ARRX 2nd Quarter 2020

Second Issue 2020 Award-Winning Quarterly Publication of the Arkansas Pharmacists Association

STATE PHARMACISTS AND APA ADAPT TO THE NEW NORMAL

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CONGRATULATIONS

2020 SCHOLARSHIP WINNERS

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

AMNA PARACHA University of Maryland Eastern Shore

MASON SYKES Samford University

BENJAMIN HIGHTOWER University of Georgia

MORGAN PLATTA University of Wisconsin–Madison

BROOKE HENRIKSEN California Health Sciences University

LESLIE VO University of Texas at Austin

JADA JENSEN University of Wyoming

ROBERTO NAVA University of California-San Diego

EMILY BRUNSON University of Texas at Austin

NEVIN RADECHEL Drake University

LAUREN BREWER University of Georgia

RAEANN KILGORE University of Missouri–Kansas City

JOHNNY ALEXANDER University of Texas at Austin

SARAH HENDERSON Virginia Commonwealth University

JULIA ANNIS University of Rhode Island

STEPHANIE MARTIN Drake University

KAYLA LELAND Washington State University

STEPHANIE LUKEVICH South University

MICHAEL DANILOV University at Buffalo

BRIANNA SMITH William Carey University

ACCEPTING APPLICATIONS FOR 2021 SCHOLARSHIP Pharmacists Mutual Insurance Company 808 Highway 18 W | PO Box 370 | Algona, Iowa 50511 P. 800.247.5930 | F. 515.295.9306 | E. info@phmic.com

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

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

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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 Office E-mail Address Staff@arrx.org

Publisher: John Vinson Editor: Jordan Foster Design: Gwen Canfield - Creative Instinct Arkansas Pharmacists Association P.O. Box 3798 Little Rock, AR 72203 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 ($15.00). Non-members subscription rate is $35.00 annually. Periodical rate postage paid at Little Rock, AR 72201. Current edition issue number 90. © 2020 Arkansas Pharmacists Association.

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

CONTENTS 4 Inside APA: Is the Arkansas Pharmacists

Association Essential?

5 From the President: The Best Laid

Plans

20 Legislator Profile: Rep Justin Boyd 21 Legislator Profile: Rep Marsh Davis 23 Rx & the Law: Social Media and HIPAA

7 Member Spotlight:

24 AAHP: Navigating a Pandemic:

8 FEATURE: State Pharmacists and APA

25 Compounding Academy: Lessons from

13 Safety Nets: Beware the "New" Types of

26 Arkansas Pharmacy Phoenix Movement

Brian Smith, Pharm.D. Prescription Pad Pharmacy Adapt to the New Normal Errors of E-prescribing

15 New Drugs: FDA Follows Through on

Commitment to Increase Competition and Lower Drug Costs

16 UAMS: Routine and Normal:

My, My How Things Can Change

17 UAMS College of Pharmacy 2020

Graduates

18 Harding: Immeasurable Challenges &

Changes

19 Harding University College of

Physically Apart but Working Closer Together than Ever 2020

ADVERTISERS 2 Pharmacists Mutual 6 Retail Designs, Incorporated 6 Arkansas Pharmacy Support Group 12 Pharmacy Quality Commitment 14 AR Pharmacy Foundation Brick Order Form 14 EPIC 22 UAMS College of Pharmacy 22 Prescribe Wellness 25 Law Offices of Darren O'Quinn 27 Biotech Pharmacal, Inc. Back Cover: Smith Drug Company

Pharmacy 2020 Graduates

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APA Board of Directors

INSIDE APA

2020 - 2021 Officers President – Kristen Riddle, Pharm.D., Greenbrier President-Elect - Max Caldwell, P.D., Wynne Vice President – Dylan Jones, Pharm.D., Fayetteville Past President – Dean Watts, P.D., DeWitt

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 - Greta Ishmael, Pharm.D., Cherokee Village 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 Kim Young, Pharm.D., Little Rock Academy of Compounding Pharmacists Brooks Rogers, Pharm.D., Little Rock Academy of Consultant Pharmacists Denise Robertson, Pharm.D., Little Rock

Ex-Officio APA Executive Vice President & CEO John Vinson, Pharm.D., Benton AR State Board of Pharmacy Representative John Kirtley, Pharm.D., Little Rock Board of Health Member Marsha Boss, P.D., Little Rock UAMS College of Pharmacy (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 Ashlyn Tedder Ward, Little Rock Harding COP Student Aritney 4 Cooper, Searcy

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John Vinson, Pharm.D. APA Executive Vice President & CEO

Is the Arkansas Pharmacists Association Essential?

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s I write this editorial, Arkansas is several months into a state-declared public health emergency for the coronavirus pandemic. COVID-19 news floods our inboxes and daily video conferences. Nothing is ‘business as usual.’ Community pharmacies remain open, many curbside or delivery only, to providing essential medications and services to their patients. Health-system pharmacists have been challenged with drug shortages, managing policies and inventory for emergency treatment of COVID-19, personnel changes, including furloughs for employees, and infection control changing daily.

Senior care pharmacists face unique challenges as outbreaks hit nursing homes and pharmacists are not even allowed inside to perform consulting.

All have been faced with the challenges of workflow changes and the stress of preventing an outbreak of COVID-19 in the workplace. Regardless of practice setting, pharmacist roles are different today than they were only a few weeks ago.

Just as a rise in COVID-19 cases is inevitable, it is also inevitable that pharmacists will be front and center during this public health emergency and global pandemic. Pharmacists and pharmacy technicians are essential members of the healthcare team and essential members of the frontline workforce. YOU, Arkansas Pharmacists Association (APA) members, are among the healthcare heroes that will rise to take care of our state – one community, one facility, one patient at a time.

While pharmacists and pharmacy technicians are essential, what about the Association that represents you? Is an association essential? Two months ago, I wondered if I would be putting my pharmacist license into action and called to practice directly alongside my colleagues on the frontlines. However, over the last 60 days, our team has

engaged in essential and time sensitive pharmacist advocacy, information sharing, consulting, timely education and secured personal protective surgical masks for our members. Through this experience, I have learned that our entire team is needed here more than ever to support each of you, healthcare professional, on the frontlines.

APA (along with numerous other associations) have opened many of our member-only benefits to share information with all pharmacy professionals in need. This has included extended the grace period of membership renewal, opening APA resources to all Arkansas pharmacists until May, and we continue to share important and time sensitive information on Facebook message boards. APA staff members spend our days providing advocacy to the 135 state legislators as well as state agencies including the Arkansas Board of Pharmacy, Arkansas Medicaid, the Arkansas Insurance Department, the Arkansas Attorney General, the Office of Medicaid Inspector General, the Arkansas Economic Development Commission, Employee Benefits Division, as well as the Executive Branch and the Governor’s staff. APA has also been in close communication with all six members of Arkansas’s United States congressional delegation and their staff, and daily with national pharmacy organizations to communicate pressing concerns to federal agencies. Our highest priority is to advocate for you, as essential healthcare providers, during this time.

We’ve worked with professional leaders in the state to conduct five statewide webinars/conference calls targeted to health systems pharmacists, community pharmacists and the profession at large.

One of those was a historic live townhall meeting with Governor Hutchinson for a question and answer session about issues specific to pharmacists. We increased emailed communication to daily in the first month and three to four AR•Rx

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times weekly in recent weeks. This has included emergent and timely communication about small business loans and grants from both federal sources and state sources that hundreds of our members were able to successfully apply for and receive.

In addition to relevant information and important advocacy in real time, we’re doing what associations excel at – strategically planning for the future. Discussing long-term implications of COVID-19 on the pharmacy profession and what the ‘next normal’ looks like for pharmacists in Arkansas and for Arkansas Pharmacists Association operations.

Whether or not an association is defined as ‘essential,’ I am convinced that the work of our association has never been more important than it is right now. We represent members of a profession who are 100% essential, and I have never been more excited to work on behalf of the pharmacy profession.

APA has embraced this additional and important work and the renewed purpose that comes with serving the profession.

From the staff team at APA – thank you – thank you for your dedication to all those you work with and serve. And thank you for the privilege of advocating on your behalf. §

FROM THE PRESIDENT

The Best Laid Plans

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hree months ago, I was looking forward to a predictable final quarter of my term as president of the APA. Dealing with only a fiscal session of the state legislature, planning the June annual convention of the APA, attending the NCPA flyin in Washington, D.C., and, unpredictably, I was to have the opportunity to attend the Supreme Court hearing of Rutledge v. PCMA. Oh well...best laid plans and all!!!

As we all know now, all of these events were altered or postponed in some fashion due to the Covid-19 pandemic. Our world has been turned upside down both for the foreseeable future and perhaps forever. I hope all our members are treating this pandemic with the respect it deserves and are able to pursue their professional goals in a cautious and safe manner.

I must take this opportunity to sing the praises of the APA staff. Under the leadership of CEO John Vinson, the APA has been directly responsible for the encyclopedia of information concerning the Covid-19 crisis that has been filtered to the membership at least weekly via the APA newsletter. Hats off to Jordan Foster for his talents of assimilation of that information and dissemination in a manner we can all consume and digest.

Thanks to Susannah Fuquay for her extraordinary efforts to scratch all her previous plans for another exciting annual convention and bringing alternative venues to the board for consideration. All the while, Celeste Reid, Debra Wolfe and Emily Wilson have maintained their “eyes on the ball” to keep the basic operations and functions of the APA in working order.

I must also recognize the efforts of these comrades in reaching outside the normal boundaries of the mission of the APA and demonstrating the true heart and soul of the public servants that they represent.

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Dean Watts, P.D. 2019 - 2020 President

The manufacture and distribution of hundreds of gallons of hand sanitizer to homeless shelters in Arkansas was the direct result of the collaboration between John Vinson, the schools of pharmacy in Arkansas and pharmacist Lyn Fuchey. Collaboration that was a result of a wish from our friends at the State Health Dept and John Vinson’s desire to return the favor of providing opportunities for all our pharmacist members.

The procurement and distribution of thousands of surgical masks to pharmacies in Arkansas was also a collaboration between APA staff and a manufacturer/importer that was introduced to us by pharmacist Eddie Mitchell.

These initiatives were successful due to the diligence and single-mindedness of John Vinson and his staff.

With that, I will conclude my final contribution to this journal.

It has been a terrific honor and pleasure to work with the individuals I have mentioned and so many others that have impressed upon me their pride in their chosen profession. A pride they carry for all to see. §

AAHP Board

Arkansas State Board of Pharmacy

Executive Director.............Susan Newton, Pharm.D., Russellville President..........................Kimberly Young, Pharm.D., Little Rock President-Elect......................Hye Jin Son, Pharm.D., Little Rock Past President...........Erin Beth Hays, Pharm.D., Pleasant Plains Treasurer...........................Kendrea Jones, Pharm.D., Little Rock Secretary..................................Melissa Shipp, Pharm.D., Searcy Board Member at Large.............Gavin Jones, Pharm.D., Benton Board Member at Large........Chad Krebs, Pharm.D., Little Rock Board Member at Large.......Amber Powell, Pharm.D., Little Rock

President..................................Lenora Newsome, P.D., Smackover

Technician Representative....BeeLinda Temple, CPhT, Pine Bluff WWW.ARRX.ORG

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Vice President/Secretary...Rebecca Mitchell, Pharm.D., Greenbrier Member..........................................Steve Bryant, P.D., Batesville

Member................................Lynn Crouse, Pharm.D., Lake Village Member..........................................Brian Jolly, Pharm.D., Beebe

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

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

Public Member............................................Amy Fore, Fort Smith 5

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MEMBER SPOTLIGHT

Brian Smith Pharm.D. Pharmacist in Charge/Owner Prescription Pad Pharmacy

Pharmacy School & Graduation Year: UAMS, 2001 Years in business: 13 years working for the chain drug stores (6 at Brookshires, 7 at Freds) 6 years in business for myself.

Favorite part of the job and why: Patients and a great staff.

Helping our patients manage their medication needs is our job. Getting to know each of them as a person establishes relationships and trust in us that last for years. We absolutely could not serve our patients without a great staff. They work hard and work together to serve on a daily basis in a pretty stressful environment.

Least favorite part of the job and why: Insurance reimbursements and PBMs.

What do you think will be the biggest challenges for pharmacists in the next 5 years? More than ever,

insurances are entering into an outcomes-based payment system. It will be imperative that pharmacists be recognized as providers to make sure those outcomes are met and be able to be reimbursed fairly for the services we provide.

Oddest request from a patient/customer: "Have your

delivery driver go by Burger King, pick up two number 1 combos, and I'll pay her when she gets here."

Recent reads: The Book of Revelations, Bottle of Lies Favorite activities/hobbies: Spending time with my family, watching my girls swim, hunting and fishing, training for triathlons WWW.ARRX.ORG

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Ideal dinner guests: My grandfather that passed away in 2009

If not a pharmacist: Plumber or electrician - I like to fix things

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

The The APA works very hard to ensure that issues facing pharmacists are addressed with legislators on a daily basis.

They keep us up to date on these issues as well as other areas of pharmacy and give us relevant information to help us make decisions in an ever-changing pharmacy environment.

How has your business and practice changed in the months since the COVID19 pandemic began?

One of the hardest decisions we had to make was closing our lobby and moving to drive through, curbside, and delivery.

We don't have a huge lobby and over the counter area that accommodates a large group of people. When we added our employees into the mix, we were over the 10 person limit. As I type this, we have moved into phase 2 and decided to reopen the lobby on June 15. There will be some differences, but we will make it through them as a team. We are looking forward interacting and spending more time with our patients again.

One advantage of this Covid-19 crisis is we have been able to focus on synchronization more. It has changed our workflow dramatically for the better in just 3 months. I would encourage any business not using sync to implement a program. ยง

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Personal protective equipment being unloaded in Arkansas

Governor Asa Hutchinson announces the first presumptive positive coronavirus case in March

State Pharmacists and APA Adapt to the New Normal

by APA Director of Communications Jordan Foster

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lthough little information was shared about the scheduled press conference on March 11, the air in the room had a grim heaviness to it as reporters gathered into the governor’s reception room at the state capitol. News reports from other states and rumors from within our own were pointing to the likeliest scenario, soon confirmed by Governor Asa Hutchinson: officials had identified the first presumed case of the novel coronavirus in Arkansas. The news came as a strikingly bitter reminder that virtually no area of the globe would remain untouched for long from the growing pandemic. Within weeks, the world would be reminded of another stark truth: while many people were able to secure the safety of themselves and their families by staying home and sheltering in place, healthcare officials including pharmacists put their lives on the line to protect the health and wellbeing of their patients.

Over the following months, Americans saw changes that were once unimaginable.

What began with advice to wash your hands repeatedly and avoid shaking hands soon lead to classes moving online for millions of students, restaurants shifting to curbside pickup, gyms, barber shops and other businesses shuttering their doors, and several “shelter in place” and mask mandates by dozens of governors and local governments. The phrases “social distancing” and “flattening the curve” 8

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became part of the national zeitgeist.

Yet through it all, pharmacists across Arkansas didn’t miss a step. Community pharmacists transitioned to drive-thru, curbside pickup, or delivery. Health system pharmacists worked diligently to monitor PPE and drug shortages at hospitals throughout Arkansas. Compounding pharmacists made thousands of bottles of hand sanitizer when a shortage hit.

Consultant pharmacists worked with state leaders to develop regulations for nursing homes, one of the earliest and hardest hit areas of the pandemic in Arkansas. UAMS and Harding faculty and staff worked feverishly to make a seamless transition to online learning and reschedule rotations to protect students. Pharmacists statewide stepped up to the challenge of serving their patients in a brand-new world.

At the Arkansas Pharmacists Association, the pandemic forced us to adapt as well. In mid-March, APA CEO John Vinson made the decision to allow staff to work remotely for their safety. Twelve-hour workdays were not uncommon as information about the coronavirus continuously evolved and state rules and regulations were constantly having to be amended, suspended, or upended. Through the APA COVID Resource webpage and daily COVID email update, we aimed to keep our members informed of the steadily changing flood of information.

AR•Rx

VIRTUAL Reality “Virtual” is a word that will be forever linked with the COVID pandemic. As many events across the country went from inperson to virtual, APA shifted many of our events to an online experience to keep in line with social distancing requirements.

We celebrated the students of the UAMS College of Pharmacy and the Harding College of Pharmacy with virtual pinning and graduation ceremonies. We hosted several virtual townhalls with Arkansas pharmacy leaders. John Vinson even interviewed Governor Asa Hutchinson during APA’s first ever Q&A with a sitting governor.

But with June approaching quickly and the APA annual convention essentially an impossibility, staff began working on an ambitious, all-day Virtual Seminar featuring topics including a Supreme Court panel discussion spanning multiple states and a COVID update from one of the state’s leading authorities. More than 100 attendees tuned in to see APA President Dean Watts and CEO John Vinson broadcasting live from a makeshift television studio at the DoubleTree Hotel in Downtown Little Rock. Due to the success of the Virtual Seminar, we are looking at similar opportunities to offer CE to our members in the future.

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The Arkansas Pharmacy Foundation and Fredeirica Pharmacy team up with student pharmacists to compound hand sanitizer

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Many pharmacies and other businesses had to adapt to new guidelines like delivery or drive thru only to protect their staffs and patients.

STAYING Safe Two crucial weapons in the fight against the COVID pandemic emerged with a commonsense approach: use a mask to help prevent passing anything from yourself to someone else and keep your hands clean through washing with soap and water or hand sanitizer.

Unfortunately, the pandemic created a rush on both masks and hand sanitizer, denying healthcare workers of valuable tools to stay safe. Due to unprecedented demand, huge shipments of personal protective equipment were being constantly diverted as virtually every global leader jockeyed for access to PPE for their country. Even here at home, Governor Asa Hutchinson, during one of his daily COVID press briefings, shared his frustrations over a shipment of PPE purchased by state officials for use in Arkansas hospitals being diverted at the last minute to other states.

For weeks, healthcare workers were re-using masks and gloves or WWW.ARRX.ORG

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Past President Dean Watts and CEO John Vinson host the first ever APA Virtual Seminar, broadcasting live from downtown Little Rock.

using whatever they could find. Finally, a break came when a tip was shared with APA CEO John Vinson about a local company that had access to a supply of masks. Through several days of bargaining, arranging, and planning and hundreds of emails, phone calls, and texts, the Arkansas Pharmacists Association procured a large shipment of surgical masks and N95 respirators and immediately announced a reservation system to allow pharmacies to claim masks for their staff.

Within an hour of announcing that masks were available to APA members and accepting orders, the word came back that the distributors supply chain had been disrupted and the cargo ship carrying our shipment of masks was being diverted to another area, meaning the masks were gone. However, in the following days, APA continued to work with our original distributor and together we were able to secure several shipments of L3 surgical masks and make them available to APA members. (As of print

time, we still have some surgical masks available. If you’d like to order a bundle, go to www.arrx.org and look for the link under News & Announcements).

While APA was securing masks for pharmacists throughout the state, the Arkansas Pharmacy Foundation teamed up with Lyn Fruchey of Freiderica Pharmacy in Little Rock and volunteer student pharmacists from UAMS and Harding Colleges of Pharmacy to focus on a vulnerable community that had been overlooked in the COVID pandemic. Volunteers from the Arkansas pharmacy community spent several days compounding 110 gallons of USP-grade pharmaceutical quality hand sanitizer into approximately 1,800 8-oz bottles to be distributed primarily to homeless shelters in Arkansas. Thanks to the organizers and volunteers, homeless shelter residents and staff had a muchneeded weapon to help combat the coronavirus.

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STATE PHARMACISTS & APA ADAPT TO THE NEW NORMAL

CHANGE & Adapt The COVID pandemic affected virtually every Arkansan in some way. As the most accessible healthcare provider, pharmacists were directly impacted by the pandemic and had to adapt to new ways of serving their communities. Here, in their own words, are some of Arkansas’s pharmacists relaying their stories of COVID’s reach and impact in Arkansas.

Helping Out “Arkansas Medicaid prefers Proair for their formulary albuterol inhalers. In March, our sources were depleted due to COVID-19.

I reached out to John Vinson at APA to see what we could do to open up options for generics. The formulary was changed by the next day. The quick action taken by John and Arkansas Medicaid was essential to making sure our patients didn't go without this important medication.” – Greta Ishmael - Econo-Med Pharmacy, Cherokee Village “We knew there would be a huge need for hand sanitizer, especially for people who work with the public on a daily basis. We donated 100 masks and 160 bottles of hand sanitizer to the LRPD to help protect the department as they work to protect our city.” – Adam Wheeler - Tanglewood Drug Store, Little Rock

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“When we closed the lobby at the pharmacy, our daughter and gift shop manager Sydney Carter, along with her employees Janie Thompson and Kari Bounds, dug out old sewing machines, cut out patterns, and sewed masks for the pharmacy employees. Word got out to the community and they ended up cutting, ironing, and sewing more than 1,000 masks and used the proceeds to make a $2,000 donation to the local food bank. Their masks were everywhere, even shipped out of state, but unfortunately the project ended when they ran out of materials and couldn’t find any more.” – Karen Watts - Dean's Pharmacy, Dewitt

Testing “Stott’s Drug Store in Searcy was selected as one of only 63 independent pharmacies in the nation to participate in a public private partnership for COVID-19 testing through a partnership with Healthmart Stores and eTrueNorth. We were honored to be the first independent pharmacy in the state to perform COVID-19 tests.

Being able to show our city, state, and nation that pharmacists can step up and provide valuable clinical services is an important step moving forward in our profession. COVID-19 testing, along with the changes we have had to make to keep our pharmacy operating during this crisis, has had its challenges, but we have all adapted and continue to serve our community.” – Peyton Harvey - Stott’s Drug Store, Searcy

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"When we were approached by HealthMart to partner with eTrueNorth and the US Department of Health and Human Services to serve as a COVID test collection site, our pharmacy leadership did not hesitate to sign on. The decision to offer COVID testing in our community was also an opportunity to advocate for the profession of pharmacy. To be recognized as essential members of the healthcare team, we must continuously adapt to do what is necessary and practice at the top of our licenses." – Allie Staton West Side Pharmacy, Benton “Walmart is part of communities all across America, and we believe we can play a vital role by helping our neighbors in a time of crisis.

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We are committed to supporting efforts to expand COVID-19 drivethru testing and have opened community testing sites in areas of need in cooperation with federal, state and local officials. We continue to look at ways to expand testing by partnering with states, labs and insurance companies in order to serve our communities during this time.” – Amber Bynum - Walmart, Bentonville “Walgreens opened a pharmacist run COVID-19 testing site in Little Rock on June 19th. At this location, Walgreens pharmacists are overseeing individuals self-administering the test in their vehicles.

We are utilizing the Abbott ID NOW COVID-19 tests, which is less invasive for the patient and we are able to provide results quicker.

All tests are processed onsite in our CLIA Waived lab in the store, so patients get their results within 24 hours. We are happy to be able to provide this service to our community during these unprecedented times.” – Lindsey Butler - Walgreens, Little Rock

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“In addition to overcoming the challenges of maintaining high levels of customer service during COVID-19, pharmacies across Jonesboro were forced to deal with the aftermath of a tornado that ripped through our city. Several of our customers, as well as one of our employees, sustained significant damage or destruction of their homes. It was amazing to see our citizens, in addition to people from surrounding areas, come together to donate their time, food, money, and whatever else was needed. Seeing everyone come together and support each other even during a pandemic was wonderful. I am proud of our city. We are truly #JonesboroStrong.”

– Krystal Soo - Soo's Drug Store, Jonesboro

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“In our community, Kevin and I have always had “friendly” competition and worked well together and collaborating in these trying times is just another example of this. I believe we should show mutual agreement in the decisions we make in the time of a pandemic to prevent overreacting and stirring panic or fear. As independent pharmacy owners, we face bigger struggles on a daily basis so we have to stand together on issues we can control.” – Eddie Mitchell - Mitchell Main St Pharmacy, Mountain View

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“Eddie Jack and I talk on a fairly regular basis. We help each other with stock shortages, check with each other concerning PBM issues and other local issues as they arise. Working together as the COVID crisis emerged seemed like a "no brainer." We also took the opportunity to coordinate with local clinics to decrease confusion for patients concerning lobby accessibility vs curbside service and will continue to do so as needed in this ever-changing environment.” – Kevin Caldwell - Best Drug, Mountain View

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“We decided to keep our lobby open in the early stages of the pandemic. While we had increased curbside & delivery, we realized how much some customers enjoyed coming in and having personal interactions outside of their home. With that knowledge & feedback, we strived harder and more diligently to maintain employee health & store sanitation. As exhausting as all the repetitive sanitary methods

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STATE PHARMACISTS & APA ADAPT TO THE NEW NORMAL

are, we were able to find some levity while performing the routine tasks. The idea for a fun, uplifting video came as an extension of the changes the staff was making to adapt to COVID. My 14-year-old daughter Bailey put it all together, we shared it on our social media, and we were humbled as the video went viral and our customers and the pharmacy community found it entertaining.” – Philip Way Remedy Drug, Little Rock

Med Watch “Amneal Pharmaceuticals donated 100,000 hydroxychloroquine tablets to the State of Arkansas to help in the treatment of the COVID-19 Pandemic. A collaborative group from UAMS, Arkansas Department of Health, Arkansas Board of Pharmacy, and Arkansas Pharmacist Association determined a process for equitable distribution. This group was made aware of the shortages caused by diversion of product to state supplies and thoughtfully decided to expand the distribution to Arkansas Community Pharmacies for the maintenance therapy in Lupus and Rheumatoid Arthritis. To date, 62,300 doses have been distributed across the state. The remaining supply is still being distributed upon request.” – Jeff Cook - UAMS, Little Rock “For health systems that were struggling with the unknowns during the COVID19 pandemic, it was a blessing to receive donations of remdesivir from Gilead. We were thankful at White River Health System to have been designated as a hospital in our area of the state to have some of the medication on hand to treat our patients as well as help our neighboring hospitals. We appreciated how well the ADH worked with our hospitals across the state to efficiently distribute the medication.” – Erin Beth Hays - White River Medical Center, Batesville

majority of our didactic (classroom) instruction to a remote delivery format and requiring strict social distancing and personal protective equipment utilization during pharmacy practice experiences for our students. Our four key health practices for a healthy semester for all of campus include hand washing, wearing face coverings in the presence of others, maintaining 6 feet of distance between individuals and daily self-monitoring for illness. We are excited for the return of our students back to campus this fall under a carefully designed plan that includes a number of contingencies designed to ensure the safest possible learning environment.” – Jeff Mercer Harding University College of Pharmacy

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Education “As with any situation that requires ‘gathering’ people, the UAMS COP has been affected by the pandemic. Our didactic learning spaces were closed to students in mid-March and we completed the semester with remote delivery of live lectures and examinations.

For the didactic Fall 2020 semester, UAMS COP will be a mix of masked face-to-face with a social distance where possible and with recommended levels of personal protective equipment where social distancing is not possible.

Our experiential education was stopped for 1-2 weeks in March but other than that we have been able to continue offering IPPEs during the summer and APPEs for the Classes of 2020 and 2021. The senior curriculum was adjusted to at least nine APPEs from ten. We are so grateful for our IPPE and APPE preceptors; they have involved students in this unprecedented time by providing them robust learning opportunities. We cannot say thank you enough!

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We are committed to providing the highest level of education and will double our efforts to support our student pharmacists during this difficult time.” – Cindy Stowe - UAMS College of Pharmacy “Harding University College of Pharmacy is committed to providing a safe and effective learning environment for our students during the COVID-19 pandemic. To date, that has included moving the

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UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY

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

Beware the "New" Types of Errors of E-prescribing This issue of Safety Nets illustrates the potential hazards associated with poorly handwritten prescriptions. Thank you for your continued support of this column.

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he e-prescription illustrated in this Safety Net was sent from a prescriber's office to a community pharmacy in Central Arkansas. The pharmacist verified the prescription for Humulin® 70/30, but immediately realized there were two problems with the order: the quantity of Humulin® 70/30 to dispense and the patient directions. The pharmacist realized to fill the order as written, ten vials would be required - an unusually large amount.

In addition, there were two separate patient directions in the Sig. field - "30 units twice a day" and "30 units in the morning and 20 units in the evening". The pharmacist telephoned the prescriber's office for clarification. A nurse answered the call and listened to the pharmacist's concerns - along with his frustration - about the order. The nurse addressed the insulin quantity (i.e. 100 mL) by replying "Give him a month supply." When asked about the patient directions the nurse said, "It clearly states 30 units in the morning and 20 units in the evening."

When the pharmacist asked why "30 units twice a day" was included in the order, the nurse ended the conversation. After this, the pharmacist entered the prescription information into the computer as Humulin® 70/30, quantity 20 mL (two vials for a month supply), with patients directions of "inject 30 units in the morning and 20 units in the evening. Record fasting and 10 p.m. blood sugar." After the prescription was filled, it was placed in the "will call" bin for patient pickup.

Figure 1

Electronic prescriptions are not 100% error-free. In fact, the legibility and neatness of e-prescriptions may increase the risk of error compared to handwritten prescriptions which may be more carefully scrutinized. Pharmacists must continue to carefully examine all prescriptions - both handwritten and electronic. § STUDENT SPOTLIGHT

Breaking the Barrier - David Roberts

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rkansas is home to many Hispanic patients who speak little or no English. This can be a significant barrier to quality patient care. I was in their shoes when I came to the United States from Costa Rica as child. It is intimidating to not understand the language of where you live. Since I can easily identify with these individuals, I am in a unique position to make a difference in their lives. I understand the difficulty when you are trying to ask a question but can’t make the other person understand what you’re trying to say.

It took me six years of hard work to become fluent in English. As a result of my efforts, I am now able to serve the Hispanic patients at the pharmacy where I intern.

Over 70% of physicians in the United States currently e-prescribe. The "benefits" of e-prescribing have been touted by many sources including the Health Resources and Services Administration (HRSA) which states "compared to paper prescriptions, e-prescribing improves safety along with prescribing accuracy and efficiency". We agree E-prescriptions do reduce the likelihood of SALAD (sound-alike, look-alike drug) mix-ups and eliminate illegible prescriber handwriting. However, e-prescribing has introduced new types of medication errors into the health care system which would have been extremely unlikely to occur with handwritten prescriptions. What is the likelihood a prescriber would actually write two, separate patient directions in the Sig. field that contradict each other? Clearly, this e-prescription does not "improve safety along with prescribing accuracy and efficiency".

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Frequently I help patients with medical information. I have counseled on a methylprednisolone pack to ensure patients know how to correctly take the six day course of therapy. I have helped patients understand the importance of finishing the entire course of antibiotic medication.

Helping people is more than just providing prescription information. I’ve helped patients find the nearest Hispanic church, and directed them to the nearest grocery store.

We will all have patients that come into our pharmacies who don’t speak English. I am proud to say I have made a difference in these individuals and so can you.

I understand the frustration some pharmacists may feel when dealing with language barriers, but we must remember these are our patients too. They rely on us for help. The next time you encounter a language barrier, try to put yourself in their shoes in order to help.

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Purchase a Brick for the “Walkway of Honor” Honor loved ones, distinguished award winners, new retirees or graduates by purchasing a brick for the Arkansas Pharmacy Foundation Walkway of Honor. The bricks will be featured prominently in the plans for the rebuilding of the Arkansas Pharmacists Association headquarters at 417 South Victory Street in Little Rock.

Purchase a 4”x8” red brick for a $125 tax-deductible contribution to the Arkansas Pharmacy Foundation. Proceeds will provide funds to sponsor, support and conduct educational programs. Personalize your brick by printing the name and other information as you would like it to appear. There is a maximum of 3 lines per brick with up to 18 characters per line, including spaces. Use an ampersand (&) for “and”.

TO ORDER Send order form along with a check for $125 to APF, PO Box 3798, Little Rock, AR 72203.

Personalization: _________________________________________ _________________________________________ _________________________________________ Name: __________________________________________

Method of Payment:

Address: ________________________________________

Card Number:___________________________________________

City: ___________________State: _________Zip:_______

Expiration Date: Mo/Year _________________ Sec Code:_______

Phone:__________________________________________

Name on Card (print): ____________________________________

Email:___________________________________________

Signature:______________________________________________

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7/28/20 4:05 PM

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FDA Follows Through on Commitment to Increase Competition and Lower Drug Costs By guest authors Wali Abdul, PharmD/MBA Candidate and Brittany Petty, PharmD Candidate

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he FDA recently approved the first generic for Daraprim® (pyrimethamine), the antiparasitic drug that made headlines in 2015 when Martin Sckreli, CEO exponentially increased its price by 5,000% from $13.50 to $750.00 per tablet. This price increase was highly criticized as Daraprim® is a lifesaving medication and the only one of its kind to help treat certain populations. The FDA followed through on its commitment to increase competition with generic availability.

approved as adjunct therapy for heterozygous familial hypercholesterolemia or established atherosclerotic disease who require additional lowering of LDL. Pizensy™ (lactitol) is an osmotic laxative used to treat chronic idiopathic constipation.

Acute: Nurtec™ (rimegepant) is the first calcitonin gene-

powder-dnfp) oral immunotherapy is the first treatment for mitigation of allergic reactions including anaphylaxis that may occur with accidental exposure to peanuts. Tepezza™ (teprotumumab-trbw) was approved through priority review as an orphan drug as the first agent to treat thyroid eye disease.

related peptide receptor antagonist available in an orally disintegrating tablet for migraines. Barhemsys® (amisulpride) injection is a dopamine-2 antagonist which is the first antiemetic approved as rescue treatment of PONV in patients who have failed prophylaxis with the current standard of care. Anjeso™ (meloxicam) injection has been approved for the treatment of moderate-to-severe pain as monotherapy or with other NSAIDs.

Oncology: Nubeqa™ (darolutamide) is an oral androgen

New Dosage Forms: Significant new dosage forms

Biologicals: Palforzia™ (peanut (Arachis hypogaea) allergen

receptor inhibitor for non-metastatic castration-resistant prostate cancer. Ayvakit™ (avapritinib) was granted breakthrough therapy designation through fast-track review as a kinase inhibitor to treat unresectable or metastatic gastrointestinal stromal tumors. Tazverik™ (tazemetostat) received accelerated approval as an orphan drug through priority review to treat metastatic or locally advanced epithelioid sarcoma. Sarclisa® (isatuximab-irfc) is an antiCD38 monoclonal antibody to treat adults with multiple myeloma who have received >2 therapies including lenalidomide and a proteasome inhibitor.

Chronic Care: Caplyta® (lumateperone) received fast-track

approval as an atypical antipsychotic for schizophrenia.

Dayvigo™ (Lemborexant) is an orexin receptor antagonist for insomnia. Isturisa® (osilodrostat) is an orphan drug and first agent approved to address the overproduction of cortisol as a cortisol synthesis inhibitor for non-surgical treatment of Cushing’s disease. Vyepti™ (eptinezumab-jjmr) for IV use is a calcitonin gene-related peptide antagonist indicated for prevention of migraines. Nexletol™ (bempedoic acid) is an adenosine triphosphate-citrate lyase inhibitor

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approved this quarter include: Avsola™ (infliximab-axxq, IV) a biosimilar to Remicade®; Conjupri® (levamlodipine, tablets) for hypertension; Bynfezia Pen™ (octreotide, SQ) for acromegaly, carcinoid tumors, or vasoactive intestinal peptide tumors; Hadlima™ (adalimumab-bwwd, SQ) a biosimilar to Humira®; Kanjinti™ (trastuzumab-anns, IV) a biosimilar to Herceptin®; Monoferric® (ferric derisomaltose, IV) for anemia; Ruxience™ (rituximab-pvvr, IV) a biosimilar to Rituxan™; Twirla® (levonorgestrel and ethinyl estradiol, transdermal patch) for contraception in women with BMI <30 kg/m2; Trijardy™ XR (empagliflozin/linagliptin/metformin) for type 2 diabetes; and Valtoco® (diazepam, nasal spray) for acute seizures. §

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7/28/20 4:05 PM

UAMS SCHOOL OF PHARMACY

Routine and Normal: My, My How Things Can Change Cindy Stowe, Pharm.D. Dean

S

ome definitions that I’ve been thinking are worth revisiting (with a chuckle) …

• Routine – a sequence of actions regularly followed; a fixed program • Normal – conforming to a standard; usual, typical, or expected So, how’s your routine? Is it normal? Ahhh yes, the ‘new normal.' I have clearly wondered what to write about for this issue, and I settled on what we are all dealing with - the ‘new normal’ brought to us by the COVID-19 pandemic; not the logistics of it specifically, but our response that translates from person-to-person that makes us similar and gives us a common language and focus. As an academic, I am comfortable with the rhythm that plays itself out in a dependable yearly pattern, where change is a meticulous process with extended rollout plans – you know, it is routine and normal. For me, Thursday March 12th to Friday, March 13th is where I draw the line; when my day-to-day activities ceased to be normal and routine.

This is something that none of us has faced, right? So, early on, some of what provided context for me was a natural disaster – weather related. Then, I was reminded of 9/11, yet this felt different and massively more disruptive for all of humanity. The activities of daily living that we had always considered ‘normal’ were thrown upside down and have been rapidly changing and calibrating to a ‘new normal’. Work from your office, now work remotely; social distance, don’t shake hands, don’t touch your face; telehealth, telemedicine, telepharmacy, telewhat?; old words and phrases being used to define where we are in the pandemic – flatten the curve, prepare for the surge; and the appropriate PPE (personal protective equipment, of course). N95 or surgical mask or homemade mask...I know that we could all go on about the specific disruptors to our pre-COVID-19 pandemic normal day-to-day routine.

We have had these feelings before, right? I believe we are feeling/coping with loss; collective loss of the normal and routine. In the world in which we live and work, we are doing our best to build a new normal while dealing with the loss of our day-to-day routines – at work, school, in our communities and, at home. For fun, I like to listen to audiobooks and occasionally podcasts. Recently, I started listening to a podcast by Brené Brown called “Unlocking Us”. One particular episode on loss and grieving struck a chord with me. I have been reflecting recently on how I can best lead, while balancing rapid, significant change and coping with the collective feelings of loss that was discussed in this particular podcast. I have been asking myself how can I “show up” to care about and support the people around me, take in and share information, solve problems, and find the right path forward.

So, in the midst of this pandemic as pharmacists and 16

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pharmacy educators, we are transforming how we deliver on our professional responsibilities, mission, and vision. I believe we are clear about why we are doing what we are doing and have a deep sense of caring – we are finding ways to connect and care for each other from a distance. I am so impressed with how our profession has responded - maintaining accessibility to patients while maximizing the safety of the work environment. As pharmacists you are innovating your day-to-day processes and providing expanded or different services to your patients as needs arise.

As we blaze our path forward and deal with our collective and individual losses, be patient with each other and yourself.

Avoid the judgement of grief, and how we show up in it. We all deal with grief and loss differently. The worst loss is always your loss – no need to compare. Make space for our differences and stay focused on our similarities and our connectedness. For those of you who are co-workers, employers, and preceptors of our student pharmacists – THANK YOU, THANK YOU, THANK YOU! Your commitment to the College and education of our students during this difficult time has filled me with pride and gratitude. No other profession, in my opinion, delivers on this like you do!

As the Spring 2020 Semester is now behind us, join me in congratulating the faculty and staff of the UAMS COP on changing from a didactic face-to-face curriculum to an online delivered curriculum overnight. Congratulate the P1, P2, and P3 students for embracing these efforts and doubling down with a commitment to learning, patience, and grace.

These students have risen to the challenge of being educated remotely with all the challenges of close habitation with friends and family and the closeness that apartment living can deliver.

Finally, congratulations to the Class of 2020 who have powered to the end of their formal education through this pandemic with rapid-cycle practice changes. The Class of 2020 is forgoing the normal, annual face-to-face celebration of the culmination of the formal professional education journey for a virtual celebration/recognition of this milestone achievement.

The resilience and determination to achieve our mission and vision have been clear to all of us as we chart the safest and most efficient path forward. I am so proud of the students, staff, and faculty of the UAMS COP as we close the 2019-2020 academic year in a time so different than when we started. I am equally impressed with the response of our profession – the leadership of our alumni and preceptors for modeling excellent accessible patient care for your communities. Stay Healthy and Strong! § Reference: Unlocking Us – Brené Brown – March 31, 2020 episode: David Kessler and Brené on Grief and Finding Meaning AR•Rx

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THE ARKANSAS PHARMACIST

7/28/20 4:05 PM

University of Arkansas for Medical Sciences College of Pharmacy Class of 2020 Senior Class 2019-2020

Pranav Amin

Michael Baker

Cheyenne Beene

Matthew Bird

Rachel Briggler

Marlee Buchanan

Brandon Bui

Kristen Burrell

Clayton Butler

Ashton Cheatham

Jacob Coffman

Chandler Craft

Christopher Croson

Brent Curry

Philip Deer

Danielle Dennis

Kailey Fogo

Brayden Fountain

Madison Gladden

Jessica Grunwald

Krystal Gunter

Kevin Hampton

Sydney Hughes

Zakary Kendrick

Danviona King

Hayden Kirchhoff

Montana Knight

Kaitlin McCann

Hunter Medford

Javier Moreno

Emily Morgan

Cortnie Peters

Jamie Randall

Morgan Rich

Zachary Smith

Allen Snider

Anh Tran

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Lindy Barnes

Brooke Becker

Jeffery Butler

Nicholas Byrd

Blaze Calderon

Charles Cassidy

Bichhong Do

Peter Egbe

Nkeseobong Essien

Kayla Eveld

Ann Fitzhugh

Brent Flowers

Jessica Hargis

Tanner Harpole

Case Henderson

Brittany Herpin

Cortni Hicks

Kellylinh Ho

Jayme Holland

Ruston Koonce

Mariko Labrada

Hannah Lakey

Dylan Ledet

Geoffrey Loux

Michael Lukacs

Laney Mason

Emma Matherne

Jack Nguyen

Zena Nguyen

Juliana Oguh

Emily Osborne

Jared Owen

Hannah Page

Barbara Patterson

Ryan Paul

Samantha Pennington

Erica Ridley

Jake Roark

Spencer Sanson

Brandon Scott

Kerry Scroggin

Chassidy Seward

Neha Sharma

Garrett Sheumaker

Bank Sinwitayarak

Allen Smith

Emily Spatz

Robert Spradlin

Emily Sprick

Autumn Stice

Seth St. John

Tyler Sweat

Sarah Talley

Ashley Temples

Trenton Terry

Magie Thannisch

Jessica Thornton

Mary Tucker

Rachel Tucker

Cody Turner

Eric Turner

Marie Turner

Yue Vang

Abraham Vierthaler

Dayton Vire

Ross Wagner

Andrew Wall

Shelby Wall

Abigail Williams

Allison Williams

Grant Womack

Kaitlin Wood

Casey Wroten

Mariya Yemets

Sarah Zulfer

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HARDING UNIVERSITY REPORT

Immeasurable Challenges & Changes

M

y, how quickly things can practice experiences—pharmacy opportunities that, for some, were now potentially front-line encounters during a health care change!

As I write this, Jeff Mercer, Pharm.D. crisis—while also providing safety and appropriate supervision. we are in the midst of a Dean While our first through third year students needed these worldwide pandemic due to the COVID-19 virus. Just a few short weeks ago, our students experiences to remain on track, for our fourth-year students, were wrapping up the first half of a quiet and uneventful spring incomplete experiences jeopardized graduation. With such semester before leaving for spring break. There was some high stakes, the experiential staff, practice faculty, and the knowledge of the rising health concern, but no one understood many pharmacy preceptors who supervise our students pooled the profound impact it would have on the rest of the semester. their resources and networks to provide alternative plans for each student. No students were Over the days that followed, many important decisions were made left behind! Through these tireless that will forever shape our memory collaborative efforts, all of our By the time that you read this, much of students are on track to progress of 2020 and influence the future for or graduate on time. While many our students. the world will have changed, and the schools and pharmacy practice future will be much more certain for On March 12, the President of sites across the nation closed their us all. This spring, the COVID-19 crisis doors to pharmacy students, I am Harding University announced forced an abrupt change to our personal especially thankful for the many the suspension of all on-campus and professional lives; however, Arkansas community and hospital classroom course delivery, sites that invited our students to activities, and gatherings until experiencing the collaborative response further notice. We had no way of continue. These opportunities and adaptability of our Harding knowing the extent of until further ensured that the next generation community has been heart-warming. notice, but all classroom content of pharmacists are well trained and ready to join the workforce. was to be moved to an online format. As the pandemic spread Aside from Harding’s official across our nation, Harding’s response to the COVID-19 pandemic, I wanted to say a word administrators communicated interim plans and teamed about our students. I am constantly encouraged and amazed educational and instructional resources to support faculty members and students in the immediate online transition. at the maturity of our young people. Through immeasurable challenges, they have demonstrated the ability to overcome Transitioning coursework to an online format was quite a and a willingness to help others. At community pharmacies throughout Central Arkansas, many of our students offered substantial undertaking for both our faculty and students.

But true to the Harding way, everyone worked together and curbside delivery service. Others, working with the APA the response was overwhelmingly positive. Faculty quickly and UAMS students at Federica Pharmacy in Little Rock, adapted to new ways of teaching, and students graciously compounded and bottled hand sanitizer for Arkansas homeless acquiesced to the new learning environment. Although born shelters. And still others collaborated with Harding engineering out of necessity, the online modality was soon accepted students to 3D-print and distribute personal protective masks to local healthcare workers. When face-to-face interactions by most— and even preferred by some—as a method to continue the quality education our students need to become were prohibited, students creatively responded to complete patient-caring activities remotely, learning about electronic pharmacists. medical record access and supporting telemedicine at work.

Of course, the pharmacy curriculum is not all classroomIn this pandemic crisis, our students adapted and provided based. The contemporary pharmacy curriculum is filled with leadership to serve their communities and be the change. laboratories, introductory and advanced pharmacy practice In total, our students have completed hundreds of hours in experiences, interprofessional events, clinical simulations, and service to others in the months since the crisis began. It’s co-curricular activities. Most require face-to-face interactions, inspiring and a true testament to the character of the HUCOP and all are essential for student progression throughout family. the program. Transitioning these learning experiences to By the time that you read this, much of the world will have alternative methods that were both safe and collaborative changed, and the future will be much more certain for us all. without compromising our educational standards required This spring, the COVID-19 crisis forced an abrupt change to creativity and persistence. Following the suspension of our personal and professional lives; however, experiencing physical gathering, our faculty and colleagues worked together so that each curricular requirement was reworked to the collaborative response and adaptability of our Harding accommodate student learning through distance delivery and/ community has been heart-warming. I am confident that or small group work that adhered to strict social distancing God is in control and that pharmacy is an integral part of the demands. solutions that will end this crisis. I am grateful for all who have invested in the future of our students and our profession. § Perhaps the most significant challenge during this COVID-19 crisis was the need to continue our students’ pharmacy 18 18

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THE ARKANSAS PHARMACIST

7/28/20 4:05 PM

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LEGISLATOR PROFILE

Representative Justin Boyd Fort Smith

District: 77 Represents (Counties): Southwest Fort Smith in Sebastian County

Years in Office: 5 Occupation: I graduated from UAMS College of Pharmacy

in 2000 and completed a Primary Care/Family Medicine Pharmacy Residency at AHEC-Northeast (now UAMS Northeast- Jonesboro) in 2000/01. I also completed an MBA in 2007 from the Walton College of Business at the University of Arkansas- Fayetteville.

Mentors: Mike Smets was my childhood pharmacist. My

interactions with Dr. Smets influenced me becoming a pharmacist. Danny Eaker employed me as an intern during pharmacy school and as a relief pharmacist during my residency; I learned a lot about community pharmacy and owning a pharmacy from him. Dr. Eaker made it a point to take me to the APA Regional meeting every year. Keith Larkin employed me part time when I moved back home to Fort Smith; I cannot express to you all the kindness and caring Dr. Larkin shows his patients and staff. Steve Bryant took me under his entrepreneurial wing and gave me the opportunity to join his growing number of pharmacies as a co-owner; this was a generous opportunity for me and my family.

What do you like most about being a legislator? Being a

legislator, like being a pharmacist, is a great opportunity to help individuals, my community and my state.

What do you like least about being a legislator? Being a

legislator takes me away from home and the pharmacy. This can be challenging to balance, but my home and pharmacy families continue to have my back. We make it work.

Most important lesson learned as a legislator: Being a legislator is a team sport. One person doesn’t call the shots, a majority does.

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Most admired politician: There are many politicians from whom I continue to learn. Choosing one is too challenging, but I feel pretty good with two: George Washington and Abraham Lincoln. George Washington did his duty and then chose to go home. He knew he wasn’t a king and set a great two term precedent. Abraham Lincoln overcame many challenges to keep the Union together and end our nation’s scourge of slavery.

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

We have a representative form of government. I have found virtually all legislators listen to their constituents especially when a legislator possesses a personal relationship with a constituent. Develop a personal relationship with your state representative and senator!

Your fantasy political gathering would be: The Second Continental Congress during the drafting of our Declaration of Independence adopted July 4, 1776 Hobbies: Hunting especially deer and turkey and when I find additional time and energy genealogy and fishing

How important is it to have a pharmacist in the Arkansas legislature? Having a pharmacist in our legislature gives

legislators direct access to a colleague who can answer questions about pharmacy. It makes a difference, because pharmacy issues are often technical and politically charged. §

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THE ARKANSAS PHARMACIST

7/28/20 4:05 PM

LEGISLATOR PROFILE

Representative Marsh Davis Cherokee Village

District: 61 Represents (Counties): All of Fulton and portions of Baxter, Sharp, and Randolph Counties

Years in Office: Served in the AR House since January 2019

Occupation: Pharmacist and Farmer (Black Angus) Hometown Pharmacist: David Jennings, Max Hill What do you like most about being a legislator? Interacting with people and trying to make a difference

What do you like least about being a legislator? Situations where I'm not able to help a constituent

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

Three words: your voice matters. As a representative, a lot of times you make decisions based on direct feedback from the people in your district.

Your fantasy political gathering would be: Martin Luther King, Jr, Ronald Reagan, and Abraham Lincoln

Most important lesson learned as a legislator: It's far more

Hobbies: Golf, hunting, cattle farming

Most admired politician: Ronald Reagan

How important is it to have a pharmacist in the Arkansas legislature? Having pharmacists in the legislature is the best

emotional and personal than I realized

way to make substantial change. ยง

Donating to AP-PAC is Contributing to Pharmacy's Future The 92nd Arkansas General Assembly saw legislators pass legislation expanding PBM regulation and significant changes to the pharmacy practice. The Arkansas Pharmacists Association Political Action Committee (AP-PAC) is one way that pharmacists can support legislators that have stood up to the PBM industry and made actual change, bringing Arkansas into the national spotlight. Please consider making an AP-PAC contribution now for the upcoming 2020 state elections so we can help those legislators who have fought for pharmacy. Your contribution could make a big difference!

Donations to AP-PAC support Arkansas political candidates who support pharmacy. Individual or corporate donations are accepted up to $5,000 per year. PAC donations are eligible for an individual income tax credit of $50 or $100 depending on if you file single or jointly. If you donate directly to an Arkansas political candidate, the limit is $2,800 per election but must be a donation from an individual only, corporations cannot donate directly to a candidate but they can donate to the Legal & Legislative Defense Fund or the AP-PAC. To make a donation, mail a check to: AP-PAC, P.O. Box 3798, Little Rock, AR 72203 or donate online at www.arrx.org/arkansas-pharmacists-pac WWW.ARRX.ORG

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

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ecently a dentist reached a resolution agreement with the Office of Civil Rights (OCR) in the Department of Health and Human Services (HHS) for a complaint regarding a violation of the Health Insurance Portability and Affordability Act (HIPAA). While this example occurred in a dental office, the lessons are equally applicable to pharmacies.

Patient Joan had filed a complaint with OCR alleging Dr. Smith's dental practice had impermissibly disclosed her protected health information (PHI) on Yelp®. While we do not have access to verbatim quotes, it is not difficult to infer what happened. Jane had left a review of Dr. Smith's practice and her experience during her last visit. Presumably it was not a positive review and in response, Dr. Smith's office included her last name, details of her treatment plan, and insurance and cost information for her treatment in their response to her review. While this information might be useful to defend yourself against a negative review, HIPAA prohibits the disclosure of such information except in certain situations.

In response to the disclosures, Jane filed her complaint with OCR. During the OCR's investigation, it was discovered that Dr. Smith's office had disclosed similar information in a number of responses to other patients' reviews. To resolve the matter, Dr. Smith's office agreed to a Corrective Action Plan and paid HHS $10,000.

Social Media can be a great way to increase a pharmacy's visibility and promote the many goods and services it provides. The trap for the unwary is the ease at which messages can be created and posted. The utility of personal devices today makes it very easy to take a picture and post it with a caption in seconds.

In this case, the dentist disclosed PHI in response to a negative review. While we might all say we would not do something like that, the ease of posting on social media can cause us to quickly do something without fully thinking it through. If, for example, you wanted to post a picture of one of your staff members, it is easy to take a quick picture. You are focused on your staff member and whether they blinked or their smile looks good. You may not notice that there is a patient in the background, or a computer screen that legibly shows a patient's profile, or the staff member is holding a prescription with the patient's name and medication clearly visible. Any of these situations would be a HIPAA violation.

Similarly, even taking pictures of your facility for your website might disclose PHI if the photos are not carefully staged and edited.

You should also have a policy for your staff regarding photos in the pharmacy and posting to social media. Pictures from someone's birthday party that inadvertently disclose PHI could be posted on an employee's Facebook page.

The employee is thinking about fun and focusing on the celebration, not the counseling session going on in the background.

The same temptations for a quick and easy post exist for your patients also. You and you staff should be alert for patients, or even just persons loitering, who are using their phone to take pictures or video in the dispensing or counseling area.

These people are giving much less conscious thought to protecting PHI than your staff. Your diligence in protecting privacy will be beneficial in your defense when an errant posting slips through.

What should you do in the event that PHI is posted on social media, whether it is by pharmacy staff, patients, or someone else? If a posting was made by the pharmacy staff, it should be taken down as soon as possible. Documentation of how the incident occurred and your corrective actions should be made. A patient can disclose their own PHI to whomever they choose, but they cannot disclose someone else's PHI. Disclosure of someone else's PHI by either a patient or a third party necessitates a call to the poster asking them to remove the PHI. It would be wise to advise a patient that disclosing their PHI to the world is probably not a good choice. Thorough investigation and documentation of all incidents should be made and retained. You will need to consult state and Federal requirements to determine who, if anyone, is required to be notified of the incident.

Social media is a great tool to market and promote the services of your pharmacy. As with any tool, careful consideration of how it is used is crucial. Bad publicity from disclosing PHI on social media could be crushing to your practice. Use social media wisely and it is worth its weight in gold. § ________________________________________________________________ © 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.

960-8147 ness.com

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ARKANSAS ACADEMY OF HEALTH-SYSTEM PHARMACISTS

Erin Beth Hays, Pharm.D. AAHP President

Navigating a Pandemic: Physically Apart but Working Closer Together than Ever

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here is no Pandemic 101 class in the pharmacy school curriculum. Over the past few months to year we have learned and experienced several things that we probably never thought would have been a part of our pharmacy career stories. One thing for sure is when the world said to start social distancing we came together as a profession to try to beat this pandemic. Thanks to technology, our networking has continued to grow during this time. Through phone calls, text messages, emails, social media groups and virtual meetings we have been able to continue to grow professionally, collaborate and build our relationships with one another.

While we have not been able to see each other in person lately, the Arkansas Association of HealthSystem Pharmacists (AAHP) has worked to provide professional growth to its members during this time through webinars about patient care in the COVID19 pandemic as well as informational emails related to medication therapy for our patients.

Some of our members have worked closely with the state health department in formulating policies and procedures for the disbursement and use of medication. Health-systems have been willing to share work with each other their criteria for use for new emergency use authorization medications.

While it would have been easy to shut out the rest of the world and only work inside our physical institution or departments while practicing social distancing, healthsystem pharmacists have been able to continue to work together across health-systems, states, and the nation to improve patient care. This time in history is a great example of how work from a professional organization can benefit the

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As my presidential year with AAHP has come to an end, I would like to thank all the wonderful colleagues I have had the honor to work with over the year. I appreciate the mentorship from Susan Newton, AAHP executive director.

I also am thankful for all the hard work from our board of directors as we have navigated the waters of the pandemic.

I encourage the members of AAHP and APA to utilize

There is no Pandemic 101 class in the pharmacy school curriculum. Over the past few months to year we have learned and experienced several things that we probably never thought would have been a part of our pharmacy career stories.

The American Society of Health-System Pharmacists (ASHP) has provided many resources related to COVID19, from toolkits to help with pharmacy surges and business recovery to free critical care training and evidence tables on treatments option during the pandemic. ASHP has also been able to provide lesson learned through networking calls among leadership of the state affiliates.

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profession. But it wouldn’t be possible without the members that are willing to network with their colleagues, collaborate on what needs to be done, and share lessons learned.

their membership to the full potential by tapping into the resources the organization provides through networking and collaboration with colleagues and providing feedback to their board of directors. These organizations are for the members and made better by the members. I will always be thankful for the relationships I have developed through my time on the board of directors of AAHP and looked forward to what the organization will continue to accomplish.§

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THE ARKANSAS PHARMACIST

7/28/20 4:05 PM

COMPOUNDING ACADEMY REPORT

Lessons From 2020 Andrew Mize, Pharm.D. Compounding Academy President

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he year 2020 started with a lot of promise. After the U.S. Solicitor General, Noel Francisco, agreed with Arkansas in December 2019, the Supreme Court granted certiorari to Rutledge v. Pharmaceutical Care Management Association. We were on the docket for our case to be heard April 27th and hopefully score a big (and much-needed) win for Arkansas pharmacies and protection against the abuse PBMs dish out day after day.

Then in mid-March we were rocked by Covid-19 which quickly became a global pandemic and immediately had significant impacts on how we could operate our pharmacies. Masks (if you could get them) became the new normal and hand sanitizer quickly became like liquid gold. Schools closed and we all gained a new appreciation for what our teachers do on a day-to-day basis. (I’m guessing teacher appreciation week, will carry a bit more meaning next school year.) While much

of society shut down, Arkansas pharmacies (as essential businesses) kept doing our thing, serving patients. Through a combination of stick-to-itiveness and creativity, pharmacies across Arkansas figured out a way to stay open and ensure that life-sustaining medications remained available.

While still in the middle of dealing with the coronavirus outbreak, our country encountered a different challenge. The tragic and indefensible death of George Floyd on May 25th, sparked a public outcry heard across the nation and also right in our own backyard. Protests and marches by concerned citizens asking for action on racial injustice and the desire to improve race relations filled our streets. Unfortunately, criminal vandals also used this time to incite violence and the destruction of property. Innocent businesses were looted and innocent people were hurt. Even the Arkansas Pharmacists Association offices were vandalized multiple times and then set on fire on live TV, likely simply because of its proximity to the Capitol building.

As Arkansas pharmacists, we have never shied away from a challenge. Whether it’s a fight against the unethical practices of PBMs that threaten the very existence of independent pharmacy; a global pandemic that made words like social distancing and self-quarantine commonplace, or the recognition that despite the advancements our society has made with regards to race, we still have a lot of work to do.

One thing I am confident in – that the pharmacists of Arkansas will rally together for the good of our profession, for the good of our patients, and for the good of one another.

We will have the hard conversations. We will be creative in our solutions. We will exhibit a new level of stick-to-itiveness that will not rest until we succeed in positively impacting the world around us. We will show up for our patients. We will show up for one another. We will not quit fighting and advocating for what is right.

Some have said that the year 2020 should be forgotten, that it’s a lost year. I think though, that we need to recognize the adversity we have experienced. Use this season as an opportunity to become stronger. Seek to understand others more. Use these tough times to remember what’s important to us. Examine ourselves to ensure the lives we’re leading match our values. Then we can look at 2020, and know that we’re better for it. §

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Arkansas Pharmacy Phoenix Movement www.arrxphoenix.com

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n June 1, many of us watched live television coverage as a fire ripped through the APA office shortly before midnight, engulfing the lobby into flames and causing extensive damage. Within moments, the foundation of APA’s history and institutional progress was reduced to mountains of smoldering ashes and oceans of murky water, leaving only charred reminders and memories of an organization whose passionate members have always united enthusiastically during times of great challenge. Now the Arkansas Pharmacists Association must set its sights forward to the future of APA’s home.

The APA Building Committee is hard at work and will soon share more information about the APA campus.

Until then, we have set up an initial opportunity for anyone who would like to make a donation to the Arkansas Pharmacy Phoenix Fund – a reserve created to prepare for the inevitable construction costs of the building repairs.

Our hope is that this fire is remembered not for the destruction of the APA office but as a spark that reenergized and reinvigorated our organization and ushered in a new era for the Arkansas Pharmacists Association. Now is the opportunity for APA to rise from the literal ashes to become a stronger, more influential and more robust organization for all of Arkansas’s pharmacists. Please consider making a donation to the future home of the Arkansas Pharmacist Association!

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