Pharmacists Mutual is proud to support pharmacy students interested in serving in an independent or small chain community pharmacy or an underserved geographic or cultural community.
EACH STUDENT LISTED RECEIVED A $3,000 SCHOLARSHIP.
Marlee Clements Mercer University
Allison Welsh North Dakota State University
Amber Conklin Ohio Northern University
Bailey Bartley Sullivan University
Celia Mix North Dakota State University
Casey O’Quinn Medical University of South Carolina
Dylan Johnston Husson University
Elizabeth Braun University of Wisconsin–Madison
Laura Harris Auburn University
Kaia’ Harrison Duquesne University
Katelyn Carswell Auburn University
Kaylen Luginbill Schier
Southwestern Oklahoma State University
Peyton Gilbert University of Texas at Tyler
Natalie Morton Novak Mercer University
Lauren Williams University of Kentucky
Megan Navarro University of the Incarnate Word
Trey Carter University of Kentucky
Taylor Williams University of Kentucky
Pharmacists Mutual Insurance Company
Algona, Iowa phmic.com
Savannah Rose Sullivan University
Victoria Vo Virginia Commonwealth University
John Vinson, Pharm.D. Executive Vice President & CEO John@arrx.org
Nicki Hilliard, Pharm.D. Director of Professional Affairs Nicki@arrx.org
Marlene Battle, Pharm.D. Health Equity Coordinator Marlene@arrx.org
Brandon Cooper, Pharm.D. Strategic Advisor Brandon@arrx.org
Jordan Foster
Director of Communications Jordan@arrx.org
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 PO 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 ($5.00). Non-members subscription rate is $30.00 annually. Periodical rate postage paid at Little Rock, AR 72201. Current edition issue number 95. © 2022 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.
Dylan Jones, Pharm.D., Fayetteville
President-Elect
James Bethea, Pharm.D., Stuttgart
Vice President
Brittany Sanders, Pharm.D., Little Rock
Past President
Max Caldwell, P.D., Wynne
Kevin Barton, Pharm.D., Bentonville
Duane Jones, P.D., Springdale
Spence Mabry, Pharm.D., Berryville
Erin Beth Hays, Pharm.D., Pleasant Plains
Jett Jones, Pharm.D., Jonesboro
Region 3 Representatives
Brandon Achor, Pharm.D., Sherwood
Randy Kassissieh, 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
Stacy Boeckmann, Pharm.D., Wynne
Rick Pennington, P.D., Lonoke
Arkansas Association of Health-System Pharmacists
Kevin Robertson, Pharm.D., Little Rock
Academy of Compounding Pharmacists
Greg Turner, Pharm.D., Searcy
Academy of Consulting Pharmacists
Emily Holton, Pharm.D., Bentonville
APA Executive Vice President & CEO
John Vinson, Pharm.D., Bryant
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
Dan Atchley, Ph.D., Searcy
General Counsel
Nate Steel, J.D., Little Rock
Treasurer
Richard Hanry, P.D., El Dorado
n Friday June 10th, 2022, I shared the state of the Arkansas Pharmacists Association talk with our convention attendees. In that presentation, we discussed major milestones for the profession over the last 25 years that would not have happened without the Arkansas Pharmacists Association and an engaged and large membership. During this talk, Arkansas Pharmacists Association members Dylan Jones, Brittany Sanders, Scott Pace, Jon Wolfe and Amy Rodgers weighed in with exciting and compelling examples of the return on investment in their professional lives that the association has provided.
Vinson, Pharm.D. APA Chief Operating OfficerOsupported, organized and promoted the heroic actions of Arkansas pharmacists and pharmacy teams during the pandemic with the majority of Arkansans receiving healthcare services from our members in all practice settings.
Advancements in Arkansas practice have included medication administration, vaccine and immunization prescribing, naloxone prescribing, nicotine replacement product prescribing, COVID-19, strep and flu test and treat, one time emergency refills, full therapeutic substitution, over the counter drug and supply prescribing, medication pouch or multi-dose packing, pharmacist consulting in medical marijuana patient encounters, and physician - pharmacist protocol patient management (disease state management). We have also protected the business environment with auditing protections, copay fairness, pharmacy benefit manager licensing, banned spread pricing, banned clawbacks, banned pharmacy benefit managers from reimbursing themselves at higher rates to pharmacies owned by PBMs compared to local competitor pharmacies in Arkansas, banned effective rate clawbacks, banned payment below cost in state insured plans and self-funded plans, 340B reform law, defined illegal patient steering for vertically integrated health care entities that own pharmacies, established a proper pharmacist - patient relationship, defined pharmacists as providers, advanced coverage of maintenance medications in the state Medicaid program and helped launch pharmacists defined as healthcare providers and prescribers in the state Medicaid program (June 1, 2022). We also have engaged in continuing education topics, media and policy discussions with staff pharmacists and regulatory agencies on staffing and safe working conditions for pharmacists. Finally, we have heavily
We invested and partnered with multiple national pharmacist associations and 49 state pharmacist associations in a legal battle helping Arkansas Attorney General Leslie Rutledge between 2015 and 2021 on the legality of states’ rights to legislate pharmacy benefit managers (PBMs) on pricing and deceptive business tactics. This financial and time investment resulted in a landmark 8-0 national victory for pharmacists, the first Supreme Court case in history to weigh in on this battle. That victory has supported 100’s of state PBM laws being introduced in all 50 states, influenced CMS to reform Direct and Indirect Remuneration (DIR) fees, and influenced the Federal Trade Commission to launch a very detailed investigation in the anticompetitive business practices of PBMs to local pharmacies.
These success stories do not happen without good leadership. One of those leaders is Eddie Glover from Conway, a well-known Arkansan and one the most memorable and charismatic Presidents for the Arkansas Pharmacists Association (APA). In the fall of 2017, Dr. Glover had just finished his term as President and was serving in his last year on the Executive Committee. The APA Board of Directors was engaged in deep discussions, strategizing for the next year and working on implementation and support for new state laws that improved pharmacy practice from 2017. In that strategy session, Dr. Glover shared an idea that our communication and engagement with membership should be organized like the United States Army. We could accomplish anything if each Board member would identify five (5) pharmacists that they could call should we ever have a professional emergency or need to immediately activate grass roots. Those 5 people could then identify their list of five (5) to call or text. It would not take long, and we would reach 75 or 80% of the active 4000 pharmacists in Arkansas. If we engage student pharmacists and pharmacy technicians as well, that number could easily reach over 10,000 members of the profession.
That fall of 2017, I was a relatively
new employee at APA, and I remember smiling during the conversation and thinking this is a good idea, but would it ever really be used or work? A few hours later, we were at dinner and networking and the idea of Eddie’s army was on a sticky note or a chart and was likely soon to be a distant memory. Those of you who remember early 2018, just a few months later, will recall that Eddie’s Army came alive, and our profession showed up 500 + strong to state legislative committee hearings, a press conference, and fought to reign in anticompetitive reimbursement strategies by the largest PBM in Arkansas that threatened to destroy the profession. This led to a whirlwind of a special legislative session and 5 years of reform in the industry that has helped to improve pharmacy practice in Arkansas and the nation.
The Arkansas Pharmacists Association was recently ranked 11th in the state of Arkansas by number of active members in Arkansas state professional associations by Arkansas Business. Our membership historically includes about 2300 members including pharmacists, pharmacy technicians, student pharmacists and associate members. Our organization is respected, large, and active, making us more effective in advocacy on important health policy issues with state agencies, the Attorney General, the Governor and state lawmakers.
All associations around the state and country have struggled during the pandemic to engage, keep and grow their membership. Despite our recent successes listed above, the Arkansas Pharmacists Association is also affected by this. We recently restructured membership including a 5 year new practitioner
benefit for emerging pharmacists accessing a 50% discounted rate. At the request of our membership, we launched an autorenewal feature that allows you to renew annually automatically to make the process easy and our membership renewal is now launched from January to March 31 of each year, rather than the hustle and bustle of November and December.
I would like to challenge each of you to activate Eddie’s army for membership. Who are 5 people that you know need to be members of APA and will strengthen the collective voice of the profession as members? Are those five (5) people willing to text or encourage five (5) people and so on? Our APA Board members are doing this now. Will you help them? In addition, many pharmacy companies will reimburse pharmacists and pharmacy technicians for their membership with APA as their success depends on each of you and the profession growing stronger. The quickest way to determine membership is to check online https://www.arrx.org/ membership or to confirm receipt of the Friday newsletter via email. You may also reach us at 501.372.5250 or email at staff@arrx.org for membership questions. We are about to open our long awaited new building at 417 South Victory Street, the Phoenix Project. We are also about to enter into another full state legislative session with major health policy issues at stake. We need Eddie’s army to grow and strengthen as we have several challenges and opportunities ahead to solve for both the current and next generation of pharmacists and pharmacy teams to thrive. We need your help to strengthen the Arkansas pharmacy army. §
It is a tremendous honor to serve as President of the Arkansas Pharmacists Association. Leading up to this opportunity, I’ve spent a lot of time reflecting on the work of those that have come before me. It is humbling to think of the effort so many have invested to advance the mission of pharmacy for both the state of Arkansas and for our country. With this in mind, the first message I wanted to share with our membership is a message of thanks.
The first thank you is to you, the reader, for being a member of this pioneering Association. The strength of our association comes from the members it represents. We are able to advocate effectively because we represent a broad set of pharmacists who take fantastic care of their patients. Our members are innovators of pharmacy practice, engaged politically with both state and federal office holders, and leaders in their organizations and in their communities. The impact you all make by providing best-inclass care and developing strong relationships is the foundation of strength of this Association. Thank you for everything you do as a representative of this profession.
As important as it is for there to be a large number of leaders, we also want to say thank you to those who embrace new ideas and opportunities and become great followers. Not everyone is going to be the first person to implement new opportunities. It’s often the early adopters who help establish new standards of practice by embracing and expanding upon these new ideas and opportunities. These folks are equally as important in bringing about change. Thank you to those in this role for continuing to advance our profession.
The next thank you is to those who have served on our board, participated in one of our committees, or worked for the Association. A lot of the work done by these folks goes without the recognition it deserves. The staff works all hours of the day on issues many of us don’t realize they are handling on our behalf. Our team is amongst the finest of any state association and we are lucky to have their skills working for us. The Board of Directors volunteer their time and expertise and offer a vision for how the profession should continue to evolve. Active participation by the members of this board year after year is one of the reasons Arkansas is considered by so many to be the best place to practice pharmacy. Members of our committees take ideas and direction from the board and turn them into reality. They heavily influence the direction of the association via recommendations that come from their work in these committees.
Lastly, I want to thank those who have donated to the building fund and to those who are making plans to donate. The new building will serve as a keystone of pharmacy in Arkansas, representing both the strength of pharmacy and facilitating further advancement. The building will be much more than office space for staff; It will be a place for us to meet with legislators, host events, and engage with student pharmacists. The success of this project will have an everlasting effect on the profession in Arkansas. Thank you to all who are helping make this a successful reality! §
By Jordan Foster APA Director of Communications
Describe your pharmacy career.
I’ve been very lucky during my career. The first pharmacy I ever worked in was Park West Pharmacy in west Little Rock. Bill Bloodworth taught me more in those 1.5 years than I immediately realized. His mentorship was a springboard for my success in pharmacy. I was also lucky enough to do my P1 rotation at Collier Drug Store on Dickson Street with Shawna Bailey. This led to a job as an intern for my P3 year, and I remained with the company for almost 10 years from that experience. After graduation, I became a staff pharmacist for Colliers, floating to each store over the next two years. In 2017, I became PIC of the flagship location on Dickson Street. It was here that I really grew into the pharmacist I’m proud to be today. I had many mentors during this time, and I’m especially thankful to Carl Collier. The time I spent observing his compassion for the patients he served, commitment to the wellbeing of the community, and desire to advance the community pharmacy practice will stay with me for the duration of my time as a pharmacist. In March of this year, I made the difficult choice to leave Colliers and join Michael Butler as the Vice President of his companies. This new opportunity to be more involved in the ‘behind the scenes’ aspect of the community pharmacy business was something I could not miss out on. My exposure to the daily challenges our profession faces has grown significantly, positioning me better to serves as President of this association. I’m still drinking from the fire hydrant but very much enjoying the challenges that come with operating eight independent pharmacy locations and two medical equipment stores.
I was not one of those people who always knew they wanted to go to into pharmacy. Honestly, I happened upon the profession as I ruled out others. I was a student good at math and science but did not want to become a physician. I enjoy being around other people and working in a fast-paced environment. After considering hoping something would stand out, and even considering law school, a friend mentioned pharmacy. The more I learned about its role in the system, the ubiquitous nature of the profession, and the opportunity to interact with many folks each day, I realized this was a great option for me.
This is a difficult question. There are so many issues right now that are critical to address. My top three are as follows. Continued efforts to curtail the abusive practices of PBMs is a top priority. The foundation of our reimbursement model is still product dispensing, so having a fair playing field and fair reimbursement for the dispensing of medication is vital to our success. Pharmacy is also needing to continue implementing non-product related clinical services. Becoming credentialed with the payers in the state to be paid for cognitive services will allow pharmacists to make bigger impacts on patient care and deliver more value to the healthcare system. We are trained and capable of doing much more than dispensing; figuring out how to implement these services into workflow and to get paid adequately for the time is key to our continued success. The last thing that has become increasingly concerning to me
"My passion in pharmacy is to make a real difference in the lives of people who allow our team to be their pharmacy."
over the last two years is that students are not deciding to go to pharmacy school at the same rates as years past. It was not that long ago that we considered the market saturated, and a reduction in pharmacists’ numbers was welcome to some degree. The COVID-19 pandemic thrust pharmacists into vital roles, expanding need and appreciation for our capabilities. This advancement was very much welcomed by the profession, but I’m afraid we will not have a healthy workforce in the years to come if we don’t recruit top students to pharmacy. The addition of new medical schools, opportunities to become a physician assistant, and even veterinary programs coupled with the overall negative portrayal within our own ranks is contributing to the decline in applications. I’m excited about the future of pharmacy and the opportunities that will continue to come, and I’m hoping our members will share in this excitement.
While I don’t have as much experience and perspective as many practicing pharmacists, I have seen a tremendous amount of change in my time. The most notable changes have all come during and post pandemic. Society has collectively increased its appreciation for the role of the pharmacist. Being a go-to resource during the pandemic allowed our profession to solidify how important a strong network of pharmacies is to the overall healthcare infrastructure. From here, we see prescriptive authorities, point of care testing and treating, and increased responsibilities on other settings. Our ability to supervise and delegate tasks to our technicians is also a tremendous change. Our technician ration was 2:1 when I started with no extra opportunities for technicians. Now it’s 3:1 with a large number of opportunities for pharmacists to extend through technicians and effect patient care.
My passion in pharmacy is to make a real difference in the lives of people who allow our team to be their pharmacy. There are so many opportunities to intervene in a way that promotes better health for our patients each day. Being able to make immunization recommendations, find a coupon for a brand name drug, recommend cheaper alternatives, discuss opportunities for better medication adherence, and to synchronize medications to reduce barriers are all ways to positively affect others. These efforts are often seemingly no big deal and require little effort on the pharmacy but make a tremendous difference for others.
The APA means a tremendous amount to me. The work this association does to advance our profession, promote a market with real opportunities, and to strengthen relationships among its members is vital to our success. As a young pharmacist with many years left to practice, I am overwhelmingly appreciative of these efforts. The healthcare market is tough, often having different professions guarding its ‘territory.’ Having a strong association to help us be successful is of paramount importance.
I am passionate about the success of this profession. We’re positioned so well to have a tremendous effect on our patients, and this has been overlooked by many of the stakeholders. Others have taken advantage of the value we add. With decreasing margins on the products that we sell, I’ve known our future depends on having strong and active advocates of the profession. I’m often considered to be loud and outspoken, characteristics that seem to fit advocacy work.
In the pharmacy, I generally take on the leadership role of pacesetter. I want my team to see know that I’m not going to ask more of them than I expect from myself. With the association, I think the Visionary style is where I land. I’m focused on continued progress and to help others advance in the services they offer in their communities.
The overall theme for my year as president is to continue building on the current momentum. We are witnessing widespread scrutiny for the PBM industry, and we must continue supporting this movement. Pharmacists are being empowered to provide additional services to patients as different payers and stakeholders realize the value we offer. Our voice is influential with legislators as they know we bring solutions and help identify real problems. Continuing to strengthen these relationships is key to my year as president leading into a legislative session.
The most important idea I’d like to share with APA members is that their membership and involvement is paramount to the success of our profession. There is no other organization actively advocating to the benefit of Arkansas pharmacists. National associations often have different priorities than where we are in Arkansas. Employers often want what is best for the pharmacy (which doesn’t always mean it’s best for the pharmacist). Payers often ignore or take for granted the value we add to the system. Other professions would love to expand into our space (physician dispensing). The work of the APA is done on the foundation of its membership. Whether your politically engaged or not, your membership in this association is meaningful.
Rather than list all the new opportunities available as there are a lot, my recommendation to colleagues is to start with just one thing. Pick something you want to implement and make a little progress each day. I used to get overwhelmed with all the opportunities as I was often trying to add too many new things at once. It didn’t always work as my resources were spread too thin. It doesn’t have to be everything or nothing. Identify a new opportunity you’re passionate about and focus on that. It will soon be a standard part of your practice, then you can start a new implementation. Rome wasn’t built in a day! §
District: Currently District 1, but will be District 100 on January 1, 2023.
Represents: Texarkana, Miller County, Arkansas
Years in Office: Completing my 6th year (3 terms, running for my 4th term in November.)
Occupation: Attorney
Hometown pharmacist: Albertson's on Stateline; Texarkana, AR
What do you like most about being a legislator: There are a number of things I like about being a legislator, but the one I enjoy the most is helping my constituents with problems or issues they may be having. It is always a good day when I can help them get an answer to their question or get them in touch with an office that can help them. It is truly an honor and privilege to advocate for the people of Texarkana.
What do you like least: No doubt there are some days that are harder than others, but all in all, the challenges that come are really opportunities to address issues in new and innovative ways. I really can't think of a downside!
Most important lesson learned as a legislator: Everyone was elected (just like I was) and it is important to recognize that each elected official brings something unique to the discussion. At the end of the day, when we leave the House Chambers and walk out of the Capitol, we are all still Arkansans and each of us truly wants what is best for our State.
Most admired politician: That's a tough question, I have a number of politicians I admire for various things they have done and for what they faced during a specific time in history. I am currently reading, "The British are Coming: The War for America, Lexington to Princeton, 1775-1777" by Rick Atkinson. This book is fascinating on many levels, but the account of George Washington, his reluctance to lead, but his willingness to lead when called upon, and to step away after his service to our Country puts him pretty close to the top of my list.
Advice for pharmacists about the political process & working with the AR Legislature: Get to know your Representative and Senator now. Don't wait until the Session begins in January to reach out. Develop a relationship built on trust and honesty. Once the session begins, there is a lot going on, bills to read, emails, phone calls, meetings to attend, and sometimes it becomes very difficult to schedule a time to sit down and visit. The ground work you do now will help you when the Session begins.
Your fantasy political gathering would be: I think it would be fascinating to have some of our early Presidents along the framers of our Constitution in the same room with some of our more recent Presidents to see how their vision of the United States is different (or the same) from what it is happening today.
Hobbies: I enjoy reading and always have a book by my bedside to read (that's the English major in me) and I enjoy spending Saturdays at Razorbac k football games with my family...Go Hogs! §
The electronic prescription illustrated in Figure One was transmitted from a prescriber's office to a community pharmacy in Eastern Arkansas. The pharmacy technician entered the patient directions as "Take one tablet on Monday, Wednesday, and Friday and two and one-half tablets on Tuesday, Thursday, Saturday, and Sunday". This information and prescription image was sent from the input queue to the pharmacist verification queue of the computer. The pharmacist initially verified the technician had correctly entered the patient directions, but after further reflection, began to question the appropriateness of a 12.5 mg warfarin dose four days a week (i.e. two and one-half warfarin 5 mg tablets per dose for a total of 12.5 mg). The pharmacist decided to call the prescriber for clarification. After listening to the pharmacist's concerns, the prescriber stated the patient was to receive warfarin 5 mg on Monday, Wednesday, and Friday, and warfarin 2.5 mg on Tuesday, Thursday, Saturday, and Sunday. The prescriber remarked "I can see how the directions we sent are confusing. I really appreciate you calling". After this, the prescription was correctly filled and the patient instructed to take "one tablet (5 mg) daily on Monday, Wednesday, and Friday, and one-half tablet (2.5 mg) daily on Tuesday, Thursday, Saturday, and Sunday.
Figure One
The electronic prescription in this case is particularly dangerous and completely unacceptable. The directions are unclear and can be interpreted several ways. They become dangerous and potentially life-threatening when they are used in conjunction with a narrow therapeutic index medication such as warfarin. If this patient had ingested 5 mg of warfarin three days a week, and 12.5 mg four days a week - for a weekly total of 65 mg - the result could have been catastrophic.
Fortunately, an alert pharmacist questioned these dangerous directions which had already been entered into the computer by the technician. If this pharmacist had been working in a robotic fashion, she could have quickly glanced at the electronic Sig. and verified the technician's interpretation as being correct. It is important for all pharmacists to treat every prescription as a
unique entity. Granted, this can be difficult in a busy, understaffed pharmacy. Pharmacists' who believe their work environment is not conducive to patient safety should bring their concerns to the pharmacy owner or manager. If their concerns are or even ignored, other employment options should be considered. Pharmacists must be allowed to practice in working conditions that promote patient safety - not jeopardize it. §
Mr. V came to the pharmacy to pick up his hydrochlorothiazide (hctz). Normally, I would advise him to take this medication during the day due to its diuretic effect. However, he mentioned he works night shifts, so taking it during the day would not be ideal for him as that is when he sleeps. After counseling him to take hctz before his shift, I wondered if our counseling frequently overlooks patients who work nightshifts.
We are the last checkpoints of medications before they are dispensed to patients. Our counseling is crucial to the patients’ effective and safe use of medications, especially for first-time users. However, it seems most of our counseling is geared towards day workers with little regard for night workers. As someone who has been working in community pharmacy, the thought of day shift versus night shift did not cross my mind as a concern when counseling. However, there are many people who work night shifts. Not only are their general health conditions at risk due to nightshift work, but whenever they come to pharmacies to pick up their medications, I feel I have failed to care for them during a counseling session.
For example, we tell patients to take “statins” at night because cholesterol is synthesized when fasting, so patients should take it before bedtime, whether it is day or night.
We often give the most obvious counseling points to patients in order to efficiently serve the next patients in line. We need to slow down and consider patients’ lifestyles and atypical work schedules to better serve them. Pharmacist should tailor counseling information to each patient to help them achieve the best possible outcome.
We blinked and 2022 is more than halfway over! Just as the news is a hodge podge of gas price hikes, war, celebrity feuds, and extreme weather, the 2nd quarter novel drug approvals cover a variety of conditions. Oncology continues to be a focal point of research, but multiple medications recently approved are indicated for the outpatient setting. Instead of focusing on the uncertainty of the future, perhaps these medications can aid in the management of chronic conditions to create a healthy present.
Ambulatory Care: VIVJOA™ (oteseconazole) is an azole antifungal indicated to reduce the incidence of recurrent vulvovaginal candidiasis (RVVC) in females with a history of RVVC who are NOT of reproductive potential. CAMZYOS™ (mavacamten) is an allosteric and reversible cardiac myosin inhibitor indicated for the treatment of adults with symptomatic NYHA class II-III obstructive hypertrophic cardiomyopathy (HCM) to improve functional capacity and symptoms. It modulates the number of myosin heads that can enter “on actin” (power-generating) states, thus reducing the probability of systolic and diastolic crossbridge formation. Excess myosin actin cross-bridge formation and dysregulation of the super-relaxed state are mechanistic hallmarks of HCM. Mavacamten shifts the overall myosin population towards an energy sparing, recruitable, super-relaxed state and improves cardiac filling pressures. VOQUEZNA™ TRIPLE PAK, is a co-packaged product containing vonoprazan, a potassiumcompetitive acid blocker, amoxicillin, a penicillin antibiotic, and clarithromycin, a macrolide antibiotic, indicated for the treatment of Helicobacter pylori (H.pylori) infection in adults. Vonoprazan suppresses basal and stimulated gastric acid secretion at the secretory surface of the gastric parietal cell through inhibition of the H+/K+ ATPase enzyme system in a potassium competitive manner. Because this enzyme is regarded as the proton pump within the parietal cell, vonoprazan has been characterized as a type of gastric proton pump inhibitor, in that it noncovalently and reversibly blocks the final step of acid production and does not require activation by acid. Acid suppression enhances the replication of H. pylori bacteria and the stability and effectiveness of antimicrobials in the treatment of H. pylori infection. MOUNJARO™ (tirzepatide) is a glucose-dependent insulinotropic polypeptide (GIP) receptor and glucagon-like peptide-1 (GLP-1) receptor agonist indicated
as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. It enhances first- and secondphase insulin secretion, and reduces glucagon levels, both in a glucose-dependent manner. VTAMA® (tapinarof) cream is an aryl hydrocarbon receptor agonist indicated for the topical treatment of plaque psoriasis in adults. The specific mechanisms by which it exerts its therapeutic action in psoriasis patients are unknown.
OPDUALAG™ is a combination of nivolumab, a programmed death receptor-1 (PD-1) blocking antibody, and relatlimab, a lymphocyte activation gene-3 (LAG-3) blocking antibody, indicated for the treatment of patients > 12 years old with unresectable or metastatic melanoma. The combination of nivolumab and relatlimab results in increased T-cell activation compared to the activity of either antibody alone. PLUVICTO™ (lutetium vipivotide tetraxetan) is a radioligand therapeutic agent indicated for the treatment of adult patients with prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer who have been treated with androgen receptor pathway inhibition and taxane-based chemotherapy. The active moiety of lutetium vipivotide tetraxetan is the radionuclide lutetium-177 which is linked to a moiety that binds to PSMA, a transmembrane protein that is expressed in prostate cancer. Upon binding of lutetium vipivotide tetraxetan to PSMA-expressing cells, the beta-minus emission from lutetium-177 delivers radiation to PSMA-expressing cells, as well as to surrounding cells, and induces DNA damage which can lead to cell death.
Miscellaneous: Ztalmy® (ganaxolone) is a neuroactive steroid gamma-aminobutyric acid A receptor positive modulator indicated for the treatment of seizures associated with cyclindependent kinase-like 5 deficiency disorder in patients > 2 years old. AMVUTTRA™ (vutrisiran) is a transthyretin-directed small interfering RNA indicated for the treatment of the polyneuropathy of hereditary transthyretin-mediated amyloidosis in adults. It is a double-stranded conjugate that causes degradation of mutant and wild-type TTR mRNA through RNA interference, which results in a reduction of serum TTR protein and TTR protein deposits in tissues. §
This is the second in a series of articles covering Arkansas’s statewide protocols for pharmacists that will be featured in several issues of the APA journal.
If there is one takeaway from the vital role that Arkansas pharmacists played during the COVID-19 pandemic, it is that increased access to vaccines, testing, and treatment helped to save lives, decrease the burden on hospitals and other health care providers, and allowed countless others to seek treatment that would otherwise not have been realized. The range of critical services that pharmacists provided over the past few years will only continue to expand in the coming months, especially here in Arkansas.
Act 503 of 2021 authorizes licensed Arkansas pharmacists to test and treat for influenza and group A streptococcal (GAS) pharyngitis pursuant to a statewide protocol approved by both the Arkansas State Board of Pharmacy and Arkansas State Medical Board. The framework and definition used in by Act 503 for “statewide protocol” in Arkansas was originally established in 2017 with Act 284. This law from 2017 allows for development of statewide protocols approved in interdisciplinary fashion by both the Arkansas State Board of Pharmacy and Arkansas State Medical Board and currently include naloxone (2017), nicotine replacement therapy (2019), oral contraception (2021), treatment for pharyngitis caused
by streptococcus A (2021), treatment for influenza (2021), and other health conditions that can be screened utilizing the waived test under the Clinical Laboratory Improvement Amendments of 1988 (2021).
There are currently 16 states that have some sort of collaborative practice agreements or statewide authority to allow pharmacists to prescribe pursuant to a rapid diagnostic test for influenza or GAS. Since being approved, Arkansas utilizes a standing order that allows Arkansas-licensed pharmacists to initiate therapy including ordering and/or dispensing treatment medications, along with any necessary supplies for administration, to eligible persons who are influenza or GAS pharyngitis positive or have household exposure to influenza.
Each year in the United States, 25 to 50 million influenza infections are reported, more than 200,000 people are hospitalized, and 23,600 die due to seasonal flu. From late September 2021, through late May 2022, over 14,700 positive influenza cases were reported to the Arkansas Department of Health online database by health care providers. This
number only reflects a portion of the actual numbers of flu cases in the state of Arkansas. While flu cases and deaths in Arkansas have dropped in recent years, just as recently as the 2017-2018 flu season there were over 220 deaths attributed to the flu, with 172 of those deaths being in patients greater than 65 years of age.
Acute pharyngitis is among the most common infectious diseases in the U.S. accounting for approximately 12 million ambulatory care visits annually. Viral pathogens and benign self-limiting processes cause most cases of acute pharyngitis. GAS is the most common bacterial pathogen associated with pharyngitis, accounting for approximately 10-15% of cases in adults and 15-30% of cases in children. Some estimates show that one in five visits to a physician’s office are for acute pharyngitis, with 15-30% of those cases originating from GAS infection and 2% from influenza. One study found that over a ten-year period there were 78 million visits to a physician’s office for acute pharyngitis and antibiotics were prescribed approximately 63% of the time. While these illnesses may be self-limiting, there are many patients that require treatment.
One way to reduce the risk of hospitalization from infection and the subsequent costs is to improve access to testing and treatment in early stages of infection. Early treatment can limit the duration of illness, thereby lowering the risk of further complications and associated costs. Unfortunately, not all patients have reliable access to care. A 2011 national survey found that 57% of patients who were sick and needed medical attention could not obtain access to care promptly. By allowing community pharmacies in Arkansas to now test and treat these patients, access to care can be improved outside of normal clinic hours and for those without a regular primary care provider.
As part of the protocol, the Arkansas Board of Pharmacy adopted a screening assessment and questionnaire to be used by pharmacists throughout the state. When a patient requests point-of-care testing services, or when a pharmacist, in his or her professional judgement, decides to initiate pointof-care testing and treatment, the patient is assessed for presenting signs and symptoms that warrant influenza or GAS testing. Parental consent will need to be obtained for individuals under the age of 18, and, if appropriate, a rapid influenza or GAS point-of-care test will then be administered to all qualifying patients.
For both influenza and GAS, eligibility criteria must be met before medications can be dispensed. These include inclusion criteria (examples include: age 3 years and older, positive test results, symptoms, and Centor Score > 2 for GAS), exclusion criteria (examples include: pregnancy, immunocompromised, and duration of symptoms), and contraindications to treatment. Pharmacists will then follow the standing order for product selection and dosing, as well as perform documentation outlined in the protocol. Test
results for both positive influenza and GAS infections may also be required to be reported to the Arkansas Department of Health. Patient records must be furnished to a health care practitioner designated by the patient upon request of the patient. Documentation may include, but is not limited to, presenting signs and symptoms that warranted testing, parental consent for individuals under the age of 18, and results of rapid diagnostic test(s). Records of all patients receiving services must be maintained for 2 years.
Act 503 of 2021 also allows for pharmacist therapeutic substitution and is in effect as of May 10, 2022. A pharmacist whose practice is located within the state of Arkansas may substitute medications for therapeutically equivalent medications, unless the prescriber indicates that no substitution is to be made or if the Arkansas State Board of Pharmacy has determined that a therapeutically equivalent product should not be substituted and has notified all pharmacists of that determination. Examples of medications that should NOT be substituted include, but are not limited to, any antipsychotics, antidepressants, controlled substances, or oncolytic agents. The pharmacist must also discuss the suggested substitution with the patient, notify the prescriber in writing or by electronic communication within 24-hours after the drug is dispensed to the patient, and make sure the substitution is equal to or less expensive for the patient. A link to the final rule from the Arkansas State Board of Pharmacy with complete rules regarding therapeutic substitution can be found under rule 07-00-0010 at www.pharmacyboard.arkansas. gov/wp-content/uploads/2022/05/7-ASBP-Rule-7-FinalVersion-May-2022.pdf
Several studies have demonstrated that allowing pharmacists to test and treat patients for influenza and GAS improves access to care and provides an option for patients outside of normal clinic hours and for those without a regular primary care provider. This can be especially vital in the underserved rural communities throughout Arkansas. Research has shown in other states that these services resulted in no reported patient harm, better antibiotic stewardship, and patient satisfaction scores over 90%. APA is already working with payors to develop ways to bill for these test and treat programs, including Arkansas Blue Cross Blue Shield who have already approved payment for these services. As more patients utilize these services that Arkansas pharmacists can now provide, it will only help to expand the role that pharmacists play as part of the overall health care team. §
Regardless of how the markets may perform, consider making the following part of your investment philosophy: Human papillomavirus (HPV) is the most common sexually transmitted disease in the United States. Nearly every sexually active person either has been, will be, or is currently infected with HPV. For most people, the virus goes away in a few years without causing many health problems. However, HPV can cause genital warts and/or cancer in both women and men. The good news is that there is a very safe and effective vaccine to prevent HPV infections. The bad news is that too many individuals don’t receive the vaccine. Pharmacists are well positioned to increase patient confidence and uptake in vaccinations. The HPV vaccine is no exception.
Children are eligible for the HPV vaccine starting at 9 years of age. It is routinely recommended for children to start the HPV vaccine series at ages 11-12.
NOTE: In Arkansas, it is not a requirement for children to receive an HPV vaccine. However, children in Arkansas are required to receive two other vaccines at ages 11-12 to attend school: Tdap and MenACWY.
HPV vaccination is routinely recommended at age 11-12 years (can start at age 9 years). HPV vaccination is recommended for all persons through age 26. It is recommended for some adults age 27-45 years, based on shared clinical decision making.
The number of doses for an HPV vaccine series is based on age at initial vaccination. (See table below.)
• If the series is started at age 9-14 years, it is a 2-dose series.
• If the series is started 15 years or older, it is a 3-dose series.
If vaccination schedule is interrupted, the series does not need to be restarted.
There are many common myths and misperceptions about the HPV vaccine that cause parents to be hesitant about vaccinating their child for HPV. In addition, healthcare providers may not feel comfortable discussing this vaccine. Why? The HPV vaccine is associated with sexual activity and this vaccine is recommended for children. This can certainly be a difficult and uncomfortable topic for parents and providers. However,
we have to remember that pharmacists are trusted healthcare professionals and an uncomfortable conversation might just save a life. There are also strategies to make this conversation less uncomfortable for both you and your patients.
When discussing HPV recommendations, consider the following:
1. The HPV vaccine is safe and effective at preventing HPV infections and HPV-associated cancers. The reason for recommending this vaccine to children is because it is most effective when administered prior to sexual activity. The HPV vaccine prevents 90% of HPV-associated cancers in both women and men. With over 15 years of research and monitoring, this vaccine has a very robust safety profile.
2. HPV causes cancer in both women and men. One of the most helpful ways to discuss HPV vaccines with your patients is to focus on cancer prevention. The HPV virus can cause cancer in both men and women. With the exception of cervical cancer, most cancers caused by HPV (in men and women) are undetectable until they cause serious health problems.
3. A strong recommendation from a healthcare provider increase uptake in HPV vaccines. Studies show that patients were more likely to receive an HPV vaccine when a healthcare provider made a strong recommendation for it. Even when patients (or parents) ask questions about the HPV vaccine, it does not mean they won’t get the vaccine – it means they have questions and they’d like to know the answers before accepting the recommendation.
Pharmacies can help increase HPV vaccination rates in Arkansas. Please consider taking the following actions to help save lives from HPV.
• The HPV vaccine IS covered for children with Medicaid and children without insurance through the Vaccines for Children program.
• The HPV vaccine is NOT covered by Medicaid once the patient is 19 years of age or older.
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UAMS College of Pharmacy
Dan Atchley, Ph.D. Dean Harding University
On behalf of the UAMS and Harding University Colleges of Pharmacy, we offer our sincere congratulations to the Arkansas Pharmacy Class of 2022. 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% (118 of 126). As collected prior to commencement, the information indicates the job market for our 2022 Arkansas pharmacy graduates has seen noticeable improvements.
Of the 118 graduates who responded to the survey, 29 indicated they had accepted a residency position and 89 indicated they were seeking employment. Of the 89 non-residency bound graduates, 84% (n=75) received an employment offer by the close of the survey and 80% (n=71) accepted a position, up from 2021’s 70% who had received an employment offer and 59% who had accepted a position. Previous work experience with an employer continues to be a factor for graduates when choosing a practice setting. Of the 71 graduates who have accepted a position, 10 had worked their employer prior to pharmacy school, 32 had worked with them as an intern, and 20 had worked with them during a rotation.
The average annual salary for accepted pharmacist positions (excluding residency) prior to graduation was $107,363, a slight increase from 2021’s $104,568 per year. Additionally, 71 graduates ranked the availability of employment opportunities with 94% (n=67) responding that they felt there were employment opportunities available, varying from some opportunities to many opportunities – a considerable increase from 68% of respondents in 2021 and 78% of respondents in 2020 who answered the same way.
Overall, 15% (n=18) of all respondents plan to own a pharmacy in the future. Graduates who have student loans make up 82% of the group completing the survey with an average amount of debt of $159,165 per student.
In summary, the COVID-19 pandemic created a non-traditional academic experience for the Class of 2022. However, their time in the classroom, their COVID-altered advanced pharmacy practice experiences, and recent federal and state legislative changes expanding the role of pharmacists have all helped prepare our graduates for the road ahead. The faculties of UAMS and Harding Colleges of Pharmacy congratulate the Class of 2022 and look forward to watching their successful careers unfold. §
• 118 Arkansas graduating pharmacy students responded to the survey.
• Harding University (n=26)
• University of Arkansas for Medical Sciences (n=90)
• The survey was sent to all 126 graduating students (35 Harding, 91 UAMS) The survey was open from 5/4/2022 to 6/1/2022.
• 75 of 89 (84%) of non-residency bound graduates received an employment offer at the close of the survey (average offers received = 2).
• 71 of 89 (80%) of non-residency bound graduates accepted a position at the close of the survey.
• Overall, 56 graduates who accepted positions will practice in Arkansas, with the majority settling in central Arkansas. Excluding residency positions, 13 will practice pharmacy outside of Arkansas, see Table 4.
• 53 graduates (excluding residency) who accepted a position did so in a community setting (chains, independent, mass-market, specialty pharmacies, consultant, etc.), see Table 3.
• Graduates had a relationship with their employer prior to accepting a position either through working prior to pharmacy school (n=10), working as an intern (n=32), or completing a rotation (n=20), see Table 2.
• The average salary for graduates (excluding residency) is $107,363.00 per year (n=71), see Table 3.
• According to respondents, the top five most sought-after job characteristics are good working conditions, fair pay, job security, flexible schedule, and understanding and appreciation.
• Top benefits offered by employers: paid vacation, health insurance, retirement plan, paid holidays.
• 64% of graduates completed a bachelor’s degree with 7% earning a master’s or PhD degree prior to admission.
• Approximately 15% of respondents plan to own a pharmacy in the future.
• 29 of 118 respondents accepted a residency position.
• 82% of graduates have student loans with an average of $159,165 and totals ranging from $29,600 to $350,000
*Once per year, APA is required to publish a Statement of Ownership and file it with the United States Postal Service.
Kayla Boyd Tatum Bishop
Lane Callahan
Jonathan Clark
Avneet Patel Secretary/Treasurer
Jamie Coalson Vice President
Ryan Huskey President
Sugey AriasResendiz
Jordan Jackson Steven Koepsell
Aritney Breshe’ Cooper Brandon Luong
Laurie Bell
Nathan Lamb
Ashlynn Dacus Blake Jenkins
Dulce McCullar
Elizabeth Ackerman
Emily Gastro
Jeremy Howard
Madison Knipe
Andrew McKeown Sooyah Milambo
Claire Moyer
Madeline
Phan Courtney Phillips
Kristin Russell Caleb Aaron Shelton Kayely-Morganne Shields
Brittney Waddle Kaylee Welcher
Kristen Dixon Ashley Herbst
Ashley Jennings
Zach McGriff
Andrea Winters
Most everyone loves some form of team sports. One of the reasons is because it’s exciting to see what teams can accomplish when they have the right people on the team, in the right roles, working toward common objectives and goals. The huge success of Apple TV’s streaming series “Ted Lasso” demonstrates the appeal of great leadership, team building and a positive message. Lately, however, especially around politics a lot of folks don’t seem to be interested in building or even possessing these essential traits. Leadership and team development takes time and lots of practice to improve. We may even have to learn the hard way by trying, failing, and learning what “not to do” given the next opportunity. Regardless of how we get there, these are such important skills, that I challenge you (and myself) to work each day on improving them.
As an inspector for the Arkansas State Board of Pharmacy, I have had the opportunity to witness what great teamwork can accomplish across our country and state. Within Arkansas’ health-system pharmacies, there are skilled teams that include administrators, clinical professionals, and pharmacy technicians. I’m lucky to have over twenty-five years of experience and perspective in pharmacy practice. I have witnessed what once would be considered “unheard of” become common place. This has been exemplified over the years by expanding institutional clinical pharmacy services by placing pharmacists on the nursing units, creation of medication history technicians, creation of specialty pharmacist positions (e.g., ED, ASP, etc), and expansion of pharmacy residency programs. This is not an all-inclusive list of possible examples. However, all were achieved by pharmacy leadership and teamwork, which often involved a multi-disciplinary approach. Also, in order for some of these to become reality, compromises had to be made, and compromise is not a dirty word.
I have had the good fortune to have worked alongside great leaders and teammates throughout my life. Some were born with their talent, while others worked hard to develop their skills. Key characteristics in all of them were their ability to listen and work well with others. They were mentors and made time for that mentor relationship to grow. The best leaders I’ve ever worked for or with were those who saw the potential in others, and inspired, challenged, and encouraged those teammates. They took more pride in witnessing their team’s successes than when they succeeded or were recognized individually. They could recognize these informal and formal leaders and put them in the correct position for success.
They never made the accomplishments about themselves or one person. They were truly and honestly humble.
This year’s AAHP Fall Seminar is the reason I wanted to talk about leadership and teamwork. The theme was “Back to the Future”. Amber Powell PharmD, who has been the team lead for this meeting for the past several years, created great learning opportunities for our fellow leaders (official or unofficial) and teammates. They didn’t choose the “Back to the Future” theme to honor Marty McFly et al. It’s time to get back to improving the future of patient care by building strong pharmacy teams who rise to meet every challenge together. We must get back on track to challenging ourselves and those around us to reach this goal by practicing leadership skills and supporting team members both within our own organizations and across our state. Be open to new ideas and sharing yours with others. I look forward to working with you to get back to the future of enhanced patient outcomes.§
Train your staff to recognize patients who may be eligible for the HPV vaccine.
• Any patient who is 9 years old to 45 years old may be eligible for an HPV vaccine.
• Many patients may have started a series but not completed the series.
• The Arkansas Pharmacists Association (APA) has a technician immunization training program for technicians who are members of APA.
Increase your confidence in making strong HPV vaccine recommendations.
• Immunize Arkansas has developed an HPV Vaccine Toolkit for Pharmacists.
• There is a one-hour HPV Vaccine CE available on the Immunize Arkansas website.
• These resources, and more, are available at www. immunizear.org/hpv-info-pharmacists. §
As a young pharmacist I was thrown for a loop after receiving a script from a local provider. After looking through Facts & Comparisons and calling all of my buddies, I was stumped. I called the local provider who had been in practice for 30 years to investigate. “Doc” I said, “I’ve looked through every reference book I have and I just don’t see anything on the drug Obecalp.” He replied, “Boy...that’s placebo spelled backwards!” The patient went on to take the prescription compliantly for six months and felt better than she had in years. This was my first face to face experience with the placebo effect.
The use of the word “placebo” in a medical context, meaning innocuous treatment to make a patient comfortable, dates back to at least the end of the 18th century. The interest in placebo effects only began with the widespread adoption of the randomized controlled trial (RCT) after World War II. There are a couple of proposed mechanisms for placebo’s efficacy and include psychological and neurobiological. From the psychological viewpoint, patient expectations, conditioning, learning, memory, motivation, somatic focus, reward and reduction of anxiety all play a part in placebo’s efficacy. On the neurobiologic side, several studies suggest that placebo effects can be completely or partially reversed by the opioid antagonist naloxone, supporting the involvement of endogenous opioids in some analgesic effects of placebo.(1)
We are trained to utilize evidence-based medicine when counseling patients. This can be challenging when asked about herbal / homeopathic remedies or other treatments that have limited clinical data. For instance, many patients have asked about the use of Low Dose Naltrexone (LDN) for a host of disease states. When you dig into the literature, you find a robust amount of anecdotal information online. Reports of efficacy in Autism, Cancer, Psoriasis and Crohn’s just to name a few…. LDN can do it all! It is hypothesized that LDN may inhibit opioid receptors and therefore cause the body to increase production of endorphins and upregulate the immune system. However, Yale University’s Dr. Steven Novella, host of The Skeptics Guide to the Universe, disputes efficacy claims for LDN and suggests that they are based on pseudoscience.
As pharmacists we are trained to respect the data, however one cannot help but be impressed by patient testimonials to the benefits of LDN. In our practice, we have many patients that use LDN with success. While LDN is not indicated for these treatments, the fact that these patients see results and get their medicine on a monthly basis says something about the efficacy of the treatment.
Regardless of whether it is the “Obecalp” related involvement of endogenous opioids or the increased production of endorphins and upregulated immune system from the LDN, we see patients getting relief when little else seems to help. §
(1) Placebo in Clinical Trials, Usha Gupta and Menka Verma, Perspect Clin Res. 2013 Jan-Mar; 4(1): 49–52.
The use of the word “placebo” in a medical context, meaning innocuous treatment to make a patient comfortable, dates back to at least the end of the 18th century.
As part of long-term care (LTC) facility reform, in 2016 Centers for Medicare and Medicaid Services (CMS) finalized the “Final rule” (commonly referred to as the “Mega Rule”) outlining the requirements LTC facilities must meet to participate in the Medicare and Medicaid programs.
Emily Holton, Pharm.D. Consulting Academy 2021-2022 President
The purpose of the Mega Rule is to improve the care and safety of residents through policies that are targeted at reducing unnecessary hospital readmissions and infections, improving the quality of care and strengthening safety measures within the facilities. A phased rollout was planned, however implementation of the three phases has been delayed, and delays have been further compounded by the COVID pandemic. Under the original plan, Phase I implementation deadline was set to be November 2016, followed by Phase 2 implementation in November 2017 and finally Phase 3 implementation in November 2019. However, CMS is currently still operating under Phase 2 of the Mega Rule. In June 2022, CMS released guidance for focus on starting Phase 3 implementation, set to be effective October 24, 2022. The following Phase 3 topics highlight significant impacts to the practice of consulting.
The final rule requires facilities to develop an Infection Prevention and Control Program (“IPCP”). The IPCP must include a system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for all residents, staff, volunteers, visitors, and other individuals providing services under a contractual arrangement. It also must include an Antibiotic Stewardship Program and Phase 3 specifically requires there be an Infection Preventionist (“IP”). The IP is responsible for the IPCP and must work at the facility (physically, cannot be an off-site position) at least part-time and go through additional, specialized training. Consultant pharmacists need to identify and collaborate with the IP to monitor the antibiotic stewardship program within the facility.
This focus addresses situations where practitioners or facilities may have inaccurately diagnosed/coded a resident to have schizophrenia using the resident assessment instrument. [Side note, if you are interested in hearing a story about a case where this occurred and enjoy podcasts, check out The Daily podcast episode “A Hidden Shame in Nursing Homes” from September 14, 2021.] This loop hole allowed a schizophrenia diagnosis to be added to a patient record along with an antipsychotic, which then exempted
nursing homes from disclosing use of the antipsychotic. Consultant pharmacists need to be diligent to identify cases in which schizophrenia diagnosis is added after a resident is admitted to a facility to prevent these inaccurate diagnoses and potential antipsychotic misuse.
Prior to the Mega Rule, LTC requirements included policies to identify antipsychotic drugs and provided specific safeguards for their use. The final rule expands the drugs to which safeguards apply to include “psychotropic” medications. Psychotropics include antipsychotics, antidepressants, anti-anxiety and hypnotic medications classes. This Phase 3 focus addresses unnecessary use of non-psychotropic drugs in addition to antipsychotics and other psychotropics, and required gradual dose reductions to better patient safety and quality of care. Consultant pharmacists already identify duplicate therapies during monthly drug regimen reviews, but will want to carefully monitor the use of all prescribed medications to additionally identify unnecessary drug use. §
ow would you like to make 9.62% on your money? No, I’m not selling you a fancy investment product. This investment comes from Uncle Sam. As of June 2022, the U.S. Government I Bond has a 9.62% return.
The I Bond or Series I Savings Bond is a savings bond you can buy directly from the federal government. You give the U.S. Government money and they pay you an interest rate that is set semi-annually.
• Maximum purchase amount is $10,000 per person per calendar year.
• I Bonds have an annual interest rate derived from a fixed rate plus a semiannual inflation rate.
• As of June 2022, I Bonds are paying 9.62%.
• Interest rates combine a fixed rate plus an inflation rate that adjusts every six months. The rate is set for these terms: May – October November - April
• Your money is locked in for 1 year. You cannot pull it out. After that, and within 5 years, you lose interest earned from the prior 3 months. After 5 years you can remove your money penalty free.
• Savings bonds are exempt from taxation by any State or political subdivision of a State, except for estate or inheritance taxes.
• Interest earnings are subject to Federal income tax.
• Interest earnings may be excluded from Federal income tax when used to finance education.
How do I go about buying these? (Now the fun part!)
• Go to www.treasurydirect.gov
• Click “Open an Account” & then click “TreasuryDirect” – you will need your social security number, driver’s license, bank account number & bank routing number (to electronically transfer money).
• After you open an account, they will email your account number.
• When you login with your account number, they will email you an OTP (one time password) for access to your account. Once you get in, you will put in your password.
• When you insert your password, it cannot be typed in. You have to click the letters/numbers with your mouse.
• After you are in your account, go to the “BuyDirect” tab. Follow their instructions.
• Make sure you are buying I Bonds (maximum $10,000 per person).
Source: www.treasurydirect.gov/indiv/products/prod_ibonds_glance.htm
Disclaimer: This is general advice on an investment and not a recommendation to buy a particular investment. Remember, all investments carry inherent risk. This article is for education purposes only. Before making any investment decision, be sure to consult your financial advisor and tax expert.
Joe Baker has taught at UAMS College of Pharmacy for over 22 years and recently co-wrote a financial book, along with his daughter, Lindsey Jordan Baker, entitled, Baker’s Dirty Dozen Principles for Financial Independence. You can order yours at www.bakersdirtydozen.com
Pharmacists from across the state and across the pharmacy spectrum gathered at the 2022 APA Annual Convention in Little Rock this June to earn CPE hours, network with other pharmacists, learn about practice updates, and enjoy camaraderie among their peers. The two-day event was APA’s first live summer convention since 2019 and covered topics from new pharmacy laws and provider status to COVID-19 therapeutics and time management. During the convention, awards were presented to some of the state’s leading pharmacists and convention attendees enjoyed a special welcome back / convention kick-off social at The Railyard. And to go along with the Lego-related convention theme of “Building for the Future,” there was even a Lego model of the new APA headquarters currently under construction! Thank you once again to all our attendees, sponsors, and exhibitors!
To fit with the convention’s theme of “Building for the Future,” APA Director of Communications Jordan Foster created a custom, one-of-a-kind model of the new APA headquarters in downtown Little Rock out of more than 1,600 Lego bricks.
APA CEO John Vinson delivers his State of the Association Address to the convention crowd, where he shares a construction update about the new APA headquarters and discusses donation opportunities
Thank you to all of our sponsors for making the 2022 APA Convention a success!
Kyle Lomax was awarded the 2022 Pharmacist of the Year Award. This award recognizes a pharmacist for his outstanding contributions to the profession of pharmacy and activities in the advancement of pharmacy during the year.
“I am honored to be recognized by the Arkansas Pharmacist Association because of the work I am doing to better the state of Arkansas, and specifically my communities in Northeast Arkansas, in my role as a pharmacist and the organizations I work with,” Lomax said.
Kyle is a graduate of Buffalo Island Central High School, Arkansas State University, and the UAMS College of Pharmacy. He is a second-generation pharmacist and worked in the family business after graduating pharmacy school. “I chose to pursue pharmacy because I saw what an impact my father had on his community and patients and wanted to follow in his footsteps.” Now, Kyle owns five pharmacy locations in Northeast Arkansas as well as a weight management clinic.
Over the past two years, Kyle transported COVID vaccines from Arkansas to New York and worked as an Arkansas Community Pharmacy Enhanced Services Network (CPESN) Board Member on a UAMS REACH grant to place Community Health Workers in Arkansas CPESN pharmacies to combat vaccine hesitancy. He is a member of the Arkansas Pharmacists Association, the National Community Pharmacists Association, and is a Board Member of Arkansas CPESN.
Allie Staton was awarded the 2022 Distinguished Young Pharmacist Award. The APA Distinguished Young Pharmacist Award is given annually to an outstanding young pharmacist who has been out of pharmacy school less than ten years and who has demonstrated leadership among his or her peers.
“I truly don’t know how to put into words what this award means to me,” Allie said. “The love and support I have received from the Arkansas pharmacy family has been incredible. My goal has always been to help lead our profession forward and practice at the top of our licenses. I am so humbled and honored for this recognition. It is a blessing to be an Arkansas pharmacist.”
Allie is a graduate of Bryant High School, attended UA Little Rock for pre-pharmacy curriculum, and earned a Doctor of Pharmacy from the UAMS College of Pharmacy. Since graduating from pharmacy school, Allie continued her education through a Community-Based Pharmacy Residency with UAMS and Bryant Family Pharmacy. She also attended the Pharmapreneur Academy, a program developed by Arkansas pharmacist Blair Thielemier, and later opened a pharmacy consulting company, EnhanceRx Pharmacy Consulting, where she teaches pharmacy owners how to implement patient care programs that will increase their profits.
During the COVID pandemic, Allie worked at West Side Pharmacy in Benton as a Clinical Pharmacy Specialist where she was one of the first providers in the nation to implement point-of-care testing for the COVID-19 virus and one of the first in the state to administer the COVID vaccine.
who has demonstrated a prominent spirit of innovation and entrepreneurship in the practice of pharmacy.
“Because this award was chosen by my peers, it makes it all the more treasured to my family and me,” Chester said. “It takes an entire team to make this award a possibility. Without them, this could not have happened.”
Chester graduated from Searcy High School, earned a bachelor’s degree in chemistry from UCA, and met his wife Roxie Elee Barber at Northeast Louisiana University College of Pharmacy where they both earned pharmacy degrees.
Chester Barber was awarded the 2022 Excellence in Innovation Award. This award was established in 1993 by the APA in cooperation with the National Alliance of State Pharmacy Associations to annually recognize a pharmacist
During the COVID pandemic, Chester and his staff gave about 13,000 COVID vaccinations (in a county with a population of 17,000) in their pharmacy and at the many vaccination clinics they organized. In August 2021, Chester and his team established a separate business for pharmacy clinical services and built a standalone medical infusion center to administer monoclonal antibody infusion treatments to about 1,400 individuals so far. They have also teamed up with a physician and a nurse to administer Evusheld to hospice patients and immunosuppressed patients in their homes or facilities across a three-county area.
Brenda McCrady was awarded the 2022 Bowl of Hygeia Award. The Bowl of Hygeia Award is sponsored by the American Pharmacists Association Foundation and National Alliance of State Pharmacy Associations, with premier support from Boehringer-Ingelheim.
This award was established to honor pharmacists who have compiled an outstanding record of community service.
“I am honored and humbled to win this award,” Brenda said. “My father was a Bowl of Hygeia recipient in 1972 (50 years ago) and I have always tried to pattern my life and service after him.”
Throughout her career, Brenda worked for Safeway which later became Harvest Foods where she worked as Director of Pharmacy, Pharmacy District Manager, and subsequently as Vice President of Pharmacy Operations with pharmacies in four states. In 2009, she returned to practice in a retail setting full time until 2011 when she was hired as the Assistant Director for the Arkansas State Board of Pharmacy, where she has spent the last 11 years.
Brenda has had a passion for helping her community since she was a teenager when she was a member of the International Order of Rainbow for Girls, an organization that taught leadership for girls through community service. Since then, she has volunteered for Habitat for Humanity and the Benevolent Order of the Elks, helped build one of the first soccer fields in North Little Rock through her son’s soccer league, secured masks for the Benton Police Department, and counseled countless Arkansas residents about COVID vaccination and treatment.
a master’s degree in public health, and UA Fayetteville where she earned a PhD in public policy.
Michelle Smith, Ph.D. was awarded the 2022 Friend of Pharmacy Award. This award symbolizes the leadership, dedication, passion, and contribution to the pharmacy profession from an individual who isn’t in a traditional pharmacy role.
Michelle is a graduate of Parkview Arts/Science Magnet, Dillard University in New Orleans, Tulane University where she received
Michelle counts many highlights throughout her career, including developing the Arkansas Minority Barber & Beauty Shop Health Initiative to provide screenings for hypertension, diabetes and cholesterol to African Americans and Latinos in a non-traditional health care setting; developing Sisters United and Brothers United, a community-based initiative and partnership with African American sororities and fraternities to address Arkansas’s high infant mortality rate, an initiative currently being replicated in other states such as Mississippi and Kentucky; spearheading the creation of the state of Arkansas’s first lactation room at an HBCU and establishing the first lactation room in the 189th Medical Group at the Little Rock Air Force Base; and securing a $41million dollar grant for state funding from the Centers for Disease Control and Prevention to address COVID-19 health disparities among populations at high-risk and underserved, including racial and ethnic minority populations and rural communities.
During the COVID pandemic, she helped develop Health Equity Strike Teams to assist state vaccination efforts and ensure hardto-reach and special populations received equitable access to vaccines. She also helped create a partnership between the Office of Health Equity, the Arkansas Pharmacists Association, and the National Guard to execute vaccine deployment statewide at 126 Health Equity Community Vaccination Clinics resulting in more than 19,000 vaccinations.
leadership, have distinguished themselves as political friends of Arkansas pharmacy.
A native of Northwest Arkansas, Rep Justin Boyd of Fort Smith earned an associate degree from the University of Arkansas in Fort Smith, a MBA from Walton College of Business, and a Doctor of Pharmacy from the UAMS College of Pharmacy. “I chose pharmacy because I had an interest in both biology and how medication works and also the opportunity to help people and improve their health.”
Representative Justin Boyd was awarded the 2022 Guy Newcomb Award. The APA Board of Directors created this award to recognize individuals who, by their legislative influence and
Rep. Boyd is serving his fourth term in the Arkansas House of Representatives representing District 77 which covers a portion of Sebastian County. For the 93rd General Assembly, Rep. Boyd serves as Co-Vice Chairperson of the Joint Budget Committee. He also serves on the House Insurance and Commerce Committee, and the House Public Health, Welfare & Labor Committee. In addition to his duties at the Arkansas State Capitol, he is a pharmacist at Coleman Pharmacy in Alma. Boyd is an active member of the Rotary Club, Arkansas Pharmacists Association, National Wild Turkey Federation, and Quality Deer Management Association. He is also part of the FBI Citizens Academy Association.
passion for his community and working with the Collier’s patients led him to attend UAMS College of Pharmacy and eventually take over as head of the family business in 1971.
Through his personal and professional experience, Carl has dedicated a large portion of his time and efforts to hospice care in NWA. Under his leadership, Collier Drug was instrumental in starting the Washington Regional Hospice Program that is still successful today. Although he “semi-retired” in 2007 and sold the business to his son Mel Collier, you can still find Carl in one of the eight Collier Drug locations almost daily working as a staff pharmacist or giving vaccines.
Throughout his career, Carl has been recognized for his service with a plethora of awards including the APA Bowl of Hygeia Award and Pharmacist of the Year Award, the Washington Regional Eagle Award, the Wes Gordon Golden Deeds Award, the University of Arkansas Community Service Award, the Washington County Historical Society Distinguished Citizens Award, the UAMS Society of the Double Helix, and the AFPNWA Lifetime Achievement Award.
Carl Collier was awarded the 2022 APA Lifetime Achievement Award. This award honors a pharmacist who has devoted his or her life and career to improving the field of pharmacy and has made an impact that affects healthcare at a local, state, and national level.
For Carl Collier, pharmacy is in his blood. In 1917, Carl’s grandfather started Collier Drug Stores, a business that has grown to several locations throughout Northwest Arkansas. Starting at 9 years old, Carl worked in the family business as a soda fountain jerk. His
“There are so many Arkansas pharmacists that should be recognized for their ongoing efforts to support and protect their communities during the COVID-19 pandemic,” Arkansas Pharmacists Association CEO John Vinson said. “Carl Collier has been a champion and advocate for his patients and his community and was a natural choice to be honored with an APA Lifetime Achievement Award.”
