ARRX 3rd Issue 2021

Third Issue 2021 Award-Winning Quarterly Publication of the Arkansas Pharmacists Association

Moving Forward Max Caldwell, P.D. 2021-2022 APA President

ARRX 3rd Quarter 2021 Updated.indd 1

12/1/21 9:37 PM

NOW AVAILABLE

Pharmacy Technician Professional Liability Insurance

Are You Covered?

WHAT IF you provide COVID-19 testing or immunizations?

WHAT IF your scope of practice as a Pharmacy Technician exposes you to liability claims?

WHAT IF you were named individually in a lawsuit?

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

phmic.com

Policy terms and conditions control. Coverage may not be available in all states and territories.

Life and disability insurance are written through PMC Advantage Insurance Services, Inc., a wholly-owned subsidiary of Pharmacists Mutual Insurance Company.

ARRX 3rd Quarter 2021 Updated.indd 2

12/1/21 9:37 PM

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

7

8

16

26

Nicki Hilliard, Pharm.D. Director of Professional Affairs Nicki@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 Office E-mail Address Staff@arrx.org Publisher: John Vinson Editor: Jordan Foster Arkansas Pharmacists Association PO Box 3798 Little Rock, AR 72201-2923 Phone 501-372-5250 Fax 501-372-0546 AR•Rx The Arkansas Pharmacist © (ISSN 0199-3763) is published quarterly by the Arkansas Pharmacists Association, Inc. It is distributed to members as a regular service paid for through allocation of membership dues ($5.00). Non-members subscription rate is $30.00 annually. Periodical rate postage paid at Little Rock, AR 72201.

Current edition issue number 94. © 2021 Arkansas Pharmacists Association.

POSTMASTER: Send address changes to AR•Rx The Arkansas Pharmacist PO Box 3798 Little Rock, AR 72203 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: It Was the Best of Times, It

Was the Worst of Times

5 From the President: Willing to Make

Changes

7 Legislator Profile: Sen Bill Sample 8 FEATURE: Moving Forward: 2021-2022

APA President Max Caldwell

11 Safety Nets: Student Spotlights 13 New Drugs: Going for Gold 14 Feature: Bakers Bears & Bulls: Can I

24 Compounding Academy: PCCA Gives

Detailed Response to FDA Warning Letter

25 USPS Statement of Ownership 26 APA Future Headquarters

Groundbreaking Event

28 Rx and the Law: Social Media

Prescriptions

29 Financial Forum: The Pros and Cons of

16 Member Family Spotlight: Chester

30 2021-2022 New APA Board Members

Barber, Elee Coleman, and Torrence Barber - DeQueen Health and Wellness Pharmacy

18 UAMS & Harding University: 2021

UAMS and Harding Colleges of Pharmacy Employment Survey Programs

ARRX 3rd Quarter 2021 Updated.indd 3

Monoclonal Antibody Treatments in Long-term Care Settings

Become a Millionaire by Working for Someone Else?

22 AAHP: Arkansas Pharmacy Residency

WWW.ARRX.ORG

23 Consulting Academy: Utilizing

Early Retirement Plan Rollovers

ADVERTISERS 2 Pharmacists Mutual 6 Retail Designs, Incorporated 6 Arkansas Pharmacy Support Group 12 UAMS College of Pharmacy 12 EPIC 15 Law Offices of Darren O'Quinn 21 Pharmacy Quality Commitment 31 Biotech Pharmacal, Inc. Back Cover: Smith Drug

33

2

12/6/21 2:23 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 3rd Quarter 2021 Updated.indd 4

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

It Was the Best of Times, It Was the Worst of Times

C

harles Dicken’s historical novel the Tale of Two Cities begins with “It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair.”

These opening lines describe how our pharmacists and other healthcare professionals are feeling during the COVID-19 pandemic. There seems to be a paradox as there are conflicting viewpoints on the state of affairs in the pharmacy profession.

On the one hand, pharmacists and pharmacy techs are reporting they are exhausted and desperate for relief from this recent wave of COVID-19 Delta cases. Some pharmacists are burned out and many want to see major changes in the way management provides adequate resources, staffing and pay. They are demanding more professional control of workflow to ensure patient safety and preserve their own mental health.

Mistrust of medical professionals and misinformation for vaccines and therapeutics for treating COVID-19 is taking a toll as well. Arkansas in particular has been hit hard by the Delta variant and pharmacists are providing COVID-19 testing, COVID-19 vaccinations, gearing up for influenza vaccines, providing pediatric vaccinations, handling off label COVID-19 therapeutic prescriptions and order sets, and ordering and administering COVID-19 monoclonal antibody treatments.

Juggling these new responsibilities with the day to day responsibilities

of Arkansas pharmacists can be overwhelming.

On the other hand, there are job openings for pharmacists with new positions in both hospitals and community settings. The majority of the nation’s COVID-19 vaccines have been administered by pharmacists and our hospitals have opened new ICU beds and new COVID-19 treatment wings resulting in new jobs for pharmacists. New opportunities have led to Arkansas Pharmacists Association members that have been in practice for 1 year, 20 years and 40 plus years to all share that the last 9 months of 2021 have been the greatest moments of their professional careers. We are needed and society appreciates our contributions to ending the pandemic.

The COVID-19 vaccinations, testing and treatment pathways are amazing opportunities for pharmacists to create new businesses and to shine as a provider in our healthcare teams.

The profession in Arkansas has been transformed from hours, jobs and salaries being cut, with no pharmacist positions for hire, to a situation where there are new opportunities, increasing pay and increased hours.

We are also collaborating more than ever with pharmacy technicians, nurses, paramedics and EMTs, community leaders and physicians to deliver better care. From this viewpoint, 2021 has been the year of the pharmacist and something to celebrate.

The Arkansas Pharmacists Association is here for you.

Regardless of where you are personally in the outlooks described above, we need you more than ever AR•Rx

|

THE ARKANSAS PHARMACIST

12/1/21 9:37 PM

for saving lives and improving the profession. Our dedicated staff and board of directors is here to help.

Whether it is a set of open ears to simply listen, or an opportunity to network and learn, or for us to help you start your own business or service, please engage with us to help you. That’s why we have an association in the first place. We are here for the pharmacists and our team members in the profession, the people.

The way I see it, we do not have a paradox, but instead the pandemic is teaching and reminding us why we

need a strong public health infrastructure with reform of payment models that supports pharmacists in the healthcare team. In addition, our pharmacists need more decision making in the delivery of healthcare and corporatization of pharmacy services without frontline pharmacist input is dangerous. When we have control of our own destiny, good things happen. With your time, talents and financial support of your favorite state association, we can build a better now and tomorrow for pharmacists and your teams. §

FROM THE PRESIDENT

Willing to Make Changes

I

Max Caldwell, P.D.

f you've been a pharmacist as long as I have (since 1981), you know that pharmacy school and the profession of pharmacy has dramatically changed.

UAMS College of Pharmacy was once a 2-year program with no summer break, then changed to a 3-year program with summer breaks. Now colleges of pharmacy are 4- year programs with a lot of emphasis on patient care and clinical services.

In 1981, the senior pharmacy students had only three rotations each lasting three weeks in length.

Now the last year of pharmacy school has nine rotations that last four weeks each in length.

With low reimbursements on each prescription that we fill and more time to fill the prescription along with counseling the patients, pharmacy owners have to think outside our box to increase business and revenues.

that your license will allow. It's APA President a win-win situation for both the owner and the new graduate.

Many pharmacists remember the APA offices in Little Rock consisting of two buildings. During the protests in June 2020, one of the APA buildings was destroyed by fire while the other building sustained damages as well. After a lot of hard work by several individuals and with the approval of the APA Board of Directors, the APA has decided to move forward with a As pharmacists, we can't just new building. This is a change that sit back and ask the question would not have taken place if it why? We have to take a wasn't for the fire. As devastating step back, get our game plan as the fire was, we can still make something positive out of the together that will be useful devastation. It's another change in the years to come, and of our changing profession.

move forward in a positive way. Sitting still is moving backwards.

We are given this new opportunity by the new laws that were passed by the last legislative session. if you've been practicing pharmacy for 25 years or longer, now is the time to keep your practice thriving by expanding your wings and bringing on new younger graduates where each of you can bring your own ideas together and practice pharmacy to the fullest

WWW.ARRX.ORG

ARRX 3rd Quarter 2021 Updated.indd 5

As pharmacists, we can't just sit back and ask the question why?

We have to take a step back, get our game plan together that will be useful in the years to come, and move forward in a positive way. Sitting still is moving backwards. We cannot lose the momentum that Arkansas pharmacy has now, not just within the state of Arkansas but nationally. We must make changes and keep moving forward. §

5

12/1/21 9:37 PM

6

ARRX 3rd Quarter 2021 Updated.indd 6

AR•Rx

|

THE ARKANSAS PHARMACIST

12/1/21 9:37 PM

LEGISLATOR PROFILE

Senator Bill Sample Hot Springs

District: 14 Represents (Counties): Parts of Garland and Saline Counties Years in Office: 16 years in office; elected to the Arkansas

House of Representatives in 2005, 2007, 2009; elected to Arkansas Senate in 2011, 2013, 2015, 2017, 2019, 2021

Occupation: Owner of termite and pest control company

Most admired politician: I have been honored to serve

Your Hometown Pharmacist: Michael Butler at Village

and learn from many legislators, so I cannot single out one individual

What do you like most about being a legislator? Helping

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

Healthmart

people

What do you like least about being a legislator? Raising

money for campaigns

Most important lesson learned as a legislator: How to work across party lines to get good legislation passed

pharmacists call so that legislators can work one on one with their hometown pharmacists

Your fantasy political gathering would be: I would like to

ask questions and listen to Lincoln, Truman, and Eisenhower

Hobbies: Hunting, fishing, and travel §

AAHP Board

Arkansas State Board of Pharmacy

Executive Director.............Susan Newton, Pharm.D., Russellville President...............................Hye Jin Son, Pharm.D., Little Rock President-Elect................ Kevin Robertson, Pharm.D., Little Rock Past President.................Kimberly Young, Pharm.D., Little Rock Treasurer.................................Andrea Boland, Pharm.D., Hector Secretary..................................Melissa Shipp, Pharm.D., Searcy Board Member at Large.............Gavin Jones, Pharm.D., Benton Board Member at Large.......Amber Powell, Pharm.D., Little Rock Board Member at Large........Ashley Wilson, Pharm.D., Little Rock

President................................Lenora Newsome, P.D., Smackover Vice President/Secretary....Rebecca Mitchell, Pharm.D., Greenbrier Past President...............................Debbie Mack, P.D., Bentonville Member................................Rodney Richmond, Pharm.D., Searcy Member.................................Lynn Crouse, Pharm.D., Lake Village Member.............................................Brian Jolly, Pharm.D., Beebe Public Member...........................................Carol Rader, Fort Smith Public Member..............................................Amy Fore, Fort Smith

Technician Representative....BeeLinda Temple, CPhT, Pine Bluff

WWW.ARRX.ORG

ARRX 3rd Quarter 2021 Updated.indd 7

7

12/1/21 9:37 PM

MOVING FORWARD

Moving Forward MAX CALDWELL, CALDWELL, P.D. 2021-2022 APA President

By Jordan Foster APA Director of Communications

W

hen Max Caldwell was elected to the position of Vice President of the Arkansas Pharmacists Association in mid-2019, the dust was beginning to settle on a dramatic time for the pharmacy profession in Arkansas. Reimbursement cuts in 2018 created a pharmacist uprising which led to sweeping PBM legislation. After such a long and hard-fought battle, Max was anticipating a productive, (but hopefully calmer) four-year track as an APA Executive Board Member that would be transformative for the

8

ARRX 3rd Quarter 2021 Updated.indd 8

profession and personally fulfilling. Within months, however, he and the rest of the APA Board and Staff were facing a series of events that would force change and growth: a global pandemic, the APA building fire, the US Supreme Court case, and the COVID vaccine deployment. Now, as we all move forward into the “next normal” Max has moved into the role of APA President with a drive and passion to keep up the positive momentum for which Arkansas pharmacists have become known at a national level.

AR•Rx

|

THE ARKANSAS PHARMACIST

12/1/21 9:37 PM

APA PRESIDENT MAX CALDWELL

What made you choose pharmacy for a career?

My older brother is a retired pharmacist and when I was a young boy, he had Caldwell Pharmacy. I would spend a lot of my afternoons at the pharmacy and I saw the way people put their trust in him and they depended on him for a lot of medical advice, whether it was for a simple cold or runny nose or cough or for more serious things like monitoring someone’s blood pressure using the blood pressure machine in the pharmacy and counseling the patient and bringing the doctor into the conversation if the patient’s blood pressure was too high. That showed me the important role that pharmacists play in the community and how much the community depends on the pharmacist. When I was growing up, our mother always told us to help other people that are in need and the community pharmacy is definitely one of the best ways you can do that.

When you can help people of every age and you know you’re making a difference, it feels good to be able to do that.

What’s the most important issue facing pharmacists?

The main issue facing pharmacists is still PBMs. Just before this interview, I checked five prescriptions and I lost money on every one. It might have been a quarter or a dollar, but you know out of five prescriptions, I lost money on every one. I feel like the PBM issues will be ongoing for a long time. APA has to stay on top of that and we have to be the cheerleader for all the other independents in the state to rally around them and don't let it get old. We have to keep it on the front burner all the time.

Even though we won the US Supreme Court lawsuit, we’re now seeing where PBMs have filed lawsuits where they don't want the transparency. They’ve got lots and lots of money and we know that, but we've got the law on our side. We know that the legislators and the court system see our side, we just have to keep fighting that battle and make independent pharmacy thrive.

How have you seen the pharmacy field change since you began in it?

I’ve been practicing pharmacy for 40 years and when I first started, all you could have behind the pharmacy counter was a pharmacist. So, they had to what we called “count, pour, lick and stick” and they really didn’t have any help behind the counter. Once that prescription came to the pharmacist, they had to fill the prescriptions from start to finish - getting medicine off the shelf, counting it, put it back, do the ordering, and so on. That’s the way it started but now you’ve got pharmacy technicians and they provide the relief of filling prescriptions, even doing some immunizations, so that the pharmacist can be focused on verifying prescriptions and counseling patients.

Letting pharmacists actually utilize a support staff, that’s been a dramatic change from what it was 20 years ago.

WWW.ARRX.ORG

ARRX 3rd Quarter 2021 Updated.indd 9

What within pharmacy is your passion?

It’s helping the patient - somebody coming in that clearly needs your help and being able to give them that help. We can complain about the reimbursements all we want, and we do care about the finances of course, but our bottom line is we care about taking care of the patients - people getting out of the hospital late and driving back from Memphis or Jonesboro and getting back after hours, the mom who takes her infant to the emergency room with an ear infection at nine o'clock at night. They don't need to wait to the next day to get an antibiotic or pain medicine. So, I do have that passion to take care of everybody and that's what keeps me motivated. I like being part of a healthcare system that's taking care of everybody.

What does APA mean to you?

I got involved several years ago with APA. It means a lot to me, it has shown me how important it is to get involved, not just with APA but how important it is to get involved with the politics of it. Personally, I'm not a very politically active individual. But being on the APA board has shown me the importance of being connected to what is happening legislatively and how APA’s efforts at the capitol help not just members of the APA board or APA members but every individual pharmacist in Arkansas. So as member of APA, this organization means progress to me. As APA president, it means making sure we are focused on what we can do to help make pharmacy prosper and what we can do to protect patients.

How has APA benefitted you?

Look back three or four years ago, when APA sent out a call for every pharmacist to go to the state capitol and for the first time in history the fire marshal had to ask people to leave the room because we had so many people show up. That's how strong we are. And look at the law passed in 2015. It goes all the way to the United States Supreme Court, and we win eight to nothing. APA has benefited not just me but every independent pharmacist pharmacy in the state by helping us keep our doors open. Additionally, being able to do flu shots and get paid for it, being able to do point of care testing and get paid for it. APA has helped pass laws to make it legal for us to do something other than just counting medicine. They’ve given us opportunities.

And now we are more of a player in the healthcare system than we were 25 years ago.

How would you describe your leadership style?

I get a goal in mind, and I go get it. I get everybody involved that can help with a problem and then try to solve it. If you know the problem is out there, you can look at it and talk about it all day

9

12/1/21 9:37 PM

MOVING FORWARD

long. But if you don't start taking the actions to solve it, that problem is always going to be there. Sometimes the problems are easier to solve and other times they are more difficult, but when you see a problem, you have to take some kind of action so that you can move toward a solution.

What’s your mission for the next year as president?

pharmacist in Arkansas reflects on what APA has done for them over the last 50 years, especially over the last five to ten years, I think they’re going to want to be a part of this new beginning and donate to the building’s construction costs. So those are my two goals for my year as president – get every pharmacist practicing to the maximum that they are allowed to do and get our new building built and the majority of the costs, if not all of them, paid.

I’ve got two main missions for What’s your message to APA the next year. First is to look at members? the legislation that was passed and went into effect around Our message is to keep moving August 1st of this year and the ball forward. We know with provide that information to every a pandemic it's been extremely independent pharmacist out hard for us. One small bright spot there so that they can change of all this is that it’s further shown their practice, according to the legislature the strength of the law, if they want to. We pharmacists and what we can do. passed 16 laws this year. Not And as a result, this year every every pharmacist is going to do pharmacy bill that we proposed them all and I understand that, passed. but I want every pharmacist to We appreciate all APA members for know that the opportunity is their support, and we encourage out there. If they want to do it, APA President Max Caldwell presents APA Past President all other pharmacists to join APA they can. I want pharmacists to Kristen Riddle with the Past President's Award at the 2021 APA and further expand our impact on know about the opportunities Annual Convention. the profession. And let's just keep to expand their practice, moving forward. Don't give up the opportunities to hire the now, don't stop now. We are on a younger pharmacists who roll, and we need to keep moving forward to make pharmacy are coming out of school who know about things like point of in Arkansas the best it can be. We are leaders on the national care testing. I’ve been out of pharmacy school for 40 years. pharmacy stage. Everything we do, other states are watching We weren't trained in a lot of the clinical aspects that student us. pharmacists are trained in today. So, hiring these younger pharmacists can change your way of practice, if you want to We have good support from our legislators. They know how change. important the role of the pharmacist is. When other states see how well APA and the legislators work together, they say, “Man, The second mission I have for this year is the new APA we need to do that to help our patients.” Because the bottom headquarters. As we all know, a fire in June 2020 destroyed the line is we’re doing it for our patients. And being a rural state, main APA building. I don’t think moving APA from that location we have a lot of people that live a long way from the doctor’s was ever an option. In my opinion, being across from the state office. They know how important the pharmacies are and how capitol we have one of the best locations in Little Rock. A new, we can help. We have to keep pushing forward for them and modern APA building will be an eye catcher for every politician for us. All the success that we’ve seen in the past few years who walks out of the state capitol and will give APA a distinct has come from the hard work of many people including our presence downtown. Raising money to help pay for the new former presidents and board members. It didn’t start with me, building will be a challenge, but I think it will be a good challenge. but I want to make sure that we continue that hard work so that APA and Arkansas pharmacists can continue to celebrate new We will be doing a lot of traveling and meeting with a lot of successes. § pharmacists in the next few months. But I think if every

10

ARRX 3rd Quarter 2021 Updated.indd 10

AR•Rx

|

THE ARKANSAS PHARMACIST

12/1/21 9:37 PM

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY

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

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

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

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

STUDENT SPOTLIGHT

STUDENT SPOTLIGHT

Unexpected Empathy

More Than a Tick

- Rachel Senn

- MaKayla Yates

I

t was a bright Saturday morning when she walked into the pharmacy. Her long grey hair flowed gracefully around her shoulders, framing her kind face.

She strode up to the counter, calm and confident as she stated her name and the refill she wanted to pick up.

I

In that polite southern way I asked how she was. At first, she responded with, “I’m fine,” but when I returned with her bag she asked me if I had listened to the news that morning. She must have read the confusion on my face because she explained: There had been a fatal accident. A young man had been killed.

He was about my age. He was her grandson.

How does a person develop an allergy like this? In short, a tick bites a mammal, Alpha-Gal gets in its saliva, then it bites a person. So, because of a tick bite, my friend can’t have any mammal products: beef, pork, or even anything with lactose. How can pharmacists help?

Her steady voice broke with that last word, and we stood there silently across the counter from each other.

I was dumbfounded. Words stumbled through my mind.

I scrambled to say something comforting to this woman.

As I stood there, “I’m so sorry for your loss” or “He’s in a better place” seemed like feeble attempts at relieving this woman’s grief.

I must have said something, because as she walked out I did not wish her a good day. There would be no such thing for her. I have never seen this woman again, but her face and story are etched in my memory with the question: When hurting patients enter my pharmacy, what do I say in the little time I have with them?

Now the statement that caught me by surprise is an opportunity for you to prepare: How will you respond?

WWW.ARRX.ORG

ARRX 3rd Quarter 2021 Updated.indd 11

have a friend who was recently diagnosed with Alpha-Gal Allergy. Alpha-Gal is a sugar that is found in most mammals, except humans. Unlike most allergies, symptoms occur just hours after a person eats a mammal product, and can vary from migraines to anaphylaxis.

When a patient lets you know their diagnosis, put it in their notes. Mark all of the mammal options available including dairy. Next, check the package inserts on any maintenance medications they take. Inactive ingredients including: gelatin, magnesium stearate, and lactose are common excipients that should be avoided. A follow up phone call to the manufacturer may be required to find out if a product like magnesium stearate is from animals or plants, because it could be either.

Some patients will take the initiative and look at package inserts or call manufacturers themselves. They may do a lot of research and know their condition and what to avoid better than most medical professionals.

Keeping a running list of safe formulations could be helpful. Most importantly, remember that this is a life altering diagnosis for most people and they will need your help.

11

12/1/21 9:37 PM

YOUR JOURNEY

BEGINS HERE!

pharmacy.UAMS.edu

Helping independent pharmacies compete since 1982.

C

M

Now with more services to thrive in today's pharmacy landscape.

Y

CM

MY

• Group volume purchasing • Profits distributed to members at year-end • EPIC Pharmacy Network – third party contracting • – claims reconciliation and automated reimbursements below cost system • – regulatory and compliance management

CY

CMY

K

800-965-EPIC (3742) | epicrx.com | memberservices@epicrx.com 12

ARRX 3rd Quarter 2021 Updated.indd 12

AR•Rx

|

THE ARKANSAS PHARMACIST

12/1/21 9:37 PM

Going for Gold

S

ummer finally brought the highly anticipated Olympics, with countries across the globe showcasing their brightest and most talented athletes. The variety of events allowed competitors the opportunity to highlight unique skills necessary for success. In much the same way, medications approved in the third quarter treat a variety of conditions – each rising to gold in their respective areas of pharmacotherapy.

Oral: Kerendia® (finerenone) is a non-steroidal mineralocorticoid receptor antagonist indicated to reduce the risk of sustained eGFR decline, end stage kidney disease, cardiovascular death, nonfatal myocardial infarction, and hospitalization for heart failure in adult patients with chronic kidney disease associated with type 2 diabetes. Fexinidazole® is a nitroimidazole antimicrobial, indicated for the treatment of both first- and second-stage human African trypanosomiasis due to Trypanosoma brucei gambiense in patients > 6 years of age who weigh at least 20 kg. Rezurock™ (belumosudil) is a kinase inhibitor indicated for the treatment of adult and pediatric patients > 12 years with chronic graft-versus-host disease after failure of at least two prior lines of systemic therapy. Bylvay® (odevixibat) is an ileal bile acid transporter inhibitor indicated for the treatment of pruritus in patients > 3 months old with progressive familial intrahepatic cholestasis.

Injections: Rylaze™ (asparaginase erwinia chrysanthemi (recombinant)-rywn) is an asparagine specific enzyme indicated as

a component of a multi-agent chemotherapeutic regimen for the treatment of acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) in adult and pediatric patients > 1 month old who have developed hypersensitivity to E. coli-derived asparaginase.

Nexviazyme™ (avaglucosidase alfa-ngpt) is a hydrolytic lysosomal glycogen-specific enzyme indicated for the treatment of patients > 1 year of age with late-onset Pompe disease (lysosomal acid alphaglucosidase deficiency). Skytrofa™ (lonapegsomatropin-tcgd) is a human growth hormone indicated for the treatment of pediatric patients > 1 year old who weigh at least 11.5 kg and have growth failure due to inadequate secretion of endogenous growth hormone.

IV Infusion: Saphnelo™ (anifrolumab-fnia) is a type I interferon receptor antagonist indicated for the treatment of adult patients with moderate-to-severe systemic lupus erythematosus (SLE), who are receiving standard therapy. Welireg™ (belzutifan) is a hypoxiainducible factor inhibitor indicated for treatment of adult patients with von Hippel-Lindau disease who require therapy for associated renal cell carcinoma, central nervous system hemangioblastomas, or pancreatic neuroendocrine tumors, not requiring immediate surgery.

Korsuva™ (difelikefalin) is a kappa opioid receptor agonist indicated for the treatment of moderate-to-severe pruritus associated with chronic kidney disease in adults undergoing hemodialysis. §

Drug

Indication

Route

Dosing

Rylaze™ (asparaginase erwinia chrysanthemi (recombinant)-rywn)

Lymphoblastic leukemia and lymphoblastic lymphoma

INJ

Every 48 hours

Kerendia® (finerenone)

Reduce risk of kidney and heart complications in CKD associated with Type-2 diabetes

PO

Daily

Fexinidazole®

Human African trypanosomiasis cause by the parasite Trypanosoma brucei gambiense

PO

Daily

Rezurock™ (belumosudil)

Chronic graft-versus-host disease after failure of at least two prior lines of systemic therapy

PO

Daily

Bylvay® (odevixibat)

Pruritus

PO

Daily

Saphnelo™ (anifrolumab-fnia)

Moderate to severe systemic lupus erythematosus along with standard therapy

INJ

Every 4 weeks

Nexviazyme™ (avaglucosidase alfa-ngpt)

Late-onset Pompe disease

INJ

Every 2 weeks

Welireg™ (belzutifan)

von Hippel-Lindau disease under certain conditions

PO

Daily

Korsuva™ (difelikefalin)

Moderate to severe pruritus associated with CKD in certain populations

INJ

At end of each HD treatment

Skytrofa™ (lonapegsomatropin-tcgd)

Short stature due to inadequate secretion of endogenous growth hormone

INJ

Weekly

WWW.ARRX.ORG

ARRX 3rd Quarter 2021 Updated.indd 13

13

12/1/21 9:37 PM

Baker's Bulls & Bears

Can I Become a Millionaire

by Working for Someone Else?

by Joe Baker

Y

es, and I will show you how. Unfortunately, a million doesn’t go as far today, but it is a nice milestone to achieve and it may be the minimum to live a comfortable lifestyle in retirement.

Let’s assume the following. You are a 30 year old pharmacist and make $100,000 (with 3% annual raises) at Big Rock Pharmacy. Big Rock Pharmacy offers its employees a 401(k) employer sponsored retirement plan with 100% employer match up to 5% of your contribution. This means that for the first 5% of your contribution ($5,000) to their 401(k) plan, Big Rock Pharmacy will match/ contribute to your account with an additional $5,000. Woo-hoo, free money! This is why I always tell everyone to do at least the company match, preferably more. A vesting schedule may apply on the employer contribution, but your contribution is vested 100% immediately.

You decide to contribute 10% ($10,000) to the 401(k) for 30 years, with an estimated 8% annual return. At age 60, you will have $2,388,712.

Would you like to check out your potential millionaire status? Go to www.bankrate.com/calculators.aspx & click 401(k) calculator under Retirement Calculators.

I chose 8% estimated rate of return because I am assuming that the portfolio will be comprised mostly of stocks. Historically, from January 1975 – August 2021, the S&P 500 (stock market) has averaged an annual return of over 8% with dividends reinvested.1 I recommend selecting either a Target Date Mutual Fund or Stock Index Mutual Fund in your 401(k).

Target Date Fund – A target-date mutual fund is a mutual fund that mechanically balances a portfolio consisting of stocks, bonds, and cash equivalents within a selected time frame suitable to a

14

ARRX 3rd Quarter 2021 Updated.indd 14

AR•Rx

|

THE ARKANSAS PHARMACIST

12/1/21 9:37 PM

CAN I BECOME A MILLIONAIRE BY WORKING FOR SOMEONE ELSE?

particular investor. A target-date fund is weighted heavier in stocks when the investor is young then shifts more to bonds and/or cash equivalents as the investor ages. The target- date fund is structured to address a particular date in the future, such as one’s retirement.

Stock Index Mutual Fund – A stock index mutual tries to equal the returns of a particular segment of the market by buying the same securities as the specific index tracks. This type of fund is often referred to as a passive fund (as opposed to an actively managed fund) because decisions are made in response to market movements and no fund manager is needed to make, buy, or sell decisions. The stated objective of most index funds is to approximate the returns of the index it is following. Index funds generally have low fees. Most employer 401(k) plans offer both of these options.

The millionaire chart below is courtesy of Lyn Alden.2 It shows just how large your money could grow over time when you start investing early and investing the amount that fits your needs.

Want to know more about investing? Order my book, Baker’s Dirty Dozen Principles For Financial Independence, at www. bakersdirtydozen.com 1 - https://dqydj.com/sp-500-return-calculator/ 2 - https://www.lynalden.com/build-wealth/

WWW.ARRX.ORG

ARRX 3rd Quarter 2021 Updated.indd 15

15

12/1/21 9:37 PM

MEMBER FAMILY SPOTLIGHT

Chester Barber P.D.

Elee Coleman Pharm.D.

Torrence Barber Pharm.D. DeQueen Health & Wellness Pharmacy Pharmacy School & Graduation Year Chester Barber: Northeast Louisiana University in 1984 Elee Coleman: University of Louisiana at Monroe School of Pharmacy in 2018

Torrence Coleman: University of Louisiana at Monroe in 2020

Years in Business Chester: I opened my store in De Queen May 8th 2000. I have owned it for 21 years.

Least Favorite Part of the Job and Why Chester: My least favorite part of the job is dealing with

pharmacy.

PBMs who want to consistently pay me below my costs for medications that I dispense.

Torrence: I have worked at our family pharmacy in De Queen,

Elee: My least favorite part of pharmacy are rude customers. I

Elee: I have been working for three years at our family

AR for one year to date.

Favorite Part of the Job and Why Chester: My favorite part of my job is trying to help people

live healthier more productive lives. I do that by counseling patients about their medication as well as recommending nutritional supplements. There are many ways a pharmacist can promote health and wellbeing in the pharmacy by teaching how to modify behavior and educate them in ways to prevent or slow the progression of various diseases.

Elee: I love working at a job where creativity is welcomed and innovation is encouraged. The definition of what pharmacists do is changing daily, and I love being a part of that.

Torrence: I enjoy getting to know our locals and vaccinating

wake up every day ready to serve the people of my community, and it is always disheartening when one person tries to ruin your day for something that is out of your control.

Torrence: My least favorite part of my job is when patients are rude or impatient.

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

Chester: I think one of our biggest challenges will be continuing to learn how to transition to a more clinical based practice.

Elee: I think the biggest challenge for pharmacists are low

reimbursements. I am extremely grateful that we have political leaders in Arkansas that are in our corner to fight for the little guys.

our community for COVID.

16

ARRX 3rd Quarter 2021 Updated.indd 16

AR•Rx

|

THE ARKANSAS PHARMACIST

12/1/21 9:37 PM

Torrence: I think the biggest

challenge in pharmacy will be pharmacists gaining recognition as medical providers.

Oddest Request from a Patient/Customer Chester: After I filled a

promethazine suppository for a mother's child, she asked me if I would administer it. I politely declined.

Elee: My oddest request from a patient has been them asking me if alcohol is okay to drink with the COVID vaccine. It seems to be a common question.

Torrence: My oddest request

from a patient was when a patient asked me if there was a way to administer the COVID vaccine through a nebulizer because they were terrified of needles.

Torrence: In my spare time, I like to relax with my dogs and wife. I, also, enjoy gaming and fishing.

Ideal Dinner Guests Chester: My ideal dinner guest is Leslie Rutledge, the

State Attorney General of Arkansas. Her efforts in getting the Supreme Court 8-0 decision to pass the PBM law for pharmacy will greatly effect all pharmacy's success in the future.

Elee: My ideal dinner guest would be George Washington. I love learning about our history as a country. I visited Mount Vernon, home of Washington, on my honeymoon and it is such a beautiful place.

Torrence: My wife is my ideal dinner guest.

If not a pharmacist, then...?

Chester: If not a pharmacist then a marketing director for

a nutritional company. I have had an opportunity in my pharmacy practice to study the benefit to patients in terms of wellness and disease prevention with nutritional therapy.

Elee: If not a pharmacist then a dendrologist. I know that sounds nerdy! Dendrology is the study of trees, and I spend what little spare time I have researching and learning about trees and plants. It is a change of scene and pace that is sometimes needed when you work in a busy pharmacy.

Torrence: If not a pharmacist then a pathologist because I Recent Reads Chester: Since we started vaccinating last January and now that we are doing Regen-Cov monoclonals, I am lucky to have time to read my Pharmacist Letter newsletter on any regular basis.

Elee: Lately, I have not had time to read anything for leisure. I

have been spending my time reading information for RegenCov and new information coming out about COVID vaccines..

Torrence: My recent reads consist of articles discussing COVID-19 vaccines and Regen-Cov antibody therapy.

Favorite Activities/Hobbies Chester: I ride my bicycle over 55 miles a week to work and back six days a week. I enjoy riding my bicycle because it helps me feel better, and it is a great way for me to relax and get my mind off of the stresses of the day.

Elee: I love a good antique store. I specifically love bookstores

enjoy using microscopes.

How did you decide to start administering monoclonal antibody therapy at your pharmacy and how has the experience been so far?

Chester: Blake Torres, owner of West Side Pharmacy and

CPESN member also, contacted us via text message and made us aware of the need in our state. It has been very busy around our pharmacy, however; it has been highly rewarding to see patients recover who would have otherwise would have been hospitalized or on a ventilator.

Elee: West Side was the first pharmacy in the state to start

administering the antibodies and we were right behind them.

I have thoroughly enjoyed giving monoclonal antibodies. It feels great knowing that you are directly making a difference in someone's life.

Torrence: I love the idea of being able to help people more than we already do. Giving monoclonal antibodies has been very fulfilling and helpful to the people of our community. §

packed full of old books! I can spend hours in an antique store or bookstore.

WWW.ARRX.ORG

ARRX 3rd Quarter 2021 Updated.indd 17

17

12/1/21 9:37 PM

UAMS SCHOOL OF PHARMACY & HARDING UNIVERSITY REPORT

CIndy D. Stowe, Pharm.D. Dean and Professor UAMS College of Pharmacy

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

2021 UAMS and Harding Colleges of Pharmacy Employment Survey

Results Compiled by: Lanita S. White, Assistant Dean for Student Affairs (UAMS COP); Sarah Griffin, Assistant Dean for Academic Affairs (HU COP); Cindy D. Stowe, Dean (UAMS COP); and Jeff Mercer, Dean (HU COP)

O

n behalf of the UAMS and Harding University Colleges of Pharmacy, we offer our sincere congratulations to the Arkansas Pharmacy Class of 2021. As they transition away from the classroom to their new careers, we wish them all the best.

As in previous years, we appreciate the students’ willingness to complete an employment survey, especially during the COVID-19 pandemic and the unprecedented changes initiated to combat the spread of the coronavirus. The response rate of the survey was 94% (143 of 152). As collected prior to commencement, the information indicates the job market for our 2021 Arkansas pharmacy graduates has held steady from 2020, despite the ongoing pandemic.

Of the 143 graduates who responded to the survey, 30 indicated they had accepted a residency position and 98 indicated they were seeking employment. Of the 98 non-residency bound graduates, 70% (n=69) received an employment offer by the close of the survey and 59% (n=58) accepted a position, similar to 2020’s 58% who had accepted a position. Previous work experience with an employer has increasingly become a major factor for graduates when choosing a practice setting. Of the 58 graduates who have accepted a position, only 22% (n=13) have no previous working experience with their employer.

The average hourly salary for accepted pharmacist positions (excluding residency) prior to graduation was $51.25 ($104,568.00 per year), a slight decrease from 2020’s $54.55 per hour. Additionally, 93 graduates ranked the availability of employment opportunities with 68% (n=63) responding that they felt there were employment opportunities available, varying from some opportunities to many opportunities -- down from 78% in 2020 but higher than 65% in 2019.

Overall, 16% (n=23) of all respondents plan to own a pharmacy, the highest percentage since 19% in 2014. Another 36 respondents (25%) are open to considering pharmacy ownership. Graduates who have student loans make up 86% of the group completing the survey with an average amount of debt of $163,560 per student.

In summary, the COVID-19 pandemic created a somewhat non-traditional academic experience for the Class of 2021. However, their time in the classroom, their COVIDaltered advanced pharmacy practice experiences, and recent federal and state legislative changes expanding the role of student pharmacists have all prepared our graduates for the road ahead. The faculties of UAMS and Harding Colleges of Pharmacy congratulate the Class of 2021 and look forward to watching their successful careers unfold. §

Summary • 143 of 152 (94%) Arkansas graduating pharmacy students started the survey • University of Arkansas for Medical Sciences (n=93) • Harding University (n=35) • Did not complete entire survey (n=15) • Did not start the survey (n=9) • The survey was sent to all 152 graduating students (47 Harding, 105 UAMS). The survey was open from 4/26/2021 to 6/1/2021.

• 128 graduating pharmacy students completed the survey.

• 75% of graduates completed a bachelor’s degree with 4% earning a master’s or PhD degree prior to admission.

• Approximately 41% plan to own a pharmacy in the future or are undecided on pharmacy ownership.

• 30 of 128 graduates accepted a residency position.

• 58 of 98 (59%) of non-residency bound graduates accepted a position at the close of the survey.

• Overall, 90% of graduates who accepted positions will practice in Arkansas, with the majority settling in central Arkansas.

Excluding residency positions, 10% percent will practice pharmacy outside of Arkansas, with half going to Texas • 81% of graduates (excluding residency) who accepted a position did so in a community setting (chains, independent, mass-market, specialty pharmacies, consultant, etc.)

• Most graduates had a relationship with their employer prior to accepting a position either through working prior to pharmacy school, working as an intern, or completing a rotation.

• The average salary for graduates (excluding residency) is $51.25 per hour or $104,568.00 per year.

• 86% of graduates have student loans with an average of $163,560 and totals ranging from $20,000 to $410,000

18

ARRX 3rd Quarter 2021 Updated.indd 18

AR•Rx

|

THE ARKANSAS PHARMACIST

12/1/21 9:37 PM

• 69 of 98 (70%) of non-residency bound graduates received an employment offer at the close of the survey (max = 5 offers received).

• Nine graduates had not accepted an offered position at graduation. The majority who had not accepted a position had not done so because they were searching for a specific location in Arkansas.

• According to respondents, the top five most sought-after job characteristics are employee assistance programs, fair pay, good working conditions, job security, and flexible schedule.

• Top benefits offered by employers: health insurance, paid vacation, paid holidays, and retirement plan • 68% of graduates felt there were at least some opportunities available at varying levels. 21% felt they had few opportunities to choose from while 10% had trouble finding a position.

Graduate Demographics

Position Information

WWW.ARRX.ORG

ARRX 3rd Quarter 2021 Updated.indd 19

19

12/1/21 9:37 PM

2021 UAMS AND HARDING COLLEGES OF PHARMACY EMPLOYMENT SURVEY

Salary Information by Position

Position Location Information

20

ARRX 3rd Quarter 2021 Updated.indd 20

AR•Rx

|

THE ARKANSAS PHARMACIST

12/6/21 2:18 PM

WWW.ARRX.ORG

ARRX 3rd Quarter 2021 Updated.indd 21

21

12/1/21 9:37 PM

ARKANSAS ACADEMY OF HEALTH-SYSTEM PHARMACISTS

Arkansas Pharmacy Residency Programs

T

he past 18 months have been extraordinary as we all faced the continued challenges of the COVID-19 pandemic. As the roles of pharmacists continue to evolve during this unprecedented time in healthcare, postgraduate training for pharmacists seems more critical than ever to provide innovative patient care, advance pharmacy practice, and develop the future leaders of our profession.

Pharmacy residencies in the United States emerged in the 1930s primarily as management training for pharmacists in the hospital setting. The ASHP implemented standards in 1948 and began accrediting pharmacy residency programs in 1962. Today, there are thousands of programs providing over 5,500 residency positions in 2021. According to ASHP, postgraduate year 1 (PGY1) residency positions have grown by 27% and postgraduate year 2 (PGY2) positions by 55% over the last 5 years.

In Arkansas, there are currently 21 residency programs with 48 positions in varying accredited stages ranging from pre-candidate, candidate, and accredited status. Two new PGY1 programs (Mercy Hospital Northwest Arkansas and St. Bernards Medical Center) and 3 new PGY2

HyeJin Son, PharmD, BCPS AAHP 2021-2022 President

programs (critical care at UAMS, ambulatory care at ARCare, and pediatrics at Arkansas Children’s Hospital/UAMS College of Pharmacy) were added within the last two years despite the COVID-19 pandemic. Other sites have been increasing the number of positions within the program such as UAMS College of Pharmacy community pharmacy program as well as the Unity Health program. It is encouraging to see the number of programs and residency positions increasing year after year to meet the demand for opportunities and need for pharmacists with advanced training.

If you are a student reading this, I highly recommend you to consider pursuing a pharmacy residency. It is designed to broaden your clinical knowledge base, strengthen your leadership and interprofessional skills, and prepare you to practice at the highest levels as the medication experts to support patients across all healthcare settings. If you are a current resident, I wish you a challenging year of learning and growth. To all the residency program directors (RPDs), residency program coordinators (RPCs), and preceptors, thank you for your dedication and commitment to our profession and for advancing pharmacy education. If there is anything AAHP can assist you with, please do not hesitate to contact me at hyejin.son@baptist-health.org.§

PGY1 Program Sites

Program Name

Location

Positions (38)

ARcare

PGY1 - Community Pharmacy

Augusta

2

Arkansas Children’s Hospital/UAMS College of Pharmacy

PGY1 - Pharmacy

Little Rock

1

Baptist Health Medical Center - North Little Rock

PGY1 - Pharmacy

N. Little Rock

2

Baptist Health Medical Center Little Rock

PGY1 - Pharmacy

Little Rock

2

Central Arkansas Veterans Healthcare System

PGY1 - Pharmacy

Little Rock

6

CHI St. Vincent Infirmary Medical Center

PGY1 - Pharmacy

Little Rock

2

Mercy Hospital Northwest Arkansas

PGY1 - Pharmacy

Rogers

2

St. Bernards Medical Center

PGY1 - Pharmacy

Jonesboro

2

UAMS Medical Center

PGY1 - Pharmacy

Little Rock

4

UAMS College of Pharmacy (Walmart, Harps, Kroger, Express Rx, Bryant Family, UAMS Outpatient)

PGY1 - Community Pharmacy

Multiple locations (6)

8

Unity Health - White County Medical Center

PGY1 - Pharmacy

Searcy

4

Veterans Health Care System of the Ozarks

PGY1 - Pharmacy

Fayetteville

2

White River Health System

PGY1 - Pharmacy

Batesville

1

PGY2 Program Sites

Program Name

Location

Positions (10)

ARcare

PGY2 - Ambulatory Care

Augusta

1

Arkansas Children’s Hospital/UAMS College of Pharmacy

PGY2 - Pediatric

Little Rock

1

Central Arkansas Veterans Healthcare System

PGY2 - Ambulatory Care

Little Rock

1

Central Arkansas Veterans Healthcare System

PGY2 - Geriatric

Little Rock

1

Central Arkansas Veterans Healthcare System

PGY2 - Pain/Palliative Care

Little Rock

2

UAMS Medical Center

PGY2 - Critical Care

Little Rock

1

UAMS College of Pharmacy

PGY2 - Ambulatory Care

Little Rock

1

UAMS College of Pharmacy

PGY2 - Geriatric

Little Rock

2

22

ARRX 3rd Quarter 2021 Updated.indd 22

AR•Rx

|

THE ARKANSAS PHARMACIST

12/1/21 9:37 PM

CONSULTING ACADEMY REPORT

Utilizing Monoclonal Antibody Treatments in Long-term Care Settings Emily Holton, Pharm.D. Consulting Academy 2021-2022 President

A

s community cases in our state continue to rise, there’s a new treatment opportunity that is available for Covid-19.

As a pharmacy consultant in the long-term care setting, educating facilities on this available therapy is imperative, as many high-risk individuals reside in nursing homes.

Monoclonal antibody therapy has been shown to be highly effective in preventing severe Covid-19 when given early in disease (within 10 days of symptoms starting) and can prevent further hospitalizations.

I encourage all consultants to take the opportunity to discuss utilizing monoclonal antibody treatments in their facilities to avoid the potential for further hospitalization of our residents. According to data from NHSN, Arkansas has the highest COVID-19 vaccination rate in the region and surpasses the national rate for staff (~67% in reporting facilities) and residents (~84% in reporting facilities).

However, let’s be sure not to miss the opportunity to further protect our residents and reduce their risk of being hospitalized by utilizing monoclonal antibody treatments when necessary.

What is antibody therapy?

Antibody therapy are proteins that work to bind to the virus and stop it from further infecting an individual, working as soon as it is given and giving protection for weeks to months after administration.

What monoclonal antibody treatments are currently available?

The FDA has approved emergency use authorization (EUAs) on three monoclonal antibody therapies: casirivimab/ imdevimab (Regen-COV), bamlanivumab/elesevimab (Lilly) and sotrovimab (GSK/Vir). All are indicated for treatment of mild to moderate Covid-19 infection within 10 days of symptoms onset in patients with high risk of progression to severe disease.

Monoclonal antibody administration includes both intravenous route and subcutaneous route. However, the only subcutaneous route approval is for the Regen-Cov product.

Who is eligible for this treatment?

To be eligible to receive monoclonal antibody treatment, individuals must be 65 or older and weigh at least 80 pounds or are age 12 or older/weigh at least 80 pounds and have any of the following: chronic kidney disease, heart or lung disease, BMI of 25 or greater, diabetes, immunosuppressive disease or other factors, including race/ethnicity, that

WWW.ARRX.ORG

ARRX 3rd Quarter 2021 Updated.indd 23

puts an individual at higher risk for progressing to severe Covid-19.

By the first requirement alone of 65 or older and weighing 80 pounds or more, a significantly high proportion of residents in the long-term care setting are eligible to be treated with monoclonal antibodies in their facility to reduce the risk of being hospitalized. This includes those who have tested positive, regardless of vaccination status and can also be used for post exposure prophylaxis in those who are not fully vaccinated or who are not expected to mount an adequate immune response to complete SARS-CoV-2 vaccination.

It’s important to note, the EUA for Regen-Cov does not cover pre-exposure prophylaxis nor are monoclonal antibodies a substitute for vaccination. Individuals who receive monoclonal antibody therapy need to defer vaccination for 90 days post administration.

Post Exposure Prophylaxis (PEP) Use: The Regen-Cov product is approved for post-exposure prophylaxis (PEP) for unvaccinated or immunocompromised individuals with high risk of progression to severe disease.

Nursing home residents, because of their age, would be considered not likely to mount adequate immune response and thus would be eligible. Residents in nursing homes who are considered to have had high risk exposure can get Regen-Cov for PEP. Treatment for PEP should be given as soon as possible and ideally within the first 4 days of highrisk exposure.

Limitations of using monoclonal antibody therapies: Monoclonal antibody treatment is not authorized for individuals who are hospitalized, who require oxygen therapy due to Covid-19, nor individuals who require an increase in baseline oxygen flow rate due to Covid-19 in those already on chronic oxygen therapy due to underlying non-Covid-19 related comorbidity.

Monoclonal antibodies may be associated with worse clinical outcomes when given to patients with Covid-10 requiring oxygen ventilation. § Sources

Centers for Disease Control and Prevention, National Healthcare Safety Network “Federal Response to COVID-19: Monoclonal Antibody Clinical Implementation Guide.” 2 Sept. 2021.

Kothari, Atul. “COVID 19 Variants and Emerging Treatments.” 18 Aug. 2021.

23

12/1/21 9:37 PM

COMPOUNDING ACADEMY REPORT

More Than a Paper Cut: The Real Threat to Pharmacy Practice Greg Turner, Pharm.D. Compounding Academy 2021-2022 President

W

hen I think of a compounding pharmacist, my mind goes back to pharmaceutics and Dr. Underwood telling us to make things “pharmaceutically elegant”. Dr. Underwood was sharing a glimpse of our deep connection to the art and science of pharmacy which is compounding active ingredients into usable dosage forms. Not until the last 50 years has pharmacy moved away from mixing and matching active ingredients to using manufactured dosage forms.

involved. The first place to learn about the FDA’s challenge to the practice of pharmacy is the Alliance for Compounding Pharmacy at https://a4pc.org. From there, go to the section on saving cBHRT for a complete breakdown of the threat.

Secondly, know that PCCA has recently presented two studies on cBHRT at prestigious medical conferences.

Specifically, PCCA presented at the Society for Investigative Dermatology’s virtual meeting in May, 2021. The article was entitled Absorption of Progesterone, Testosterone, Estriol and Estradiol in VersaBase Cream and VersaBase That’s right, not until the 1970’s did manufacturers begin Anhydrous HRT. This study demonstrated that bioidentical making pills, pastes and other dosage forms in bulk. hormones penetrate through the skin (stratum corneum, Now, after billions of dollars in marketing, providers are epidermis and dermis) upon application of corresponding conditioned to believe that manufactured products are PCCA formulas that used VersaBase Cream and VersaBase the only way to treat patients. While Anhydrous HRT. These results are the amount of compounding for the important evidence to support average pharmacist has dwindled the effectiveness of compounded While the amount of compounding dramatically, pharmaceutics is still a bioidentical hormone replacement for the average pharmacist therapy since the in vitro model used rudimentary part of pharmacy school has dwindled dramatically, has proven to accurately predict in curriculum across the country. Thus, pharmaceutics is still a compounding is in our DNA and vivo permeation kinetics. The second rudimentary part of pharmacy study was presented at the ACOG an integral part of who we are as school curriculum across the pharmacists.

Virtual Annual Clinical and Scientific country. Thus, compounding is Meeting on April 30 - May 2, 2020. in our DNA and an integral part You have probably heard the The study was entitled “Case Study: of who we are as pharmacists.

Testosterone Replacement Therapy expression “Death by a thousand in a Premenopausal Women”. In paper cuts”. Slowly, over time, the practice of pharmacy has been this case study, the patient suffering eroded by manufacturers, PBM’s, $4 dollar prescriptions, from bothersome psychological symptoms and sexual disfunction was successfully treated with testosterone 0.75 etc. The latest afront to the practice of pharmacy has been mg/g topical gel (Versabase Anhydrous HRT). Following 6 levied by the Food and Drug Administration. Recently, the FDA commissioned the National Academies of Sciences, months of testosterone (T) therapy, the patient reported Engineering, and Medicine (NASEM) to conduct a study of good clinical outcomes and her salivary testosterone compounded bioidentical hormones (cBHRT). The study levels increased from low to optimal. Despite the myths concluded that there isn’t much clinical evidence for or and misconceptions associated with testosterone, there is against cBHRT. As a result, the FDA has recommended that scientific evidence to support the safety and effectiveness cBHRT be restricted. Talk about a double standard. The of compounded T-therapy in women. These studies along FDA requires drug companies to conduct multiple studies with patient experiences across the country and in your own in different patient populations and dosages to approve locale support the efficacy of cBHRT. a drug, yet…they are restricting cBHRT based on one study conducted by a group with little or no credentials in The FDA’s threat could have devastating impact on the lives of patients that count on these compounds. To you, it medicine. Have you ever seen any clinical studies of merit may seem small if you are not actively serving this patient from NASEM? population. The question to you is how many more paper So, how do we as pharmacists combat this challenge to cuts can the profession of pharmacy take until we finally the practice of pharmacy? The number one thing that bleed out and we are replaced by Amazon Kiosks? you can do is to get educated on the subject and then get

24

ARRX 3rd Quarter 2021 Updated.indd 24

AR•Rx

|

THE ARKANSAS PHARMACIST

12/1/21 9:37 PM

Statement of Ownership, Management, and Circulation (All Periodicals Publications Except Requester Publications)

1. Publication Title

2. Publication Number

94 4 720

ARRX, The Arkansas Pharmacist 4. Issue Frequency

_

5. Number of Issues Published Annually

Quarterly

10/7/2021

7. Complete Mailing Address of Known Office of Publication (Not printer) (Street, city, county, state, and ZIP+4 ®) Arkansas Pharmacists Association 417 S Victory St Little Rock, AR 72201-2923

15. Extent and Nature of Circulation

a. Total Number of Copies (Net press run)

Contact Person Jordan Foster Telephone (Include area code) 501-372-5250

8. Complete Mailing Address of Headquarters or General Business Office of Publisher (Not printer) Arkansas Pharmacists Association 417 S Victory St Little Rock, AR 72201-2923 9. Full Names and Complete Mailing Addresses of Publisher, Editor, and Managing Editor (Do not leave blank) Publisher (Name and complete mailing address) John Vinson PO Box 3798 Little Rock, AR 72203

(1) Mailed Outside-County Paid Subscriptions Stated on PS Form 3541 (Include paid distribution above nominal rate, advertiser’s proof copies, and exchange copies) b. Paid Circulation (By Mail and Outside the Mail)

09/01/2021

John Vinson PO Box 3798 Little Rock, AR 72203 10. Owner (Do not leave blank. If the publication is owned by a corporation, give the name and address of the corporation immediately followed by the names and addresses of all stockholders owning or holding 1 percent or more of the total amount of stock. If not owned by a corporation, give the names and addresses of the individual owners. If owned by a partnership or other unincorporated firm, give its name and address as well as those of each individual owner. If the publication is published by a nonprofit organization, give its name and address.)

Full Name Complete Mailing Address PO Box 3798 Little Rock, AR 72203

3022

2159

2350

2069

502

0

Mailed In-County Paid Subscriptions Stated on PS Form 3541 (Include paid distribution above nominal rate, advertiser’s proof copies, and exchange copies)

(3)

Paid Distribution Outside the Mails Including Sales Through Dealers and Carriers, Street Vendors, Counter Sales, and Other Paid Distribution Outside USPS®

0

(4)

Paid Distribution by Other Classes of Mail Through the USPS (e.g., First-Class Mail®)

0

d. Free or (1) Free or Nominal Rate Outside-County Copies included on PS Form 3541 Nominal Rate Distribution (2) Free or Nominal Rate In-County Copies Included on PS Form 3541 (By Mail and Free or Nominal Rate Copies Mailed at Other Classes Through the USPS Outside (3) (e.g., First-Class Mail) the Mail)

Managing Editor (Name and complete mailing address)

Average No. Copies No. Copies of Single Each Issue During Issue Published Preceding 12 Months Nearest to Filing Date

(2)

c. Total Paid Distribution [Sum of 15b (1), (2), (3), and (4)]

Editor (Name and complete mailing address) Jordan Foster PO Box 3798 Little Rock, AR 72203

Arkansas Pharmacists Association

14. Issue Date for Circulation Data Below

ARRX, The Arkansas Pharmacist

6. Annual Subscription Price

$5.00

4

13. Publication Title

3. Filing Date

(4)

Free or Nominal Rate Distribution Outside the Mail (Carriers or other means)

2852

0 0 2069

0

0

0 0

0 0

100

50

100

50

f. Total Distribution (Sum of 15c and 15e)

2952

2119

g. Copies not Distributed (See Instructions to Publishers #4 (page #3))

70

40

h. Total (Sum of 15f and g)

3022

2159

96

97

e. Total Free or Nominal Rate Distribution (Sum of 15d (1), (2), (3) and (4))

i. Percent Paid (15c divided by 15f times 100)

* If you are claiming electronic copies, go to line 16 on page 3. If you are not claiming electronic copies, skip to line 17 on page 3.

11. Known Bondholders, Mortgagees, and Other Security Holders Owning or Holding 1 Percent or More of Total Amount of Bonds, Mortgages, or x None Other Securities. If none, check box Full Name

Complete Mailing Address

12. Tax Status (For completion by nonprofit organizations authorized to mail at nonprofit rates) (Check one) The purpose, function, and nonprofit status of this organization and the exempt status for federal income tax purposes: Has Not Changed During Preceding 12 Months Has Changed During Preceding 12 Months (Publisher must submit explanation of change with this statement) PS Form 3526, July 2014 [Page 1 of 4 (see instructions page 4)] PSN: 7530-01-000-9931

PS Form 3526, July 2014 (Page 2 of 4)

PRIVACY NOTICE: See our privacy policy on www.usps.com.

Statement of Ownership, Management, and Circulation (All Periodicals Publications Except Requester Publications) 16. Electronic Copy Circulation

Average No. Copies Each Issue During Preceding 12 Months

No. Copies of Single Issue Published Nearest to Filing Date

*Once per year, APA is required to publish a Statement of Ownership and file it with the United States Postal Service.

a. Paid Electronic Copies b. Total Paid Print Copies (Line 15c) + Paid Electronic Copies (Line 16a) c. Total Print Distribution (Line 15f) + Paid Electronic Copies (Line 16a) d. Percent Paid (Both Print & Electronic Copies) (16b divided by 16c Í 100)

I certify that 50% of all my distributed copies (electronic and print) are paid above a nominal price.

17. Publication of Statement of Ownership x

If the publication is a general publication, publication of this statement is required. Will be printed in the 11/01/2021 issue of this publication.

18. Signature and Title of Editor, Publisher, Business Manager, or Owner

Publication not required.

Date

10/07/2021 I certify that all information furnished on this form is true and complete. I understand that anyone who furnishes false or misleading information on this form or who omits material or information requested on the form may be subject to criminal sanctions (including fines and imprisonment) and/or civil sanctions (including civil penalties).

PS Form 3526, July 2014 (Page 3 of 4)

WWW.ARRX.ORG

ARRX 3rd Quarter 2021 Updated.indd 25

PRIVACY NOTICE: See our privacy policy on www.usps.com.

25

12/1/21 9:37 PM

APA Future Headquarters Groundbreaking Event After more than a year of planning, researching, and designing, APA broke ground on our future headquarters on September 8th. Guests heard remarks from APA CEO John Vinson, APA Phoenix Committee member Mark Riley, architect Tim Yelvington, Lisa Turpin of Colliers International, and representatives from CBM construction company. The current projected completion date for the building is around the end of 2022. Thank you to all those who attended the groundbreaking ceremony!

Members of the APA Phoenix Committee and guests officially break ground on the future home of the Arkansas pharmacy

APA CEO John Vinson delivers remarks about the new building and how it will be used to serve Arkansas' pharmacists

26

ARRX 3rd Quarter 2021 Updated.indd 26

Pharmacists, legislators, family, and friends gather to watch the official groundbreaking

AR•Rx

|

THE ARKANSAS PHARMACIST

12/1/21 9:37 PM

Architectural Rendering of the future APA headquarters

WWW.ARRX.ORG

ARRX 3rd Quarter 2021 Updated.indd 27

27

12/1/21 9:37 PM

Social Media Prescriptions 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.

T

he growth and use of social media has definitely changed the society in which we live. Chain letters and phone trees are no longer the most efficient ways to communicate with a large number of people. The use of social media and the Covid-19 pandemic have intersected in a way no one imagined.

I call this phenomenon the Social Media prescription. In 2020, it was the clamor for hydroxychloroquine. In 2021, the clamor is for ivermectin. Pharmacists were, and are, faced with demands to fill these prescriptions without much or any knowledge of the recommended dosage or its safety and effectiveness. While these are two recent examples, this phenomenon is not likely to go away. Social media has the capacity to create fads and demands overnight. While we knew to keep laundry detergent pods away from our toddlers, we didn't think we would have to do so with our teenagers.

I have been asked numerous times in the last year whether a pharmacist has potential liability when filling a prescription for hydroxychloroquine or ivermectin for Covid-19. The answer is yes. Using the basic premise First, Do No Harm as the guideline, the pharmacist can analyze the Social Media prescription in a two-step fashion. First, will the patient benefit from the drug? In these two examples, and most likely in future scenarios, the pharmacist is not sure. When the clamor started, there were no controlled studies to indicate any effectiveness.

Would the mechanism of action for an antiparasitic drug be effective against a virus? It seems unlikely, but we do not know. If the effectiveness of the prescription is unknown, the second question is whether the patient would be injured by taking the drug. There are some risks associated with every drug and every treatment. If a recommended dose is unknown, how does a pharmacist assess the appropriateness of the prescription? Ivermectin can cause serious side effects in an overdose situation. Prescriptions that could harm the patient should not be dispensed, especially when there is no corresponding benefit to taking it. If the pharmacist believes there is a high probability that the patient will be harmed, no one can order them to dispense the prescription.

Another question frequently asked this past year is whether their insurance policy would cover the pharmacist for dispensing the Social Media prescription. I can answer in generalities, but each pharmacist will need to read their own policy for definitive answers. Pharmacy Professional Liability policies generally don't single out specific drugs in the policy language.

Pharmacy practice is too fluid and complex for that to work.

Insurance companies depend on the professional judgment of the dispensing pharmacist to assess the risk/benefits of any unapproved use before dispensing. Policies typically have an exclusion that addresses injury that is expected by the insured.

If the dose is large enough or the lack of data is stark enough, it 28

ARRX 3rd Quarter 2021 Updated.indd 28

could be alleged that the patient's injury was expected and the claim excluded. Another common exclusion addresses injuries arising out of the pharmacist's reckless disregard for the safety or lives of others. That can be difficult to prove, but what is different here is that most unapproved uses are not addressed on the Food and Drug Administration's (FDA) website. The FDA's statement that ivermectin has not been shown to be safe or effective for the treatment or prevention of Covid-19 in people or animals could be used by a plaintiff's attorney to assert that the pharmacist acted in a reckless manner.

The final question I get asked is if the pharmacist can have the patient sign a release form absolving the pharmacist of any liability for dispensing the Social Media prescription. While it is possible to draft such a release, it most likely would not hold up in court. The professional responsibilities of the pharmacist under statutes and regulations were created to protect patients.

Those responsibilities are placed on the pharmacist because of their education and experience. The pharmacist's duty is to protect the patient, and sometimes this means protecting them from themselves. If the idea of a release like this was viable, every professional would use one with every transaction or encounter.

I tell pharmacists in these situations it is easier to defend a case where the pharmacist refuses to fill a questionable prescription than it is to defend a case where the pharmacist has doubts about what was dispensed. When asked at your deposition “And what did you do when you became aware of this potential danger?” you don’t want your answer to be “Nothing.” Pharmacists can’t guarantee 100% safety, but they should avoid prescriptions with high probabilities of serious harm.

Social Media is not going away. Pharmacists will continue to face the dilemma of patients demanding treatments generated from Social Media. It isn't easy to tell a patient no. But an uncomfortable encounter in the pharmacy will be shorter and less damaging than an uncomfortable encounter in the witness chair. § ____________________________________________________________________

© 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

12/1/21 9:37 PM

The Pros and Cons of Early Retirement Plan Rollovers Should you withdraw and reinvest your retirement plan money while you are still on the job?

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.

D

id you know you might be able to take some or all of the money in your 401(k), 403(b), or 457 plan and roll it over into another type of retirement account? Were you aware that you could do this while you are still working for your current employer – without any withholding or early withdrawal penalties? Let’s look at how these rollovers can happen and the pros and cons of making them.

Some 401(k), 403(b), and 457 plans offer this kind of flexibility.

If your plan provides this choice, you must first pay attention to the rules.

To start, some basics. Distributions from 401(k) plans and most other employer-sponsored retirement plans are taxed as ordinary income, and if you take one before age 59½, a 10% federal income tax penalty commonly applies.

(The 2020 CARES Act allows some one-time exceptions to penalties this year.) In addition, 20% of the withdrawn amount is withheld for tax purposes. Generally, once you reach age 72, you must begin taking required minimum distributions.1 Now, the fine print. You may be able to take money out of your plan in your fifties or sixties, while still working, via an in-service non-hardship withdrawal by arranging a direct rollover of these assets to an Individual Retirement Account (IRA), avoid both the 10% penalty and the 20% tax withholding in the process.2 An IRA may give you a wider range of investment options than many employersponsored retirement plans. If you are dissatisfied with the range of choices your plan presents, this alone may motivate you to make a direct rollover.3 You should certainly speak to a financial professional with the knowledge to help you coordinate a direct rollover (also called a trustee-to-trustee transfer). A direct rollover moves assets from your workplace retirement plan into an IRA without a taxable event.2 Generally, distributions from traditional IRAs must begin once you reach age 72. The money distributed to you is taxed as ordinary income. When such distributions are taken before age 59½, they may be subject to a 10% federal income tax penalty; although, the CARES Act allows some exceptions to these penalties in 2020. You may continue to contribute to a Traditional IRA past age 70½ under the SECURE Act as long as you meet the earned-income requirement.4

them. Others permit them when you have been on the job for at least five years or when assets in your plan have accumulated for at least two years or you are 100% vested in your account.2 In addition, you will want to ask your employee benefits or human resources officer some questions. How long will a direct rollover take? Is there a dollar or percentage limit on how much can be rolled over?

Can you withdraw and roll over matching contributions as well as your own account contributions and earnings?

Weigh the pros and cons. Who knows if your reinvested assets will perform better in an IRA than they did in your company’s retirement plan? Only time will tell. Right now, you can put up to $7,000 into an IRA, annually, if you are 50 or older; that pales in comparison to the $26,000 yearly contribution limit on a basic 401(k), 403(b), or 457 plan. Lastly, if your employer matches your retirement plan contributions, getting out of the plan may mean losing future matches.5 § Sources: 1 - IRS.gov, February 20, 2020 2 - DWC401k.com, May 10, 2020 3 - CNBC.com, April 21, 2020 4 - Investor.Vanguard.com, May 10, 2020 5 - IRS.gov, November 6, 2019 ________________________________________________________________ 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

The criteria for making in-service non-hardship withdrawals can vary. Some workplace retirement plans simply prohibit WWW.ARRX.ORG

ARRX 3rd Quarter 2021 Updated.indd 29

29

12/1/21 9:37 PM

2021-2022 New APA Board Members

JAMES BETHEA, PHARM.D.

JETT JONES, PHARM.D.

STUTTGART

JONESBORO

HYEJIN SON, PHARM.D.

GREG TURNER, PHARM.D.

VICE PRESIDENT

REGION 2 REPRESENTATIVE

COMPOUNDING ACADEMY

AAHP PRESIDENT

PRESIDENT

LITTLE ROCK

SEARCY

EMILY HOLTON, PHARM.D.

LINDSEY WORTHINGTON

PRESIDENT

STUDENT REPRESENTATIVE

BENTONVILLE

LITTLE ROCK

CONSULTING ACADEMY

UAMS COLLEGE OF PHARMACY

HANNAH FERGUSON

HARDING COLLEGE OF PHARMACY STUDENT REPRESENTATIVE SEARCY

30

ARRX 3rd Quarter 2021 Updated.indd 30

AR•Rx

|

THE ARKANSAS PHARMACIST

12/1/21 9:37 PM

ARRX 3rd Quarter 2021 Updated.indd 31

12/1/21 9:37 PM

ARRX 3rd Quarter 2021 Updated.indd 32

12/1/21 9:37 PM