FALL 2 017 Award-Winning Quarterly Publication of the Arkansas Pharmacists Association
STATE LAW CHANGES ALLOW PHARMACISTS TO PROVIDE A
LIFELINE
2017 LEGISLATURE UPDATES PHARMACY PRACTICE ACT
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APA Staff Scott Pace, Pharm.D., J.D. Executive Vice President and CEO Scott@arrx.org
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John Vinson, Pharm.D. Vice President of Practice Innovation John@arrx.org Jordan Foster Director of Communications Jordan@arrx.org Susannah Fuquay Director of Membership & Meetings Susannah@arrx.org Elisabeth Mathews, Pharm.D. Executive Fellow Elisabeth@arrx.org Celeste Reid Director of Administrative Services Celeste@arrx.org Debra Wolfe Director of Government Affairs Debra@arrx.org Office E-mail Address Support@arrx.org Publisher: Scott Pace Editor: Jordan Foster Design: Gwen Canfield - Creative Instinct Arkansas Pharmacists Association 417 South Victory Street 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 81. © 2016 Arkansas Pharmacists Association.
POSTMASTER: Send address changes to AR•Rx The Arkansas Pharmacist 417 South Victory Little Rock, AR 72201 Opinions and statements made by contributors, cartoonists or columnists do not necessarily reflect the attitude of the Association, nor is it responsible for them. All advertisements placed in this publication are subject to the approval of the APA Executive Committee. Visit us on the web at www.arrx.org.
CONTENTS 4 Inside APA: Arkansas’s Congressional
Delegation is All In for Provider Status
5 From the President: A Thoughtful Act
to Create Order
7 Member Spotlight: Debbie Mack,
Senior Director of U.S. Ethics & Compliance - Walmart, Bentonville
8 FEATURE: State Law Changes Allow
Pharmacists to Provide A Lifeline
12 Legislator Profile: Representative
Jeff Wardlaw
13 Safety Nets: Don’t Let Lack of
Familiarity Cause Danger for Patients
15 New Drugs: FDA Hits Their Stride 16 FEATURE: 2017 Brings Changes to
Arkansas Pharmacy Practice Act
18 UAMS: Observations from Academia 20 Harding University: 2017: A Time of
Self-Study
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23 AAHP: Fall Seminar Recap 24 AAHP 2017 Fall Seminar 26 Staff Spotlight: Elisabeth Mathews,
Executive Fellow
28 Compounding Academy Report:
Best Practices for Marketing
29 2017 APA Regional Meetings 35 USPS Statement of Ownership ADVERTISERS 4 Pharmacists Mutual 6 Retail Designs, Incorporated 6 Arkansas Pharmacy Support Group 11 Pace Alliance 14 Wright, Lindsey, Jennings 17 Law Offices of Darren O'Quinn 19 UAMS College of Pharmacy 21 Smith Drug Company 22 Pharmacy Quality Commitment 27 EPIC Pharmacies Back Cover: Pharmacy Partners of America / Compliant Pharmacy Alliance
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APA Board of Directors
INSIDE APA
2017 - 2018 Officers President - Lynn Crouse, Pharm.D., Lake Village President-Elect – Stephen Carroll, Pharm.D., Benton Vice President – Dean Watts, P.D., DeWitt Past President – Eddie Glover, P.D., Conway
Regional Representatives Region 1 Representatives - Dylan Jones, Pharm.D., Fayetteville - Spencer Mabry, Pharm.D., Berryville - Lacey Parker, Pharm.D., Centerton Region 2 Representatives - Max Caldwell, P.D., Wynne - Darla York, P.D., Salem Region 3 Representatives - Brandon Achor, Pharm.D., Sherwood - Clint Boone, Pharm.D., Little Rock - Lanita White, Pharm.D., Little Rock Region 4 Representatives - Betsy Tuberville, Pharm.D., Camden Region 5 Representatives - James Bethea, Pharm.D., Stuttgart At Large Representatives - Amber Bynum, Pharm.D., Little Rock - Yanci Walker, Pharm.D., Russellville Academy of Compounding Pharmacists Becca Mitchell, Pharm.D., Greenbrier Arkansas Association of Health-System Pharmacists Brandy Owen, Pharm.D., Conway
Ex-Officio APA Executive Vice President & CEO Scott Pace, Pharm.D., J.D., Little Rock Board of Health Member Gary Bass, Pharm.D., Little Rock AR State Board of Pharmacy Representative John Kirtley, Pharm.D., Little Rock UAMS College of Pharmacy Representative (Dean) Keith Olsen, Pharm.D., Little Rock Harding College of Pharmacy Representative (Dean) Jeff Mercer, Pharm.D., Searcy Legal Counsel Harold Simpson, J.D., Little Rock Treasurer Richard Hanry, P.D., El Dorado UAMS COP Student Meghan Petersen Harding COP Student Chithien Le 4
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Scott Pace, Pharm.D., J.D. Executive Vice President & CEO
Arkansas’s Congressional Delegation is All In for Provider Status
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ongressman Rick Crawford (R – Arkansas’s 1st Congressional District) signed on as a cosponsor to HR592 – The Pharmacy and Medically Underserved Area Enhancement Act. HR592, also called the “Pharmacist Provider Status Bill,” would recognize pharmacists as healthcare providers in the Social Security Act, which would allow pharmacists to bill the Medicare Part B program for outpatient services provided by pharmacists, such as services that help patients manage their chronic diseases, which typically involve the patient being on large quantities of prescription medications. Congressman Crawford joins Congressman French Hill, Congressman Steve Womack, and Congressman Bruce Westerman as a co-sponsor on HR592. Arkansas’s Congressmen join 211 of their colleagues from around the country, from both political parties as co-sponsors of this important piece of legislation. Both of Arkansas’s Senators, Sen. John Boozman and Sen. Tom Cotton are cosponsors of S109, the senate companion version of HR592. Sens. Boozman and Cotton join 45 of their Senate colleagues as co-sponsors of the Senate bill. The forward momentum that has been made over the past three sessions of the U.S. Congress is amazing, and with the addition of Congressman Crawford as a co-sponsor of HR592 all of Arkansas’s congressional delegation are now cosponsors of pharmacist provider status. A big thank you to every pharmacist and student pharmacist who have contacted their member of congress advocating for this important change. Our collective voices helped bring our members of congress on board. Creating appropriate financial incentives for optimal patient outcomes will result in better care and a more efficient healthcare system.
Arkansas’s Congressional Delegation is also in strong support of HR1038 & S413 the “Improving Transparency and Accuracy in Medicare Part D Spending Act.” These bills would prohibit plan sponsors and pharmacy benefits managers (PBMs) from retroactively reducing payment on clean claims submitted by pharmacists under Medicare Part D (i.e. it would ban retroactive direct indirect remuneration fees [DIR fees]).
The forward momentum that has been made over the past three sessions of the U.S. Congress is amazing, and with the addition of Congressman Crawford as a co-sponsor of HR592 all of Arkansas’s congressional delegation are now co-sponsors of pharmacist provider status. If passed, these bills would require point of sale reporting of any DIR fees for Part D plans thereby increasing transparency in drug pricing, lowering costs for taxpayers and addressing the concerns of the Centers for Medicare and Medicaid Services (CMS) regarding the “variations in the treatment of costs and price concessions (that) affect beneficiary cost sharing.” Congressman Crawford, Westerman and Womack are all co-sponsors of the House legislation and both Senators Boozman and Cotton are co-sponsors of the Senate version. §
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FROM THE PRESIDENT
A Thoughtful Act to Create Order
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egional meetings are a distant but fond memory at this point. I cannot say I miss the Arkansas heat and the short tempers it elucidates. I do not feel, or really remember, the fatigue and nervousness of the travel schedule. As Fall moves into full swing, I only treasure the meeting of new friends and seeing old friends and classmates. It’s always a great feeling seeing old friends again. I am impressed with the diligent work in the various pharmacy practice settings all over our state. I see and feel the anxious anticipation of each pharmacist as we look towards challenges on our horizon. Many solutions and viewpoints to these challenges have been expressed. In all actuality, the answer may be staring pharmacy directly in the face and has been for quite some time.
than just dilating or constricting Lynn Crouse, Pharm.D. a vessel. It may also be inhibiting President the adequate or timely release of a hormone, leading to osteoporosis, thyroid imbalances, or insulin resistance. The examples of this application are varied and numerous. Most of the time, a pharmaceutical is feeding or fast forwarding a pathway or system to work at a level when otherwise it would not; and, in the process, consume or steal much needed requirements from other pathways or systems. No wonder many of our patients complain about taking a drug because they are taking a drug.
With our expertise, we can and do As I have stated in the previous issue, influence a pathway to perform we must take the very best possible optimally without a depletion in some Our patients are looking to us to other system or pathway in the body. care of each patient. We must be focus not just on the drugs for willing to meet or even exceed their To me, that is promotion of health. their disease-state condition but Almost every drug we dispense wants and needs that may require more importantly, how to be a carries this likelihood of nutritional our expertise. Pharmacists are still person possessing health. depletion and we should facilitate in a very unique position for their what our bodies were originally patients. Our patients are looking designed to do...heal itself. The to us to focus not just on the drugs for their disease-state condition but more importantly, how promotion of health is nothing more than a THOUGHTFUL act to create order. to be a person possessing health. The state of Arkansas expects us to know pharmaceutical drugs and how they are Exploring and familiarizing ourselves with this train of thought utilized to manage disease. As pharmacists, we know our will preserve and strengthen our practice settings. We have knowledge of these drugs or chemical compounds is fostered always been great problem solvers. Reacquaint yourself with in our understanding of the various biochemical pathways, how or why the medication you dispense may prevent overall cycles, or systems each of them affect and how. Armed with health in your patient. Many Arkansans are looking for ways our knowledge and current accessibility, we are uniquely to stay off prescription drugs. They want to avoid diabetes, positioned to endear our capabilities to the overall healthcare cardiovascular disease, osteoporosis, etc. They want a good team, our communities and our patients. sleep at night without addiction potential or relief from painful neuropathies without addictive painkillers. These people are A person does not go from nothing to dyslipidemia, insulin resistance, osteoporosis, cardiovascular disease, etc...in seeking willing providers of health that possess a strong an instant. These conditions start long before diagnostic knowledge base and are accessible. We fit that role and that procedures set a course of action. Supporting a person role fits pharmacy. through a targeted nutritional supplementation plan and a So, as Fall cools into Winter, the challenges of 2018 will be focused, sound dietary plan can and does prevent and reverse many abnormalities that can lead a patient into a disease upon us. The accessibility realities of lower reimbursement state. Also, if you have not heard, people want it. and narrower networks will be clear and the frenetic pace of adversity and adaptation to the PBM model of healthcare will Aside from our knowledge base and accessibility, our continue. The ancillary services you adopt and provide in your greatest segue into this theater of practice is our grasp and practice setting today will have greater value in the future. As reimbursement for Pharma's products deteriorate maybe our understanding of drug-induced depletions of necessary patients will value greater our expertise in providing avenues vitamins and nutrients that can gradually lead our patients into further anomalies requiring more prescription drugs and of health and preventing pharmaceutical drug therapies. diminishing health. One of our first lessons in pharmacy school Pharmacists must endeavor to look deeper into the patient’s overall status to determine the best course to attain health. § is that when considering a drug always remember there is no magic bullet. So, yes, when someone takes a medication it really does more than the indication. It is in reality doing more
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MEMBER SPOTLIGHT
Debbie Mack, RPh, CHC, CCEP Senior Director of U.S. Ethics & Compliance Walmart - Bentonville
Pharmacy school: University of Texas at Austin. Hook ‘em
Horns!
What is your favorite part of the job and why?
I love being a retail pharmacist – taking care of patients at the pharmacy and ensuring that their healthcare needs are met gives me tremendous personal, and professional satisfaction. When the opportunity arose to take on additional responsibility at the corporate office, I experienced ways to impact patient care in a different way. In my current role, I have the ability to influence quality patient care across the country, which I really enjoy.
What is your least favorite part of job and why?
As part of their professional and corresponding responsibility, pharmacists are required to provide not only excellent care, but also to determine the validity of every prescription that comes in the pharmacy. This has become more complex and I believe this leads to increased pressure for pharmacists as they use their professional judgment. Sometimes I have to support pharmacists with these tough judgment calls and I empathize because I know how much stress those pharmacists are experiencing.
What do you think will be the biggest challenges for pharmacists in the next 5 years?
I am excited to see how we are able to expand the pharmacists’ role in order to provide better access to healthcare services for our patients. With a greater focus on online shopping, we have the luxury of keeping our patients in our pharmacies due to our service industry. We can expand service, provide access and improve healthcare right in our pharmacies. I know it will be challenging to balance the time to provide those additional services, but just consider the positive outcomes we will see in the US as we continue to expand pharmacists’ services and continue to provide world-class healthcare. WWW.ARRX.ORG
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Name one unique responsibility you have in your current role.
The most unique responsibility I have is to build a relationship for Walmart Pharmacy with 17 State Boards of Pharmacy. Through my role, I am able to provide guidance and speak to pharmacists all over the country to share best practices and help expand pharmacist services. I am proud to share with the Boards of Pharmacy how professional our pharmacists are and how committed our pharmacists are to their patients. In addition, I am engaged with changes in the industry, while helping ensure that Walmart implements these changes safely and effectively. Our pharmacies help support the mission of our company…”to save people money so they can live better.”
Fun activities and hobbies
With two sons, we spent all of our free time watching the boys play baseball with my husband as their coach. The remainder of our free time was spent hunting and relaxing as a family at our ranch in Texas. I really enjoy hiking and riding bikes on all the beautiful trails here in Northwest Arkansas, but my favorite thing in the world is spending time with my four precious grandchildren.
If not a pharmacist, then…
My dad owned a pharmacy when I was growing up, so I knew at a very young age that I was going to be a pharmacist. I worked at the soda fountain and as soon as I learned to drive, I was out delivering prescriptions. I was amazed at how respected my dad was in our community and how he took such great care of all of his patients. I can’t imagine being anything other than a pharmacist! §
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State Law Changes Allow Pharmacists to Provide A
LIFELINE By Jordan Foster
Brooks Rogers of Don's Pharmacy in Little Rock reviews Narcan (naloxone HCI) with a patient.
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s the healthcare community knows, Arkansas stands in the grips of one of the worst epidemics in the state’s history. An epidemic of such grand proportions that, along with Alabama, our state leads the nation in the amount of opioid prescriptions prescribed per person. However, ask any patient that’s taken opioids long term if there should be concern about the deadly rise of abuse and a common thread of “everyone else but me” arises - as in, this is an issue that affects other people, not me - a sentiment that echoes the “I can quit anytime I want” idea that people struggling with substance abuse often cling to in denial. The bitter pill of truth is this: Arkansans are becoming dependent on short term solutions for long term relief with sometimes fatal results.
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As part of the pharmacy community, we know that opioids have a purpose. However, we also know the dangers that these powerful medications pose when taken incorrectly. Fortunately, thanks to the work of APA and the state legislature, pharmacists in Arkansas now have the power to fight back against an epidemic that’s already taken too many lives.
Act 284
Each state’s legislature grants medical professionals the right to practice their profession in the state. They establish governing boards to oversee the professions and they define the scope of practice that each provider possesses once they have been granted a license. Because scope of practice is determined by the legislature, it can only be changed by
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STATE LAW CHANGES ALLOW PHARMACISTS TO PROVIDE A LIFELINE
the legislature and changes can sometimes be political and heated. Armed with CDC statistics and reports about opioid abuse throughout the country, APA’s CEO Scott Pace and Director of Government Relations Debra Wolfe looked to the 2017 Arkansas legislature as the perfect opportunity to transform the national opioid dialogue into local action. They engaged with senators and representatives and showed that pharmacists were ready to step up to the front line as medication experts and help to mitigate some of the potential dangers of opioid abuse.
2016 Opioid Prescription Rate Per 100 Persons3
“There’s a reason pharmacists are consistently named one of the most trusted professions in America – we council, we advocate, we share our knowledge and education to protect our patients,” Pace said. “As members of the healthcare team, we have to be proactive when there are dangers threatening the safety of not just our patients, but our neighbors, our friends, and our families. Being able to utilize all the tools and strategies at our disposal should be a priority to fight back against this deadly epidemic.” APA teamed up with Senators Cecile Bledsoe and Lance Eads and Representative Justin Boyd to craft legislation that would provide pharmacists in Arkansas with a strategy to combat the abuse that many have seen creep into their communities. Modeled after states with similar legislation, the final solution was a change to the Arkansas Pharmacy Practice Act allowing the licensed pharmacists in Arkansas to order, dispense and/or administer naloxone without a prescription, thereby allowing patients that struggle with opioid addiction easier access to a lifeline at their local pharmacy. The new availability of the lifesaving drug also provided a fringe benefit to pharmacists: being able to prescribe naloxone to patients at-risk of an overdose provided a crack in the door for what can sometimes be a tough dialogue between pharmacist and patient about understanding the dangers of long-term opioid use and re-evaluating the patient’s need for high doses. After debate in the House and Senate, the bill crossed the governor’s desk where he signed it into law, becoming Act 284 and allowing pharmacists to prescribe naloxone, through a statewide standing protocol, to patients, family members, first responders, police officers, and school nurses. “The effects of opioid addiction – on individuals, families, and our state – are staggering,” said Governor Asa Hutchinson. “Reports of drug-related injuries and deaths across the nation are increasing, and sadly, we’ve seen the tragic effects of this epidemic on the communities in our state, as well. The Naloxone Standing Protocol is just one step Arkansas is taking to fight back by allowing easier access to this lifesaving medication and helping to reduce the number of lives lost to opioid abuse. There is no doubt that putting Naloxone in the hands of more Arkansans, including our first responders, will save lives.”
< 57.2 57.2 - 82.3 82.4 - 112.5 > 112.5
Thanks to the work of APA and the state legislature, pharmacists in Arkansas now have the power to fight back against an epidemic that's already taken too many lives.
Moving Forward
The ability of pharmacists to provide Naloxone therapy comes at a time when the opioid abuse epidemic has it the nation hardest. According to the CDC’s website, “the majority of drug overdose deaths (more than six out of ten) involve an opioid. Since 1999, the number of overdose deaths involving opioids quadrupled. From 2000 to 2015 more than half a million people died from drug overdoses. An average of 91 Americans die every day from an opioid overdose.”1 In addition, the CDC released statistics revealing that, although the national average opioid prescription rate sits at 66.5 prescriptions per 100 people, the rate in Arkansas is much steeper at 114.6 prescriptions per 100 people, making Arkansas the state with the second highest opioid prescription rate in the country.2 These staggering numbers led the CDC to implement new guidelines for prescribers. The recommendations included initially opting for non-opioid therapy, starting low and going slow if opioids are prescribed, avoiding combinations of opioids and anti-anxiety medication, and randomly screening patients for other prescribed drugs that could have dangerous interactions. In addition, the CDC recommended offering a prescription for naloxone to patients taking opioids. (Continued)
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STATE LAW CHANGES ALLOW PHARMACISTS TO PROVIDE A LIFELINE
As opioid abuse swells across the country, here in Arkansas pharmacists have been fighting back every way they can. However, advising patients that have been using opioids for months or even years can sometimes fall on deaf ears, especially when the patients falsely feel they have control over the situation. Now, with changes to the Arkansas Pharmacy Practice Act and the approval of the State Medical Board and the State Board of Pharmacy, Arkansas pharmacists can continue to protect their patients by saving the lives of those who struggle with addiction. § 1 www.cdc.gov/drugoverdose/epidemic/index.html 2 3
www.cdc.gov/drugoverdose/maps/rxstate2016.html www.cdc.gov/drugoverdose/maps/rxcounty2016.html
Member Classifieds
After debate in the House and Senate, the bill crossed the governor’s desk where he signed it into law, becoming Act 284 and allowing pharmacists to prescribe naloxone, through a statewide standing protocol, to patients, family members, first responders, police officers, and school nurses.
Member Classifieds are free to APA members and $65 per issue for nonmembers. Contact communications@arrx.org for more information.
Relief Pharmacist available, 37 years experience. I am currently available for part-time relief work. I work a few days a month at Health South Rehab Hospital in Fort Smith. I have been a pharmacist 37 years. I have experience in retail and hospital work. I am familiar with several computer systems. I live between Clarksville and Russellville. I will also consider full-time employment if there is any available. Please call 479-774-3239. Terry Bowen P.D. Shelves and Counters For Sale: I have relocated my pharmacy and have the used pharmacy shelves and counter for sale. You can contact me at rosedrugdardanelle@ Hotmail.com if you are interested.
Relief Pharmacist available. Many years experience. Proficient in ComputerRx, Pioneer, and Liberty software with some exposure to QS1. Call 501-231-1130. LEED Certified Pharmacy Fixtures and Shelving for Sale. Less than seven years old and in excellent condition. LEED Certified and hand crafted from maple wood. Made in the USA, in Eugene, Oregon. All shelving and counter tops to be sold as one unit, together, in a one time sale for $37,500. Originalapproximate retail value was $80,000. Contact caritablack@yahoo.com for inquiries.
AAHP Board
Arkansas State Board of Pharmacy
Executive Director............Susan Newton, Pharm.D., Russellville
President.......................................Tom Warmack, P.D., Sheridan
President................................Brandy Owen, Pharm.D., Conway
Vice President/Secretary..................Steve Bryant, P.D., Batesville
President-Elect.....................David Fortner, Pharm.D., Sherwood
Member..........................................Debbie Mack, P.D., Bentonville
Past President...................Kendrea Jones, Pharm.D., Little Rock
Member...................................Lenora Newsome, P.D., Smackover
Treasurer...........................Kendrea Jones, Pharm.D., Little Rock
Member...........................Rebecca Mitchell, Pharm.D., Greenbrier
Secretary..................................Melissa Shipp, Pharm.D., Searcy
Member....................................Ken Lancaster, P.D., Arkadelphia
Member-at-Large........Erin Beth Hays, Pharm.D., Pleasant Plains
Public Member........................................Carol Rader, Fort Smith
Member-at-Large.....................Joy Brock, Pharm.D., Little Rock
Public Member............................................Amy Fore, Fort Smith
Technician Representative.....Holly Katayama, CPhT, Little Rock
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LEGISLATOR PROFILE
Representative Jeff Wardlaw WARREN
District: 8 Represents (Counties): all of Bradley, parts of Ashley, Calhoun, Cleveland, Dallas, and Drew
Years in Office: Four terms, seven years to date Occupation: Farmer What do you like most about being a legislator: The most
gratifying aspect of being a legislator is getting to help the people in my district and across the state. Connecting people to the resources they need makes my job worthwhile.
What do you like least about being a legislator: Partisan
politics. I wish people could engage in civil discourse and help one another more without regard to political affiliation.
behind the scenes and under the radar. One of the greatest legislators I worked with showed up every day and worked diligently for his district. He went about his business quietly and effectively and he knew more about state government than almost anyone else.
Advice for pharmacists about the political process and working with the AR Legislature: Have a voice and contact your legislators daily to let them know issues important to them. Come with solutions.
Toughest issue of the session: Prescription Drug Monitoring bill
Hobbies: Father to 3 great kids (Mason, Reed, and Paisleigh), hunting, and working in my church. ยง
Most important lesson learned as a legislator: I've
learned the importance of spending time and energy building relationships with directors of state agencies and colleagues to further the business of our state.
Most admired politician: The men and women I have
admired most in my political career have been those working
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UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY
Melanie Reinhardt, Pharm.D. Eddie Dunn, Pharm.D.
Don’t Let Lack of Familiarity Cause Danger for Patients This issue of Safety Nets once again examines the potential hazards associated with electronic prescriptions. Thank you for your continued support of this column.
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prescriber transmitted the electronic prescription (Figure One) to a pharmacy in Southeast Arkansas. A pharmacy technician entered the Atripla® ((600 mg efavirenz, 200 mg emtricitabine, 300 mg tenofovir) patient directions into the pharmacy computer as "take three tablets on an empty stomach three times a day." This information - along with the prescription image - was transmitted from the input queue to the pharmacist verification queue of the computer. After the pharmacist verified the prescription information was correct as transmitted, the order was filled by a technician and placed in line for final verification and patient counseling. During the counseling session, the pharmacist informed the patient they were to take three Atripla® tablets three times daily. The surprised patient replied "I've been taking one daily for months. Are you sure? Did the doctor increase my dose?" After reexamining the prescription, the pharmacist telephoned the prescriber for clarification. A nurse responded the patient was to take one tablet daily - not nine tablets daily. After affixing a corrected prescription label to the vial, the patient thanked the pharmacist for clarifying the discrepancy. Figure 1
If this medication error had not been detected during patient counseling, it is entirely possible the patient - who asked during counseling "Did the doctor increase my dose?" could have started taking a nine-fold Atripla overdose daily. This could have resulted in severe problems including psychomotor disturbances, lactic acidosis, renal toxicity, and acute renal failure. Fortunately for this patient, the potential overdose was detected by the pharmacist during counseling. This case illustrates the potential hazards associated with medications indicated for treatment of human immunodeficiency virus (HIV) infection. Studies have suggested that some errors associated with these medications are caused, at least in part, by pharmacists' lack of familiarity with antiretroviral medications. This is understandable since some pharmacists rarely receive prescriptions for this medication class. In spite of this knowledge deficit, the
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pharmacist in this case was still able to prevent this error from reaching the patient through patient counseling. This remains our last - and best - safety net to protect our patients. § STUDENT SPOTLIGHT
OTC Medications - Ashley Ragland Every day our patients ask, “What can I take for *insert sign/ symptom here*?” As an intern working in a community pharmacy, I frequently encounter patients who ask a variety of questions about OTC medications. Usually, I can answer these questions (with my preceptor's guidance) quickly and efficiently. From time to time however, a patient will ask me a question I have no idea how to answer. Recently, several patients have inquired about Berberine. At first, I had never heard of the product neither had my preceptor. The second time a patient asked for the product, I knew we had the product in stock, but still didn't know anything about its purpose, mechanism of action, etc. When a third patient asked for Berberine, I knew it was time to learn about the product so I could better help these patients. [Note: Berberine is a plant product touted for treatment of hyperglycemia and hyperlipidemia.] It is important for pharmacists and student pharmacists to stay abreast of OTC medications, their ingredients, and indications. This is true for frequently requested products (i.e. analgesics, antipyretics, laxatives, etc.) as well as less familiar products such as Berberine. Patients consider us THE medication experts. To them, that means ALL medications. It is so important for us to be knowledgeable about as many medications as possible - both prescriptions and OTC. There are many resources available to help keep our knowledge upto-date. The more we are informed, the more credible we become, the more patients will count on us to be THEIR medication expert. It's a win-win for all.
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FDA Hits Their Stride By guest author Randy Dumornay, P4 PharmD Candidate - Harding University College of Pharmacy This column, presented by the Harding University College of Pharmacy, aims to briefly highlight information on new molecular or biological entities, new indications, or significant new dosage forms recently approved by the FDA.
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his past quarter, the FDA approved 21 new drugs or biologics and several new dosage forms. Interestingly, accelerated approvals continue despite results from a recent study that only half the sponsors completed required postapproval confirmatory studies a minimum of 3 years after approval, and of these most relied on surrogate measures rather than clinical outcomes.
Oncology: Four oncology agents received fast-track and/
or breakthrough orphan drug status including Aliqopa™ (copanlisib) for follicular lymphoma, Besponsa™ (inotuzumab ozogamicin) for acute lymphoblastic leukemia, Idhifa® (enasidenib) for acute myeloid leukemia in patients with specific gene mutation, as well as Tafinlar® (dabrafenib) and Mekinist® (trametinib) as the first targeted therapies to treat metastatic non-small cell lung cancer with BRAF V600E mutation. Rituxan Hycela™ (rituximab/hyaluronidase) was granted approval for various blood cancers. Nerlynx™ (neratinib) became the first extended-adjuvant therapy approved to reduce the risk of recurrent early-stage HER2-positive breast cancer. Mylotarg™ (gemtuzumab ozogamicin) returned to the market after a 7-year absence for acute myeloid leukemia. And, representing a new frontier with the ability to reprogram a patient’s own cells to attack cancer, Kymriah™ (tisagenlecleucel-T) is the first T-cell ‘living drug’ gene therapy and is used in acute lymphoblastic leukemia.
Infectious Diseases: Benznidazole became the first drug
approved in the U.S. to treat Chagas disease. Baxdela™ (delafloxacin) received priority review for acute bacterial skin infections. Vosevi™ (sofosbuvir/velpatasvir/voxilaprevir) and Mavyret™ (glecaprevir/pibrentasvir) were granted priority breakthrough approval as combination therapies for chronic hepatitis C. Vabomere™ (meropenem/vaborbactam) received priority review to treat complicated UTIs.
approved for on-demand treatment of bleeding episodes and management of perioperative bleeding in patients with hemophilia B. Tremfya™ (guselkumab) is a monoclonal antibody used in moderate-to-severe plaque psoriasis. Endari™ (L-glutamine), an orphan drug, became the first approval for sickle cell disease in almost 20 years. Gleolan® (aminolevulinic acid HCl) is the first fluorescing optical imaging agent approved for use during glioma surgery. New Dosage Forms: Significant new dosage forms approved include: Aristada™ (aripiprazole, 2-month extended-release injection) for schizophrenia; Cyltezo™ (adalimumab-adbm, biosimilar for SQ injection) for multiple chronic inflammatory diseases; Benlysta® (belimumab, SQ self-injection) for systemic lupus erythematosus; Contempla XR-ODT™ (methylphenidate, extended-release orally disintegrating tablet) and Mydayis™ (amphetamine, mixed salts, extendedrelease capsule) for ADHD; Duzallo® (lesinurad/allopurinol, tablet) for gout; Gocovri™ (amantadine, extended-release capsules) for Parkinson’s dyskinesia; Isentress HD™ (raltegravir, tablet) once-daily for HIV; Jadenu® Sprinkle (deferasirox, granules) for chronic iron overload; Myasi™ (bevacizumab-awwb, biosimilar for IV infusion) for multiple types of cancer; Nityr™ (nitisinone, tablet) for hereditary tyrosinemia type 1; Symjepi™ (epinephrine, pre-filled syringe) for emergency treatment of allergic reactions; Triptodur™ (triptorelin, extended release IM) for central precocious puberty; Zerviate™ (cetirizine, ophthalmic) for allergic conjunctivitis; Vyxeos™ (daunorubicin/cytarabine, liposomal) for AML; and Zypitamag™ (pitavastatin, magnesium salt) for hyperlipidemia. §
Other: Haegarda® (C1 estrace inhibitor) received
orphan status in the prevention of hereditary angioedema. Bevyxxa™ (betrixaban) became the first and only anticoagulant for hospital and extended-duration (35-42 days) prophylaxis of venous thromboembolism. Kedrab™ (rabies immune globulin, human) is for passive transient post-exposure prophylaxis against rabies infection. Rebinyn® (Factor IX, glycopegylated) was
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2017 BRINGS CHANGES TO THE
ARKANSAS PHARMACY PRACTICE ACT By Elisabeth Mathews, Pharm.D. APA Executive Fellow
D
uring the 2017 legislative session, APA worked diligently to advocate for pharmacists on multiple issues and came away with some big wins for Arkansas pharmacists, including several significant changes to the Pharmacy Practice Act. These changes to the state law give pharmacists the ability to initiate naloxone therapy, administer medications, provide up to a 30-day supply of medications during an emergency refill, and recognize pharmacists as healthcare providers. With the painful tragedies of the opioid epidemic making headlines all across the country, the naloxone piece of our state law has gotten quite a bit of publicity. The law reads as follows: “Pursuant to a statewide protocol, a pharmacist may initiate therapy and administer or dispense, or both, Naloxone;” This is historic because it is the first time Arkansas state law has given pharmacists the ability to both initiate and dispense a prescription medication using solely their own professional discretion. For more details on the state-wide Naloxone Protocol and how you can start initiating naloxone therapy for your patients, see the cover story on page 8. Previously, the Arkansas Pharmacy Practice Act only allowed pharmacists to administer seven classifications of medications: immunizations, vaccines, allergy medications,
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vitamins, minerals, antihyperglycemics, and antinausea medications. This restriction has been removed and now reads, “Except as limited by rules adopted by the Arkansas State Board of Pharmacy, a pharmacist has the ability to administer medications.” While this law did go into effect on July 31st with all the other laws adopted during the 2017 legislative session, it is not yet legal for pharmacists to administer any type of medication because the Arkansas Board of Pharmacy regulations have not yet been updated. The BOP has proposed updates to this regulation, but they do not anticipate legislative approval until before the end of 2017. So, until this regulation change has been adopted, the Arkansas State Board of Pharmacy does have rules limiting you to only be able to administer the seven classifications of medications listed above. As soon as this regulation update is finalized, you can expect notice in APA’s weekly newsletter, Interactions. Pharmacists have been able to provide emergency refills on prescription medications for quite some time, but the law limited us to providing only a 72-hour supply. This was a challenge for pharmacists in several situations, like on holiday weekends or when the product was packaged in such a way that you could not break it into a 3-day supply. Too often,
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2017 CHANGES TO ARKANSAS PHARMACY PRACTICE ACT
“In the event a pharmacist receives a request for a prescription refill and the pharmacist is unable to obtain refill authorization from the prescriber, the pharmacist may dispense a one-time emergency refill of the prescribed mediation, provided that: 1. The prescription is not for a medicinal drug listed in Schedule II as defined in § 5-64-205; 2. The medication is essential to the maintenance of life or to the continuation of therapy; 3. In the pharmacist’s professional judgement, the interruption of therapy might reasonably produce undesirable health consequences or may cause physical or mental discomfort; 4. The pharmacist properly records the dispensing; and 5. The dispensing pharmacist notifies the prescriber of the emergency dispensing within a reasonable time after the one-time emergency refill dispensing.“
Boyd for the roles they played in sponsoring pharmacy friendly legislation during the 2017 session. §
Changes to the Pharmacy Practice Act weren’t the only thing on APA’s agenda during the 2017 Legislature. After Arkansans approved a medical marijuana bill in the November 2016 election, APA worked to see that the people’s decision was carried out in a way that was medically responsible and as safe as possible. Sponsored by Representative Clint Penzo and Senator Missy Irvin, HB2190 put in place a common-sense requirement that a pharmacist consultant be available via phone or video conferencing to assist patients with potential drug-drug interactions or drug-disease state interactions that may occur with marijuana. Additionally, HB2190 also prevents the sale of marijuana paraphernalia used for combustion in dispensaries. This is to encourage the use of safer methods of ingesting marijuana, such as vaporizers, oils or edibles.
SIDEBAR
pharmacists were put in compromising positions of choosing between doing the right thing for their patient or following the law. The law passed in 2017 allows for a one-time emergency refill and reads as follows:
For the purposes of your pharmacy’s record keeping, create a new one-time prescription to document the emergency refill utilizing the same prescriber from the expired prescription. Note, that for Schedule II drugs there is still a 72-hour limit on emergency prescriptions, and they do still require oral authorization by a prescribing practitioner. Finally, pharmacists are now recognized as healthcare providers in the Arkansas Pharmacy Practice Act. The change reads, “A “licensed pharmacist” shall be considered an individual healthcare provider;” This is significant because when the federal provider status legislation passes, pharmacist services would be reimbursable under Medicare Part B if provided to patients in medically underserved communities as long as the services are consistent with state scope of practice laws. Currently, the federal provider status companion bills (H.R. 592 and S.B. 109) have 215 cosponsors in the House and 45 cosponsors in the Senate. For the first time since the federal provider status bills were introduced, all six congressmen of the Arkansas delegation have signed on as cosponsors. These practice act changes have loosened the reigns a bit, and given Arkansas pharmacists more room to utilize professional judgement in the delivery of patient care. Let’s resolve to use these new opportunities to show the legislature when they give us a greater role to play, we step up and help improve the healthcare of Arkansans all across the state. Special thanks to Senator Cecile Bledsoe, Senator Lance Eads, Representative Clint Penzo, and Representative Justin
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UAMS SCHOOL OF PHARMACY
Observations from Academia
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steady but showed a gradual decline over the past several t seems the pharmacy profession years. A valid question is “How did we get here?” has more opportunities and challenges at this time than I can remember in my 37 years as a The Pharmacy Manpower Project experts anticipated a significant expansion of the pharmacist workforce and licensed pharmacist. These are not limited to, but include shrinking reimbursements, the Affordable Care Act (ACA), a change in services and responsibilities for patient care. direct and indirect remuneration (DIR) fees, pharmacy benefit Most pharmacists would agree the change in services and responsibilities has slowly evolved, perhaps more rapidly in managers (PBMs), specialty pharmacy, 797 application to the hospital/ambulatory care setting, but also in community community pharmacies, medication therapy management pharmacy. The experts estimated that by 2020 there would (MTM), 503 A/B, community pharmacy enhanced service network (CPESN), opioid crisis, and pharmacy manpower. be a 27% decrease in the number of pharmacist full-time Academia is also confronting other issues as we prepare equivalents (FTEs) engaged pre- dominantly in order filling pharmacy graduates for the NAPLEX and entry into (136,400 to 100,000) and an increase in the pharmacist FTEs the workforce as practice ready pharmacists. Colleges providing primary patient services (30,000 to 165,000). Thus, and schools of pharmacy are dealing with evolution in a shift in the content of pharmacy school curricula followed. expectations for pharmacy practice, In 2001, there were 80 pharmacy the new NAPLEX exam format, curricular change to meet new schools with an anticipated The national demand for 7,000 graduates. In 2013, a practice models, change in learning pharmacists has been steady but styles of current students, a smaller paper highlighted the academic showed a gradual decline over the applicant pool, and pharmacy pharmacy expansion and cited a past several years. A valid question manpower issues. growth to 128 pharmacy schools. A recent conversation with the is “How did we get here?” A recent post of a 1995 Pharmacy American Association of Colleges Today headline on the AR of Pharmacy (AACP) indicated Pharmacist Q&A suggested the this number is now at 144 demand for pharmacists was reduced; thus, the number of schools. The majority of growth has been in new colleges of pharmacy often associated with private institutions on nonpharmacy schools should be reduced. In 2001, a conference academic medical center campuses. Concurrent growth in called the Pharmacy Manpower Project brought pharmacy existing colleges also significantly contributed to expansion leaders together to project the types of services pharmacists by increasing class sizes and establishing branch campuses would provide and the manpower needed for the year 2020. Ultimately, this group promoted expansion of the number to house additional students. The dynamics of increasing the of students educated as pharmacists. The landscape of supply of pharmacy graduates into the job market results in a pharmacy manpower is rapidly changing in the United States 4-year lag period from the time at which a PharmD program starts or expands, with an additional 2-3 year equilibration and will require adjustments in academic pharmacy over the coming years. The 2016 Arkansas Graduating Pharmacists adjustment to see the new the graduates’ impact on the salary survey conducted by UAMS and Harding Colleges market. The profession is now in a lag/equilibration period, of Pharmacy demonstrated a continued strong demand for which would be expected to continue as new schools of graduates with rising salaries compared to previous years. pharmacy produce graduates. Additionally, the applicant However, the most recent survey published July 2017 in the pool for admission to pharmacy school has remained flat AR-Rx Journal indicated a slight decrease in the mean salary or slightly decreased over the past several years. There and a reduction in work hours for some graduates. The UAMS are approximately 16,700 individual student applicants for College of Pharmacy closely analyzes the survey, feedback approximately 15,000 slots or about 1.2 individual applicants from Arkansas pharmacists and alumni, and the pharmacy per pharmacy school slot. demand indicator (PDI), a tool (see table 1) that estimates job opportunities for pharmacists across the country. In 2016 The UAMS College of Pharmacy is closely monitoring enrollment, the applicant pool, and pharmacy manpower this tool demonstrated a strong demand for pharmacists needs. The College is balancing the changing pharmacy in Arkansas with a score of 4.0; however, this number has decreased with the most recent data (2nd quarter 2017) to landscape with adjustments to our curriculum, how we train 3.33, contrasted to a national score of 3.11. For comparison, and educate our student-pharmacists, and the financial impact, both internally and externally, that results from Tennessee has a score of 2.75 that is likely representative of pharmacy manpower changes. Always at our forefront the 5 new pharmacy schools compared to just 1 school 15 is what is best for Arkansas pharmacy and our studentyears ago. The national demand for pharmacists has been Keith Olsen Pharm.D., FCCP, FCCM Dean and Professor
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UAMS: OBSERVATIONS FROM ACADEMIA
pharmacists. A healthy demand for graduates, but not excessive demand is the best scenario for all of pharmacy, pharmacists and academia. Pharmacy remains a great profession for pharmacist and student-pharmacists. If you wish to discuss or comment on any parts of this article, please call me at the College (501-686-5558) or email (kolsen@uams.edu). § ________________________________________________________ References 1. Knapp DA. Professionally determined need for pharmacy services in 2020. Am J Pharm Educ. 2002; 66 (Winter):421-429. 2. Brown DL. A Looming joblessness crisis for new pharmacy graduates and the implications it holds for the academy. Am J Pharm Educ.2013; 77 (5) Article 90. 3. National Pharmacist Demand by Practice Setting – July 2017. Pharmacy Workforce Center. American Association of Colleges of Pharmacy. http://www.pharmacymanpower.com/setting.jsp. Accessed October 10, 2017.
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Table 1. The 5-point scale used in the Pharmacy demand indicator. 5 = high demand—difficult to fill open positions 4 = moderate demand—some difficulty filling open positions 3 = demand in balance with supply 2 = demand is less than the pharmacist supply available 1 = demand is much less than the pharmacist supply available
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HARDING UNIVERSITY REPORT
2017: A Time of Self-Study
I
If I had to choose my favorite time of year, I think it would be fall, especially in relation to the Jeff Mercer, Pharm.D. happenings at Harding University Dean College of Pharmacy. The summer is a nice quiet time that allows for focused work and perhaps some relaxation, but nothing feels more exciting than the rush of students returning in the fall.
introduced to Harding through pharmacy camp as juniors or seniors in high school. Harding offers the opportunity for students to pursue their Master in Business Administration degree and graduate with special business training in addition to their pharmacy degree. And of course, Harding offers the opportunity for students to participate in medical missions and other service opportunities that speak to the deeper desires of many students seeking to make a difference in the lives of others.
You may recall me describing 2016 as a year of transition. And, my how it was! I became dean, our executive team It is obvious that I love Harding. It’s easy for me to talk about, was shuffled, and we gained a number of new faculty, and because it’s such a part of who I am. However, I would be of course new students. Everything remiss if I left you thinking that everything we do only happens seemed to be in constant change. Having experienced that, I am within the confines of our campus "So much of what we do depends happy to report that things have or even within the city limits of upon many of you who serve as now settled a bit. Our administrative Searcy. That’s not the case at all. preceptors, mentors, advocates team is full and working well In fact, so much of what we do and encouragers for our students." depends upon many of you who together, and we are near capacity serve as preceptors, mentors, in faculty and staff. advocates and encouragers for our If I had to describe our current atmosphere at the college, students. So many of you contribute in ways that influence it would be a time of self-reflection or self-study. As you our work every day. From student recommendations for may have guessed, that is due in part to our impending admission to preceptors who choose to offer students training in real world settings, we simply could not do it ACPE accreditation visit set for this fall. Faculty, students, preceptors and alumni have all combined to create our selfwithout you. Please know you are appreciated and so very study document in preparation for our site visit on October essential in identifying, training, and even employing the 31, 2017. The entire process has been eye-opening for us pharmacists of tomorrow. all. It’s been a great opportunity to look directly at ourselves and see what we do well, to see what we can improve upon, Well, that’s a quick synopsis of the happenings at Harding and to set our sights on where we want to go. University College of Pharmacy. We love to hear from you! If you have any questions or interest in our program, please contact us at the College and let us know how we can be of Believe it or not, we enrolled our tenth class of student service to you. § pharmacists this year – the class of 2021! They are comprised of 55 students from 13 states and 2 foreign countries. Forty percent are from Arkansas, although nearly 60% previously attended Arkansas universities. They are mostly female (73%) and 24% are underrepresented minorities. Sixteen students are from Harding undergrad, which represents the largest cohort to date. We are really proud of this class. They were hand picked based on more identifying criteria than in any previous year, and I feel confident that we have chosen wisely. As many of you know, the national admissions trends in pharmacy education have changed substantially over the last few years. Students have a lot more choice about where they decide to go to school. They don’t apply to as many places, and they choose schools based on cost, quality, mission, and fit. It’s all the more reason that we need to be certain in who we are and what makes Harding College of Pharmacy unique. Things such as the pharmacy camp that we host each summer – ten of our current students were first
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ARKANSAS ACADEMY OF HEALTH-SYSTEM PHARMACISTS
Fall Seminar Recap
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At various times during the seminar, I received compliments and high praise to the quality of CE that AAHP provides yearly. It was my pleasure to accept those on behalf of our organization, but I quickly and assuredly gave credit where credit is due. This event could not happen without the tireless energies of our Fall Seminar Committee. Led by Kim Young, Amber Powell, and Joy Brock, this group of women worked all year, alongside their subcommittee chairs (Speaker Chair: David Fortner. Exhibitor/Contributor Chair: Stacy Lindsey, Student Session Co-Chairs: Rayanne Story, Ryan Pritchard, Fall season for AAHP means Fall Seminar! We just held our Tiffany Dickey, Poster Session Chair: Neil Roe, Technician 51st annual 2-day, educational extravaganza at the North Chair: Holly Katayama, Silent Auction: HyeJin Son Grant, Little Rock Wyndham Riverfront and AV Chair: Derek Williamson), hotel. This is also one of my to bring us this terrific event. A big favorites because I get to catch thank you to all, as well as the many up with pharmacy classmates other pharmacists, technicians, This year’s seminar, entitled and colleagues from across the residents, and students who Explore, Dream, Discover, state. This year’s seminar, entitled volunteered their time and talents. featured 11 hours of ACPEExplore, Dream, Discover, featured I would also like to thank the other accredited education, a 11 hours of ACPE-accredited members of AAHP Executive education, a silent auction, Board and the APA staff who were silent auction, technician all hands on deck to help us in any technician certification training, a certification training, a poster poster session, separate student and every possible way. Finally, I session, separate student and and resident programming, as want to thank YOU, our wonderful resident programming, as well well as ample time for networking. membership and Fall Seminar attendees. We certainly couldn’t Our keynote speaker was Diane as ample time for networking. continue this endeavor without Ginsburg, PharmD from the COP you. In addition to our mission at The University of Texas at of providing quality pharmacy Austin, and she gave a terrific education and networking address on our professional and personal journeys. If you ever get the opportunity to hear opportunities, this year we added a mission of charity. We this lady lecture, I highly recommend it. Her enthusiasm for asked registrants to consider donating to Hurricane Relief the profession is infectious! Other programming from Fall efforts and AAHP would match dollar for dollar donations Seminar included education on antimicrobial stewardship, up to $1,000. I am pleased to announce $1,318 was raised preceptor tips, controlled drug diversion programs, safe to help fellow Americans recover from these devastating opioid use, 797, CPESN, CV writing, and, of course, the storms. New Drug Update for 2017. If you are a member, you can find links to the presentations on the AAHP page of the APA If you haven’t already, please “friend” us on Facebook, Twitter, website. If you attended Fall Seminar, be looking for emails and Instagram. You’ll be seeing more information about regarding online program evaluations and post-tests. You AAHP and its members in the coming months. Also, consider must complete this to be granted CE credit. joining me and other Arkansas health system pharmacists at the ASHP Midyear 2017 Clinical Meeting and Exhibition held in Orlando, FL from Dec 3-7. Happy Fall Y’all! § Each year of Fall Seminar, we have our Awards Banquet during the lunch break on Friday. In addition to the annual awards given out, this year we were honored to award the Louise Pope Lifetime Achievement Award to Don E. Garner, PD of Baptist Health Systems. Dr. Garner has been instrumental in expanding the role of pharmacy within the largest health system in Arkansas. Please join me in congratulating Don and all our award and poster winners! Be looking for their pictures and bios on our Facebook page. reetings from AAHP! Fall is one of my favorite seasons because it means spending almost every weekend hanging out with friends and family watching college football, enjoying tailgating goodies, and finally (hopefully) cooler weather. Yes, I’m still cheering for my Razorbacks, but it certainly hasn’t been easy. Mostly awkward. And painful. And sad…But I digress. Brandy M. Owen Pharm.D., BCPS President
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AAHP 2017 Fall Seminar
Mark and Brenda Riley
Manager of the Year – Dr. Jen Perry, CHI St Vincent
Clinician of the Year – Dr. Mandy Baker, Arkansas Children’s Hospital
Staff Pharmacist of the Year – Dr. Steve Richards, North Arkansas
New Practitioner of the Year – Dr. Hye Jin Son, Baptist Health Medical Center - Little Rock
Residency Preceptor of the Year – Dr. Christi Smith, UAMS Medical
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Louise Pope Lifetime Achievement Award – Dr. Don E. Garner, Baptist Health Systems
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Keynote Address - Dr. Diane Ginsburg
Dr. Buddy Newton
Student Poster Session
Exhibitors Showcase
Technician of the Year - Russell Dorsey, Baptist Health Medical Center-Little Rock
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Roundtable Discussions
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STAFF SPOTLIGHT
ELISABETH MATHEWS Executive Fellow Hometown: I am very proud to be from the small town of
Huntsville, AR, population 2,418. It is just 30 miles east of Fayetteville and most famously the hometown of Governor Faubus and Mayor Ralph Baker, for better or for worse. I loved growing up in a small town where everyone knows everyone else. When I first moved to Little Rock it felt almost lonely to go to the grocery store or a restaurant and not run into someone I knew.
Education: I earned a BS in Chemical Engineering from the University of Arkansas, Fayetteville in 2013 and a Pharm.D. from UAMS earlier this year. Typically, when people hear what my undergrad degree is in, they assume I did not originally plan to become a pharmacist, but that’s not true. I had a very wise mentor in high school who encouraged me to choose a major that would allow me to get all the prerequisites for pharmacy school and earn a degree that would set me up for a good job if I ended up changing my mind over the years. Career background: I’m really just getting started. As an intern, I spent a couple years working at the Arkansas Children’s Hospital inpatient pharmacy and a couple years at a Kroger Pharmacy. As a student, I was an officer in APhA-ASP for 3 years and served as the UAMS student representative on the APA Board of Directors.
Personal goal for APA: One personal goal I have for APA
is to foster a greater pharmacy technician membership and provide targeted training for Arkansas pharmacy technicians. With the role of community pharmacists transitioning from a dispensing focus to a focus on clinical services for payment, technicians will need to play an even more vital role. In order for pharmacies to continue filling prescriptions at the current rate and take on more clinical services, the pharmacist’s time will need to be more flexible. I believe one important step in achieving this, is to have a better trained pharmacy technician workforce in Arkansas.
Best part about working at APA: For me, the best part about
working at APA is getting to meet and learn from so many successful independent pharmacy owners across the state. I love learning about some new innovative practice they’re starting or some new workflow changes that have altered the way they provide patient care in the community setting.
Dream job: This is easy. I would love to own my own
pharmacy someday in a rural community somewhere in the Northwest Arkansas area, closer to family. Growing up in Huntsville, I saw firsthand the value pharmacists provide in rural communities, where traditionally there aren’t as
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many healthcare professionals and the people tend to be underserved.
Family: In Madison County, my parents own a chicken farm,
run a small cattle operation, and on the weekends, they can be found at their flea market/craft store off of highway 412 in Hindsville. I have two older brothers, both married to women who are also in the healthcare field. One sister-in-law is a dental hygienist and the other is a nurse practitioner. I have an 8-year-old nephew and a 4-year-old niece. Brandon, my husband of three years, graduated from the UofA at the same time as me, and fortunately was starting his graduate program in Little Rock around the same time I was starting pharmacy school. He has a Masters of Public Service from the Clinton School and over the last two years he has been working in development for the Arkansas Foodbank. In November, he began working as the Development Associate for the UAMS College of Pharmacy alongside Will Arnold. Brandon is also a champion of college and university food pantries. As a student at the UofA, he helped lead the campus Jane B. Gearhart Full Circle Food Pantry. Today, in his spare time he volunteers for the College and University Food Bank Alliance (CUFBA) as the Associate Director of Campus Resources. A couple years ago, Brandon and I adopted an adorable basset hound/lab mix puppy named Bernie from Out of The
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STAFF SPOTLIGHT: ELISABETH MATHEWS
Woods adoption agency in central Arkansas. He’s been a wonderful addition to our family and brings us both a lot of joy. We’re trying to give him as much attention as possible right now, because we are expecting our first child in April!
three weeks traveling around Spain with my friend’s family. They were perfect hosts and showed me all the best places in Madrid, Barcelona, and the Basque Country of northern Spain. It was a really eye-opening experience for me and taught me a lot about how small my own world view was at the time.
Most unusual/interesting job: In undergrad, I worked as
a peer mentor for the Freshman Engineering Program. The College of Engineering had a high freshman dropout rate, so the program was designed to help students navigate their first year and boost the success of freshman engineering students. Each year, I was assigned 14 freshman whom I met with one-on-one for 30 minutes each week throughout the school year. In all, I mentored over 40 students while I was at the UofA. I thoroughly enjoyed getting to know them all, hearing each of their unique stories, learning where they came from and where they were trying to go, and getting the opportunity to help them along their way. This job helped me develop a passion for connecting with people that has made me a better pharmacist.
Favorite meal: In the fall, definitely homemade chili with some Fritos and freshly grated cheddar cheese.
Favorite hobbies and why you like them: I love indoor and
outdoor volleyball, canoeing with my husband when the weather is nice, hiking through the woods, camping on the weekends with friends or family…really anything that gets me active and out of the house.
Best piece of advice you’ve ever received: My mentor
from high school frequently reminds me, “The hard is what makes it worth doing. If it were easy everyone would do it.” And when my grandpa was alive he would always say, “Anything worth doing is worth doing right.” I think both of these pieces of advice fit together really well, encouraging me to push myself to new boundaries and always put forth my best work. §
Best vacation: My senior year of high school I worked all
year at a gas station in town to save enough money to visit one of my good friends, a former foreign exchange student from Spain. Just before I started college, I was able to spend
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COMPOUNDING ACADEMY REPORT
Best Practices for Marketing Compounds
O
ne of the questions that compounding pharmacists frequently asked themselves is, “How can I advertise my compounding services?” Whether your advertising is radio bits, hired sales representatives, or your own time spent calling on prescribers and talking to patients, there are important guidelines you should know. These policies are especially important if you bill patients’ prescription insurance, and while the regulations are constantly evolving, the following are suggestions for best practices in 2017: Becca Mitchell, PharmD FIACP
Marketing Materials
All marketing materials should be approved by the pharmacy. Any hired marketing/sales representatives should not create, modify, or distribute unapproved materials. Anything given or said to a prescriber is considered marketing and should be approved. Marketing materials should discuss the pharmacy’s compounding capabilities without making unsubstantiated claims about compounded medications and services. This is VERY important to staying out of the FDA’s crosshairs. To make a claim of safety or efficacy, you must reference a clinical study, preferably one that has been published in a peer-reviewed journal like the International Journal of Pharmaceutical Compounding. Avoid including pricing information in marketing efforts, especially for controlled substances. Advertising that compounded alternatives to commercially manufactured drug therapies is a cost-savings for the patient is also not advisable, since the decision to choose a compounded preparation should be motivated by clinical advantages, not financial ones. Pre-printed prescription pads are a common pitfall for compounding pharmacies. Arkansas regulations prohibit prescription blanks to be pre-printed with a pharmacy’s information, to ensure the patient’s freedom of choice for his or her pharmacy. DEA regulations prohibit pre-printing controlled substances on prescription blanks. Marketing material should not use “trade” or “code” names for compounded prescriptions. Many compounds are known by common names, like “Dr. Smith’s Oily Nose Drops” or “Magic Mouthwash” but in reality the formulations can vary dramatically between prescribers. To ensure clarity, all marketing materials should contain the common name(s) and strength(s) of the active pharmaceutical ingredient(s) in the preparation.
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Marketing Guidelines
Market compounds in a manner in which it does not constitute a bribe or kickback – the use of financial incentives in any form, including gifts or monetary payment, is prohibited. Be careful when describing the indications of the preparations you compound, as this can be interpreted as a claim of efficacy and a slippery slope to a burdensome lawsuit with a pharmaceutical giant. For example, Pfizer currently owns a patent on the use of sildenafil for erectile dysfunction. Sildenafil troches compounded by a pharmacy may not violate pharmacy regulations; however they do likely violate Pfizer’s patent protections. Advertising compounded sildenafil troches for erectile dysfunction is a risky venture, because Pfizer can and has aggressively taken action against compounders to enforce its federal patent protections.
Training Personnel
If you hire Sales and Marketing personnel, they should have documented training on the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Health Information Technology for Economics and Clinical Health Act of 2009 (HITECH), and Fraud Waste and Abuse training prior to visiting with prescribers. If you are conducting the marketing yourself, make sure you have documented your own training on these topics. No pharmacy employee, regardless of role, should access Protected Health Information via email, unless the pharmacy has invested in encrypted systems that comply with HITECH. All Marketing/Sales Representatives employed by the pharmacy to market compounding services that will be billed to prescription insurance should be W2 Employees, not 1099 Independent Contractors. According to Safe Harbor, the federal anti-kickback statute, the pharmacy is obligated to supervise employees who market to prescribers. Having written policies and documented training is critical to demonstrating the appropriate control is in place. § References: Pharmaceutical Research and Manufacturers of America (PhRMA) Code on Interactions with Healthcare Professionals. International Academy of Compounding Pharmacists (IACP) Guide for Marketing Compounded Medications Responsibly. Office of the Inspector General Health Care, HHS 42 CFR Ch V (10-1- 10 Edition) §1001.952
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THE ARKANSAS PHARMACIST
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2017 Arkansas Pharmacists Association REGIONAL MEETINGS The Arkansas Pharmacists Association held its 2017 Regional Meetings in 11 cities across the state during the months of August and September. Members were able to engage with state pharmacy board and APA leaders, get updates from the colleges of pharmacy, AAHP, and CPESN, and enjoy camaraderie and fellowship with fellow pharmacists in the area. APA member participation is integral to the success of the association. Thank you to all who attended!
Bentonville – Bob Jones, Guy Lessenberry
Bentonville – Jeremy Veteto, Tom Crisler
Bentonville – Andrew Mize, Kristin Eccles
Bentonville – Kevin Barton, Steve Sparks
Bentonville Reception
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Bentonville – APA Region 1 Representative Dylan Jones
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Camden – Jennifer Davis, Casey de Yampert
Camden - Connie Gordy, Ron Morris
Camden - Lauren Carrol, Fred Harris
APA wishes to thank our Regional Meeting Sponsors: AmerisourceBergen, Cardinal Health, Chartwell Financial Group, Harding College of Pharmacy, McKesson, Smith Drug, and UAMS College of Pharmacy.
Fort Smith - Bill Leonard, Debbie Cloud, Frank Post
Fort Smith - Joe Korkames, Ed Valley, Blake Rainwater
Fort Smith - Allison Clem, Lisa Chamblee
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Fort Smith - Terri Dart, Kerri Kelley, Alan Dodd, Alena Rogers
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THE ARKANSAS PHARMACIST
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Hot Springs - Elliott McVey, Nick Utyesonich
Jonesboro - Lauren Felts, Greta Ishmael, Blair Thielemier, Greg Lance
Jonesboro - David Hill, Jimmy Mauldin, Ramey Rogers, Billy Barnett
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Hot Springs - Bryna Criswell, Laura Wagner, Lana Philpot
Hot Springs â&#x20AC;&#x201C; APA Region 3 Representative Brandon Achor
Jonesboro - Karen Clark, Amanda Nichols
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Little Rock – Heather Flowers, Talon Burnside, Kaley Achor
Little Rock - Rob Christian, Hyejin Son
Little Rock Regional Meeting
Little Rock - Sheree McConkey, Jan & Kim Fifer Monticello - Brian Smith, Will Cyphers, Leah Youngblood, Lucy Cyphers
Monticello - Eddie Beard, Bobby Beard, Jeff Dunn
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Monticello – Rayanne Story, Lynn Wilson, Daniel Bryant, Shane Dixon
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THE ARKANSAS PHARMACIST
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Mountain Home - Angie Powell, Karen Rorex
Mountain Home - Erin Jeffrey, Sera Snow, Josh Bright
Mountain Home - Susan McNutt, Danny Ponder, Steve Thomas
Mountain Home – APA Region 2 Representative Darla York
Mountain Home – APA CEO Scott Pace and AR Board of Pharmacy Assistant Director Brenda McCrady
Russellville – Bill Matthews, Bart Beggs
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Russellville - Randa Jankowski, Marsha Duvall
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Russellville - Will Walker, RD Walker, Billie Newton
Searcy - Courtney Selby, Gabriella Douglass
Searcy - Sarah Griffin, Candace Duncan, Chris Hill, Rayanne Story
Searcy - Dennis Moore, Steve Bryant, Paul Holifield, Dianna Waldrip, William Hamill
Stuttgart Regional Meeting
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THE ARKANSAS PHARMACIST
11/13/17 2:28 PM
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