ARRX Spring 2017

SPRING 2017 Award-Winning Quarterly Publication of the Arkansas Pharmacists Association

DIR Fees

Practical Tips to Save Money for Your Pharmacy

HPV Vaccine Update: What You Should Know About Human Papillomavirus

AR-Rx_Spring 2017.indd 1

4/28/17 10:31 AM

AR-Rx_Spring 2017.indd 2

4/28/17 10:31 AM

APA Staff Scott Pace, Pharm.D., J.D. Executive Vice President and CEO Scott@arrx.org

7

8

18

41

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 Celeste Reid Director of Administrative Services Celeste@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 79. © 2017 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.

WWW.ARRX.ORG

AR-Rx_Spring 2017.indd 3

CONTENTS

Debra Wolfe Director of Government Affairs Debra@arrx.org

4 Inside APA: Provider-Led Organized

18 FEATURE: HPV in America

Care Comes to Arkansas

23 2017 APA Annual Convention

5 From the President: Pharmacy

30 APA Hosts Legislative Day

Principles to Live By

7 Member Spotlight: Stephen Carroll,

PharmD, MBA AllCare Specialty Pharmacy

12 RX and the Law: The Learned

Intermediary Doctrine

13 Safety Nets: Beware of Sound-Alike

Words, Not Just Sound-Alike Drugs

14 2017 Calendar of Events 15 New Drugs: New Drug Approvals at

the FDA Sink to a Six Year Low

16 Compliance Corner: Judge Issues

Order Ending PBM Lawsuit

34 UAMS Report: Community Pharmacy

Residencies

8 FEATURE: DIR Fees: Practical Tips To

Save Money for Your Pharmacy

January 25

36 Harding University Report: Harding

University College of Pharmacy Welcomes New ACPE Standards

38 AAHP: Antimicrobial Stewardship:

Improving Quality of Care through Bugs and Drugs

40 Member Classifieds 41 Legislator Profile: Representative

Clint Penzo

42 2017 APA Golf Tournament 45 Staff Spotlight: Celeste Reid

DIRECTORY OF ADVERTISERS 2 6 6 11 14 17

Pace Alliance Retail Designs, Incorporated Arkansas Pharmacy Support Group Smith Drug Law Offices of Darren O'Quinn EPIC Pharmacies

22 Pharmacists Mutual 40 UAMS 46 2016 Recipients of the Bowl of Hygeia Award 47 Pharmacy Quality Commitment Back Cover: APA Honors Smith Drug

3

2

4/28/17 10:31 AM

INSIDE APA

APA Board of Directors 2016 - 2017 Officers President - Eddie Glover, P.D., Conway President-Elect - Lynn Crouse, Pharm.D., Eudora Vice President - Stephen Carroll, Pharm.D., Arkadelphia Past President - Brandon Cooper, Pharm.D., Jonesboro

Area Representatives Area I (Northwest) Michael Butler, Pharm.D., Hot Springs Area II (Northeast) Darla York, P.D., Salem Area III (Central) Clint Boone, Pharm.D., Little Rock Area IV (Southwest/Southeast) Dean Watts, P.D., DeWitt

District Presidents District 1 - Denise Clayton, P.D., Mayflower District 2 - Max Caldwell, P.D., Wynne District 3 - Dylan Jones, Pharm.D., Fayetteville District 4 - Betsy Tuberville, Pharm.D., Camden District 5 - James Bethea, Pharm.D., Stuttgart District 6 - Yanci Walker, Pharm.D., Russellville District 7 - Lacey Parker, Pharm.D., Centerton District 8 - Rodney Richmond, P.D., Searcy Academy of Consultant Pharmacists Anthony Hughes, P.D., Little Rock Academy of Compounding Pharmacists Becca Mitchell, Pharm.D., Greenbrier Arkansas Association of Health-System Pharmacists Kendrea Jones, Pharm.D., Little Rock

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 Mary Elizabeth Bradley, Little Rock Harding COP Student Alyssa Stormes, Searcy

4

Find the APA on Facebook, or visit our website at www.arrx.org

AR-Rx_Spring 2017.indd 4

Scott Pace, Pharm.D., J.D. Executive Vice President & CEO

Provider-Led Organized Care Comes to Arkansas

A

rkansas has a new healthcare phrase to learn, Provider-Led Organized Care (PLOC). PLOC was created by HB1706 during the recent session of the Arkansas General Assembly. It is a pseudo-managed care concept that is the brainchild of Arkansas Department of Human Services consultant Dennis Smith.

Mr. Smith served at the Centers for Medicare and Medicaid Services under the George W. Bush administration as the Director of Medicaid and State Operations and briefly as the interim CMS Administrator. The twist on the PLOC that does not make it traditional “managed care” is that the ownership control of the PLOC is with the healthcare providers, not a giant managed care company.

So why do we need a new pseudomanaged care system in Arkansas?

The Arkansas Medicaid program covers almost 1,000,000 Arkansans and has an annual budget of approximately $6.5 billion. Almost $1 billion of those dollars are spent on just 30,000 patients with developmental disabilities and behavior health issues. This subset of the Medicaid population is the most expensive to treat, the most medically frail and the most in need of intensive treatment from their healthcare providers, especially their pharmacists.

The new PLOC is an attempt to put the healthcare providers, collectively, back in control for the treatment of these complex, difficult to treat patients, and to allow the providers to share risk for their treatment expense and outcomes with the promise of financial reward for helping the system save dollars on the treatment of these patients.

The system will work through the creation of multiple Provider-owned Arkansas Shared Savings Entities (PASSE). These PASSEs must be at

least 51% owned by the providers. The providers will create their own networks, define covered services, establish provider payments, and will bring an administrative service organization (a third-party administration type organization) into the group to assist with many of the administrative services and clinical program development and, in some cases, to assist the PASSEs in bearing risk in the program.

The whole premise that the PASSEs will attempt to do better than traditional Medicaid and traditional capitated managed care programs is care coordination. This is a great opportunity for APA and for pharmacists. The two main types of therapy for the developmentally disabled and behavior health populations are psychiatric therapy and medication therapy.

APA has inserted pharmacists into the legislation that creates this new model in three important ways: we have ensured that an Arkansas-licensed pharmacist must be on the governing board of each PASSE, we have included the community-based management of medications into the definition of “care coordination,” and we have identified the Community Pharmacy Enhanced Services Network (CPESN) in the law as manner that PASSEs should consider for medication optimization, patient engagement and care coordination.

This is an exciting opportunity for pharmacists and for all healthcare providers in Arkansas to regain control over a high cost patient population from traditional managed care. APA is meeting aggressively with the different healthcare and PASSE partners as they are forming to ensure that pharmacists’ collective expertise is used to the fullest and rewarded accordingly in this new model. Stay tuned! §

AR•Rx

|

THE ARKANSAS PHARMACIST

4/28/17 10:31 AM

FROM THE PRESIDENT

Pharmacy Principles to Live By

A

s pharmacists, we are responsible to our patients for helping to protect their health. They look to us for knowledge and experience during some of the hardest times of their lives and we must be that beacon for them. However, for many of us, we aren’t just healthcare professionals. We often wear the hat of business owner, manager, or team leader, roles that have completely different foundational principles

Eddie Glover, PD

President from what we learned in pharmacy school. For my last article as APA president, I want to share with you some of the invaluable lessons I’ve learned from my 40-year career in pharmacy. I hope you take them to heart and use them to further your relationships with your patients.

10 Business Principles We Must Have: 1. Vision: We must have a vision for the future. Without 2.

3.

4.

5.

vision, we parish. Know what you want for the future of your career and the profession of pharmacy.

Leadership: No organization rises above its leadership. We must have good leadership to lead APA but we must all be leaders.

Attitude: Do you know how many apples it takes to ruin a barrel? ONE! We must have an attitude that is positive and an attitude of change. You are one of the people that patients will see during difficult times in their lives. Be aware of your attitude, especially when interacting with patients.

Delegate: You can’t do everything. You have other pharmacists, technicians, and clerks. Give up some duties if you’re feeling overwhelmed.

Take Chances: We must take some calculated chances to be successful.

6. Persistence: There is no GIANT step that does it, it’s a

lot of LITTLE steps. The journey of 1,000 miles begins with a single step.

7. Crown the Patient: Put the patient first and it will lead to success.

8. Well Rounded: We can’t be a one or two-dimensional profession or have our head in the sand. We should be spreading our clinical knowledge to show patients (and insurance companies and Congress) that pharmacists have a wealth of skills that can be used to benefit patients.

9. Up the Ante: Being satisfied with where we are will lead to future failure. We must up the ante to move forward and upward. When you’ve reached one goal, set another one.

10. Never Stop Learning: The wisest mind has something yet to learn. When we stop learning, we stop growing.

Thank you all for a wonderful year as your APA President. I have enjoyed traveling the state and meeting you – our members that are helping take care of Arkansans and living up to the high standards of the pharmacy profession. It’s been a year that I will not forget. Thank you for letting me serve as your president. §

AAHP Board

Arkansas State Board of Pharmacy

Executive Director.............Susan Newton, Pharm.D., Russellville President..........................Kendrea Jones, Pharm. D., Little Rock President-Elect.......................Brandy Owen, Pharm.D., Conway Past President.....................Rob Christian, Pharm.D., Little Rock Treasurer............................Marsha Crader, Pharm.D., Jonesboro Secretary...................................Melissa Shipp, Pharm.D., Searcy Member-at-Large......Erin Beth Hays, Pharm.D., Pleasant Plains Member-at-Large..................David Fortner, Pharm.D., Sherwood Member-at-Large......................Joy Brock, Pharm.D., Little Rock Technician Representative.....Holly Katayama, CPhT, Little Rock

President.....................................Stephanie O’Neal, P.D., Wynne Vice President...............................Tom Warmack, P.D., Sheridan Secretary.............Kevin Robertson, Pharm.D., BCPS, Little Rock Member..........................................Steve Bryant, P.D., Batesville Member.......................................Debbie Mack, P.D., Bentonville Member...............................Lenora Newsome, P.D., Smackover Public Member........................................Carol Rader, Fort Smith Public Member......................James Burgess, DDS, Greenwood

WWW.ARRX.ORG

AR-Rx_Spring 2017.indd 5

5

4/28/17 10:31 AM

6

AR-Rx_Spring 2017.indd 6

AR•Rx

|

THE ARKANSAS PHARMACIST

4/28/17 10:31 AM

MEMBER SPOTLIGHT

Stephen Carroll, PharmD, MBA AllCare Specialty Pharmacy

Pharmacy school and graduation year: UAMS College of Years in business/years teaching: 11

Oddest request from a patient/customer: A Hepatitis C patient being counseled on not taking herbal supplements while on treatment asked if it was ok to use the flavor packets that are mixed with Ramen noodles.

Favorite part of the job and why: I enjoy working to be on

Recent reads: I am in the middle of getting licensed in 14

Pharmacy 2005

the cutting edge of innovation in pharmacy through niche practice settings and new technology. I enjoy learning more about business innovation and new ways to create patient loyalty. Specialty Pharmacy presents new challenges constantly to improve patient health. I enjoy working with our entire pharmacy team to ensure that our patients are receiving the best care possible.

Least favorite part of the job and why: The constant battle to gain access to third-party networks or limited distribution drug networks when we have the proper accreditations as well as disease state expertise.

What do you think will be the biggest challenges for pharmacists in the next 5 years? The biggest challenge will be evolving the practice of pharmacy with healthcare reform. I believe that pharmacists are in a great position to be an integral part of healthcare reform to help give patients better access to care and to improve patient health.

WWW.ARRX.ORG

AR-Rx_Spring 2017.indd 7

states so my most recent reads have not been too interesting: the Kentucky Pharmacy Lawbook and the Virginia Pharmacy Lawbook. I will then turn my attention to the West Virginia Pharmacy Lawbook, the Maryland Pharmacy Lawbook, and the Michigan Pharmacy Lawbook.

Fun activities/hobbies: Enjoy spending time with my wife

(Lauren) and my 3 sons (William, Jacob, and Andrew). I also enjoy playing basketball and golf and spending time at the lake during the summer.

Ideal dinner guests: My family including my grandparents, Mike Krzyzewski, Warren Buffett, and Vince Vaughn

If not a pharmacist then‌: A career in athletics, whether it be an athletic director or sports management position. §

7

4/28/17 10:31 AM

DIR FEES Practical Tips to Save Money for Your Pharmacy

By Jordan Foster

88

AR-Rx_Spring 2017.indd 8

Although DIR fees have become engrained in pharmacy, there are several actionable steps you can take to be proactive in lowering your DIR fees.

AR•Rx

|

THE ARKANSAS PHARMACIST

4/28/17 10:31 AM

O

riginally, DIR fees were created to allow CMS to track rebates from drug manufacturers and other price adjustments applied to prescription drug plans that were impacting the total cost of Medicare Part D medications. The PBM would receive a discount from a drug manufacturer and that savings was passed on to CMS in the form of a DIR fee. Over time, DIR fees changed to become a catch-all for many different reimbursements and fees, including a fee for a pharmacy meeting or failing to meet certain quality measures.

Although DIR fees have become engrained in pharmacy, there are several actionable steps you can make to be proactive in lowering your DIR fees.

Medication therapy management – MTM is an incredibly

beneficial way to get a patient on track to a better and healthier life, but a new program developed by a UAMS resident and a grocery/drug chain is now a proven tool to lowering your DIR fees. Duane Jones of Harp’s Food and Nikki Scott, during her UAMS residency, brought to life this new program that creates a workflow for your clinical duties, including MTM, by utilizing existing staff in the most efficient way possible. “The challenge that we have across the United States is workflowing clinical in pharmacies. ‘How do I get this MTM in workflow when I’m trying to fill prescriptions.’ This program teaches pharmacists and technicians how to do that by incorporating staff and using your technicians in the same way that doctors and nurses work in tandem. So a technician would prepare the chart, the pharmacist goes in and does the clinical duties, and then the chart is turned back over to the technician to document it in the platform.”

As provider status gets closer to reality, Duane says it benefits pharmacists to get a solid workflow in place soon. “One of the challenges that we have going forward is that we don’t have clinical protocols in our pharmacies. This gives your clinical protocols in your pharmacy so that when provider status comes, you’re ready to go. So that gives us this basis for being able to raise our hand and say, ‘We’re ready for provider status, can we have it please now?’ Because we’re taking care of patients already.”

From an efficiency standpoint, developing a workflow is a crucial way to provide structure and direction for your pharmacy. Not only that, but Duane says since starting the program, Harp’s has seen impressive returns on investment.

“As a result of our increased completion rates of MTM and the increase in our Equip scores, with one company the first quarter of 2016, we saved over $20,000 in DIR fees.”

Motivational interviewing – Part of lowering your DIR fees

and raising your STAR rating involves how the patient feels about the care they’re receiving. However, many times the patient can be non-communicative about how they’re feeling and what their day to day health is like. Counseling sessions are an incredibly important part of getting through to a patient one-on-one and even finding out if there are other concerns beyond what their immediate issue involves. Is the patient

WWW.ARRX.ORG

AR-Rx_Spring 2017.indd 9

aware of why they are on a certain drug? Do they feel like they’re being heard in the healthcare process? If the patient is on maintenance drugs, do they know that sometimes healthy lifestyle changes can lessen the number of pills they must take?

Catherine O’Brien of UAMS College of Pharmacy, in her presentation at the APA 2016 Convention, defined motivational interviewing as a “patient-centered counseling approach that optimizes the possibility that patients will consider and implement health behavior change.” She goes on to describe it as a “collaborative conversational style for strengthening a person’s own motivation and commitment to change” and “a deeply respectful approach that lets patients take ownership of the changes they want to see in their health.”

The distinction of being patient-centered is an important one because it demonstrates to the patient that they are being heard and respected, harnesses the patient’s own motivation, and acknowledges that the patient is ultimately the individual with the most control in improving their health.

Some basic skills that O’Brien emphasizes during motivational interviewing are:

• Reflective listening – repeating a patient’s concerns back to them to clarify/confirm the concerns and build a rapport by showing you’re listening • Show empathy – be explicit and accurate, but don’t presume you understand how the patient feels or downplay their emotion • Give information – avoid dumping large amounts of information on the patient, opt for smaller doses of information when possible and allow the patient to draw their own conclusions • Elicit the patient’s own motivation – let the patient tell you about what motivates them instead of telling them what their motivation should be

9

4/28/17 10:31 AM

PRACTICAL TIPS FOR LOWERING YOUR DIR FEES

Shared decision tools - For some

patients, being involved in the decision making is an important part of getting to and sustaining a healthy lifestyle.

They value your opinion and expertise, but they want to be heard as well. As a pharmacist, this can be used to your advantage to educate and convince patients of certain changes that need to be made. Shared decision making is a process that health care providers and patients to make decisions together as experts – you as a medication expert and the patient as an expert in his or her own experiences, priorities, and goals.

For pharmacists, this open discussion, accompanied by shared decision tools, can allow a patient to make the right decision about his health, especially if he is pushing back on some of the medical advice you’re providing.

For example, the Mayo Clinic offers a wide variety of shared decision tools to educate patients and guide them toward a decision that will benefit them, while providing them with the likely outcomes of each decision. One tool they offer concerns a patient that should be taking statins, but has some hesitation. The tool below offers both scenarios of taking and not taking the statin, the risks associated with each option, and the downsides of taking the cholesterol pill, allowing the patient to see all the information and

have a voice in the decision. By using the shared decision tools, you can make the patient an active decision maker in his own healthcare, increasing the likelihood that he will adhere to his personalized medical plan.

Medication synchronization may

be one of the easier programs for you to convince patients to sign up for, considering there are clear and immediate benefits that will be easy for them to see.

With a patient enrolled in med sync, all their maintenance medications will be synchronized for them to pick up one day a month, allowing them to not only make less trips to the pharmacy, but also to choose which paycheck they use to pay for their medications.

Most of your bills coming out of one paycheck? Schedule your medication to pick up during the other pay period.

Providing a way to give your patients even a small dose of financial relief doesn’t just help with their pocketbook, it could provide fringe benefits in the form of a stronger, more open relationship between the two of you. When a patient sees that you really do care and are trying to help in many different ways, they may be more likely to be communicative during counseling sessions and receptive to your ideas for improving their overall health. It may be cliché, but it still rings

true: people don’t care what you know until they know that you care.

Financial planning and loyalty aren’t the only benefits to medication synchronization. As a pharmacist, if many of your patients only come into your pharmacy once a month, that provides you with more time to have in-depth counseling sessions with patients. Instead of a patient getting your attention for 2 minutes every week, they could come in once a month and get 10 minutes of your full attention, which could allow you to use some motivational interviewing to find the source of a patient’s problem.

Lowering your DIR fees should be a top concern for most pharmacies but it may sometimes feel like there’s no end in sight. However, there is legislation in Congress, filed in February 2017, “to prohibit Medicare Part D plan sponsors from retroactively reducing payment on clean claims submitted by pharmacies.”

APA will be following this bill, among others, and will alert our members to any progress made in Congress. Until then, use the tools available to you to ensure that you’re doing everything you can to lower your pharmacy’s DIR fees. §

What is my risk of having a heart attack in the next 10 years?

10

AR-Rx_Spring 2017.indd 10

AR•Rx

|

THE ARKANSAS PHARMACIST

4/28/17 10:31 AM

WWW.ARRX.ORG

AR-Rx_Spring 2017.indd 11

11

4/28/17 10:31 AM

The Learned Intermediary Doctrine 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.

I

t is almost impossible to attend a pharmacy law conference and not have a discussion about the Learned Intermediary Doctrine. The Doctrine was first expressed in a lawsuit against a drug manufacturer in 1966.1 The Doctrine states that a drug manufacturer has no duty to warn a patient about the risks of a drug. The manufacturer’s duty is fulfilled by informing the prescriber (the “Learned Intermediary”) of the drugs risks and benefits. The prescriber then has the responsibility of choosing the appropriate therapy because the prescriber has knowledge of the patient’s medical condition.

Through the years, the Learned Intermediary Doctrine was expanded to include pharmacists. This was done through court decisions, by statute, or other procedural means.

Specifically, courts held that pharmacists had no duty to warn patients of the risks of a particular drug. The Learned Intermediary Doctrine put that responsibility on the physician.

There was fear that the pharmacist would somehow interfere in the physician-patient relationship. Under the Doctrine, the pharmacist discharged their duty by correctly filling the physician’s prescription for the patient.

As the different states have looked at the Learned Intermediary Doctrine, they have taken different approaches to it; some adopted it, some rejected it, and some created exceptions to it. And as things usually go in the law, the different states didn’t agree on the exceptions. So what is a practicing pharmacist supposed to do?

This is where I give you a different answer depending on whether I’m wearing my lawyer hat or my pharmacist hat. A common exception to the Learned Intermediary Doctrine in states that have adopted it is situations where the pharmacist has specific information about the patient’s condition (e.g., she is pregnant or he is allergic to penicillin). My advice as a lawyer in these situations would be to advise my pharmacist clients to know as little about their patients as possible.

That way you can fall under the protection of the Learned Intermediary Doctrine. As a pharmacist, this advice is contrary to the direction that the pharmacy profession is headed. We are trying to become more involved in patient care, not less.

At these same conferences, there are also many discussions about gaining provider status. How can pharmacists make a case to be considered health care providers and hide behind the Learned Intermediary Doctrine at the same time?

12

AR-Rx_Spring 2017.indd 12

Cases rejecting the Learned Intermediary Doctrine state that pharmacists are not merely order-fillers and want to discourage robotic compliance with the physician’s order.

So what is the pharmacist to do? Relying on the Learned Intermediary Doctrine is not necessarily a good strategy. The courts have not consistently applied the Learned Intermediary Doctrine. My review of cases leads me to conclude that courts really don’t understand what pharmacists can and are supposed to do. For example, one case reached the right answer for the wrong reason. There are exceptions to it and you don’t want your case to be the one in which the court creates another exception. Many of the cases were decided before OBRA ’90 and its resulting regulations were implemented. Few discussions today talk about OBRA’s impact on the Learned Intermediary Doctrine, but I believe that it is underestimated. It is beyond the scope of this article to recite a detailed history of these decisions. Suffice it to say that relying on the Doctrine is a risky strategy because it is too difficult to predict the court’s outcome.

The better option is for the pharmacists to use their training, experience, and expertise for the benefit of the patient.

Protecting patients from harm is a strategy within the pharmacist’s control. Intervene when you see something that raises a red flag. Protecting your patients ultimately protects you. Additionally, utilizing our expertise and making a positive impact on patient outcomes is a more persuasive way of convincing payers, patients, and regulators that pharmacists are a vital part of the health care team. Let’s move into the 21st Century. § Sterling Drug, Inc. v. Cornish, 370 F.2d 82 (8th Cir., 1966) Morgan v. Wal-Mart Stores, Inc., 30 S.W. 3d 455 (Tex. App.-Austin, Aug. 10, 2000) 3 Omnibus Budget Reconciliation Act of 1990, Pub. L. No. 101-508, 104 Stat. 1388. ________________________________________________________________ 1

2

© Don R. McGuire Jr., R.Ph., J.D., is General Counsel, Senior Vice President, Risk Management & Compliance at Pharmacists Mutual Insurance Company.

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

AR•Rx

|

THE ARKANSAS PHARMACIST

4/28/17 10:31 AM

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY

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

Beware of Sound-Alike Words, Not Just Sound-Alike Drugs Welcome to another issue to Safety Nets. 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 Central Arkansas. The pharmacy technician entered the patient directions as "take one tablet twice daily as directed." 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 order information, a pharmacy technician filled the prescription for potassium chloride 20 mEq tablets and placed it in line for final pharmacist verification and patient counseling. During the counseling session, the pharmacist instructed the patient to take one tablet twice daily. The patient interrupted the pharmacist and said "the doctor told me to take three a day." The pharmacist reexamined the order and realized that he and the technician had both misinterpreted the word "thrice" as "twice". After this, a corrected prescription label was generated instructing the patient to take the medication three times daily, not twice daily.

Figure 1

Many Safety Nets columns have focused on errors resulting from medications names that sound and/or look alike (i.e.

SALAD's). This order is unique in that a medication error nearly reached a patient as a result of a sound-alike word in a prescription Sig. (i.e. thrice vs. twice). Fortunately, the pharmacist in this case performed State Board required patient counseling where the error was discovered. If counseling had not occurred, it is entirely possible the patient could have taken two potassium chloride tablets daily even though they distinctly remembered the prescriber's verbal instruction to take three daily. Patients trust the directions on their prescription labels. This trust could have resulted in the patient questioning their memory of what their prescriber actually said.

The Safety Net authors thank the pharmacist who sent us this unique, interesting case. Old English has no place in modern prescription writing. Its use should be confined to actors portraying characters such as Richard the Lionheart and Eleanor of Aquitaine who lived in the 12th century. §

WWW.ARRX.ORG

AR-Rx_Spring 2017.indd 13

STUDENT SPOTLIGHT

Are We Listening?

- Kayla Eveld

“How are you today?” Many pharmacists ask this question and many pay no attention to the response.

Ringing phones, drive through chaos, along with staff member issues are distractions that may prevent us from truly listening to what our patients tell us.

A typical patient visits their primary care physician once a year. A pharmacist is usually available seven days a week. This accessibility is critical for the health care of many patients. When we ask a patient “how are you today”, it is important for us to pay close attention to their response. Responses such as “I’m tired today”, “I don’t feel very good”, “I’m hurting”, could be that person revealing symptoms of an underlying problem.

For example, Mrs. Jones arrives to pick up her maintenance prescriptions and you greet her with “how are you today?” She says “I don’t know. I’m thirsty all the time. It’s weird.” If Mrs. Jones arrived on a hectic day full of distractions, it would be easy to acknowledge her response without truly listening to what she said.

If we had really listened, we might have considered providing her with a quick blood glucose screening, or doing a quick medication review to determine if any of her medications could have caused her extreme thirst.

Every day, pharmacists act as safety nets to “catch” medication errors before they reach their patients. It is equally important that we act as a safety net by “catching” verbal clues patients give us. Truly listening improves our ability to provide the best patient care possible.

13

4/28/17 10:31 AM

2017 Calendar of Events

JUNE ______________________________

DECEMBER ______________________________

June 8-10 APA 135th Annual Convention Downtown Marriott Little Rock, AR

Date TBD* American Society of HealthSystem Pharmacists Location TBD

AUGUST ______________________________ Dates TBD APA Regional Meetings Around the State

December 3* APA Board Meeting TBD

December 2* APA Committee Forum TBD

*Dates have not been finalized.

SEPTEMBER ______________________________ Dates TBD* APA Regional Meetings Around the State

OCTOBER ______________________________ October 5-6 AAHP Fall Seminar Wyndham Riverfront North Little Rock, AR October 14-18 National Community Pharmacist Association Annual Convention Orlando, FL October 26* APA Golden CPE Hosto Center Little Rock, AR

NOVEMBER ______________________________ November 3-5 American Society of Consultant Pharmacists Annual Meeting & Exhibition Kissimmee, FL 14

AR-Rx_Spring 2017.indd 14

AR•Rx

|

THE ARKANSAS PHARMACIST

4/28/17 10:31 AM

New Drug Approvals at the FDA Sink to a Six Year Low 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.

L

ast year turned out to be a disappointing one with the FDA approving only 19 new drugs, a stark comparison to the 45 drugs that were approved in 2015 and the lowest number since 2010. The slowdown suggests the pharmaceutical industry may be returning to more normal productivity levels after the spike in approvals in 2014-15 hit a 19-year high. Two factors that led to the low 2016 approval rate include a decline in the number of NDAs being filed while the FDA rejected or delayed more applications than in previous years. There is increasing political pressure over the slow approval rate, but the recently passed 21st Century Cures Act should speed up new drug approvals. There remains additional political concern over high drug prices, and President Trump has vowed to bring down drug prices.

Spinraza pricing (see table) is likely to invite a firestorm of criticism and perhaps a few Presidential tweets.

New Drugs: Emflaza™ (deflazacort) was granted a priority

fast track, rare pediatric disease, orphan drug review as the first corticosteroid approved to treat Duchenne muscular dystrophy. The cost of this drug has caught the eyes of Congress as it is sold in other parts of the world for $1,500 per year. Eucrisa™ (crisaborole) is a phosphodiesterase 4 inhibitor approved to treat atopic dermatitis (eczema) in patients 2-years and older. Odactra™ (house dust mite extract) is the first allergen extract to be administered sublingually for symptoms of nasal inflammation with/ without conjunctivitis. Parsabiv™ (etelcalcetide) is a novel calcimimetic approved for secondary hyperparathyroidism in adults with chronic kidney disease on hemodialysis. Its cost is not yet known but is expected to be comparable to Sensipar® at $2,000 per month. Rubraca™ (rucaparib) was granted accelerated priority review status as an orphan breakthrough therapy to treat advanced ovarian cancer with the deleterious BRCA gene mutation. It was approved along with the CDxBRCA companion diagnostic that detects the

WWW.ARRX.ORG

AR-Rx_Spring 2017.indd 15

presence of BRCA gene mutations. Siliq™ (brodalumab) is approved for moderate-to-severe plaque psoriasis but has restricted use through a REMS program due to suicidal ideation and behavior. Prescribers and pharmacies must be certified through the REMS program, and patients must sign a participation agreement. Spinraza™ (nusinersen), also receiving a priority fast track, rare pediatric disease, orphan drug review, is the first drug approved to treat spinal muscular atrophy, a rare and often fatal genetic disease but it comes with a high price tag. Trulance™ (plecanatide) was approved to treat chronic idiopathic constipation in adults. Xermelo™ (telotristat ethyl) was granted fasttrack priority review as an orphan drug to treat carcinoid syndrome diarrhea along with somatostatin analog therapy.

Expanded Indication: The Dexcom G5 Mobile Continuous Glucose Monitoring System, previously used only as an adjunct to finger-stick testing, was approved to replace finger-stick testing for determining insulin doses in diabetics 2-years of age or older.

Rx-to-OTC Switch: Xyzal® Allergy 24HR (levocetirizine, tablets) for allergic rhinitis.

New Dosage Forms: Significant new dosage forms that

were approved this quarter include: Airduo™ Respiclick® (fluticasone/salmeterol, inhalation) new combination for asthma; Armonair™ Respiclick® (fluticasone, inhalation) for asthma; Arymo™ ER (morphine, extended-release tablet) for severe pain; ColPrep Kit (sodium, potassium magnesium sulfate) as an osmotic bowel prep; Corphedra™ (ephedrine, injectable) for hypotension during anesthesia; Tepadina® (thiotepa, intravenous, intracavitary, intravesical injectable) an alkylating agent; Tirosint®-Sol (levothyroxine, oral solution) for thyroid replacement; and Vantrela™ ER (hydrocodone, extended-release tablet) for severe pain. §

15

4/28/17 10:31 AM

Judge Issues Order Ending PBM Lawsuit

A

s many of you know, on March 1, 2017, Federal Judge Brian Miller issued an order ending Pharmaceutical Care Management Association v. Leslie Rutledge, Case No. 4:15-CV-00510, USDC-ED Ark., otherwise known as the case challenging Act 900 of 2015 (the Act). You can access Judge Miller’s full order at the WLJ site: https://tinyurl. com/joablce. This column will take a closer look at the arguments raised by the pharmacy benefit manager (PBM) trade group Pharmaceutical Care Management Association (PCMA) and the Judge’s ultimate decision on those issues.

It will also look to the future of Act 900 and potential new areas of litigation between PBMs and Arkansas pharmacies regarding reimbursement issues.

Act 900, codified at Ark. Code Ann. § 17-92-507 et seq, controls the reimbursement of generic drugs priced using a Maximum Allowable Cost (MAC) list. The crux of the Act establishes an appeal procedure which allows pharmacies to challenge reimbursements that are “below the pharmacy acquisition cost.” § 507(c)(4)(A)(i). Among other provisions, the Act also gives pharmacies the right to refuse to dispense a prescription which will be reimbursed at less than the acquisition cost, even if the pharmacy’s contract with the PBM says otherwise. § 507(e).

The lawsuit filed by the PCMA raised several legal challenges to the Act. It claimed that the provisions of this Arkansas statute were preempted, or overridden, by two different federal statutes (ERISA and Medicare) and that the Act was unconstitutional because it violated the Commerce Clause of the United States Constitution and the Contract Clauses and Due Process Clauses of the US and Arkansas Constitutions. Broadly, the ERISA and Medicare statutes both create comprehensive statutory schemes that specifically preempt any state law to the contrary.

First, PCMA argued that Act 900 must be invalidated because it interfered with ERISA’s provisions requiring nationally-uniform employee health insurance plan administration. Judge Miller’s decision agreed with this argument, and found that Act 900’s provisions as they apply to ERISA-covered plans, was preempted and could not be applied. However, Judge Miller made sure to state that his initial decision would have found that ERISA did not preempt Act 900, but he was bound to follow the Eighth

16

AR-Rx_Spring 2017.indd 16

Circuit Court of Appeals’ January 2017 decision regarding a similar Iowa law. This is a notable comment from Judge Miller, and an indication that future courts may disagree with the Eighth Circuit’s decision on this issue.

Next, PCMA argued that Act 900’s regulation of MAC pricing interfered with Medicare’s requirement for “negotiated prices” for drugs covered by Medicare Part D. However, Judge Miller rejected this argument, holding that Medicare did not restrict “additional contingent amounts”—additional costs, in other words—that may result from a pharmacy’s successful appeal of MAC pricing under the Act 900 provisions. PCMA also argued that Act 900’s decline-to-dispense provision was in conflict with Medicare’s requirement to maintain “convenient access to network pharmacies.” He found that if a pharmacy declined to dispense because the reimbursement rate was too low under Act 900, the pharmacy “is not thereby transformed into an out-of-network pharmacy.” As a result, the Medicare statutes do not preempt Act 900 and its provisions still apply with respect to all Medicare Part D plans. This is an important point because this case is the first time a court has ruled on Medicare reimbursement in this context anywhere in the country.

Next, Judge Miller decided that the Commerce Clause did not invalidate Act 900, because it did not discriminate against out-of-state interests in favor of in-state interests.

He also found that the possible effects of Act 900 on the administrative costs or profits of PBMs was not excessive in relation to the local benefit—maintaining and increasing the public’s access to pharmacies.

He also rejected PCMA’s arguments on the other constitutional issues. Specifically, he found that Act 900 did not “substantially impair preexisting contractual relationships” so as to invalidate the statute under the Contract Clause. In his discussion of that issue, he noted that the purpose of the Act is legitimate: “It is undisputed that Arkansas pharmacies were in economic distress, that MAC lists are confidential and unregulated, and that contracts allow PBMs to reimburse pharmacies for generic drugs in any manner they see fit.” He also overruled the argument that Act 900’s provisions were so vague that they violated the Due Process Clause.

AR•Rx

|

THE ARKANSAS PHARMACIST

4/28/17 10:31 AM

COMPLIANCE CORNER

Of course, the conflicts between PBMs and pharmacies will not end here. Not only are some plans still not subject to these provisions, Act 900 does not cover brand-name drugs and it does not address other issues that commonly arise between PBMs and pharmacies, like getting access to PBM pharmacy networks. So, there are likely to be new lawsuits filed in Arkansas and around the country that focus on these related issues as the relationship between these two groups continues to develop.§

So, the next question is: what does this all mean? First of all, it means that the provisions that Act 900 established are still intact, for the most part. So, any prescriptions filled for Medicare and all other non-ERISA covered insurance plans will be subject to the reimbursement and appeal provisions of Act 900. The tricky part is that pharmacies really have no reliable way to know which private insurance plans are covered by ERISA—so Act 900 would not apply to reimbursements—and which plans are not covered by ERISA, where Act 900 would apply. Regardless, this decision is great news for Arkansas pharmacies. Attorney General Leslie Rutledge and Senior Assistant Attorney General Shawn Johnson are to be commended for the hard work that went into getting this result.

_______________________________________________________

About the author: Erika Gee represents clients in government relations, regulatory and compliance matters at Wright, Lindsey & Jennings LLP. She previously served as general counsel to the Arkansas State Board of Pharmacy for 6-1/2 years and as Chief of Staff and Chief Deputy Attorney General for Attorney General Dustin McDaniel. She uses her experience as general counsel for state agencies and licensing boards to assist clients to resolve regulatory and disciplinary disputes with state government.

We Deliver Solutions for a Healthier Bottom Line EPIC Pharmacies, Inc. provides more than 1,500 independent member pharmacies across the U.S. with the group buying power and managed care solutions essential to delivering quality patient care.

Membership offers: • Group volume purchasing power • Aggressive wholesaler pricing programs • Successful rebate program - $60.8 million returned to members in 2016 • EPIC Pharmacy Network, Inc. (EPN) membership fee included at no cost – access to third-party contracts • Clinical services tools, including expert assistance from our in-house pharmacist and access to custom PrescribeWellness offerings and EQuIPP •

PUT THE POWER OF A NETWORK BEHIND YOU

800-965-EPIC | EPICRX.COM

•

TM

– free third-party claims reconciliation program and automated reimbursements below cost system – Web-based solution for pharmacy regulatory and compliance management

EPIC Half Page Ad - 7”W x 4.875”H, CMYK, 300dpi. Rev. 01.31.17 WWW.ARRX.ORG

AR-Rx_Spring 2017.indd 17

17

4/28/17 10:31 AM

HPV in America

By John Vinson, PharmD, Mary Bradley (UAMS P3) and Sarah Smith (UAMS P2)

The Human Papillomavirus (HPV) is virtually ubiquitous in America.

HPV is the most common sexually transmitted infection, and shockingly, it is estimated that nearly all sexually active men and women will get the virus at some point in their lives. Over 14 million people in the United States will become newly infected with HPV this year alone.

W

hile the above statistic sounds frightening at first, not all HPV infections are harmful or even symptomatic in patients. The body’s immune system naturally clears HPV in about 2 years in 90% of cases, but persistent infection by certain types of the virus can lead to serious problems such as genital warts or certain types of cancers. About 3 in 4 HPV types lead to warts on the skin such as the common wart or plantar wart. However, out of the more than 40 HPV types that can infect the genital tract, there are four types that are the most concerning. HPV types 6 and 11 are to blame in about 90% of genital warts cases worldwide, while types 16 and 18 are responsible for more than 70% of cervical cancers. Cervical cancer is the most prevalent cancer to

18

AR-Rx_Spring 2017.indd 18

arise from HPV, but women are not the only ones at risk. HPV can also cause cancers of the vagina, vulva, penis, anus, and even the back of the throat. In the United States each year, HPV causes around 30,000 cases of cancer in both men and women. This equals out to about one person being diagnosed with an HPV-caused cancer every 20 minutes.

Genital HPV is spread through intimate person-to-person contact with someone who already has the virus. Usually, HPV is transmitted via vaginal or anal sex. It can also be spread through oral sex and other intimate contact. A person can be infected even if their partner is asymptomatic for an HPV infection, and a person can have HPV even if several years

AR•Rx

|

THE ARKANSAS PHARMACIST

4/28/17 10:31 AM

HPV iN AMERICA

have passed since their contact with an infected person.

Since most people do not know that they are infected, they are also at risk of infecting other sexual partners in the future.

There is no treatment for HPV itself, but complications that arise from the virus can be treated if caught early enough.

Women aged 21-65 are recommended to be screened for cervical cancer routinely. This screening involves a Pap test which is often co-tested with an HPV test if needed. However, at this time, there is no HPV test available for men nor any HPV test capable of finding the virus in places other than the cervix. For this reason, measures should be taken to prevent contracting HPV in the first place. Using latex condoms during sex can reduce one’s risk of spreading the virus, but HPV can infect areas not covered by condoms so it is not full protection.

The best recommendation is to get vaccinated to prevent diseases caused by HPV.

Updated ACIP HPV Vaccination Recommendations In December of 2016, the Centers for Disease Control and Prevention (CDC) released an updated HPV vaccination schedule via their Morbidity and Mortality Weekly Report (MMWR). The HPV vaccination schedule update was guided by the Advisory Committee on Immunization Practices (ACIP), an expert panel that advises the CDC on immunization recommendations. ACIP reviewed clinical trials comparing the two and three dose series from November 2015 to October 2016 and determined that the immunogenicity of the three dose vaccine series was non-inferior to the two dose vaccine series for persons aged 9 through 14 years of age and there was similar efficacy and effectiveness between the two vaccine series options (Meites, Kempe, Markowitz, 2016).

The updated schedule for persons aged 9 through 14 years of age is as follows: • ACIP recommends that the HPV vaccine series be initiated at 11 or 12 years of age, but can be given as early as 9 years of age.

• For patients initiating the vaccine series before the age of 15 years old, they are recommended to receive 2 doses of the HPV vaccine, with the second dose received 6 to 12 months after the initial dose.

• If a patient received their first dose of the HPV vaccine prior to their 15th birthday AND the ACIP updated recommendations, only one additional dose is necessary (i.e. two doses total).

WWW.ARRX.ORG

AR-Rx_Spring 2017.indd 19

Helpful information for pharmacists about the HPV vaccine:

• Patients over the age of 15 years old and special patient populations are still recommended to receive 3 doses of the HPV vaccine.

• Duration of vaccine protection - it is suspected that immunity to HPV after receiving the vaccine is lifelong for both the 2 and 3-dose series.

• If the patient's vaccination series was interrupted, the series does not need to be restarted. The number of their total doses depends on the age of their initial dose of the series.

For more information, visit: https://www.cdc.gov/vaccines/ hcp/acip-recs/vacc-specific/hpv.html.

How can Arkansas pharmacists help increase HPV vaccination rates in Arkansas?

The key to increasing HPV vaccination rates in Arkansas is a strong recommendation from pharmacists to patients and parents. According to the America’s Health rankings 2016 Health of Women and Children Report, Arkansas ranks 47th and 49th out of 50 states in HPV vaccination for females and males ages 13 to 17 respectively. At the same time, Arkansas has the highest rate of cervical cancer incidents.Clearly, there is a lot of ground to cover in increasing our state’s HPV vaccination rates. The good news is that pharmacists can help! With authority granted by the Arkansas State Board of Pharmacy, Arkansas pharmacists may offer vaccines to children, adolescents and adults age 7 and over.

Patients over the age of 15 years old and special patient populations are still recommended to receive 3 doses of the HPV vaccine. _______________________ Duration of vaccine protection - it is suspected that immunity to HPV after receiving the vaccine is lifelong for both the 2 and 3-dose series. _______________________ If the patient's vaccination series was interrupted, the series does not need to be restarted. The number of their total doses depends on the age of their initial dose of the series.

19

4/28/17 10:31 AM

Options for Arkansas pharmacists to offer HPV vaccine: Children and Adolescents: • Age 9 to 17 – a patient specific prescription for the HPV vaccine and administration (verbal, paper, electronic prescription, faxed prescription) • Age 9 to 17 – Arkansas State Board of Pharmacy Regulation 9-01 Disease state Management protocol between a specific physician and a specific Arkansas disease state management credentialed pharmacist for patients that have a patient- physician established relationship with the physician that signed the protocol • Note: An Arkansas physician-pharmacist generalized immunization protocol is not allowed to be used for vaccines in children, except for influenza, for ages 7 to 17. Currently, Arkansas pharmacists are not allowed to administer immunizations under any circumstances to children age 6 years old and younger.

Adults: • Age 18 to 26 - a patient specific prescription for the HPV vaccine and administration (verbal, paper, electronic prescription, faxed prescription) • Age 18 to 26 - A generalized immunization protocol that authorizes HPV immunization

Immunization Coverage in Arkansas Pharmacies by Selected Health Plans Billing CPT code 90649 (Gardasil®) ICD 10 - Z23 for all vaccination diagnoses • State Employees and Public School Teachers: HPV coverage in pharmacies • Arkansas Blue Cross Blue Shield (BCBS) private plans: expected coverage in pharmacies for most plans • Arkansas Health Exchange Plans including Arkansas Works (Ambetter of Arkansas, Arkansas BCBS, QualChoice Arkansas): expected coverage in pharmacies for most plans • Medicare part B (very few eligible patients are age 26 or younger): HPV vaccine is not covered • Medicare part D (very few eligible patients are age 26 or younger): HPV vaccine is usually not covered • Medicare Advantage (very few eligible patients are age 26 or younger): HPV vaccine is usually not covered • Arkansas Medicaid age 19 and over- HPV vaccine is not currently covered • Arkansas Medicaid Age 7 to 18: Coverage of HPV vaccine is through the Arkansas Medicaid and Arkansas Department of Health Vaccine for Children Program or ARKids-B SCHIP Vaccine program Vaccines for Children (VFC): In 1993 Congress created the Vaccines for Children (VFC) program through the passage of the Omnibus Budget Reconciliation Act. In 1994, the program became operational within all 50 states and U.S. territories. The purpose of the VFC program is to improve

20

AR-Rx_Spring 2017.indd 20

vaccine availability by providing Advisory Committee on Immunization Practices (ACIP) recommended vaccines at no cost to eligible children who might not otherwise be vaccinated due to an inability to pay. The program is federally funded through the Centers for Disease Prevention and Control and the National Immunization Program and state-operated through each State Department of Health, certain local and territorial public health agencies, and Division of Medicaid.

Children are eligible to receive free vaccines through the VFC program if they are Medicaid-eligible, uninsured, underinsured (insurance does not the cover cost of immunizations), or American Indian or Alaskan Native ethnicity. In Arkansas, the program is administered by the Arkansas Department of Health. The Arkansas Department of Health distributes vaccine and provides technical support for best practices and workflows to eligible VFC providers. Arkansas Medicaid provides reimbursement opportunities to eligible VFC and ARKids-B SCHIP providers for vaccine administration.

The Arkansas Pharmacists Association is not currently aware of any Arkansas pharmacies that have successfully participated in offering vaccine in Arkansas VFC and successfully billing the administration modifier codes. The opportunity exists and our organization would like to hear from you if you are interested in a pilot to participate.

The Arkansas Medicaid Program will reimburse pharmacies the administration fee for selected vaccines that are obtained through the Vaccine for Children Program (VFC) or ARKids-B SCHIP Vaccine program. Please refer to section 292.950 of the Physician manual for VFC vaccines billing procedures and section 262.430 for ARKids-B SCHIP vaccine.

All Arkansas State Board of Pharmacy laws and regulations will apply.

To be eligible for participation, the pharmacy must meet the following criteria, in addition to those specified in Section 201.000: A. Complete Section III, Item 22, of the enrollment application (view or print Provider Enrollment application material) if the pharmacist is certified to administer the influenza virus and pneumococcal polysaccharide vaccines and B. Pharmacies must be enrolled in the Title XVIII (Medicare) Program to administer the vaccines listed above.

Refer to Section 210.100 for scope of coverage; Section 213.000 for benefit limits.

Refer to https://www.medicaid.state.ar.us. Click on Provider / Provider Manuals / Physician to access the online Arkansas Provider Manuals and fee schedules. Currently the immunization administration fees in VFC and ARKids-B SCHIP are covered and billed as EP/TJ modifier codes at a rate of $9.56 administration fee per vaccine.

For more information on the Arkansas Vaccines for Children program visit: http://www.immunizear.com/vfc

AR•Rx

|

THE ARKANSAS PHARMACIST

4/28/17 10:31 AM

Arkansas Immunization Action Coalition (AIAC)

The Arkansas Immunization Action Coalition (AIAC) is exploring options with the Arkansas Department of Health and other adolescent immunization stakeholders to help pharmacists collaborate with physicians and other prescribers in their area to potentially give the second or third dose of the series.

Adolescents age 11 to 18 typically receive one well child visit per year at the doctor, making administration of dose number 2 and 3 according to the CDC/ACIP schedule challenging to provide for some pediatric or family practice clinic settings. The intent for pharmacist involvement in the delivery of the HPV vaccine is to increase successful completion of the 2 or 3-dose series as we are more accessible to patients, especially in rural Arkansas.

For more information on the Arkansas Immunization Action Coalition visit: http://www.immunizear.org.

Arkansas WebIZ

The Arkansas Immunization Action Coalition (AIAC) is exploring options with the Arkansas Department of Health and other adolescent immunization stakeholders to help pharmacists collaborate with physicians and other prescribers in their area to potentially give the second or third dose of the series.

The Arkansas WebIZ system is the statewide immunization registry and is administered by the Arkansas Department of Health. The mission of the Arkansas Immunization Information System and registry is to utilize information management technology as the basis for an information system capable of improving Arkansans’ immunization documentation and increasing the immunization rates of Arkansans, in order to prevent and/or reduce the morbidity and mortality from vaccine preventable disease.

Arkansas state law REQUIRES that all immunizations administered to patients 21 years of age and younger must be reported to the state's immunization registry WebIZ. Despite the law, it is best practice to report all immunizations for all ages into the state's immunization registry WebIZ. For example, those pharmacists who collaborate with Dr. Jennifer Dillaha at the Arkansas Department of Health and her immunization protocol are required to report all vaccines into WebIZ regardless of age. In addition, Arkansas CPESN (Community Pharmacy Enhanced Services Network) has

a requirement in their participation agreement to report all vaccines to WebIZ for all ages. This best practice will ensure better care coordination with immunizations for Arkansans.

Although our HPV vaccination rankings are currently poor, there is nowhere to go but up from here! § _____________________________________________________ Meites E, Kempe A, Markowitz LE. Use of a 2-Dose Schedule for Human Papillomavirus Vaccination — Updated Recommendations of the Advisory Committee on Immunization Practices MMWR. 2016;65(49);1405-8. http://www.americashealthrankings.org/explore/2016-health-ofwomen-and-children-report/measure/Immunize_HPVmale_MCH/ state/AR

Resources:

• https://www.cdc.gov/hpv • America’s Health Rankings (United Health Foundation): Arkansas cervical cancer data - http://www.americashealthrankings.org/explore/2016health-of-women-and-children-report/measure/Immunize_HPVfemale_MCH/state/AR • American Cancer Society monthly newsletter: https://www.mysocietysource.org/sites/HPV/ResourcesandEducation/Lists/Clearinghouse/ Attachments/583/HPV%20VACs%20Partner%20Newsletter%20-%20October%202016.pdf • http://www.middleschoolhealth.org • https://www.youtube.com/watch?v=NthPcXk81TI&feature=youtu.be • https://www.youtube.com/watch?v=wQSTUIw8_1U

WWW.ARRX.ORG

AR-Rx_Spring 2017.indd 21

21

4/28/17 10:31 AM

22

AR-Rx_Spring 2017.indd 22

AR•Rx

|

THE ARKANSAS PHARMACIST

4/28/17 10:31 AM

APA 20

WWW.ARRX.ORG

APA 2017 Conv Brochure.indd 1 AR-Rx_Spring 2017.indd 23

23

4/5/17 10:31 5:20 AM PM 4/28/17

Photos Courtesy of Arkansas Department of Parks and Tourism

ELEVATE your

PROFESSIONAL GAME 135TH APA ANNUAL CONVENTION JUNE 8-10, 2017 The Arkansas Pharmacists Association’s (APA) 135th Annual Convention will be held at The Little Rock Marriott Downtown in Little Rock from June 8-10, 2017. The conference theme, Elevate Your Professional Game, reflects the environment of constant change for pharmacists and other healthcare providers.

Pharmacists can stay up-to-date and informed with the Continuing Pharmacy Education sessions and networking opportunities planned at the convention. This annual conference will welcome up to 350 pharmacists, pharmacy technicians, exhibitors, students, and special guests.

______________________________________________________

WHY ATTEND

______________________________________________________

CONTINUING PHARMACY EDUCATION: APA will offer 15.5 hours of Continuing Pharmacy Education credit with highly-regarded instructors on topics ranging from medical marijuana to workflow innovation.

COMPREHENSIVE EXHIBITION: Exhibitors including pharmacy wholesalers, manufacturers, insurers, Colleges of Pharmacy, hospitals, and software vendors will be on hand to discuss their newest products and services that will benefit the practice of pharmacy in Arkansas. Be sure to visit with these professionals to learn about their innovative products.

SOCIAL AND NETWORKING EVENTS: Join old and new friends at the convention social events. In addition to the always popular Opening Reception at the Exhibit Hall, the Friday evening reception will be held at the Marriott and feature an Extreme Bingo night. Enjoy this fun entertainment as well as beverages and a dinner. ____________________________________________________

ACCOMMODATIONS

____________________________________________________

The host hotel for the 135th APA Annual Convention is The Little Rock Marriott Downtown at 3 Statehouse Plaza in Little Rock. Check-in is at 3:00 PM and checkout is 12:00 PM. For reservations, call 877-759-6290.

Room rate starts at $145.00 plus tax. Mention Arkansas Pharmacists Association Group for group rate. Cut-off date for rooms is May 22, 2017.

WE APPRECIATE THE SUPPORT OF OUR WHOLESALE BUSINESS PARTNERS! * AmerisourceBergen Cardinal Health McKesson Morris & Dickson Company, LLC Smith Drug Company * These organizations did not provide any financial support for continuing education activities.

24 2 AR-Rx_Spring APA 2017 Conv 2017.indd Brochure.indd 24 2

4/28/17 4/5/17 10:31 5:20 AM PM

APA 201

SCHEDULE OF EVENTS ____________________________________________________

WEDNESDAY, JUNE 7, 2017

2:00 - 5:30 PM

AFTERNOON CPE BLOCK • Arkansas Pharmacy Law Update • Battling the Opioid Epidemic Success from the Field with Naloxone • Harding University College of Pharmacy APhA-ASP: Generation RX - Education of the Youth & Prescription Drug Abuse

4:00 - 5:30 PM

Arkansas Pharmacists Foundation Board Meeting

5:45 - 6:15 PM

President’s Reception Honoring APA President Eddie Glover Opening Reception / Student Poster Session in Exhibit Hall

____________________________________________________ 9:00 AM - 12:00 PM

APA Board of Directors Meeting

1:00 PM

Arkansas Pharmacy Foundation Golf Tournament Greystone Country Club, Cabot

_____________________________________________________

THURSDAY, JUNE 8, 2017

_____________________________________________________ 7:00 AM - 4:30 PM

Registration

7:30 - 8:45 AM

Breakfast

6:15 - 8:15 PM

9:00 AM - 12:00 PM

MORNING CPE BLOCK • Medical Use of Cannabis • Safety Nets LIVE (Drug Interactions & Prescribing Errors)

______________________________________________________

12:15 - 1:45 PM

Luncheon & Awards Ceremony

APA President Eddie Glover and 2016 Pharmacist of the Year Keith Larkin

FRIDAY, JUNE 9, 2017

_____________________________________________________ 7:00 AM - 4:30 PM

Registration

7:30 - 8:45 AM

AP-PAC Breakfast and Speaker

9:00 AM - 12:00 PM

MORNING CPE BLOCK • Real World Success Stories • State of the Association Address* • The Art of Positive Communication

10:00 AM - 12:30 PM

Arkansas Association of Health-System Pharmacists (AAHP) Board Meeting

*No CPE credit awarded for this session

253 5:20 PM

APA 2017 Conv2017.indd Brochure.indd AR-Rx_Spring 25 3

4/5/17 10:31 5:20 PM 4/28/17 AM

______________________________________________________

SATURDAY, JUNE 10, 2017

_____________________________________________________ 7:00 - 10:00 AM

Registration

7:30 - 8:45 AM

Breakfast

9:00 AM - 12:30 PM

MORNING CPE BLOCK • Entrepreneurship/Business Plan/RWSS • Immunization Update

12:30 PM

Convention Adjourns

Photo Courtesy of Arkansas Department of Parks and Tourism

10:00 AM - 2:00 PM

Spouse Trip Painting with a Twist (lunch provided)

Painting with a Twist is the premier place to go for a fun, creative night out! Never painted before? No problem! Let our talented local artists guide you through a painting step by step. We provide all of the materials needed for the painting.

Spouses will make a special visit to the Old Mill, featured in the opening credits of Gone with the Wind, and then paint their own version of an Arkansas landmark.

12:15 - 1:45 PM

Luncheon in Exhibit Hall

2:00 - 5:15 PM

AFTERNOON CPE BLOCK • Optimizing the Medical Neighborhood • Hypertension

6:30 - 9:00 PM

Extreme Bingo Night

— Honoring APA’s Wholesale Partners — AmerisourceBergen, Cardinal Health, McKesson, Morris & Dickson, and Smith Drug

This ain’t your mama’s Bingo. Music, refreshments, surprise giveaways, and more await you at this one of a kind game night. You may think you know Bingo, but you have no idea.

CONTINUING PHARMACY EDUCATION SESSIONS ______________________________________________________

THURSDAY MORNING

_____________________________________________________ MEDICAL USE OF CANNABIS – Kari Franson, Pharm.D., Ph.D., BCPP - Associate Dean for Professional Education, Department of Clinical Pharmacy at Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado ACPE# 0004-9999-17-025-L01-P ACPE# 0004-9999-17-025-L01-T 1.5 Contact Hours This CPE activity will be knowledge based CPE Objectives: • Identify the main constituents of cannabis • Review the endocannabinoid system • Describe the pharmacology of cannabis to explain medical uses, effect on the reward pathway, and acute toxicity and long-term risks • Review various dosing methods for medical cannabis • Outline the pharmacokinetic differences between different cannabis dosage forms DRUG INTERACTIONS & PRESCRIBING ERRORS – John Horn, Pharm.D., FCCP - Associate Director Pharmacy Services, University of Washington ACPE # 0004-9999-17-026-L01-P ACPE # 0004-9999-17-026-L01-T 1.5 Contact Hours This CPE activity will be knowledge based CPE Objectives: • Review how DDI databases are constructed • Understand limitations to current DDI clinical decision support • What is Alert Fatigue and how to avoid it • Review examples of appropriate and inappropriate DDI alerts • What the future holds for computerized DDI screening

26 4 AR-Rx_Spring 26 4 APA 2017 Conv2017.indd Brochure.indd

4/28/17 AM 4/5/17 10:31 5:20 PM

APA 201

_____________________________________________________

___________________________________________________

___________________________________________________

THURSDAY AFTERNOON

___________________________________________________

ARKANSAS PHARMACY LAW UPDATE – John Kirtley, Pharm.D. - Executive Director of Arkansas State Board of Pharmacy ACPE# 0004-9999-17-027-L03-P ACPE# 0004-9999-17-027-L03-T 1.5 Contact Hours This CPE activity will be knowledge based

REAL WORLD SUCCESS STORIES – Bobby Glaze, Pharm.D.- Morrison Clinic Pharmacy, Camden; Max Caldwell, PD- Caldwell Drug, Wynne; Leslie Reed, Pharmacy Tech, Harps Food, Northwest Arkansas ACPE# 0004-9999-17-029-L04-P ACPE# 0004-9999-17-029-L04-T 1.5 Contact Hours This CPE activity will be knowledge based

CPE Objectives: • Analyze recent changes in pharmacy regulations in Arkansas • Discuss the reasoning behind changes to pharmacy regulations • Describe recent pharmacy regulatory changes and challenges • Identify three practice changes to protect your controlled substance inventory BATTLING THE OPIOID EPIDEMIC - SUCCESS FROM THE FIELD WITH NALOXONE Chief Kirk Lane, Benton Arkansas Chief of Police ACPE# 0004-9999-17-028-L01-P ACPE# 0004-9999-17-028-L01-T 1.5 Contact Hours This CPE activity will be knowledge based CPE Objectives: • What is Naloxone?

• How Naloxone works in preventing opioid overdose • Arkansas Act 1222 • Naloxone for first responders program • Success and the need to develop more programs and awareness HARDING UNIVERSITY COLLEGE OF PHARMACY APHA-ASP: GENERATION RX - EDUCATION OF THE YOUTH AND PRESCRIPTION DRUG ABUSE - Taryn Eubanks, Harding University College of Pharmacy Student CPE Objectives: • What is Generation RX • HUCOP contribution to Generation RX • Future insights for Generation RX

FRIDAY MORNING

CPE Objectives: Therapeutic Substitution in Arkansas: Tools for a Successful Pharmacy Practice Model - Bobby Glaze • What is therapeutic substitution and outline of the law in Arkansas?

• What are the benefits of therapeutic substitution for both the provider and pharmacy?

• Layout of how I have incorporated therapeutic substitution into my practice and success and failures • How to approach providers and start the conversation of therapeutic substitution • A detail of references that have been helpful in setting up therapeutic substitutions Workflow Innovation - Max Caldwell • Describe how technology can drive efficiency in workflow • Discuss how dedicated workstations for pharmacists and technicians can streamline workflow MTM The Future: The Complete Team-Based Training Program - Leslie Reed • The role of the pharmacy technician in MTM • The importance of integrating the pharmacy technician in clinical services • The impact of the pharmacy technician on MTM completion • The team-based training experience • How to incorporate and empower pharmacy technicians in the community pharmacy THE ART OF POSITIVE COMMUNICATION – Julien C. Mirivel, Ph.D. - Interim Associate Dean for Student Success Associate Professor, Department of Applied Communication, College of Social Sciences & Communication, University of Arkansas at Little Rock ACPE# 0004-9999-17-034-L04-P ACPE# 0004-9999-17-034-L04-T 1.5 Contact Hours This CPE activity will be knowledge based CPE Objectives: • Have a practical model in hand to guide their communication with others • Know what communication behaviors make a real difference • Have the tools to build high-quality connections, serve patient effectively, and foster a positive workplace climate 27 5

5:20 PM

AR-Rx_Spring 27 5 APA 2017 Conv2017.indd Brochure.indd

4/28/17 AM 4/5/17 10:31 5:20 PM

___________________________________________________

FRIDAY AFTERNOON

___________________________________________________ OPTIMIZING THE MEDICAL NEIGHBORHOOD: TRANSFORMING CARE COORDINATION THROUGH THE COMMUNITY PHAMACY ENHANCED SERVICES NETWORK – Joe Moose, Pharm.D. - Moose Pharmacy, North Carolina ACPE# 0004-9999-17-030-L04-P ACPE# 0004-9999-17-030-L04-T 1.5 Contact This CPE activity will be knowledge based CPE Objectives: • Discuss strategies for creating a CPESN to integrate community pharmacy into the medical neighborhood • Evaluate the basic standards common to existing community pharmacy enhanced service networks (CPESNs) • Outline processes and best practices for forming a CPESN HYPERTENSION: GUIDELINES GALORE AND CASES – Michelle Piel, Pharm.D. - Professor at UAMS College of Pharmacy ACPE# 0004-9999-17-031-L01-P ACPE# 0004-9999-17-031-L01-T 1.5 Contact Hours This CPE activity will be knowledge based CPE Objectives: • Risks associated with uncontrolled hypertension • Determining a patient’s blood pressure goal according to treatment guidelines (JNC-8, ASH/ISH, ADA, KDIGO, etc.)

• Four drug classes considered first-line agents for HTN • Application of current treatment guidelines and patientspecific factors to clinical cases with and without other compelling indications (including diabetes, chronic kidney disease, coronary artery disease, and history of stroke or myocardial infarction) • Treatment strategies for resistant hypertension ___ __________________________________________________ ____

SATURDAY MORNING

___________________________________________________ ENTREPRENEURSHIP/BUSINESS PLAN/RWSS – UAMS College of Pharmacy Business Plan Team, Brandon Achor, Pharm.D. - Lackie Drug Store; Kevin Barton, Pharm.D.- Walmart ACPE# 0004-9999-17-032-L04-P ACPE# 0004-9999-17-032-L04-T 1.5 Contact Hours This CPE activity will be knowledge based

CPE Objectives: The Next Generation of Entrepreneurs - UAMS COP Business Plan Team • NCPA student business plan competition • Entrepreneurship in the curriculum • Innovative Community practice model • Location/Financial analysis of community pharmacy • Feasibility of new services • Improving the patient experience, improving population health, and reducing healthcare cost Business Plan to Practice - Brandon Achor • Explain the processes of the student business plan competition both locally and nationally • Discuss skills developed during business plan drafting and presentation • Explain the mutual benefits of sweat equity partners and leveraging • Recount personal struggles and successes of independent pharmacy management and ownership • Highlight managing partnership opportunities and advantages for both sellers and buyers Quest to Improve Patient Care - Kevin Barton • The importance of networking • My motivation & passion for the pharmacy profession • Leading the next generation of pharmacists IMMUNIZATION UPDATE – Stephen Foster, Pharm.D.Professor at University of Tennessee, Memphis College of Pharmacy ACPE# 0004-9999-17-033-L01-P ACPE# 0004-9999-17-033-L01-T 2.0 Contact Hours This CPE activity will be knowledge based CPE Objectives: • Apply CDC immunization schedule to a patient case based on age and/or disease state.

• Discuss strategies to inform patient’s decision on vaccinations.

The University of Arkansas for Medical Sciences (UAMS) College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of Continuing Pharmacy Education.

Continuing Education Credit: The UAMS Academic Affairs Office of Continuing Education is accredited by the Accreditation Council for Pharmacy Education as a provider of Continuing Pharmacy Education.

These activities will provide pharmacists up to 15.5 contact hours or 1.55 CEU.

ACPE# 0004-9999-17-025-L01-P ACPE# 0004-9999-17-025-L01-T ACPE# 0004-9999-17-026-L01-P ACPE# 0004-9999-17-026-L01-T ACPE# 0004-9999-17-027-L03-P ACPE# 0004-9999-17-027-L03-T ACPE# 0004-9999-17-028-L01-P ACPE# 0004-9999-17-028-L01-T ACPE# 0004-9999-17-029-L04-P ACPE# 0004-9999-17-029-L04-T ACPE# 0004-9999-17-034-L04-P ACPE# 0004-9999-17-034-L04-T

ACPE# 0004-9999-17-030-L04-P ACPE# 0004-9999-17-030-L04-T ACPE# 0004-9999-17-031-L01-P ACPE# 0004-9999-17-031-L01-T ACPE# 0004-9999-17-032-L04-P ACPE# 0004-9999-17-032-L04-T ACPE# 0004-9999-17-033-L01-P ACPE# 0004-9999-17-033-L01-T ACPE# 0004-9999-17-034-L04-P ACPE# 0004-9999-17-034-L04-T

28 6 AR-Rx_Spring 2017.indd 28 APA 2017 Conv Brochure.indd 6

4/28/17 4/5/17 10:31 5:20 AM PM

APA 20

APA 2017 ANNUAL CONVENTION REGISTRATION FORM Register online at www.arrx.org First Name: _________________________________________ Last Name: _________________________________________ Designation: P.D. Pharm.D. Technician Student Other Nickname (for badge): _______________________________ Home Address: _____________________________________ City: _________________ State: ___ Zip: _______________ Cell Phone:_____________ Work Phone: ________________ Email: ______________________________________________ Employer: __________________________________________ Pharmacist License # (e.g. PD01234): _________________ NABP E-Profile #:____________________________________

PHARMACIST FULL REGISTRATION PACKAGE

Includes: All education sessions and CPE, receptions, exhibit hall admission, prize drawings, breaks and social event tickets for Thursday, Friday and Saturday.

Cutoff Date for Early Bird Registration is May 22, 2017.

APA MEMBER

Before 5/22 After 5/22

NON MEMBER

Before 5/22 After 5/22

Full Registration

$279

$309

$374

$404

Full Registration

$379

$409

$474

$504

& Spouse/Guest

PHARMACIST DAILY REGISTRATION PACKAGE

Includes: All education sessions and CPE, receptions, exhibit hall admission, prize drawings, breaks and social events for the day of registration.

APA MEMBER NON MEMBER

APA MEMBER NON MEMBER Full Registration

$175

$210

Thursday Only Registration

$120

$140

Friday Only Registration

$120

$140

Saturday Only Registration

$120

$140

PHARMACY STUDENT SPONSORSHIP Pharmacy Student Sponsorship - $85

Sponsor a student pharmacist to provide the opportunity for a UAMS or Harding College of Pharmacy student to attend the APA convention for free.

# of Students to Sponsor _____ @ $85 each = __________

ADDITIONAL CONVENTION ACTIVITIES Wednesday, June 7 Convention Golf Tournament, Greystone Country Club, Cabot - $65 # of Golfers ______ at $65 per player = ________________ Name(s) of Golfers ________________ _________________ ________________ _________________ Friday, June 9 Spouse Trip to Old Mill and Painting with a Twist - $50 Name of Attendee: _________________________________

SOCIAL EVENT TICKETS - Friday, June 9

Social Event Tickets are included in the Full Registration Package. However, we need to know which event you want to attend so that we have correct numbers for reservations.

Evening Social Event, Extreme Bingo Night # of Additional Tickets: ________ @ $50 each = _________

RESERVATIONS

Please let us know the number of attendees for each event you plan on attending. _____ Thursday, June 8 - Awards Luncheon and Ceremony _____ Thursday, June 8 - Opening Reception _____ Friday, June 9 - AP-PAC Breakfast _____ Friday, June 9 - Exhibitor Lunch _____ Friday, June 9 - Extreme Bingo Night _____ Saturday, June 10 - Breakfast & State of the Assoc.

Thursday Only Registration

$199

$249

Thursday Only Registration and Spouse/Guest

$249

$299

Friday Only Registration

$199

$249

Friday Only Registration and Spouse/Guest

$249

$299

Total Amount: ______________________________________

Saturday Only Registration

$149

$199

Card# ______________________________________________

Saturday Only Registration and Spouse/Guest

$199

$249

Refund Policy

By May 19, 2017, 50 percent refund will be issued. After May 19, 2017, no refund will be issued. All refund/cancellation requests must be submitted to APA in writing. Registrations are non-transferrable.

5:20 PM

TECHNICIAN REGISTRATION PACKAGE

APA 2017 Conv2017.indd Brochure.indd AR-Rx_Spring 29 7

PAYMENT

Pymt. Type: __Visa __AmEx __MC __Discover __Check Exp____________________ Sec Code___________________ Billing Address_______________________________________ City__________________ State________ ZIP______________ Please make checks payable to Arkansas Pharmacists Association: 417 S. Victory St., Little Rock, AR 72201 Fax to: 501-372-0546 or register at www.arrx.org/2017convention 29 4/5/17 10:31 5:20 PM 4/28/17 AM

APA Hosts Legislative Day January 25 APA’s 2017 Legislative Day and Reception brought together pharmacists and legislators for a day of discussing important topics relevant to pharmacy in Arkansas. Pharmacists started the day with a luncheon at APA headquarters before being formally recognized in both the Arkansas Senate and House of Representatives.

Attendees then convened at the Old Supreme Court room where APA CEO and Executive Vice President Scott Pace provided a look at possible legislation being introduced during the 2017 session. The pharmacists also earned three hours of CPE before joining legislators for the Legislative Reception at Trapnell Hall in Little Rock

Pharmacists gather in the gallery to be recognized by the House of Representatives.

Scott Pace welcomes pharmacists to the Arkansas State Capitol for APA Legislative Day.

Rep. Mat Pitsch, Lacey Parker, Keith Larkin, and Rep. Justin Boyd

Darla York and Rep. Scott Baltz

30

AR-Rx_Spring 2017.indd 30

Pharmacists gather in the Old Supreme Court room at the Arkansas State Capitol for APA Legislative Day. AR•Rx

|

THE ARKANSAS PHARMACIST

4/28/17 10:31 AM

Pharmacists gather in the Old Supreme Court room at the Arkansas State Capitol for APA Legislative Day.

Amanda Camp and Josh Bright

James Bethea, Debra Wolfe-Shepard, and Rep David Hillman

John Kirtley, Kendrea Jones, Rayanne Story, and Lanita White

John Cobb and Rep Trevor Drown

Ed Pat Wright and Rep. Steve Hollowell

Elisabeth Mathews, Mary Bradley, and Nicki Hilliard

WWW.ARRX.ORG

AR-Rx_Spring 2017.indd 31

31

4/28/17 10:31 AM

Pharmacists and legislators mingle at Trapnell Hall in Little Rock

Buddy Newton and Rep David Whitaker

Dylan Jones, Sen Uvalde Lindsey, and Jo Lindsey

Sparky Hedden, Rep Ken Bragg, and Rep Johnny Rye

Scott Pace, Attorney General Leslie Rutledge, and Rep Justin Boyd

WWW.ARRX.ORG

AR-Rx_Spring 2017.indd 32

Rep Les Eaves and Rodney Richmond

32

4/28/17 10:31 AM

Sen. Ron Caldwell and Rodney Richmond

THANK YOU to all who attended APA Legislative Day! Kelley Linck and Rep Jack Ladyman

Rep Michelle Gray and Darla York

Harold Simpson and Rep Aaron Pilkington

33

AR-Rx_Spring 2017.indd 33

Ana Tran, Ashley Earley, and Kaitlyn Dillard

AR•Rx

|

THE ARKANSAS PHARMACIST

4/28/17 10:31 AM

UAMS REPORT

Community Pharmacy Residencies

Megan Smith Pharm.D. Assistant Professor

Keith Olsen Pharm.D., FCCP, FCCM Dean and Professor

O

Changing healthcare needs require accelerated competency ne key area of the UAMS COP strategic plan is to increase opportunities for the growing demand for community in the market. Diverse patient populations require diverse skills pharmacy residencies. In my last ARRX article (Winter 2017) to participate in patient outcomes. The new Accreditation about integrating MTM into pharmacy workflow, I referred Standards for community-focused practice leaders emphasize to a training program created in Arkansas for implementing the shift from looking at dispensing and patient care services MTM clinical services into the workflow of community separately to blending them together. Residency-trained pharmacy practice. This now nationally recognized step-byclinical specialists’ skills impact complex patient population step integrative process became possible largely because outcomes, while increasing capacity for advanced practice UAMS graduate Nikki Scott, Pharm.D. had time to focus in technology, research, and integrated care relationships. In a broader context for the pharmacy profession, residencies on practice advancement during her community pharmacy residency with Harps (2015-2016). We provide multiple patient care services recognize that often staff pharmacists do in the community setting and translate Community residencies not have the time to develop enhanced innovative ideas and services into all of often focus on creating a our clinical practices. service improvements. In contrast to health-system residencies, community new pharmacy service or Today, 141 PGY1 community pharmacy residencies often focus on creating a new improvement of an existing residency programs are listed in ASHP’s pharmacy service or improvement of an service and the impact to the existing service and the impact to the Online Residency Directory, available business and sustainability business and sustainability of the service. in independent, grocery store, national of the service. chain, specialty, and health-system The APhA/ASHP defined purpose of a outpatient pharmacies. At UAMS we are residency program is to build upon the committed to enhancing student learning doctor of pharmacy (Pharm.D.) education and outcomes to opportunities with our Arkansas pharmacies/pharmacists partners. In Arkansas specifically, ARcare in Augusta, AR develop community-based pharmacist practitioners with diverse patient care, leadership, and education skills who are holds candidate status, Kroger Pharmacy/UAMS (operating eligible to pursue advanced training opportunities including since 2008 in Little Rock) holds candidate status for March postgraduate year two (PGY2) residencies and professional 2017 accreditation decision, and Harps Foods and Walmart certifications. Historically, in 1986, PGY1 Community Bentonville began residencies in 2013. Harps Foods, Walmart Pharmacy Residencies were established to develop skills in and Kroger will transition to a multi-site residency program areas such as management, drug distribution and clinical in Spring 2017, and welcome a new site, Bryant Family services. In 1997 the APhA updated the guidelines to address Pharmacy in Bryant, AR, which will host their first resident the growing shift toward patient care. The first APhA-ASHP in July 2017.

Community Pharmacy Residency Accreditation Standards were adopted in 1999. These standards were again updated At a recent (November 2016) International Pharmaceutical in 2006, implemented for resident class 2007.

Federation (FIP) Global Conference on Pharmacy & Pharmaceutical Sciences Education gathering, the world The 2006 Accreditation Standard for PGY1 Community agreed that, on the pharmacy practice side, there is a need Pharmacy Residency Programs is being replaced by for more direct patient care education for pharmacy students. the Accreditation Standard for PGY1 Community-Based Specialized patient care requires advanced pharmacy training.

Pharmacy Residency Programs effective July 1, 2017.

Though we believe community pharmacy residencies provide These new standards reflect the diversity of programs in ultimate benefit to patients, they also provide opportunity for settings other than the traditional community pharmacy, preceptor leadership and guidance, inspire options for future such as outpatient settings, nonprofit health care systems career practice areas, and offer site retention of internally and specialty pharmacies. They introduce a new term, trained practitioners. The need continues to grow to meet the “community-focused practice leaders”, serving as an access demands of practice and our students requesting advanced point for care, and having the skillset necessary to provide training opportunities. § quality generalist patient care services wherever health and medication needs arise.

34

AR-Rx_Spring 2017.indd 34

AR•Rx

|

THE ARKANSAS PHARMACIST

4/28/17 10:31 AM

WWW.ARRX.ORG

AR-Rx_Spring 2017.indd 35

35

4/28/17 10:31 AM

HARDING UNIVERSITY REPORT

Harding University College of Pharmacy Welcomes New ACPE Standards

I

f you keep up with the changing world of pharmacy education, you Jeff Mercer, Pharm.D. Dean may be aware that the Accreditation Council for Pharmacy Education (ACPE) recently implemented a new set of standards for Pharm.D. programs. “Standards 2016” is the first major revision of ACPE expectations for quality assurance of schools and colleges of pharmacy since 2007. Among a number of key points of emphasis, the current Standards place a heavy focus on the importance of both curricular and co-curricular experiences in advancing the personal and professional development of students.

According to ACPE, “Co-curricular activities complement and advance the learning that occurs within the formal didactic and experiential curriculum.” While most educational programs can identify some forms of co-curricular aspects embedded within and alongside the formal curriculum, assessment of these activities is often overlooked. This is the first time that ACPE has emphasized the need for all schools to identify and assess the effectiveness of co-curricular activities in student learning and development.

ACPE’s new Standards 2016 also rely heavily upon the 2013 Center for the Advancement of Pharmacy Educational Outcomes (CAPE 2013) resource as the target for a welldeveloped pharmacy curriculum. In this fourth revision of its pharmacy educational outcomes, CAPE moved beyond the traditional domains of assuring knowledge and skills and added a new domain focused squarely upon personal attributes and professional skills development. Subdomains are affective in nature and include student outcomes in self-awareness, leadership, innovation/entrepreneurship, and professionalism needed for pharmacy practice.

Students and faculty at Harding University College of Pharmacy (HUCOP) welcomed the ACPE Standards 2016 revisions with appreciation and a sense of familiarity. From our onset, HUCOP has identified itself as a mission and service-based College of Pharmacy. Our program is designed around patient advocacy, community engagement, and holistic student development. To accomplish this, we intentionally embedded a co-curriculum alongside our formal didactic and experiential curriculums in an effort to teach students life-long learning through selfassessment and directed improvement.

Perhaps the most visible example of a co-curricular feature at HUCOP is our weekly mentor-mentee program. Throughout each semester, groups of 6-8 pharmacy students, representing each of the first three professional years, meet with an assigned faculty mentor. Topics and resources are provided to facilitate active engagement and growth in areas of personal and professional development. Specific topics covered include professionalism, academic integrity, pharmacy organizations, 36

AR-Rx_Spring 2017.indd 36

interprofessional practice, college governance, stress management, team-based practice, cultural competence, and health disparities. Additional mentor-mentee sessions include formal aspects of the traditional (graded) curriculum, including student presentations of current events, introductory pharmacy practice experience (IPPE) reflections on shadowing, Patient Caring (longitudinal IPPE), and pharmacy service learning (PSL) activities as well as completion of simulated clinical scenarios.

In total, students spend up to 30 hours each year in mentormentee related activities designed to help students develop personally and professionally.

Harding is committed to teaching students while making a positive difference in the communities we serve. Our experiential program incorporates the same traditional set of pharmacy experiences required of all pharmacy students throughout the nation. However, we have chosen to layer in an additional cocurricular expectation of pharmacy service. Some students choose to serve in well-established areas of pharmacy need (e.g. community immunization clinics, health fairs, indigent medical clinics, etc.), while others create service experiences aligned with curricular requirements and the college mission.

All PSL activities encourage self-awareness, professionalism modeling, and aspects of leadership and innovation in applying a service mindset to a pharmacy-related activity. Creative thinking, vision, innovation, leadership, and responsibility are reinforced as students develop and implement pharmacy services that improve community health outcomes and overcome barriers to advance the profession.

At minimum, each of our students completes more than 300 hours of pharmacy related service during their time at HUCOP through layered aspects of curricular and cocurricular designed activities. Assessments are performed utilizing data from student structured reflections, professional portfolios, and presentations. The impact on the community is assessed through various quantitative and qualitative means to measure quality. While the number of service hours and various assessments can quickly add up among a cohort of students, the full impact on the community and the personal and professional development of each student is truly immeasurable.

In a world of ever refining accreditation standards, it is comforting to see validation of current academic practices.

Harding University College of Pharmacy has a well-established curriculum with co-curricular activities embedded throughout to provide students with the opportunities to grow as they learn to serve others. § If you would like to learn more about the ACPE Standards 2016, please visit www.acpe-accredit.org. CAPE 2013 is available through www.aacp. org. Questions about HUCOP pharmacy service activities - pharmacy@ harding.edu.

AR•Rx

|

THE ARKANSAS PHARMACIST

4/28/17 10:31 AM

37

AR-Rx_Spring 2017.indd 37

AR•Rx

|

THE ARKANSAS PHARMACIST

4/28/17 10:31 AM

ARKANSAS ACADEMY OF HEALTH-SYSTEM PHARMACISTS

Antimicrobial Stewardship: Improving Quality of Care through Bugs and Drugs Kendrea Jones, Pharm.D. President

F

or over three years, most health-systems have been preparing for the Antimicrobial Stewardship Joint Commission standard that became effective on January 1, 2017 that requires hospitals, critical access hospitals, and nursing homes to implement formal antimicrobial stewardship programs (ASP). In institutions that are not Joint Commission accredited, preparation for the Centers of Medicare and Medicaid Services (CMS) requirements is underway.

What is Antimicrobial Stewardship?

Antimicrobial stewardship at its foundation is matching the right drug with the right bug to reduce the overuse of antimicrobials and development of resistant pathogens.

ASP improves patient outcomes through evaluating the entire antibiotic selection process including diagnostic testing to determine if an antibiotic is needed, educating healthcare professionals on choosing the right antibiotic at an effective and safe dose, implementing guidelines to guide duration of therapy but also when to deescalate, and improving workflows to improve timeliness of initial therapy.

It requires collaborating with infection preventionist and microbiologist to reduce hospital-associated infections and evaluating negative outcomes of overuse of antibiotics including emergence of resistance and clostridium-difficile infection rates.

requirement of antimicrobial stewardship programs in all health-systems and mirrors national standards. AAHP was been very involved in providing language that incorporated pharmacists in all aspects of antimicrobial stewardship. In a rural state in which there are few infectious-disease trained physicians in each facility, pharmacists are playing key role in implementing antimicrobial stewardship programs. Please follow us on Facebook and Instagram for more information on how to get involved with our stewardship efforts or for opportunities to get involved with AAHP, contact any board member at http://www.arrx.org/aahp. ยง _____________________________________________________

References/Resources: https://www.cdc.gov/getsmart/healthcare/ pdfs/core-elements.pdf; https://www.jointcommission.org/assets/1/6/ New_Antimicrobial_Stewardship_Standard.pdf

What is AAHP doing to help Pharmacists and Antimicrobial Stewardship Efforts?

In 2015, AAHP began working closely with the Arkansas Department of Health (ADH) the Arkansas Hospital Association (AHA) to start a pharmacist-led collaborative for antimicrobial stewardship. The interprofessional collaborative brings together key stakeholders to share best practices on implementing stewardship programs.

A recent article featured by the CDC highlighting the collaborative efforts can be found at https://www.cdc.gov/ getsmart/community/pdfs/16_272181-a_statehealthdept_ ar_508.pdf. We are excited that our very own past AAHP president and current treasurer, Dr. Marsha Crader has been appointed to serve on an Arkansas Department of Health Antimicrobial Stewardship Committee. Additionally, during this legislative session AAHP worked with House Representative David Whitaker and a multidisciplinary team to draft House Bill 1815 (HB1815) that mandates the

38

AR-Rx_Spring 2017.indd 38

ARโ ขRx

|

THE ARKANSAS PHARMACIST

4/28/17 10:31 AM

AAHP: ANTIMICROBIAL STEWARDSHIP

What is included in the new Antimicrobial Stewardship Joint Commission Medication Management Standard? What are Health-Systems doing to meet the standard?

The Joint Commission standard includes eight key elements and the CMS requirements align closely with these elements.

WWW.ARRX.ORG

AR-Rx_Spring 2017.indd 39

39

4/28/17 10:31 AM

Member Classifieds

Member Classifieds are free to APA members and $65 per issue for nonmembers. Contact communications@arrx.org for more information.

Pharmacy Signs and Fixtures. Email chris@csipharmacy. com for additional details. https://littlerock.craigslist.org/ for/6035160241.html Full Time Pharmacist Needed in Retail Setting: AllCare Pharmacy in Texarkana, AR is looking for a highly motivated, outgoing individual. We are a growing company with a competitive salary. Please contact Dean at: dean.sikes@ allcarepharmacy.com or 870-246-5553.

NEW Arkansas Children’s Northwest opening January 2018, Springdale. Help bring care close to home for the children of NW Arkansas. Our new facility needs a Pharmacy Manager, which requires a BS in Pharmacy or Pharm D, 3 years of hospital pharmacy experience which includes 1 year of management experience. Must have current Pharmacist License. NOTE: This position will require 3 – 9 months of onboarding in Little Rock at Arkansas Children’s Hospital, dependent on experience. Contact: Laura Spies - spiesl@ archildrens.org - 479-750-0125 ext. 290

40

AR-Rx_Spring 2017.indd 40

Oncology Pharmacist position available at Ozarks Medical Center. The Oncology Pharmacist under general direction oversees or prepares (compounds and oral) commercially available and investigational antineoplastic drugs; assesses medication orders; assists with patient care activities including planning and implementing antneoplastic and antiemetic drug regimens; monitors patients' response to drug therapy and fluid and pain control medications; recommends changes or alternative therapy; compounds and dispenses medication; provides drug related information to patients, physicians, and nurses. Requirements: Bachelor's degree or PharmD from accredited college; Oncology or Pharmacotherapy Board Certification preferred. Contact Sherrie Lane at sherrie.lane@ ozarksmedicalcenter.com or call 417-257-5837 if interested.

New Position Available at Cantrell Drug Company: Regulatory Affairs/Regulatory Compliance Leader.Experience required, please contact Human Resources at lwilson@ cantrelldrug.com

AR•Rx

|

THE ARKANSAS PHARMACIST

4/28/17 10:31 AM

LEGISLATOR PROFILE

Representative Clint Penzo DISTRICT 88

Represents (Counties): Washington Years in Office: Sworn in for first term January 9th, 2017 Occupation: Realtor and Team Leader for the Penzo Group at Re/Max Associates in Fayetteville, AR Your hometown pharmacist: Steven Barnes with Harps Pharmacy, 1007 Jones Road, Springdale, AR 72762

What do you like most about being a legislator: There are

so many components that I love, but I mostly enjoy being able to make a positive impact on my community. I am fortunate that my job as a Realtor for the last 14 years has allowed me to be in close contact with the people of my district and hear their concerns. Being the voice for my community at the state level has been among the highest honors I have ever received.

What do you like least about being a legislator: What I

like least about being a legislator is the inability to create a win-win situation for my community on every issue. There are many difficult decisions that have to be made; unfortunately, you can’t always please everyone every time.

Most important lesson learned as a legislator: While some

issues are very polarizing, other problems facing Arkansans can be solved with bipartisan support. Even though my colleagues share diverse political views, we are all striving to improve the lives of Arkansans.

Most admired politician: Ronald Reagan is one of the

greatest political leaders of modern time. I admire not only his beliefs, but he had the ability to articulate his position and influence real change in our country.

connected with the Arkansas Pharmacy Association. They are working hard to protect your profession. As a Realtor, I am familiar with the hard work our state association performs to protect our industry.

Your fantasy political gathering would be: Since this is a

fantasy gathering, I would meet with some of the great political leaders of the past. Reagan, Lincoln, Washington, Madison, Jefferson, Churchill, and FDR would be on the invitation list.

These leaders were involved in some of the greatest pivotal points in history including establishing the US Constitution, fighting in WW2, ending slavery, and the Cold War. It would be fascinating to discuss these issues and inquire why some decisions were made.

Toughest issue of the session: We have had several issues

that have been debated heavily such as school choice, medical marijuana, alcohol, and tort reform. We were faced with a huge responsibility with medical marijuana in finding balance between respecting the will of the people, while legislating to protect the public. Marijuana is federally illegal, yet we were put in a position to create state laws for medicinal use.

I am working on consumer protection legislation that would allow for a collaborative agreement between pharmacists and dispensaries. I feel it is important to have pharmacists involved to screen for possible drug interactions and other contraindications.

Hobbies: Traveling is my favorite hobby; I love experiencing

different cultures and foods. When I am home, gardening and cooking help me decompress. I also enjoy running, hiking, and scuba diving. §

Advice for pharmacists about the political process and working with the AR Legislature: Reach out to your

representative with issues that will impact your profession.

Your input is important, as we may not see potential implications from our perspective. It is also important to stay WWW.ARRX.ORG

AR-Rx_Spring 2017.indd 41

41

4/28/17 10:31 AM

2017 APF Scholarship

Golf Tournament

T

he 2017 Arkansas Pharmacy Foundation Golf Tournament was held at Mountain Ranch Golf Course in Fairfield Bay on April 13. Eleven teams played the beautiful 18-hole course with prizes going to the longest drive and closest to the pin.

The winning teams of the tournament were (1st) Dave Bell, Don Curran, Steve Bell, Ron Curran (2nd) Andy Roller, Ben Ramsey, Case Henderson, Chris Cooper (3rd) John Norris, Mark Riley, Gary Bass, Terry Baskin. The four-player scramble golf tournament benefits the Arkansas Pharmacy Foundation and the Charles M. West Leadership Award Scholarship. The Arkansas Pharmacy Foundation promotes the profession of pharmacy in Arkansas through financial contributions and continuing education. Special thanks to our generous sponsors – Pharmacists Mutual, Smith Drug Company, Cornerstone Pharmacy – Markham, UAMS College of Pharmacy, Harding College of Pharmacy, East End Pharmacy, Medcare, Rose Drug, Kavanaugh Pharmacy, McCoyTygart Pharmacy, and McKinney Drug.

2nd Place - Cornerstone Pharmacy-Markham - Andy Roller, Ben Ramsey, Case Henderson, Chris Cooper

42

AR-Rx_Spring 2017.indd 42

Winning Team - McKinney Drug - Dave Bell, Don Curran, Steve Bell, Ron Curran

3rd Place - East End Pharmacy - John Norris, Mark Riley, Gary Bass, Terry Baskin

AR•Rx

|

THE ARKANSAS PHARMACIST

4/28/17 10:32 AM

Harding College of Pharmacy - Rodney Richmond, Clayton House, Bradley Cowdrey, Tanner Rogers

Rose Drug - Mike Smith, Richard Harmon, Roy McSpadden, Gary Denton

McCoy-Tygart Pharmacy - Bill Crossley, Max Caldwell, Sparky Hedden, John Manatt

Kavanaugh Pharmacy - Andrew Lowery, Representative Mark Lowery, Scott Pace, John Vinson

The Arkansas Pharmacy Foundation promotes the profession of pharmacy in Arkansas through financial contributions and continuing education.

WWW.ARRX.ORG

AR-Rx_Spring 2017.indd 43

43

4/28/17 10:32 AM

Pharmacists Mutual - John Bradley, Josh Cummings, Jarrod King, Tyler Soo

SPECIAL THANKS TO OUR GENEROUS SPONSORS: Pharmacists Mutual, Smith Drug Company, Cornerstone Pharmacy – Markham, UAMS College of Pharmacy, Harding College of Pharmacy, East End Pharmacy, Medcare, Rose Drug, Kavanaugh Pharmacy, McCoy-Tygart Pharmacy, and McKinney Drug

East End Pharmacy - Chad Vance, Daniel Price, Trent Shipley, Chad Riley

UAMS College of Pharmacy - Howell Foster, Seth Hildenbrand, Schwanda Flowers, Will Arnold 44

AR-Rx_Spring 2017.indd 44

Medcare - Scott Swanson, Larry Sparks, Eddie Glover, Matt Frazier

AR•Rx

|

THE ARKANSAS PHARMACIST

4/28/17 10:32 AM

APA STAFF SPOTLIGHT

Celeste Reid

Director of Administrative Services Arkansas Pharmacists Association

Hometown: Little Rock, AR Education: Emergency Medicine Technician/Paramedic Personal goal for APA: Help APA advance the profession

of pharmacy in Arkansas so that every citizen knows the importance of pharmacists as part of the healthcare team

Best part about working at APA: I love my job here at APA!!!

I work with a wonderful team; they are my second family! I also feel honored to work with such respected healthcare professionals, the best of both worlds!

Dream job: To have the money and the land to own/operate an animal rescue. My passion is helping animals in need. I currently foster and volunteer for Little Rock Animal Village and help rescue with other small local groups.

Family: My fiancé, Joe Scheel of 6 years, 2 adopted sons, 2 dogs, 2 cats and a squirrel.

Most unusual/interesting job: Rebuilding starters and

alternators. A friend of the family was looking for help so I took the job. I love learning new things and this was definitely something new to me, but I was good at it!

Best vacation: Vacation/CE in Paradise for the Arkansas Pharmacy Foundation trip to Costa Rica. It was beautiful!

This was also the first time I had boarded a plane and went out of the country…now I’m ready to go again.

Favorite meal: Mexican Food! Anything Mexican!

Favorite quotes: I have 2…“Be yourself; everyone else is

already taken” – Oscar Wilde And “Be who you are and say what you feel, because those who mind don’t matter, and those that matter don’t mind” – Bernard Baruch

You are happiest when: After rescuing an animal and seeing the happiness on their little faces once they know they are safe and loved.

Favorite hobbies and why you like them: Making jewelry.

Not only is it relaxing for me but I enjoy creating new things.

Best piece of advice you’ve ever received: Life is short,

live and love life! §

Recent Reads: Stone Cold by C.J. Box and Self-Defense by Jonathan Kellerman

People would be surprised to find out that you: Love big

trucks! I guess it’s the country girl in me, but I love big lifted trucks.

WWW.ARRX.ORG

AR-Rx_Spring 2017.indd 45

45

4/28/17 10:32 AM

46

AR-Rx_Spring 2017.indd 46

AR•Rx

|

THE ARKANSAS PHARMACIST

4/28/17 10:32 AM

WWW.ARRX.ORG

AR-Rx_Spring 2017.indd 47

47

4/28/17 10:32 AM

WWW.ARRX.ORG

AR-Rx_Spring 2017.indd 48

48

4/28/17 10:32 AM