ARRx - The Arkansas Pharmacist Winter 2013 by Arkansas Pharmacists Association

Winter 2013 Award Winning Quarterly Publication of the Arkansas Pharmacists Association

Health Care Engages

89th General Assembly Preparing Your Pharmacy for Theft or Burglary

AR•Rx

THE ARKANSAS PHARMACIST

Dear Arkansas Pharmacist, The Arkansas Pharmacists Association’s more than 2,400 members help shape the future of pharmacy in Arkansas. Please help us help you! This is an important year for the state legislature to consider Medicaid expa nsion and other issues important to pharmacy. We need your support in order to continue to make strides to expand your professional practice scope, address oner ous PBM practices, work closely with the state agencies that regulate pharmacy, ensure pharmac ists’ involvement in health care reform imp lementation and maintain the best healthcare and business environment for pharmacists here in Arka nsas. Your APA membership helps to determin e the direction of the profession and prot ects your livelihood regardless of practice setting. In addition to advocating for pharmacists before the Arka nsas legislature, APA provides weekly communications on industry trends and changes, the quar terly journal AR•Rx The Arkansas Pharmacist, more than 20 hou rs annually of Continuing Education and plenty of networking opportunities. In 2012 we implemented a Pharmacist Immunization Program that provided training tools and allowed pharmacists to earn revenue by providing immunizations to patients. Please renew your membership for the coming year. The easiest way to rene w is to go online to www.arrx.org and complete the informa tion there. Your username is on the fron t of the magazine. Or, please call our office and staff will take your credit card information over the pho ne. Membership is a small investment in the

future of our great profession.

If you are haven’t gotten around to rene wing your membership for several year s, we look forward to serving you again! Sincerely,

Mark S. Riley, Pharm.D. Executive Vice President

417 South Victory Street | Little Rock, AR

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72201-2923 | p 501-372-5250 | f 501-3720546

| www.arrx.org

Contents

Dear Arkansas Pharmacist Letter

Inside APA: Doing Our Part in a Changing Health Care Environment

From the President: Find Time for Your Professional Association

APA 2013 Calendar of Events

APA 2013 Annual Convention Preview

COVER: Health Care Engages 89th General Assembly

RX and the Law: Do I Have to Fill this Prescription?

Safety Nets: Decadron®

FEATURE: Preparing Your Pharmacy for Theft or Burglary

Legislator Profile: Senator Michael Lamoureux (R-Russellville)

Quality Notes from AFMC: Million Hearts Campaign

Pharmacist Immunization Program: Pharmacists Provide Flu and Tdap Immunizations

Harding Report: Drug Take Back, Immunizations and Advocacy

In Memoriam

UAMS Report: College of Pharmacy Instills Entrepreneurial Spirit

Member Spotlight: Maggie Miller, White River Medical Center, Batesville

Arkansas Association of Health-System Pharmacists: Continue to be Progressive and Innovative APA Compounding Academy: Compounding Academy Discusses Regulation

Medicaid Report: Making Continuation Criteria Work

APA 2013 Awards Solicitation

Call for Pharmacy and APA Board Nominations

2012-2013 APA Board of Directors

Member Classifieds

Directory of Advertisers

24 Cover photo: Governor Mike Beebe with APA Executive Vice President Mark Riley. AR•Rx

APA Membership Ad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Bell & Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Merck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 First Financial Bank . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Law Offices of Darren O’Quinn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Pace Alliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 EPIC Pharmacies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Arkansas Pharmacy Support Group . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Pharmacy Quality Commitment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 UAMS Alumni Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30 Pharmacists Mutual Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 APA Honors McKesson Drug . . . . . . . . . . . . . . . . . . . . . . . . . .Back Cover

THE ARKANSAS PHARMACIST

APA Staff Mark S. Riley, Pharm.D. Executive Vice President Mark@arrx.org Scott Pace, Pharm.D., J.D. Associate Executive Vice President Scott@arrx.org Matt Merrigan Director of Membership & Meetings Matt@arrx.org Debra Wolfe Director of Government Relations Debra@arrx.org Eileen Denne Director of Communications Eileen@arrx.org Celeste Reid Director of Administrative Services Celeste@arrx.org Eric Crumbaugh, Pharm.D. Immunization Grant Coordinator Eric@arrx.org Office E-mail Address Support@arrx.org Publisher: Mark Riley Editor: Eileen Denne Art & 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 01993763) 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). Nonmembers subscription rate is $30.00 annually. Periodical rate postage paid at Little Rock, AR 72201. Current edition issue number 61. © 2013 Arkansas Pharmacists Association. POSTMASTER: Send address changes to AR•Rx The Arkansas Pharmacist 417 South Victory Little Rock, AR 72201 Opinions and statements made by contributors, cartoonists or columnists do not necessarily reflect the attitude of the Association, nor is it responsible for them. All advertisements placed in this publication are subject to the approval of the APA Executive Committee. Visit us on the web at www.arrx.org

APA Board of Directors

INSIDE APA

2012 -2013 Officers

Inside APA

President - Dennis Moore, Pharm.D., Batesville President-Elect - Dana Woods, P.D., Mountain View Vice President - Brandon Cooper, Pharm.D., Jonesboro Past-President - Gary Bass, Pharm.D., Little Rock

Doing Our Part in a C hanging Health Care Environment – Easier Said Than Done

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 Jim Griggs, P.D., Fayetteville

Academy of Compounding Pharmacists Kristen Riddle, Pharm.D., Conway

Arkansas Association of Health-System Pharmacists

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

Ex-Officio APA Executive Vice President: 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, El Dorado UAMS College of Pharmacy Student Representative: Andy Roller, Fayetteville Harding College of Pharmacy Student Representative: Jackie Dabbour, Searcy

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

Mark Riley, Pharm.D. Executive Vice President

ometimes when the government screams that the fiscal sky is falling, it turns out not to be the case. But this time, in relation to Medicaid, there is overwhelming evidence that it is true. Your APA Board of Directors has embraced the fact that our state is headed toward a very real financial shortfall in the Medicaid program. The Board has challenged the staff to explore ways that pharmacists can use their knowledge to address these problems. However, it is not as simple as saying “here we are and this is what we can do to help.” Obstacles to implementation of our ideas come from various sources. To start, Medicaid Director Andy Allison has a lot on his plate and he is absorbed with payment reform initiatives around “episodes of care.” This model involves paying a set amount for treatment of a particular medical malady or condition (for instance, pregnancy) from onset of care until resolution or wellness occurs. Financial incentives are available if the responsible party (physician group or hospital etc.) can hold costs down to below a certain pre-determined level. Pharmacist involvement in this process has yet to be determined, but we have had productive conversations with Dr. Allison. Second, physicians have been put into a precariously dangerous position through uncertainty in the familiarity and reliability of this new payment model. In short, this is all new and understandably scary and risky for physicians. While we have tried to be clear that our proposals are intended to facilitate working with physicians

cooperatively and avoid turf battles, they have legitimate questions and need time and information to understand and become comfortable with our purpose. If we can forge a partnership based on common sense application for what we bring to the table, and respect for each other’s core practice elements, then our patients and our state will win. Third, the fact that pharmacists are not recognized as providers under Centers for Medicare and Medicaid Services guidelines is problematic in receiving payment for delivering patient care outside of traditional dispensing where all payment is tied to the pharmacy rather than the pharmacist. We are addressing this problem with those in a position to help solve it and making progress. Finally, the biggest challenge of all may be the willingness of pharmacists statewide to find time and places in their practice settings to perform whatever tasks that we find the opportunity to perform. Pharmacists have amazing knowledge for providing medicationrelated expertise and skillsets for patient screenings and other service. Their knowledge will result in patients receiving appropriate medical care from physicians and other suitable healthcare providers. We must accept the challenge that comes with opportunity and wrestle with the age-old “chicken or egg” scenario in the quest to improve health care outcomes in Arkansas. Every one of us must be ready to step up to the plate. §

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THE ARKANSAS PHARMACIST

FROM THE PRESIDENT

From the President Find Time for Your Professional Association

am well into the fifth decade of my professional career. Along that path, membership in my professional organization has been a given. For many years I was outside the state, and my primary employment was not in the area of traditional pharmacy. Yet, through it all, I always maintained an anchor in my profession by being active in an association.

and work experiences that will support our organizational mission. I encourage you to support him as he gets to know our membership, our mission and our organizational goals.

Dennis Moore, Pharm.D. President

And while I have contributed along the way, I have always felt that I was the greatest benefactor of maintaining a membership in my professional association. Some of the greatest growth experiences and professional opportunities have occurred as the result of that involvement.

As we go through life, there are constant challenges of maintaining a balance of family, church, professional, and civic responsibilities. Various life stages helps dictate the amount of time available for these activities. Finding time to involve ourselves in our professional association will be time well spent.

Over the past year, APA has struggled in the area of membership with a decline of approximately a hundred members. While there are a lot of potential reasons for the drop, the staff and Board have responded by hiring Matt Merrigan to assist in membership development and meeting planning. Matt comes to us with a range of educational

These are tough economic times as we fundamentally restructure health care delivery. It is important to have you at the table through your membership as we go down this path. Your thoughts are important to us, and we can best keep you informed of our issues through your active and participatory membership. §

2013 Calendar of Events March 12 APA Legislative Reception — Trapnall Hall Little Rock, AR March 17 APA Board of Directors Meeting — Hosto Conference Center Little Rock, AR March 1-4 APhA Annual Meeting & Exposition Los Angeles, CA April 11 APF Annual Golf Tournament — Tannenbaum Golf Course Drasco, AR May 7-8 NCPA Legislative Conference Washington, D.C. May 11 Harding University College of Pharmacy Commencement Searcy, AR May 12 UAMS College of Pharmacy Commencement Little Rock, AR June 5-8 APA 131st Annual Convention — The Peabody Hotel Little Rock, AR AR•Rx

THE ARKANSAS PHARMACIST

CONVENTION PREVIEW

2013 APA Annual Convention to be Held June 5-8, 2013 at Peabody Dispensing Knowledge for Better Heath

Pharmacists participate in Continuing Pharmacy Education during APA’s 2012 Annual Convention in Rogers.

he 131st Annual Convention of the Arkansas Pharmacists Association will be held June 5-8 at the Peabody Hotel in Little Rock. The theme of this year’s convention is Dispensing Knowledge for Better Health, reflecting what pharmacists do for their patients every day. Once again, APA will offer over 15 hours of continuing pharmacy education (CPE). This year’s CPE will be divided into themes, such as: Accreditation in Pharmacy, Clinical Practices, Prescription Drug Abuse and Pharmacy Management.

There will be plenty of opportunity for members and guests to learn about the latest innovations in pharmacy practices 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 5. Convention registration will open shortly. Stay tuned for more information through InteRxActions and www.arrx.org/annual-convention. §

Welcome Matt Merrigan, new Director of Membership and Meetings

Matt Merrigan joined the staff on January 2. Matt most recently served as Manager, Membership Services, for the American Case Management Association in Little Rock. Before that he was Specialist, Membership and Commmunity, for the Society of Teachers of Family Medicine in Leawood, Kansas; and Membership Specialist for the American Association of School Personnel Administrators in Overland Park, Kansas. Matt holds a B.S. degree in Public Relations from University of Central Missouri and a Master's degree in Organizational Development from Avila University.

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THE ARKANSAS PHARMACIST

Health Care Engages

89th General Assembly By Eileen E. Denne

We will look at whether it makes sense to change the definition of a prescription in the Arkansas Pharmacy Practice Act.

Arkansas State Capitol ready to welcome new legislators in 2013.

f all the issues that will engage the 89th General Assembly at the Arkansas State Capitol, health care issues promise to absorb the most time and attention, followed by new lottery rules. New legislators, including 45 who have not held a state office before, convened on January 14. APA Executive Vice President Mark Riley and Director of Government Affairs Debra Wolfe are ready for them. Riley recently responded to questions about the session.

A change in the practice act is a statutory change that the state legislature would have to make. In addition to traditional prescription, physicians would be allowed to write therapeutically. For example, if a physician wrote a prescription for omeprazole 40mg, therapeutic substitution allowable, this would allow for a change in drug within the same therapeutic class. The purpose of this change would be to facilitate or make formulary compliance easier and most cost effective for patients.

Q and A with APA Executive Vice President Mark Riley

Now, a doctor calls in prescription in a particular therapeutic class and if it is not the drug covered by the patient’s formulary, the pharmacist would communicate with the physician and patient to ultimately get to a place where the formulary drug is prescribed. This change that we are suggesting in the practice act would allow a doctor to write a prescription in a way that would accomplish that immediately. It would save time and phone calls for the physician, pharmacist and patient. Most importantly, the patient would get the drug they need in a timely manner. This becomes more important as we move closer to electronic prescriptions because you can’t have that conversation with an electronic prescription. Pharmacist formulary compliance changes would be sent to the doctor as a for-your-information courtesy. This new process only occurs if the physician chooses to do so.

What do you think the legislature will be focused on during this session? Medicaid shortfall will be the primary issue and whether or not the exchange process occurs. The legislature will also be deciding on whether to expand Medicaid. What are the issues APA will be looking at? There are three areas we’ll be pursuing: 1. We’re going to be looking at legislation related to generic drug issues and Maximum Allowable Costs (MAC) with the Pharmacy Benefit Managers (PBM). 2. We’ll be looking at the definition of specialty drugs. 3. And, we will look at whether it makes sense to change the definition of a prescription in the Arkansas Pharmacy Practice Act to allow doctors to write therapeutically where appropriate and by their choice. AR•Rx

THE ARKANSAS PHARMACIST

HEALTH CARE ENGAGES 89TH GENERAL ASSEMBLY

(L to R) Senator David Wyatt (D-Batesville) exchanges news with APA’s Executive Vice President Mark Riley and Director of Government Affairs Debra Wolfe.

We have agreement in theory with the Arkansas Medical Society on the concept of physician-designated therapeutic substitution and are currently working through the language with them. In December, APA completed an interim study on the Practice Act change because it may be viewed as a scope of practice issue. In the House, we have to have interim study before running a scope of practice issue. You can’t run a bill on a Practice Act change for 30 days so there is plenty of time for discussion. This time allows those in the professions to try to work it out without having a legislative battle. Who are the leaders pharmacists will be working most closely with? We will be working with all of the members of the Senate and House Public Health Committees. Senator Cecile Bledsoe (R-Rogers) is chair of the Senate Committee and Representative John Burris (R-Harrison) is the chair of the House Committee. What do you anticipate with Medicaid expansion? The Legislature will decide if Medicaid expansion will occur. APA is suggesting what pharmacists can do to handle the patient load – the ages 18 to 64 population. What we’re offering is to allow people a service to have their blood pressure and blood sugar checked so we can facilitate early detection of hypertension and diabetes. Our proposal is to 10

screen: we believe patients will have to choose their Primary Care Physician, but they could choose the convenience and ease of having tests done at the pharmacy to detect these two disease states. If the pharmacist determines the patient has elevated numbers, he or she would be referred to their physician for a diagnosis. The whole point is early detection. This is where we’re recommending protocolbased prescribing so Medicaid can save money. We think this approach makes a lot of sense but we will report on progress as we go.

Our proposal is to screen: we believe patients will have to choose their Primary Care Physician, but they could choose the convenience and ease of having tests done at the pharmacy to detect these two disease states. What can pharmacists do to ensure that pharmacy is heard? It is important for pharmacists to get involved with the local legislator. They should also be sure to come to APA’s Legislative Reception in Little Rock on Tuesday, March 12, 2013. What do you enjoy the most about working with legislators? What I enjoy most is the general process of democracy — that AR•Rx

THE ARKANSAS PHARMACIST

HEALTH CARE ENGAGES 89TH GENERAL ASSEMBLY

everyone is able to have their voice heard. I believe legislators are all trying to do the right thing and serve the public and do good things for Arkansas. I enjoy the fact that I get to represent pharmacy. Pharmacists always ask for things that are good for their patients. They don’t run legislative issues that are selfish for them - it is about what pharmacists can deliver for better care. Pharmacist issues are fairness issues and having the ability to serve patients in an unimpeded way. Six things you can do for your legislators: 1. Get to know them. 2. Take them out for breakfast, lunch or dinner; invite them to your practice location. 3. Give them money to help finance their campaigns. 4. Engage them on issues other than pharmacy. 5. Help solve their problems; ask what you can do for them. 6. Encourage them to seek assistance from the APA. §

APA Associate Executive Vice President Scott Pace briefs new legislator Douglas House (R- North Little Rock).

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THE ARKANSAS PHARMACIST

Legislators on Public Health Committees

Cecile Bledsoe, Chair (R-Rogers) Phone: 479-636-2115 cecile.bledsoe@senate.ar.gov

Paul Bookout, Vice-Chair (D-Jonesboro) Phone: 870-336-5013 paulbookout@hotmail.com

Linda Chesterfield (D-Little Rock) Phone: 501-888-1859 lchesterfield@comcast.net

Stephanie Flowers (D-Pine Bluff) Phone: 870-535-1032 stephanie.flowers@senate.ar.gov

David Burnett (D-Osceola) Phone: 870-563-5667 david.burnett@senate.ar.gov

Missy Irvin (R-Mt. View) Phone: 870-269-2703 missy.irvin@senate.ar.gov

Jonathan Dismang (R-Beebe) Phone: 501-766-8220 dismang49@hotmail.com

Ronald Caldwell (R-Wynne) Phone: 479-582-9410 ronald.caldwell@senate.ar.gov

John Burris, Chair (R-Harrison) Phone: 870-688-6181 burrisforstaterep@gmail.com

Reginald Murdock, Vice Chair (D-Marianna) Phone: 870-295-3208 rkm_72360@yahoo.com

Mark Perry (D-Jacksonville) Phone: 501-982-4561 mperry@windstream.net

Stephanie Malone (R-Fort Smith) Phone: 479-452-4554 stephanie.malone@arkansashouse.org

James Word (D-Pine Bluff) Phone: 870-543-6391 jword@aaasea.org

Hank Wilkins (D-Pine Bluff) Phone: 870-536-6366 hank.wilkins@arkansashouse.org

Greg Leding (D-Fayetteville) Phone: 479-422-8099 greg@gregleding.com

Fredrick Love (D-Little Rock) Phone: 501-612-3939 fred@fredricklove2010.com

Butch Wilkins (D-Bono) Phone: 870-972-5503 butch.wilkins@arkansashouse.org

Kelley Linck (R-Yellville) Phone: 870-453-6149 kelley@kelleylinck.com

Justin Harris (R-West Fork) Phone: 479-871-8542 justin.harris@arkansashouse.org

Jeff Wardlaw (D-Warren) Phone: 870-226-9501 jeff@jeffwardlaw.com

Kim Hammer (R-Benton) Phone: 501-840-3841 kimdhammer@yahoo.com

David Branscum (R-Marshall) Phone: 870-448-2408 davidlbranscum@hotmail.com

David Meeks (R-Conway) Phone: 501-277-9340 david.meeks@arkansashouse.org

Andy Mayberry (R-Hensley) Phone: 501-888-3522 andymayberry@windstream.net

Betty Overbey (D-Lamar) Phone: 479-885-6479 betty.overbey@arkansashouse.org

Chris Richey (D-Helena) Phone: 870-995-2499 chris.richey@arkansashouse.org

Richard Womack (R-Arkadelphia) Phone: 870-403-6287 richard@richardwomack.com

Deborah Ferguson (D-West Memphis) Phone: 870-735-7098 deborah.ferguson@arkansashouse.org

HOUSE

SENATE

HEALTH CARE ENGAGES 89TH GENERAL ASSEMBLY

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THE ARKANSAS PHARMACIST

DENNIS MOORE VIEWS PHARMACY FROM 5,000 FEET

MEMBER SPOTLIGHT

Maggie Miller

White River Medical Center

Pharmacy practice: Hospital Graduate pharmacy school and year: UAMS College of Pharmacy 2002, ASHP Residency in Pharmacy Practice with an Emphasis in Ambulatory Care at the Regional Medical Center in Memphis 2002-03. Years in profession: 10 years; nine years at WRMC. Favorite part of the job: I enjoy solving problems that can have a positive and direct impact on patient care. I also enjoy working with a wonderful staff; many of us have worked together for most of my nine years here at WRMC. Least favorite part of the job: When I have to discipline employees; fortunately this doesn’t happen very often.

Recent reads: The Spiritual Disciplines of the Christian Life and The Nearby Faraway. Fun activities: I really enjoy photography, exercising, cooking, and learning new crafts. One of my absolute favorite things is when our family gets together. Both of my sisters live out of state and when we are able to get together we have a great time. Ideal dinner guests: Martin Short, Thomas Mangelsen, and Neil Diamond. If not a pharmacist then…: Before I decided to pursue pharmacy as a career, I majored in and earned a degree in Animal Science with an emphasis in food science. I might be working for the food industry or in research. §

Oddest request from a patient/customer: There was a request from a physician to make 0.1 N solution of hydrochloric acid IV for a patient. It had been done in the past, but this was the first time I had heard about it. We ended up getting the order changed.

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THE ARKANSAS PHARMACIST

RX AND THE LAW

AND THE L AW By Don R. McGuire Jr., R.Ph., J.D.

Do I have to fill this prescription? 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.

any pharmacists have asked the question, “I have some doubts about this prescription, do I have to fill it?” We will deal with this question in terms of therapeutics and patient health. We will reserve the topic of conscientious objection for a different time. When I was a young pharmacist, a more experienced colleague at the hospital received a phone order for IV propranolol, but at an oral dosage. The other pharmacist refused to dispense it, even in the face of verbal threats from the prescriber. In the end, the order wasn’t filled and any potential harm to the patient was avoided. What should you do if faced with a prescription that you believe is harmful to the patient? This harm may come from serious side effects, drug interactions, or possible addiction to controlled substances. Some states deal directly with this question in their regulations. For example, California states that pharmacists can refuse to fill prescriptions that would be against the law or that could potentially have a harmful effect on a patient’s health. Indiana states that the pharmacist can refuse to fill a prescription that is contrary to law, that is against the best interests of the patient, that would aid or abet an addiction or habit, or that is contrary to the health and safety of the patient. Two general rules can be formulated from these examples. 1. Prescriptions that are illegal or invalid can’t be filled. This is one of the most difficult scenarios for a pharmacist when it comes to controlled substances. The Drug Enforcement Administration (DEA) takes the position that to be valid, a prescription for a controlled substance must be issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice. The DEA believes that the law does not require a pharmacist to dispense a prescription of doubtful, questionable, or suspicious origin. It is difficult for a pharmacist to know when the line has been crossed from legitimate treatment to addiction. I think it is safe to say that if the current prescription presented to you is causing you to ask the question, then the line is very close or perhaps already crossed. 2. Prescriptions that could harm the patient shouldn’t be dispensed. This seems obvious, but is not always easy to apply in the real world. The dosage is on the high side of normal, the patient has had penicillin before, the drug interacts with a previous prescription, or any other scenario that you can imagine where the prescriber directs you to go ahead and fill the prescription. However, if you think there is a high probability that the patient will be harmed, no one can order you to dispense the prescription.

While California and Indiana spell out the responsibility of the pharmacist in these two situations, I believe that the same responsibility exists even in jurisdictions that don’t explicitly cite it. If not, then why bother to require that drug utilization reviews be performed? And if the pharmacist is powerless to act when something is detected, again, why require them? We all know that there are some risks associated with every drug and every treatment. What we are talking about here are the large, severe risks. In the propranolol example given earlier, the pharmacist was convinced that the patient would die if he dispensed that order as prescribed. If the prescriber can overrule the pharmacist’s professional judgment in this situation, then the chances of an irreversible, negative outcome increase. But you can’t make these decisions in a vacuum. Discussion with the prescriber will probably be necessary. Perhaps discussions with the patient also will be necessary. Use the information from these discussions in conjunction with your professional knowledge, experience and judgment. As I tell pharmacists in these situations, it is much easier to defend a case where the pharmacist refuses to fill a questionable prescription than it is to defend a case where the pharmacist has doubts about what was dispensed. You don’t want your answer to the deposition question, “And what did you do when you became aware of this potential danger?” to be, “Nothing.” We can’t insure 100 percent safety, but we want to avoid high probabilities of serious harm. Pharmacists owe patients their highest efforts to treat their health problems and try to protect them from avoidable harm. The pharmacist’s duty to a patient does not require the pharmacist to do anything illegal. However, I do believe that it requires pharmacists to use their professional judgment for the patient’s benefit. That may mean refusing to dispense a particular prescription. And that situation may require some intestinal fortitude on the part of the pharmacist. § _______________________________________________________ © Don R. McGuire Jr., R.Ph., J.D., is General Counsel 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.

1 California Code of Regulations, Division 17, Title 16, Article 2, Section 1707.6. 2 Indiana Code 25-26-13-16

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THE ARKANSAS PHARMACIST

UNIVERSIT Y OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY

Decadron® 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.

pharmacy technician received the original handwritten prescription illustrated in Figure One. The prescription was written by an endocrinologist for a patient who had just received radioactive iodine therapy (I -131). During the order-entry process, the technician realized Decadron® (dexamethasone) tablets are not commercially available in a 1-gram tablet strength. After examining the pharmacy’s dexamethasone inventory, she decided to fill the prescription with dexamethasone 4 mg tablets. Figure One Using this tablet strength, the technician calculated that it would take 8,750 dexamethasone 4 mg tablets to fill the prescription as written. In addition, the technician calculated that in order to comply with the prescribed dosage regimen the patient would have to selfadminister 250 dexamethasone 4 mg tablets per dose. Before proceeding, the technician asked the pharmacist to double-check her calculations. When the pharmacist realized the technician’s calculations were correct, she decided to telephone the endocrinologist’s office for clarification about this order. The pharmacist was unable to talk with the prescribing physician and was directed by the receptionist to a nurse. After listening to the pharmacist describe the order confusion, the nurse – who admitted she transcribed the physician’s verbal order - adamantly told the pharmacist the prescription was correct as written. The pharmacist bluntly asked the nurse if the physician actually expected the patient to administer 250 dexamethasone 4 mg tablets per dose. Once again the nurse said the prescription was correct as written. The annoyed nurse went on to say the physician frequently prescribed this dexamethasone regimen to patients receiving radioactive iodine therapy. The nurse then abruptly terminated the telephone call with the pharmacist and immediately telephoned the patient on her cellular phone. The nurse told the patient to leave the pharmacy and take the prescription to a larger chain pharmacy (mentioned by name) where -

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according to the nurse - the pharmacists would be familiar with this type of medication regimen [note: the prescriber was located in a major metropolitan area. The patient took the prescription to his/her regular local pharmacy located in a small town in Eastern Arkansas]. After learning the nurse’s recommendation, the pharmacist immediately telephoned the Arkansas Drug Information Center requesting documentation that would support a 1 gram dose of orally administered dexamethasone. The Drug Information pharmacist reported that after conducting an exhaustive literature/database search, she was unable to provide any documentation supporting this dexamethasone regimen for any indication. At this point, the pharmacist decided to telephone the endocrinologist’s office a second time. Unfortunately, he was once again directed to the same nurse who adamantly defended the accuracy of the prescription. The pharmacist demanded to talk to the prescribing physician. The nurse said he was busy and would have to return the telephone call. Later that same afternoon, the nurse returned the pharmacist’s telephone call and admitted the medication order was erroneous. She then instructed the pharmacist to dispense 1 mg dexamethasone tablets. After this, the prescription was correctly filled and the patient appropriately counseled. The medication error described in this case illustrates the potential hazards associated with transcription errors. If this prescription had been dispensed as written, the patient would have received a 1000-fold overdose of dexamethasone. Upon first examination of this order, most pharmacists would have correctly assumed that the patient was to receive 1 mg dexamethasone tablets. The case became complicated, however, when the nurse who transcribed the order adamantly defended the accuracy of the prescription not once, but twice. Further, the nurse instructed the patient to take the

SAFETY NETS

prescription to another pharmacy where pharmacists were perhaps more familiar with this medication regimen. This left the pharmacist with two options: (1) locating information to support the dexamethasone regimen or (2) not filling the prescription. Fortunately, the pharmacist took a third option: to persist until he had a proper medication order that could then be provided to the patient. The pharmacist in this case took the time and effort necessary to obtain a corrected prescription from the prescriber. Unfortunately, the patient’s corticosteroid therapy was delayed for several hours. This could have been completely avoided if the nurse in this case had taken the time to investigate the pharmacist’s initial concerns about the dexamethasone dose. All health care professionals must work together for the benefit of their patients. Defensiveness, egos and a territorial attitude have no place in modern health care.

An order for a thousand-fold overdose is probably a once-ina-career event. The added stress of the nurse’s intransigence surely made it feel worse. The pharmacist was then forced to press on for the patient’s benefit in the face of a nurse’s statement that might be legally actionable – that the community pharmacist was not as fully competent to handle the medication order as some other pharmacists. § We partnered with Dr. Mark Estes, Director of the Arkansas Drug Information Center, on this edition of Safety Nets.

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PREPARING YOUR PHARMACY FOR

Theft or Burglary REED DISCOVERED THE

NEED TO PREPARE FOR THE EMOTIONAL TOLL A ROBBERY CAN TAKE ON EMPLOYEES.

o matter how well prepared pharmacists are for theft or robbery at their stores, there will always be lessons learned during or after the act.

Pharmacist Kristy Reed, owner of Super V Drugs in Jonesboro, whose store was robbed at gunpoint twice last fall, said that one of the things they didn’t anticipate was having to close for the day, including figuring out how to make the store phone go to voice mail and calling another pharmacy to take care of their patients' needs while they worked with police. Robbery at Super V The first robbery occurred on Sept. 20, 2012, around 9:30 a.m. by a middle-aged white male wearing a hooded sweatshirt. He came in pointing a gun and demanded the potent narcotic hydromorphone. Employees gave him the medicine while pushing the silent panic alarm, a device that notifies police of distress without triggering an audible alarm. The robber fled the store and was caught by police in minutes. On Oct. 1, 2012, just 10 days after the first robbery, the second robber came in at 4:30 p.m. He had his hands in a front pocket of a hooded sweat shirt. When asked if he needed a prescription filled, he pulled out a note, said he had a gun and listed several drugs that he wanted, including OxyContin, oxydocone, Soma and hydrocodone, Xanax and pseudoephredrine. Employees pushed the silent alarm and the police caught him just after he left the store.

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In both cases, Reed said, employees remained calm and gave the robbers what they wanted. Super V Drugs has state of the art security, including visible security cameras, and they were instantaneously able to show police exactly what happened. After the robberies, police were everywhere and investigators were in the store. “We had to shut the door to the public,” Reed said. “Investigators were taking fingerprints and interviewing employees. It was a good idea to lock the door for the public’s safety.” Having a sign ready to put on the door, the phone ready to be transferred and a back-up plan in place were among their lessons learned, Reed said. She also discovered the need to prepare for the emotional toll a robbery can take on employees. “The phone message needs to say ‘if you are a doctor, call this pharmacy’. We were busy with the follow up the rest of the day. Then we let everyone go home because they weren’t mentally equipped to finish the day.” Break-In at Dean’s Pharmacy A break-in that occurred at Dean’s Pharmacy in Marianna last summer did not require the same time commitment as Reed’s incidents, according to pharmacist and owner Dean Watts. He said between 2 and 3 a.m. on August 30, 2012, three hooded, gloved individuals threw bricks through the glass back door, entered the pharmacy and stole cough syrup.

THEFT OR BURGLARY

Watts said he was lucky; store employees only had to do a partial inventory of what was taken; fortunately, he knew what the burglars picked up so they didn’t have to do inventory of all controlled substances. “That would have delayed us opening for business,” Watts said. “The DEA form asks what security measures you have taken to prevent future loss,” he added. “As a result of the break in, we moved the cough syrup to an area further behind the counter because the robbers could see cough syrup from the cash register. We already had a camera and an alarm system which worked well, although this incident erased any thought I had that these security measures would prevent burglars from coming in. These people were skilled, prepared, and in a hurry. They probably would have stuffed more in their bags if the policemen weren’t right outside the store.” The store has a camera security alarm and an audible alarm that goes off when there is a breach. Watts said it took them three hits with a brick to tear out the safety glass in the back door. All of the action was caught on camera as the alarm was going off.

Watts added, “Cameras aren’t going to assure conviction or arrest. These people had hoods and gloves and long clothes and you couldn’t tell much about them.”

How to Help Law Enforcement Captain Terry Hastings, Southwest Division of the Little Rock “I could see that they had cased the place,” Watts said. Police Department, and husband of pharmacist Jan Hastings, “They went directly to that section in the pharmacy where said there are many devices that can help to prevent or catch the cough syrup was. Each had a back pack. After 43 a robber. Video cameras, Smoke Cloak, seconds, the robbers ran back out the robbery alarms, and safety glass are just a door with multiple bottles of Phenergan few things that can help cut the chances Video cameras, Smoke cough syrup. They got four pints of plain of being a victim of a robbery. Cloak, robbery alarms, promethazine with codeine and two pints of promethazine VC with codeine, and safety glass are just If it does happen, Hasting said, “You plus several pints without codeine. I a few things that can should always report a robbery to police think they missed what they were as quickly as possible. After detectives help cut the chances looking for. I thought at first that they arrive, make sure you obtain their contact of being a victim of didn’t take anything, then I noticed a information so you can provide more spot on the shelves where there was a robbery. information later.” Police need the best bottle turned over. I watched the tape description of the suspects they can get, - Capt. Terry Hastings and could see exactly what they did.” he said. They are looking for: Fortunately for Watts, the police happened to be at the intersection in front of the store when the alarm went off; within 40 seconds, they made a U-turn to investigate. The robbers were on foot, however, and got away before the police could get there. Watts said he reported controlled substance losses to the Drug Enforcement Agency (DEA) in Form 106, a step-by-step online form to report what is stolen, which should also be submitted to the State Board of Pharmacy and the Health Department.

Height of the suspect. You can use the door frame or merchandise displays to tell height. Weight of the suspect. Compare the size of the suspect to other employees to get an estimate. Physical Build. Fat, slim, skinny, long legs, big belly, etc. Clothing description. Shirt, pants, hat, shoes, anything you can remember. Facial Features. Mustache, beard, big eyes, scars, marks, etc. Hair. Long, short, shaggy, dirty, etc. What did he say? The words he used to let you know this is a robbery.

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THEFT OR BURGLARY

How did he sound? Country, other accent, slurred, etc. Did you see a car? Make, model, color, identifying marks, etc. Type of weapon? Handgun, rifle, knife, club, etc. What did he take? Money, drugs, what type of drugs, etc. Advance Planning Beneficial Knowing what to do after a robbery is helpful, but advance planning will make a difference, said Michael L. Warren, ARM, OHST, Risk Manager at Pharmacists Mutual Companies. “The biggest thing is training employees on what to do and to have a plan. If the store has panic buttons, make sure employees understand how the police will respond.” “Burglaries are 90 percent of what we see as an insurance company,” Warren said. Over 50 percent [of burglars] come right through the front door by breaking the glass, doing a smash and grab and leaving. They can sweep lots of shelves in less than two minutes, which is how long most robbers are in a store. Or, if they can find a security cabinet, they will pop it open.” Warren suggested store owners purchase an alarm system, which is required by most state Pharmacy Boards. He said stores need to have a central station so the alarm rings in a remote location. Other suggestions are to test the system, have cell phone back-up and protect the alarm codes (don’t stick the code on a wall somewhere). He suggested a safe or gun safe or reinforced security cabinets. If C2 and C3 narcotics are not locked up, consider protecting glass with window film http://glassprotectioncompany.com or replacing with Lexan or hurricane glass. Some pharmacies will put in glass break sensors because when someone breaks in, an alarm may take 30-40 seconds to turn on. He recommended good lighting – keeping the inside and out well-lit. With video surveillance, he said, put a camera at eye level behind the counter. Warren said there are tracking devices on some of the pills to catch bad guys. Larger chains are using things like 3Si aggressively, he said; there are also time delay safes. Tracking devices do have a high success rate on apprehensions. If a chain store has them, and you don’t, you may be at a disadvantage. Robbers, he said, can go on a blog to get instructions on how to rob a pharmacy (a recent Google search revealed eight entries). Warren recommended looking at a pharmacy as a criminal would look at it in terms of its vulnerabilities. “Pay attention to what is happening in your community and surrounding community. You may see gangs [targeting pharmacies]. They may go through roofs and walls as they’re doing in Houston.”

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Pharmacists Mutual includes this article on pharmacy crime on its website: http://www.phmic.com/ SiteCollectionDocuments/Pharmacy%20Crime%202011. pdf. Warren’s contact information is 515-395-7229, mike.warren@phmic.com. Follow-Up To Theft As Pharmacists Mutual’s Warren said, even the best security devices are not fool-proof. If your pharmacy is robbed and controlled substances are stolen, Arkansas State Board Executive Director John Kirtley suggests the following steps: 1. Notify the DEA in writing within 24 hours online, by phone or fax. 2. Deliver a completed DEA Form-106 to the DEA, Arkansas State Board of Pharmacy and Arkansas Board of Health within seven days of the occurrence of the loss or the discovery of the loss. 3. Do a Controlled Substance inventory: Count everything. Be sure you are up-to-date on your biennial inventory. 4. Get a police record of the theft. 5. Notify authorities if you notice something else is missing.

Tracking Inventory Effectively 1. Check on hand quantities. 2. Store controls correctly - lock up all CII’s or disperse in inventory. 3. Do not hide controls together; this is a DEA violation. 4. Limit access to controlled substances. 5. Interview potential employees and verify their licensure. 6. Perpetual inventory must be checked to actually work. Kirtley said that pharmacists can help to deter theft by letting customers know they are on camera and having a well-lit parking lot. He said break-ins tend to be seasonal and happen around holidays and having any security measures can be a deterrent. He also reminded pharmacists that

THEFT OR BURGLARY

not all robbers break into the stores; internal theft by employees can also be an issue. Impact on Work Flow, Business and Well-Being Following the fall 2012 robberies, Super V’s Reed was caught off guard by personnel issues. She did not anticipate the need to have a personnel policy on time off and a possible mental health counselor after the robbery. “You have to operate the pharmacy so you have to have someone in to work. My best friend was there answering the phone and door while I was telling the police what happened. A fellow pharmacist came to help cover the work. A robbery impacts your workflow, business, mental wellbeing.” Before it happened, Reed said, she wasn’t as well-prepared as she could have been. “I did go to an RxPATROL® presentation in 2011. From that training, I learned to be calm and call the police. But the training included nothing on how to manage the business after that.” “I know now that you have to prepare for employees being off, shut the store down and figure out logistics. Make sure relief pharmacists are trained and that every tech knows what to do.” When it happened, Reed said, having a panic alarm probably helped more than anything. Pharmacists should have cameras, a security gate or bars. “The more barriers you can have between you and the front end is helpful. He came around the pharmacy counter waving the gun. Since the robbery, we installed more swinging gates so there is a barrier and the pharmacy is not as easy to access.” Another consideration is whether to use a safe. Reed has since talked to a company that has GPS tracking devices for prescription bottles called Pharma Tracker. She did contact Pharmacists Mutual to find out what she should do from a worker’s comp standpoint. “You lose what the stolen drugs actually cost but Victim Notification keeps you notified of court proceedings and you can apply for restitution. A robbery entails more cost than just the drugs that are stolen,” Reed said. “You have to include employee

Pharmacy counter behind the checkout at Super V Drugs in Jonesboro.

time off, pharmacists’ time, and the average sales loss for being closed. I have turned all that in to a Victim Witness Coordinator who works with the prosecuting attorney.” Reed thinks pharmacy burglaries can be attributed to prescription drug abuse. “If we can help curb abuse by monitoring the prescriptions we dispense, we’ll be safer,” she said. “You don’t want to be an easy target, dispensing 100 doses of OxyContin, especially from out-of-state prescriptions. I’ll just say I am out of the drug or can’t fill the prescription. We can’t feed the habit.” RxPATROL® Tips RxPATROL® (Pattern Analysis Tracking Robberies and Other Losses) is an initiative designed to collect, collate, analyze and disseminate pharmacy theft intelligence to law enforcement throughout the nation. RxPatrol is administered by individuals with former law enforcement experience from Purdue Pharma’s Corporate Security Department, and a senior law enforcement executive who works independently to conduct intelligence analysis utilizing a leading incident analysis software platform capable of analyzing data, identifying trends and incorporating streaming video and CCTV photos. For more information, visit the website: http://www.rxpatrol. com. There is useful information in the Pharmacy Security Checklist: http://www.rxpatrol.com/pdf/A7957-draft.pdf. §

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BEHIND THE SCENES: DISTRICT MEETINGS

LEGISL ATOR PROFILE

Senator Michael Lamoureux District: Senate District 16. Represents: I represent all of Newton and Pope Counties and portions of Boone, Carroll and Van Buren Counties. Years in Office: Arkansas House of Representatives: 2003 – 2009. Arkansas Senate: December 2009 present.

(R -Russellville) President Pro Tem pore

Advice for pharmacists about the political process and working with the Arkansas Legislature: I encourage pharmacists and all Arkansans to realize their respective state senator and representative will care more about what they have to say as an individual constituent than what someone says on their behalf in the State Capitol. Elected officials always want to hear from their constituents. The individual is the most powerful advocate.

Occupation: Attorney. Your pharmacist: Mike Smith at Rose Drug in Russellville.

Your fantasy political gathering would include: Arkansas State Senators Max Howell and Knox Nelson and Arkansas State Representatives Lloyd Reed George and Doc Bryan.

Like most about office: I most enjoy the ability to help Arkansans and the opportunity to meet new and interesting people.

Toughest issue of the past Session: Redistricting.

Like least about office: The demands of public office require more time than a 24-hour day allows. With over 80,000 citizens in my district and layers of legislative duties, I find sometimes people do not understand we have so much to do with very limited time in which to accomplish all we are assigned.

What you do for fun: Watch my children play their respective sports. §

Most admired politician: President Ronald Reagan.

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Team Up. Pressure Down: How Pharmacists Can Engage in the Million Hearts Campaign

ardiovascular disease (CVD) and stroke are among the most serious and costly health care issues facing our nation today. Despite the declining mortality rate over the past 30 years, CVD remains the leading cause of death nationwide. 1 In 2008, approximately 2 million Americans suffered a heart attack or stroke, and CVD accounted for 1 of every 3 deaths in the United States. 2 According to a 2005 analysis from the Centers for Disease Control and Prevention (CDC), a total of 3 million people nationwide reported being disabled because of heart disease or stroke. 3 In Arkansas, heart attack and stroke are the number one and number three causes of death, respectively. 4 The death rate from cardiovascular disease in Arkansas is the fifth highest in the United States; the age-adjusted rate in 2009 was 218.8 per 100,000 population, compared with a national rate of 180.1. 1 The state’s death rate from stroke is the second highest in the country, at 50.8 per 100,000 population, compared with 38.9 nationwide. 1 In addition to these staggering statistics, heart disease and stroke accounted for more than $444 billion in health care costs and lost economic productivity in 2010, and that figure is estimated to top $1 trillion by 2030.5

Million Hearts

The CDC and the Centers for Medicare & Medicaid Services (CMS) are conducting a national initiative called Million Hearts to improve cardiovascular health through a combination of clinical and community-based efforts. The goal of the campaign, which began in September 2011, is to prevent 1 million heart attacks and strokes through 2017. The initiative emphasizes CVD prevention activities across public and private sectors in order to help patients live longer, healthier and more productive lives. Million Hearts brings together numerous organizations, including the American Pharmacists Association and Walgreens, as well as other programs and campaigns designed to make a positive impact across the spectrum of CVD prevention and care. The Million Hearts campaign consists of two key components: clinical prevention and community prevention. Clinical prevention strategies include focusing on the “ABCS”— aspirin therapy for at-risk patients, blood pressure control, cholesterol management and smoking cessation – as research has shown that improving the management of these major risk factors can reduce the mortality rate from CVD. As the Medicare Quality Improvement Organization for Arkansas, the Arkansas Foundation for Medical Care (AFMC) is working with CMS to promote the Million Hearts initiative statewide. AFMC quality specialists are providing technical assistance to providers across Arkansas to improve the delivery of services needed to manage the ABCS, such as maximizing health information technology functionality, helping outpatient practice staff with data capture to enable clinicians to monitor improvement, benchmarking and identifying best practices. AFMC will work with participating practice staff to help align competing priorities and initiatives and to help AR•Rx

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assess, develop and implement interventions needed to support sustainable organizational and/or practice-level processes to improve cardiovascular health in the practices’ patient populations and communities.

Team Up. Pressure Down.

“Team Up. Pressure Down.” is a nationwide program, designed in alignment with the Million Hearts initiative, aimed at lowering blood pressure results and preventing hypertension through pharmacist-patient engagement. This program, in partnership with many national pharmacy associations and organizations, seeks to promote pharmacists’ services in the prevention of CVD. Through expert medication and disease state counseling, pharmacists have the unique ability to empower patients to take an active role in the management of their hypertension. “Team Up. Pressure Down.” includes a collection of tools and resources for pharmacists in a variety of different formats that facilitate identification and engagement of hypertensive patients. Some of the tools include posters and fact sheets that can be displayed in pharmacies to encourage pharmacist participation, while others can be distributed to patients, providing education on hypertension and tracking sheets for blood pressure readings. The program also includes a nine-question worksheet to help pharmacists standardize and manage patient conversations around medication adherence. “Team Up. Pressure Down.” information, along with downloadable tools, videos and continuing education programs can be found at http://millionhearts.hhs.gov/resources/teamuppressuredown.html. Preventing 1 million heart attacks and strokes in the next five years will require the cooperation and coordination of all health care professionals, as well as family, friends and community members, to work together to improve both clinical practice and community health. For more information regarding how AFMC can assist you or your community in the “Team Up. Pressure Down.” and Million Hearts initiatives, contact Christi Quarles Smith at csmith@afmc.org, or Jo Nycum at jnycum@afmc.org. § REFERENCES 1. Kochanek K, Xu J, Murphy S et al. Centers for Disease Control and Prevention. Deaths: final data for 2009. National Vital Statistics Reports. 2011;60(3). 2. Roger VL, Go AS, et al. on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics — 2012 update: a report from the American Heart Association. Circulation. 2012;125:e2-e220. 3. Centers for Disease Control and Prevention. Prevalence and most common causes of disability among adults — United States, 2005. MMWR. 2009;58(16):421-426. 4. Beach A., Eigenbrodt M., on behalf of the Arkansas Heart Disease and Stroke Prevention Task Force. Cardiovascular Health: More than Just Preventing Heart Disease and Stroke! A Comprehensive Plan for Cardiovascular Health in Arkansas, 2011-2015. Arkansas Department of Health, Heart Disease and Stroke Prevention Section, 2011. 5. Heidenreich PA, Trogdon JG. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123:933-944. This article was written in collaboration with Michelle Murtha, RN. Michelle is a quality specialist at AFMC.

Pharmacists Provide Flu and Tdap Immunizations for Arkansas Child Care Employees Little Rock Cornerstone pharmacist Stacy Riley provides flu and tdap shots to Better Beginnings child care facility employee at First United Methodist Church in North Little Rock.

he APA’s immunization program, launched in February 2012, added a big challenge last fall: providing 5,000 free shots to employees at child care facilities throughout Arkansas by the end of 2012.

reimbursed a $20 administration fee for each immunization given. In order to receive payment, they had to provide the supplies and personnel for the clinic, report all doses given to the Arkansas Immunization Registry, and submit a roster bill to the APA.

Last September, APA was awarded a $140,000 grant to provide Tetanus, diphtheria, and pertussis To reach the goal of 5,000, APA called (Tdap) and flu vaccinations to uninsured Among the challenges in each of the 600 Better Beginnings facilities employees at Better Beginnings child in the state with help from University of care facilities throughout Arkansas. The conducting the program Arkansas for Medical Sciences college of goal of the program was to provide 2,500 — the first of its kind for pharmacy students who were on rotation influenza and 2,500 Tdap vaccinations APA and pharmacies — in September, October and November, to employees at these state-accredited including Nicki Coburn, Tyler Shinabery were getting through to facilities. The Arkansas Center for Health and Brandyn England. About 100 of Improvement (ACHI) conducted a survey the child care director these facilities scheduled clinics with asking child care centers 1) if they or decision-maker for pharmacists. provided insurance to their employees, the center and getting and, 2) if they would be interested in After these clinics were complete, participation from child having a healthcare provider come to there were still about 1,500 of each their location to provide free Tdap and flu care center employees. immunization to be given. In December, immunizations. ACHI provided names of APA got approval to schedule the nonthe interested child care facilities so APA Better Beginnings child care facilities. could contact and schedule clinics. The strategy then became to give the pharmacies the list of child care centers and have them schedule and conduct the APA created a state-wide pharmacy provider network and clinics. By the end of December, pharmacists had given contract for the program. These in-network pharmacies were almost 1,300 flu and 2,150 Tdap immunizations. assigned the scheduled centers and went on-site to provide the free Tdap and flu immunizations. The pharmacies were 24

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PHARMACISTS PROVIDE FLU & TDAP IMMUNIZATIONS

Among the challenges in conducting the program — the first of its kind for APA and pharmacists -- were getting through to the child care director or decision-maker for the center; and getting participation from child care center employees who did not see a need to receive the Tdap vaccination. Despite news of pertussis outbreaks in the state, many child care employees still did not want to receive Tdap vaccinations. Finally, many of the larger child care facilities had a free influenza vaccination clinic at their location conducted by the Arkansas Department of Health. Despite these obstacles, the child care employee immunization program was a big success. Pharmacists conducted over 170 clinics that provided 3,424 free influenza and Tdap immunizations to patients who would not have been vaccinated under normal circumstances. These employees interact with small children on a daily basis and need to be vaccinated not only to protect themselves, but also to protect the children who may not be old enough to receive some immunizations. Thank you to all who participated in this program. We look forward to working on similar initiatives for APA members in the future. §

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COLLEGES OF PHARMACY

HARDING UNIVERSIT Y

2012 Milestones for Harding University College of Pharmacy

he fall semester was a busy one at Harding University College Julie Hixson-Wallace of Pharmacy (HUCOP). In Pharm.D., BCPS addition to the routine of classes Dean and exams, our students and faculty completed several other exciting projects. As part of the national Millions Hearts Initiative, pharmacy practice faculty member Dr. Jeanie Smith led activities through the month of September to emphasize the “ABCS” (aspirin, blood pressure management, cholesterol management, and smoking cessation) utilizing a $5,000 grant she received from the National Association of Chain Drug Stores Foundation. Between the White County Fair and Get Down Downtown (a Searcy city festival), over 700 members of the community were educated on the ABCS with the majority receiving blood pressure and cholesterol screening. One participant said, “This is a wonderful service. It tells me that I need to get back to doing what I need to do and that I don’t need to be doctoring myself, and the students were all so patient!” Individuals who were not at goal blood pressure (18.6%) and cholesterol (12.8%) values were referred to their primary care provider for additional follow-up. In October, pharmaceutical sciences faculty member Dr. Kaci Bohn organized a drug take back event in cooperation with local law enforcement. The event was affiliated with the Texas Tech Medication Cleanout program (www. medicationcleanout.com) that not only endeavors to assist the public in returning unused medications to prevent poisonings, abuse, and misuse, but also involves a research component through which more information regarding types of medications returned and regional patterns can be obtained. The event involved a drive-through drop off where participants did not even have to leave their cars to turn in their old medications. Forty-two participants completed the event survey and returned 65.8 pounds of medications including 6.6 pounds of controlled substances, 16.2 pounds of liquids, and 29,000 individual medication dosage units (tablets, patches, milliliters, etc.). Based on feedback from

the Medication Cleanout organizers, this was an excellent yield, especially since we purposefully advertised the event on a limited basis to allow us to start small the first time through. In November, attention turned to immunizations. Dr. Jeanie Smith organized flu shot clinics for the faculty, staff, and students in the physician assistant and pharmacy programs at Harding allowing them to receive the 2012 flu vaccine at no out-of-pocket cost. Additionally, HUCOP partnered with the Arkansas Pharmacists Association, Stanley Pharmacy, and the Arkansas Department of Health to administer flu and Tdap vaccines with a total of 5,140 vaccines being given. In the realm of travel medicine, HUCOP has established relationships with a variety of on-campus and church groups who are planning out-of-the country travel for mission trips. HUCOP obtains and administers travel vaccines to these groups in a convenient setting and at a very low cost. In December, pharmacy practice faculty member Rodney Richmond and students in the HUCOP political advocacy elective class hosted the first HUCOP Evening with Our Legislators to establish dialog between local constituents and elected officials. Senator Jonathan Dismang (R – Beebe) and Representative Mark Biviano (R – Searcy) along with Dr. Mark Riley from the Arkansas Pharmacists Association, served as panelists. Over 30 representatives from the pharmacy community including students, faculty, practicing pharmacists, and Arkansas Pharmacist Association staff members gathered for the discussion in the Cone Chapel on the Harding campus. This event allowed the pharmacy community to become better educated about the legislative process and the importance of grassroots development while at the same time exposing the legislators to the importance of pharmacy and the roles pharmacists can play in health care. We hope this will be just the first of many such events we will host at HUCOP. From the HUCOP family to all of you, best wishes for a wonderful 2013! §

In Memoriam Alex Reed, age 49, passed away December 16, 2012, in Russellville. He was born in West Helena. His career included pharmacy practice at Wal-Mart, USA Drug and Paris Family Pharmacy. He was a past co-owner of Rose Drug in Paris and a member of the Arkansas Pharmacists Association. He was a deacon at West Side Church of Christ in Russellville. 26

Don Baggett, age 68, passed away January 8, 2013, in Mansfield. He was born in Rogers and was a member of First Baptist Church of Mansfield. He was the owner of Don’s Drug in Mansfield.

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COLLEGES OF PHARMACY

UAMS

College of Pharmacy Instills Entrepreneurial Spirit

s the pharmacy profession evolves to meet the state’s ever-changing health care needs, so does our role as educators at the University of Arkansas for Medical Sciences (UAMS) College of Pharmacy.

pharmacy stressed the “community” in independent community pharmacy and provided health care with innovative science and technology.

It is essential for us to instill a sharp, forward-thinking business sense in our future pharmacists, whether it is fine-tuned for running a community, independent pharmacy or implementing innovative best practices at an established chain, health-system, or nuclear pharmacy. We are ahead of the game at UAMS, where our students enter the workforce with an entrepreneurial spirit prepared to tackle the business end of the profession at the level of their choosing.

The team won a trip to Aruba to attend the NCPA Multiple Locations Conference, a gathering of pharmacy owners with multiple stores who are looking for new investments and ideas. Another perk of winning the competition includes a trip to Palm Springs, Calif., to meet with the Independent Pharmacy Cooperative.

Our state is known nationally as a leader in independent pharmacy ownership. It is one of only a few states that can report a higher number of independently owned pharmacies than chain practices. That leaves the UAMS College of Pharmacy with a great responsibility to not only prepare our students to enter Arkansas’ rich, business-minded landscape, but to instill in them an entrepreneurial spirit that will mold them for success. I am proud to report that we not only have a history of accomplishing this, but we continue to dive even deeper into the business education side of our profession. The most recent example of our success includes a team of five student pharmacists who won the prestigious National Community Pharmacists Association (NCPA) Pruitt-Schutte Good Neighbor Business Plan Competition during the organization’s annual convention on Oct. 14 in San Diego. The 9th annual competition brought three teams of students together as finalists from a much larger pool of 40 entries to present ideas of community pharmacy ownership. Schwanda Flowers, Pharm.D., associate dean for Student Affairs and Faculty Development, and Anne Pace, Pharm.D., assistant professor in the Department of Pharmacy Practice, advised the team. The students identified a longtime independent pharmacy in Little Rock and presented a scenario in which the owner wishes to transfer ownership to a junior partner. To grow the pharmacy and repay the purchasing costs, the team outlined opportunities for an innovative marketing plan, created a more effective and patientfriendly store front end and developed wellness-centered services for patients, including a personalized medication dosing program based on a patient’s individual genetic makeup. The proposed

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Stephanie Gardner Pharm.D., Ed.D. Dean

The curriculum at the UAMS College of Pharmacy offers much to support our students’ entrepreneurial spirit. We have an option for students to pursue a concurrent degree in the MBA program at UALR. We also have an option for our Northwest students to pursue a certificate in Entrepreneurship by the University of Arkansas at Fayetteville Sam M. Walton College of Business. In addition to many didactic opportunities for coursework in entrepreneurship and business, all of our students undertake an advanced community practice rotation during their senior year where they are exposed to ownership and management. We realize that not every future pharmacist who passes through our college will own his or her own pharmacy, but in the next 10 years they will need the skills they learn at UAMS to market and promote their value as critical members of the health care team. §

NCPA Business Plan Competition winners: (L to R) Kevin Barton, Tyler Shinaberry, Dr. Schwanda Flowers, Blake Johnson, Tiffany Berkemeyer, Brandyn England, Dr. Anne Pace, Dean Stephanie Gardner. 27

ARKANSAS ASSOCIATION OF HEALTH-SYSTEM PHARMACISTS

Health-System Pharmacists Need to Continue to be Progressive and Innovative

y goal this year is to work with Arkansas Association of HealthSystem Professionals (AAHP) members to continue to push progressive pharmacy practice and innovative thinking. As pharmacists, we have been very well educated whether through residency training, fellowship training or through the uncompromising years of experience. We each bring different skills and experiences to the table.

Lanita S. White, Pharm.D. President

But we all have two things in common: our concern for the well-being of our patients and our unquestionable expertise in medication administration and management. No one knows more about medication and its proper uses than pharmacists. There are several conversations taking place related to our practice and we, as pharmacists, need to have a voice in these conversations. One of the critical discussions taking place where pharmacists can make an impact concerns the expansion of the state Medicaid Program. If the program is expanded, there is the potential to cover an additional 250,000 Arkansans. These additional people would then have a payment source for medical services rendered in our facilities. We are providing these services now in the form of uncompensated care. As the discussion of readmission rates continues, we are facing uncompensated care that is repeated due to readmissions. As pharmacists, we love numbers, so here are a few to think about. A study published in the New England Journal of Medicine last month compared three states which expanded adult Medicaid eligibility to neighboring states that did not expand eligibility. The study included adults between the ages of 20 and 64 who were observed 5 years before and 5 years after the expansions. The primary outcome was all-cause county-level mortality. The results were as follows: Medicaid expansions were associated with a significant reduction in adjusted all-cause mortality. The results corresponded to 2,840 deaths prevented per half million people that acquired coverage. So, what does this mean in Arkansas? We have approximately 250,000 people who would be newly covered under a Medicaid expansion. If we extrapolate the data, we could prevent 1,420 deaths – right here in Arkansas. As healthsystem pharmacists, this discussion is important in several ways – 1) we would have a payment source for uncompensated care, which has been particularly difficult on critical access rural hospitals and the state institution; 2) pharmacists have an opportunity to start new services which have the potential

to decrease readmission rates and in turn, decrease costs; and 3) we have the potential to save lives. A parallel discussion is happening as the Affordable Care Act is implemented. The discussion revolves around the opportunities for other professions to take a more prominent role in health care and as well as for pharmacists to take a more prominent role. Medication management services, diabetes and hypertension management, post discharge follow-up to prevent readmissions, antibiotic selection and monitoring and the list goes on. Again, no one is better equipped with knowledge of medication use and their management than we are. Because of this, we must join the conversation and articulate all that we can contribute to patients’ health care – the things we do everyday behind the scenes. The literature shows that pharmacists make a significant impact in lowering health care costs and have often produced better health outcomes. Now is the time to take the opportunity to open a dialogue about the services we can and do offer, show our impact on the bottom line and patient outcomes – and get paid for it. I truly believe that if we do not engage in the conversation, we will leave it to others to dictate what we can, should and would do best. We must define our important role ourselves. As the 2012 Fall Seminar theme stated so nicely, it is about “Promoting Pharmacy as an Essential Component of the Health Care Team.” This is truly an exciting time in the profession and we are in a prime position to advance the practice and expectations of the pharmacist. I would like to challenge you to continue to be progressive and innovative by: starting new clinical services, thinking of yourselves as educators – whether to students, residents or other professionals, starting new training programs for existing staff or expanding your residency program and finally, documenting and displaying your impact. As AAHP works to better serve health-system pharmacy in Arkansas, I encourage members to stay involved and engage with AAHP and the critical discussions happening all around us. We need your ideas and experiences to continue the synergy that is happening in the state and the profession of pharmacy in Arkansas. As for AAHP, we will continue to partner with you as our purpose is still to Advance the Profession of Pharmacy in Arkansas. I appreciate your support and look forward to working with you and for you in the coming year. §

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COMPOUNDING ACADEMY

Compounding Academy Discusses Regulation in Wake of Deaths from Sterile Compounding

ollowing the crisis involving New England Compounding Center’s (NECC) tainted doses that have caused 44 deaths and more than 678 illnesses throughout the country, the APA Compounding Academy met last November to discuss actions Congress and the Food and Drug Administration (FDA) may take regarding compounding. Academy President Kristen Riddle, Pharm.D., of U.S. Compounding, led the meeting that included 20 members, guests and APA staff. She talked about the accusations that the FDA did not protect the public, quoting Senator Tom Harkin (D-IA): “And yet despite the abundance of documentation, neither the FDA nor the Massachusetts Board [of Pharmacy] took the necessary action to protect the public from these products.” NCPA Submits Comments to Congress The National Community Pharmacists Association (NCPA) submitted comments and an accompanying survey to two congressional committees holding separate hearings examining the fungal meningitis outbreak at NECC. NCPA’s comments were submitted to the U.S. House Energy and Commerce Subcommittee on Oversight and Investigations and to the U.S. Senate Committee on Health, Education, Labor & Pensions, respectively. The comments outlined the differences between customized medications that prescribers ask independent pharmacists to prepare through traditional compounding for specific patients versus the large-scale manufacturing that NECC appears to have engaged in and allegedly led to the meningitis cases. The survey of 400 independent community pharmacists found that while 85 percent provide traditional compounding, 62 percent say it makes up no more than five percent of their business. In addition, 72 percent provide only non-sterile medications, as opposed to sterile medications mass-produced by NECC. Arkansas Sets Standards for Inspections Compounding Academy members discussed practices in Arkansas versus other states. NECC and Ameridose, which were co-owned and both lost their licenses in Massachusetts, were licensed with the Arkansas State Board of Pharmacy. However, no contaminated products were shipped to Arkansas. Arkansas already follows United States Pharmacopeia (USP) <797> and <795> voluntary standards as well as requiring testing for sterility, endotoxins and potency for sterile products produced in batches. The Arkansas State Board of Pharmacy also is an autonomous board rather than a section of a larger health-related super board, department of health, department of education or department of professional licensure for the state. The State Board utilizes licensed pharmacists with expertise and training to perform compounding specific inspections on any pharmacy performing sterile compounding functions. In addition, the State Board makes every effort to inspect every retail

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pharmacy including compounding Kristen Riddle, Pharm.D. pharmacies on a calendar year basis President which is much more often than most other states. Arkansas inspection forms have been shared with other states as they seek similar practices and State Board staff has also jointly visited Arkansas compounding pharmacies with inspectors from another board of pharmacy. Two hundred eighty out-of-state pharmacies are licensed in Arkansas. Seventeen states have USP <797> and <795> standards on their books. Compounding Academy members suggested at the November meeting that a uniform set of standards for all compounding should include USP <797> and <795>. If Congress asks all states to adopt these standards, Academy members said they should provide financial incentives to help pharmacists adhere to these new regulations. Members agreed upon the need to educate the general public on what compounders do and how compounding helps to address drug shortages. Follow-up at FDA According to Arkansas State Board Executive Director John Clay Kirtley, at a December FDA meeting partners representing all 50 states responded to specific questions such as: what should the federal role be in regulating high risk compounding; is there a way to rebalance state and federal participation; is there a role in states in enforcing federal standards, and if so, what is their role. During the discussions, he said, it was clear that almost every state was comfortable with what happened in their own states but they were not comfortable with standards for drugs shipped in from other states. At the federal level, the FDA is looking at compounding definitions and how state Boards regulate compounders. Both the FDA and the National Association of Boards of Pharmacy (NABP) are looking at what happens in licensed pharmacies. Some of NABP’s recommendations to the FDA are in conflict with Arkansas recommendations, according to Kirtley. Arkansas regulations specifically allow non-traditional compounding or outsourcing because this is often the only way to prepare and obtain medications that are in critical shortage that are also critically needed by our hospitals and patients. Kirtley said it is difficult to predict FDA’s response because there is no agreement on the issues. If Congress passes new laws regarding compounding, determining a legal way to regulate compounding may take a decade to implement. The Arkansas State Board meeting in February will include discussion on compounding and appropriate oversight in the state. The State Board will consider how to ensure public safety of products from out-of-state pharmacies that may not have the same oversight as Arkansas pharmacies. § 29

MEDICAID REPORT

Pharmacists Play Valuable Role in Making Continuation Criteria Work at Point of Sale We need your help! When you see a prescription for an ADHD medication and the prescriber has written for an “odd” quantity (e.g., “19”), please do not assume this is for a 19-day supply. If you have questions about the correct days’ supply, please talk to the parent or guardian, or contact the prescriber, to verify the correct days’ supply. Entering the prescription for a quantity of 19 for the correct 30-day supply will ensure that the child will meet the Point Of Sale (POS) continuation criteria, which will allow claims to process correctly and remove the unnecessary burden of the time consuming phone calls.

drug, generally, for 90 out of 120 days. What we are learning for the ADHD medications is the prescriber may write for a quantity of 19, as an example, to be taken only on days the child attends school. Because of “drug holidays” or weekends off of the drug, this quantity of 19 represents a 30 or 31 day supply. This results in the child’s profile appearing to be non –compliant, the claim rejected and the prescriber making an unnecessary phone call requesting a prior authorization. Again, please take the appropriate steps to ensure continuation of care and reduce unnecessary requests.

Continuation criteria may be voted by the DUR Board within certain drug classes for persons who have been compliant on a

Thank you for your support! §

Arkansas State Board of Pharmacy President. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ronnie Norris, P.D., McGehee Vice President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Steve Bryant, P.D., Batesville Secretary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Justin Boyd, Pharm.D., Fort Smith Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Lenora Newsome, P.D., Smackover Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Stephanie O’Neal, P.D., Wynne Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Tom Warmack, P.D., Sheridan Public Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Larry Ross, Sherwood Public Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Joyce Palla, Arkadelphia

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2013 APA AWARDS SOLICITATION Award Nominations

ach 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 Noon, April 12, 2013. 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

Past Winners: 2012 Charles Born - Little Rock, 2011 Don Johnson - Little Rock, 2010 Richard Hanry - El Dorado

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

Past Winners: 2012 Clint Recktenwald - Gassville, 2011 Cheryl Bryant - Little Rock, 2010 Rob Christian - Little Rock

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 Past Winners: 2012 Sparky Hedden - Sheridan, 2011 Tom Warmack - Sheridan, 2010 Ronnie Norris - McGehee

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 Past Winners: 2011 Gene Boeckmann - Wynne, 2009 Percy Malone - Arkadelphia

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 Past Winners: 2012 Melissa Brown - Fayetteville, 2011 Eric Crumbaugh - Benton, 2010 Maggie Miller - Batesville

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: ______________

Email or fax written nomination form and material to: Awards Committee, Arkansas Pharmacists Association; eileen@arrx.org; Fax 501-372-0546. Please submit by Noon, April 12, 2013.

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Call for Board Nominations in 2013-2014

PHARMACY HISTORY

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 hospital pharmacy 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 Mark Riley (mark@arrx.org) at 501-372-5250. Nominations will close at Noon, March 15, 2013. _________________________________________________________________________________________________________

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 APA Statewide (One-year term as Vice President, four total years as Board Member) Area III Representative APA Board Member Central â&#x20AC;&#x201C; District 1(Four-year term) Area III Counties: Faulkner, Lonoke, Prairie, Pulaski, Saline and Monroe. District 1 President Central District (Two-year term) Central Counties: Faulkner, Lonoke, Prairie, Pulaski, Saline and Monroe. District 2 President Eastern District (Two-year term) Eastern Counties: Clay, Craighead, Crittenden, Cross, Greene, Lawrence, Lee, Mississippi, Phillips, Poinsett, Randolph and St. Francis. District 4 President Southwest District (Two-year term) Southwestern Counties: Crawford, Franklin, Logan, Polk, Scott and Sebastian. District 5 President Southeast District (Two-year term) Southeastern Counties: Arkansas, Ashley, Bradley, Chicot, Cleveland, Desha, Drew, Grant, Jefferson and Lincoln.

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 Noon, March 29, 2013.

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2013-2014 APA Board of Directors

PHARMACY HISTORY

President Dennis Moore, Pharm.D. Batesville

President-Elect Dana Woods, P.D. Mountain View

Vice President Brandon Cooper, Pharm.D. Jonesboro

Past-President Gary Bass, Pharm.D. Little Rock

Area I Representative Michael Butler, Pharm.D. Hot Springs Village

Area II Representative Brent Panneck, Pharm.D. Lake City

Area III Representative Eddie Glover, P.D. Conway

Area IV Representative Lynn Crouse, Pharm.D. Eudora

District 1 President Clint Boone, Pharm.D. Little Rock

District 2 President Kristy Reed, Pharm.D. Jonesboro

District 3 President Chris Allbritton, Pharm.D. Fayetteville

District 4 President Lise Liles, Pharm.D. Texarkana

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

District 6 President Stephen Carroll, Pharm.D., MBA Arkadelphia

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

District 8 President Casey McLeod, Pharm.D. Searcy

AAHP President Lanita White, Pharm.D. Little Rock

Compounding Academy President Kristen Riddle, Pharm.D. Conway

Consulting Academy President Jim Griggs, P.D. Fayetteville

Board of Health Member John Page, P.D. Fayetteville

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

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

UAMS Student Member Michael (Andy) Roller Fayetteville

Harding Student Member Jaclene (Jackie) Dabbour Searcy

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

Legal Counsel Harold Simpson, J.D. Little Rock

Treasurer Richard Hanry, P.D. El Dorado

Executive Vice President Mark Riley, Pharm.D. Little Rock

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Member Classifieds Director of Pharmacy, St. Bernards Medical Center in Jonesboro- Full-time, days. Comprehensive Benefits Package Included. JOB REQUIREMENTS: Education- Graduation from an accredited school of pharmacy with at least a Bachelor of Science in Pharmacy (BSPH) degree or Doctor of Pharmacy (PharmD) degree required. Must be licensed to practice pharmacy in the state of Arkansas, such licensure granted by the State Board of Pharmacy after passing the required examinations or by reciprocity based in passing such examinations in another state. ExperiencePrevious experience in hospital pharmacy is required. Previous management experience in the hospital and/or ambulatory setting is preferred. Physical- Normal hospital environment. Close eye work. Hearing within normal range. Operates computer, typewriter, calculator. Finger dexterity. Eye-hand coordination. Frequent sitting, standing and walking. May lift and carry up to 35 lbs. Some exposure to chemical hazards when making chemotherapy. JOB SUMMARY: Must be familiar with professional and commercial phases of pharmacy. Must have a working knowledge of pharmaceutical purchasing, compounding, dispensing, and control procedures. Must understand the role of the pharmacy department in the hospital, its interrelationships with other departments, and the functions of a department head. Must know principles of personnel management. Contact Tonya Riney, Recruiter, triney@sbrmc.org. Staff Pharmacist, Mercy Hospital Hot SpringsFull-time, day/evening rotation. Education: BS or PharmD, Must be licensed to practice pharmacy in the state of Arkansas. Board certification or post residency beneficial. Experience- Previous experience in hospital pharmacy is preferred. Job Summary: Mercy Hot Springs utilizes EPIC CPOE and full med dispense from Omnicell cabinets. Pharmacists participate in order verification in addition to full clinical duties including pharmacokinetic, pain, anticoagulant, and TPN dosing consultation as well as antimicrobial stewardship. Day pharmacists are deployed to patient care floors for direct patient and medical staff contact.Contact Candice Rhea, recruiter at Candice.rhea@mercy.net or apply at www.mercyjobs.com. Part-time Pharmacist Wanted- Local independent pharmacy in Ft. Smith, AR seeking licensed pharmacist for one to two nights a week and one weekend a month. Competitive salary, benefits. Send resume to 700 Lexington Ave. Ft. Smith, AR 72901, email Anderson.1@live.com or call 479-782-2881. Walgreens Community Pharmacists neededWalgreens is currently seeking community pharmacists throughout Arkansas, specifically in the following cities: Benton, Bryant, Forrest City, Fort Smith, Harrison, Hot Springs, Little Rock, Malvern, Newport, North Little Rock, Paragould, Pine Bluff, Russellville, Sherwood and Warren. Sign-on bonuses offered and relocation assistance provided (available based on location and for a limited time only). Please send resume to pharmacyjobs@walgreens.com if youâ&#x20AC;&#x2122;re interested! 34

Member Classifieds are free to APA members and $65 per issue for non-members. Contact eileen@arrx.org for more information. Pharmacy technician positions available-Cantrell Drug Company is currently seeking to fill multiple non-retail pharmacy technician positions. These full-time positions will be on 2nd and 3rd shifts, to include weekends. The successful candidate will have proven experience in compounding while demonstrating an attention to detail and a focus on quality. Please send resume to dconaway@ cantrelldrug.com.

1400 plus 1000 extra in drawing area. Located in a clinic with nurse practitioners. Average 125 scrips per day. Hours 9 to 5 five days a week. Contact Bob Wright at 870-829-1044 or 870-816-5269.

Pharmacist positions- Cantrell Drug Company is currently seeking to hire three full-time pharmacists for day and evening shift positions. These positions will be in our sterile compounding areas and compounding experience is preferred. Please send resume to dconaway@cantrelldrug.com.

Relief Pharmacist Needed- Independent pharmacy in Van Buren/Ft. Smith, AR area is seeking relief pharmacist for Saturdays. Hours on Saturday are 9 a.m. to 1 p.m. Call or text 479-414-7503 or send resume or email: kbarlow@pharmacyexpressvb.com.

Full-time pharmacy technician needed at Lackie Drug Store in Lonoke. Monday - Friday 8:00 a.m. 6:00 p.m. Experience in independent retail is a must. Previous experience with Enterprise Rx software is a plus. Please fax resume to 501-676-6009, attn: Kyle Lackie, or email kylelackie77@yahoo.com.

Looking for Relief Pharmacist Work- Looking to serve as a relief pharmacist during the day within 2 hours of Pine Bluff. Was a licensed DMST educator; can handle MTM diabetic work; familiar with home packaging as well as LTC packaging. Would love to find an opportunity. Contact Robert Rosen, Pine Bluff at (phone and fax) 870-536-4460 or rrnr66@att.net.

Seeking pharmacist-in-charge for NW Arkansas store. Contact Kenny Harrison at 501-580-1895. Johnson Regional Medical Center seeking a fulltime staff Pharmacist- JRMC is a growing eightybed hospital located in Clarksville, Arkansas. We are seeking a full-time staff pharmacist for our Pharmacy Department. JRMC offers competitive wages, flexible scheduling and a comprehensive benefit package, including health, dental, vision, life, disability, 401(k) with matching contributions, child care assistance, paid time off, discounts on hospital services and over-the-counter medication, continuing education, paid license renewal and Arkansas Pharmacists Association membership. If you or anyone you know will like to learn about the staff Pharmacist position at JRMC, call Sherrie Lane at 479-754-5454 Ext. 554 or 479-477-2006. Licensed pharmacist with compounding experience available for relief- Please contact Pegah at 479-236-2244 or pegah@mtnsystems. com. I have been fortunate to train under the direction of highly professional pharmacists who have coached and mentored me. I am experienced in both retail and hospital, and have worked at Wal-Mart for 6 years. With my outgoing personality and energy and dedication, I believe I can provide the best customer service and make an immediate contribution to your team. Pharmacist needed in Jonesboro- New pharmacy business locating in Jonesboro, Arkansas. Seeking full-time pharmacist. Competitive salary plus bonus structure and benefits. Ownership opportunity available. Motivated applicants can email resumes to jonesboropharmacy@yahoo.com. Pharmacy Tech needed- Experienced tech needed for independent retail pharmacy in Helena. Send resume to carol@ssipharmacy.com. Marvell Pharmacy for Sale- Want to be home every night, every weekend and every holiday? Want to make in excess of $200K/yr? Like to hunt and fish? Be your own boss? Plenty of opportunities to expand the business. Located in Marvell. AR, pop

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.

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. Seeking Relief Pharmacist work- Booneville pharmacist looking for relief pharmacist work for independent pharmacists in Arkansas. Please contact Bill Carpenter at 479-675-6246 or cripplec@magtel.com. 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, or Mike Geeslin, President 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: Ivanrx4u@aol.com or Ivanrx4u-tracy@hotmail.com. 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. ARâ&#x20AC;˘Rx

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