New Frontiers in Pharmacy School Education

Over-the-Counter Medication Trends

New Frontiers in Pharmacy Education

Preparing students for their role in an evolving pharmacy practice

By Sandra Levy

When Todd Sorensen attended pharmacy school there wasn’t a formal course in the curriculum on leadership development, or how to produce quality improvements in medication use.

Fast forward to 2021, and Sorensen, a professor and senior executive associate dean at the University of Minnesota College of Pharmacy in Minneapolis, is part of efforts to create curricular strategies that focus on emerging trends in pharmacy and health care.

Make no mistake, this is not your grandmother’s pharmacy school’s curriculum.

To be sure, the new crop of pharmacy students nationwide will need much more than an introduction to rudimentary science courses, thanks to the notable progress that the pharmacy industry has made in advancing the clinical role of pharmacists. The pandemic also has elevated pharmacists’ roles and allowed them to assume expanded responsibilities.

Many pharmacy schools are stepping up to the plate with new courses and electives, as well as honing some of their existing courses, to ensure that their students are well prepared to meet the myriad challenges that they will face as newly minted pharmacists.

Leadership development is one area that is a huge component of the new frontier in pharmacy school education.

In the late 2010s, the University of Minnesota College of Pharmacy began to address leadership, but Sorensen said that the emphasis on leadership development has evolved. His view is that new graduates are going to need to assume responsibility for creating the change that follows trends in health care.

“How can we empower students to envision change and realize they can develop the skills necessary to create that change as new practitioners is a question that is guiding the school’s leadership development

Students at the University of Mississippi School of Pharmacy have a new elective called Pandemic and Society, which covers COVID-19 and previous pandemics.

experience,” he said.

To that end, the school created an extensive 16-credit leadership “emphasis area,” a program that results in a transcript subplan designation in leadership development with the student’s Pharm.D. degree.

The University of Mississippi School of Pharmacy also is focusing on developing students’ leadership skills, with an elective on leadership and advocacy.

“One of the outcomes in all of the curriculum is for each student to adopt the lifestyle of professionalism and commitment to the improvement of the profession of pharmacy, which entails leadership and advocacy,” said University of Mississippi School of Pharmacy interim dean Donna Strum.

She noted that the state of Mississippi is advocating for pharmacists to provide precision patient care, such as strep tests, and then treating the patient in consultation or collaboration with a patient’s provider. “If our pharmacy students can adapt to contemporary practice models, and they are committed to professionalism, to learn and improve, that would be an improvement for the profession and for patient care,” Strum said.

The Notre Dame of Maryland University School of Pharmacy in Baltimore is yet another pharmacy school that is not standing on the sidelines when it comes to advancing students’ leadership skills and development.

“We recognize that in order for the profession of pharmacy to advance, we need all pharmacists to be leaders,” said Anne Lin, dean of the Notre Dame of Maryland University School of Pharmacy.

One of the pharmacy school’s courses includes content related to leadership development. “There are a lot of things that go

The University of Minnesota College of Pharmacy in Minneapolis has created curricular strategies that focus on emerging trends in pharmacy and health care, as well as leadership development.

into leadership,” Lin said. “You can’t lead if you don’t know who you are. We have a lot of self-exploration that goes into that. Being emotionally intelligent is incorporated into our course work as well. Entrepreneurialism also is an important part of the curriculum.”

Pharmacy schools also are acknowledging that students need to be knowledgeable about public health issues.

At the University of Mississippi School of Pharmacy, there is a new elective called Pandemic and Society, which covers COVID19 and previous pandemics.

“We can learn a lot from smallpox and other pandemics that the world faced,” Strum said. “We are now looking at COVID- 19 and … learning about how the virus is transferred, the vaccines’ effectiveness, as well as public policy, such as masking and vaccine requirements. We are comparing the way other pandemics have been handled and how we eventually overcame them. The behavior change component to the curriculum was already there, but we present it in a new way, of how do you educate patients about getting vaccinated?” Strum said.

Pharmacy schools also are rolling out innovative educational programs and planning events for students to learn outside of the classroom and from experts in the industry.

The University of Minnesota is a case in point. The school created an annual half-day event a few years ago, titled PED-Rx, which stands for Practice Education Dialogue. Modeled after engaging TED talks, PED-Rx brings together students, faculty and healthcare leaders from outside of the school to engage in a lively discussion about important trends that are currently not in the school’s curriculum, but should be on students’ radar. For example, in November, PED-Rx participants explored the influence digital health will have on medication use and the work of pharmacists.

With a shift to distance learning during the pandemic, the program took place virtually last year, and even though it can once again take place live, the school decided on a virtual format.

“The adoption of a virtual platform for the event allows us to engage speakers who are national in presence,” Sorensen said.

The University of Mississippi School of Pharmacy also has innovative educational programs for its pharmacy students, including Leadership Day, which took place in September. Students were excused from class and offered training in different leadership topics to enhance their skills.

In addition, a Professional Pharmacy Development Speaker Series, which takes place every week at noon, recently brought in leaders of state professional pharmacy associations to discuss their efforts around the pandemic. A retail pharmacy group also recently spoke about their practice and how they are evolving.

The University of Mississippi School of Pharmacy’s division of professional development also posts a monthly Pharmacy Forward podcast on its website that is targeted to pharmacy students and students who have graduated within the past five years.

“A recent episode was about identifying professional formation, figuring out who you are as a professional,” said Strum, who also noted that the school offers an elective in mindfulness and wellness.

The dissemination of weekly electronic newsletters from the dean’s office and student body, enabling students to link to things that they should read or to other resources on campus, also is part of the University of Mississippi’s educational efforts for students.

The Notre Dame of Maryland University School of Pharmacy also has ramped up its out-of-classroom education programs. For example, Lin conducts a weekly Dean’s Hour, during which she invites different guests to talk about many practice-related topics, including career pathways. This semester, a 2015 graduate, who completed an industry fellowship and a master’s degree in applied health economics and outcomes research, was invited to broaden students’ horizons about his career in the pharmaceutical industry.

If that weren’t enough, the school of pharmacy also participated in a new PBS documentary, dubbed “Vaccination for the Misinformation Virus.”

The school had a screening for the students with the documentary’s producer, a physician with expertise in vaccine research and a faculty member who appeared in the film, all of whom took part in a Q&A panel.

Pharmacy schools also are taking their pharmacy practice experiences in new directions.

For example, in the spring of 2021, the University of Minnesota expanded the learning experience in its introductory pharmacy practice experience, or IPPE, program.

“Our students still do traditional experiences in community pharmacies and hospitals, but one of the new experiences we

added this last year was a focus on systemslevel quality improvement processes aimed at improving medication use,” Sorensen said.

The program seeks to create a win-win for students and host sites, pairing students with pharmacists leading longitudinal quality improvement initiatives.

“The students are directly contributing to an organization’s quality improvement work,” Sorensen noted. “We’ve created learning modules for the students they complete online while they are engaged with a practice site, so they are in a dual mode. They are learning in a didactic manner while they are in an experiential site.”

The same modules were made available to the school’s preceptors to help them better understand quality improvement principles and quality improvement strategies. “We believe one of the future roles of the pharmacist is having greater responsibility and expectation for driving changes in care delivery systems that generate improvements in medication use,” he said.

Sorensen noted that while the school will be tweaking and improving this offering, he said, “We came out of it believing that this continues to be an important learning experience for students, and it’s a great way for us to partner with practice sites and our pharmacist colleagues. We can create an educational partnership that offers a learning experience to pharmacists, as well as a quality improvement project from students.”

Enabling better patient outcomes also is a priority for the University of Mississippi School of Pharmacy, which was in the process of completely overhauling its curriculum “to be more dynamic and to keep up with the evolving role of the pharmacist,” Strum said. “As practice changes, we have to change our curriculum. We have been updating it so that it was more disease-based,and patient-based.”

Although Mississippi doesn’t have prescriptive authority for pharmacies, state law permits under protocol a pharmacy to be set up with a clinic. “It could be for an umbrella of patients seen by that clinic or physician for pharmacists to alter, adjust or change the therapy,” Strum said. “We have cases within our different modules, whether it be endocrinology, cardiovascular or oncology cases where pharmacy students practice doing that.”

During a student’s P3 year, the school offers a course titled Multi-System Complex Patient Care, in which there are patients who have multiple conditions and multiple therapies. Students learn how to make drug therapy recommendations and adjust therapies to achieve better outcomes.

Additionally, the University of Mississippi School of Pharmacy is continuing to find ways to have more interprofessional education experiences in its curriculum.

“The conditions and the drug therapies and treatments often require a team, whether that’s a physician, pharmacist, nurse, social worker, dietitian, nutritionist, physical therapist or respiratory therapist in the COVID world, it is a team approach to taking care of patients in the hospital and ambulatory care setting,” Strum said.

When it comes to medication adherence, the Notre Dame of Maryland University School of Pharmacy is using several approaches to convey to its students how technology can be used to help manage patients and medication therapy.

“Technology is very broad, from dispensing technology to point- of-care testing technology,” Lin said. “We handle some of this learning of technology in school, but they will learn the nuts and bolts when they go out to their rotations.”

For instance, the school has rotations at Johns Hopkins Hospital where students can observe the use of technology. When they’re on their advanced rotations, they learn about electronic medical records, and the school also has EMRs in its labs so students can learn how they are used to retrieve data and input information in caring for patients.

Preparing future pharmacists to be adept at point-of-care testing is yet another goal of pharmacy schools.

For example, the Notre Dame of Maryland University School of Pharmacy teaches students to perform blood glucose, cholesterol and COVID-19 testing.

The University of Mississippi School of Pharmacy also introduces students to how technology can be used in the treatment of certain diseases.

“For example, insulin pumps are integrated into the endocrinology module, and the students would see that in skills lab,” Strum said. “They see different glucose monitors and blood pressure systems and how they may sync results with the patients’ medical chart, and how you can monitor their blood pressure and adjust the medication.”

Pharmacy schools also are in a position to

The Notre Dame of Maryland University School of Pharmacy in Baltimore instructs students on how to perform blood glucose, cholesterol and COVID-19 testing.

combine research and practice development opportunities, as illustrated by a project led by the University of Minnesota that focused on a payer-provider partnership centered on delivery of comprehensive medication management to health plan beneficiaries experiencing cardiovascular disease and diabetes.

“We have payment opportunities for patient care services in Minnesota, and many of the pharmacies in the state are not engaged in delivering these services, often because they are unsure how to navigate the process of partnering with a health plan,” Sorensen said. “We worked with a health plan that pays for comprehensive medication management services and a cohort of community pharmacies, helping them adapt their work to deliver the services and receive payment from this health plan for those services.”

He indicated that his team learned a great deal about why pharmacist engagement was limited, and the adaptations required by the pharmacies to engage payment opportunities rooted in population health and the expectations of value-based payment models.

Through the relationship with the health plan, pharmacists received lists of plan beneficiaries at risk for poor outcomes. “That’s a target population with which pharmacists can demonstrate great value collaborating with the patient’s care team to achieve defined clinical goals,” Sorensen said.

Preparing students for the time that pharmacists in all states will be authorized to administer medication is yet another area that is ripe for pharmacy schools’ curriculum.

For instance, the University of Mississippi School of Pharmacy is a site for administration for the monoclonal antibody treatment REGEN-COV, which will be available to students and school employees who get COVID-19 and require treatment.

Although pharmacy students can’t administer the medication, they can volunteer to do paperwork and observe licensed pharmacists provide this COVID-19 treatment on campus.

With all of the new additions to the curriculum, some schools like the University of Mississippi are finding that rather than completely eliminate a course, it is integrating topics together.

“We don’t have a communications class anymore, but we have skills lab where they practice communication, and different communication techniques are integrated within all of these different disease modules,” Strum said. “How do you communicate with a patient with cancer? How do you show empathy and help them understand the information so they can make informed choices as compared to the patient that has Type 2 diabetes?”

Lin chimed in saying, “We’re constantly looking at what we’re doing, what needs to come out and what needs to be put in,” she said.

Finally, Sorensen acknowledged that while the school has added things to the curriculum, he said, “Unfortunately we don’t have as many examples of things we’ve removed. “That’s part of our conversations now. We need to continue to have new things, but we have to be better at sunsetting material that is less relevant for producing graduates who can succeed in an evolving healthcare system.”

What educational topics are on pharmacy schools’ radar?

Looking ahead, Sorensen said informatics is going to be a huge part of health care in the future. “It’s already growing. In some cases, we are not as far along as we should be in pharmacy with informatics,” he said.

He also envisions digital health, particularly wearable technology, will be incorporated into pharmacy schools’ curricula. “How devices will support monitoring patient progress on a chronic health condition, and feed data directly into platforms so that practitioners can effectively and efficiently use that data to adapt therapy or coach patients in self-management strategies will expand greatly,” Sorensen said.

Lin said pharmacogenomics and personalized medicine is not part of day-to-day practice yet, but pharmacists need to understand pharmacogenomics and genetics, “and how we use that to design drug regimens. Schools are incorporating that,” she said.

Pharmacy schools, like Notre Dame of Maryland University, also are looking more closely at the topic of telehealth.

“The pandemic caused us to rethink what we teach students about how to interact with patients,” Lin said. “Previously, our focus was on how to interact with patients in person. With the increased use of telehealth, we now need to also teach students how to interact with patients using technology.”

Lin also said that schools also are looking at how to incorporate issues regarding health disparities and systemic racism.

“We’ve always had a public health course where we talk about social determinants of health and a course, “Care for Diverse Populations,' which is required,” she said. “It’s an entire course devoted to cultural competence, understanding how you approach the health of different groups. Issues of health disparities will come up in both classes.”

Lin explained that students entering the school are assigned to a team to work with a nonprofit in the community that provides care to the underserved, such as homeless men, people with HIV or Head Start.

“They provide health-related services that meet their needs,” Lin said. “It’s also part of understanding issues dealing with underserved people and how healthcare disparities are seen in the community. The goal is when students go out and practice, they will continue to be areas that are important that they will spend some time on, whether at their job or on a volunteer basis.”

In addition to precision patient care, the future according to Strum will include artificial intelligence and how that is going to impact pharmacy practice. “We are beginning to look at what is happening in the whole artificial intelligence world and how that impacts drug discovery and treatment, and therapeutic decisions,” she said.

Finally, Sorensen sees the future of pharmacy schools and the role of the pharmacist in this light: “What we have the challenge of doing is helping our students realize that pharmacy practice as they see it today is not going to be pharmacy practice they will experience in 10 or 15 years from now. The class that graduates from pharmacy school this year, if they work 40 years, will retire in 2065. Imagine what health care is going to look like in the last two decades of their period as being pharmacists, from 2045 to 2065. Remarkable change is going to occur, and we have to prepare them for that.” dsn

Dr. Reddy’s Unveils Generic BiCNU

Dr. Reddy’s is launching carmustine for injection.

The medication is the generic version of Heritage’s, which is doing business as Avet Pharmaceuticals, BiCNU, used to treat the symptoms of brain tumors, multiple myeloma, Hodgkin’s disease and Non-Hodgkin’s lymphoma.

The BiCNU brand and generic had a market value of approximately $19.4 million for the most recent 12 months ending August 2021, according to IQVIA.

Dr. Reddy’s carmustine for injection is a lyophilized powder available as a package, which includes a single-dose vial containing 100 mg of carmustine and a vial containing 3 ml of sterile diluent.

Hikma Introduces Micafungin for Injection

Hikma is offering micafungin for injection in dosage strengths of 50 mg and 100 mg.

The medication is indicated for the treatment of candidemia, acute disseminated candidiasis, Candida peritonitis, abscesses in adult and pediatric patients aged 4 months old and older, esophageal candidiasis in adult and pediatric patients aged 4 months old and older, and prophylaxis of candida infections in adult and pediatric patients aged 4 months old and older undergoing hematopoietic stem cell transplantation.

Micafungin for injection had a market value of $132 million in the 12 months ending August 2021, according to IQVIA.

Boehringer Ingelheim Obtains FDA OK for Interchangeable Humira Biosimilar

The Food and Drug Administration has approved Boehringer Ingelheim’s Cyltezo, or adalimumab-adbm, as the first interchangeable biosimilar with AbbVie’s Humira, or adalimumab.

Originally approved in 2017, Cyltezo was designated for the treatment of multiple chronic inflammatory diseases, and this latest approval designates it as interchangeable across all of these indications.

“We are proud to be the company driving the advancement of biosimilars and delivering the first and only Interchangeable biosimilar with Humira. It is a true milestone and an important step forward for broader adoption in the U.S. and for patient access to affordable medicines,” said Thomas Seck, senior vice president of medicine and regulatory affairs at Boehringer Ingelheim. “The interchangeability status of Cyltezo reinforces our goal of expanding overall treatment options and contributing to the quality and sustainability of the U.S. healthcare system.”

“As the first interchangeable biosimilar of Humira, Cyltezo (adalimumab-adbm) represents an important step toward bringing patients more affordable treatment options for complex, and often expensive, biologic reference products,” said Martin Alan Menter, chairman of the division of dermatology at Baylor University Medical Center. “This is incredibly important for patients, who can be confident that once available, citrate-free Cyltezo has the same efficacy and safety as the originator medicine with the added benefit of cost savings.”

Cyltezo’s commercial license will begin on July 1, 2023.

Dan Leonard Reflects on First Year as President of AAM

Dan Leonard, president and CEO of the Association for Accessible Medicines, recently celebrated his first year leading the association. He reflected on some of the association’s accomplishments this past year in a post on AAM’s website.

Leonard noted that one of the first things that he did was a media tour of over 25 markets around the country to talk about the incredible data contained in AAM’s 2020 annual savings report.

“For someone like me, who spent many years working on the brand side of the pharmaceutical industry, that introduction to the generic and biosimilar side of the industry was eye-opening,” he said. “Innovation is important — to brands, patients and our industry — but a drug that a patient can’t afford does just as much good for that patient as a drug that does not exist. Our products are valuable not only because they are safe and effective, but also because the vast majority (92%) of them are available to patients at under $20 out-of-pocket.”

He noted that he is excited to embark on his second annual media tour this month to talk about AAM’s latest savings report and the data it contains. “Savings to the American healthcare system was up nearly $25 billion dollars over 2019, meaning that Americans saved $338 billion in 2020 through the use of generic and biosimilar medicines,” he said. “ Our industry fills 90% of prescriptions, but accounts for only 18% of the total spending on prescription drugs in this country, all at an average co-pay of $6.61 compared to $55.82 for brand name drugs.”

Leonard continued, “As policymakers are spending incredible amounts of time and energy working to solve the problem of outof-control drug prices, the data show that generics and biosimilars are the solution. But, while those data represent real savings, they are at the end of the day numbers on a page. The stories behind those numbers — the stories of real people whose lives are positively affected by the medicines our members produce — bring to life the full picture of the value our industry creates for America’s patients.”

He said that one of his goals, when he came to AAM, was to bring the story of generics and biosimilars to life, “and not just the lifesaving medicines we produce. I wanted to go beyond the data to tell the story of the history of this industry and the hurdles we overcame to get to the point where we fill 90% of prescriptions, to talk about the incredible people who helped build this association and the people who make it work so well today, and to highlight the lives of patients that our medicines make better every day.”

To accomplish that goal, he pointed to some of the changes made and new projects launched over the last year.

“You may notice this year’s savings report is a little different than years past. We’ve focused this report completely on the data and created a separate annual report we will release each spring, Voices of Access, that is 100% focused on patients and the importance of generic and biosimilar medicines in their lives,” he said.

AAM also launched the All Access podcast, “where I get to return to my roots as a broadcast journalist and have fascinating conversations with people from across the healthcare landscape,” he said. “Thus far, we’ve interviewed member CEOs like Vinita Gupta of Lupin and Jeff Watson of Apotex, policy experts like Avik Roy and former Veterans Affairs Secretary Anthony Principi, and industry veterans like Bob Billings, who was instrumental in making our association what it is today.”

Looking ahead, Leonard said he is optimistic. “I am excited about the seeds that we’ve sown over my first year as AAM president and CEO, and I am thankful to all of my colleagues who welcomed me and have helped steer our association through what was a challenging year on many fronts. I am incredibly optimistic about the future of the generic and biosimilar industries, and the future of AAM itself, and I look forward to continuing to tell our story for years to come.”