ARRx - The Arkansas Pharmacist - Winter 2014 by Arkansas Pharmacists Association

Winter 2014 Award Winning Quarterly Publication of the Arkansas Pharmacists Association

AR•Rx

THE ARKANSAS PHARMACIST

Dear Arkansas Pharmacist, Membership in the Arkansas Pharmacists Association hel ps shape the future of pharma Arkansas. Join us as we work cy in together to influence state leg islation, regulation and policie impact the profession. s that 2013 was a successful year at the state capitol on issues important to pharmacy. We nee continued support in order to d your make further strides to expand your professional practice sco address onerous PBM practic pe, es, work closely with the sta te agencies that regulate pha ensure pharmacists’ involvem rmacy, ent in the Arkansas Health Ins urance Exchange, and mainta best healthcare and business in the environment for pharmacists here in Arkansas. In short, we make sure all pharmacists are nee d to positioned to take advantage of healthcare reform. Regardless of practice setting , membership in APA helps to protect your livelihood. In add advocating for pharmacists bef ition to ore the Arkansas legislature, APA provides the weekly e-newslet InteRxActions on industry ter trends and changes, the qua rterly journal AR•Rx The Ark Pharmacist, more than 20 hou ansas rs annually of Continuing Pha rmacy Education and lots of net opportunities. The Pharmacist working Immunization Program trained more than 200 pharmacists in 2013 and provided online trai 2012ning tools to help provide imm unizations to patients. Please renew your members hip for the coming year. The easiest way to renew is to go www.arrx.org/renew and com online to plete the information there. Your username is on the fron magazine. Or, please call our t of the office and staff will take your credit card information over the phone. Membership is a small invest ment in your future and in the next generation’s future. Please renew your membership today! Sincerely,

Mark S. Riley, Pharm.D. Executive Vice President & CE O

417 South Victory Street | Little

Rock, AR 72201-2923 | p 501-37 2-5250 | f 501-372-0546 | ww w.arrx.org

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APA Staff

Mark S. Riley, Pharm.D. Executive Vice President and CEO Mark@arrx.org Scott Pace, Pharm.D., J.D. Chief Operating Officer Scott@arrx.org Eileen E. Denne, APR Senior Director of Communications Eileen@arrx.org Eric Crumbaugh, Pharm.D. Director of Clinical Programs Eric@arrx.org

Contents 3 Letter from APA’s Mark Riley 6 Inside APA: Ringing in the New Year with Healthcare Reform 7 From the President: Get Ready for New and Continuing Challenges in 2014 8 APA 2014 Annual Convention Preview: Meet us in Fayetteville! 9 COVER: Ready or Not, Here Comes Healthcare Reform 13 Member Spotlight: Robert and Elizabeth Woolsey, Ozark 14 RX and the Law: The Drug Quality & Security Act 15 Safety Nets: Oxycodone and Fentanyl 17 FEATURE: Time to Add MTM to Your Practice 20 Legislator Profile: Senator Bill Sample (R-Hot Springs) 22 FEATURE: Branding Your Pharmacy

25 New Drugs: 2013 New Drugs – The Year in Review 26 UAMS Report: Resolutions and Optimism for 2014 27 Harding Report: Residency Programs an Excellent Option 28 Arkansas Academy of Health-System Pharmacists: Seizing Opportunities Available to Pharmacists 29 APA Compounding Academy: Compounders Have New and Conflicting Law 30 2013-2014 APA Board of Directors 31 Call for 2014 Pharmacy and APA Board Nominations 32 Member Classifieds 33 APA 2014 Awards Solicitation 34 APA 2014 Calendar of Events 34 In Memoriam: Fred Williams

23 Quality Notes from AFMC: Influenza: It’s Not Too Late to Vaccinate

Celeste Reid Director of Administrative Services Celeste@arrx.org Debra Wolfe Director of Government Affairs Debra@arrx.org Office E-mail Address Support@arrx.org Publisher: Mark Riley Editor: Eileen Denne 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 65.

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.

Directory of Advertisers 2 APA Membership Ad 4 APA Honors Amerisource Bergen 8 First Financial Bank 8 CPE in Paradise 11 Arkansas Pharmacy Support Group

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Bell & Company UAMS Alumni Association Pace Alliance Pharmacy Quality Commitment EPIC Pharmacies

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Retail Designs Law Offices of Darren O'Quinn Pharmacists Mutual Life Insurance APA Honors Pharmacy Partners of America

APA Board of Directors

INSIDE APA

2013-2014 Officers

INSIDE APA

President - Dana Woods, P.D., Mountain View President-Elect - Brandon Cooper, Pharm.D., Jonesboro Vice President - John Vinson, Pharm.D., Fort Smith Past President - Dennis Moore, Pharm.D., Batesville

Ringing in the New Year and Healthcare Reform

Area Representatives Area I (Northwest) Michael Butler, Pharm.D., Hot Springs Village Area II (Northeast) Brent Panneck, Pharm.D., Lake City Area III (Central) Eddie Glover, P.D., Conway Area IV (Southwest/Southeast) Lynn Crouse, Pharm.D., Eudora

District Presidents District 1 - Clint Boone, Pharm.D., Little Rock District 2 - Kristy Reed, Pharm.D., Jonesboro District 3 - Chris Allbritton, Pharm.D., Springdale District 4 - Lise Liles, Pharm.D., Texarkana District 5 - Dean Watts, P.D., DeWitt District 6 - Stephen Carroll, Pharm.D., MBA, Arkadelphia District 7 - C.A. Kuykendall, P.D., Ozark District 8 - Casey McLeod, Pharm.D., Searcy

Academy of Consultant Pharmacists Larry McGinnis, Pharm.D., FASCP, Searcy

Academy of Compounding Pharmacists Warren Lee, Pharm.D., Fort Smith

Arkansas Association of Health-System Pharmacists

Lanita S. White, Pharm.D., Little Rock

Ex-Officio APA Executive Vice President & CEO: Mark Riley, Pharm.D., Little Rock Board of Health Member: John Page, P.D., Fayetteville AR State Board of Pharmacy Representative: John Clay Kirtley, Pharm.D., Little Rock UAMS College of Pharmacy Representative (Dean): Stephanie Gardner, Pharm.D., Ed.D., Little Rock Harding College of Pharmacy Representative (Dean): Julie Hixson-Wallace, Pharm.D., Searcy Legal Counsel: Harold Simpson, J.D., Little Rock Treasurer: Richard Hanry, P.D., El Dorado UAMS College of Pharmacy Student Representative: Dylan Jones, Fayetteville Harding College of Pharmacy Student Representative: Mark Egbuka, Searcy

Mark Riley, Pharm.D. Executive Vice President & CEO

here has been a lot of talk in the last year about Medicaid expansion and the Arkansas Health Insurance Exchange; both established to facilitate the provision of health insurance to Arkansans with income levels between 100 and 400% of the Federal Poverty Level (FPL). The recipients in this income range are divided into the Medicaid expansion group (100 to 138% of FPL) and those who have commonly been referred to as the “working poor” (138 to 400% of FPL). Health coverage for the expansion group became the most important and controversial issue of the 89th General Assembly; to cover or not to cover and how to structure the coverage if it ultimately occurred.

The passage of a bill to authorize coverage only required a simple majority (51 votes in the House; 18 votes in the Senate). If that passed, then an appropriations bill would also have to be passed which required a threefourths vote (75 votes in the House; 27

First let me address the Health Insurance Exchange which was authorized in the Affordable Care Act to cover those in 138 to 400% of FPL group. The state was charged with building an Arkansas exchange or defaulting to a federally-run exchange if no action was taken, which is what occurred. Later, however, the state discovered that a third option existed. Even if the state did not set up its own exchange, it could have a partnership with the federal government that allowed the state much of the same input into the exchange that it would have had if the state had its own exchange. That premise is what we are working under now.

votes in the Senate). The consensus among the leadership was that there was a zero chance of obtaining the votes to pass an expansion of traditional Medicaid (an increase in the number of Medicaid patients in the existing model where the state and federal governments shared all of the costs through a mathematical formula). Then Senator Jonathan Dismang came up with an out-of-the-box idea.

The Medicaid expansion was even a bigger hurdle for those members of the legislature that believed we needed to supply individuals in the 100 to 138% of FPL a reasonable level of coverage.

What if we could get the federal government to agree to allow Arkansas to build a hybrid system for the new Medicaid patients….?

What if we could get the federal government to agree to allow Arkansas to build a hybrid system for the new Medicaid patients (100 to 138% of FPL) that involved the use of Federal dollars to buy insurance for the newly covered Medicaid patients through the private marketplace – the insurance exchange that would already exist for the working poor (138 to 400% of FPL)? This innovative approach was the first of its kind in healthcare.

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FROM THE PRESIDENT

Through a lot of hard work, the necessary votes for passage of this bill were obtained and, now, many other states are considering Arkansas’s model.

Dismang and David Sanders and Representative John Burris for the long, hard work that they put in to accomplish an acceptable, workable way to provide needed coverage. §

While there were many legislators that worked on this compromise to provide insurance for those in need of health coverage in Arkansas, our hat goes off to Senators Jonathan

FROM THE PRESIDENT

Get Ready for New and Continuing Challenges in 2014

s we move into 2014, pharmacists will face new and continuing challenges. New challenges will come with implementation of the Affordable Care Act (ACA) and old challenges still confront us in price increases and fair compensation from pharmacy benefit managers (PBMs).

Dana Woods, P.D. laws like the MAC bill that are President on the books. While we can’t pass new legislation until 2015, we can ask the legislature to help with enforcement of the laws we have now.

Affordable Care Act here to stay

There was lots of debate politically and practically over the last several years about whether passing the ACA was a good thing (see cover story on page 9). Pharmacists weighed in on both sides of the issue as it was debated during the 89th General Assembly. Whichever side you took on healthcare reform, the reality is that the ACA is with us and we’ll have to work within the system. We will need to help patients navigate the complexities of the process so they can get the intended benefits of the program. I encourage you to learn the highlights of the Arkansas Health Insurance Exchange and keep your patients informed as they come in during this first of the year on the plan. Although our work is cut out for us in ACA implementation, other issues that will be very difficult to solve in 2014 include Maximum Allowable Cost (MAC) pricing issues and recognition of pharmacists as providers. Although we are working on these issues and turning over every rock we can, change will happen slowly.

Legislative reminder to PBMs

In 2014 we will ask legislators to help remind PBMs about the Maximum Allowable Cost law (Act 1194) and put pressure on them. The PBM audit bill passed in 2011 (Act 517) was about fairness. As with the 2007 audit bill which was revised in 2011, APA will look to improve the

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Whichever side you took on healthcare reform, the reality is that the ACA is with us and we’ll have to work within the system.

Provider status inquiry

Another area we are addressing now is provider status. The Task Force, under the capable leadership of UAMS’ Dr. Nicki Hilliard, will work on official recognition of pharmacists as healthcare providers, at both the federal and state levels. The Task Force will also work on getting payers to recognize the importance of pharmacies being paid for patient care services. Success may come through the marketplace if we can come up with payments that help providers save costs such as adherence, compliance, and MTM services. Then pharmacists will be paid as providers whether we’re recognized or not. Our goal is to do both. With a little help from our friends, colleagues, and of course, the Arkansas Pharmacists Association, I know we’ll meet our 2014 challenges head on. §

Pharmacists at Continuing Pharmacy Education session during APA’s 2013 Annual Convention in Little Rock.

2014 APA Annual Convention to be Held June 12-14 in Fayetteville

he 132nd Annual Convention of the Arkansas Pharmacists Association will be held June 12-14 at the Chancellor Hotel in Fayetteville. Once again, APA will offer up to 15 hours of continuing pharmacy education (CPE). The 2014 CPE will again be divided into themes including: Shoot for the Stars—Medicare Star Ratings; Team-Based Healthcare; Pharmacists & Public Health; Clinical Checklist; and Protect Your License. Members and guests will be able to learn about the latest product trends in pharmacy from more than 40 exhibitors. Exhibitors will be showcasing new products to potential customers while working to maintain and strengthen relationships with existing customers. APA is planning several special social events as well as the traditional golf tournament on Wednesday afternoon, June 11. Convention registration will open shortly. Stay tuned for more information through InteRxActions and www.arrx.org/annual-convention. §

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Ready or Not, Here Comes Healthcare Reform By Scott Pace, Pharm.D., J.D.

eginning with the 2008 presidential campaign, we have been unable to read the news without hearing about “healthcare reform.” The centerpiece of Obama’s 2008 campaign was reforming the healthcare system. During the first 14 months of his presidency, Congress passed and the President signed the Patient Protection and Affordable Care Act (PPACA). PPCCA is now shortened to the Affordable Care Act (ACA) and more commonly referred to as “Obamacare.”

had no insurance coverage, yet these same uninsured Americans were able to show up in emergency rooms and receive medical care without paying for it, shifting the financial burden for the service to the remaining insured individuals in the form of higher premiums. Opponents of reform contend that people should not be forced to buy (insurance) that they do not want, or perceive they do not need. They contend that if such a mandate is going to be imposed upon individuals, it should be done by state governments, instead of the federal government. Regardless of your stance on whether reform is a good or bad thing, it is upon us. And January 1, 2014, was when the major provisions of ACA became effective.

President Obama is not the first president to attempt to make massive changes to our healthcare system. Since President Theodore Roosevelt, presidents have desired to ensure affordable access to healthcare services for all citizens. While many presidents have tried to pass federal laws that ensured universal access AFFORDABLE CARE ACT COVERAGE to healthcare, until recently, they Regardless of your had to settle for less than universal Perhaps the most daunting task care. President Lyndon B. Johnson with requiring healthcare coverage is stance on whether ultimately secured healthcare access exactly how to facilitate individuals reform is a good or bad for our senior and impoverished getting coverage, and how to penalize thing, the Affordable populations with his “Great Society,” people who do not follow the law. [This Care Act is upon us. which created Medicare and Medicaid later point proved to be significant with in 1965. President Bill Clinton signed the Supreme Court when they ruled on the State Children’s Healthcare the law in 2012.] Insurance Program in 1997, which expanded healthcare coverage to children of low-income, working parents. To accomplish this feat, the ACA used three different methods to facilitate getting uninsured individuals Most recently, President George W. Bush signed the coverage: the employer mandate, the individual mandate, Medicare Modernization Act of 2003, which created the & Medicaid expansion. Medicare Prescription Drug Program that provides drug The Employer Mandate coverage to Medicare-eligible patients. Many insured Americans currently get their health insurance through their employers. The ACA attempts to build on The case for healthcare reform passed in 2010, centered around a basic premise that over 45 million Americans this long-established practice by requiring employers that

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have greater than 50 full-time employee equivalents to provide affordable health insurance to their employees. If an employer that is required to provide coverage does not provide health insurance to its employees or if the coverage is not affordable, it will be assessed an Employer Shared Responsibility Payment (i.e. a penalty) for not following the law.

importantly, the exchanges are the only vehicles for individuals to access government premium subsidies to help reduce the cost of purchasing coverage. The amount of premium subsidy that an individual is eligible for depends on his or her annual household income, as calculated using the Adjusted Gross Income (AGI).

Subsidies are available for households that make up to 400% of the federal poverty level (FPL) (i.e., $45,960 for an individual; $94,200 for a family of four). The ACA caps the amount of premium that a person has to pay as a percentage of their AGI, with very low income individuals being responsible for as little as 2% of their AGI for healthcare premiums, to people making 400% of the FPL being responsible for up to 9.5% of their AGI for healthcare premiums. The Kaiser Family Foundation has a Subsidy Calculator at http://kff.org/interactive/subsidyTo help individuals calculator to see specific examples of comply with the how the subsidy amount is calculated.

While some believe that businesses will simply calculate the cost of providing insurance vs. the cost of the penalty to determine whether or not to provide coverage, it is worth noting that employer contributions to healthcare premiums are deductible, while employer penalties paid in the form of the Employer Shared Responsibility Payment, are not. The Employer Mandate was initially scheduled to go into effect on January 1, 2014, but the Obama Administration has delayed the implementation until January 1, 2015.

The Individual Mandate

individual mandate, Congress established Healthcare Exchanges, which are online portals to help people shop for plans.

Perhaps the most controversial provision in the ACA is the individual mandate. The individual mandate requires individuals who do not have health insurance to obtain it, either through their employer, through their spouse’s plan, or through a private insurance policy. If an individual does not obtain a policy that meets the ACA’s minimum essential coverage requirements, they will be accessed a penalty on their annual income tax filing. The 2014 penalty is $95 per person or 1% of your adjusted gross income, whichever is greater; 2015 penalty is $325 per person or 2% of your adjusted gross income, whichever is greater; 2016 penalty is $695 per person or 2.5% of your adjusted gross income, whichever it greater.

The constitutionality of the individual mandate was challenged by a number of groups after the ACA was signed into law in 2010. The Supreme Court ruled on the case in 2012. Chief Justice John Roberts, writing for the majority of the court, upheld the individual mandate provision of the ACA saying, “Put simply, Congress may tax and spend. This grant gives the Federal Government considerable influence even in areas where it cannot directly regulate.” With those words, the Chief Justice acknowledged that the Congress had properly exercised its constitutional power to tax and spend and put to rest the question over whether the individual mandate was constitutional. To help individuals comply with the individual mandate, Congress established Healthcare Exchanges, which are online portals to help people shop for plans. More

Medicaid Expansion

Expanding states’ existing Medicaid programs to cover lower income individuals was originally seen as one of the easier ways of getting large numbers of eligible people enrolled with healthcare coverage. This expansion of Medicaid was originally a mandatory part of the ACA where states either were forced to expand their existing Medicaid programs, or they would risk losing all of their existing federal Medicaid funding. This forced expansion was challenged by a number of states’ attorneys general who claimed that Congress holding states’ entire Medicaid budget hostage in exchange for expanding their programs was too coercive. Chief Justice Roberts declared that the forced expansion “is much more than ‘relatively mild encouragement’ – it is a gun to the head.” The Supreme Court ultimately determined that the forced expansion was unconstitutionally coercive and struck the mandatory provision in the ACA. It did, however, leave the possibility of Medicaid expansion on the table by allowing each state to decide for itself if it wanted to expand its Medicaid program. At last count, only 24 states, including Arkansas, have decided to expand their Medicaid programs to provide health coverage for individuals up to 138% of the FPL. In Arkansas alone, the decision to expand means that approximately 250,000 low income Arkansans will have access to health insurance. The Arkansas General Assembly chose to expand the Medicaid program during the 2013 legislative session, but they did so in a unique manner. Rather than simply

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HEALTHCARE REFORM

adding lower income Arkansans to the state’s existing Medicaid roles, they decided to use the federal expansion dollars to pay the premiums for private-sector insurance for the newly-created expansion population. This allows the expansion individuals to shop for the coverage that best suits them and provides an even bigger risk pool for the insurance carriers to spread their risk. This innovative manner to expand Medicaid has garnered national attention for the bipartisan efforts of House Speaker Davy Carter, Senate President Michael Lamoureux, and Governor Mike Beebe. Arkansas’s model has recently been adopted by Iowa, and other states are certain to look at our state’s approach to providing coverage to our low-income population. So with January 2014 here, ready or not, the era of healthcare reform is upon us. While uncertainty looms, as healthcare professionals, we now have the opportunity to provide care to all individuals. Lack of healthcare coverage will no longer be a barrier to access care. Pharmacists

AR•Rx | THE ARKANSAS PHARMACIST

At last count, only 24 states, including Arkansas, have decided to expand their Medicaid programs to provide health coverage for individuals up to 138% of the FPL. In Arkansas alone, the decision to expand means that approximately 250,000 low income Arkansans will have access to health insurance.

are resilient individuals. We saw the advent of online claims adjudication twenty years before the rest of the healthcare industry; we have been computerized for almost three decades; and we have help implemented major government programs before, like Medicaid and Medicare Part D. So there is little doubt in my mind that we will adapt to healthcare reform and help our patients lead happier, healthier lives. §

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Member Spotlight

Rob & Elizabeth Woolsey MEDI-QUIK PHARMACIES IN PARIS AND OZARK How did you meet: We met in 1991 at UAMS College of Pharmacy. Rob was a P2 student and Elizabeth was a P1. We were married in 1995 after Elizabeth graduated from UAMS College of Pharmacy. We lived in Fort Smith for two years while we both worked retail. We then moved to Ozark and have lived there ever since. We have three children: Lauren (14), Daniel (12), and Anna (9), who all attend Ozark schools. The Woolseys are big supporters of the Ozark Hillbillies!

How do you keep your professional and family lives separate? We take trips in the summer and spring break and around Thanksgiving. We attend all our children’s school and extracurricular activities. If we are not at the store, we are with our children.

Pharmacy practice: We opened Medi-Quik Pharmacy in Paris in 2007. We bought Medi-Quik Pharmacy in Ozark in 2008 right after Rob’s father died. Before this Elizabeth was a stay-at-home Mom and Rob worked retail pharmacy.

Fun activities: Rob – Coaching Little League football, baseball, and basketball. Elizabeth – taking our girls shopping, helping my 14-year-old with her pageants and attending local and state pageants, and even the Miss America pageant.

Graduate pharmacy school and year: University of Arkansas for Medical Sciences College of Pharmacy: Rob – 1994 and Elizabeth – 1995.

Ideal dinner guests: The Apostle Paul, Ronald Reagan, and our late grandparents.

Years in business: 7 years.

Recent reads: Rob - Killing Lincoln by Bill O’Reilly; Elizabeth – The Harbinger by Jonathan Cahn.

If not a pharmacist then: Rob – Football coach; Elizabeth – accountant. §

Favorite part of the job: Being your own boss. Least favorite part of the job: PBMs (Modern day Mafia). Oddest request from a patient/customer: Honestly, we don’t think anything of it when someone asks us something off the wall. It has become part of our daily life.

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The Drug Quality and Security Act 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.

ost pharmacists are aware that the Drug Quality and Security Act (DQSA) was signed into law by President Obama on November 27, 2013. Most are also aware that the law provides additional regulatory oversight over the compounding of sterile products. This comes from the Compounding Quality Act (CQA) portion of the DQSA. However, many pharmacists are unaware of the other provision in the DQSA, the Drug Supply Chain Security Act (DSCSA). This portion will increase the ability to track and trace products from manufacturers downstream to the ultimate users. The CQA creates a new entity in the drug distribution model; the Outsourcing Facility. An Outsourcing Facility compounds sterile products and elects to register as an Outsourcing Facility under the act. A facility that compounds only non-sterile preparations cannot register as an Outsourcing Facility. An Outsourcing Facility is not required to be a licensed pharmacy. In addition, the Outsourcing Facility may or may not obtain prescriptions for identified individual patients. Registration and abiding by the provisions of the CQA allow the products compounded by the Outsourcing Facility to be exempt from the requirements of the New Drug Application process. Section 503A of the Food, Drug and Cosmetic Act contains another avenue for exemption when there is an identified individual patient who is the recipient of the compounded item, whether it is sterile or non-sterile. The CQA provides a broad definition of compounding. Compounding includes the combining, admixing, mixing, diluting, pooling, reconstituting, or otherwise altering a drug or bulk drug substance to create a drug. The inclusion of the words diluting and reconstituting show the intent to cover everything sterile that is compounded, no matter how simple the action. Note that the inclusion of admixing shows that IV admixture programs are considered compounding. Outsourcing Facilities will have to register with the FDA annually. The list of registrants will be public information. Outsourcing Facilities will also have to file with the FDA reports of their activities twice per year. The contents of these reports will not be public information. Outsourcing Facilities will be subject to FDA inspection on a risk-based schedule. The CQA will also require the implementation or completion of some lists of products/components in order for Outsourcing Facilities to be able to comply with the section. An Outsourcing Facility cannot compound a product if it is on a list of drugs that

have been withdrawn or removed from the market for reasons of safety or effectiveness. Also, an Outsourcing Facility cannot compound a product that is on the Demonstrable Difficulties for Compounding list. In addition, bulk substances without an USP/NF monograph must not be used unless they are on an approved list of bulk substances. None of these lists are currently complete, but the FDA will be convening a Pharmacy Compounding Advisory Committee to help compile these lists. The second part of the DQSA is the Drug Supply Chain Security Act. This provision will impact many more pharmacies than does the CQA. This act creates a drug product history, starting with the manufacturer that must be passed on with the product as is it sold or distributed down the supply chain. This encompasses wholesalers, third party logistics providers, trading partners, repackagers, and dispensers. The drug product history is not required to be provided by the dispenser to the prescribed patient. But the dispenser is required to have policies and procedures in place to quarantine suspect or illegitimate products, return them as necessary and notify any patients who may have received them from the dispenser. Another provision of the act will require that a product identifier be affixed to the packaging of prescription drugs. This identifier will need to be readable by both humans and machines. The act also specifically outlines the content of the drug histories. Implementation of the different requirements of the act varies according to the type of entity involved, but many items will need to be implemented no later than July 1, 2015. The DQSA has been covered in the media primarily as a compounding law, but the tracking and tracing requirements will apply to all participants in the drug distribution chain. So it behooves all pharmacists to review the act and determine which provisions impact their practice and when that impact will occur. Â§ _______________________________________________________ ÂŠ Don R. McGuire Jr., R.Ph., J.D., is General Counsel, Senior Vice President, Risk Management & Compliance at Pharmacists Mutual Insurance Company. This article discusses general principles of law and risk management. It is not intended as legal advice. Pharmacists should consult their own attorneys and insurance companies for specific advice. Pharmacists should be familiar with policies and procedures of their employers and insurance companies, and act accordingly.

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UUNNI IVVEERRSSI ITTYY OOFF AARRKKAAN CE ES C CO OLL LL E EG GE E O O FF PP H HA A RR M MAACCYY NSSAASS FF O OR M E D I C A L S C I E NC

Oxycodone and Fentanyl Welcome to another issue of Safety Nets. This column illustrates the potential hazards associated with illegible prescriber handwriting. Thank you for your continued support of this column.

he original handwritten prescription illustrated in Figure 1 was presented to a pharmacy technician in Northeast Arkansas. The prescription was brought to the pharmacy by the patient’s daughter who stated the medication was to control pain in her terminally-ill mother. The technician interpreted the order as oxycodone solution concentrate, 20 mg/mL, quantity 3000 mL, to be administered 25 mL by mouth every 4 hours as needed for pain. The technician immediately questioned the large quantity (3000 mL) of oxycodone to be dispensed. Before entering the prescription information into the computer, she shared her concern with the pharmacist. The pharmacist was also concerned about the large volume of oxycodone solution to be dispensed. In addition, he was concerned about the extremely large oxycodone dose (i.e. 25 mL or 500 mg of oxycodone) the patient was to receive. At this point, the pharmacist decided to telephone the prescriber’s office for clarification.

Figure One

After the pharmacist stated that he had “some concerns” about the way this particular order was written, the person who answered the telephone said “what did I do wrong?” Further conversation revealed this order – for oxycodone solution concentrate - had been written by a member of the physician’s support staff rather than by a healthcare professional. After talking to an office nurse, the pharmacist learned the patient was to receive oxycodone solution concentrate, quantity 30 mL, with directions of “give 0.25 mL (5 mg) by mouth every four hours as needed for pain.” After this, the prescription was correctly filled and the patient’s caregiver appropriately counseled. The original prescription illustrated in Figure 2 was presented to a pharmacy technician in Central Arkansas. The prescription was brought to the pharmacy by the patient, not a caregiver. The technician entered the information into the computer as fentanyl transdermal system 75 mcg/hour, quantity ten, with directions to the patient of “apply one patch to the skin every

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72 hours.” The order for this DEA CII substance was filled by a pharmacist in accordance with store policy. After filling the order, the pharmacist began to counsel the patient. The patient immediately interrupted and said “I have been using these for several months and I know all about them.” After this, the patient paid for the prescription and left.

Figure Two

The patient returned to the pharmacy the next day with the fentanyl systems. He told the pharmacist that after returning home from the pharmacy the day before, he had applied one of the fentanyl systems. He went on to say that several hours later he began to “feel funny.” He then noticed he had received the 75 mcg/hour system, not the 25 mcg/hour system he had been using for the past several months. The pharmacist checked the patient’s medication profile and confirmed the patient had received the 25 mcg/hour system for several months. A telephone call to the prescriber verified the patient was to receive the 25 mcg/hour system. After this, the pharmacist correctly filled the prescription and apologized to the patient for the mistake. The first case clearly illustrates the hazards associated with prescriptions written by members of a prescriber’s support staff. While it is very unlikely that any pharmacist would actually dispense 3000 mL of oxycodone solution concentrate – at 25 mL per dose – other prescriptions written by support staff could contain more discrete errors that are harder to detect. Pharmacists must use extreme caution when presented with prescriptions written by support staff. The second case illustrates the hazards associated with illegible prescriber handwriting. The handwritten fentanyl release rate could easily be interpreted as either 25 mcg/hour or 75 mcg/ hour. Unfortunately the wrong strength was dispensed. The pharmacist in this case, however, is to be commended on how he handled the situation. Rather than making excuses or putting up a defensive front, he quickly corrected the error and apologized to the patient. When confronted with a medication error, all pharmacists should follow this practitioner’s example. The authors of Safety Nets thank him for sharing this case with our readers. §

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Improving Your Pharmacy Practice

Time to Add Medication Therapy Management to Your Practice By Eileen E. Denne and Eric Crumbaugh, Pharm.D.

Dr. Aubrey Harton of Cornerstone Pharmacy counsels a patient on medications.

edicare Part D was enacted as part of the Medicare Modernization Act of 2003 (MMA) and went into effect on January 1, 2006. MMA requires Medicare Part D plans to establish Medication Therapy Management (MTM) programs. The Patient Protection and Affordable Care Act enacted in March 2010 (now known as the Affordable Care Act, or ACA) expands prescription drug and prevention benefits covered under Medicare and introduces new programs designed to improve the quality and delivery of care to people covered by Medicare. 1 Although the term MTM was first used in 2003, pharmacists have provided similar services since the concept of “pharmaceutical care” was introduced in 1990. MTM is designed to enhance patient understanding of appropriate drug use, increase adherence to medication therapy (taking the right medications at the right times), improve detection of adverse drug events, and increase collaboration and communication between pharmacists and other healthcare professionals. The pharmacist evaluates medications, including non-prescription drugs and health supplements that the patient is taking, and then designs a plan of care so the patient is getting maximum benefit from the drugs. Medicare recommends that patients take advantage of MTM services and refers patients through several third party

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companies such as Mirixa and Outcomes, to pharmacists to provide MTM. Pharmacists can elect to counsel the patient or not; they then have a limited time to do MTM. If they miss the deadline, the MTM referral goes to another pharmacist.

MTM is designed to enhance patient understanding of appropriate drug use, increase adherence to medication therapy (taking the right medications at the right times), improve detection of adverse drug events, and increase collaboration and communication between pharmacists and other healthcare professionals.

The American Pharmacists Association produced a guide in 2008 that spells out kinds of MTM services and how they might be provided. Despite the push from organizations like APhA, less than half of the retail pharmacists in Arkansas have adopted MTM as a regular practice. If MTM does not become a more commonplace practice, pharmacists may be in danger of losing the benefit to other healthcare providers. (Continued)

Dr. Eric Crumbaugh (right) confers with Dr. Scott Polk of Polk Pharmacy in England on immunizations.

Less than 50 Percent of Arkansas Pharmacists Do MTM

A February 2012 phone survey conducted by the Arkansas Pharmacists Association revealed that 48.7 percent of retail pharmacies reported they offered MTM services:

*Chains include Walmart, Walgreens, Kroger, Harps, Fred’s and USA Drug, which was still in business at that time. The data would likely be different today; 25 independent pharmacies have opened since Sept. 2012 when USA Drug was acquired by Walgreens. Many of the new stores are offering MTM.

Medicare Star Ratings

One good reason to think about incorporating MTM into your practice now is that the ACA ties federal reimbursement rates for insurance carriers administering Medicare Advantage products to performance, as measured by a Stars rating system. MTM is mentioned ten times throughout the ACA and it requires plans to offer these services to targeted beneficiaries. Pharmacists are specifically mentioned 19 times and are listed as the “preferred” provider of MTM services. According to Medicare, in 2014, among the proposed changes for plan ratings are MTM program measures (Medicare Advantage Organizations Notice, 2012). Pharmacists will get more financial incentives to provide MTM services under the star ratings. In addition, the number of patients eligible for MTM will grow as more patients get on Medicare.

MTM Services Provided During a Normal Day

In his practice as a pharmacist, APA’s Director of Clinical Programs, Dr. Eric Crumbaugh, sees opportunity to provide

(and be compensated for) MTM services being conducted throughout a normal day in the pharmacy. According to Crumbaugh, “MTM is more than sitting down with a patient and going through every single medication a patient is taking.” “I can remember one afternoon when one of our regular patients from a close by retirement community came in to the pharmacy and as soon as I went to greet her I saw that her arms were covered in bruises. She calmly said, “I think I am falling apart… I have bruises all over my body, but for the life of me, I can’t figure out where they are coming from.” I replied back, “Have you recently taken up rugby, joined a tackle football league, or did you change anything with your medications?” She laughed and reported that she had recently been to a new heart doctor who gave her samples of Plavix© and told her to start taking it every day. After reviewing her medication profile, I saw that she was also taking Coumadin© and she went on to tell me she takes a baby aspirin every day.

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MEDICATION THERAPY MANAGEMENT

“I then asked her if her new doctor had asked her what other medications she was taking. She remembered him specifically asking if she took some medication that started with a “w” which we ended up discovering he had asked her about warfarin and she said no. I then informed her that warfarin was the generic form of Coumadin©. Then I asked her why she didn’t tell the doctor she was taking aspirin and her response was, “It’s over-the-counter; they just asked what prescriptions I was on.” I called the cardiologist’s office and spoke with his nurse. She confirmed what my patient had told me, and said they had no idea she was taking warfarin and aspirin. Their recommendation was to have her stop the Plavix© and aspirin, continue the warfarin, and for her to be seen in the clinic in the next few days. I relayed the information to the patient and told her to make sure and tell all of her healthcare providers that she was taking Coumadin© or warfarin to prevent future problems of this nature.” The consequences of just adding one simple medication could have resulted in stroke, internal bleeding, or even death. However, preventable medication interactions like the one described above are estimated to impact more than 7 million patients, contribute to 7000 deaths, and cost almost $21 billion in direct medical costs across all healthcare settings annually. 2 Would you consider the pharmacist-patient interaction discussed above an MTM service? In this simple but perhaps life-saving scenario, there was assessment, medication review, inter-professional collaboration, development and execution of a plan, and follow up. Also, it potentially saved the insurer from having to pay for a potential hospitalization which, if caused by a stroke, could average around $15,000. It is safe to say that this example constitutes MTM. It is no different than performing a drug utilization review, checking for drug-drug interactions, counseling a patient on how to use an inhaler, or even ensuring a patient is being compliant with their medication regimen. Of the Arkansas pharmacists offering MTM in 2012, most reported to APA that they had few cases assigned to them and even fewer patients who would come in for the comprehensive medication review. When Crumbaugh offered MTM services, for example, for every 10 patient cases that were assigned to him, only two or three patients would schedule an appointment to come to the pharmacy. About 25 percent of the time, the patients would not show up for their appointments.

Community and Health-System Pharmacists at Important Crossroad

Implementation of the ACA and the focus on decreasing healthcare costs places community and health-system pharmacists at an important crossroad. In most patients’ minds, AR•Rx

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the pharmacist is tied to a product such as a prescription drug or over-the-counter (OTC) cream; however, the pharmacist may recommend that they stop certain medications, or may counsel a patient on how to better control their blood sugar with diet. In these instances the pharmacist’s knowledge is the product, but how does the pharmacist get reimbursed? The most important part for billing these encounters is documentation. There are several online platforms that pharmacists can register with and receive targeted patients for MTM services. Once a patient is identified as MTM eligible, a successful practice in several pharmacies is to put a note on the patient’s profile and document every issue and interaction with this patient. The documentation does not need to be in a formal SOAP note or Pharm note structure. Just be sure there is enough information so that you, another pharmacist, student, or technician can enter the encounter into the online billing portal and conduct follow up.

Implementation of the ACA

The Pharmacist and the focus on decreasing Immunization Program healthcare costs places was implemented to community and healthincrease the number of system pharmacists at an immunizations given by pharmacists across the important crossroad. state and many have adopted the practice. There are many similarities between pharmacy-based immunization services and MTM. For example, immunization services are required to be documented with a consent form. Pharmacies generally market whether they offer vaccinations. It isn’t quite as obvious when a store offers MTM services. All pharmacists check new prescriptions for accuracy, review patient’s drug utilization history, explain results of blood pressures tests from the store’s machine, recommend OTC products, and a large number of other cognitive services. But unlike immunizations, pharmacists are not routinely compensated for these services. Pharmacists have had the authority to bill for MTM services for the last seven years. MTM is more than a one-time, sit-down appointment with a patient about all of their medications. It is about collaborating with healthcare professionals to manage a patient’s chronic diseases, prevent any complications, minimize adverse effects, and maximize the return on investment of everyone’s healthcare dollars. Arkansas pharmacists need to own this practice and take advantage of the ability to be paid for things they may already provide. § Medicare: a Primer (2010). Kaiser Family Foundation. Retrieved from: http://kff.org/medicare/issue-brief/medicare-a-primer/

2 American Health & Drug Benefits (2012). National Burden of Preventable

Adverse Drug Events Associated with Inpatient Injectable Medications: Healthcare and Medical Professional Liability Costs. Retrieved from: http://www.ahdbonline.com/issues/2012/november-december-2012vol-5-no-7/1224-feature-1224

Legislator Profile

Senator Bill Sample District: Senate District 14 Represents: Portions of Garland and Saline Counties Years in Office: Finishing my 9th year. I spent 6 years in the House of Representatives before being elected to the Arkansas State Senate. Occupation: I retired in 2013. Prior to that my wife, Betty Ann, and I owned Pestco, a pest control company, for 37 years. Your pharmacists: Gary and Michael Butler. They have pharmacies in Hot Springs and Hot Springs Village. Like most about office: I really enjoy helping constituents cut through the government red tape to get services they need or solve a problem they may be having with a particular agency. Like least about office: Government has become very complicated. It is difficult to keep up with all of the information you need to make good decisions. I read and study constantly but often I have to rely on others for insight and direction because many of the issues are so complex. I wish I had more hours in the day to further educate myself on the issues.

Most admired politician: President Harry Truman. I always admired his ability to pick the perfect person for a particular task and when they presented him with their findings he put their plans into effect. A prime example is his selection of George Marshall who created the Marshall Plan. Advice for pharmacists about the political process and working with the AR Legislature: Help educate legislators about your particular issues. As I mentioned in an earlier question we cannot be experts on everything so we really appreciate the insight you can provide. You are experts in your industry and you need to share your knowledge with us. Your fantasy political gathering would include: Thomas Jefferson, Dwight Eisenhower and, of course, Harry Truman. Toughest issue of the past Session: Without a doubt, it would have to be the debate concerning the Affordable Care Act. I am so pleased Arkansas was able to come up with the private option. Our legislation has been cited nationally numerous times as an excellent compromise and solution. What do you do for fun: I love to hunt and fish. I am hoping with my retirement I might have more time to do both. ยง

Upcoming election: I am up for election in 2014.

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MARKETING IDEAS

Branding Your Pharmacy Marketing Ideas from Pharm Fresh Media By Liz Tiefenthaler

your eyes for a moment and see if you are able to Close call up an image when you hear the following words. • Nike • Apple • Coca-Cola • Harley Davidson

Of course, you can. In fact, I'll bet you were able to see the logos in the correct colors, as well as being able to describe what the name means to you. That is what comes with having a strong brand. And that is why you and your pharmacy need to develop your own strong brand based on the ideals and beliefs that you hold most important.

What is a brand?

A brand is the consumer's idea of who you are and what you stand for. Or, as it would apply to you, a good pharmacy brand is one where patients not only know who you are, but they understand what their experience will be with you. Great brands change people's lives and are led by men and women who inspire those around them. A great brand understands how to communicate its ideals to the people who most want what they have. I always begin a marketing conversation with a new customer by asking them to define who they are. More often than not, I hear answers like we offer MTM or free delivery. These are attributes of your brand but they are not what truly defines who you are. A brand speaks from the heart; you are a pharmacy that cares about my health and well-being for example and you do this by offering specific pharmacy services.

Why is having a brand so important?

First of all, having a well-defined brand helps you communicate who you are to your employees. If your brand is being the friendliest pharmacy in your town and you are employing people who are not friendly, then there will be a disconnect when people come into your store. If an employee does not live your brand, it is time to replace that person. Secondly, having a strong brand positions you to your target audience. If I am looking for a pharmacy that can organize my medications for me and you have done a good job of positioning yourself in that market, then I will seek you out for my care. 22 22

Having a strong brand distinguishes you from your competition. Did you know that there are over 90 brands of television sets, yet the average consumer can only name five? It is not that much different in pharmacy so let’s make sure your pharmacy brand is memorable. And finally, knowing your brand will help you determine where to best spend your marketing dollars.

How do I start establishing my brand?

I know that this sounds simple, but you need to start with a strong logo that always appears in the same colors, whether on a sign, a shirt or your website. If you decide to include a tag line with your logo, it should be relevant to your brand. “Fast, friendly service” could stand for a fast food restaurant or an oil change garage. Make sure that the words you use describe who you are. You must have a web presence to support your brand and your website graphics should be consistent with your other messaging. I cannot tell you how many times I talk to a store owner and am excited about their brand, only to go to an outdated, or in some cases, non-existent website. If you are having a hard time establishing your brand, it may be worth your while to hire a consultant to get you started. Once you have your brand message, the rest of your marketing will be much easier. § About Liz Tiefenthaler: Liz is the President of Pharm Fresh Media, a marketing services company serving Independent pharmacy. She is a columnist for America's Pharmacist and Drugstore Canada as well as a frequent presenter for NCPA.

APA Brand Challenge: Write APA a letter by February 28 with no more than 500 words telling us why your pharmacy needs a brand makeover. Send examples of your current brand images such as logo or signs. Three businesses will be selected for a brand makeover by Pharm Fresh Media, courtesy of APA (must be an APA member to be eligible). Send letter and images to communications@arrx.org.

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PHARMACIST IMMUNIZATION PROGRAM

Influenza: It’s Not Too Late to Vaccinate rkansas’s 2012-2013 influenza season was one of the A worst on record predicating the need for continued quality improvement around the awareness, prevention

and treatment of influenza. According to research from the Arkansas Department of Health’s (ADH) Comprehensive Influenza Report and data from the Centers for Disease Control and Prevention’s (CDC) FluView surveillance, it is evident that the number of reported Influenza cases was elevated considerably during last year’s influenza season. ADH’s Dr. Jennifer Dillaha, ADH Medical Director for Immunizations, stated that Arkansas’ 2012-2013 Influenza season was “clearly the worst influenza season since 2009.”1 Influenza-related hospitalizations, mortality rates and intensive care units were elevated significantly compared to the previous 2011-2012 season. Similar to the trend seen throughout the nation, the activity of influenzalike illness in Arkansas peaked during Week 51 (ending December 21, 2012) through Week 4 (ending January 25, 2013). The influenza season is also particularly impactful for the nation’s Medicare population. Each year, approximately 90 percent of deaths and the majority of hospitalizations due to influenza occur in patients age 65 and older. In the 2012-2013

season, the laboratory-confirmed influenza hospitalization rate nationwide for patients age 65 and older was the highest recorded since the inception of this data collection metric in 2005 – nearly triple that reported during the 20102011 season.2,3 In addition to death and hospitalization, this population is also more likely to experience other complications as the result of contracting influenza. These complications include pneumonia, bronchitis, myocarditis, and worsening of underlying chronic conditions, such as congestive heart failure and asthma.

Recommendations for Pharmacists

As one of the most trusted and accessible healthcare providers, pharmacists have a responsibility to ensure their patients and other healthcare staff are educated on the potential complications of the influenza virus and are vaccinated against the illness. The following recommendations were adapted from the CDC’s Key Points released during National Influenza Vaccination Week (NIVW) in December 2013 4 :

Figure 1. US Laboratory-Confirmed Influenza Reported to the CDC by Type, Surveillance Week and Year*

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1. All patients age 6 months and older should receive the influenza vaccination yearly, unless contraindicated. Contraindications include children under the age of 6 months and patients with a history of severe allergic reaction to the vaccine. Patients with a concurrent moderate/severe illness, egg allergy or history of Guillain-Barré should consult with a physician prior to receiving a vaccination. 2. It’s not too late to vaccinate. Vaccination activity typically drops dramatically following the month of November. However, influenza activity usually doesn’t peak until December-January or later. Therefore, pharmacists should continue to recommend the vaccination to patients as long as the virus is circulating. 3. High risk patient populations should be educated and vaccinated. Patients at risk for developing serious influenzarelated complications include children under the age of 5, patients age 65 and 23

INFLUENZA: IT'S NOT TOO LATE TO VACCINATE

older, pregnant women and patients with the following chronic conditions: asthma, neurological conditions, heart disease, chronic lung disease, blood disorders, diabetes mellitus, kidney/liver disease, immunosuppressive disorders and obesity.

The CDC does not recommend one influenza vaccine over another. This includes the trivalent and quadrivalent vaccines. The key is to educate patients about their best options.

3. Centers for Disease Control and Prevention’s Morbidity and Mortality Report. Influenza Activity — United States, 2012–13 Season and Composition of the 2013–14 Influenza Vaccine. June 14, 2013:62(23);473-479. 4. Centers for Disease Control and Prevention’s 2013 National Influenza Vaccination Week (NIVW) Key Points. <http://www.cdc.gov/flu/pdf/nivw/nivwkeypoints-2013.pdf> Retrieved on November 1, 2013. _________________________________________________________ Christi Quarles Smith, PharmD, is a pharmacy specialist at the Arkansas Foundation for Medical Care (AFMC), and is the team lead for AFMC's reducing adverse drug events and care transitions projects. She is a graduate of the University of Arkansas for Medical Sciences (UAMS) and completed a Pharmacy Practice residency at UAMS. She can be reached at csmith@afmc.org. AFMC is the state's healthcare Quality Improvement Organization and contracts with the Centers for Medicare & Medicaid Services to give technical assistance to healthcare providers. AFMC's mission is to promote excellence in health and healthcare through education and evaluation. _________________________________________________________

5. Ensure all healthcare colleagues and staff are vaccinated. During the 2011-2012 influenza season, only 63 percent of healthcare workers received the influenza vaccination. It is important for all healthcare workers to be vaccinated in order to prevent the spread of influenza among themselves, their patients and their families.

Continued Awareness

The Arkansas Foundation for Medical Care (AFMC) and the Arkansas Pharmacists Association (APA) are engaged in a campaign to promote continued awareness, prevention and treatment of Influenza during the current 2013-2014 season. As part of this campaign, Dr. Haselow presented “The Flu in Arkansas: Highlighting the 2012-1013 Flu Season, Surveillance and Expectations for the 2013-2014 Flu Season” via webinar. A recording of this webinar is posted here: http://qio.afmc.org/HealthCareProfessionals/ CareTransitions/CareTransitionsLAN.aspx. Additionally, informational flyers, fact sheets and posters created by AFMC, the APA and the CDC are being distributed to pharmacies, hospitals, nursing homes, home health agencies, local health units and other providers. For more information on how you and your staff can engage in this work contact Dr. Christi Quarles Smith (csmith@afmc.org) or Dr. Eric Crumbaugh (eric@arrx.org). § REFERENCES 1. Haselow, Dirk. Arkansas Influenza Season Update: influenza infections widespread and continuing to rise in Arkansas. January 8, 2013. 2. Centers for Disease Control and Prevention’s FluView Influenza Report prepared by the Influenza Division. <www.cdc.gov/flu/weekly/fluactivitysurv.htm> Retrieved on November 1, 2013.

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2013 New Drugs — The Year in Review

elcome to this new column, the aim of which is to help members keep current on the FDA’s approval of new drugs, new indications, significant new dosage forms, and other important labeling changes. Efforts will be made to ensure that information appearing in this column is accurate and upto-date. As of this writing, the FDA has approved 26 new molecular entities or therapeutic biological products in 2013. By comparison, this lags slightly behind 2011 and 2012 during which 30 and 39 new drugs were approved, respectively. The table below briefly summarizes drugs approved. In addition to drugs that are used to treat or modify disease, the new agents have also been approved to aid in diagnostic imaging. These include Vizamyl™ (Flutemetamol F18) for visualizing beta-amyloid plaques in Alzheimer’s disease and dementia, Lymphoseek® (technetium Tc 99m tilmanocept) for lymphatic mapping in melanoma or breast cancer, and Dotarem® (gadoterate meglumine) for MRI of the brain and spinal tissue.

have reformulated several opioid/APAP combination products. Abbott introduced their Vicodin® product line with a reduced strength of 300mg of APAP and discontinued distribution of prior Vicodin® formulations. As a result, prescriptions written for Vicodin®, Vicodin ES® and Vicodin HP® can no longer be filled with a generic substitute. Otherwise, prescribers must order hydrocodone/APAP in a generically available strength (e.g. 5mg/325mg tablets). In other news, while groups ranging from the DEA, Congress, and national pharmacy organizations were weighing in on the merits of reclassifying all hydrocodone products from Schedule III to Schedule II, the FDA curiously approved Zohydro ER, the first hydrocodone-only drug in the US in a formulation that does not have abuse-limiting properties. Not surprisingly, attorneys general from 28 states have asked the FDA to reconsider its decision or to set a rigorous time line for Zohydro to be reformulated with abuse-deterrence. § _____________________________________________________________ Rodney Richmond, RPh, is Associate Professor, Pharmacy Practice, at Harding University College of Pharmacy in Searcy.

Two drugs made the Rx-to-OTC switch this year including Oxytrol® for Women (oxybutynin) transdermal patch for the treatment of overactive bladder, and Nasacort® Allergy 24HR (triamcinolone acetonide) for allergic rhinitis. Drugs that were withdrawn from the market in 2013 include Iclusig™ due to a risk of blood clots and narrowing of blood vessels, and Omontys® related to serious hypersensitivity reactions and deaths. A number of drugs were on schedule to lose patent protection in 2013. Out of approximately 120 drugs that were expected make the expiry list, the top ones in terms of total sales for which generic equivalents are now available include Cymbalta®, Lidoderm®, Maxalt®, Niaspan®, Reclast®, Temodar® (oral), Xeloda® and Zometa®. Others for which a generic is not yet available include Avonex®, Humalog®, Neupogen®, OxyContin®, Procrit® and Rebif®. Two other drugs made the list but have found new life through reformulation. Aciphex®, a generic of which is available for the 20mg tablet, now has two new strengths in a sprinkle formulation for children with GERD. Warner Chilcott received approval for Delzicol™ (mesalamine) delayed-release capsule as Asacol® reached the patent cliff. Finally, hydrocodone was one of the drugs capturing the most headlines in 2013. In order to meet a January 14, 2014 mandate that all APAPcontaining prescription products be limited to no more than 325mg per dosage unit, manufacturers AR•Rx

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COLLEGES OF PHARMACY

UAMS

Resolutions and Optimism for 2014 Stephanie Gardner Pharm.D., Ed.D. Dean

s 2014 begins, I think about resolutions for the new year. I have personal resolutions, most of which revolve around healthier living. During a year when I hit the 50-year mark, I know that a healthy diet and exercise are more important than ever before. I also know taking time to de-stress and spending time with family and friends are things I will never regret. But in my role at work, I also think a We are committed to lot about resolutions educating students about the for the new year for challenges we face in this the UAMS College country in health equity, and of Pharmacy. We we want them to provide are in the initial care that includes the patient stages of a strategic and their family members as plan that focuses integral parts of the health on four primary care team. goals. We have resolved to focus more on the learning process than the delivery of lectures. New approaches will include more active learning strategies, such as "flipped" classrooms, simulation, and team-based learning. We will expand our drug discovery research, especially in the areas of cancer and radiation injury. We will work with pharmacists across the state to assist in the implementation and assessment of new practice models, and we will regularly communicate with all of our stakeholders (internally and externally). We also have resolved as a campus to incorporate interprofessional education into the learning experiences of all of our students. We want our students to learn from, with, and about each other. To be successful in the new healthcare environment, it will be critical for them to respect each other and to appreciate the roles and responsibilities of each member of the team. We also want

each student to fully understand the social determinants of health and to be able to communicate effectively with patients who have low health literacy. We are committed to educating students about the challenges we face in this country in health equity, and we want them to provide care that includes the patient and their family members as integral parts of the healthcare team. Recent data has indicated that Arkansas ranks second as the least healthy state in the country. We are one of the states with the highest infant mortality rate and the highest prescription drug abuse. We also are in a state where obesity, cardiovascular disease, tobacco use, and diabetes contribute to a shortened life expectancy, with some areas of the state having life expectancy shortened by almost a decade as compared to other areas. As pharmacists, educators, and future pharmacists, we have tremendous opportunity to be part of the solution. I believe that pharmacists are best positioned to motivate people in their communities to improve their health behaviors. The widespread availability of immunizations provided in local pharmacies is evidence of our ability to improve health outcomes. Our challenge is to implement practice changes that impact health outcomes, while continuing to push for changes in reimbursement that will make the model sustainable. I am very optimistic about 2014. I believe it will be the year when interprofessional education will become the expectation, rather than an "add-on." I think it will be a year when we will see new models emerge in a variety of pharmacy settings, from community pharmacies to patient-centered medical homes and institutional settings. And I hope it's a year when "50" becomes the new "40" for me! I wish you and your family a great 2014. Â§

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COLLEGES OF PHARMACY

HARDING UNIVERSITY

Residency Programs an Excellent Option Julie Hixson-Wallace Pharm.D., BCPS Dean

recently returned from the American Society of HealthSystem Pharmacists Midyear Clinical Meeting (ASHP MCM) in Orlando, FL. The ASHP MCM is the largest meeting of pharmacists in the world attended by over 20,000 individuals from around the globe. The meeting has become increasingly student-centric over the years with a focus on preparation for a career in health-system pharmacy. For many students, this means completion of a post-graduate residency program. Residency programs are divided into post-graduate year one (PGY1) and post-graduate year two (PGY2) programs with PGY1 residencies generally being in pharmacy practice and PGY2 residencies being in specialty areas such as pediatrics, oncology, infectious disease, pharmacokinetics, geriatrics, etc. In 2013, a total of 5,637 individuals enrolled in the residency matching program, often referred to simply as “The Match.” Of these, 4,928 were seeking a PGY1 position with the remaining candidates seeking a PGY2 position. A total of 3,156 residency positions were available nationally in 2013, so you can see there is a bit of a mismatch between the number of individuals seeking residency and the number of residency positions available. When the match was completed, a total of 2,866 applicants matched with a residency program. There were approximately 14,000 pharmacy graduates in 2013. If you do the math, about 23% of the graduates in 2013 could have been accommodated in ASHP-accredited residency programs. The administration of ASHP hosts an annual deans’ update during the ASHP MCM and provides academic pharmacy with data from the most recent match cycle. In the 2013 match cycle, Harding had 12 of its 50 graduates register for the match, 11 who submitted rank lists, and 7 who matched with an ASHP-accredited residency program. One additional student also secured a position in a residency program outside of the match. We are very pleased with the number of Harding students (16% of the

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class of 2013) who are seeking residency training. This is just one career path pharmacy students today may choose to pursue. While ASHP is the official accrediting agency for residency programs, they work very closely with other professional pharmacy organizations in developing standards for community residency and managed care residency programs. The American Pharmacists Association No matter in what arena (APhA) helps develop one wishes to practice, a and monitor community residency program is an residency programs excellent place to start. As while the Academy the subject of pharmacist of Managed Care Pharmacy (AMCP) credentialing becomes ever assists with managed more discussed, residency care residency program training and specialty guidelines. No matter in pharmacy board certification what arena one wishes are sure to be part of the to practice, a residency conversation. program is an excellent place to start. As the subject of pharmacist credentialing becomes ever more discussed, residency training and specialty pharmacy board certification are sure to be part of the conversation. Certainly one of the beauties of our profession is the variety of positions and opportunities available to pharmacists and residency training is just one avenue making the way better paved for potential job seekers. On behalf of the faculty, staff, and students of the Harding University College of Pharmacy, I wish you a very happy new year! §

ARKANSAS ASSOCIATION OF HEALTH-SYSTEM PHARMACISTS

Seizing Opportunities Available to Pharmacists Lanita S. White, Pharm.D. President

his is an exciting time of year for health-system pharmacists. In December 2013 we traveled to the American Society of Health-System Pharmacists Midyear Clinical Meeting which was held in Orlando, Florida. When we arrived, we were greeted by a banner that proclaimed that this meeting was the largest gathering of pharmacists in the world! WOW! The Midyear meeting featured many of the topics we are discussing in Arkansas including the Affordable Care Act, pharmacists’ provider status, where pharmacists fit in Accountable Care Organizations (ACOs), collaborative practice and Patient Centered Medical Homes (PCMH). There was a wealth of ideas and perspectives on these topics and we are looking forward to seeing how we can implement some of them in Arkansas. As usual at Midyear, talk of residencies was the buzz of the week. Our residency programs were well represented at the residency showcase recruiting for programs across the state in health-system as well as community pharmacy. Meanwhile, the AAHP Residency Council presented a poster entitled “Preparation and Implementation of a Statewide Residency Preceptor Development Seminar”.

Welcome banner at ASHP Midyear Meeting.

This poster presented by Drs. Melanie Claborn, Sarah Cochran, Christy Holland and Kendrea Jones highlighted the process of creating a statewide preceptor development seminar including providing distance sites, developing preceptors in all stages of their career and fostering open dialogue among those involved in residency training. On the other side of the convention center, the University of Arkansas for Medical Sciences (UAMS) College of Pharmacy fourth-year students, Lauren Miller and Bobby Glaze, made it to the top ten at the National Clinical Skills Competition! They had a great presentation and made UAMS proud and brought home new iPad minis for their efforts. Congratulations! The 2013 Midyear meeting was phenomenal! It gave us time to re-focus on our goals for the organization and re-energized us for 2014. This is a great time for the profession as we are ready at the state level to seize the many opportunities that are becoming available for pharmacists. It is great to know that our national organizations are working together toward the same goals. In 2014, we are ready to take pharmacy to new heights! §

Dr. Christy Holland and AAHP Residency Council poster at ASHP Midyear Meeting.

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COMPOUNDING ACADEMY

Compounders Have New and Conflicting Law Warren Lee, Pharm.D. President

R 3204, titled the Drug Quality and Security Act (DQSA), passed the Senate on November 18, 2013, and was signed into law by the President on November 27, 2013. The law has two sections: Title I is the Compounding Quality Act and Title II is the Drug Supply Chain Security Act. The Compounding Quality Act does the following: 1. It divides compounders into one of two categories: Traditional compounding pharmacies or Outsourcing Facilities. 2. Traditional compounding pharmacies will fall back under old Section 503A of the Food, Drug and Cosmetic Act (FDAMA; which was enacted in 1997), minus the unconstitutional advertising and promotion restrictions, which the newlyenacted DQSA removed from Section 503A. According to the FDA, Section 503A does not permit any compounding for office use, even when it is limited to intrastate commerce. It allows compounders to dispense compounds only for identified individual patients based on the order of a prescription. This interpretation will pit those state laws permitting office use compounding against Federal Law. 3. It establishes a new Section 503B that allows facilities engaged in sterile compounding for office-stock to “voluntarily” register with FDA as a new type of entity deemed an “outsourcing facility.” Outsourcing facilities do not have to be a licensed pharmacy, but their activities must be supervised by a licensed pharmacist. Outsourcing facilities are subject to: cGMPs, risk-based inspections, user fees and new labeling and adverse event reporting requirements. Outsourcing facilities may compound from bulk substances only when drugs are on FDA’s published shortage list or when a substance is listed on FDA’s yet-to-be published “clinical need” list . Outsourcing facilities may not compound drugs that are essentially copies of commercially available drugs. 4. The Act requires the Secretary of HHS to facilitate communication between the agency and the state boards of pharmacy about concerns with, or actions taken against, compounding pharmacies. FDA states that it will still maintain enforcement authority over Section 503A pharmacies, although those pharmacies will be “primarily” regulated by state boards of pharmacy. 5. As stated above, the Act requires the development of a “clinical need” list. Outsourcing facilities will only be able to compound products from bulk active ingredients if the ingredients appear on this list. On December 4, 2013, FDA published a request for nominations for products to be included on this list. Nominations must be submitted by March 4, 2014. 6. Under Section 503A, there are strict limits on interstate AR•Rx

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shipment of compounded products, even when they are shipped on a prescription basis for a single, identified patient and shipped directly to the patient’s home. The default limit is 5%, unless there is a Memorandum of Understanding on file between the state and the FDA. FDA has stated it will not enforce this provision The Act requires until 90 days after a MOU has been presented to the states the Secretary of for their consideration and HHS to facilitate approval.

communication

7. The Act requires between the agency the development of a and the state boards “Demonstrably Difficult of pharmacy about to Compound” list. Any concerns with, or products on this list will be illegal to compound (entities actions taken against, compounding such products compounding will be subject to penalties pharmacies. for violations of the FDCA), whether you are a Section 503A traditional compounder or an outsourcing facility registered under 503B. There has been a difference in interpretation concerning this provision also. While to some it seems to implicate only individual drug products, FDA has interpreted it to mean entire classes of drugs may be deemed “demonstrably difficult.” Some examples that have already been put forth for consideration for the list include: all transdermal products, bio-identical hormones, suspensions for injection, etc. FDA is seeking nominations for the “Demonstrably Difficult to Compound List,” which must be submitted by March 4, 2014. Because of the conflicts of interpretation of this law, it is expected that compounders will soon find themselves back in court with FDA. While it was originally thought that this law was much better than what could have resulted from the NECC tragedy, we are now finding that there are multiple legal “land mines” that could have a significant detrimental effect on compounding, patient access to compounded drugs, and the health of those that rely on compounded medications. The next six to twelve months are going to be critical to anyone involved with compounding. So if compounding is a part of your business model and you are not currently involved with this process, now would be a great time to join the International Academy of Compounding Pharmacists and get involved! You can visit their website at: www.iacprx.org. §

2013-2014 APA Board of Directors

President Dana Woods, P.D.

President-Elect Brandon Cooper, Pharm.D.

Vice President John Vinson, Pharm.D.

Past-President Dennis Moore, Pharm.D.

Area I Representative Michael Butler, Pharm.D.

Area II Representative Brent Panneck, Pharm.D.

Area III Representative Eddie Glover, P.D.

Area IV Representative Lynn Crouse, Pharm.D.

District 1 President Clint Boone, Pharm.D.

District 2 President Kristy Reed, Pharm.D.

District 3 President Chris Allbritton, Pharm.D.

District 4 President Lise Liles, Pharm.D.

District 5 President H. Dean Watts, P.D.

District 6 President Stephen Carroll, Pharm.D.

District 7 President C.A. Kuykendall, P.D.

District 8 President Casey McLeod, Pharm.D.

Hospital Academy President Lanita White, Pharm.D.

Compounding Academy President Warren Lee, Pharm.D.

Consulting Academy President Larry Mcginnis, Pharm.D.

Board of Health Member John Page, P.D.

UAMS College of Pharmacy Stephanie Gardner, Pharm.D., Ed.D.

Harding College of Pharmacy Julie Hixson-Wallace, Pharm.D., BCPS

UAMS Student Member Dylan Jones

Harding Student Member Mark Egbuka

State Board of Pharmacy John Clay Kirtley, Pharm.D.

Legal Counsel Harold Simpson, J.D.

Treasurer Richard Hanry, P.D.

Executive Vice President and CEO Mark Riley, Pharm.D.

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Call for Board Nominations in 2014 Take advantage of the opportunity to give back by serving on the Arkansas State Board of Pharmacy or the APA Board of Directors. We are seeking nominations for enthusiastic and energetic individuals who want to make an important contribution to the pharmacy profession.

Arkansas State Board of Pharmacy Elections

APA Bylaws: Article IV- Nominee and Delegates Section 1: BOARD OF PHARMACY NOMINEES. Only Arkansas registered pharmacists primarily engaged in an active practice of profession in Arkansas for the past five (5) years and who for the past five (5) years shall have been an active member in good standing in the Arkansas Pharmacists Association shall be eligible as a candidate for Association nomination to the Arkansas State Board of Pharmacy for a six (6)-year term. Candidates for the State Board election shall be nominated from the statewide APA membership and elections for each position shall be on a statewide basis. APA will submit the names of the three nominees receiving the most votes to the Governor for his consideration. Governor Beebe will evaluate the nominees recommended by APA and make the appointment to the Arkansas State Board of Pharmacy. If interested in nominating yourself or another individual, please contact APA Executive Vice President and CEO Mark Riley (mark@arrx.org) at 501-372-5250. Nominations will close at 4:30 p.m., March 14, 2014.

APA Board of Directors Call for Nominations

Nominations are invited for each of the following positions on the Arkansas Pharmacists Association Board of Directors.

Vice President of APA

Statewide (One-year term as Vice President, four total years as Board Member)

Area I Representative APA Board Member

Area I - Northwest, West and West Central Districts (Four-year term) Area I Counties: Baxter, Benton, Boone, Carroll, Clark, Conway , Crawford, Franklin, Garland, Hot Springs, Johnson, Logan, Madison, Marion, Montgomery, Newton, Perry, Pike, Polk, Pope, Searcy, Sebastian, Scott, Washington and Yell Counties.

District 3 President

Northwest District (Two-year term) Northwest Counties: Baxter, Boone, Benton, Carroll, Madison, Marion, Newton, Searcy and Washington.

District 6 President

West Central District (Two-year term) West Central Counties: Clark, Conway, Garland, Hot Springs, Johnson, Montgomery, Perry, Pike, Pope and Yell.

District 7 President

Western District (Two-year term) Western Counties: Crawford, Franklin, Logan, Polk, Scott and Sebastian.

District 8 President

White River District (Two-year term) White River Counties: Cleburne, Fulton, Independence, Izard, Jackson, Sharp, Stone, Van Buren, White and Woodruff.

APA OFFICERS AND BOARD OF DIRECTORS

The requirements for nominees of the APA Officers are as follows: Arkansas licensed pharmacist who has been a member of this Association in good standing for the past three (3) consecutive years. No elected member of the APA Board of Directors shall serve for more than eight (8) consecutive years or more than two (2) consecutive terms in the same capacity. If interested in nominating yourself or another individual, please contact APA Executive Vice President Mark Riley (mark@arrx.org) at 501-372-5250. Nominations will close at 4:30 p.m., March 28, 2014.

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Member Classifieds Pharmacists needed at Cantrell Drug in Little Rock - We are growing again! Cantrell Drug Company needs to fill pharmacist positions for evening shift (3:30 p.m. – 12 a.m.). These positions are non-retail positions. They are full-time with a great benefit package. The successful candidate will want to work in a lab-type environment while demonstrating attention to detail and a focus on quality. Please send your resume to chutts@cantrelldrug.com. (1/16/14) Pharmacy Tech needed in central Arkansas - Contact John Norris for more information at 501-202-2462 or john.norris@baptist-health.org. (1/16/14) Pharmacy Tech needed in North Little Rock - Independent retail pharmacy located in North Little Rock. Please call 501-353-1984 for more information or email lakewood@cornerstonepharmacy.com to send resume. (1/16/14) For Sale - Germfree Laminar Flow Glovebox/Isolator (Class 10). Four-foot-wide work area with 3 glove ports, airlock antechamber, and stainless steel stand. In excellent condition. Pictures available upon request. Contact Laura Beth Martin at Family Pharmacy 870-777-5713. (1/7/14) Harp's Pharmacy in Cabot needs parttime tech - The applicant must be friendly, have good people skills, courteous, hardworking and able to learn and follow computer software. The job entails a mixture of pharmacy clerking and tech duties. Contact Greg Orlick or Noah Rabb at 501-843-3374, Mon.-Fri. 9 a.m. to 7 p.m. (1/6/14) Pharmacy Technician needed in Little Rock - Compounding- fulltime, excellent hours (M-F 9am-5:30pm), competitive pay plus performance bonus, and great work environment. Experience necessary - Frederica Pharmacy & Compounding, 400 W. Capitol Ave., Little Rock, AR -email resume to freiderica1@att.net. (1/6/14) Part-Time Pharmacist or Pharmacy Technician needed in Little Rock - Teach PT students Monday through Thursday, 8:30 a.m. to 1:30 p.m. Résumés to Dr. Lampone: rosalie.lampone@remingtoncollege.edu. (10/17/13). Pharmacy techs needed at Cantrell Drug in Little Rock - We are growing again! Cantrell Drug Company needs to fill 10 pharmacy technician positions ASAP. These positions are non-retail positions. 32

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

They are full-time with a great benefit package. The successful candidate will want to work in a lab-type environment while demonstrating attention to detail and a focus on quality. Please send your resume to dconaway@cantrelldrug.com. (9/23/13) Pharmacy for sale in Marvell - Pharmacy for sale in Marvell, Arkansas. $1.2 million in annual sales; 99 percent prescriptions. In building with nurse practitioner. Open M-F 9 am - 5 pm. Nearest competitor is 20 miles away. Contact Bob Wright: 870-816-5269 or bobwright@eastark.com. (7/29/13) Walgreens Community Pharmacists needed - Walgreens is currently seeking community pharmacists throughout Arkansas, specifically in the following cities: Bryant, Cabot, Conway, Forrest City, Fort Smith, Jonesboro, Little Rock, Magnolia, Malvern, Monticello, Mountain Home, North Little Rock, Paragould, Pine Bluff, Rogers, Russellville, Searcy, Sherwood, Springdale and West Memphis. Please send resume to pharmacyjobs@walgreens.com if you’re interested! (3/22/13) Northwest Arkansas Free Health Center in Fayetteville looking for pharmacy volunteers - We provide health and dental care to low income and uninsured individuals. Our pharmacy hours are Wednesday 1-3 and Thursday 6-8. Contact Monika Fischer-Massie at mfischerm@nwafhc.org or call 479-444-7548. (12/12/12) Relief Pharmacist Available - Pharmacist with compounding experience looking for relief pharmacy work in Arkansas. Please contact Buzz Garner at 479-234-1100 or drbuzz@arkansas.net. (5/8/12) Charitable Clinic Needs Service Minded Pharmacists - Want to be thanked dozens of times a day? Tired of dealing with insurance? Join our team at River City Charitable Clinic in North Little Rock. We are looking for volunteer pharmacist to take an active role in the healthcare of low income, uninsured, unassisted patients. Volunteer(s) are needed specifically for a new "refill clinic". You can pick your ideal clinic time on Monday, Wednesday, or Thursday. Staff it weekly or share with a friend. Interested pharmacists can contact Pam Rossi at PRRossi@uams.edu or call Anne Stafford, RN Medical Manager at 501-376-6694. (2012)

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Experienced Relief Pharmacist Available - Experienced relief pharmacist (retail/ hospital/IV) available in Central Arkansas. Willing to travel reasonable distances. Fred Savage 501-350-1716; 501-803-4940; fred.savage@sbcglobal.net. (5/7/12) Volunteer Pharmacists Needed at Hot Springs Charitable Clinic - Wanted: VOLUNTEER pharmacists to assist in dispensing prescriptions, checking prescriptions, and counseling for low income and uninsured patients at a charitable clinic in Hot Springs. Volunteers are needed for bi-weekly evening clinics from 6 p.m. to 9 p.m.. and daily clinics, Tuesday and Wednesdays from 9 a.m. to 3 p.m.. Interested pharmacists should call or email Reita Currie at 501-623-8850, reitacurrie52@yahoo.com, at the Charitable Christian Medical Clinic, 133 Arbor Street, Hot Springs, AR 71901. (2011) IVANRX4U, Inc., Pharmacist Relief Services, Career Placements - Relief pharmacists needed - FT or PT. Based in Springfield, MO and now in Arkansas. Staffing in Missouri, Arkansas, Eastern Kansas and Oklahoma. We provide relief pharmacists for an occasional day off, vacations, emergencies — ALL your staffing needs. Also seeking pharmacists for full or part-time situations. Please contact Christine Bommarito, Marketing and Recruiting Director, for information regarding current openings throughout Arkansas, including temporary as well as permanent placements. Let IvanRx4u help staff your pharmacy, call 417-888-5166. We welcome your email inquiries, please feel free to contact us at: ivanrx4uchristine@centurylink.net. (2011) STAFF RPH, Inc. - Pharmacist and Technician Relief Services. We provide quality pharmacists and technicians that you can trust for all your staffing needs. Our current service area includes AR, TX, OK and TN. For more information call Rick Van Zandt at 501-847-5010 or email staffrph@att.net. (2011) §

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2014 APA AWARDS SOLICITATION

Award Nominations

Each year APA encourages members to submit the names of individuals who are deserving of special recognition for their professional activities during the past year. Any active APA member is eligible to nominate a person for the awards. Award recipients are chosen by an APA committee following a review of all nominees. Nominations are now being accepted for the following annual awards to be presented by the Association. Nominations will close at 4:30 p.m., April 4, 2014. Please mark your nomination with an X. If you have more than one nomination, please feel free to copy this form. ______Pharmacist of the Year The Pharmacist of the Year Award is given to recognize the pharmacist for his/her outstanding contributions to the profession of pharmacy and activities in the advancement of pharmacy during the year. ______Young Pharmacist of the Year Nominee must have an entry degree in Pharmacy, received nine or fewer years ago, and be a member of the APA. Nominee must be in the active practice of pharmacy in the year selected, and actively involved in the profession of pharmacy, displaying an interest in the future of the profession. ______APA Bowl of Hygeia Award This award was established by the A.H. Robbins Company to honor pharmacists who have contributed to the progress of their community. Criteria include: 1) Pharmacist licensed in the State of Arkansas; 2) Recipient must be living and must not be a previous recipient of award; 3) Recipient must not be currently serving, nor has he/she served within the immediate past two years, as an officer of the APA in other than an ex-officio capacity or on its awards committee; 4) Recipient must have compiled an outstanding record of community service, which, apart from his/her specific identification as a pharmacist, reflects well on the profession. ______ Percy Malone Public Service Award This award was established in 2009 by the Arkansas Pharmacists Association. The recipient must have made a contribution to public service by being elected to any public office and by displaying an interest in the people of Arkansas. ______Innovative Pharmacy Practice Award This award was established in 1993 by the APA in cooperation with the National Council of State Pharmacy Associations and DuPont Pharmaceuticals to recognize, annually, a pharmacist who has demonstrated a prominent spirit of innovation and entrepreneurship in the practice of pharmacy. Name of Nominee________________________________________________________________________________________ Address_________________________________________________________________________________________________ City/State/Zip ____________________________________________________________________________________________ Phone__________________________________________________________________________________________________ Reasons for selecting nominee: Attach one page with a description of reasons and/or the individual nominee’s resume. Nominator’s Name: ___________________Phone____________________________Date_______________ Fax or email written nomination form and material to: Awards Committee, Arkansas Pharmacists Association; eileen@arrx.org; Fax 501-372-0546. Please submit by 4:30 p.m., April 4, 2014.

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2014 Calendar of Events FEBRUARY

MAY

Feb. 28 CPE at the Races Oaklawn Racing and Gaming Park Hot Springs, AR

May 10 Harding University College of Pharmacy Commencement Searcy, AR

Feb. 11-12 Arkansas State Board of Pharmacy Meeting Little Rock, AR

MARCH

May 7-8 National Community Pharmacists Association Legislative Conference Washington, D.C.

May 16 UAMS College of Pharmacy Convocation

March 9 APA Board Meeting Little Rock, AR March 28-31 American Pharmacists Association Annual Meeting & Exposition Orlando, FL

APRIL

April 10 (tentative) Arkansas Pharmacy Foundation Golf Tournament Location TBD

May 17 UAMS Commencement Little Rock, AR

JUNE

June 10-11 Arkansas State Board of Pharmacy Meeting Little Rock, AR June 12-14 APA 132nd Annual Convention The Chancellor Hotel Fayetteville, AR

In Memoriam Dr. C. Fred Williams, 69, of Little Rock, University of Arkansas at Little Rock (UALR) history professor (1971-2011) and author, was born December 24, 1943, in Allen, Oklahoma, and passed away November 23, 2013. Dr. Williams was a graduate of Murray State in Tishomingo, OK; East Central University, Ada, OK; Wichita State University; and the University of Oklahoma. He was a member of Calvary Baptist Church, Little Rock; West Little Rock Rotary; Arkansas Historical Association; Agricultural History Society; AACHT; and the Southern History Association. He was also among conference leaders at LifeQuest, and volunteered in Little Rock Public Schools. Dr. Williams authored “A History of Pharmacy in Arkansas” in 1982, under the sponsorship of the Arkansas Pharmacists Association when Dr. Charles West was Executive Vice President.

Arkansas State Board of Pharmacy President. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Steve Bryant, P.D., Batesville Vice President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Justin Boyd, Pharm.D., Fort Smith Secretary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Lenora Newsome, P.D., Smacko Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Stephanie O’Neal, P.D., Wynne Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Kevin Robertson, Pharm.D., North Little Rock Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Tom Warmack, P.D., Sheridan Public Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Larry Ross, Sherwood Public Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Joyce Palla, Arkadelphia

AAHP Board Executive Director . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Susan Newton, Pharm.D., Russellville President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Lanita Shaverd-White, Pharm.D., Little Rock President-Elect. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Marsha Crader, Pharm.D., Little Rock Past President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Willie Capers, Pharm.D., Jonesboro Treasurer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sharon Vire, Pharm.D., Jacksonville Secretary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Wendy Koons, Pharm.D., Jonesboro Member-at-Large . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Maggie Miller, Pharm.D., Batesville Member-at-Large. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Niki Carver, Pharm.D., Little Rock Member-at-Large . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .James Reed, Pharm.D., Conway Technician Representative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Janet Liles, MS, CPht, Searcy 34

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