ARRX 4th Quarter 2020

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

COVID-19 Vaccine Pharmacist Checklist Strengthening the Arkansas Immunization Infrastructure for Now and the Future

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Pharmacy Insurance

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

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Lynn Crouse, Pharm.D. Director of Pharmacy Practice Lynn@arrx.org 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 Design: Gwen Canfield - Creative Instinct 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 91. © 2020 Arkansas Pharmacists Association.

POSTMASTER: Send address changes to AR•Rx The Arkansas Pharmacist PO Box 3798 Little Rock, AR 72201-2923 Opinions and statements made by contributors, cartoonists or columnists do not necessarily reflect the attitude of the Association, nor is it responsible for them. All advertisements placed in this publication are subject to the approval of the APA Executive Committee. Visit us on the web at www.arrx.org.

WWW.ARRX.ORG

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CONTENTS 4 Inside APA: Provider Status in Arkansas During a Pandemic 5 From the President: Here We Stand 6 FEATURE: COVID-19 Vaccine Pharmacist Checklist 10 Legislator Profile: Representative Robin Lundstrom 12 Member Spotlight: Bill Altland, R.Ph. 14 Rx and the Law: Social Media and HIPAA 15 Safety Nets: Gabapentin 16 Financial Forum: The Major Retirement Planning Mistakes 17 New Drugs: Oncology and Chronic Care Drugs Still Priority During Pandemic 18 FEATURE: Leading the Way: Scott Knoer Takes the Reins of the American Pharmacists Association

22 UAMS: Social Connection and Meaningful Relationship - the Heart of the Pharmacy Profession 23 Harding University: 2020 HUCOP Annual Report 24 AAHP: Giving COVID Our Best Shot 25 Compounding Academy: Proud to Be an Arkansas Pharmacist 26 Arkansas Pharmacy Phoenix Movement / Project SOS ADVERTISERS 2 Pharmacists Mutual 11 Biotech Pharmacal, Inc. 13 Retail Designs, Incorporated 13 Arkansas Pharmacy Support Group 20 Baker's Dirty Dozen Book 21 UAMS College of Pharmacy 21 EPIC 25 The Law Offices of Darren O'Quinn 26 Pharmacy Quality Commitment Back Cover: APA Honors PPA / CPA

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

Regional Representatives Region 1 Representatives - Kevin Barton, Pharm.D., Bentonville - John Hall, Pharm.D., Fort Smith - Spencer Mabry, Pharm.D., Berryville Region 2 Representatives - Erin Beth Hays, Pharm.D., Pleasant Plains - Greta Ishmael, Pharm.D., Cherokee Village Region 3 Representatives - Brandon Achor, Pharm.D., Sherwood - Brittany Sanders, Pharm.D., Little Rock - Lanita White, Pharm.D., Little Rock Region 4 Representative - Betsy Tuberville, Pharm.D., Camden Region 5 Representative - Lelan Stice, Pharm.D., Pine Bluff At Large Representatives - Stacy Boeckmann, Pharm.D., Wynne - Rick Pennington, P.D., Lonoke Arkansas Association of Health-System Pharmacists Kim Young, Pharm.D., Little Rock Academy of Compounding Pharmacists Brooks Rogers, Pharm.D., Little Rock Academy of Consultant Pharmacists Denise Robertson, Pharm.D., Little Rock

Ex-Officio APA Executive Vice President & CEO John Vinson, Pharm.D., Benton AR State Board of Pharmacy Representative John Kirtley, Pharm.D., Little Rock Board of Health Member Marsha Boss, P.D., Little Rock UAMS College of Pharmacy (Dean) Cindy Stowe, Pharm.D., Little Rock Harding College of Pharmacy (Dean) Jeff Mercer, Pharm.D., Searcy General Counsel Nate Steel, J.D., Little Rock Treasurer Richard Hanry, P.D., El Dorado UAMS COP Student Ashlyn Tedder Ward, Little Rock Harding COP Student Aritney 4 Cooper, Searcy

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INSIDE APA

Provider Status in Arkansas During a Pandemic

P

rovider Status is a term that describes the opportunity for pharmacists to deliver patient care and be compensated for their time and professional services. It can take on many different meanings depending on the conversation, the practice site or policy discussion. Despite the complexity of the policy, the current COVID-19 pandemic has presented opportunities to implement our current provider status into action. Rather than focusing on the barriers, pharmacists are finding solutions to implement and operationalize the provider status opportunities that we do have. This can-do spirit will not only save lives, it will revolutionize a path forward as clinicians.

Provider status can be broken down into 3 basic concepts: 1. A label or recognition with law, regulation, contract, or policy 2. Scope of practice as defined by state or federal law 3. Payment for those provider services with either cash or third party Arkansas state law has recognized Arkansas pharmacists for many years, including the Any Willing Provider law also known as the Patient Protection Act of 1995 or Act 505 of 1995 (SB 299). In this law the Arkansas General Assembly finds that patients should be given the opportunity to see the healthcare provider of their choice. In order to assure the citizens of the state of Arkansas the right to choose the provider of their choice, it is the intent of the Arkansas General Assembly to provide the opportunity of providers to participate in health benefit plans. The defined health care providers in this law includes pharmacists and the healthcare services we provide.

In addition, Act 284 of 2017 (SB162), modernized the Arkansas Pharmacy Practice Act to clearly define pharmacists consistent with the 1995 law listed above as healthcare providers. This law also expanded scope of practice for pharmacists with naloxone prescribing through a statewide protocol and clarified that medication administration was within scope of practice for any medication. Arkansas

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

pharmacists also are able to engage via state law in disease state management (protocols with physicians), prescribe nicotine replacement therapy under a statewide protocol, provide counseling for tobacco cessation, and provide point of care testing, including COVID-19 testing. Additional scope of practice has also recently been passed at the federal level for pharmacists to independently prescribe and administer vaccines under the federal Prep Act during the state of emergency for age 3 to 18 and for all COVID-19 vaccines as long as certain requirements are met.

It should be recognized that many of the first two concepts of provider status are already met at the state level despite what barriers are going on with Medicare B at the federal level. The Arkansas any willing provider law of 1995 is strongly written and is opening up doors for medical billing for provider services that pharmacy benefit managers do not recognize or engage with in pharmacy program billing. Some services are beginning to be paid in the pharmacy benefit, like administration fees for long acting antipsychotics, but medical billing pathways should also be pursued because the pharmacy benefit designs are often oversimplified and inadequate.

The third concept or payment for provider services for provider status is an operational challenge that needs to be solved. Pharmacists are working through this and currently getting credentialed and enrolling with Medicaid for medical billing for both adult influenza vaccines and most vaccines in the Vaccines for Children program. Pharmacists are also pursuing third party medical billing for COVID-19 to include collection, testing and Evaluation and Management (time-based billing) for their professional services. This pursuit should include recognition and adequate compensation for both the test itself (the product) and also your services (billing Evaluation and Management codes).

The interpretation of the results, clinical advice, and referral to the appropriate medical professional when needed should AR•Rx

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INSIDE APA

be recognized and appropriately compensated as it is for other healthcare providers under Arkansas law.

Realizing the full potential of the 3rd concept, payment pathways for the existing scope and “label” we already have, will take hard work. Being paid adequate professional dispensing fees for community pharmacy dispensing support in the pharmacy benefit is just as crucial as being paid in medical billing for vaccine administration fees for COVID-19 vaccine or influenza vaccine purchased with federal funds. The business models must have pathways for our services to be compensated for our profession to grow and thrive for the next 3 or 4 generations. In addition, medical billing pathways have practical implications for documentation in

pharmacy dispensing software, eCare Plans, an Electronic Health Record or paper charts with billing pathways established with plans.

Blazing paths is never easy but new trails are needed.

The Arkansas Pharmacists Association is committed to being a resource, providing expertise and connecting members to solve these difficult challenges together. Evaluating technology solutions, addressing educational gaps, advocacy work, working through medical billing credentialing, surviving audits and prompt payment will all present challenges, but those challenges can be overcome and must be overcome for pharmacists to unleash their potential to save lives during the pandemic. §

FROM THE PRESIDENT

Here We Stand

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hat a humbling experience I have had this fall! Arkansas the ability to oversee PBM activity in leadership has worked tirelessly for years to fight for our state. This case originates from Kristen Riddle, Pharm.D. our ability to continue to serve our patients through our PBM grassroots legislation to protect APA President patient access and insure our efforts. This year, I'm blessed to be APA President as our state took this fight to our highest court. community pharmacies remain in our towns and cities.

This case impacts every pharmacist across the nation

When I stood on the steps of the Supreme Court of the United States (SCOTUS) in October and prepared for the but we know ultimately it is a patient access issue. We've all had patients who we've worked with to improve their media interviews, I was overwhelmed by humility. I think it medication adherence and compliance, only to lose those is appropriate for us to reflect on the hard work each of our patients to mandatory mailorder. We have painfully watched as past presidents have contributed to this fight (starting with patients began the hospital readmission Brandon Cooper and the passage of Act 900 in 2015, Eddie Glover, Lynn Crouse, cycle again once they've lost access to Stephen Carroll, and Dean Watts) as well their local pharmacist.

The opposing side says this is as our APA Executive Directors/CEOs about profit. They are wrong! Profit for through the years. Mark Riley was one of the first to educate our lawmakers about them maybe but not for us. We want the right to serve our patients and we want the PBM structure and practices and is our patients to have the right to chose still known nationally as the PBM expert. us! We want our local hospitals to be Scott Pace continued the fight in 2018 by able to have local pharmacists helping taking us to the Arkansas State Capitol in transition of care for our patients. Our and getting a special session to pass laws desire is to be paid a fair reimbursement for our state insurance commissioner to rather than below cost. have oversight. John Vinson continues the

In Rutledge v. PCMA, PCMA’s fight, including working with the legislature attorney Mr. Waxman argued that by during the 2019 legislative session to Rutledge winning the case, the cost of strengthen PBM oversight. healthcare would increase. Absolutely

This has been a process and John Vinson, Kristen Riddle, and Jordan not! Not if there is transparency and the didn’t land at SCOTUS overnight! We are Foster on the steps of the US Supreme state has the ability to regulate. We all thankful for Attorney General Rutledge and Court Building know increased cost is a common claim her staff, Shawn Johnson, and Arkansas that is just not true. The PBM “behind Solicitor General Nick Bronni and their the curtain" deals drive up our healthcare costs and onerous leadership and courage to continue the fight. Arkansas is a special place. Win or lose, this fight is not over. I am thankful mandates by the PBMs hurt patient care. While I do not for Arkansas leadership past, present, and future!! believe in overregulation, when there are billions of dollars to hide by the middlemen in their shell game, PBMs must have UPDATE: We won! The Supreme Court ruled in Arkansas's oversight. The purpose of Act 900 passed in Arkansas in 2015, favor unanimously in December! Keep watching for APA's the basis of the Supreme Court case, was to give the state emails with updates § WWW.ARRX.ORG

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COVID-19 Vaccine Pharmacist Checklist

By APA Director of Communications Jordan Foster

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s the global population continues to feel the deadly effects of COVID-19, the scientific community stands at the verge of one of the greatest marvels of modern science. What could have taken years under normal circumstances was condensed to months as several pharmaceutical companies developed COVID-19 vaccines without sacrificing any safety measures. Using messenger RNA (mRNA), scientists are able to utilize genetic code to guide cells in creating proteins, triggering the body's immmune system to produce antibodies without using the actual virus.

While the mRNA technology has been around for decades, its never before been used in an authorized vaccine.

Preliminary results from the companies show that the earliest vaccines from Pfizer and Moderna have shown impressive results (95% and 94% effectiveness rates, respectively) and several countries have already begun administering the vaccines to the general public.

In Arkansas, health officials have been working for months to develop a plan for the massive rollout of the vaccine.

Based on the Arkansas Department of Health's vaccination plan, Arkansas is planning the initial phase of its COVID-19 vaccination distribution in three parts, covering the time period when the number of initial doses is limited:

• Phase 1A uses Arkansas’s first shipment of vaccines to target healthcare workers in high-risk settings and people at significantly high risk for severe disease due to underlying health conditions such as hospital employees and first responders.

• Phase 1B will continue after 1A and will target essential workers such as grocery store workers, meatpacking plant workers, daycare employees, correctional workers, essential government workers, and primary, secondary, and higher education employees.

• Phase 1C will continue when the number of doses is limited but increasing and will target people at high risk for severe disease such as people 65 years of age and older and adults of all ages with high-risk medical conditions (chronic diseases).

With such a monumental effort to accomplish, pharmacists are poised and prepared to be on the frontline of the state’s COVID-19 immunization efforts. While it may take some time for your facility to gain access to the vaccines, there’s plenty to do in preparation.

For clickable links of this list, visit www.arrx.org/covid-links

Setting Up Are you certified to administer vaccinations in Arkansas?

Enroll in Medicare • If you are already enrolled as Medicare Part B or mass immunizer1, you don’t need to take any action to administer and bill

• If you are not enrolled with Medicare2, you can enroll as a Medicare mass immunizer via an expedited 24-hour process (Novitas Solutions: 1-855-247-8428)3 or via the submission of an 855B application. The $595 fee is being waived due to the pandemic

and the Provider Transaction Access Number (PTAN) provided will be good for five years. Note: If you sign up via the hotline process, you will be screened and will establish temporary Medicare billing privileges within 24 hours. However, this enrollment will only last during the public health emergency (PHE) and will need to be converted to a permanent enrollment when the PHE ends.

Review billing options: • Arkansas Medicaid Immunization Billing4,5 • Private Insurance Medical Billing (e.g. Blue Cross / Blue Shield Pharmacist Credentialing for Medical Benefits)21 • Review COVID-19 Vaccine Billing and Reimbursement Document22

Sign up for CDC COVID-19 Vaccine Enrollment through the Arkansas Department of Health 6 Complete WebIZ Registration The facility and each staff member at the facility must have a WebIZ registration, unless they already have one. All COVID-19 vaccinations must be entered into WebIZ within 24 hours of administration.

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COVID-19 VACCINE CHECKLIST

Enroll in VaccineFinder.org All facilities administering COVID-19 vaccines must enter COVID-19 vaccine inventory into vaccine finder daily, including weekends and holidays. The CDC will monitor this requirement and contact facilities that do not comply. Pharmacies must update their information no less than every 14 days or else they will be removed from the site.

Training Complete required training: • Storage and Handling Training • CDC - You Call the Shots Module 10: Vaccine Storage and

• WebIZ Training

Handling7

• CDC - Storage and Handling Toolkit - COVID Vaccine Addendum8

• CDC - COVID Vaccine Training Module9 • CDC Guidance for Planning Vaccination Clinincs Held at

• WebIZ General Use Training12

• WebIZ Inventory Reconciliation Power Point13 • WebIZ Inventory Reconciliation Instructions and Tips14

• WebIZ Inventory Training15

Satellite, Temporary, or Off-Site Locations (if applicable)10

• CDC Off-site Vaccination Clinic Checklist (if applicable)11

Review recommended resources: • Arkansas Department of Health Draft Plan16 • CDC COVID Toolkit17

• HHS New Rules for Who Can Vaccinate18 • HHS has ruled that during the public health emergency, qualified pharmacists, pharmacy interns, and pharmacy technicians are authorized to administer COVID-19 tests and COVID-19 vaccines to individuals ages three years and up and administer childhood vaccines to individuals ages three through 18 years

Storage Identify refrigerators and freezers to store vaccine 19 • Ultra-cold vaccines

• Ultra-cold freezer that can maintain temperatures between -60°C and -80°C

• Ultra-cold shipping container may be used for up to 10 days to store ultra-cold vaccines, but must be returned to manufacturer no later than 20 days after receipt • Frozen vaccines • Stand-alone freezer or pharmaceutical/purpose-built freezer • Cannot use freezer portion of dorm-style refrigerator to store frozen vaccines • Refrigerated vaccines • Stand-alone refrigerator or pharmaceutical/purpose-built refrigerator.

• No dorm-style refrigerators allowed, even for temporary storage • For combination refrigerator/freezer, freezer portion must not be used if storing refrigerated vaccines in refrigerator portion

Plan for temperature monitoring All refrigerated and frozen COVID-19 vaccines must be monitored using a digital data logger with a current Certificate of Calibration.

Vaccine storage temperatures must be reviewed and documented at the beginning and ending of each clinic day; vaccine storage minimum and maximum temperatures must be documented at the beginning of each clinic day and the minimum and maximum temperatures reset on the data logger.

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COVID-19 VACCINE CHECKLIST

COVID-19 Vaccine Pharmacist Checklist Post a “Do Not Unplug” sign on the storage unit plug outlet and a “Do Not Turn Off” sign on the circuit breaker to the storage unit

Logistics Identify key employees to take the lead • Designate a primary and back-up vaccine coordinator to monitor and manage the vaccine inventory • Designate at least two employees to be trained to receive deliveries of COVID-19 vaccines

Complete a Vaccine Management Plan and post on all storage units (PDF) 20 Help vaccine recipients keep track Develop a process for monitoring and tracking staff and patients who receive the vaccine and a way to remind them of the date of their second dose

Plan how to communicate to your patients about vaccine availability and priority groups Be prepared for questions Gather information and develop responses to patients who have questions about the vaccine, its safety, and how effective it could be. CDC Talking to Patients About COVID-19 Vaccines

Resources

(All resources available as clickable links at www.arrx.org/covid-links) 1 - https://www.cms.gov/files/document/covid-19-vaccine-enrollment-scenario-1.pdf 2 - https://www.cms.gov/files/document/covid-19-vaccine-enrollment-scenario-3.pdf 3 - https://www.cms.gov/files/document/covid-19-mac-hotlines.pdf 4 - https://apa.memberclicks.net/assets/Interactions/NewInteRxActions/2020/September/September18/Arkansas%20Medicaid%20 Immunization%20Billing%20ARRx.pdf 5 - https://apa.memberclicks.net/assets/Interactions/NewInteRxActions/2020/September/September18/Medicaid%20PV%20Request.pdf 6 - https://www.healthy.arkansas.gov/programs-services/topics/covid-19-vaccine-provider-forms 7 - https://www.cdc.gov/vaccines/ed/youcalltheshots.html 8 - https://www.cdc.gov/vaccines/hcp/admin/storage/toolkit/index.html 9 - https://www2.cdc.gov/vaccines/ed/covid19/ 10 - https://www.cdc.gov/vaccines/hcp/admin/mass-clinic-activities/index.html 11 - https://documentcloud.adobe.com/link/track?uri=urn:aaid:scds:US:4642ae60-a345-4f7b-b74d-807a95106d49 12 - https://documentcloud.adobe.com/link/track?uri=urn:aaid:scds:US:b8f6b4d6-7bbf-49ec-8b50-1e830398779e 13 - https://documentcloud.adobe.com/link/track?uri=urn:aaid:scds:US:d481f4e5-9d49-4b8b-b806-7e1589fb6518 14 - https://documentcloud.adobe.com/link/track?uri=urn:aaid:scds:US:12ec0ac0-632f-4ab2-b0bd-30db388cbda8 15 - https://documentcloud.adobe.com/link/track?uri=urn:aaid:scds:US:ab3d2dee-f09c-47c2-844e-151ba37dd26d 16 - https://www.healthy.arkansas.gov/programs-services/topics/covid-19-vaccine-plan 17 - https://www.cdc.gov/coronavirus/2019-ncov/communication/toolkits/index.html 18 - https://www.hhs.gov/about/news/2020/10/21/trump-administration-takes-action-further-expand-access-vaccines-covid-19-tests.html 19 - https://apa.memberclicks.net/assets/Coronavirus/Vaccines/COVID-19%20Program%20Enrollment%20Instructions%2012-2.pdf 20 - https://documentcloud.adobe.com/link/track?uri=urn:aaid:scds:US:0692eaec-e82a-4bbb-903b-ef2001e173b6#pageNum=1 21 - http://apa.memberclicks.net/message2/link/c1df8e6d-a7b0-4123-893c-5df33213256e/27 22 - https://apa.memberclicks.net/assets/Coronavirus/Vaccines/Vaccine_Webpage/COVID-19%20Vaccine%20Billing%20and%20

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2021 Calendar of Events JANUARY January 6 APhA Immunization Training Hosted by APA Virtual January 11 93rd General Assembly of the Arkansas State Legislature Convenes Virtual/In-Person Little Rock, AR January 27 APhA Immunization Training hosted

by APA Virtual

FEBRUARY February 9-11 AR State Board of Pharmacy Board Meeting Virtually February 19 Winter Virtual CE Virtually

MARCH March 3 UAMS P3 Pinning Ceremony UAMS Campus Little Rock March 7 APA Board Meeting Virtual/In-Person Little Rock, AR March 8 UAMS P3 Pinning Ceremony Northwest AR Campus Fayetteville, AR March 12-15 APhA Annual Meeting & Exposition Los Angeles, CA

APRIL April 22* Arkansas Pharmacy Foundation Golf Tournament Tannenbaum Golf Course

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April 30* Harding P3 Pinning Ceremony Harding Campus Searcy, AR

MAY May 7* Harding Class of 2021 Meeting Searcy, AR May 8 Harding College of Pharmacy Commencement Searcy, AR

SEPTEMBER Every Thursday in September (2, 9, 16, 23, 30) APA Regional Meetings Around the State In-Person/Virtual TBA

OCTOBER October* AAHP Fall Seminar Wyndham Riverfront North Little Rock, AR

May 13* UAMS Class of 2021 Meeting Little Rock, AR

October 9-12, 2021 National Community Pharmacists Association Annual Convention Charlotte, NC

May 15 UAMS College of Pharmacy Commencement Little Rock, AR

October 28* APA Golden CPE Hosto Center Little Rock, AR

JUNE June 5-9 American society of Health-System Pharmacists Summer Meeting Long Beach, CA June 8-9 AR State Board of Pharmacy Board Meeting Virtually/In-Person Little Rock, AR June 9 APA Board Meeting Doubletree by Hilton Little Rock, AR June 10-12 APA 138th Annual Convention Doubletree by Hilton Little Rock, AR

AUGUST August 5-6* APA Board Retreat and Committee Chair Orientation TBA

NOVEMBER November 4-7 American Society of Consultant Pharmacists Annual Meeting and Exhibition Town and Country San Diego, CA

DECEMBER December 3* APA Board Meeting Virtual/In-Person Little Rock, AR December 5-9 American Society of Health-System Pharmacists Midyear Clinical Meeting Orlando, FL December 7* APA Committee Forum Virtual/In-Person Little Rock, AR

* denotes dates subject to change

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LEGISLATOR PROFILE

Representative Robin Lundstrom SPRINGDALE

District: 87 Represents (Counties):

Washington and Benton Counties

Years in Office: Six years

Occupation:

I started out as associate professor at John Brown University.

While teaching, we started with two properties just as a side gig but it's grown into a serious business that has blossomed in the last 26 years. I enjoy buying a property, fixing it up and leasing it out to a family.

Your Hometown Pharmacist:

I am loyal to Lowell Pharmacy. John and James always take their time and do a great job on compounding my thyroid medications. Harps Pharmacy in Springdale is who we use for our “general needs” since we shop there as well.

What do you like most about being a legislator?

EVERYTHING! I still feel excited when I step on the floor of the House of Representatives. It is hard to pick one aspect of being a legislator! I love helping my constituents. I love the bill process and being a very small part of Arkansas History. I realize that sounds corny, but the moment it stops being special I think you should leave; this is such a privilege that you should take the job seriously, but not yourself too seriously.

What do you like least about being a legislator?

Being away from my husband, I actually like the guy after 34 years of marriage!

Most important lesson learned as a legislator:

Be BOLD! You are elected to represent a platform and your constituents expect you to follow that platform, they hired you to do a job. I also think it is very important to return your calls and try to get your constituents the answers to whatever concerns they have even if it’s an answer they may not like.

Respect them enough to return the call.

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Most admired politician: Margaret Thatcher

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

Give both sides of the issue, always shoot someone straight and treat them like you would want to be treated. Legislators are not special, we want to do our job to the best of our ability so giving us good information helps us make good decisions.

Your fantasy political gathering would be:

Playing spades with Ronald Reagan, Winston Churchill, Abraham Lincoln, Golda Meir, and William Wilberforce.

Hobbies:

I love to hang out with my family, travel, read and I enjoy working on my rental properties and puttering around my house, I always have a “project going” somewhere.

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MEMBER SPOTLIGHT

Bill Altland, R.Ph. Retired Craig, Alaska

Pharmacy/academic practice: Co-founder (with

Pharmacist wife Sarah) of Whale Tail Pharmacy, the first and only retail community pharmacy on Prince of Wales Island, Alaska

Pharmacy school and graduation year: UAMS Class of

1980

Years in business/years teaching: We owned our

pharmacy business in Alaska for 14 years. But we were also pharmacist missionaries in Zaire (now called the Democratic Republic of Congo) for 4 years, as well as at a mission hospital in Haiti for 6 months.

Favorite part of the job and why: Helping our friends and

neighbors in rural remote Southeast Alaska as well as in Congo and Haiti.

Least favorite part of the job and why: Time spent dealing

with insurance companies when we should have been using that time helping our friends & neighbors.

What do you think will be the biggest challenges for pharmacists in the next five years? In a pharmacy

business: Having enough time to adequately help pharmacy patrons due to time restraints caused by the time spent dealing with all the details necessary to process insurance claims and insurance boondoggles.

Oddest request from a patient/customer: A request by a

customer for a 20cc syringe, a large gauge needle and a bottle of formaldehyde. He was a local commercial fisherman who wanted to preserve the exoskeleton of an Alaska king crab - that he had caught off Kodiak Island, Alaska.

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Bill Altland and his wife Sarah

Recent books read: “My Utmost for His Highest” by Oswald Chambers

Favorite activities/hobbies: Taking LONG motorcycle road trips. Once rode a moto solo on a 5 month trip from Alaska to the southern tip of South America.

Ideal dinner guests: Abraham Lincoln And Winston Churchill

If not a pharmacist then…: I just can’t think of anything I’d rather do than be a small town pharmacy business owner.

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

To be part of the “action” of our profession, not just a spectator. And to meet colleagues who have the same interests & challenges as you do. *Bill is an Arkansas native who regularly returns to Arkansas for the APA Annual Convention. He was scheduled to be a featured speaker at the 2020 Annual Convention prior to the pandemic.

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

R

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

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

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

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

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

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

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You should also have a policy for your staff regarding photos in the pharmacy and posting to social media.

Pictures from someone's birthday party that inadvertently disclose PHI could be posted on an employee's Facebook page. The employee is thinking about fun and focusing on the celebration, not the counseling session going on in the background.

The same temptations for a quick and easy post exist for your patients also. You and you staff should be alert for patients, or even just persons loitering, who are using their phone to take pictures or video in the dispensing or counseling area. These people are giving much less conscious thought to protecting PHI than your staff. Your diligence in protecting privacy will be beneficial in your defense when an errant posting slips through.

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

Social media is a great tool to market and promote the services of your pharmacy. As with any tool, careful consideration of how it is used is crucial. Bad publicity from disclosing PHI on social media could be crushing to your practice. Use social media wisely and it is worth its weight in gold. § ________________________________________________________________ © Don R. McGuire Jr., R.Ph., J.D., is General Counsel, Senior Vice President, Risk Management & Compliance at Pharmacists Mutual Insurance Company.

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

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THE ARKANSAS PHARMACIST

12/28/20 7:23 PM

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY

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

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

T

he electronic prescription illustrated in Figure One was transmitted from a prescriber’s office to a community pharmacy in Northwest Arkansas. The technician entered the gabapentin patient directions into the pharmacy computer as “take one capsule by mouth two times a day and two capsules at bedtime.” This information and the prescription image were then transmitted to the pharmacist verification queue.

While verifying the accuracy of this order, the pharmacist noticed two additional sig’s – “take one tab in a.m. and 2 in pm” in the Comments section of the order, and “2 tablets at bedtime” in the Admin Instructions section. The pharmacist immediately telephoned the prescriber’s office for clarification about the multiple patient directions contained in the order.

The prescriber’s nurse confirmed the patient was to follow the sig. listed in the Comments section – “take one capsule in the morning and two in the evening.” After this, the prescription was correctly filled and place in the will-call bin for patient pick up.

Figure 1

by pharmacy staff. The days of traditional handwritten prescriptions are rapidly coming to an end. Pharmacists must realize that many individuals – prescribers, nurses, even office staff – could be involved in “writing” an electronic prescription before transmission to the pharmacy. Legibility and neatness do not mean error-free. Electronic prescriptions must be carefully examined – perhaps even more so – than handwritten prescriptions of the past. § STUDENT SPOTLIGHT

Isn't a Migraine Just a Bad Headache?

- Sydney Zotti The short answer is “no”. I suffer from migraines and I want to give insight about what it’s like living with them.

I have migraine symptoms every day. Did you know that eye floaters are a symptom of migraines? These are spots in my vision that move with every eye movement.

My migraines are also trigged by weather. I check the forecast daily to plan around the likelihood of a migraine.

This case clearly demonstrates the hazards associated with electronic prescriptions. While this type of medication order may have certain advantages over handwritten prescriptions, their use does not guarantee error-free medication orders. In this case, the electronic prescription itself is the problem – not just one part of it – because it actually contains three separate, different instructions to the patient in a single medication order.

This E-prescription might be the gold standard for a confusing, hazardous, and ultimately dangerous medication order. Whoever devised sections on medication orders such as Comments and Admin Instructions in addition to the traditional “Sig:” section familiar to all pharmacists, has never heard of USP requirements for a valid, safe prescription. It is clearly not in the interest of patient safety to create this type of software.

Electronic prescriptions are not guaranteed to completely free from errors. In fact, the legibility and neatness of E-Prescriptions may actually increase the likelihood of error compared to handwritten orders which may be more carefully examined

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It’s discouraging to wake up and KNOW I’m going to have a migraine that day. On these mornings, I have a stiff neck and a mild headache. Throughout the day, the pain radiates up my neck into the base of my skull and into my eye. Unless you suffer migraines, the pain is impossible to describe. It’s like having knives slowly pushed into your skull, which becomes unbearable if you try to walk or even sit up.

My migraines are also associated with visual problems.

I lose vision in one eye and peripheral vision in the other making it impossible to see clearly. This is compounded by nausea which for me is the worst part of it all. I vomit with every migraine. It’s frustrating for me to have to lay in a dark room for hours until my migraine passes.

Pharmacists interact with migraine sufferers daily. I hope my story increases your empathy for these patients. Migraines are debilitating and detrimental to one’s life. Let your migraine sufferers know you care about their wellbeing. They will appreciate it – I would.

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12/28/20 7:23 PM

The Major Retirement Planning Mistakes Why are they made again and again?

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.

M

uch is out there about the classic financial mistakes that plague start-ups, family businesses, corporations, and charities. Aside from these blunders, some classic financial missteps plague retirees. Calling them “mistakes” may be a bit harsh, as not all of them represent errors in judgment. Yet whether they result from ignorance or fate, we need to be aware of them as we plan for and enter retirement.

Leaving work too early. As Social Security benefits rise about 8% for every year you delay receiving them, waiting a few years to apply for benefits can position you for higher retirement income. Filing for your monthly benefits before you reach Social Security’s Full Retirement Age (FRA) can mean comparatively smaller monthly payments. Meanwhile, if you can delay claiming Social Security, that positions you for more significant monthly benefits.

Underestimating medical bills. In its latest estimate of retiree health care costs, the Center for Retirement Research at Boston College says that the average retiree will need at least $4,300 per year to pay for future health care costs. Medicare will not pay for everything. That $4,300 represents out-of-pocket costs, which includes dental, vision, and long-term care.

Taking the potential for longevity too lightly. Actuaries at the Social Security Administration project that around a third of today’s 65-year-olds will live to age 90, with about one in seven living 95 years or longer. The prospect of a 20- or 30year retirement is not unreasonable, yet there is still a lingering cultural assumption that our retirements might duplicate the relatively brief ones of our parents.

Withdrawing too much each year. You may have heard of the “4% rule,” a guideline stating that you should take out only about 4% of your retirement savings annually. Many cautious retirees try to abide by it. So, why do others withdraw 7% or 8% a year? In the first phase of retirement, people tend to live it up; more free time naturally promotes new ventures and adventures and an inclination to live a bit more lavishly.

Ignoring tax efficiency & fees. It can be a good idea to have both taxable and tax-advantaged accounts in retirement.

Assuming your retirement will be long, you may want to assign this or that investment to its “preferred domain.” What does that mean? It means the taxable or tax-advantaged account that may be most appropriate for it as you pursue a better after-tax return for the whole portfolio. Many younger investors chase the return. Some retirees, however, find a shortfall when they

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try to live on portfolio income. In response, they move money into stocks offering significant dividends or high-yield bonds – something you might regret in the long run. Taking retirement income off both the principal and interest of a portfolio may give you a way to reduce ordinary income and income taxes.

Avoiding market risk. Equity investment does invite risk, but the reward may be worth it. In contrast, many fixed-rate investments offer comparatively small yields these days.

Retiring with heavier debts. It is hard to preserve (or accumulate) wealth when you are handing portions of it to creditors.

Putting college costs before retirement costs. There is no “financial aid” program for retirement. There are no “retirement loans.” Your children have their whole financial lives ahead of them. Try to refrain from touching your home equity or your IRA to pay for their education expenses.

Retiring with no plan or investment strategy. An unplanned retirement may bring terrible financial surprises; the absence of a strategy can leave people prone to market timing and day trading.

These are some of the classic retirement planning mistakes.

Why not plan to avoid them? Take a little time to review and refine your retirement strategy in the company of the financial professional you know and trust. §

________________________________________________________________ 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

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THE ARKANSAS PHARMACIST

12/28/20 7:23 PM

Oncology and Chronic Care Drugs Still Priority During Pandemic

D

espite fear the FDA would be inundated with requests related to COVID-19 slowing the approval of other lifesaving medications, the agency has managed to approve 29 new drugs and biologicals and authorize 13 new dosage forms from June through September.

Acute Care:

Byfavo™ (remimazolam) is a rapid-acting injectable benzodiazepine for induction and maintenance of procedural sedation. Sevenfact® (factor VIIA, recombinantjncw) is a coagulation factor used to control bleeding in patients with hemophilia A or B with inhibitors. Xeglyze™ (abametapir) is a lotion for the treatment of headlice in patients >6 months.

Olinvyk™ (oliceridine) received fast track status for acute pain relief during procedures.

Chronic Care:

Bafiertam™ (monomethyl fumarate), the active metabolite of dimethyl fumarate, has been approved for relapsing forms of multiple sclerosis. Dojolvi™ (triheptanoin) is a liquid medium-chain triglyceride used as a source of calories and fatty acids for patients with long-chain fatty acid oxidation disorders. Hulio™ (adalimumab-fkjp) has become the sixth approved biosimilar to the anti-TNF agent, Humira®.

Lyumjev™ (insulin lispro-aabc), is a new rapid-acting insulin analog for diabetes available in two concentrations—100 and 200 units/mL. Nexlizet™ (bempedoic acid/ezetimibe) is approved as adjunct to diet and statin therapy for the treatment of familial hypercholesterolemia. Palforzia® (peanut, arachis hypogaea allergen powder-dnfp) is an oral powder immunotherapy approved for mitigation of peanut allergic reaction. QWO™ (collagen clostridium histoyticum-aaes) is an injectable treatment approved for moderate to severe cellulite in women. Rukobia (fostemsavir) is a novel HIV-1 gp 120-directed attachment inhibitor indicated in combination with other antiretrovirals for multidrug-resistant HIV-1 infection.

Semglee™ (insulin glargine) is a long-acting insulin to be marketed by Mylan as an affordable alternative to Lantus®.

Both Uplizna™ (inebilizumab-cdon), a novel B-cell depleting monoclonal antibody, and Enspryng™ (satralizumab-mwge), an IL-6 receptor antagonist, have been approved to treat neuromyelitis optica spectrum disorder in adults who are anti-AQP4 antibody positive. Sogroya (somapacitan) is the first subcutaneous human growth hormone dosed weekly.

Winlevi® (clascoterone) is a novel topical acne treatment that inhibits the androgen receptor. Viltepso™ (viltolarsen) received accelerated approval for the treatment of Duchenne muscular dystrophy. Evrysdi™ (risdiplam) was approved for the treatment of spinal muscular atrophy. Lampit® (nifurtimox), an antiprotozoal medication, received accelerated approval for the treatment for Chagas disease in patients <18 years old.

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Oncology: Darzalex Faspro™ (daratumumab/hyaluronidase-

fihj) subcutaneously administered treatment for multiple myeloma. Inqovi® (decitabine/cedazuridine) as an oral combination was granted priority review for myelodysplastic syndromes and chronic myelomonocytic leukemia. Nyvepria (pegfilgrastim-apgf) is a colony stimulating factor and the 4th biosimilar for Neulasta®. Phesgo™ (pertuzumab/ trastuzumab/hyaluronidase-zzxf) is a monoclonal antibody administered subcutaneously in combination with other drugs for HER2-positive breast cancer. Zepzelca™ (lurbinectedin) is an alkylating drug that was granted accelerated approval for metastatic small cell lung cancer with disease progression on or after platinum-based chemotherapy. Monjuvi™ (tafasitamabcxix) was approved to treat relapsed or refractory diffuse large B-cell lymphoma. Blenrep (belantamab mafodoti-blmf), the world’s first anti-B-cell maturation agent monoclonal antibody, received accelerated approval to treat multiple myeloma.

Gavreto™ (pralsetinib) received accelerated approval for certain types of non-small cell lung cancer. Detectnet™ (copper CU 64 dotatate injection), a diagnostic agent used with PET, is approved for the localization of somatostatin receptor positive neuroendocrine tumors in adults.

New Dosage Forms:

Several new dosage forms were approved including: Fintepla® (fenfluramine, oral solution) for seizures associated with Dravet syndrome; Gimoti™ (metoclopramide, nasal spray) for patients with diabetic gastroparesis; Impeklo™ (clobetasol propionate, lotion) for corticosteroid-responsive dermatosis; Kynmobi™ (apomorphine, sublingual film) for intermittent treatment of “off” episodes of Parkinson’s disease; Mycapssa® (octreotide, oral capsule) for long-term maintenance treatment of acromegaly; Oriahnn® (elagolix/estradiol norethindrone, capsules) for fibroid-associated heavy menstrual bleeding in premenopausal women; Phexxi™ (lactic acid/citric acid/potassium bitartrate, vaginal gel) for on-demand prevention of pregnancy; Tivicay PD® (dolutegravir, oral tablet for suspension) for HIV-1 infection in patients > 4 weeks old and weighing at least 3 kilograms; Upneeq™ (oxymetazoline, ophthalmic solution) for blepharoptosis (droopy eyelid); Zilxi™ (minocycline, topical foam) for adult rosacea; Breztri Aerosphere™ (budesonide, glycopyrrolate, and formoterol fumarate, metered dose inhaler) as COPD maintenance treatment; Wynzora® (calcipotriene/ betamethasone dipropionate, cream) for plaque psoriasis; and Xywav™ (calcium, magnesium, potassium, and sodium oxybates), containing 92% less sodium per dose than comparable sodium oxybate (Xyrem™), both from Jazz pharmaceuticals, for narcolepsy. §

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12/28/20 7:23 PM

LEADING the Way Scott Knoer Takes the Reins of the American Pharmacists Association

By APA Director of Communications Jordan Foster

W

eeks into 2020 and on the verge of a global pandemic sweeping through the United States, Scott Knoer prepared to step into the national spotlight in a year when pharmacy itself would soon take center stage. On February 1, the American Pharmacists Association announced Knoer, formerly the Chief Pharmacy Officer of the Cleveland Clinic, as the 13th Chief Executive Officer / Executive Vice President of APhA.

Name

As his first year in the role begins to wind down, it promises to be an unforgettable one as pharmacists stand on the front lines ready to administer COVID vaccines and the United States Supreme Court prepares its opinion in the landmark pharmacy case Rutledge v PCMA. We recently asked Knoer to introduce himself to Arkansas pharmacists and weigh in on the state of pharmacy in America.

Previous Position

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Scott J. Knoer, MS, PharmD, FASHP

Education

Bachelor of Arts in Psychology - Creighton University Doctor of Pharmacy - University of Nebraska Medical Center Residency / Master of Science in Hospital Pharmacy University of Kansas Cleveland Clinic Chief Pharmacy Officer - lead almost 1,600 pharmacy employees and oversaw a $1.4 billion drug budget at the Clinicâ&#x20AC;&#x2122;s 1,300-bed tertiary care referral hospital, its clinics and cancer center, 18 family health centers and 11 community hospitals in the Cleveland area with facilities in Florida, Las Vegas, Canada, London and Abu Dhabi

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THE ARKANSAS PHARMACIST

12/28/20 7:23 PM

LEADING THE WAY

Former APhA CEO Tom Menighan, Scott, and 2019-2020 APhA President Brad Tice

APhA senior staff members Rafael Saenz, Ilisa Bernstein, and Joseph Janela joined Scott as he presented a $10,000 check on behalf of APhA to the Arkansas Pharmacists Association's Phoenix Fund.

Scott Knoer and John Vinson at the APhA headquarters in Washington, D.C.

What’s the most important issue facing pharmacists?

Undoubtedly payment reform. This has so many ramifications.

It encompasses national provider status, state Medicaid payment, convincing insurers to pay pharmacists for cognitive services, PBM reform and ultimately the poor working conditions in many busy pharmacies, especially the large chains. We need to ensure that pharmacists can practice at the top of their education and perform the functions that we were all trained to do in pharmacy school.

What’s your mission/vision for your time as CEO? Simply put, it’s APhA’s job to: empower pharmacists to care for patients. The patient is at the center of everything we do here at APhA. As pharmacists, our patient care lens is through the management of medications. Our mission is to ensure that pharmacists in all practice sites can reach their patient care potential.

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Scott Knoer, along with NASPA Executive Vice President Rebecca Sneed, APA's John Vinson and Kristen Riddle, and NCPA CEO Doug Hoey, pose on the steps of the United States Supreme Court after the four pharmacy organizations collaborated on a live video preview of the Rutledge v PCMA case for pharmacists across the country.

What would you like for pharmacists to know about APhA? APhA gets a LOT of important stuff done for our members and our patients. Unfortunately, we have not historically not been very good at honking our own horn. Our team is extremely dedicated and effective. We achieve a lot, but we haven’t been so good at taking credit for our amazing work. It’s Marketing 101 to say: “If nobody knows, it didn’t happen...”

If people don’t know that the primary reason Health and Human Services preempted state law to allow pharmacists to provide COVID testing, pediatric vaccinations and ultimately to administer the COVID vaccine is because APhA drove that behind the scenes, then APhA has failed to let members know the value of their membership. These things literally happen every day where we are working with coalitions and government entities to help improve practice, but members don’t see that and therefore may not appreciate it. (cont)

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LEADING THE WAY

How would you describe your leadership style?

Pretty simple. I recognize and reward talent and create an environment that lets people be their best. I create a culture of accountability and transparency and I make sure that people are in the right roles for their skill sets. I promote high performers and I recruit those who want to achieve greatness for our profession. Once I have a team together, which I do now, I ensure that everyone works toward common goals.

I don’t allow infighting and siloed thinking. Basically, I hire and promote good people, create a supportive environment, and ensure that high expectations are met. I remove barriers and get out of my team’s way. I set a vision, but don’t micromanage. People need to feel empowered to make decisions.

than we do. We need you to join APhA and give to the APhA PAC so we can fight this fight alongside you. Let’s do this together my friends!

What within pharmacy is your passion?

Advocacy and practice advancement. We inherited a glorious profession because leaders and clinicians before us innovated and created it for us. I feel a profound sense of duty and obligation to drive our profession as far forward as humanly possible in my lifetime. This position has given me an opportunity and platform for good that few people ever get. I will not squander my chance. I will push every day as hard as I possibly can to empower pharmacists to care for patients.

What’s your message to pharmacists across the country?

How can pharmacists innovate their practice?

APhA is fighting hard for you and your patients every day. We can’t do it alone. We are up against powerful, well financed, entrenched special interests. PBMs literally have hundreds of billions of dollars to lose that they are fighting to protect and they fight dirty. The AMA is against provider status.

These organizations have a lot more resources and lobbyists

Become benevolent opportunists. Use the current pandemic health crisis for good. Take this opportunity to advance telemedicine, increase immunizations and continue to demonstrate to policy makers and legislators the importance of pharmacy in society. Be bold. §

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THE ARKANSAS PHARMACIST

12/28/20 7:23 PM

YOUR JOURNEY

BEGINS HERE!

pharmacy.UAMS.edu

Helping independent pharmacies compete since 1982.

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

• New! Exclusive! ERxDirect telemed platform with care management revenue opportunities • New! Consumer engagement model for better outcomes and adherence • 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

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A Network Of Independently Owned Pharmacies 800-965-EPIC (3742) | epicrx.com membersupport@epicrx.com

12/28/20 7:23 PM

UAMS SCHOOL OF PHARMACY

Cindy D. Stowe, Pharm.D. Dean and Professor

Social Connection and Meaningful Relationship – the Heart of the Pharmacy Profession

A

finding creative ways to stay connected are sought and employed, such as phone call and text check-ins.

Although isolation can be felt regardless of the outside world, our current pandemic situation has heightened our risk for loneliness. We are actively isolating ourselves to decrease the spread of COVID-19 and while at first we thought it was temporary, it has now lingered for more than six months.

Without a clear end in sight, I’ve found myself thinking a lot about how to build and maintain social connection during this pandemic, how to care about those around me, and how building meaningful relationships are at the core of our profession as pharmacists.

At the College, much of our efforts have been to stay connected within and between the faculty, staff and students. Maintaining the safety of our students, faculty, and staff, while delivering a high-quality education, has been at the core of our decision-making. Enhancing and improving communication has been an ongoing focus to support functional and caring connections. Where possible, flexible work arrangements have been implemented to allow faculty and staff the ability to work from home. Students are able to live with their families, instead of splitting time between home and school. The level of engagement by students in learning activities has been tremendous, whether synchronously or asynchronously delivered. Additionally, the students are finding creative ways to stay connected through their professional organizations by conducting remote social and professional activities.

t the heart of human nature is connectivity to one another. We learn early in life how to bond with others and do so through our relationships with family, friends and even strangers. This social connection is essential to our wellbeing and without such, leads to isolation.

Social connection is the feeling that you belong or that you feel close to other people. Social connection involves feeling cared for and valued, and forms the basis of interpersonal relationships. Relationships are defined as the way in which two or more concepts, objects, or people are connected, or the state of being connected. Strong social connections are beneficial to us in the moment but also translate over time into health benefits. Moreover, socially supportive actions benefit the giver as well as the receiver. Outward expressions of kindness and caring for others have far-reaching benefits and create a positive feedback loop of wellbeing.

Research has shown the benefits of connection, and it has been proposed that social connection be considered a ‘vital sign’ with positive impact on a wide range of health outcomes. Positive benefits from social connection have been seen in obesity, diabetes, cancer, and cardiovascular disease, not to mention impact on psychological health. So, during the pandemic our efforts to enhance and maintain connection with the most at risk populations is critical.

So, what can we do to help others? I believe the first step begins with us. Although it may seem impossible to have meaningful conversations through telecommunication, it can be done and keeping ourselves connected to those who support us is important in maintaining our own sense of wellbeing and belonging. We then need to extend that to others. Community pharmacists have strong social connections and relationships with their patients and often serve as a vital source of care and support for these individuals. Finding ways to reach out and stay connected with these patients are critical during this time of social distancing. When patients cannot come into the pharmacy, 22

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But all of this takes effort, much more than in pre-COVID times. Impromptu social contact is no longer part of our daily lives and so we must be intentional in creating opportunities to connect with those around us. Efforts focused on acts of kindness and compassion are central to building meaningful social connection. Whether in your personal life or your professional life, reach out to others. Be the conduit for kindness and connectivity. By doing so, we not only will we be serving others, but we will be helping ourselves as well. I am providing you some references that you may find helpful and I will leave you with a quote that I think suits the time.

“When you are kind to others, it not only changes you, it changes the world.” – Harold Kushner Stay healthy and strong! - Cindy § References Together: The Healing Power of Human Connection in a Sometimes Lonely World. Vivek H. Murthy HarperCollins, New York City Copyright 2020.

Martino J, Pegg J, Frates EP. The Connection Prescription: Using the Power of Social Interactions and the Deep Desire for Connectedness to Empower Health and Wellness. Am J Lifestyle Med 2017;11(6):46677. Last accessed on 2020-09-22. https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC6125010/pdf/10.1177_1559827615608788.pdf CDC post “Loneliness and Social Isolation Linked to Serious Health Conditions”. Last accessed on 2020-09-22. https://www.cdc.gov/ aging/publications/features/lonely-older-adults.html

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THE ARKANSAS PHARMACIST

12/28/20 7:23 PM

HARDING UNIVERSITY REPORT

2020 HUCOP Annual Report

H

ello from Searcy and everyone at the Harding University Jeff Mercer, Pharm.D. College of Pharmacy (HUCOP)!

Dean and Professor Our family continues to grow and expand with faculty, staff, students, alumni, preceptors, practitioners, and friends. I hope you find yourself somewhere in that group. We love our HUCOP family and enjoy every opportunity to visit together.

I say it every year, and it rings true once again—Fall is my favorite time of year. It’s a time when we welcome new and returning students. It’s also a time when we are privileged to visit with many of our friends throughout the state during the APA Regional Meetings. Of course, everything looked quite different this fall semester amidst the COVID pandemic.

Students resumed classes, but they did so under a strict protocol of masking and social distancing. The Regional Meetings were still conducted, but they were combined into four virtual meetings rather than the traditional faceto-face meetings in your communities. I sure miss the days where students could gather freely, and I missed visiting pharmacists and friends throughout the State of Arkansas during the Regional Meetings this year. But, that’s just how it is this year. Until life returns to normal, we are resolved to make 2020 the best it can be for our students and the HUCOP family.

We were delighted to welcome our thirteenth class of pharmacy students this year—the class of 2024! This group of 34 students hail from several different states and two foreign countries. I’ve had the opportunity to get to know this new cohort in an introduction to pharmacy course, and I am so impressed with them. They are such a diverse and bright group of individuals, and they are really bonding in their time together at Harding. We are excited for these new students that have joined out program and hope you get the opportunity to meet them soon.

of virtual and distance learning, Harding remains committed to on-campus and in-classroom instruction. Doing so has been a challenge, but we prepared all summer with plans for social distancing rules and masking regulations, as well as physical space and classroom modifications necessary to facilitate our students’ return to campus. And, thus far, it has worked! Not only are we physically together for teaching and learning, but our students have also safely resumed patient care simulations, group work, professional organization meetings, and other social activities that we feel are so important in supporting the overall health and wellbeing of our students.

By far, the most exciting news that I have to share concerns a recent curricular revision that reshapes the structure and duration of our program. Following a recent faculty vote and final approval by the University and our accreditor, we will roll out a revised 3 ½ year curriculum this next year!

Beginning Summer 2021, this student-centered, enhanced curricular plan will optimize students’ time and investment while preparing them for contemporary pharmacy practice and graduation in December 2024. That’s right, students will graduate one semester earlier than traditional 4-year Pharm.D. programs. If you know a student interested in pharmacy, we’d love for you to share this exciting news or have them contact us for more information.

In closing, I would like to express our gratitude to all of you who serve as preceptors, mentors, advocates and encouragers to our students. We consider you a part of our HUCOP family, and truly value your support and prayers as we seek to provide a well-rounded education for our students. We simply could not do what we do without you!

One common question that I have received recently is whether or not our students are “on” campus. The answer is yes!

While many colleges and schools have chosen various forms

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That’s a bit about what’s going on at Harding University College of Pharmacy. If you have any questions or interest in our program, please visit us at www.harding.edu/pharmacy or give us a call at 501-279-5528. §

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ARKANSAS ACADEMY OF HEALTH-SYSTEM PHARMACISTS

Kim Young, PharmD AAHP President

In the last issue, I mentioned that AAHP is offering monthly LIVE ACPE accredited CE to its members through mid-day live webinars. In August Kate Callaway, PharmD Candidate (UAMS P4 Student), presented a CE titled Giving COVID our Best SHOT. The information presented was very informative and extremely timely in our current practice setting. I have asked her to share highlights from the presentation.

Giving COVID Our Best Shot

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OVID-19 has taken the world by surprise during 2020.

Devastation and confusion have swept across our country. There have been more than 289,000 deaths in America alone as of December 9th and over 15 million confirmed cases. This virus has had significant economic, public health, and political impacts as well as influences on the way we live our daily lives. Treatment options for this unique disease are limited and sporadic, changing rapidly with ongoing research.

are also in development. As of the beginning of September, there were nine phase three, fourteen phase II, twenty-four phase 1, and ninety-one pre-clinical candidate vaccines in development worldwide. Some are reported to be available as soon as October and many are projected to be large-scale manufactured by January of 2021, a goal of Operation Warp Speed funded by the US Congress and the CARES Act. The phase III vaccine AZD1222, developed by AstraZeneca, is an adenovirus vaccine expected to be ready for manufacturing

by October of this year. In this vaccine, a COVID spike protein has been attached to a weakened version of the The search for a cure related to COVID-19 is consistent with the historic approach to pandemics. In the past, vaccines common cold in order to elicit an immune response upon have played an integral role in combatting virulent diseases. subsequent exposure. Ad5-nCOV developed by CanSino The consequences of polio, measles, and the influenza Biologics is another DNA vaccine that works similarly; its have been largely mitigated over time due to vaccination data is suggestive of a single dose with a booster shot for the development. There have been elderly population. Safety profiles no US-originated polio cases for the phase III vaccinations have Recommendations regarding since 1979, and measles was been relatively benign, mostly declared eradicated in the US in including local reactions and mild COVID-19 are constantly changing 2000 (although a resurgence has systemic effects such as fever, due to research developments. headache and malaise. Recent occurred due to the anti-vaccination information suggests that many movement).

Although there have been many of the vaccinations will have coldsporadic suggestions for this unique Vaccine types can be broadly storage requirements. broken down into live-attenuated, virus, vaccines remain a staple in inactivated, and recombinant.

Recommendations regarding healthcare for prevention efforts.

Technological advancement has COVID-19 are constantly changing led to the investigation of nucleic due to research developments. acid vaccines. Currently, there are Although there have been many no FDA-approved vaccinations of this type. However, there sporadic suggestions for this unique virus, vaccines remain are several candidates in trial for various disease states, a staple in healthcare for prevention efforts. The search including SARS-CoV, Zika virus, and COVID-19. Specifically, continues for a safe and effective option for COVID-19. ยง mRNA and DNA vaccines integrate genetic information from the pathogen of interest into either a plasmid or mRNA strand RAPS 2020; COVID-19 Vaccine Tracker CDC 2018; Vaccines & Preventable Diseases to replicate; once delivered into the body, host cells produce CDC 2019; Global Immunization proteins that mimic a viral infection, creating an immune CDC 2018; Measles (Rubeola) response.

WHO 2015; Measles Glob Pediatr Health 2019; doi: 1177/2333794X19862949 Nucleic acid vaccines are prominent among the search Nat Rev Genet 2015; 9(10): 776-788 for a COVID-19 vaccine. The types being investigated are diverse including recombinant, inactivated, and protein, NIH 2019; Vaccine Types plant and measles based. Oral and intranasal dosage forms

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12/28/20 7:23 PM

COMPOUNDING ACADEMY REPORT

Brooks Rogers, Pharm.D. Compounding Academy President

Proud to be an Arkansas Pharmacist

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eflecting on the past few weeks and all that the pharmacy profession has endured is remarkable. Technically this section should be compounding-related, but I feel the need to give Arkansas Pharmacy a shout out. As I write this, we are in a waiting period to hear the results of the Rutledge vs. PCMA case that was heard before the United States Supreme Court on Tuesday, October 6th. (UPDATE: We won!)

The core issue being argued is whether states have the authority to regulate essential aspects of drug pricing or does federal law (specifically the Employee Retirement Income Security Act) preempt state law. The Supreme Court’s decision will hopefully bring some consistency to an otherwise broad ERISA law. By the time this issue is published, we may or may not know the outcome of the Rutledge vs. PCMA case. The decision does not have to be released until June 2021 at the latest. You can’t rush a good thing, right?

(twice), read and watched all of the post-event discussions, and my immediate thought was ‘we have a chance.’ After watching the pre-events, listening to the case discussions, and watching the post-events, I am still beaming with pride for our State and for our industry.

As pharmacists, we put the patient first in everything we do, even if it means missing something that could directly impact our future. I want to thank the APA staff and its members for working tirelessly on this case. It has been a long road to get to this point, but we got there. No matter the outcome, there is still work to be done. We are slowly but surely pulling back the Rx curtain and I can’t wait to see what’s behind it. When I look back on the past few weeks, I feel the need to borrow a quote from Razorback football head coach, Sam Pittman.

“We’re a proud damn state” and I couldn’t be prouder to be an Arkansas Pharmacist. §

Confession: I did not get to listen to the oral arguments live.

As a pharmacy junkie, this really pained me. I liken this to a die-hard Razorback fan not being able to watch the Hogs play in the SEC championship, for instance. And just as if the Razorbacks were to play in the SEC championship game, it would be a long and grueling road to get there. But once you’re there, anything can happen! That’s how I feel about this case.

It has taken years, with many peaks and valleys. But now that we are there, we have a chance. As much as I would have loved to listen live to the oral arguments, I had a flu vaccine clinic in Little Rock to attend to. Our patients come before all else. This is what pharmacists do. I’m sure many of you were in the same boat. I’m sure many of you were even facing the issues that Rutledge vs. PCMA addresses at your own stores at the same time the case was being argued. A huge decision was being debated in front of the United States Supreme Court that could have implications on our careers but patient care trumps all of that. I wanted to listen to it live more than anyone, but our job as pharmacists is patient care.

No matter the timing, the patient comes first.

That being said, when I got home that night, I was like a kid on Christmas morning. I listened to the arguments

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Arkansas Pharmacy Phoenix Movement www.arrxphoenix.com

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

The APA Building Committee is hard at work and will soon share more information about the APA campus. Until then, we have set up an initial opportunity for anyone who would like to make a donation to the Arkansas Pharmacy Phoenix Fund – a reserve created to prepare for the inevitable construction costs of the building repairs.

Our hope is that this fire is remembered not for the destruction of the APA office but as a spark that reenergized and reinvigorated our organization and ushered in a new era for the Arkansas Pharmacists Association.

Now is the opportunity for APA to rise from the literal ashes to become a stronger, more influential and more robust organization for all of Arkansas’s pharmacists. Please consider making a donation to the future home of the Arkansas Pharmacist Association!

Project SOS

www.arrx.org/project-sos Grants for uninsured patients and those financially harmed by the COVID-19 pandemic

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he Arkansas Pharmacy Foundation in collaboration with the Arkansas Pharmacist Association and an anonymous donor from the Fort Smith area want to help Arkansans who have been affected by the COVID-19 Pandemic and can no longer afford their medications.

Project SOS will assist the underserved areas of the community who have been harmed by the COVID-19 pandemic (e.g. lost job/insurance due to COVID-19 pandemic). Pharmacies can apply for “mini grants” of $1,000 to $5,000 to assist patients/families with the costs of pharmacy services identified at your discretion.

Patients must be residents of one of the following Arkansas counties: Crawford, Franklin, Johnson, Logan, Montgomery, Polk, Pope, Sebastian, Scott, Yell Timeline - All funds will be used between January 1, 2021 and December 31, 2021 Visit www.arrx.org/project-sos for more information or to apply for one of these mini-grants.

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THE ARKANSAS PHARMACIST

12/28/20 7:23 PM

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