • Cyber Liability • Sexual Misconduct and Physical Abuse • Employment Practices Liability • Pharmacy Professional Liability • Commercial Property • Coverage Enhancements

Additional Coverage Options

• Pharmacist Professional Liability • Pharmacy Technician Professional Liability • Workers’ Compensation • Commercial Auto • Commercial Umbrella • Executive Liability including: • Directory and Officers Liability • Employment Practices Liability • Fiduciary Liability • Surety and Fidelity Bonds • Life - Business and Personal Coverage • Group Disability

LEARN MORE AT: phmic.com/vista-pharmacy Professional | Commercial | Personal | Life & Disability

phmic.com

Executive Liability, Surety and Fidelity Bonds, Life, and Disability insurance are written through PMC Advantage Insurance Services, Inc., a wholly-owned subsidiary of Pharmacists Mutual Insurance Company.

ARRX 2nd Quarter 2022.indd 2

5/16/22 5:03 PM

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

7

10

11

18

Nicki Hilliard, Pharm.D. Director of Professional Affairs Nicki@arrx.org Marlene Battle, Pharm.D. Health Equity Coordinator Marlene@arrx.org Brandon Cooper, Pharm.D. Strategic Advisor Brandon@arrx.org Jordan Foster Director of Communications Jordan@arrx.org Susannah Fuquay Director of Membership & Meetings Susannah@arrx.org Celeste Reid Director of Administrative Services Celeste@arrx.org Debra Wolfe Director of Government Affairs Debra@arrx.org

CONTENTS

Office E-mail Address Staff@arrx.org

4 Inside APA: FDA Wages War on

22 Consulting Academy: Update to

Publisher: John Vinson Editor: Jordan Foster

5 From the President

23 Compounding Academy: Marketing 101

Arkansas Pharmacists Association PO Box 3798 Little Rock, AR 72201-2923 Phone 501-372-5250 Fax 501-372-0546

7 Member Spotlight:

24 Rx and the Law: Drug Recalls

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 94. © 2022 Arkansas Pharmacists Association.

POSTMASTER: Send address changes to AR•Rx The Arkansas Pharmacist PO Box 3798 Little Rock, AR 72201-2923 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.

ARRX 2nd Quarter 2022.indd 3

Arkansas Pharmacists

Megan Smith, Pharm.D.

8 FEATURE: Arkansas Statewide

Protocols: Oral Contraception

10 Legislator Profile: Senator Bart Hester

Pneumococcal Vaccines and Guidelines

25 Financial Forum: College Funding

Choices

26 2020 Bowl of Hygeia Award Recipients

11 2022 APA Annual Convention Brochure 15 New Drugs: Springing Into the 2022 1st

Quarter FDA Drug Approvals

16 Immunization Update: Vaccines for

Children Program

17 Safety Nets: Warfarin 18 Feature: Baker's Bulls & Bears - The

Benefits of Donating Stocks

20 UAMS: Events of Spring 2022

ADVERTISERS 2 6 6 14 19 23 27

Pharmacists Mutual Retail Designs, Incorporated Arkansas Pharmacy Support Group Pharmacy Quality Commitment UAMS College of Pharmacy Law Offices of Darren O'Quinn Biotech Pharmacal, Inc.

Back Cover: McKesson

21 Harding: Springtime at Harding

33

2

5/16/22 5:03 PM

APA Board of Directors

INSIDE APA

2021 - 2022 Officers President – Max Caldwell, P.D., Wynne President-Elect - Dylan Jones, Pharm.D., Fayetteville Vice President – James Bethea, Pharm.D., Stuttgart Past President – Kristen Riddle, Pharm.D., Greenbrier

Regional Representatives Region 1 Representatives - Kevin Barton, Pharm.D., Bentonville - John Hall, Pharm.D., Fort Smith - Spencer Mabry, Pharm.D., Berryville Region 2 Representatives - Erin Beth Hays, Pharm.D., Pleasant Plains - Jett Jones, Pharm.D., Jonesboro Region 3 Representatives - Brandon Achor, Pharm.D., Sherwood - Brittany Sanders, Pharm.D., Little Rock - Lanita White, Pharm.D., Little Rock Region 4 Representative - Betsy Tuberville, Pharm.D., Camden Region 5 Representative - Lelan Stice, Pharm.D., Pine Bluff At Large Representatives - Stacy Boeckmann, Pharm.D., Wynne - Rick Pennington, P.D., Lonoke Arkansas Association of Health-System Pharmacists HyeJin Son, Pharm.D., Little Rock Academy of Compounding Pharmacists Greg Turner, Pharm.D., Searcy Academy of Consultant Pharmacists Emily Holton, Pharm.D., Bentonville

Ex-Officio APA Executive Vice President & CEO John Vinson, Pharm.D., Benton AR State Board of Pharmacy Representative John Kirtley, Pharm.D., Little Rock Board of Health Member Marsha Boss, P.D., Little Rock UAMS College of Pharmacy (Dean) Cindy Stowe, Pharm.D., Little Rock Harding College of Pharmacy (Dean) Jeff Mercer, Pharm.D., Searcy General Counsel Nate Steel, J.D., Little Rock Treasurer Richard Hanry, P.D., El Dorado UAMS COP Student Lindsey Worthington, Little Rock Harding COP Student 4 Ferguson, Searcy Hannah ARRX 2nd Quarter 2022.indd 4

FDA Wages War on Arkansas Pharmacists John Vinson, Pharm.D. APA Executive Vice President & CEO

W

hen President Biden mentioned a new “test-to-treat” initiative during this year’s State of the Union address, pharmacists initially applauded the move as another validation of the vital role our profession played during the recent coronavirus pandemic. The initiative, which allows people to be tested for COVID-19 at local pharmacies and community health centers and receive oral treatments immediately if they test positive, would be another valuable component in our fight against the coronavirus.

However, in a March 4 statement, the American Medical Association (AMA) President Gerald E. Harmon, MD, blasted the move by the Biden Administration and criticized the inclusion of pharmacists as points of access in the “Test-to-Treat” initiative. “The pharmacy-based clinic component of the…plan flaunts patient safety and risks significant negative health outcomes,” said Harmon. “This approach, though well intentioned… simplifies challenging prescribing decisions by omitting knowledge of a patient’s medical history, the complexity of drug interactions, and managing possible negative reactions.” He went on to say that COVID-19 treatments must be administered “under the guidance and supervision of physicians with expertise to deal with complex medications.”

As you can imagine, the backlash that ensued, not only from concerned pharmacists, but also from physicians and other groups who value the role pharmacists play as a member of the healthcare TEAM came fast and furious.

Many providers, including AMA members, took to social media to disagree with the organization’s stance. One emergency room physician tweeted that “in fact, it’s pharmacists that are experts on drug-drug interactions” and countless others praised pharmacists for protecting patients by discovering dangerous drug interactions and stepping to the plate to take care of patients when time is of the essence.

In a letter to President Biden, fourteen pharmacy organizations

including the National Alliance of State Pharmacy Associations (NASPA) urged the Administration to remove limitations place on the emergency use authorization (EUA) of COVID-19 antivirals by the Food and Drug Administration (FDA) that prevents pharmacists from ordering the medications. They stressed that that these EUA limitations put unnecessary burdens on the timeliness of starting antiviral treatments and that patients in rural and underserved communities will be less likely to see benefits from the “test-to-treat” approach. Despite the statement made during the State of the Union address, the pharmacy groups noted that only patients who tested positive at a small number of pharmacies, in large metropolitan areas, with in-house access to non-pharmacist prescribers would benefit from the program.

The Federal Drug Administration deliberately blocked Arkansas pharmacists and all American pharmacists from initiating or prescribing molnupiravir, Paxlovid (Nirmatrelvir packaged with ritonavir) and Evusheld (tixagevimab co-packaged with cilgavimab) in the Emergency Use Authorization approvals in December of 2021. Evusheld is a passive immunization for COVID-19 in patients with immunocompromised disease states or for patients with contraindications to the approved COVID-19 vaccines on the market. The FDA’s decision to block Arkansas pharmacists from prescribing or initiating Evusheld was especially a professionally frustrating and eye opening FDA decision. Arkansas pharmacists have ordered or administered 75% of the COVID-19 vaccines in Arkansas and have administered or ordered thousands of passive immunizations (COVID-19 monoclonal antibodies) under their scope of practice and training. The FDA ignored the facts and this training and endangered Arkansans with their decisions in December of 2021.

Most states allow pharmacists to order medications either independently or in collaboration with other providers,

AR•Rx

|

THE ARKANSAS PHARMACIST

5/16/22 5:03 PM

INSIDE APA

including here in Arkansas. Arkansas pharmacists have prescribed vaccines and immunizations through protocol for the last 25 years. Arkansas Act 406 of 2021 (Rep Justin Boyd and Sen Ben Gilmore) expanded that authority to independent prescriptive authority. In addition, Act 503 of 2021 creates a state based pharmacist “Test and Treat” program via statewide protocol approvals, over the counter Arkansas pharmacist prescribing, and Arkansas pharmacist therapeutic substitution proactive authority. Act 408 of 2021 (Representative Aaron Pilkington and Senator Breanne Davis) established a pathway for Arkansas pharmacist prescribed oral contraceptives in community settings. Once these programs have rules written, approved, and signed off by legislative review and the respective licensing Boards, pharmacists in Arkansas will remain at the forefront of providing greater access to care, especially in underserved areas of our state unless impeded by federal government overreach like the Food and Drug Administration (FDA) has done recently with COVID-19 therapeutics.

We have significant current policy challenges from our federal government interfering with states’ ability to deliver excellent healthcare. The FDA’s overreach on COVID-19 therapeutics is the latest. COVID-19 therapeutic dispensing underpayments by PBMs, Tricare underpayments, Medicare part D underpayments, Medicare part D DIR fees, antitrust activity by vertical integrated healthcare entities with the need for the Federal Trace Committee to study this with pharmacy benefit managers, the broken HRSA / Optum program for uninsured claims for COVID-19 testing, treatment and vaccination, and the

confusing coverage of COVID-19 OTC testing are all additional federal issues that remain unsolved. The Arkansas Pharmacists Association has been communicating and advocating with our Congressional delegation as well as our national pharmacy association partners to create change in these issues. It is important to not only support and communicate to your state pharmacist association but also our national pharmacist associations and Congress. Arkansas has two US Senators and four US House of Representatives who need to hear from you on these issues.

During the past few years, pharmacists have proved themselves to be an incredibly valuable part of the healthcare TEAM through providing vaccines, COVID treatments, and making sure patients were receiving the best possible care available to them in their local communities. Our profession was already the best kept secret in health systems and Veteran’s Affairs for the last 50 years as providers delivering care in team based fashion. The recent moves by the FDA are the antithesis of this TEAM-based approach and jeopardize patient care.

Pharmacists are medication experts and every effort to help expand our role in making sure patients are treated and cared for in the most effective and efficient manner should be our goal.

In order to accomplish this, it will take significant advocacy, engagement, and communication to keep healthcare decisions local at the state level and we must continue to fight for states’ rights and push back on the federal government’s antiquated policies that damage healthcare and threaten lives in our state.§

FROM THE PRESIDENT

T

ime passes so fast that it seems like it was just last month that I was writing my first article and now this is my last. I would like to thank all Arkansas pharmacists for putting their confidence in me to lead the APA for the last year. I want to thank all of the APA staff - John Vinson, Celeste Reid, Susannah Fuquay, Jordan Foster, Debra Wolfe, Nicki Hilliard, Marlene Battle, and Brandon Cooper - for all they do for all the pharmacists of Arkansas. Without each one of these employees, the APA would not be what it is today.

The last two years have been trying times for everyone especially the APA staff. From working at home for a year then moving to a temporary office for the last year, this group of employees at the APA office are superstars in my opinion. I just wish every pharmacist knew how challenging the responsibilities are that the APA employees have on them on a daily basis.

If you've been in Little Rock recently and have gone by 401 South Victory Street, you have to be very impressed.

After seeing our old offices on the corner lot for so many years, what you see now really is a huge change. I'd like to report that the contractors have finished putting up steel beams and the building is taking shape. The height of the building and location will definitely catch everyone's eye, especially the legislators as they exit the front doors of the capitol.

As you know the building has a cost of $3.8 million dollars and the APA is in a fundraising campaign now. I'm challenging ALL pharmacists to make a pledge to help fund the WWW.ARRX.ORG

ARRX 2nd Quarter 2022.indd 5

new building. The APA is looking for five year pledges in the amount that you feel comfortable pledging. All donations are made to the Arkansas Pharmacy Foundation which is a 501-C3 non-profit organization and is 100% tax deductible. The APA Max Caldwell, P.D. APA President Pharmacy Foundation will forward all of the donations to the APA for the new building.

Also, there is a way to donate stock which will cost the donor even less. For example, if you bought a stock for $1,000 and now the stock is worth $5,000, the donor gets credit on their taxes for $5,000 and it will actually only cost the donor $1,000 and the donor does NOT have to pay capital gains tax.

(Read more about this in Joe Baker's article later in this issue).

This is a good tax strategy to donate more and cost the donor less. If anyone would like to take advantage of this strategy, please contact John Vinson at the APA office or Joe Baker at 501-317-5905 to complete the necessary forms. If you would like more information about the building fund campaign, please call John Vinson at the APA office or Max Caldwell at 870-5887902.

Once again thank you for the opportunity to serve as President of your APA, the strongest pharmacy association in the nation. § 5

5/16/22 5:03 PM

ARRX 2nd Quarter 2022.indd 6

5/16/22 5:03 PM

MEMBER SPOTLIGHT

Megan Smith Pharm.D. Assistant Professor UAMS College of Pharmacy

Pharmacy School & Graduation Year: UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, 2013

Years teaching: 1 year community residency, 2 years research fellowship, 6 years teaching

Favorite part of the job and why: My favorite part is getting

to create, find, and share information to pharmacists and students about community pharmacy. To do this, I intentionally and equally spend time in service, research, and teaching. My research helps to organize and collect best practices and the “why’s” and “how’s” of practice transformation. This helps to inform my teaching and service activities. I get to work collaboratively across states and institutions on creating resources to help schools and colleges of pharmacy focus on community pharmacy practice of today and tomorrow. I then get to share that through several means of presentations, and organization meetings and publications. And the source of all this is the incredible talent and innovations of Arkansas community pharmacists. I started working in community pharmacy as a cashier in 2001 and as my career has formed, that relationship and passion continued to grow. I love that I can work with so many community pharmacists, support them, and tell their story.

Least favorite part of the job and why: That’s a hard one!

It’s easier for me to think about the challenges; staying up to date and prioritizing a lot of great ideas is definitely tough.

Essentially, how and when to spend my time will benefit the profession the most? It’s a daily struggle!

What do you think will be the biggest challenges for pharmacists in the next 5 years? The biggest challenge

(yet greatest opportunity and what we are collectively striving for) is defining, implementing, and executing an expanded business model for patient centered care in community pharmacy settings. There’s also been great achievements in scope of practice this year (e.g. point of care test and treat services, prescribing oral contraceptives), and implementing those is not as easy as flipping a light switch. Careful planning, staffing, and workflows will need to be defined to fully capitalize the new opportunities.

Favorite activities/hobbies: Going on adventures with my two-year old and four-year old boys; if not for them,

WWW.ARRX.ORG

ARRX 2nd Quarter 2022.indd 7

I’d be more of a couch potato enthralled in documentaries.

A favorite pastime is crocheting and I enjoy singing in my church choir, and learning about Instagram reels.

Recent reads: Factfulness: Ten Reasons We’re Wrong About the World and Why Things are Better Than You Think; The Radium Girls: The Dark Story of America’s Shining Women

If not a pharmacist, then...: an administrator of some kind; I’d probably still be organizing, scheduling, and paper pushing somehow! If I had talent, I would either play or sing in musicals.

Why should a pharmacist in Arkansas be an active member of the Arkansas Pharmacists Association? First,

coming from a different state, it is immediately apparent the impact of a strong pharmacy association. My home state is better now, but when I first moved to Arkansas, the APA greatly impressed me by the strong connection and participation of its members. It was also apparent to me how much the Association values and services its membership: regional meetings, on-demand webinars, personal site visits - the Association is committed to being present with the membership. But why a member should be an active member, in my opinion, relates back to the challenges I mentioned above – communication. The APA excels at communication.

The APA provides value to members on federal and state legislation updates and professional resources to help you in your daily practice. What the APA cannot do is communicate shared concerns, values, or best practices without an active membership. To best represent Arkansas pharmacists, you need to be an active member. To best learn with and from each other, you need to be an active member. §

7

5/16/22 5:03 PM

Arkansas Statewide Protocols: Oral Contraception

By Austin Sayyar, Nicki Hilliard, Pharm.D., BCNP, and John Vinson, Pharm.D. This article is the first in a series covering Arkansas's statewide protocols for pharmacists that will be featured in the next several issues of the APA journal.

I

n March 2021, Arkansas passed a law, Act 408 of 2021 (HB1069), to allow pharmacists to prescribe oral contraception under a statewide protocol to those aged eighteen (18) and older. The framework and definition used in by Act 408 of 2021 for “statewide protocol” in Arkansas was originally established in 2017 with Act 284.

This law from 2017 allows for development of statewide protocols approved in interdisciplinary fashion by both the Arkansas State Board of Pharmacy and Arkansas State Medical Board and currently include naloxone (2017), nicotine replacement therapy (2019), oral contraception (2021), treatment for pharyngitis caused by streptococcus A (2021), treatment for influenza (2021), and other health conditions that can be screened utilizing the waived test under the Clinical Laboratory Improvement Amendments (CLIA) of 1988 (2021). Draft protocols for oral contraception, pharyngitis caused by streptococcus A, and influenza are currently being considered in summer of 2022 by both the Arkansas State Board of Pharmacy and Arkansas State Medical Board.

Over the last few years, there has been a growing interest in expanding the authority of pharmacists to directly prescribe and dispense hormonal contraception methods. As of May 2022, there are 24 states, including the District of Columbia, that allow for pharmacists to

8

ARRX 2nd Quarter 2022.indd 8

prescribe and dispense self-administered hormonal contraceptive methods such as the progestin-only oral contraception, combined hormonal contraception, transdermal patches, rings, and IM injection. In the state of Arkansas, the statewide protocol only allows for pharmacists to prescribe oral contraceptives; this includes and is limited to combined oral contraception (COC) and progestin-only contraception (POC). Pharmacists in Arkansas may NOT prescribe IUDs, patches, rings, or IM injections.

Currently, the rate of unintended pregnancy in the U.S. is 45%, to which 95% can be attributed to inconsistent, inappropriate or nonuse of contraception.

Despite the availability of various contraception options and recent expansions in healthcare insurance coverage, many patients, especially those in underserved rural communities, continue to encounter barriers in accessing contraception. Potential solutions to this issue include increasing the accessibility of contraception, reducing waiting times when visiting a provider to obtain contraception, and lowering the associated costs of obtaining contraception. Implementation of this service in other states has shown to increase patient access to contraception, reduce waiting times, reduce overall health care costs, and to reduce the rate of unintended pregnancies.

Patients seeking contraception in underserved rural communities may find it difficult to obtain a prescription; with common barriers including provider

AR•Rx

|

THE ARKANSAS PHARMACIST

5/16/22 5:03 PM

ARKANSAS STATEWIDE PROTOCOLS: ORAL CONTRACEPTION

shortages, poverty, and long-distance travel for healthcare. For many Arkansans, convenient and dependable access to contraception remains a challenge as many patients either do not have a primarycare physician (PCP) or women’s healthcare provider (WHP), or the patient must travel long distances in order to reach their PCP or WHP. Time-consuming delays in accessing a prescriber for contraception may inadvertently contribute to unintended pregnancies, with potentially heavy personal and societal consequences.

In the state of Arkansas, 55% of all pregnancies are unplanned; this takes a massive toll on impoverished households as well as the state taxpayers. 72% of these unplanned pregnancies were paid for by public funds costing the taxpayers of Arkansas over $320 million each year. However, the majority of Arkansans live within five miles of a pharmacy with business hours that often include evenings, weekends, and holidays. This places the pharmacist in an important position to address these barriers to access as pharmacists are among the most accessible health care providers. Implementation of such a program eliminates the need to wait for a doctor's appointment and reduces the total distance a patient would have to travel to receive a prescription or refill as it may be obtained directly from a pharmacist.

In 2012, a report published by the American College of Obstetricians and Gynecologists (ACOG) arguing that oral contraception should be over the counter found that 70% of women who were at risk of unintended pregnancy would utilize a pharmacy for oral contraception and that a large number of uninsured and low-income women who were not using a highly effective contraceptive method would be more likely to use and continue oral contraceptives therapy if they were available at a pharmacy. Enabling community pharmacists to practice to their full scope of practice has the potential to facilitate proactive and comprehensive interventions to time-sensitive prescribed medications such as contraception. In general, services provided by a pharmacist are less costly when compared to that of physician. Lowering the cost of obtaining a prescription for contraception is especially important for increasing access to uninsured patients. The lowered associated costs when utilizing a pharmacy for contraception is not accompanied with a lower quality of service. Data from states that have already implemented such programs have shown equivalent safety outcomes when compared to traditional clinician prescribed birth control. Many women's healthcare providers have also shown strong support for direct access to birth control provided by pharmacists. Approximately 95% of patients can safely use birth control with only small percentage having existing factors that increase the risk of adverse effects.

Pharmacists are well trained to assess blood pressure, obtain medical history, and to provide information on the

WWW.ARRX.ORG

ARRX 2nd Quarter 2022.indd 9

dosing and side-effects of contraception. Pharmacists are, by trade, medication experts and are well-trained to select the appropriate medication for the patient and know when a referral is deemed necessary.

When approved, the statewide protocol will grant pharmacists the authority to prescribe oral contraceptives for the purpose of initiating therapy and administering or dispensing, or both, to persons aged 18 years or older. The pharmacist must screen the patient seeking oral contraceptives to assess whether the patient has been seen by a PCP or WHP within the previous six months. If the patient has NOT been seen by a primary care provider or women’s healthcare provider within the previous six months, the pharmacist must provide the patient with a referral to a local PCP or WHP and not dispense more than a six-month supply of oral contraceptives or the equivalent number of refills to the patient until the patient has been seen by a PCP or WHP. Under the state statute, a pharmacist shall NOT provide the patient with a referral to a licensed abortion provider.

If the patient does have a PCP or WHP, then the PCP or WHP must be notified of the oral contraceptive provided.

An informed consent form, written documentation of the oral contraceptives prescribed as well as a standardized fact sheet must be provided to the patient. The fact sheet must contain the indications and contraindications, the appropriate method for the use, and the need for medical follow-up. A verbal explanation must be given to the patient regarding the possible side-effects of an oral contraceptive and possible health complications and adverse reactions. Lastly, after the initiation of therapy, the number of and age of all women who received oral contraception must be reported to the Department of Health.

The new prescriptive authority of pharmacists in Arkansas to prescribe and initiate oral contraceptive therapy in Arkansas will help reduce associated barriers to access and lower the state’s unintended pregnancy rates. Implementation of this protocol will help increase a patient’s ability to access oral contraception as pharmacists are among the most accessible healthcare providers. It could reduce the waiting times associated with booking an appointment with a PCP or WHP as the patient may directly obtain the prescription from their local pharmacy; this is especially vital for patients in underserved rural communities. The current law will also ensure that women treated by pharmacists receive timely referrals to physicians and other primary care healthcare providers in team based care for other vital healthcare screenings needed for our patients. In conclusion, patients will find additional options to obtain contraception and the benefits extend not only to the personal and societal level but to the profession of pharmacy as a whole. §

9

5/16/22 5:03 PM

LEGISLATOR PROFILE

Senator Bart Hester Cave Springs

District: New District #33 Represents (Counties): Benton County Years in Office: 10 years Occupation: Real Estate / Construction Your Hometown Pharmacist: Walmart What do you like most about being a legislator?

Constituent Service is easily the most rewarding part of being in the Legislature.

What do you like least about being a legislator? The

routine 3 hour drive to the Capitol is the largest challenge but I am grateful I get to do it.

Most important lesson learned as a legislator: Take wins

regardless of how small they seem. Zero sum strategies usually yield zero.

Most admired politician: George W Bush, his leadership following 911 will forever stand out to me.

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

at home that helps to ensure you are heard during times of intense debate on legislation.

Your fantasy political gathering would be: Back stage at a presidential debate.

Hobbies: I have four kids so whatever their current hobbies are are my hobbies. §

AAHP Board

Arkansas State Board of Pharmacy

Executive Director.............Susan Newton, Pharm.D., Russellville

President............................Rebecca Mitchell, Pharm.D., Greenbrier

President...............................Hye Jin Son, Pharm.D., Little Rock

Vice President/Secretary......Lynn Crouse, Pharm.D., Lake Village

President-Elect................ Kevin Robertson, Pharm.D., Little Rock

Past President............................Lenora Newsom P.D., Smackover

Past President.................Kimberly Young, Pharm.D., Little Rock

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

Treasurer.................................Andrea Boland, Pharm.D., Hector

Member.........................................Debbie Mack, P.D., Bentonville

Secretary..................................Melissa Shipp, Pharm.D., Searcy

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

Board Member at Large.............Gavin Jones, Pharm.D., Benton

Public Member...........................................Carol Rader, Fort Smith

Board Member at Large.......Amber Powell, Pharm.D., Little Rock

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

Board Member at Large........Ashley Wilson, Pharm.D., Little Rock

10

ARRX 2nd Quarter 2022.indd 10

AR•Rx

|

THE ARKANSAS PHARMACIST

5/16/22 5:03 PM

139 Convention th

ARRX 2nd Quarter 2022.indd 11

june 9-10, 2022

5/16/22 5:03 PM

139TH APA ANNUAL CONVENTION — JUNE 9-10, 2022 — DOUBLETREE BY HILTON, DOWNTOWN LITTLE ROCK

The Arkansas Pharmacists Association’s (APA) 139th Annual Convention will be held at Doubletree by Hilton in Downtown Little Rock from June 9-10, 2022. The convention theme, Building the Future of Pharmacy, reflects the growing role of pharmacists in the present and future due to the COVID pandemic and simultaneously references the new APA building that will be completed later this year.

Pharmacists can stay up-to-date and informed with the Continuing Pharmacy Education sessions and networking opportunities planned at the convention. This annual conference will welcome up to 350 pharmacists, pharmacy technicians, exhibitors, students, and special guests. ______________________________________________________

WHY ATTEND

____________________________________________________

Continuing Pharmacy Education: APA will offer many hours of Continuing Pharmacy Education credit with highlyregarded instructors on topics ranging from insurance issues to the latest ways to win in a challenging economy.

Comprehensive Exhibition: Exhibitors including pharmacy wholesalers, manufacturers, insurers, Colleges of Pharmacy, hospitals, and software vendors will be on hand to discuss their newest products and services that will benefit the practice of pharmacy in Arkansas. Be sure to visit with these professionals to learn about their innovative products.

12

Social and Networking Events: Join old and new friends at the convention social events. In addition to the always popular Opening Reception at the Exhibit Hall, there will be an opening kick-off social event at the Railyard Little Rock where you can enjoy a night out at the food trucks with all your colleagues. __________________________________________________

Accommodations

__________________________________________________

The host hotel for the 139th APA Annual Convention is the Doubletree by Hilton in Downtown Little Rock, 424 W Markham Street. Check-in is at 3:00 PM and checkout is 12:00 PM. For reservations, call 800-222-8733 or visit www.arrx.org/convention-hotel. Room rate starts at $129.00 plus tax. Mention Arkansas Pharmacists Association Group for group rate.

WE APPRECIATE THE SUPPORT OF OUR WHOLESALE BUSINESS PARTNERS!*

AmerisourceBergen Cardinal Health McKesson Morris & Dickson Company, LLC Smith Drug Company * These organizations did not provide any financial support for continuing education activities.

APA 2022 ANNUAL CONVENTION

ARRX 2nd Quarter 2022.indd 12

5/16/22 5:03 PM

SCHEDULE OF EVENTS Register at www.arrx.org/annual-convention ____________________________________________________

Wed., June 8, 2022

____________________________________________________ 9:00 - 11:00 AM APA Executive Committee Meeting 11:00 AM - 12:30 PM APA Board of Directors Lunch

1:00 - 6:00 PM APA Board Meeting 6:30 - 9:00 PM

Convention Kick-Off at Rail Yard Food Truck Park 12:00 - 1:45 PM AP-PAC Luncheon and Awards Ceremony 2:00 - 5:15 PM • Immunization Update • Adventures in Pharmacy 5:30 - 6:00 PM

President’s Reception Honoring 2021-2022 APA President Max Caldwell and APA Past Presidents

6:00 - 8:00 PM Opening Reception in Exhibit Hall ______________________________________________________ ____________________________________________________

Thu., June 9, 2022

____________________________________________________ 7:00 AM - 4:30 PM Registration

7:30 - 8:30 AM Breakfast

8:30 - 11:45 AM

• Payment for Pharmacist Provided Services • Therapeutics

Fri., June 10, 2022

____________________________________________________ 7:00 AM - 4:30 PM

Registration

7:15 - 8:30 AM Arkansas Pharmacists Foundation Board Meeting

7:30 - 8:30 AM Breakfast

8:30 AM - 12:00 PM • Medical Billing and Insurance Reimbursements • State of the Association Address/

Real Stories from the Field • Time Management 10:00 AM - 12:30 PM Arkansas Association of Health-System Pharmacists (AAHP) Board Meeting

12:00 - 2:00 PM Luncheon in Exhibit Hall

2:00 - 5:15 PM • Law Update • Consulting-Controlled Substance

5:30 PM Convention Adjourns

BUILDING THE FUTURE OF PHARMACY ARRX 2nd Quarter 2022.indd 13

13

5/16/22 5:03 PM

ARRX 2nd Quarter 2022.indd 14

5/16/22 5:03 PM

Springing Into the 2022 1st Quarter FDA Drug Approvals With contributions from Nathan Lamb

J

ust as spring symbolizes revival and reinvigoration, the FDA has galvanized pharmacy practice by approving 7 novel medications to begin 2022. Hematology/Oncology remains a focus area for research and development. However, products for outpatient use are still being pursued. As we say goodbye to winter and the cold weather, it’s time to give a warm welcome to these new therapeutic agents.

Hematology/Oncology: Kimmtrak® (tebentafusp-tebn) is an intravenous bispecific gp100 peptide-HLA-directed CD3 T-cell engager indicated for the treatment of HLA-A*02:01positive adult patients with unresectable or metastatic uveal melanoma. Enjaymo™ (sutimlimab-jome) is a classical complement inhibitor indicated to decrease the need for red blood cell transfusion due to hemolysis in patients with cold agglutinin disease (CAD). Pyrukynd® (mitapivat) is a pyruvate kinase inhibitor indicated for the treatment of hemolytic anemia in adults with pyruvate kinase deficiency.

Vonjo™ (pacritinib) is a Janus Kinase 2 (JAK2) inhibitor

indicated for the treatment of adults with intermediate or high-risk primary or secondary myelofibrosis with a platelet count below 50 x 109 cells/L. Miscellaneous agents: Quviviq™ (daridorexant) is an orexin receptor antagonist that is indicated for the treatment of adult patients with insomnia characterized by difficulties with sleep onset and/or sleep maintenance. Cibinqo™ (abrocitinib) is a Janus Kinase inhibitor indicated for treatment of adults with refractory, moderate-to-severe atopic dermatitis whose disease is not adequately controlled with other systemic drug products, including biologics, or when use of those therapies is inadvisable. Vabysmo™ (faricimab-svoa) is a vascular endothelial growth factor and angiopoietin-2 inhibitor indicated for intravitreal use in patients with neovascular (wet) age-related macular degeneration (nAMD) and diabetic macular edema (DME). §

Drug

Indication

Route

Dosing

Kimmtrak® (tebentafusp-tebn)

Unresectable or metastatic uveal

INJ

Day 1, 8, and 15 of treatment cycle, and

melanoma Enjaymo™ (sutimlimab-jome)

Decrease need for RBC transfusion

weekly thereafter INJ

Weekly for 2 weeks, then every 2 weeks

PO

Twice Daily

PO

Twice Daily

due to hemolysis secondary to cold agglutinin disease Pyrukynd® (mitapivat)

Hemolytic anemia in pyruvate kinase deficiency

Vonjo™ (pacritinib)

Intermediate or high-risk primary or secondary myelofibrosis in adults with low platelets

Quviviq™ (daridorexant)

Insomnia

PO

Daily

Cibinqo™ (abrocitinib)

Refractory, moderate-to-severe atopic PO

Daily

dermatitis Vabysmo™ (faricimab-svoa)

Neovascular age-related macular

INJ

Every 4 weeks, initially

degeneration and diabetic macular edema

WWW.ARRX.ORG

ARRX 2nd Quarter 2022.indd 15

15

5/16/22 5:03 PM

Vaccines for Children Program

S

ince the mid-1990s, pharmacists across the nation have been able to administer vaccinations. Immunization services in pharmacies may soon be an expectation from patients and no longer seen as an “additional service” in a traditional retail pharmacy. There is no denying that the COVID-19 pandemic has highlighted the importance of pharmacies administering vaccines. However, the COVID-19 pandemic has had a negative impact on patients receiving routine vaccinations, especially children.

Many pharmacies have been unable to provide routine vaccinations to children, due to the child having Medicaid or not being insured. Over half of the children in Arkansas have Medicaid.

Pharmacies will usually refer these children to a pediatrician or local health unit for vaccinations. Due to COVID-19, many local health units do not have available appointments for children to receive routine vaccinations for the next several months. This includes vaccines that are required for children to attend school.

Children in Arkansas are currently struggling to receive routine vaccinations on time. As healthcare providers, I believe we can agree that we do not want outbreaks of vaccine-preventable diseases. We do not want parents to “opt-out” of receiving routine vaccinations for their children because it is difficult to get their child vaccinated.

So, what can Arkansas pharmacists do to help? The Vaccines for Children (VFC) program is a federally funded program that provides vaccines to children who might not otherwise be vaccinated because of inability to pay. For children with Medicaid or without insurance, you do not have to refer children to somewhere other than your pharmacy to receive routine vaccinations. All you have to do is become a VFC provider. As a VFC provider, you receive vaccines from the government (which are free to you), and you administer them to eligible patients.

Eligibility Requirements for Vaccines for Children in Pharmacies • Children through 18 years of age who meet at least one of the following criteria: • Insured through Medicaid • Uninsured • American Indian or Alaskan Native • *Children whose health insurance covers the cost of vaccinations are not eligible for VFC vaccines, even when a claim for the cost of the vaccine and its administration would be denied for payment by the insurance carrier because the plan’s deductible had not been met.

Over the years, the Vaccines for Children program in Arkansas has been difficult for pharmacies to justify spending the time, money, and effort to participate in the program. The

16

ARRX 2nd Quarter 2022.indd 16

application system wasn’t designed for pharmacies. There are a lot of rules to follow, including extra equipment required for vaccine storage. The return on investment has been little to none.

However, COVID-19 vaccines provided a unique opportunity for pharmacies to go through the motions of a government-funded vaccine program. If you have been compliant with the storage requirements for COVID-19 vaccines, you should already have most of the necessary equipment to be a VFC provider. The requirements for storage, administration, and reporting COVID-19 vaccines are almost identical to those of the Vaccines for Children program.

The payment model for administering VFC vaccines is also similar to that of COVID-19 vaccines. Since the vaccine is free to you, you must bill $0 for the product, but you can bill an administration fee. For eligible patients without insurance, you may technically “bill” them an administration fee, but you may not deny administration of the vaccine due to the patient’s inability to pay. In other words, you can’t force someone without insurance to pay you an administration fee for a VFC-funded vaccine. Currently, Medicaid reimbursement for administration of VFC vaccines is $15.45 for influenza vaccines and $13.14 for any other vaccines.

While there is a need for more providers in Arkansas to offer all routine vaccinations for children, we recognize that some Arkansas pharmacies may not have a need or wish to provide all childhood vaccines to patients three years and older. Some pharmacists have expressed an interest in offering flu vaccines through the VFC program but not offering other routine vaccinations through VFC. We have been your advocates.

Pharmacies in Arkansas have the choice to either offer all childhood vaccinations to children three years and older, or they may choose to only provide influenza vaccines through VFC. The details for becoming and practicing as a VFC provider are available on the WebIZ homepage. If you are interested in becoming a VFC provider but do not have all necessary equipment, the Arkansas Pharmacists Association (APA) has been awarded grant funding to help pharmacies purchase the essential equipment to become VFC providers. Please visit the following website to submit a request for funding: https://apa. memberclicks.net/minigrants#/. Funding is limited, but you are encouraged to apply. If you have questions regarding becoming a VFC provider, please refer to the Vaccines for Children section on the WebIZ homepage. Information is also available on the Immunize Arkansas website, at: https://www.immunizear.org/ vaccines-for-children Resources: https://www.cdc.gov/vaccines/programs/vfc/index.html

AR•Rx

|

THE ARKANSAS PHARMACIST

5/16/22 5:03 PM

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY

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

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

T

he electronic prescription illustrated in Figure One was transmitted from a prescriber's office to a community pharmacy in Eastern Arkansas. The pharmacy technician entered the patient directions as "Take one tablet on Monday, Wednesday, and Friday and two and one-half tablets on Tuesday, Thursday, Saturday, and Sunday". This information - along with the prescription image was sent from the input queue to the pharmacist verification queue of the computer. The pharmacist initially verified the technician had correctly entered the patient directions, but after further reflection, began to question the appropriateness of a 12.5 mg warfarin dose four days a week (i.e. two and one-half warfarin 5 mg tablets per dose for a total of 12.5 mg). The pharmacist decided to call the prescriber for clarification. After listening to the pharmacist's concerns, the prescriber stated the patient was to receive warfarin 5 mg on Monday, Wednesday, and Friday, and warfarin 2.5 mg on Tuesday, Thursday, Saturday, and Sunday. The prescriber remarked "I can see how the directions we sent are confusing.

I really appreciate you calling". After this, the prescription was correctly filled and the patient instructed to take "one tablet (5 mg) daily on Monday, Wednesday, and Friday, and one-half tablet (2.5 mg) daily on Tuesday, Thursday, Saturday, and Sunday.

Figure 1

The use of electronic prescriptions continues to increase.

Unfortunately, their use does not automatically translate into improved patient safety. The electronic prescription in this case is particularly dangerous. The patient directions contained in this order are unclear and can be interpreted several ways: • Take one tablet (5 mg) on Monday, Wednesday, and Friday and two and one-half tablets (12.5 mg) the rest • Take one tablet (5 mg) on Monday, Wednesday, and Friday, and a 2.5 mg tablet the rest • Take one tablet (5 mg) on Monday, Wednesday, and Friday, and one-half tablet (2.5 mg) the rest (the intended directions) These electronic patient directions are completely unacceptable.

They become dangerous and potentially life-threatening when they are used in conjunction with a narrow therapeutic index medication such as warfarin. If this patient had ingested 5 mg of warfarin three days a week, and 12.5 mg four days a week - for a weekly total of 65 mg - the result could have been catastrophic Fortunately, an alert pharmacist questioned these dangerous directions which had already been entered into the computer by the technician. If this pharmacist had been working in a robotic fashion, she could have quickly glanced at the electronic

WWW.ARRX.ORG

ARRX 2nd Quarter 2022.indd 17

Sig. and verified the technician's interpretation as being correct.

It is important for all pharmacists to treat every prescription as a unique entity. Granted, this can be difficult in a busy, understaffed pharmacy. Pharmacists' who believe their work environment is not conducive to patient safety should bring their concerns to the pharmacy owner or manager. If their concerns are ignored, other employment options should be considered. Pharmacists must be allowed to practice in working conditions that promote patient safety - not jeopardize it. §

STUDENT SPOTLIGHT

Patient Accessibility to Opioid Antagonists - Arthur G. Shaw

P

eople suffering from pain, whether caused by abnormal physiological functions or physical trauma, find ways to alleviate their distress. Many times, pain is managed through use of prescription medication. Sometimes, after completion of therapy, patients have become dependent and have difficulty discontinuing their medication. This dependency can lead to addiction. The Naloxone Access Act allows healthcare professionals to dispense opioid antagonists to people at risk of an overdose or people in a position to assist individuals at risk of an opioid overdose. I believe all pharmacists should be diligent in offering naloxone to patients they feel may be at risk for opioid overdose.

It’s unfortunate that public perception views people suffering from addiction as ne’er-do-wells. After researching causes of addiction and visiting APhA’s Addiction Institute, I realize addiction is a disease. All diseases are worth providing therapy. Pharmacists have a duty to present drug education and necessary access to medications improving quality of life.

Currently, Arkansas pharmacists may initiate therapies, such as naloxone, to people at risk of opioid overdose. Naloxone may be provided to family members, friends, or people in a position to assist individuals at risk of opioid overdose. As a family member and friend of people that have suffered from addiction, I am aware of its negative stigma. Weighing the benefits and risks involving patients’ access to opioid antagonists appear difficult, but I think it’s more difficult imagining a world where your loved one’s no longer exist due to a fatal overdose preventable with opioid antagonists.

17

5/16/22 5:03 PM

Baker's Bulls & Bears

The Benefits of Donating Stocks

by Joe Baker

H

ave you thought about making a difference in Arkansas pharmacy while also leaving a legacy? Allow me to outline a simple plan that will allow you to accomplish both.

As you know, the Arkansas Pharmacists Association is building a new 10,900 square foot building that will be a testament to all pharmacists in Arkansas. Wouldn’t you want to be a part of this historic building event?

Obviously, I am talking about donating money.

I realize that you have been asked many times to donate to one cause or another, but I would like to suggest a way in which you can leverage your money to make a big contribution.

Recently, I endowed a $25,081 scholarship for UAMS College of Pharmacy. You may be saying, “That’s a lot of money”. Yes it is, but do you know what it actually cost me? $6,721. This is because I “donated” 3 individual stocks (Abbott, AbbVie & Pfizer) that appreciated from $6,721 value to $25,081 in just a few years.

Instead of selling the stocks, which would require me to pay a 20% tax rate on the $18,360 gain, I donated the three stocks to UAMS and got a $25,081 charitable tax deduction!

The story behind the stocks I contributed involved UAMS pharmacy students. I teach a personal finance elective at UAMS COP and one of the assignments is for the students to pick an individual company stock, along with reasoning on why it would be a good buy, like P/E ratio, earnings history, dividends, etc. I then pick one or two recommended stocks each semester and buy them during class as a way to teach.

A win – win. The pharmacy students learn something about buying stocks and I get to make a little money, actually, a lot of money. Three of the stocks recommended were Abbott (ABT), AbbVie (ABBV) and Pfizer (PFE), which were the ones I donated to UAMS. If you have appreciated stock or other securities investments and don’t want to sell it and pay the long-term capital gains tax, consider donating your securities to the APA. Both John Vinson and I will be happy to walk you through the process. All you have to do is be willing to make the first step in leaving a fantastic legacy.

18

ARRX 2nd Quarter 2022.indd 18

AR•Rx

|

THE ARKANSAS PHARMACIST

5/16/22 5:04 PM

THE BENEFITS OF DONATING STOCKS

At a Glance

$6,721 -

Original stock value (cost basis)

$18,360 -

Appreciation (long-term capital gain) of stocks. This amount would be subject to a long-term capital gains tax of 20% ($3,672) “if” I had decided to sell the stocks and keep the money.

$25,081 -

Value at time of donation to UAMS Foundation. I received a charitable tax deduction for my income tax in the $25,081 donated value.

Joe Baker has taught at UAMS College of Pharmacy for over 22 years and recently co-wrote a financial book, along with his daughter, Lindsey Jordan Baker, entitled, Baker’s Dirty Dozen Principles for Financial Independence. You can order yours at www.bakersdirtydozen.com so that you will be able to leave a legacy one day. Chapter 13 in my book, “Make a difference in your family, community, and place of worship. This will make you wealthy in your heart, body, and soul. Amen!”

Investment Definitions • COST BASIS - is the original value or purchase price of an asset or investment for tax purposes. The cost basis value is used in the calculation of capital gains or losses, which is the difference between the selling price and purchase price.

• APPRECIATION - in general terms, is an increase in the value of an asset over time.

• LONG-TERM CAPITAL GAINS - are derived from assets that are held for more than one year before they are disposed of. Long-term capital gains are taxed according to graduated thresholds for taxable income at 0%, 15%, or 20%.

• CHARITABLE TAX DONATION - a gift of cash or property made to a nonprofit organization to help it accomplish its goals Source: www.investopedia.com

YOUR JOURNEY

BEGINS HERE!

pharmacy.UAMS.edu

ARRX 2nd Quarter 2022.indd 19

5/16/22 5:04 PM

UAMS SCHOOL OF PHARMACY

Events of Spring 2022 Cindy Stowe, Pharm.D. Dean and Professor UAMS College of Pharmacy

W

ith the new calendar year comes the planning for the end of the academic year. This year for the first time since 2019 we are planning primarily in-person recognition/ celebration events. This is surreal as I am writing this almost exactly two-years to the day that the COP marked the beginning of the local implications of the pandemic with remote delivery of our didactic curriculum and a brief suspension of our experiential curriculum. We are working hard to navigate the unwinding of the pandemic interventions through ups and downs of the variant pandemic waves. Our progress has been slow, and patience has been short at times, but we are moving forward to be as safe as conditions will allow.

We are excited to be doing the planning work to bring people together to celebrate and mark transitions of our students.

The first event of the Spring Semester, was the Class of 2023’s Pinning Ceremony. This ceremony celebrates the transition from mostly in-class education (lectures, etc.) to experiential education (practice setting, etc.) of the curriculum. The Class of 2023’s Pinning Ceremony was on March 4, 2022. For the first time with a regional campus, we did this event synchronously as one college on two campuses with the support of Zoom. Students, Faculty, and Staff on both campuses gathered to mark this transition. Dr. Kate Halloran from the Class of 2021 delivered the keynote address. Executive Director, Dr. John Vinson and PresidentElect, Dr. Dylan Jones joined us in recognizing each student with a lapel pin. A special thank you to members of the Class of 2022 who recommended doing this event together – great idea!

By the time this article is published we hope to have had or are very close to having the rest of our Spring events inperson. Here’s the list of events and the planning highlights.

Awards Ceremony for P1, P2, & P3 Students (April 6, 2022) Last done in-person in 2019, this event recognizes student recipients of awards and scholarships annually.

This year the College was able to award four new student scholarships because of the incredible generosity of four families. The new scholarships are as follows: • • • •

Drs. Brandon & Kaley Achor Advancement in Community Pharmacy Endowed Scholarship The Groves Family Endowed Scholarship Dr. Don Kenneth Hall Class of 1962 Endowed Scholarship Gene D. Pynes, PhD, PharmD, and Mrs. Bobbie Pynes Memorial Scholarship

20

ARRX 2nd Quarter 2022.indd 20

Innovation in Pharmacy Practice Endowed Chair Investiture (April 14, 2022) Unfortunately, this is not an annual event – this investiture marks the 4th COP based professorship or chair. The vision for this Chair started more than ten years ago with Dean Gardner and innovative entrepreneurial Arkansas pharmacists in partnership to better intertwine the work of the College and the Profession.

Fifty-two donors contributed to the establishment of this Endowed Chair that will ensure that the College of pharmacy will be able to recruit and retain a prominent scholar who can help create new roles for pharmacists and conduct practical clinical research that will be the foundation for innovation in pharmacy practice. We are excited to have Dr. Geoffrey Curran invested as the inaugural holder of the Innovation in Pharmacy Practice Endowed Chair. Geoff is an internationally recognized implementation scientist who conducts research in community pharmacies to develop and implement innovative solutions to increasing demands for access and quality healthcare in rural communities using local pharmacists and pharmacy care teams.

Our final Spring events occur the same weekend, Honors Convocation and the University Commencement, and as I write this, I’m hoping not to jinx our plans to have fully in-person events on the most important weekend of the academic year. Reminder, I am writing this in March for you to read in May/June… Class of 2022 Honors Convocation (5/20 evening) and Commencement (5/21 afternoon) We will recognize the Class of 2022 by individually hooding each member of the class with the doctoral hood representing the Doctor of Pharmacy degree in preparation for degree conferral on Saturday. These events mark the last outward symbols of the formal education in the preparation to become a pharmacist. I think the faculty will join me in saying that we have dearly missed celebrating in-person with our Class of 2020 and 2021 graduates.

I close by highlighting the loss of a pillar in healthcare delivery. In February Dr. Paul Edward Farmer passed away unexpectedly while working in Rwanda. Dr. Farmer is known for his unwavering commitment to preferential option for the poor in health care. Dr. Farmer’s legacy shows us how one person can make such a profoundly positive difference to humanity. Stay healthy and well and continue making positive differences in your communities. §

AR•Rx

|

THE ARKANSAS PHARMACIST

5/16/22 5:04 PM

HARDING UNIVERSITY REPORT

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

H

ello from Harding University College of Pharmacy (HUCOP)! As I write this, we are wrapping up a wonderful semester and continue to enjoy being back together in the classroom as the grip of the COVID-19 pandemic has continued to loosen. I am so proud of the work that our students, faculty, and staff have accomplished in persevering through challenging times and continuing to make HUCOP such a special place.

Much like the season, Springtime at Harding is filled with many new opportunities and celebrations. Our fourth-year students have counted down the days to graduation and are well-prepared and poised to begin their pharmacy careers. We also celebrate our third-year students each spring with a formal Pinning Ceremony that signifies their transition from classroom learning into advanced pharmacy practice experiences. It seems that each milestone our students reach is warmly greeted and celebrated by the Arkansas Pharmacists Association. We are so thankful to have Dr. John Vinson and members of the APA attend our Pinning Ceremony and to officially recognize our graduating students with complimentary APA memberships. These meaningful occasions for our students represent years of focused and dedicated work toward the goal of becoming pharmacists, and we look forward to watching our HUCOP family grow and advance each year.

One of the highlights of each spring semester is Match Day where students find out about their pharmacy practice residency matches. This year, we were pleased that more than 70% of our participating P4 students were matched with a first-year postgraduate pharmacy practice (PGY-1) residency. What’s more, three of our 2021 graduates were matched with second-year postgraduate pharmacy practice (PGY-2) residencies. Please join me in congratulating the following members of our HUCOP family for these residency selections: • • • •

21

Jamie Coalson, PGY1 Institutional Residency at Mercy Hospital Northwest Arkansas, Rogers, AR Karlee Carney, PGY2 Ambulatory Care Specialty Residency, Augusta, AR Aritney Cooper, PGY1 Community Residency, ARcare, Augusta, AR Kassandra Fetz, PGY2 Oncology Specialty Residency, Norton Children’s Hospital, Louisville, KY

WWW.ARRX.ORG

ARRX 2nd Quarter 2022.indd 21

•

• • • • • •

Emily Gastro, PGY1 Institutional Residency at SSM Health Cardinal Glennon Children’s Hospital, St. Louis, MO Nathan Lamb, PGY1 Institutional Residency, University of Arkansas Medical Center, Little Rock, AR Lincoln Neal, PGY1 Institutional Residency, Unity Health – White County Medical Center, Searcy, AR Madeline Phan, PGY1 Community Residency, UAMS/ Harps Food Stores, Little Rock, AR Caleb Shelton, PGY1 Institutional Residency, CHI St. Vincent Infirmary, Little Rock, AR Natalie Stirrup, PGY2 Critical Care Specialty, University of Arkansas Medical Center, Little Rock, AR Andrea Winters, PGY1 Community Residency, Indian Health Service, Choctaw Nation, OK

We were also delighted to learn that one of our rising P3 students, Marilyn Gafford, was selected to complete a summer internship in the FDA Office of Clinical Pharmacology. This highly competitive research internship will take place at the U.S. Food and Drug Administration’s White Oak Campus in Silver Spring, MD. Ms. Gafford, and select other students from across the nation, will be involved in regulatory research involving clinical pharmacology and drug development and will have a schedule of lectures/ conferences on clinical pharmacology topics including policies and guidances.

With the conclusion of each new school year, our attention quickly turns to the next incoming class. This year, we will welcome the Class of 2025 on June 7th. It’s hard to believe, but this will be our 15th entering cohort of students! We are excited for their arrival, and I look forward to sharing more about our newest additions to the HUCOP family with you soon. If you, or someone you know, is interested in learning more about our program, please reach out or visit www. harding.edu/pharmacy. §

21

5/16/22 5:04 PM

CONSULTING ACADEMY REPORT

Update to Pneumococcal Vaccines and Guidelines Emily Holton, Pharm.D. Consulting Academy 2021-2022 President

A

s a long-term care consultant pharmacist, it is critical to educate appropriate nursing home personnel and clearly convey new or updated recommendations or guidelines to ensure the best care for residents.

On January 27, 2022 the CDC released new simplified recommendations for pneumococcal vaccination, including the use of two recently approved vaccines, Prevnar 20 (PCV20) and Vaxneuvance (PCV15). Prevnar 20 and Vaxneuvance received approval by the FDA in July of 2021 and recommendation by the Advisory Committee on Immunization Practices (ACIP) in October 2021 Pneumococcal disease is an infection caused by the bacteria Streptococcus pneumoniae, or pneumococcus, and different strains of the bacteria are referred to as serotypes. There are greater than 90 known serotypes, however some serotypes more frequently cause serious disease than others. Invasive pneumococcal disease (IPD) is an infection occurring in a part or parts of the body that are usually free from germs, including but not limited to: blood, cerebrospinal fluid, joints and bones.

Currently, there are two types of pneumococcal vaccines available— pneumococcal polysaccharide vaccine (PPSV23) and pneumococcal conjugate vaccines (PCV13, PCV15, and PCV20). Polysaccharide vaccines contain polysaccharide antigens that direct the immune system to respond to invading bacteria, and while they are very effective in eliciting immune response in people with mature/competent immune systems, these vaccines do not work in young children and are less effective in older adults and those with certain underlying risk factors. Conjugate vaccines contain the same polysaccharide antigens attached to a much “stronger” protein antigen, which allows for a more robust immune response, including memory B cells, and thus potentially longer-lasting immunity.

Compared with the Prevnar13 vaccine, the newly approved Prevnar20 protects against seven additional serotypes while the newly approved Vaxneuvance protects against an additional 2 serotypes that are known to cause invasive pneumococcal disease (IPD) and pneumonia.

The new recommendations apply to PCV-naïve adults who are either: aged 65 years or older, or who are 19-64 years with risk factors (cancer, diabetes, smoking, etc.) and have not previously received a pneumococcal vaccine, or if vaccination history is unknown. New recommendations have eliminated the use of Prevnar13 for adults. CDC now recommends Vaxneuvance followed

by Pneumovax23 one year later (or as soon as 8 weeks later in immunocompromised adults) or Prevnar20 alone, after which, no boosters are needed. CDC does not specify

22

ARRX 2nd Quarter 2022.indd 22

preference of one strategy over the other. However, a onetime dose of Prevnar20 may be more attractive to providers due to a more simplified and practical dosing schedule.

A recent Pharmacist’s Letter article provides the following simplified approach: •

No prior pneumococcal vaccines - give 1 dose of Prevnar 20

•

Prior Pneumovax 23 only - consider giving 1 dose of Prevnar 20 after 1 year

•

Prior Prevnar 13 with or without Pneumovax 23 don't give Prevnar 20 or Vaxneuvance yet. There aren't data on whether giving one of the new vaccines on top of Prevnar 13 adds much benefit. For now, complete the prior Pneumovax 23 schedule...such as giving Pneumovax 23 to adults 65 and older 1 year after Prevnar 13.

The CDC has developed an app for pneumococcal vaccination that has streamlined the screening process and gives the appropriate recommendation for an individual based on past vaccination status, eliminating the challenges of interpreting multiple recommendation statements.

The app is called PneumoRecs Vax Advisor and can be downloaded in the app store, making it readily accessible.

A desktop version is also available if using a device without support to apps (https://www2a.cdc.gov/vaccines/m/ pneumo/pneumo.html). The app is simple to use and is patient specific. Start by entering a date of birth. If under 65, select any specific underlying medical conditions. Lastly, answer questions regarding pneumococcal vaccination history. The app will then provide guidance on which vaccines are needed and when.

Sources:

Article, Clarify New Guidelines for Prevnar 20 and Vaxneuvance, Pharmacist's Letter, March 2022 CDC Issues New Pneumococcal Vaccine Recommendations for Adults - Medscape - Feb 01, 2022.

Kobayashi M, Farrar JL, Gierke R, et al. Use of 15-Valent Pneumococcal Conjugate Vaccine and 20-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:109–117. §

AR•Rx

|

THE ARKANSAS PHARMACIST

5/16/22 5:04 PM

COMPOUNDING ACADEMY REPORT

Marketing 101 Greg Turner, Pharm.D. Compounding Academy 2021-2022 President

I

f idea of marketing is pulling the chain on the open sign, you are destined to either mediocrity, bankruptcy, or both! For years now most of your patients have had some sort of prescription pay source with a copay. Essentially, in most cases this means that a patient can go anywhere (PBM willing) to get their prescriptions filled. The question is “why should they come to your pharmacy?” Have you ever thought about it? Besides your dazzling personality and excellent pharmaceutical care, why would someone want to do business with your pharmacy? Do you have some sort of draw that is different than those other pharmacies?

Is it a huge front end with gifts? Is it staffing built for fast prescription filling? Is it free delivery? Is it testing? Is it $4 prescriptions?

Let’s move beyond location, location, location, and count that as a given. Ultimately, there are two ways to get business through your door, you can DRIVE IT or PULL IT. Let’s explore both.

Driving Demand

Pulling Demand

The world of marketing your business has certainly changed.

Radio, billboards, and newsprint options have been either replaced or supplemented with online options. Marketing has moved from a shotgun approach for the masses to a precise pinpoint selection of both target and message.

While I do not claim to be an expert in social media marketing, I do know that having professional help with your online platforms is a must. Whether it is geofencing, Facebook Ads, Instagram, Tik Tok, or Twitter, having a clear and consistent brand voice in the marketplace will help you grow your business.

Although there are many companies that can help you get your message out to target customers, having a clear branding proposition is key. Before you get caught up in having an online presence, you must take time away from the bench to determine what your brand is all about?

Be careful to separate the thrill of clicks and likes from the sound of a cash register. One pays your bills and the other strokes your ego. §

Pharmaceutical companies have been doing this for years.

As a matter of fact, Colonel Eli Lilly used pharmacists as the company’s “detail men” from the beginning. Decked out in dark suits, fedora hats and a bag full of promotional materials, Lilly pharmacists made the rounds educating providers on drugs from Ceclor to Humulin to Prozac and beyond. They even stopped at every drugstore in town and walked the shelves looking for returns of out-of-date stock.

Lilly pharmacists were the face of the brand. I remember the first Lilly pharmacist that I met at Petty’s Drug on Markham.

Pat would come into the store in the late afternoon looking sharp and professional. Everyone in town knew Pat and could count on him to provide the answers that mattered.

Colonel Lilly knew that by sending in pharmacists, the most trusted profession, he would get instant credibility with providers. Not until the late 1980’s did Lilly begin to hire non-pharmacists to detail their products to providers.

So…..you are not a trained salesperson and may loathe the term, however you are THE disease state and medication expert. Who better to speak on topic than a pharmacist! You could begin with your local Rotary, Kiwanis or Lions Club or maybe the local senior center. How about an in-service? You would be surprised how much impact a simple lunch and learn with nurses can have on your relationship. It is nice to put a name and face with the person on the other end of the fax/e-script/telephone.

Wherever you decide, choose a disease state, put some slides together and voila, you are ready to connect and drive demand.

WWW.ARRX.ORG

ARRX 2nd Quarter 2022.indd 23

23

5/16/22 5:04 PM

Drug Recalls This series, Pharmacy and the Law, is presented by Pharmacists Mutual Insurance Company and the Arkansas Pharmacists Association through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community.

A

s a young pharmacist, I experienced my first recall when the drug Oraflex (benoxaprofen) was taken off the market in 1982. The drug was effective in treating arthritis but had some serious side effects. What I remember were patients telling us this was the only drug that worked for them and asking us to sell it to them rather than returning the drug to the manufacturer. Ultimately, we decided to send it back to the manufacturer. The recent recall of ranitidine and other products for nitrosamine impurities caused me to reflect on how little I understood recalls in 1982.

Drug recalls are voluntary actions taken by a manufacturer to remove a defective product from the marketplace. A recall can be initiated by the manufacturer or the Food and Drug Administration (FDA) can request a recall. Recalls are almost always voluntary by the manufacturer and FDA rarely requests a recall. FDA's role in a drug recall is the same as in the recall of other FDA regulated products; e.g. medical devices, cosmetics, food, etc. The agency's role is to classify the recall, to oversee the manufacturer's strategy, and assess the adequacy of the recall.

Recalls are classified by their severity. Class I recalls involve a dangerous or defective product that could cause serious health problems or death. Class II recalls involve products that could cause a temporary health problem or a slight threat of serious harm. Products involved in Class III recalls are unlikely to cause adverse health reactions, but the products violate labeling or manufacturing laws. You will not hear about every recall on the news. Public notification of a recall usually occurs when the product has been widely distributed or poses a serious health hazard, such as in a Class I recall. However, all recalls are posted weekly on the FDA website through their Enforcement Reports page. (https://www.fda.gov/ safety/recalls-market-withdrawals-safety-alerts/enforcementreports) You can also register to receive email notifications of new and updated recalls. Familiarizing yourself with current recalls will be beneficial when your patients contact you with a question about a recall. FDA recommends patients talk to their pharmacists about recalled medications. Class I recalls generally provide information specifically for patients, but other Class recalls do not. Being informed about current recalls will assist you in helping your patients get replacement therapies.

24

ARRX 2nd Quarter 2022.indd 24

The ranitidine recall applied to both prescription and overthe-counter (OTC) versions of the drug. The recall notice advised patients to stop taking OTC ranitidine immediately, but to consult with their health care professional about other treatment options before discontinuing prescription ranitidine.

These types of instruction will generate questions from your patients. Besides being aware of the recommendations for your patients, the recall notice will advise the pharmacy on the removal of the drug from stock and the return procedures.

From a liability perspective, you should follow the procedures outlined in the recall notice. Remove items from stock as instructed. Some recalls will advise you to contact patients currently taking a prescription product. Verify that you have or had the affected lots and notify your patients who received the affected lots as soon as practical. Keeping your computer system updated with current lot numbers and expiration dates of prescription products is crucial to being able to identify those who have received the recalled product. If you receive a new prescription after the recall notice, use the opportunity to help educate prescribers in your area. Be ready to suggest alternatives that are not affected by the recall. Needless to say, it is not a good idea to sell or dispense recalled products at the patient's request instead of following the return process in the recall notice. Another bad idea is compounding the recalled medication when the manufactured product isn't available due to a recall.

Rather than being a passive recipient of information, going online to regularly review recall notices will allow you to be proactive with you patients' therapies. Your patients will see you as a trusted partner in their healthcare. Follow the recall procedures, make sound professional judgments when necessary, and your patients will value your services even more. § ____________________________________________________________________

© Don R. McGuire Jr., R.Ph., J.D., is General Counsel, Senior Vice President, Risk Management & Compliance at Pharmacists Mutual Insurance Company.

This article discusses general principles of law and risk management. It is not intended as legal advice. Pharmacists should consult their own attorneys and insurance companies for specific advice. Pharmacists should be familiar with policies and procedures of their employers and insurance companies, and act accordingly.

AR•Rx

|

THE ARKANSAS PHARMACIST

5/16/22 5:04 PM

College Funding Choices

Explore the different ways you can help finance the costs of higher education.

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

H

ow can you help cover your child’s future college costs? Saving early (and often) may be key for most families. Here are some college savings vehicles to consider.

qualified education expenses. Contributions may be made until the account beneficiary turns 18. The money must be withdrawn when the beneficiary turns 30, or taxes and penalties may occur.3,4

529 college savings plans - Offered by states and some educational institutions, these plans allow you to save up to $15,000 per year for your child’s college costs without having to file an I.R.S. gift tax return. A married couple can contribute up to $30,000 per year. However, an individual or couple’s annual contribution to a 529 plan cannot exceed the yearly gift tax exclusion set by the Internal Revenue Service. You may be able to frontload a 529 plan with up to $75,000 in initial contributions per plan beneficiary—up to five years of gifts in one year—without triggering gift taxes.1,2 Remember, a 529 plan is a college savings play that allows individuals to save for college on a tax-advantaged basis. State tax treatment of 529 plans is only one factor to consider prior to committing to a savings plan. Also, consider the fees and expenses associated with the particular plan.

Whether a state tax deduction is available will depend on your state of residence. State tax laws and treatment may vary. State tax laws may be different than federal tax laws. Earnings on non-qualified distributions will be subject to income tax and a 10% federal penalty tax. If your child doesn’t want to go to college, you can change the beneficiary to another child in your family.

You can even roll over distributions from a 529 plan into another 529 plan established for the same beneficiary (or another family member) without tax consequences.1,2 Grandparents can also start a 529 plan or other college savings vehicle. In fact, anyone can set up a 529 plan on behalf of anyone. You can even establish one for yourself.1,2

UGMA & UTMA accounts. These all-purpose savings and investment accounts are often used to save for college. They take the form of a trust. When you put money in the trust, you are making an irrevocable gift to your child. You manage the trust assets until your child reaches the age when the trust terminates (i.e., adulthood). At that point, your child can use the UGMA or UTMA funds to pay for college; however, once that age is reached, your child can also use the money to pay for anything else.5 Using a trust involves a complex set of tax rules and regulations. Before moving forward with a trust, consider working with a professional who is familiar with the rules and regulations.

Imagine your child graduating from college, debt-free.

With the right kind of college planning, that may happen.

Talk to a financial professional today about these savings methods and others.§

Coverdell ESAs - Single filers with modified adjusted gross incomes (MAGIs) of $95,000 or less and joint filers with MAGIs of $190,000 or less can pour up to $2,000 into these accounts annually. If your income is higher than that, phaseouts apply above those MAGI levels.

Money saved and invested in a Coverdell ESA can be used for college or K-12 education expenses.3 Contributions to Coverdell ESAs aren’t tax-deductible, but the accounts enjoy tax-deferred growth, and withdrawals are tax-free, so long as they are used for

WWW.ARRX.ORG

ARRX 2nd Quarter 2022.indd 25

Citations: 1. IRS.gov, March 5, 2021 2. FINRA.org, 2021 3. IRS.gov, March 5, 2021 4. TheBalance.com, April 27, 2021 5. Finaid.org, 2021 ________________________________________________________________ Pat Reding and Bo Schnurr may be reached at 800-288-6669 or pbh@ berthelrep.com. Registered Representative of and securities and investment advisory services offered through Berthel Fisher & Company Financial Services, Inc. Member FINRA/SIPC. PRISM Wealth Advisors LLC is independent of Berthel Fisher & Company Financial Services Inc. This material was prepared by MarketingLibrary.Net Inc., and does not necessarily represent the views of the presenting party, nor their affiliates.

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

25

5/16/22 5:04 PM

2021 Recipients of the “Bowl of Hygeia” Award

Rebecca Sorrell Alabama

Richard A. Holt Alaska

Michael R. Blaire Arizona

Paul Ackerman Florida

Laird Miller Georgia

Chris Lynch Illinois

Robert E. Hodge II Arkansas

Omolola A. Adeoye-Olatunde Indiana

Katherine E. Bass California

Nancy Stolpman Colorado

Jill Fitzgerald Connecticut

Megan Willey Delaware

Steven W. Sayler Iowa

Doug Funk Kansas

Melinda C. Joyce Kentucky

TJ Woodard Louisiana

Bill Mosby Mississippi

Salim (Sam) Tadrus Missouri

Mike Bertagnolli Montana

Jennifer Ortega New Mexico

Gary A. Rotella New York

Mollie Ashe Scott North Carolina

Cheri Kraemer South Dakota

Thomas Marcrom Tennessee

Amelia Arnold Charmaine Rochester-Eyeguokan JoAnn Sanborn Maine Maryland Michigan

Jennifer Tilleman Nebraska

Cheryl Durand New Hampshire

Lucio R. Volino New Jersey

Terry Altringer North Dakota

Greg Adams Oklahoma

Amy D. Valdez Oregon

Gregory Myers Utah

Troy D. Spaulding Vermont

The “Bowl of Hygeia”

Trish Klatt Pennsylvania

Charles Tarasidis Virginia

Tara Higgins Rhode Island

C. A. Leon Alzola Washington Photo Not Available

David E. Burke Ohio

Merrie Kay Alzola Washington Photo Not Available

John T. Johnson South Carolina

Carolyn Rachel-Price Washington DC

Charlotte Weller Texas

Krista D. Capehart West Virginia

Photo Not Available

Fran D’Egidio West Virginia

2020 Recipient Presented in 2021

Hashim Zaibak Wisconsin

Craig Frederick Wyoming

The Bowl of Hygeia award program was originally developed by the A. H. Robins Company to recognize pharmacists across the nation for outstanding service to their communities. Selected through their respective professional pharmacy associations, each of these dedicated individuals has made uniquely personal contributions to a strong, healthy community. We offer our congratulations and thanks for their high example. The American Pharmacists Association Foundation, the National Alliance of State Pharmacy Associations and the state pharmacy associations have assumed responsibility for continuing this prestigious recognition program. All former recipients are encouraged to maintain their linkage to the Bowl of Hygeia by emailing current contact information to awards@naspa.us. The Bowl of Hygeia is on display in the APhA History Hall located in Washington, DC.

ARRX 2nd Quarter 2022.indd 26

5/16/22 5:04 PM

ARRX 2nd Quarter 2022.indd 27

5/16/22 5:04 PM

ARRX 2nd Quarter 2022.indd 28

5/16/22 5:04 PM