The Journal of the Iowa Pharmacy Association | A Peer-Reviewed Journal
Building a Community Pharmacy Enhanced Services Network In IOWA (pg. 8)
APR.MAY.JUN 2016
Peer Review: The Potential Impacts of “Provider Status” in Iowa 2016 IPA Annual Meeting Details Iowa Medicaid Managed Care Begins
APR.MAY.JUN 2016 | Vol. LXXII, No. 2
TABLE OF CONTENTS 8515 Douglas Avenue, Suite 16, Des Moines, IA 50322 Phone: 515.270.0713 Fax: 515.270.2979 Email: ipa@iarx.org | www.iarx.org
PUBLICATION STAFF David Schaaf, Managing Editor dschaaf@iarx.org Kate Gainer, PharmD kgainer@iarx.org Anthony Pudlo, PharmD, MBA, BCACP apudlo@iarx.org Laura Miller lmiller@iarx.org
OFFICERS
CHAIRMAN John Swegle, PharmD, BCPS, Mason City 641.428.7182, john-swegle@uiowa.edu PRESIDENT Bob Greenwood, RPh, Waterloo 319.234.1589, bob@greenwoodpharmacy.com PRESIDENT-ELECT Rick Knudson, PharmD, BCPS, MS, MBA, Clear Lake 515.707.1174, raknudson@hotmail.com TREASURER Steve Firman, RPh, Cedar Falls 319.277.7540, steve@pmgrx.com SPEAKER OF THE HOUSE CoraLynn Trewet, MS, PharmD, BCPS, CDE, Ankeny 515.360.0065, coralynn.trewet@sanofi.com VICE SPEAKER OF THE HOUSE Susan Vos, PharmD, BCPS, FAPhA, Iowa City 319.335.8837, susan-vos@uiowa.edu
TRUSTEES REGION 1 Kristin Meyer, PharmD, CGP, CACP, FASCP, Marshalltown 641.753.4580, kristin.meyer@drake.edu REGION 2 Ryan Jacobsen, PharmD, BCPS, Iowa City 319.321.4436, ryan-jacobsen@uiowa.edu REGION 3 Erik Maki, PharmD, BCPS, Johnston 515.326.0171, erik.maki@drake.edu REGION 4 Jerod Work, PharmD, Sioux Center 712.722.0845, jerodwork@gmail.com AT LARGE David Weetman, RPh, Iowa City 319.356.2577, david-weetman@uiowa.edu Laura Knockel, PharmD, North Liberty 319.354.7121, lauraknockel@gmail.com Brett Barker, PharmD, Nevada 515.382.4179, brett-barker@uiowa.edu Stevie Veach PharmD, BCACP, Tiffin 563.580.9662, stevie-veach@uiowa.edu HONORARY PRESIDENT Dennis Jorgensen, RPh, Panora 641.755.2520, dkjorgensen@netins.net PHARMACY TECHNICIAN G. Jean Gallogly, CPhT, Vincent crittersandstuff@yahoo.com STUDENT PHARMACISTS Christina Bravos, Drake University christina.bravos@drake.edu Robert Nichols, University of Iowa robert-nichols@uiowa.edu
FEATURES Board of Trustees Election Results . . . . . . . . . . . . . . . . . . . . 7 Building a Community Pharmacy Enhanced Services Network . . . . . . . . . . . . . . . . . . . . . . . . . 8 Foundation Set for Iowa CPESN . . . . . . . . . . . . . . . . . . . . . . 11 2016 IPA Annual Meeting . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Midwest Pharmacy Expo Recap . . . . . . . . . . . . . . . . . . . . . . 16 Practice Advancement Forum . . . . . . . . . . . . . . . . . . . . . . . 25 Peer Review: Impact of “Provider Status” in Iowa . . . . . . . 28
IN EVERY ISSUE
President’s Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 CEO Editorial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Health Care Hot Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Iowa Pharmacy News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Practice Advancement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 IPA Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Public Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Member Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Technician’s Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 College of Pharmacy News . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Student Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Pharmacy Time Capsule . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Calendar of Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
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The Journal of the Iowa Pharmacy Association is a peer reviewed publication. Authors are encouraged to submit manuscripts to be considered for publication in the Journal. For Author Guidelines, see www.iarx.org. “The Journal of the Iowa Pharmacy Association” (ISSN 1525-7894) is published 4 issues per year: January/ February/March issue; April/May/June issue; July/August/September issue; and October/November/ December issue by the Iowa Pharmacy Association, 8515 Douglas Avenue, Suite 16, Des Moines, Iowa 50322. Periodicals postage paid at Des Moines, Iowa and additional mailing offices. POSTMASTER: Send address changes to: The Journal of the Iowa Pharmacy Association, 8515 Douglas Ave., Suite 16, Des Moines, IA 50322. Published quarterly The Journal is distributed to members as a regular membership service paid for through allocation of membership dues. Subscription rates are $100 per year, single copies are $30. Printed by ColorFx; Graphic Design done by Iowa Pharmacy Association.
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President’s Page
The Times They Are A-Changin’
I
’ll use this Bob Dylan song as the framework for my last article for the Journal of the Iowa Pharmacy Association. I ask everyone who has a chance to read this to check out the lyrics of this famous Dylan song released in 1964. Here’s what I see changing in the pharmacy world that I live and work in.
Bob Greenwood, RPh IPA President
The concept of paying pharmacists for improving health outcomes is being demonstrated through various projects funded by CMS Innovation Center around the country. The success of these projects is spreading the value proposition of enhanced pharmacist services networks through the pharmacy association circles I am associated with, and the opportunity they bring is refreshing and exciting to me. The problem is the healthcare cost curve has to bend; the trick is to bend the curve without interrupting or diminishing the quality of care that is currently being delivered. Commercial health plans are finding value in Patient Centered Medical Homes. Medicaid, as we have seen here in Iowa, hopes to find better value in managed care models. IPA staff has been working with the MCO’s to make them aware of the value proposition that Iowa pharmacists bring to the table. IPA staff and a number of Iowa pharmacists have had ongoing meetings with Wellmark over the past year to better understand each other’s challenges. The discussions have been professional and frank, and I believe Iowa pharmacists and Wellmark will be better for taking the time. I have been encouraged by the discussions that will help us better serve our patients and also make it more affordable. My hope is to see a transition in pharmacy to payment for performance - keeping people well and bending the cost curve, while providing quality service scaled to a high service level across the state. To achieve these goals, reimbursement has to change. While
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attending the APhA Annual Meeting in Baltimore, MD, I had conversations with some experts on pharmacy economics and population management. We all agreed the present reimbursement model simply does not work.
“My hope is to see a transition in pharmacy to payment for performance...” I’ll use this analogy - being a fairly skilled baseball player in high school I fell into a batting slump. After seeing my struggles at the plate, my coach suggested that I could not keep doing what I was doing and to try a different approach. It worked. Let’s try a different approach to reimbursement. Using the National Average Drug Acquisition Cost (NADAC) combined with a true cost to dispense that includes a reasonable profit, would present a totally transparent model that can shift reimbursement to the pharmacies and pharmacists that actually provide the service and product. I would like to congratulate the newly elected officers and trustees of IPA and especially thank the pharmacists and technicians that put their name up for election that did not win, we still need all hands on deck. It would be great to see you all at the IPA Annual Meeting on June 17-18 in West Des Moines. I would like to thank all of you for your support and encouragement this past year. It has truly been an honor to serve as the President of this great association. I would like to extend a special thanks to my wingman from Black Hawk Co. Steve Firman who is finishing up his term as treasurer in June, we have made countless trips to Des Moines and national meetings through the years. Thank-you also to my family - Chery, Joe & Torie, Amelia & Spencer, Tim and Abby. ■
CEO EDITORIAL
Different Stripes
R
ecently, at a meeting hosted by Wellmark to discuss and help develop the tenets of an HPP Network (High Performing Pharmacy Network), I proposed ways for IPA to assist pharmacies selected by Wellmark to participate in their HPP Network. For example, IPA could develop and provide targeted education or training; share the message with other key (non-pharmacy) stakeholders; host webinars or conference calls to keep the sites in contact and accountable to one another; and share best practices to help target the quality metrics established by Wellmark. The Chief Medical Officer (CMO) participated in the eight-hour meeting and was highly interested in the development of a HPP Wellmark Network. Following the suggestions of how IPA could assist, he responded with a question and a comment that have since stuck with me. His question: “Around this table, you (pharmacists) represent different stripes…is it possible to work together as Kate suggests?” As you may imagine, heads nodded yes, and I responded with an emphatic YES. It’s one of the things IPA and our members do so well. It is one of the reasons that makes Iowa a great place to practice pharmacy. Not only are IPA members innovative and collaborative, but IPA members recognize that – together – the profession must move forward. Individually, pharmacists provide enhanced services and care to their patients and communities, which changes the way individual patients and caregivers view their pharmacist. But if pharmacists do not have a way to band together, it is increasingly difficult to shift the paradigm of payers, policy makers, and other healthcare providers. Currently, IPA offers similar forums and support to pharmacies participating in other Iowa initiatives including the New Practice Model community pharmacy sites and IHIN (Iowa Health Information Network) enrolled pharmacies.
“And…. Sharing best practices is simply sharing. The key piece that can’t be shared is execution. I’m willing to share with you my processes and knowledge, but whomever I’m sharing with must be able to go to their practice and execute.” This salient statement by Wellmark’s CMO stuck with me, and I’ve heard others in attendance that day reference it since. What we share enables others to do more and do better, but each individual pharmacist or site must be able to execute. At IPA, we see firsthand that pharmacies of different stripes can – together – paint a beautiful landscape and picture of how pharmacy is practiced in the state of Iowa.
Kate Gainer PharmD IPA Executive Vice President & CEO
The issue of ‘different stripes’ came up a second time for me this month, when I was contacted by another state pharmacy organization asking for feedback and advice related to merging two state pharmacy organizations. While I was not at IPA during Iowa’s unification of Iowa Society of Heath-system Pharmacists and Iowa Pharmacists Association, I have read the history books and spoken with many leaders that spearheaded the process. Today, nearly 20 years later, I cannot imagine Iowa pharmacy without a unified voice. As health care continues to transform, both in care delivery and payment processes, having pharmacists from different backgrounds, “different stripes,” within our leadership and membership has served IPA tremendously in understanding the pharmacists role throughout care transitions in all settings and in positioning pharmacists as healthcare providers in Iowa. Through communication, collaboration, trust and innovative thinking, IPA and the profession of pharmacy continues to make great strides each year. ■
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board of trustees ELECTION
IPA’s Newly Elected Leaders Congratulations to the newly-elected Board of Trustee members! These IPA members will be installed into office at the 2016 IPA Annual Meeting on June 17-18, 2016 in West Des Moines.
PRESIDENTELECT
PRESIDENT
Rick Knudson, PharmD, MS, MBA, BCPS Clear Lake
Craig Logemann, RPh, BCACP, CDE Ankeny
TRUSTEE REGION 1 Christopher Clayton, PharmD, MBA Manchester
TRUSTEE REGION 3 Rachel Digmann, PharmD, BCPS Ankeny
TRUSTEE AT LARGE Jessica Frank, PharmD
TRUSTEE AT LARGE Nora Stelter, PharmD, CHWC
Winterset
Urbandale
TRUSTEE PHARMACY TECHNICIAN Meg Finn, CPhT North Liberty
TREASURER
Sue Purcell, RPh Dubuque
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Feature
Building a Community Pharmacy Enhanced Services Network: Is this the Right Step for Iowa? Ashley Branham, PharmD, BCACP Director of Clinical Services Moose Pharmacy Concord, NC
H
eadlines have flooded the media announcing collaborations of healthcare corporate entities. Recently, it was reported that 10 health systems in Kentucky have formed a statewide collaboration to improve health outcomes in the state through the sharing of best practices and efforts to reduce costs of care. In early 2016, CVS Health announced its affiliation with four large hospital groups in Michigan, California, North Carolina and Illinois to focus on enhancement of chronic care and wellness clinical activities. These new collaborations mark a total of 70 clinical collaborations for CVS Health. What is the cause of this changing healthcare landscape and why are we seeing strong affiliations between large hospital groups and the major chain pharmacies? The answer - Health care reform. Health care reform has made waves in the creation of new payment models that no longer reward providers for the quantity or duration of health services offered, but reward for the quality of care and all of those responsible including providers, health plans and any other value purchaser. The new payment models are driving a revolution to incentivize healthcare providers to deliver services that keep patients out of the emergency room, out of the hospital and adherent to the most appropriate medication regimen. The good news to community pharmacists is that you can provide services that can contribute to improving patients’ health and reduce total cost of care. Community pharmacists can provide value not only to the patient, but also to value purchasers and providers delivering care.
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The Value of Community Pharmacy in the Medical Neighborhood—The NC Experience Over its 25 year history, Community Care of North Carolina (CCNC) has expanded to 14 networks covering all 100 counties in the state with the underlying goal to improve quality and cost effectiveness while enhancing the ability of the primary care physician to improve care outcomes for patients with chronic diseases. Pharmacy has always been included as part of the plan to achieve this goal in strengthening the medical home. In addition to activities provided by care managers, behavior health professionals, and nutritionists, CCNC employed pharmacists in each network to oversee local medication use optimization initiatives. This included embedding pharmacists into primary care offices, long term care facilities and hospitals. This vision however, never included formalizing medical home relationships with local community pharmacies. In early 2013, CCNC released Medicaid claims data that indicated high-risk patients were visiting the community pharmacy 35 times per year compared to 3.5 visits to their primary care provider. This data, along with other environmental conditions related to health care at the time, challenged CCNC Pharmacy Program Vice President, Troy Trygstad to examine opportunities to incorporate community pharmacy into the CCNC model. If the population that needs medication management the most visits a pharmacy 35 times annually, how can these
Feature encounters in community pharmacy be leveraged most effectively to improve patients’ overall health trajectory and reduce total cost of care?
A CPESN is Launched
Like most great collaborations, the genesis of the NC Community Pharmacy Enhanced Services Network (CPESN) started with recognition of an opportunity and the sharing of ideas. CCNC developed a position for a lead community pharmacy coordinator with the main goal of building a network in North Carolina. Joe Moose, an independent community pharmacy owner, who knew the NC community pharmacy environment well and was dedicated to the idea of transforming community pharmacy practice, filled the role as the “luminary.” He took the idea of integrating a community pharmacy within the medical neighborhood and began to share with a few more pharmacists. The idea began to spread and it seemed as if in no time, pharmacists were gathered in a room discussing components of building a CPESN. They addressed the tough questions, how do we differentiate ourselves as high performing pharmacies, what types of enhanced services can we collectively offer as a CPESN, what are the minimum criteria for pharmacies to participate, how can we up hold quality in a network? By the end of this meeting, the ground work for a voluntary CPESN had been completed. Sixty-seven independent pharmacies signed on to offer enhanced services. In exchange for participation, these pharmacies were given access to CCNC information systems whereby the pharmacist could review prescription claim data, adherence data and population management tools to assist with their provision of enhanced services to the patient populations in most need of their services. The framework for the NC CPESN was developed as an open network, allowing all pharmacies with the willingness to deliver enhanced
Figure 1: Geographic Representation of CPESN Pharmacies as of November 1, 2015
services, document interventions and meet the established minimum criteria to participate. Participating pharmacies were also committed to the goal of improving quality of care and patient outcomes related to medication use, enhancing patients’ overall health trajectory and reducing the total cost of care. CPESN Expansion Shortly after the formation of the CPESN, CCNC was funded a 3-year grant from the Center for Medicare and Medicaid Innovation (CMMI) to test payment reform in community pharmacies for Medicaid, Medicare, dually eligible Medicare-Medicaid and NC Health Choice beneficiaries by using a collaborative care model where community pharmacy is part of the medical home team. The project, “Optimizing the Medical Neighborhood: Transforming Care Coordination through the North Carolina Community Pharmacy Enhanced Services Network” supports the provision of enhanced services offered by CPESN pharmacies. Pharmacies have the potential to be compensated for services through a hybrid of payment types depending on intensity and time required to perform the medication optimization service. By 2014, 246 North Carolina pharmacies committed to broadening the availability of medication management resources to the state’s highest-needs population. Key to CPESN approach is active integration
of pharmacist activity with the larger care team including the primary care physicians, specialty providers such as behavioral health professionals, and the extended care team of the Patient Centered Medical Home. Each local Community Care Network identifies a lead pharmacist and care manager for the CPESN, along with other clinicians ready to provide additional support as needed. Defining the Minimum Criteria As part of the participant criteria, all participating pharmacies agreed to support medication adherence, conduct medication reconciliation after hospital discharge and prevent medication waste by verifying patient need prior to each fill. Likewise, clear and clinically-relevant communication with the provider and care team is a core service of all CPESN pharmacies. Pharmacies participating in the CPESN additionally offer comprehensive medication review, care plan development and reinforcement, and longitudinal follow up. Locating CPESN Pharmacies How do I know which pharmacies in my area are offering enhanced services? As we began to socialize the concept of an enhanced community pharmacy network with providers in the state, CCNC staff were frequently asked this question. In response to ensuring that a connection could be made between providers seeking to partner with CPESN pharmacies, a ”collaboration card” was developed
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Feature Table 1: Optional Enhanced Services Provided by CCNC CPESN Pharmacies 24-hour Emergency Service/ Once Call Dispensing and Non-Dispensing
Home Delivery
DME Billing-Medicare and Medicaid
Adherence Packaging
Medication Synchronization Program
Home Visits
Collection of Vital Signs and Standardized Assessments (i.e. PHQ)
Medication Dispensing with Presumptive Medicaid Eligibility
Care Plan Development/ Reinforcement
Comprehensive Medication Review
Smoking Cessation Program
Point of Care Test
Immunizations
In Depth Counseling/ Coaching
Long-Acting Injections
Multi-Lingual Staff
Naloxone Dispensing
Nutritional Counseling
Readily Available to Provide Personal Medication Record
Specialty Pharmacy Dispensing
Disease State Management Programs
Compounding, Sterile and/or Non-Sterile
as a tool to identify participating pharmacies by county, contact information and the specific enhanced services offered. To further improve this process, a searchable website is currently in development. This application will allow providers and patients to quickly locate CPESN pharmacies in specific areas of the nation that offer enhanced services.
Network Building Across the Nation
Pharmacy organizations, community pharmacists and even value purchasers have expressed interest in learning more about the Community Pharmacy Enhanced Service Network (CPESN) model. Moreover, many community pharmacies are challenged with sustaining current revenue while building pharmacy care management services to remain competitive in the marketplace. In September 2015, CCNC launched the Multi-State High-Performing Community Pharmacy Collaborative (MSPC) to facilitate the expansion of additional high performing networks nationally. The MSPC was developed to connect pharmacists and other pharmacy stakeholders who have an interest in the delivery of financially viable, patient-centered care that exceed traditional pharmacy
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dispensing services. Through this voluntary collaborative, pharmacies, organizations and other entities have the opportunity to share knowledge, highlight emerging and sustainable practice models, share resources and technology to catalyze understanding, development and enhancement of value-based activities without substantial investment in financial or human capital. It is our goal to catalyze the growth of other open access, quality, high performing pharmacies that ensure training and consistent provision of services that lower the cost of healthcare. To date, MSPC is engaged with twelve states with strong interest in launching a CPESN. As Iowa continues to explore the opportunity to create a CPESN, the MSPC will continue to be a resource to guide framework and sustainability.
Tips for CPESN Formation
In closing, there are a few important points to consider when setting the framework of a CPESN. First, do not wait until a value purchaser has approached you to make effort toward organizing a CPESN. Many times, it is too late and the opportunity will pass before your enhanced services network can be put in place. The state of Iowa is recognized for its ability to advance pharmacy practice. With Iowa positioned as one of the 11 states
included in the CMS Enhanced MTM Model demonstration program, it is a prime opportunity to differentiate your high performing pharmacies. Second, do not get overwhelmed by sophisticated details of the network. If Iowa pursues the development of a CPESN, remember that you are organizing a provider network. The services offered represent the value of your network. It is possible for the CPESN to thrive absent of technology or a documentation system. While technology is an enabler of services and quality assurance and quality improvement, it is peripheral to goals of a CPESN network. As value purchasers engage the CPESN and other opportunities present themselves, the network will mature and solutions for technology and data systems will be available. The first step is identifying participating community pharmacies and organizing around the idea of defining your enhanced services to end goal of reducing total cost of care in the patient population that needs intervention the most. Third, a process for quality assurance and quality improvement is vital to success of your network. It will be important for an advisory board and/ or the CPESN pharmacy participants collectively to determine the minimum criteria set forth for participating community pharmacies. It is in the best interest of the CPESN to ensure quality is maintained if you are going to hold yourselves out as providing high value. ■Funding Opportunity Notice – Part of this presentation references a project that was supported by Grant Number 1C12013003897 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. General Disclaimer- The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.
Feature
Foundation Set for Iowa Community Pharmacy Enhanced Services Network
A
seismic shift is taking place in health care as payors and providers are moving towards payment structures that focus on quality of care and patient outcomes. By 2018, CMS reports that 90% of its payments will be quality related. In Iowa, several initiatives, including Medicare Part D’s enhanced MTM test model and Wellmark’s performance based network, are working towards a quality based payment system for pharmacists. Seeing an opportunity for Iowa pharmacists, IPA began facilitating conversations centered around developing a pharmacy network in Iowa based on quality. This network would establish a minimum criteria set for participating pharmacies based on enhanced services provided to patients. In turn, the network would create the framework for payers or health-systems to reimburse these services that positively impact patient outcomes. Community Care of North Carolina (CCNC) has a functioning community pharmacy network and is serving as a resource to Iowa in the establishment of our network. Following a series of webinars and a live meeting at the Midwest Pharmacy Expo, a leadership structure was established to begin developing the Iowa Community Pharmacy Enhanced Services Network (CPESN). Interested pharmacists from across the state have taken the lead on this important initiative.
Network Development
The CPESN is a volunteer and member driven network and the torch has been passed for its creation to five luminaries - Ryan Frerichs, Bob Greenwood, Randy McDonough, Cheri Rockhold-Schmit and myself. In addition to leading the creation of the network, the luminaries will seek out those pharmacies that offer enhanced services to join the network and ensure the quality of the network. These luminaries all practice in community pharmacies that will participate in the CPESN and are available to answer any questions related to the initiative. In addition to these luminaries, three practitioner led committees of network pharmacists have begun creating the
structure of the network and building out the details for services provided and operations within the network. There are currently three work groups: • Service Sets: Defining standard and optional service and communicating those services • Network Operations & Communications: Establish, monitor and grow the CPESN; communication within the network and maintain the sustainability of the network • Quality Assurance & Performance Measurement: Determine measures needed to monitor performance and quality of the network.
Matt Osterhaus, BSPharm, FASCP, FAPhA
President, Osterhaus Pharmacy Maquoketa, IA Iowa CPESN Luminary
With this structure in place, we are working to create a network that delivers a core set of enhanced services that provide the highest value impact to stakeholders. Defining what makes a service enhanced for the purpose of the network requires a balancing act. On one hand, these services must be clearly defined to achieve an advanced level of service that provides documentable value to patients and other stakeholders. On the other hand, our goal is to include any pharmacy practice willing and able to meet the standards to participate in the network.
Next Steps
The work groups are continuing to shape the network and define services. We will be reaching out to Iowa pharmacies in the very near future to gauge interest in participating in the network. We are also exploring collaboration opportunities with the colleges of pharmacy at Drake University and the University of Iowa. The Iowa CPESN is completely volunteer led by Iowa pharmacists with IPA and CCNC providing administrative support. That being said, we need input from Iowa pharmacists so this network provides the highest value impact for all stakeholders. If you are interested in getting involved, contact IPA at ipa@iarx.org or me at most@osterhausrx.com. Please use Iowa CPESN in the subject line, include full contact information and if you are interested in volunteering for a particular work group. ■ APR.MAY.JUN 2016 |
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June 17-18, 2016 Sheraton West Des Moines Hotel
friday, june 17
1800 50th Street, West Des Moines, IA 50266
7:00 a.m.
REGISTRATION OPENS 8:30-11:30 a.m.
HOUSE OF DELEGATES SESSION 1 The IPA Annual Meeting is the annual gathering of Iowa pharmacists, pharmacy technicians and student pharmacists to shape policy, celebrate achievement and connect with colleagues. This year promises lively debate in the House of Delegates, fun and furious bidding at the IPA Foundation Silent Auction and plenty of opportunities to network and connect with colleagues from across the state!
Questions? Contact IPA at 515-270-0713 Register online at www.iarx.org/IPAAnnualMtg
Keynote
Jean Paul Gagnon, PhD Retired, Senior Director of US Policy & Strategic Advocacy, Sanofi US Dr. Gagnon will speak on the evolution of value and outcomes in US healthcare, its impact on key stakeholders and the continuing need for pharmacy to showcase its value in healthcare quality and delivery. House of Delegates Session 1: IPA’s Speaker of the House, CoraLynn Trewet, will preside over delegate orientation, the report of officers, policy committee hearings and new business review. This is your opportunity to provide feedback and participate in the discussions that will shape the policy decisions at Saturday’s session.
CoraLynn Trewet
See this year’s policy topics at www.iarx.org/IPAAnnualMtg 11:30 a.m.-1:00 p.m.
LUNCH & MOTIVATION
June 16, 2016 • West Des Moines Sheraton IPA will once again be hosting the Practice Advancement Forum on the day before Annual Meeting. This year’s forum will focus on practical “how-tos” to implement change in your practice. See the full Practice Advancement Forum agenda on pg. 25 or www.iarx.org/PracticeAdv. If you plan on attending both events, be sure to select the “Practice Advancement Forum & Annual Meeting” bundle for a discount on registration!
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Motivational Keynote Scott Siepker Founder Iowa Filmmakers
The “Iowa Nice Guy” Scott Siepker, known for his hit Iowa Nice video series, will share his story of growing up in Iowa, how he became the “Iowa Nice Guy” and his belief that you can accomplish nearly anything in this state... even being an actor. Following the lunch keynote, IPA will present its 2016 Appreciation Awards and the GenerationRx Award.
1:00-2:30 p.m.
DESSERT, POSTER PRESENTATIONS & EXHIBITS Enjoy dessert as you learn about the exciting research projects that are advancing practice and improving patient care in Iowa. Exhibitors will also be on hand to showcase their latest products and services. 2:30-4:00 p.m.
OPEN NETWORKING & COMMITTEE MEETINGS This time has been set aside for you grow your professional network and meet pharmacists, pharmacy technicians and student pharmacists from across the state. You can also take this opportunity to sit in on a committee meeting. 6:00-9:00 p.m.
PRESIDENT’S RECEPTION & ANNUAL BANQUET
Rick Knudson
The Annual Banquet is a celebration of the previous year for Iowa pharmacy. PresidentElect Rick Knudson will be installed as the 138th IPA President and give his inaugural address. The banquet will conclude with the presentation of IPA’s most prestigious awards.
9:00-10:00 p.m.
IPA FOUNDATION SILENT AUCTION
The evening will conclude with the popular IPA Foundation Silent Auction to support the Foundation’s educational and student programs. Plan to bid on an impressive array of items and participate in the wine/beer ring toss and red envelope fundraiser. Plan to come early during the President’s Reception and preview the silent auction items before the doors open!
Hotel Information Sheraton West Des Moines 1800 50th Street West Des Moines, IA 50266 515-223-1800 When making your lodging reservation, please indicate that you will be attending the IPA Annual Meeting to receive the Rate of $109.00. To guarantee availability and rate, please make you reservation on or before May 25, 2016. Registration Full registration includes attendance at all Friday and Saturday programs and activities. CPE information is available on IPA’s website at www. iarx.org/IPAAnnualMtg.
saturday, june 18 7:00-8:00 a.m.
FUN RUN/WALK
This Annual Meeting tradition is open to anyone who wants to start the day off on the right (or left) foot! If you plan to participate, indicate your shirt size when you register. 7:00-9:00 a.m.
REGISTRATION & INDUSTRY SYMPOSIUM BREAKFAST 9:00-11:30 a.m.
HOUSE OF DELEGATES SESSION 2 Keynote
Shannon Peter, PharmD Clinical Pharmacy Manager, Think Whole Person Healthcare Omaha, NE John Jacobsen, MD Medical Director, Think Whole Person Healthcare Omaha, NE Saturday’s keynote will focus on innovative approaches to team-based care at the primary care level with examples from Think Whole Person’s focus on care transitions and utilization of pharmacists. House of Delegates Session 2: Speaker Trewet will preside over the final policy debate, nomination of the 2016 Honorary President, ratification of the Nomination’s Committee report and the installation of Susan Vos as the Speaker Susan Vos of the House. In addition, the 2016-2017 Vice-Speaker of the House will be elected, the Poster Presentation Award winner will be announced and 2015 Honorary President, Dennis Jorgensen, will be recognized.
If you plan to attend the Practice Advancement Forum on Thursday, June 16, please select the “Practice Advancement Forum & Annual Meeting” option. Target Audience Pharmacists, pharmacy technicians, student pharmacists and their guests. Cancellations The refund policy is full refund less a $50.00 administrative fee, before June 1. No refund after June 1. An additional $25.00 will be added to registrations after June 1 and to on-site registrations.
Student Sponsorship Annual Meeting attendees are encouraged to support IPA’s ability to provide student pharmacists discounted meeting rates by donating to the student attendance fund. Silent Auction & Red Envelope Prize Donations If you or your pharmacy would like to donate to the silent auction, please contact Laura at lmiller@iarx.org and provide a short description and approximate value (if available) of the item(s) you plan to donate. While items will be accepted up through the weekend of Annual Meeting, in order to have your item listed in the silent auction catalog, please notify Laura prior to June 1.
Poster Presentation Submission If you would like to present a poster, please submit an abstract at www.iarx.org/IPAAnnualMtg.
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IOWA PHARMACY RECOVERY NETWORK
Assisting Impaired Pharmacists, Student Pharmacists, and Pharmacy Technicians
Where do you turn when you, a co-worker or someone you care about needs help with an addiction, physical illness or psychiatric disorder?
Providing support . . . through caring volunteers
HOPE FOR RECOVERY 1-877-890-IPRN
http://www.iowarecovery.org/
health care hot topics
New Accreditation Standards for PGY-1 Community Pharmacy Residencies Approved
APhA and ASHP have jointly approved new accreditation standards for PGY-1 community-based pharmacy residency programs. According to ASHP’s VP of practice and science affairs, James Owen, the new standard provides increased flexibility for organizations looking to create such a residency program and accounts for needed training in increasingly diverse outpatient settings. Documents including guidance, goals, competencies, and objectives will be released later this year. Mandatory implementation of the new standards is expected by July 2017.
Emergency Medicine Drug Shortages Increase Drastically
A study published in the journal Academic Emergency Medicine by Dr. Jesse Pines and George Washington University found that drug shortages in the emergency room increased by over 400% from 2001 to 2014. The study was based on drug shortage reports submitted through an ASHP website and analyzed by the University of Utah Drug Information Services. The primary reasons given were manufacturing delays, supply and demand, and availability of raw materials.
Martin Shkreli invokes the Fifth Amendment before Congress The former CEO of Turing Pharmaceuticals was called to testify during a congressional hearing on drug prices regarding the practice of purchasing the rights to older drugs and immediately raising prices by a large margin. Although Shkreli did not respond to questions from the committee, Howard Schiller, interim CEO of Valeant Pharmaceuticals admitted that some of his company’s pricing was excessive.
Robert Califf Confirmed as New FDA Commissioner
The former Duke University researcher and administrator was nominated by President Obama last September and confirmed by the senate on February 24. Califf was overwhelmingly confirmed by a vote of 89 to 4 despite criticism from some over past ties to industry and general outcry over the nation’s opioid epidemic. Califf stated that he also believes the overutilization of opioids is a major issue that must be addressed.
Study Finds Decline in Hydrocodone Prescribing
In a research letter to JAMA Internal Medicine, an analysis of data before and after the rescheduling of hydrocodone to Schedule II showed a 22% decrease in dispensed prescriptions for hydrocodone products. This resulted in 1 billion fewer tablets dispensed in the 12 months following the rescheduling. Most of the decreases are a result of refills being prohibited on Schedule II substances. The study also found a 5% increase in prescriptions dispensed for non-hydrocodone containing opioid analgesics.
WHO Declares Public Health Emergency of International Concern Regarding Zika Virus
The declaration was in response to microcephaly and neurological disorders in areas affected by Zika. The CDC also elevated its response efforts to Level 1 activation. Due to the development of microcephaly, a birth defect in which the baby’s head and brain are smaller than normal, pregnant women should avoid travel to endemic areas. As of March 2 there had been 153 cases of Zika virus in the continental US, three in Iowa.
Cigna Medicare Advantage Enrollment Halted by CMS
The halt stems from problems with the coverage-appeals process. CMS states that Cigna has been non-compliant with CMS requirements in multiple instances in recent years and has been issued warning letters and notices of non-compliance in the past. According to CMS, Cigna improperly handled customer complaints regarding denied coverage for health or drug benefits. The penalty will have low immediate effects on Cigna due to coming after the end of the Medicare open enrollment period.
Government Agencies Address Opioid Epidemic
The CDC and the FDA have both recently issued new guidelines regarding chronic pain management and opioids. The CDC guidelines recommend using non-drug and non-opioid therapies before starting an opioid, prescribing the lowest effective dosage of opioids, and closely monitoring all patients. The FDA guidelines are meant to encourage the development of generic abusedeterrent formulations of opioids. These generics will require more extensive testing to prove that the abuse-deterrent mechanism is as effective as the brand-name. The FDA has also announced that it will require “black box” warnings on immediate-release opioids that will highlight the risk of neonatal opioid withdrawal syndrome and stating that these medications should be reserved for patients who have already failed alternative therapies. ■
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BOLD AGENDA DRIVES RECORD EXPO ATTENDANCE
Over 300 pharmacists, technicians and students from 17 states attended the 3rd annual Midwest Pharmacy Expo on February 12-14, 2016. This year’s featured the most extensive Expo agenda yet, drawing a record crowd to learn connect and be inspired with their colleagues from across the Midwest!
MORE FROM EXPO WEEKEND!
Read about programs and events from Expo:
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Expo Tech Forum
pg. 47
Political Leadership Breakfast featuring Rep. Buddy Carter
pg. 36
Heartland PRN Conference
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FRIDAY
Expo started Friday with the first of its kind BPS Recertification Track, a partnership with the American Society of Health-System Pharmacists (ASHP). 74 pharmacists took advantage of this opportunity to earn live BPS recertification credit. Expo was the first time that BPS programming was offered at a statebased event.
SATURDAY
Saturday began with an energetic and motivational keynote from Dr. Ned Hallowell. The best-selling author, psychiatrist and ADHD expert from Boston explained how a person’s emotional state drives their performance. He offered tips on how to better connect with people, take momentary breaks, and other tools to maintain a healthy emotional and mental state.
A full slate of continuing education breakout sessions followed. In addition to the 3 pharmacist tracks – Practicing Outside the Box, Difficult Cases and Advanced Clinical, Expo welcomed the new Expo Tech Forum and the Heartland PRN Conference this year. Over the lunch hour, attendees took the opportunity to visit with the 30 exhibitors in the Expo Exhibit Hall.
SUNDAY
Early morning snowfall didn’t stop Expo’s Sunday programming which featured long-time Expo favorites New Drugs and Gamechangers. Sunday wrapped with a new program called Looking Ahead. Four presenters gave a brief 15-minute talk on a developing trend or innovation in pharmacy or healthcare. The four topics covered in this year’s session were house calls, pharmacogenomics, 3D printing, and telehealth.
2017 MIDWEST PHARMACY EXPO
SAVE THE DATE:
FEBRUARY 17-19, 2017 Holiday Inn Des Moines-Airport Conference Center 6111 Fleur Dr., Des Moines, IA 50321 The 2017 Midwest Pharmacy Expo will be on February 1719, 2017. We are changing locations to the Des Moines Airport Holiday Inn so next year you can eat, sleep, park and enjoy the Expo all in the same place! Mark your calendar for February 17-19 and join us next year to learn connect and be inspired with your colleagues from across the Midwest! APR.MAY.JUN 2016 |
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iowa pharmacy news
RENAE Chesnut named dean of Drake University College of Pharmacy and Health Sciences Following a national search, Renae Chesnut, professor of pharmacy practice, has been named dean of the Drake University College of Pharmacy and Health Sciences (CPHS), effective immediately. She has been serving as interim dean since June 2015. Chesnut earned her bachelor of science in pharmacy, master of business administration, and specialist and doctorate of education degrees from Drake University. She joined the Drake faculty in 1993, and served as associate dean of academic and student affairs in the CPHS since 2004. Chesnut has been recognized as the CPHS Mentor of the Year twice, and received the Donald V. Adams Spirit of Drake Award in 2009. She has served on Faculty Senate and has been the Faculty Athletic Representative to the NCAA and Missouri Valley Conference since 2000. She is a past president of the Iowa Pharmacy Association, is a member of the Cardinal Health Women in Pharmacy Advisory Board, and was the 2014 recipient of the national Lambda Kappa Sigma Vanguard Leadership Award. “Renae Chesnut brings to the position of dean a rich knowledge of her college and the University, an extensive range of experience, a broad network of contacts with alumni and health professionals, and a near inexhaustible energy for innovation,” said Drake University Provost Joe Lenz. “Her commitment and collaborative spirit have accelerated the success of the College of Pharmacy and Health Sciences and Drake University.” Chesnut says she hopes to enhance the college’s reputation as a premier institution at the leading edge of education, scholarship, and service.
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As interim dean, she has been instrumental in the development and implementation of the college’s new Occupational Therapy Doctorate (OTD) and Masters in Athletic Training (AT) programs, as well as the preprofessional OTD and AT programs, which are now recruiting for fall 2016. She prioritized the CPHS’ early adoption of Drake’s balanced scorecard continuous improvement and strategic planning initiative. She also facilitated the incorporation of technology that enhanced student services and the quality of the learning environment. Through her leadership and administration of the DELTA Rx Institute, she has helped to instill a spirit of change and innovation in the pharmacy profession. The DELTA Rx Institute promotes entrepreneurial leadership in pharmacy, creating leaders who work to advance the profession of pharmacy by identifying and pursuing new opportunities to create value for patients and society. “As a four-time Drake degree-holder, with two decades of professional experience on campus, I am deeply committed to the rich tradition of educational excellence for which Drake University is nationally known,” Chesnut said. “I am energized by the professional challenges presented by serving as dean, and excited about the opportunity to advance the college’s mission to provide an intellectually stimulating learning environment that emphasizes collaborative learning and excellence in professional education, service, and leadership.” Submitted by the Drake University College of Pharmacy and Health Sciences
IPA Participates in Opioid Abuse Summit
Opioid abuse and diversion is a growing problem in Iowa, with 44 Iowa residents dying from opioid overdoses in 2013— up from 16 in 2004. This alarming trend prompted the Iowa Medical Society (IMS), in partnership with the Alliance of Coalitions for Change, to convene a thought leaders’ summit on the issue. Kate Gainer, IPA Executive Vice President, participated in the summit and co-presented with Clare Kelly, IMS Executive Vice President. The attendees discussed both short- and long-term solutions, including the IPA legislative priority of expanded access to Naloxone, an opioid antagonist. When Naloxone is administered to an individual suffering from an opioid overdose, it counteracts the depression of the central nervous and respiratory systems for up to 40 minutes. This additional time gives the individual time to reach a hospital and receive further medical care. IPA supports legislation proposed by IMS to allow physicians, and pharmacists under a statewide protocol, to prescribe the drug to friends and family of addicts, provide legal protections to laypersons who administer it in an emergency situation, and provide protections for individuals who call for assistance to an overdosing individual and stay on the scene. The next steps from the Summit include subgroup meetings for education; legislation and policy; data; and integrated, multi-disciplined systems of care. In addition to IMS and IPA, the Summit included attendees from the Iowa Academy of Family Physicians, the Governor’s Office of Drug Control Policy, Iowa Poison Control, the Iowa Healthcare Collaborative, the Iowa Behavioral Health Association, the Iowa Osteopathic Medical Association, and Pfizer, among others.
iowa pharmacy news TakeAway Expands into Controlled Substance Disposal
they receive transaction information, history, and statements (TI, TH, and TS) for each product received from a supplier. This information must be kept by the pharmacy for six years.
With recent funding increase approved by the Iowa Board of Pharmacy, the Iowa TakeAway program will expand to offer patients the ability to dispose of controlled substances. Over the past several years, IPA has experienced substantial growth in the current TakeAway program, which collects only non-controlled substances, and has seen demand for controlled substance disposal option with the national attention on prescription medication abuse and misuse.
Pharmacies dispensing a product to a patient, providing another pharmacy with a product for a specific patient need or returning a product do not need to provide TI,TH, and TS to the subsequent owner. Also exempt are first responders and dispensers transferring ownership of a product to first responders. If a pharmacy has not received product tracing information at the time of receiving the product, the FDA recommends contacting the previous owner of the product to obtain that information. If the product is determined to be illegitimate the pharmacy must remove it from the supply chain, notify all immediate trading partners, and retain a sample for further examination. Over the next few years, manufacturers and wholesalers will begin to mark each product with a unique identifier. Beginning on November 27, 2020 pharmacies should only accept products with these unique identifiers. At this point pharmacies will be required to verify the identifier of suspect products for at least three packages or 10% of suspect products, whichever is greater. On November 27, 2023 the final step of the DSCSA will require pharmacies to exchange TI and TS electronically in a way that allows for package-level verification.
Funding will cover the purchase of MedSafe units for installation in ten pharmacies in high-risk areas, and provide each of these pharmacies four inner liners. The pharmacy would be responsible for installation and any additional inner liners over the year. In addition, the funding will cover half the cost of TakeAway envelopes for controlled substance disposal. These envelopes must be provided to patients at no-charge. IPA will have updated marketing and promotional materials for participating pharmacies. In addition, the program’s mascot, Pill Dude, will be updated and reconstructed to allow for easier outreach at community-based events Watch for upcoming communications on how your pharmacy can take advantage of these changes to the TakeAway program in Iowa.
Enforcement of Track and Trace Begins
After several delays, the FDA began enforcement of key elements of the Drug Supply Chain Security Act (DSCSA) on March 1, 2016. DSCSA was signed into law on November 27, 2013. With the law now being enforced, pharmacies should not accept ownership of a product unless
Trends in the Iowa Pharmacist Workforce
Since 1996, The University of Iowa Carver College of Medicine’s Iowa Health Professions Tracking Center has monitored trends in the pharmacist workforce in Iowa related to: benchmarking, geographic distribution, access, trends, and comparisons to other health professions. Here is a short summary of the most recent report (data through December 31, 2014) provided to the Iowa Pharmacist
Tracking System Advisory Committee, for which IPA, the Board of Pharmacy, and the colleges of pharmacy are represented. • Iowa has 2,894 current practicing pharmacists. • The breakdown of most common work locations, include: community (58.6%), hospital (25.0%), state/ federal government (5.2%), consultant (LTC) (3.1%), and academic (2.5%) • Degrees: 54% have a PharmD, 46% have a BS or other degree • Gender: 62% female, 38% male • Age Distribution: <30 years (11.9%), 30-39 years (30.4%), 40-49 years (24.2%), 50-59 years (20.3%), and >60 years (13.2%) • There are 21 of 99 counties with 50% of pharmacists that are aged 55 years or older If you have questions about this data, contact Anthony at apudlo@iarx.org.
Jeff Reist Named New Chair of IPRN Committee
Jeffrey C. Reist BS, PharmD, BCPS, Clinical Associate Professor and Director of the Pharmacy Practice Laboratory at the University of Iowa College of Pharmacy, was recently elected as the Chair of the IPRN Committee. He is a graduate of the University of Iowa College of Pharmacy (BS Pharm) and the University of Florida College of Pharmacy (PharmD), and maintains a practice site at University of Iowa Hospitals and Clinics Department of Family Medicine Geriatric Clinic. Dr. Reist has had longstanding interest in the intersection of substance abuse and the profession of pharmacy, serving as a member of the IPRN committee over the past 15 years. During this time of leadership transition in IPRN as several long-term colleagues having retired, Jeff’s many years of service on the committee will new leadership
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iowa pharmacy news build on our past success and allow IPRN to continue to thrive in our everchanging environment.
Board of Pharmacy IPRN Planning Committee Recommends Action
In January 2016, representatives from the Board of Pharmacy and other interested stakeholders met to discuss the services of IPRN to make recommendations to the entire Board of Pharmacy about how best to manage a pharmacy recovery program for Iowa. This group heard from representatives from IPRN, IPA, and the Board of Medicine about current services offered for healthcare professionals in Iowa. During the March Board of Pharmacy meeting, the Board voted to pull key operating components of the IPRN under the Board of Pharmacy. IPA will look to work with Board of Pharmacy to provide certain ancillary support services to still be offered under IPRN. These ancillary support services could include: grant support to student PRN chapters, stipend for students and pharmacists to attend the APhA Institute in Utah, monthly support meetings for pharmacy professionals in recovery, education, and marketing and communications for IPRN.
Heartland PRN Conference Convenes at Expo
As part of a regular rotation around the Midwest states, Iowa hosted the annual Heartland PRN Conference as a component of the Midwest Pharmacy Expo. Over 20 attendees from ten different states attended this year’s program. Sessions provided for thorough review of PRN programs, symptoms of addiction, new methods for treating addiction, as well as offering attendees to hear from each other about their path towards recovery.
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Update on a Statewide Technician Education Program
In February 2015 the University of Iowa College of Pharmacy invited over 55 representatives from Drake University, Iowa’s community colleges and additional national, state, and other pharmacy organizations to discuss future perspectives on pharmacy technician roles and education, with particular attention to the upcoming changes in requirements for eligibility to sit for the certification exam provided by the Pharmacy Technician Certification Board (PTCB). The Iowa Pharmacy Technician Education Summit marked the beginning of a now ongoing process to develop an accredited, coordinated pharmacy technician education program available across the state of Iowa. The Iowa Pharmacy Technician Curriculum Task Force was formed from volunteers attending the Summit who agreed to begin to work on a coordinated curriculum that could be delivered by all 15 of Iowa’s community colleges. The curriculum would meet the new ASHP/ACPE “Accreditation Standards for Pharmacy Technician Education and Training Programs” and would seek accreditation status by 2020, the year all applicants for the Pharmacy Technician Certification Exam (PTCE) must be graduates of accredited pharmacy technician training programs. The Task Force met three times in the year following the Summit. The June 2015 meeting focused on discussions of course content provided by existing pharmacy technician education and gaps in content relative to the ASHP/ ACPE accreditation standards. In August 2015, the Task Force continued to discuss the development of new curricular content. Small working groups were formed to review textbooks and to develop common experiential clinical site competencies and objectives, and preliminary discussions regarding the composition of a consortium of community colleges that would participate in the
coordinated curriculum were initiated. A small pilot group concept to offer and test portions of the coordinated curriculum was proposed. It was also determined that the Task Force had reached a point in the planning process where input from the Iowa Department of Education would be beneficial in order to gain insight regarding any additional requirements that would need to be met by a coordinated program offering from multiple Iowa community colleges. The most recent meeting of the Task Force was held in January 2016. The small working groups presented their recommendations regarding textbooks, common experiential objectives, and an additional report was presented on the potential to include adaptive learning in the new curricular offerings. The pharmacy technician programs from both Indian Hills Community College (IHCC) and Western Iowa Tech Community College (WITCC) volunteered to participate in the Small Program Pilot Group to plan and test new curricular components and coordinate all course objectives in an effort to align their curricula with the ASHP/ACPE accreditation standards. Following the 2016-17 pilot year, the opportunity to expand the pilot group will be discussed among the interested community colleges and appropriate curricular plan will be submitted for approval by the Iowa Department of Education. Upon approval, this timeline will allow additional pilot testing of a statewide coordinated curriculum during the 2017-18 academic year and would be followed by preparations for an accreditation evaluation during the 2018-19 or 2019-20 academic years. For additional information regarding the Iowa Pharmacy Technician Education Task Force, the pilot group activities, or to share your ideas with the Task Force, contact Maureen Donovan, Associate Dean for Undergraduate Education, and Professor, Pharmaceutics and Translational Therapeutics, at maureen-donovan@uiowa.edu or 319335-9697.
iowa pharmacy news APhA 2016: Expanding Opportunities through Patient Care
Over 150 Iowa pharmacists, student pharmacists, and friends of Iowa pharmacy attended the APhA Annual Meeting in Baltimore, MD. Another successful meeting occurred as attendees heard from renown speakers, debated policy, and enjoyed the camaraderie from numerous networking opportunities. Attendees heard from Dr. Rajiv Shah present on “Pharmacists Improve Care Through Team Collaboration.” Most recently, Dr. Shah has been seen on YouTube videos strongly advocating for pharmacists and encouraging the ‘dream team’ to battle the medication non-adherence problem holistically. The APhA House of Delegates focused their policy debate on biologic, biosimilar, and interchangeable biologic drug products, and point-of-care testing; while ultimately referring policy statements on medication optimization services. Save-the-Date: APhA 2017 – March 24-27, 2017 in San Francisco.
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iowa iowapharmacy pharmacy news
STAY ENGAGED. STAY INFORMED. 2/2/2 is IPA’s free monthly webinar series designed to keep you engaged and informed on the hot issues impacting the pharmacy profession. When is it? 2nd Tuesday of every month at 2:00 p.m. CST. UPCOMING WEBINARS YOU WON’T WANT TO MISS: May 10, 2016
Open Forum on Proposed IPA Policies
June 14, 2016 Cyber Liability
July 12, 2016 DIR Fees
August 9, 2016 CMS Rule Change
Take advantage of these virtual engagement opportunities by registering at www.iarx.org/222. Recordings of previous 2/2/2 programs are available at no charge at www.iarx.org/222. Previous subjects include 340b compliance, Incident-to Billing, Track-n-Trace, and more. Topics subject to change. Watch IPA communications for updates and registration instructions. 2/2/2 webinars are not accredited for CE.
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PRACTICE ADVANCEMENT New Practice Model Continues IPA’s New Practice Model (NPM) Initiative continues to move forward. With the support of the National Association of Chain Drug Stores (NACDS) and the Community Pharmacy Foundation, 17 pharmacies implemented Tech-Check-Tech (TCT) for refill prescriptions as a means to provide advanced pharmacy services. IPA continues to actively support sites through calls, live meetings and site visits.
In January 2016, an 18 month report was presented to the Board of Pharmacy for seven Phase 1 locations. Error rates for technician-verified refills remained low throughout the initial 18 month pilot, were similar to pharmacist-verified refills. There was a statistically significant increase in the number of patient care services provided and time spent in patient care doubled compared to baseline. Ten Phase 2 sites were added in February 2015 and have demonstrated similar results. All locations are currently approved as New Practice Model pilot sites by the Board of Pharmacy through July 2016. New Practice Model stakeholders met in March 2016 to discuss future directions, including possible expansion to include new prescriptions, including additional pharmacies in the pilot, and possible expansion of current TCT rules to include community pharmacy practice.
IHIN Project Moves Forward
The Iowa Health Information Network (IHIN) is an electronic hub operated by the Iowa Department of Public Health (IDPH) which allows various health care settings to securely exchange patient information. For the past six months, a group of pharmacies have been working with IDPH to showcase the functionality of pharmacy’s use of IHIN to improve coordination of patient care across health care settings. Throughout the pilot project, pharmacies have offered guidance to
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IDPH to improve the functions of IHIN and identify currents barriers within IHIN. For example, the timeliness of data upload into IHIN can be problematic when a pharmacist is working with a patient just discharged from the hospital.
Stewardship.”
Moving forward, IPA and IDPH will be coordinating efforts with pharmacy software vendors to integrate their technology with IHIN in order for pharmacy data to be uploaded into IHIN. These new efforts should align with recent news that federal funding could assist to make such efforts possible. Available federal funds provided under the Health Information Technology for Economic and Clinical Health Act (HITECH) would match 90% of state expenditures that go towards implementing a statewide HIE and incorporating pharmacies into IHIN
Antimicrobial therapy is indicated for asymptomatic bacteriuria (ASB) only in patients either pregnant or undergoing a genitourinary procedure with high bleed risk. More than 15% of patients over 75 years of age and up to 50% of patients in residential facilities have ASB, and unfortunately, nearly 50% of these patients are inappropriately treated with antimicrobial therapy.
Antimicrobial Stewardship Updates from Across Iowa
With upcoming guidelines and federal regulations, IPA’s HealthSystem Liaison Board (HSLB) has focused their efforts on Antimicrobial Stewardship (AS) awareness and education. A survey was sent during the winter months asking questions pertaining to the level of understanding of AS and what each hospital is currently doing in regards to AS. Volunteers from the initial survey were then asked to provide answers to more advanced Stewardship-related questions. In January 2016, HSLB members Amanda Bushman, Lisa Lambi, and Jeffrey Houseman presented an IPA 2/2/2 Webinar on Stewardship in Iowa, which provided basic information related to the topic, discussed antibiotic resistance, current AS activities in Iowa, and detailed publications leading up to the development of new guidelines and upcoming regulations. Similar information was detailed in the Jan/ Feb/March 2016 edition of IPA’s Journal entitled “Antibiotic Resistance: The Threat Driving Antimicrobial
Stewardship Case Example: A Form of Process Improvement at Mercy Medical Center – Des Moines
To reduce overtreatment of ASB, a process change is being made at Mercy Medical Center to decrease the number of urine cultures processed following urinalysis. When prescribers order a urinalysis, they have the option of adding a “Culture if Indicated”, based on broad categories within the urinalysis (ex: If Leukocyte Esterase is positive, culture the urine). This often leads to a urine culture showing bacteria, pressuring prescribers to inappropriately prescribe antimicrobials regardless of indication. A retrospective chart review was done to determine optimal criteria for prompting urine culture that would more accurately identify patients warranting antibiotics. These new criteria will safely reduce the number of positive urine cultures reported to prescribers and reduce our treatment of ASB.
PRACTICE ADVANCEMENT
June 16, 2016 • West Des Moines Sheraton The Practice Advancement Forum is an opportunity for Iowa pharmacists from all practice settings to collaborate and create a foundation for practice advancement across the state. This year’s forum will focus on how to implement innovation in your practice. Keynotes and workshops will give you practical applications and insight that will enable you to advance your practice and align it with the evolving healthcare landscape. “How-to” workshops will cover topics like using collaborative practice agreements, documenting services, leading change and bringing other stakeholders on board. The Practice Advancement Forum will once again be held the day before IPA’s Annual Meeting at the same location, making easy to attend both meetings!
Agenda 8:00 a.m.
Welcome
8:15 a.m.
Keynote: The Time is Now. Really. The Time is Now!
9:45 a.m.
Break
10:00 a.m.
How to Expand Your Pharmacy Practice with Collaborative Practice Agreements and New Revenue Sources for Patient Care Services
11:00 a.m.
How-to Workshops 1. How to Use Pharmacy Technicians to Expand Pharmacist Services 2. How to Document Your Services (to physicians and patients)
12:00 p.m.
Lunch, Industry Symposium
1:00 p.m.
How to Effectively Partner with Physicians
2:15 p.m.
Active Networking
2:45 p.m.
How to Implement System Change
4:00 p.m.
Call to Action/Next Steps
See the full agenda and register at: www.iarx.org/PracticeAdv
IPA 2016 Annual Meeting will start the day after the Practice Advancement Forum. Attend both for discount and additional opportunities to network with colleagues from across the state and shape pharmacy practice in Iowa. If you plan on attending both the forum and Annual Meeting, be sure to select the “Practice Advancement Forum & Annual Meeting” registration option. APR.MAY.JUN 2016 |
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ipa foundation
THe 2016 RAGBRAI Team Is Taking Shape! JULY 24-30, 2016
Our week-long riders are set, but there is still room for more daily riders!
OTTUMWA
CRESTON
GLENWOOD
MUSCATINE
The 2016 IPA Foundation RAGBRAI team is starting to take shape and we still have plenty of opportunities to be a part of the team!
WASHINGTON
SHENANDOAH
LEON
CENTERVILLE
Week–Long Riders
Mark Adams, Drake Student Quinn Bott, PharmD Sharon Cashman, RPh Sarah Cashman Andrew Funk, PharmD Theresa Legg, DPT Donald Letendre, PharmD Courtney Morris, PharmD Anthony Pudlo, PharmD, MBA Daniel Ricci, PharmD Mark Sorenson, RPh Ben Urick, PharmD Richard Wenzel, PharmD
Daily Riders
2016 RAGBRAI HOSTS
Thank you to these volunteers who will be hosting the team at each overnight stop on the route. Glenwood: Susan and Clark Fry Shenandoah: Nathan Peterson’s (PGY2 Resident, Mercy Medical Center) parents Creston: Larry Richardson, Retired Leon: Kellie Lesher & Garret Saxton Centerville: Bill and Linda Johnson Ottumwa: Eric Carlson, South Side Drug Washington: John & Danielle Majewski
Doug Schara, RPh
Join the Team!
Drive
It is not too late to be a part of the RAGBRAI team! This team is more than just riders. See where you fit in:
Fix-a-Flat
Ride
The deadline to join the team for the week-long ride has passed, but you can still register to ride for up to 3 days as a daily rider. For details and registration instructions, visit iarx.org/ RAGBRAI. The deadline to register as a daily rider is May 31, 2016.
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We are looking for volunteers to help get the team from the Missouri River to the Mississippi River. Volunteer to drive our support van for a day or two. If interested, contact Laura Miller at lmiller@iarx.org or 515-270-0713.
Help keep the team rolling with Fixa-Flat kits! For a $30 donation per kit, you can make sure the team is prepared for any roadside repair!
Sponsor
Sponsorship opportunities are available to support the entire team or a specific rider. Visit www.iarx.org/ RAGBRAI for details.
Wear the Jersey
Support the team by wearing the official IPA Foundation RAGBRAI Jersey! It’s a great way to promote the profession during your own cycling adventures. Purchase yours at www.iarx.org/IPAStore.
IPA FOUNDATION IPA Welcomes Conner Dierks as the 2016 Max W. Eggleston Executive Intern! Hello everyone. My name is Connor Dierks and I will be the 2016 Max W. Eggleston Executive Intern in Association Management for the Iowa Pharmacy Association. I am very excited to serve in this position and am really looking forward to an exciting summer. I am from originally from Fox Lake, Illinois, a North Chicago suburb. I took two years of undergraduate classes at the University of Iowa before beginning my first year of pharmacy school at the University of Iowa College of Pharmacy. I am currently finishing my first year of the pharmacy program and I am involved in various organizations both within and outside of the College of Pharmacy. I am serving as the President of a gymnastics club at the University of Iowa and compete with this team as well. I am also an active member of the American Pharmacists Association as well as the Academy of Managed Care Pharmacy. I have learned so much this year in school and through my experiences with the Iowa Pharmacy Association and I am eager to begin working as the Executive Intern. I gained a lot of knowledge by attending the IPA Legislative Day and enjoyed getting the chance to meet some more Iowa pharmacists, as well as members of IPA and legislators alike. Through this experience, among others, I have come to respect all the incredible work that the IPA does and am so excited to soon be able to contribute more to this organization.
2016 IPAF Silent Auction Donate and prepare to bid for a good cause! The 2016 IPA Annual Meeting is set for Friday and Saturday, June 17-18 in West Des Moines. Friday evening will conclude with the popular IPA Foundation Silent Auction to support the Foundation’s educational and student programs. Plan to bid on your favorite items and participate in the wine/beer ring toss and red envelope fundraiser. Come early during the President’s Reception and view the silent auction items before doors open!
To Donate
If you or your pharmacy would like to donate to the silent auction, please contact Laura at lmiller@iarx.org and provide a short description and approximate value (if available) of the item(s) you plan to donate. While items will be accepted up through the weekend of Annual Meeting, in order to have your item listed in the silent auction catalog, please notify Laura prior to June 1.
SAVE THE DATE: September 23, 2016 Brown Deer Golf Club in Coralville, Iowa | 1:00 p.m. shotgun start. The Eggleston-Granberg Golf Classic brings together student pharmacists, alumni and friends for a fun-filled day at the golf course with a purpose. All proceeds benefit the IPA Foundation’s support of student pharmacists at Drake University and The University of Iowa Colleges of Pharmacy. Save the date, get your foursome together and join us on September 23 for some friendly competition on the golf course for a good cause! APR.MAY.JUN 2016 |
27
PEER REVIEW
The Potential Impacts of “Provider Status” in Iowa: Perceived Changes in Provision of Clinical Services and Barriers to Implementation Scott Morrett, Drake University College of Pharmacy and Health Sciences Erin Ulrich, PhD, Assistant Professor, Drake University College of Pharmacy and Health Sciences Zachary Pape, Drake University College of Pharmacy and Health Sciences The corresponding author for the manuscript is: Erin Ulrich, PhD Fitch Hall 113 2507 University Ave Des Moines, IA 50311-4505 Phone: (515) 271-1846 Fax: (515) 271-1867 Email: erin.ulrich@drake.edu No conflicts of interests were identified by the authors. No funding was required for this project. There have been no prior presentation of this work
Abstract
Background: In Iowa, patient access to providers is sparse with 72 of Iowa’s 99 counties labeled as “Medically Underserved Areas.” The objective of this study was to describe pharmacy managers self-report of anticipated changes in their own provision of clinical services and possible barriers to implementation were the Pharmacy and Medically Underserved Areas Enhancement Act (“Provider Status”) to pass. Methods Setting: Underserved areas of Iowa, as defined by the US Department of Health and Human Services, in Summer 2015. Participants: Pharmacy managers of 535 pharmacies. Data Collection: An online anonymous questionnaire was emailed to pharmacy managers whose location fell within a medically underserved area in Iowa. Data was collected from May, 2015- July, 2015. Questionnaire sections included characteristic data of both pharmacists and pharmacies, current provision of clinical services, anticiapted change in provision of clinical services, and perceived barriers to implementation. Analyses: Descriptive statistics were calculated. Following past literature, to determine level of social desirability, agreement with the four statements regarding a pharmacists’ own willingness and their perceived willingness of
Introduction
Citizens of the United States are currently spending twice the amount on health care as citizens of other developed countries, yet have worse health outcomes in many capacities such as life expectancies, infant mortality rates and diabetes. Additionally, half the adult population suffers from a chronic disease and managing those chronic diseases currently accounts for 86% of US healthcare costs.1 Pharmacists are equipped with the professional training and education to provide clinical services which have a direct relation to increased patient outcomes and decreased cost of healthcare.2 Additionally, pharmacists are already legally able to provide many clinical services within their scope of
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practice. However, pharmacists are often limited by barriers that prevent them from practicing to the top of their degree, making implementation of clinical services difficult or impractical.1 One particular barrier is the fact that pharmacists are not currently recognized as providers at a federal level. This renders them unable to directly bill Medicare Part B for patient care services they provide, even when they may be the only healthcare worker in a community.3 At a state level, the role of a pharmacist is expanding with the help of collaborative practice agreements and the implementation of medication therapy management. However, an inability to bill and receive adequate reimbursement from third parties for
other pharmacists to accommodate additional clinical services if the bill were passed were asked. These four items were summed and t-tests were conducted. Results A total of 139 pharmacy managers completed the questionnaire (28% response rate). Overall, the responding majority of pharmacy managers identified as practicing in a community setting and had been practicing pharmacy for around 20 years, while managing their current practice for an average of 10 years. Only 63 (45.3%) reported currently offering services that are billed to OutcomesMTM, the state Medicaid PCM, or other platform for pharmacist-led clinical services. The paired t-test revealed a statistically significant difference (p=0.004) between pharmacists’ perception of their own willingness and other pharmacists’ willingness to adjust practice. Conclusions Currently, fewer than half of all pharmacies offer billable clinical services, however, all pharmacies responded that they would consider offering additional services if the bill were to pass. Commonly reported potential barriers to providing additional reimbursable services include time constraints, lack of billing knowledge, fear of implementation failure, and need for increased staffing to provide these services. Keywords: Provider Status, Pharmacy and Medically Underserved Areas Enhancement Act, Pharmacy Law, Current Legislation, Clinical Services.
services provided creates a barrier to wider implementation and provision of clinical services by pharmacists. A newly proposed bill would make drastic changes in access to healthcare. As of January 2015, two companion bills, H.R. 592 and S. 314, both titled the “Pharmacy and Medically Underserved Areas Enhancement Act”, have been introduced in the United States House of Representatives and Senate respectively. If passed, these bills would amend title XVIII of the Social Securities Act and would effectively label pharmacists as providers in medically underserved communities and would allow for reimbursement of pharmacist led clinical services through Medicare Part B.4,5
PEER REVIEW In Iowa specifically, patient access to providers is sparse with 72 of Iowa’s 99 counties labeled as “Medically Underserved Areas” (MUAs) as defined by the US Department of Health and Human Services.6 MUAs are determined based on criteria such as percent of population below the poverty line, percent of population over 65 years of age, infant mortality rates, and number of full-time equivalent primary care physicians. Of the 99 counties, 16 counties have a pharmacist as the only midlevel practitioner.7 With over 3,300 pharmacists in the state of Iowa, there is a large opportunity to increase patient access to clinical services provided by pharmacists.2 With the Pharmacy and Medically Underserved Areas Enhancement Act proposing to involve pharmacists as a member of the health care team, expected results include higher rates of patient satisfaction and reduced health care costs.8,9 However, despite knowing what the proposed bill would change legally, a gap in knowledge exists when looking at expected changes in actual implementation of clinical serves by pharmacists in Iowa. At this time it remains unclear whether pharmacists in Iowa would increase the amount of clinical services they provide, were proposed bills to pass.
Objectives
The first objective was to determine the current level of clinical service provision in pharmacies in underserved areas of the state. It was hypothesized that pharmacists are currently providing minimal levels of clinical services in underserved areas in the state which would be measured by amount of pharmacies providing services. The second objective was to determine their own willingness and their perceptions of other pharmacists’ willingness to increase provision of the reimbursable services if the bill were to pass. It was hypothesized that pharmacists are willing to increase provision of services if the bill were to pass, while they feel other pharmacists in the state will be not as willing. The third objective was to determine if there are perceived barriers to implementation of new clinical services were the bill to pass. It was hypothesized that there are perceived barriers to implementation of new clinical services.
Methods
A listing of pharmacies located in Iowa was obtained from the Iowa Board of Pharmacy. This list was cross referenced with the US Department of Health and Human Services website in order to identify which pharmacies would be covered under the proposed legislation. According to the text of the bill, affected areas included pharmacies that fell into MUAs, served medically underserved populations, or were located in a Health Professional Shortage Area (all of which, from now on, will be collectively referred to as Medically Underserved Areas [MUAs]). All ineligible pharmacies were then trimmed from the final list before sending surveys via email to eligible pharmacy managers. After screening for duplications, a total of 535 eligible pharmacy managers were asked to participate. An initial invite to participate and the URL to the online questionnaire were emailed to each pharmacy that met the inclusion criteria. Within this invitation, it was made clear that they were selected because their pharmacy was located within a MUA. Two identical follow-up reminder emails were sent to all pharmacies, at two and four weeks after the initial email was sent. Informed consent was conducted electronically. This study utilized an anonymous one-time online Qualtrics questionnaire. This questionnaire was intentionally made anonymous to encourage pharamcists to participate and to decrease social desirability of responses. Data collection occurred between July 1, 2015 and August 15, 2015. This study was approved by the institutional review board of Drake University in spring of 2015. There were four sections of this survey. The survey was pilot-tested individually with four practicing pharmacists to identify any readability and comprehension issues (face validity). The first section asked 14 closed- and open-ended items related to the characteristics of the pharmacy and the pharmacist responding to this questionnaire. Pharmacy characteristics include type of pharmacy setting, average number of prescriptions filled in a week, and number of pharmacists, pharmacy technicians, and student interns working on an average workday. In addition, subjects were asked how many days a week their pharmacy is too busy with dispensing activities to provide managerial/clinical services. Respondents
were asked how many years they have practiced pharmacy and how many years they have been the manager at their current pharmacy location. The second section focused on type and amount of current clinical service provision. Respondents reported if their pharmacy currently submits claims to OutcomesMTM, Mirixa, the state Medicaid PCM, or any other platform for pharmacist led clinical services. From a list of 16 common clinical services, respondents selected which ones they provide and reported, on average, the number of hours per week they spend providing the services. An open-ended option was offered for respondents to writein any other clinical services not listed. Data from this section will be used to test hypothesis 1. At the beginning of the third section, a detailed description of the Pharmacy and Medically Underserved Areas Enhancement Act was provided, confirmation that the bill would apply to their pharmacy, and that ‘clinical services’ mentioned in the description are those that would be billable through Medicare Part B. This description was then followed by 6 items where respondents could rate their extent of agreement using a five-point Likert scale (1 – strongly disagree to 5 – strongly agree and 6 – not applicable) of willingness of themselves and their fellow pharmacists to increase provision of clinical services and to compare their self-reported willingness to their perceptions of other pharmacists’ willingness to increase provision. These items were modeled after Rickles et al. to determine the comparative attitudes of pharmacists and to implicitly identify potential for social desirability. 11 Data from this section were used to test hypothesis 2. The fourth section, consisted of 8 potential barriers to increasing provision of clinical services. Respondents were able to check any that applied to their pharmacy practice. This information would be very useful to institutes of higher education, the board of pharmacy, and the state pharmacy association in order to understand the needs of pharmacists and to support those needs during a potential time of drastic change in the pharmacy profession. Data from this section was used to test hypothesis 3. Results were analyzed using SPSS 20.0. Frequencies and descriptives were conducted on all measures of interest.
APR.MAY.JUN 2016 |
29
PEER REVIEW Modeling after Rickles et al. to determine the potential presence of social desirability in responses, paired t-tests were conducted between respondents’ summed willingness to provide more clinical services if the legislation were to pass and their perception of their peers willingness to provide new services.11
Results
Of the 535 email invitations to participate with a URL link to an online survey, 36 email accounts were undeliverable and 11 stated that they were out-of-the-office during the data collection period. A total of 139 pharmacy managers completed the online questionnaire, for a response rate of 28.0%. Overall, the responding majority of pharmacy managers identified as practicing in a community setting (36.0% Independent, 14.4% Chain, and 8.6% Grocery Store Chain) with only 20.9% of managers identifying as practicing outside of community pharmacy (Table 1). There was almost level distribution between the six weekly dispensing load categories; however, about 20.0% of respondents reported filling between 400799 prescriptions per week. Approximately 60.0% of respondents reported having between 1-4 days of the week with little or no time to provide clinical services (Table 1). Respondents have, on average, been practicing pharmacy for around 20 years, while managing their current practice for an average 10.2 years, ranging from 0-41 years (Table 1). Of the 139 respondents, 63 (45.3%) reported currently offering services that are billed to OutcomesMTM, the state Medicaid PCM, or other platform for pharmacist-led clinical services. These 63 respondents submitted an average of 2 claims to OutcomesMTM and 2 claims to Mirixa each week (Table 2). Very few stated they submit claims the state Medicaid PCM or another platform. Medication monitoring and patient education were the two services that respondents spent the most hours on per week (Table 2). Agreement with the four statements regarding a pharmacists’ own willingness and their perceived willingness of other pharmacists were summed. Higher sum scores indicate greater agreement with the willingness statements. Table 3 shows the comparative differences between these two summed willingness scores. The paired t-test revealed a statistically significant difference (p=0.004) between pharmacists’
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perception of their own willingness and other pharmacists’ willingness to adjust practice in order to accommodate additional clinical services being provided at their site of practice (Table 3).
time per week.10 Patient care activities not associated with dispensing included: assessing and evaluating patient medication-related needs, monitoring and adjusting patients’ treatments to attain desired outcome, and other services designed for patient care management. This data found that on average within the community pharmacy setting, pharmacists spent only about 11.8% of their week on these non-dispensing activities. Based on respondents in this study, 65.7% of responders stated that anywhere from 1-4 days of the week are completely unavailable to perform clinical services
There were no respondents that said they would be unwilling to implement additional billable services. In the final survey section findings, it was apparent that respondents reported many barriers to being able to implement change if the legislation were to pass (Table 4). Finding time (46.0%) and knowing how to bill for the services (42.4%) were the two most common barriers. In addition, all other perceived barriers TABLE 1: Overall Pharmacy Characteristics (n=139) were recorded to be present at above 19.0% n(%) in respondents. Very few Type of Pharmacy pharmacists reported Chain 20 (14.4) corporate policy as a barrier to improving their Grocery Store Chain 12 (8.6) practice is legislation were Independent 50 (36.0) to pass (Table 4). Other 29 (20.9)
Discussion
In this study determining the current level of clinical service provision in MUAs of Iowa, only 45.3% of respondents were found to be currently offering clinical services and submitting to pharmacistled reimbursement platforms. It has been established that pharmacists play a vital role in the improvement of patient outcomes both in safety and therapeutic outcomes.8 However, a pharmacist’s time and effort may be occupied by other factors besides clinical services such as phone calls, verifying prescriptions, etc. In the 2014 National Pharmacist Workforce Survey (NPWS) performed by the Midwest Pharmacy Workforce Research Consortium; patient care services not associated with medication dispensing were reported by different areas of pharmacy based on mean percentage of
Missing
28 (20.1)
Number of Rx filled/week 0-399
17 (15.3)
400-799
23 (20.7)
800-1119
22 (19.8)
1200-1599
14 (12.6)
1600-1999
12 (11.7)
2000+
20 (10.8)
Missing How many days per week would you consider that your pharmacy staff has little to no time to perform clinical services due to the high level of prescriptions filled at your pharmacy? 0 days
9 (8.1)
1-2 days
35 (31.5)
3-4 days
38 (34.2)
5-6 days
13 (11.7)
7 days
6 (5.4)
Missing Mean (SD)
(MinMax)
Number of pharmacists working an average week day
1.88 (1.37)
(1-12)
Number of technicians working an average week day
3.19 (3.17)
(0-30)
Number of students/interns working during an average weekday
0.26 (.55)
(0-2)
Number of years practicing
19.61 (12.39) (1-51)
Number of years as manager in Current place of employment
10.23 (10.14)
(0-41)
PEER REVIEW TABLE 2: overall pharmacy services currently provided by those pharmacies that stated they currently bill OutcomesMTM, Mirixa, Iowa Medicaid PCM, or other platform for pharmacist-led clinical services (N=63) How many claims per week
Number of hours spent providing service
Mean (SD)
(Min-Max)
Mean (SD)
OutcomesMTM
2.03 (3.0)
(0-15)
Mirixa
1.88 (1.86)
(0-12)
Iowa Medicaid PCM
0.22 (.85)
(0-5)
Other
0.79 (3.44)
(0-15)
(Min-Max)
Number of claims per week to:
Hours/Week on: Chronic disease state management
1.61 (2.63)
(0-10)
CLIA
0.37 (0.78)
(0-3)
Comprehensive medication reviews
2.37 (2.81)
(0-20)
Disease state education
2.66 (5.88)
(0-40)
Immunizations
1.46 (1.64)
(0-10)
Medication adherence
2.52 (3.48)
(0-20)
Medication changes
3.32 (7.62)
(0-40)
Medication boxes
3.39 (5.21)
(0-25)
Medication monitoring
6.34 (11.09)
(0-50)
Medication sync
3.86 (7.05)
(0-40)
Smoking cessation
0.31 (0.50)
(0-2)
Wellness services
1.03 (1.30)
(0-5)
Transition of care
2.11 (2.99)
(0-10)
Patient education
6.42 (8.08)
(0-40)
TABLE 3: comparative attitudes towards potential change due to provider status being passed (n=139) Pharmacist surveyed Mean (SD)
Other pharmacists Mean (SD)
Would increase the amount of pharmacist led clinical services offered to Medicare patients, were the bill to pass
4.18 (0.95)
4.01 (0.79)
Would be willing to implement changes to current workflow in order to accommodate for more clinical services to be offered
4.31 (0.76)
3.96 (0.78)
Would be willing to hire new staff to support the pharmacists in order to provide more clinical services.
3.62 (1.09)
3.51 (0.84)
Would be willing to learn how to best implement these newly billable clinical services.
4.48 (0.75)
4.01 (0.83)
Sum (range 5-20), mean (SD)
16.53 (3.10)
15.55 (2.89)
t=2.30, p = 0.004
Likert Scale: 1- Strongly Disagree, 2- Disagree, 3- Neither Agree or Disagree, 4- Agree, 5Strongly Agree, 6- Other, 7- Not applicable to my pharmacy
for reimbursement. This followed the findings from the NPWS of 2014 which also showed minimal time being spent on patient centered non-dispensing services.10 The data collected in this study matches past data and shows that pharmacies in MUAs of Iowa currently offer low levels of clinical services and there is much room for improvement. This study also examined the willingness of pharmacists to participate in additional patient-care centered clinical services for reimbursement, as well as the perceptions of their peer’s willingness to implement clinical services if H.R. 592 and S. 314 were to pass into law. It was found that, in general, pharmacists in MUAs of Iowa were willing to implement changes like hiring new staff or participate in additional education in order to implement new or improved clinical services in their workplace. Rickles et al. surveyed pharmacists to determine their attitudes and willingness to provide mental health services.11 To capture the presence of potential social desirability, the authors conducted comparison analyses between the pharmacists’ reported attitudes on mental health and the pharmacists’ report on their peers’ attitudes on mental health.11 This method was adapted for this study to determine if social desirability existed in pharmacist reporting of their anticipated provision of services if the provider status bill were to pass. The study also found that there was a significant difference between pharmacists’ selfwillingness and their perceptions about their peer’s willingness. Most pharmacists believe that as individuals, they are more willing to implement changes than their peers with regards to the potential passing of the “Provider Status” bill. This may illustrate a social desirability bias in pharmacists’ report of their willingness to implement changes. However, there was still an overall willingness to increase clinical services provided and to learn more about how the bill could potential change their area of practice. The third hypothesis discussed potential perceived barriers that pharmacy mangers may encounter when trying to implement or increase the amount of clinical services they provide at their site. Potential barriers were listed and pharmacy managers completing the questionnaire could choose one or more barriers they foresaw being relevant to them. Each barrier is now listed in order of responder prevalence:
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PEER REVIEW TABLE 4: perceived barriers to increase number of clinical services offered if provider status bill were to pass (n=139) n(%) Finding time to provide the services
64 (46.0)
Finding personnel to provide the services
42 (30.2)
Not knowing how best to implement these services into my practice
50 (36.0)
Training pharmacists to provide the services
29 (20.9)
Not having a large enough patient base to make services worthwhile
27 (19.4)
Not knowing how to bill for these services
59 (42.4)
The fear that these services would cost the pharmacy money rather than make money
38 (27.3)
Corporate policy that dictates what services can be offered
12 (8.6)
Not applicable: I am not willing to implement these services
0
Finding time to provide the services In this study 46.0% of respondents reported that they perceived time as being a barrier to implementation of reimbursable services. (Table 4) Pharmacists in the community setting might find it hard to functionally change their practice quickly from primarily dispensing to incorporation of reimbursable patient-care centered services when traditionally those activities have not been included. Not knowing how to bill for these services This was the second most common perceived barrier among respondents at 42.4%. (Table 4) A significant percentage of respondents are worried that their unfamiliarity with Medicare Part B reimbursement or documentation processes could be a downfall in utilization of these practices in the community setting. State and national organizations like Iowa Pharmacy Association (IPA) and American Pharmacists Association (APhA) have the ability to educate pharmacists in MUAs on how to properly complete billing and paperwork procedures related to these clinical services.
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Not knowing how best to implement these services into my practice It is imperative for state and national organizations to provide assistance via recommendations and strategies to effectively incorporate a dramatic change successfully into the community pharmacy setting. In this study 36.0% of respondents noted implementation as a perceived barrier to providing reimbursable clinical services. (Table 4) It has been shown that because the adoption of community pharmacy services is slow, it is hard to find pharmacists who have been through the implementation process before, which is a predictor for service adoption.12 In addition, past literature has shown that a pharmacistsâ&#x20AC;&#x2122; Entrepreneurial Orientation may influence the implementation of practice change.13 Although some pharmacists have great work ethic and desire to move the pharmacy profession forward, they may not be willing to take as much risk as others.13 Assistance to pharmacists may include a mentorship program where a newer pharmacist is paired with an individual who has past experience implementing pharmacy services. Another option to encourage the provision of new services would be to create a program that aims for pharmacists with low entrepreneurial orientation to identify a willing colleague with higher entrepreneurial organization to assist them in the initiation of the implementation process. Other implementation assistance may be in the form of generalized business plans or common effective strategies to implementation within an established business plan. Educating pharmacists on successful strategies and providing evidence of effectiveness in the community setting would likely ease the fear of this barrier. Finding personnel to provide the services This study aligned with past literature stating that personnel is the major expense to providing pharmacy services.14-16 Staffing and employment costs have a significant role in a community pharmacyâ&#x20AC;&#x2122;s bottom line and operational costs. Additional services provided by any pharmacy cause an increase in workload, which could result in a need for additional staffing. It may be hard for pharmacy managers to justify adding additional staff when currently there is little data that verifies the financial sustainability of adding clinical services. In this study, 30.2% of respondents perceived this as a barrier faced by community
pharmacies with the passing of the proposed legislation. (Table 4) Were the bill to pass, it would be beneficial for data to come out supporting the sustainability of implementing clinical services so as to provide justification of adding personnel. The fear that these services would cost the pharmacy money rather than make money With implementation of new services, there is always a cost-benefit considerations. Of respondents in the study, 27.3% feared that additional clinical services could cost the pharmacy more than it would make in reimbursements. (Table 4) This could be thought because of the possible money it would cost for additional staff to either provide the services or support the pharmacists providing the services. Additionally, reimbursement rates are currently unknown, which could make pharmacists weary of providing the services. It is hard to justify services that would cost the owner of the business money rather than contribute to savings or profit. With proper education about billing and implementation of services, pharmacists may be at a lesser risk of losing money from offering these reimbursable services on a regular basis. Training pharmacists to provide the services Out of the responding pharmacists in this study, 20.9% believed that additional training would be required and is currently a barrier to implementation.(Table 4) Some pharmacists may not be properly trained in performing certain clinical services. Universities can help on the ground level with training student pharmacists, while state and national organizations could offer continuing education credits and additional certifications for pharmacists properly trained in providing clinical services. Not having a large enough patient base to make services worthwhile Because new legislation focuses on pharmacies located in MUAs, a concern for 19.4% of respondents is the appropriate size of patient base to make reimbursable clinical service implementation worthwhile from a business perspective. (Table 4) Corporate policy that dictates what services can be offered The perceived barrier that was of least worry was the dictation of corporate policy with only 8.6% of respondents believing this would hold them back from offering clinical services. (Table
PEER REVIEW 4) The worry centers on the corporate entities deciding that pharmacists are not allowed to offer specific services to their patients likely for liability, cost-based, or workflow altering reasoning. Not applicable: I am not willing to implement these services No respondents in this study noted that they were outright unwilling to implement additional reimbursable services. Pharmacists are capable practitioners and can assist other healthcare team members in reducing overall healthcare costs and improving therapeutic and safety based outcomes for patients.2 Respondents are in agreement about the potential benefit to patients that clinical services could offer if the proposed H.R. 592 and S. 314 were to pass. Overall, when looking at the results and comparing them to our three hypotheses, we were able to show few pharmacies currently provide clinical services, pharmacists are willing to implement new billable clinical services if the bill were to pass, and that pharmacists perceive many barriers to implementation.
Limitations
This study was conducted solely with pharmacy managers in underserved areas of Iowa, causing limitations in external validity. While barriers to implementation may be more similar in pharmacies across the nation, the amounts of billable services currently offered and pharmacist enthusiasm may differ greatly state to state. Non-response bias was a limitation due to the anonymous nature of the survey. Anonymity was important in order to elicit more accurate and honest responses. Additionally, the list of pharmacies obtained through the Board of Pharmacy contained only email addresses of pharmacy managers. Several situations arose where the contact on file would not necessarily be the person in charge of making these types of decisions for their pharmacy. Lastly, considering all pharmacy managers said they would be willing to implement additional billable services were the bill to pass, response bias is also a possibility.
Conclusion
This study demonstrated that community pharmacies in MUAs of Iowa are currently offering limited clinical services, however, participating pharmacy managers indicated that there is a positive outlook
on the idea of adding additional clinical services billable under Medicare Part B. Pharmacists most commonly noted concerns such as time, billing, workflow implementation, and personnel/staffing as perceived barriers to implementation. Overall, this study shows us that Iowan pharmacists in MUAs are interested to adopt change and offer more clinical services if the proposed bill were to pass. Resources and training provided by schools of pharmacy and state and national bodies may be crucial if prompt and effective implementation is to happen in the field of pharmacy.
References
1. Bipartisan Policy Center Prevention Task Force. A Prevention Prescription for Improving Health and Health Care in America. http://bipartisanpolicy.org/library/ a-prevention-prescription-for-improvinghealth-and-health-care-in-america/ (Accessed 2015 August 27)
(2003). 2010;50(6):704-13. doi:10.1331/ JAPhA.2010.09042. 12. Roberts AS, Benrimoj SI, Chen TF, Williams KA, Aslani P. Practice change in community pharmacy: quantification of facilitators. Ann Pharmacother. 2008;42(6):861-8. 13. Doucette WR, Nevins JC, Gaither C, et al. Organizational factors influencing pharmacy practice change [published online ahead of print September 28, 2011]. Res Social Adm Pharm. 14. Mcdonough RP, Harthan AA, Mcleese KE, Doucette WR. Retrospective financial analysis of medication therapy management services from the pharmacy’s perspective. J Am Pharm Assoc (2003). 2010;50(1):62-6. 15. Carroll NV, Rupp MT, Holdford DA. Analysis of costs to dispense prescriptions in independently owned, closed-door long-term care pharmacies. J Manag Care Spec Pharm. 2014;20(3):291-300. 16. Rupp MT. Analyzing the costs to deliver medication therapy management services. J Am Pharm Assoc (2003). 2011;51(3):e19-26.
2. Avalere Health LLC. Exploring Pharmacists’ Role in a Changing Healthcare Environment. May 2014. 3. United States Social Securities Act. Title XVIII. Sections 1833(a)(1) & 1861 (s)(2) 4. Pharmacy and Medically Underserved Areas Enhancement Act. Title XVIII. H.R. 592. (2015) 5. Pharmacy and Medically Underserved Areas Enhancement Act. Title XVIII. S. 314. (2015) 6. U.S. Department of Health and Human Services. http://datawarehouse.hrsa.gov/ tools/analyzers/muafind.aspx (Accessed 2015 April 22) 7. Iowa Health Professions Tracking Center, Office of Statewide Clinical Education Programs UI Carver College of Medicine. January 2015 8. Chisholm-burns MA, Kim lee J, Spivey CA, et al. US pharmacists’ effect as team members on patient care: systematic review and metaanalyses. Med Care. 2010;48(10):923-33. doi: 10.1097/MLR.0b013e3181e57962. 9. Giberson S, Yoder S, Lee MP. Improving Patient and Health System Outcomes Through Advanced Pharmacy Practice: A Report to the U.S. Surgeon General 2011. Accessed July 18, 2013. 10. Gaither CA, Schommer JC, Doucette WR, et al. 2014 National Pharmacist Workforce Survey: Final Report of the 2014 National Sample Survey of the Pharmacist Workforce to Determine Contemporary Demographic Practice Characteristics and Quality of WorkLife. April, 2015. 11. Rickles NM, Dube GL, Mccarter A, Olshan JS. Relationship between attitudes toward mental illness and provision of pharmacy services. J Am Pharm Assoc
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PEER REVIEW Appendix: Questionnaire
First, a little background on you and your pharmacy is needed: 1. Your date of birth: 2. Years served as pharmacy manager in current place of employment: 3. Please indicate the type of pharmacy you currently work at: □ Chain □ Independent □ Mass Merchandiser □ Food Store □ Other (please indicate) 4. On average, how many prescriptions does your pharmacy fill per week? □ 0 – 199 □ 200 – 399 □ 400 – 599 □ 600 – 799 □ 800 – 999 □ 1000 – 1199 □ 1200 – 1399□ 1400 – 1599 □ 1600 – 1799 □ 1800 – 1999 □ 2000+ □other _____________ 5. Number of pharmacists working during an average week day (assume 8-4 or 9-5): □0 □1 □2 □3 □4 □5 □6 □7 □other ___________ 6. Number of pharmacists working during an average week day evening: □0 □1 □2 □3 □4 □5 □other__________ 7. Number of pharmacists working each day during an average weekend: □0 □1 □2 □3 □4 □5 □other____________ 8. Number of technicians working during an average week day (assume 8-4 or 9-5): □0 □1 □2 □3 □4 □5 □6 □7 □other ___________ 9. Number of technicians working during an average week day evening: □0 □1 □2 □3 □4 □5 □other__________ 10. Number of technicians working each day during an average weekend: □0 □1 □2 □3 □4 □5 □other__________ 11. Number of students/interns working during an average week day (assume 8-4 or 9-5): □0 □1 □2 □3 □4 □5 □6 □7 □other ___________ 12. Number of students/interns working during an average week day evening: □0 □1 □2 □3 □4 □5 □other__________ 13. Number of students/interns working each day during an average weekend: □0 □1 □2 □3 □4 □5 □other____________ 14. How would you self-describe the pharmacy you work at in terms of how busy it gets per week? For these purposes busy will mean days where there is only time to get prescriptions out the door and little to no time for managerial and clinical services to be offered. □ Busy zero days □ Busy one or two days per week □ Busy three to four days per week □ Busy five to six day per week □ Busy every day of the week 15. Do you currently bill OutcomesMTM, Mirixa, or any other platform for pharmacist led clinical services? □ Yes □ No (if no, skip to question 16) 15a. If yes, how many claims do you submit per week on average? _____ 16. What pharmacist led clinical services are currently offered at the pharmacy you work at? (select all that apply) □ Comprehensive Medication Reviews □ Medication Changes □ Physician calls □ Patient calls □ Immunizations □ Transition of care medication coordination □ Medication Monitoring □ Chronic Disease Management □ Disease Education □ Prevention and Wellness Services □ Patient Education □ Other_____ □ Other_____ □ Other_____ 17. On average, how many of each of these services would you estimate are provided each week? (provide spaces for them to manually enter the number) □ Comprehensive Medication Reviews □ Chronic Disease □ Medication Changes Management □ Physician calls □ Disease Education □ Patient calls □ Prevention and Wellness □ Immunizations Services □ Transition of care medication coordination □ Patient Education □ Medication Monitoring □ Other____
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PEER REVIEW
The Pharmacy and Medically Underserved Areas Enhancement Act (Pharmacist Provider Status) would allow pharmacists to bill Medicare Part B for reimbursement of clinical services provided to patients with Medicare in medically underserved areas. This amendment to title XVIII of the Social Securities Act would go into effect January 1st, 2016, if passed. If you are receiving this survey, your pharmacy is located a county in Iowa labeled as medically underserved and pharmacist led clinical services provided to Medicare patients would be eligible for reimbursement under Medicare Part B. With the above information in mind, please indicate how strongly you agree or disagree with the following statements: (Likert scale, 1-5) Keep in mind that “clinical services” include any service consistent with state scope of practice laws that would be billable through Medicare Part B were the Pharmacy and Medically Underserved Areas Enhancement Act were to pass. (CMRs, medication changes, doctor calls, patient calls, immunizations, coordinating medications during transition of care, medication monitoring, chronic disease management, disease education, prevention and wellness services, patient education, etc…) 1=Strongly Disagree 2= Disagree 3= Neither Agree or Disagree 4= Agree 5= Strongly Agree 6= Other ______________ 7= Not applicable to my pharmacy 18. As the pharmacy manager, I would plan on increasing the amount of pharmacist led clinical services offered to Medicare patients, were the bill to pass 19. As the pharmacy manager, I am interested in the potential financial benefits associated with billing Medicare Part B for clinical services provided by pharmacists 20. As the pharmacy manager, I feel that providing clinical services to patients at the pharmacy is important 21. As the pharmacy manager, I would be willing to implement changes to current workflow in order to accommodate for more clinical services to be offered 22. As the pharmacy manager, I would be willing to hire new staff to support the pharmacists in order to provide more clinical services. 23. As the pharmacy manager, I would be interested in learning more about how best to implement these newly billable clinical services into current workflow 24. As the pharmacy manager, I think this new legislation will financially benefit community pharmacies 25. As the pharmacy manager, I would not be able to implement any new services without the consent of a corporate decision 26. I personally feel this proposed legislation is a step in the right direction for the profession of pharmacy 27. As the pharmacy manager, the obstacles that would prevent me from increasing the amount of clinical services my pharmacy offers would be: (choose all that apply) □ Finding time to provide the services □ Finding personnel to provide the services □ Not knowing how best to implement these services into my practice □ Training pharmacists to provide the services □ Not having a large enough patient base to make services worthwhile □ I am not willing to implement these services □ Corporate policy that dictates what services can be offered □ Not knowing how to bill for these services □ The fear that these services would cost the pharmacy
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public affairs IPA Connects with DC
In the first half of 2016, IPA has had several opportunities to work closely with Iowa’s two US Senators, Sen. Charles Grassley and Sen. Joni Ernst. Senator Grassley introduced S.314, Pharmacy and Medically Underserved Areas Enhancement Acton January 29, 2015, and since that time has continued to be an advocate for expanding the role of pharmacists to healthcare providers in Medicare Part B. On April 8, 2016, Senator Grassley published a guest column in the Cedar Rapids Gazette highlighting the importance of this legislation and the opportunity for pharmacists to offer greater healthcare services in underserved areas. IPA hosted Dr. Karen Summar, Senator Grassley’s new Health Policy Officer during her first visit to Iowa. Dr. Summar and Kate Gainer, IPA’s CEO, discussed S.314, and real-life examples of pharmacists providing billable services, as well as issues ranging from PBM regulation, opioid abuse and medication disposal, to 340B. IPA looks forward to continuing the strong relationship we have with Senator Grassley and working more closely with Dr. Summar on health issues in the coming months. The first issue IPA has worked closely with Senator Ernst and her staff has been the issue of controlled substance disposal and pharmacies serving as collectors for controlled substances. Through several phone calls and information sharing, IPA worked with Senator Ernst and her staff to develop amendment language to CARA (Comprehensive Addiction and Recovery Act) that would lessen the restrictions faced by pharmacies that are interested in serving as collectors for controlled substances. While this amendment was not included in the final bill, Senator Ernst discussed this very issue in a Cedar Rapids Gazette article and stated, “Based on feedback from the Iowa Pharmacy Association, I am working on a request to the Government Accountability
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Office (GAO) to conduct a thorough review of the program and report to Congress with recommendations to address the barriers to participation that local pharmacies face. These recommendations will help us to find appropriate ways to maximize participation in the program and ensure that this important service to the community is widely available.”
PBM Rules Finally Adopted!
After two years of effort, rules are now in the books from the PBM laws passed in 2014 and 2015. With rules in place, the Iowa Insurance Division (IID) has the enforcement authority to audit PBMs and ensure that they comply with Iowa’s PBM statute and rules. As you may remember, H.F. 2297 passed unanimously in both the Iowa House and Senate in 2014 following a strong grassroots effort by IPA members. PCMA then sued the state over the law, which delayed the rulemaking process. With the dismissal of the lawsuit last September, IID began the rule making process. IPA provided comments throughout the process.
Rep. Buddy Carter Speaks at Political Leadership Breakfast
Each year at the Midwest Pharmacy Expo, the Political Leadership Breakfast is an opportunity to engage with important political leaders while raising funds for the IPPAC. This year’s Political Leadership Breakfast welcomed Rep. Buddy Carter (R-Georgia) who is the only pharmacist serving in Congress. Rep. Carter shared his perspective as a legislator on a range of issues including provider status, PBMs,
FDA drug approvals and what needs to happen in Washington, D.C., to address these issues. He also shared stories about his experience as a congressman and a pharmacist. Rep. Carter closed by urging everyone in the pharmacy profession to engage with their elected officials, and their staffs, so that they can see the need for action on these issues.
IPA & NCPA File Brief Supporting State of Iowa Against PCMA
On February 4, 2016, IPA and the National Community Pharmacy Association (NCPA) filed an amicus curiae brief in the U.S. Court of Appeals in support of the state of Iowa and against PCMA’s appeal of its dismissed lawsuit. An amicus curiae (latin – “friend of the court”) brief is a legal brief filed by an entity not directly involved in the case, but has an interest in the court’s decision, providing information it deems important to the case. The entity filing the brief cannot be solicited by either party in the case. The IPA and NCPA amicus curiae brief support’s the District Court’s dismissal of the PCMA’s lawsuit and outlines compelling legal reasons why Iowa’s PBM law is not preempted by ERISA or is unconstitutional under the socalled dormant Commerce Clause of the Constitution as PCMA has alleged. The brief also describes the negative impact of the PBM practices that the law addresses.
ONLINE FEATURE!
Read the IPA/NCPA amicus curiae brief. As you may recall, PCMA sued the state on September 2, 2014, over Iowa’s PBM law (H.F. 2297) passed unanimously that year thanks to a strong grassroots effort by Iowa
public affairs pharmacists. The law requires PBMs to reveal their MAC pricing list and methodology to the Iowa Insurance Commissioner upon request. PCMA’s lawsuit was eventually dismissed on September 8, 2015, and PCMA has since appealed the decision.
IPA Recommendations Iowa’s Health Improvement Plan
The Iowa Department of Public Health (IDPH) is in the process of forming the Healthy Iowans 2020 vision plan. As part of this process they are gathering input from over 170 groups around the state in their most comprehensive health needs assessment to date. IPA was asked to submit recommendations related to the practice of pharmacy in Iowa. IPA submitted the following three recommendations to the IDPH: 1. Collaboration among key stakeholders to develop and deploy strategies to reduce prescription drug abuse in Iowa. 2. Optimize patient outcomes and reduce medication errors during care transitions with pharmacistdelivered medication reconciliation and medication therapy management services. 3. Broaden availability, coverage, and public knowledge of immunizations to increase Iowa’s immunization rates in children, adolescents, and adults. Collecting all of these recommendations is step 1 of 3 for Healthy Iowans 2020. After the submissions are narrowed down to the final priority health issues, step 2 will be creating objectives and strategies to address those issues. The final step will be to implement the plan. As the most accessible healthcare professional to many patients, it is important that pharmacists are engaged in public health efforts such as this. ■
Legislative Day 2016 On January 27, over 200 pharmacists, pharmacy technicians and student pharmacists to advantage of the opportunity to advocate for their profession by attending the 2016 IPA Legislative Day. The day started with updates on pharmacy issues both in Iowa and nationwide. Matt Osterhaus gave an update on the progress of provider status legislation currently in the U.S. House and Senate. IPA’s legislative counsel then gave updates on statewide issues concerning Iowa Medicaid, PBMs and IPA advocacy message for this year. Students and first time participants were then paired with experienced advocates and everyone headed for the Capitol.
the afternoon feature CE sessions with regulatory agencies including Iowa Medicaid Enterprise discussing the transition to MCOs and the Iowa Insurance Division providing updates on PBM regulations stemming from the legislation passed over the last two years. The efforts of IPA Members on Legislative Day go a long way as IPA continues to advocate for our profession with legislators, the executive branch and the regulatory agencies in our state.
The Iowa Medicaid transition to managed care was a hot topic for legislators and IPA members alike. In addition to expressing their concerns, members were also able to explain to their legislators the larger role for pharmacy and opportunities to advance the profession through statewide protocols. Members reported positive conversations with their legislators who were supportive and receptive to Iowa pharmacy’s message. Following the visit to the Capitol and the traditional “Paint it White” photo,
Capitol Screenings
Student pharmacists from Drake University and the University of Iowa provided over 90 health screenings at the Capitol Rotunda to legislators and staff. See the full recap on page 53. APR.MAY.JUN 2016 |
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public affairs
New Rules from the Board of Pharmacy and Other Regulatory Updates PMP Annual Report Shares Trends in Controlled Substance Prescribing The Iowa Prescription Monitoring Program (PMP) provides authorized prescribers and pharmacists with information regarding their patients’ use of controlled substances and is used as a tool in determining appropriate prescribing and treatment of patients without fear of contributing to a patient’s abuse of or dependence on addictive drugs or diversion of those drugs to illicit use. The Iowa PMP became fully operational on March 25, 2009. Since then, the data indicate steady increases in the number of pharmacists and prescribers registering to use the Iowa PMP and in the number of requests for patient prescription history being submitted and used by those authorized users.
In its Annual PMP Report to the State of Iowa, the data demonstrate that the prescribing and dispensing of these controlled substances has not been unnecessarily or adversely affected by the implementation of the Iowa PMP. The number of prescriptions dispensed and the number of doses dispensed increased during each year of the program. The number of patients obtaining prescriptions from multiple prescribers and multiple pharmacies decreased each year except 2014 when there was an increase in those numbers, likely attributable to the commencement of nonresident pharmacies reporting prescriptions dispensed to patients located in Iowa.
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ONLINE FEATURE!
Read the report at www.pharmacy.iowa.gov
Compounding Practices Ask for Extension to Implement Rules on USP Standards
After a Compounding Task Force was convened and recommendations developed in 2015, the Board of Pharmacy amended its compounding regulations to utilize USP Chapters <795> and <797> as the standards for non-sterile and sterile compounding practice in Iowa. The new compounding rules took effect on November 18, 2015. All pharmacies in Iowa engaging in sterile or non-sterile compounding need to be compliant with USP compounding standards. If your pharmacy is not compliant with USP <795> or <797>, you may request a waiver from the Board of Pharmacy to provide your pharmacy ample time to adhere to these new regulations. As evidenced by March 2016 Board of Pharmacy meeting, the Board understands the necessary changes needed for a pharmacy practice to adhere to the USP standards and they approved a time extension for various pharmacies to comply with the new regulations.
Board of Pharmacy Meets with NCPDP Representatives on the PMP
On January 22, 2016, representatives from the Iowa Board of Pharmacy along with IPA met with representatives from the National Council for Prescription
Drug Programs (NCPDP) to review opportunities to evolve the PMP in Iowa. NCPDP is a not-for-profit, multistakeholder forum for developing and promoting industry standards and business solutions that improve patient safety and health outcomes, while also decreasing costs. Through the standards development process, NCPDP offers a unique position to allow for a real-time process that integrates tracking information obtained from PMPs into the pharmacy and physician e-prescribing workflow. The Board of Pharmacy was receptive to learning more about how NCPDP could further advise the Board in finding a more meaningful solution to monitoring prescribing behaviors and drug-seeker patterns by evolving the Iowa PMP.
Database Licensing System Options
The Board of Pharmacy continues to work to find a workable solution to create an online license renewal program that also provides for a workable database for Board staff. The Board of Pharmacy has experienced struggles with the Office of the Chief Information Officer (OCIO) to moving forward with the Board’s recommendation for a new licensing database system. A preferred option is cheaper for the Board as well as more user-friendly for pharmacy professionals and Board staff. However, this option (eLicense) is not an approved database option by the OCIO. Two other database options (Salesforce and AMANDA) are preferred and approved by the OCIO, which are considerable more
public affairs expensive for the Board of Pharmacy. The Board continues to have active dialogue with OCIO to move forward with an option that is beneficial to the Board of Pharmacy, OCIO, and licensed pharmacy professionals in Iowa.
Iowa’s Health Improvement Plan 2020
The Board of Pharmacy discussed its priority health issues to the Department of Public Health, who is compiling input from over 170 stakeholder groups into the most comprehensive health needs assessment ever undertaken by the department. The Board of Pharmacy submitted its recommendations as (1) prescription drug monitoring program, (2) contribute to the control of controlled prescription diversion of opioid addiction, (3) sterile compounding issues, (4) pharmacy access in rural Iowa, and (5) the TakeAway program. The needs assessment process will result in the selection of priority health issues for inclusion in Healthy Iowans: Iowa’s Health Improvement Plan 2020. Coordinated by IDPH, this statewide effort is designed to help Iowans live longer, healthier, more productive lives. To review the recommendations submitted by IPA, please go to page 37.
New Rule Changes That Took Effect on March 23, 2016
A number of regulatory changes were approved during the January 13th Board of Pharmacy meeting are summarized here: • Chapter 4, “Pharmacist-Interns” was amended so that the Board will now accept an individual tax identification number (ITIN) in the absence of a social security number for the purpose of pharmacist-intern registration. Registrants who are not eligible for social security (such as foreign students) may use their ITIN as a valid form of identification. • Chapters 6, “General Pharmacy Practice,” and 8, “Universal Practice
Standards,” were amended to implement 2015 Iowa Acts, Senate File 462, which allows epinephrine auto-injectors to be prescribed in the name of a facility, school district, or an accredited nonpublic school. Patient profiles, dispensing records, and labels shall be maintained under the same name. These prescriptions are exempt from the requirement of a preexisting patientprescriber relationship. • Chapter 8, “Universal Practice Standards,” was amended to require that a continuous quality improvement (CQI) event is initially documented no more than three days after the discovery of the event. • Chapter 10, “Controlled Substances,” was amended to temporarily designate three cannabinoids and acetyl fentanyl as Schedule I controlled substances under the Iowa Controlled Substances Act (CSA). Naloxegol was also removed from control under the CSA following the DEA’s decision to do the same. • Chapters 6, “General Pharmacy Practice,” 7, “Hospital Pharmacy,” 8, “Universal Practice Standards,” 10, “Controlled Substances,” 17, “Wholesale Drug Licenses,” and 23, “Long-term Care Pharmacy Practice,” were amended to incorporate updated federal regulations allowing for the voluntary administration of authorized programs to collect unwanted controlled substances from patients for the purpose of disposal. These federal regulations can be found at http:// deadiversion.usdoj.gov/drug_ disposal/. IPA is working to develop short podcasts after each Board of Pharmacy meeting to provide members with a short, quick update as to what occurred at that Board meeting that is relevant to practicing pharmacists and pharmacy technicians. Watch for further communication as this new member benefit becomes available. ■
L-R: Brett Barker (NuCara), Sen. Joni Ernst and Randy Edeker (Hy-Vee)
NACDS RxIMPACT Day Keeps Momentum Rolling in DC
Nearly 400 individuals from over 40 states, including several Iowa pharmacists and student pharmacists, traveled to Washington, DC and participated in the 8th Annual NACDS RxIMPACT Day on March 16-17. These pharmacy professionals stepped forward to indicate the importance of being involved in the policymaking process, and brought their voice to Iowa’s Congressional delegation. Representatives from Hy-Vee, NuCara Pharmacy, and Walgreens met with all four US Representatives from Iowa as well as Senators Grassley and Ernst. Save-the-Date: 2017 NACDS RxIMPACT Day on March 14-15, 2017
Drake Student Pharmacists Carson Klug and Natalie Roy
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public affairs
Iowa Medicaid Managed Care Begins Take the Fight to PBMs by Supporting the Preserve Pharmacy Practice Fund
IPA’s Preserve Pharmacy Practice Fund (PPPF) is a restricted fund specifically used for ongoing efforts to regulate PBM practices in Iowa. PBM’s unregulated and unfair practices have given them deep pockets to defend the status quo. The PPPF is Iowa pharmacy’s answer to strategically support efforts to rein in those practices and level the playing field in our state. This fund was instrumental in supporting the state of Iowa as it successfully sought the dismissal of PCMA’s lawsuit over Iowa’s MAC transparency law. The fund has allowed IPA to continue to support the state through PCMA’s appeal, allowing IPA to file an amicus curiae brief with the U.S. Court of Appeals supporting the dismissal and the state of Iowa’s position in PCMA’s appeal. With the ongoing PCMA suit and the transition of Iowa Medicaid to managed care opening the door to more PBM influence in the state, it is imperative that IPA and our partners have the necessary resources to continue to build on the victories achieved the past two years. Please consider supporting the ongoing fight for PBM regulation and transparency by contributing to the Preserve Pharmacy Practice Fund. Contributions can sent to IPA at: Iowa Pharmacy Association 8515 Douglas Ave., Suite 16 Des Moines, Iowa 50322
On April 1, Iowa’s Medicaid program officially transitioned to managed care. IA Health Link, which is the name for Governor Branstad’s Iowa Medicaid Modernization Initiative that has contracted three managed care organizations (MCOs) – Amerigroup Iowa, Inc., AmeriHealth Caritas Iowa, Inc., and UnitedHealthcare Plan of the River Valley, Inc. – to manage Iowa’s 560,000 Medicaid patients. The Centers for Medicare and Medicaid Services (CMS) approved the program’s April 1 start date on February 25, just days before the already delayed implementation date of March 1. The original start date of IA Health Link was January 1, 2016. With the implementation delays pushing the start date into the legislative session, the Iowa legislature, particularly the Senate, has been working to pass legislation to terminate the program or provide legislative oversight. An oversight bill was passed in the Senate, however it was not assigned to a committee in the House before the second funnel deadline and therefore stalled.
Reimbursement Rate Approved In addition to approving the program, CMS also approved the contract amendment that kept the current reimbursement rate of AAC + $11.73. Following a series of steps between the state, the MCOs and their PBMs, contracts now include the amended language. Maintaining this reimbursement formula is an important, hard fought and unprecedented achievement.
Resources for Pharmacists
IPA has published two resources for
pharmacists as they work through this transition. The Iowa Medicaid FAQ answers important questions about contracts, procedures, policy and enrollment. The MCO Pharmacy Reference Grid provides quick access to contact and policy information for all three of the contracted MCO’s. Both of these resources are continually updated and are available on IPA’s website – www.iarx.org/IowaMedicaid.
Opening Doors for Pharmacists While this transition presents challenges to pharmacists, it is also an opportunity to assert the value that pharmacy can deliver to this patient population (and all Iowans).
IPA has met with the Governor’s office, the Department of Human Services (DHS), Iowa Medicaid Enterprise (IME) and the three contracted MCOs throughout the process to show how pharmacists can contribute to the program’s goals of providing more care and reducing costs. Governor Branstad and his staff have been very receptive to these conversations.
Going Forward
IPA continues to have weekly communications with IME as well as scheduled upcoming meetings with the 3 MCOs. We have collected feedback, and need to continue gathering information from pharmacists and technicians that are working with patients and providers during this transition. Please send your feedback - both good, bad or otherwise, to IPA@iarx.org with the subject: Medicaid. ■ APR.MAY.JUN 2016 |
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member section IPA Member Spotlight:
Greg Yeakel, RPh Alyssa Billmeyer 2016 PharmD Candidate The University of Iowa College of Pharmacy Growing up in North Central Iowa, now pharmacist, Greg Yeakel had always dreamt of being a park ranger or a storeowner. Due to frequent illnesses as a child, Greg quickly realized that park ranger was not the path for him. So he chose to pursue becoming a storeowner and it was quite obvious to him what kind of storeowner he would be. Healthcare was a part of who he was - with multiple house calls from his physician every month he learned to understand the benefits of a healthcare provider who is compassionate and invested in his wellbeing. He wanted to pay that forward so he decided to pursue a profession in pharmacy.
The Path
Shortly after graduation, Greg and his wife, Sue, both 1974 graduates from Drake University College of Pharmacy and Health Sciences, moved away from Des Moines to fulfill Greg’s dream of becoming a storeowner. Together, Greg and Sue started and managed Yeakel Pharmacy, an independent pharmacy in Story City, Iowa. They offered many progressive pharmacy services such as compounding, long-term care, supplements, and durable medical
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equipment. These services aligned with their mission to provide quality healthcare that would increase the livelihood of the patients they serve. Through many business ventures, including starting up Pharmacy Associates, ltd, Greg decided to take a risk, which eventually landed him the career of a lifetime. In 2001, Greg took his position at Iowa State University Thielen Student Health Center in Ames, Iowa where he is currently still working and is functioning as chief staff pharmacist. As a pharmacist in the student health center, Greg interacts with students, pharmacists, and other healthcare providers to ensure the best care for his patients (exactly what he was looking for as a child).
The Passion
Greg believes that respect, dignity and an understanding attitude sets a pharmacist up for success. In his current position at student health he is not only functioning as an impactful pharmacist, but is leading the way through example by serving as a preceptor for Drake University, The University of Iowa, Creighton and Wyoming Colleges of Pharmacy Students. He states that the most rewarding part of his job is the opportunity to work with students.
Greg believes that respect, dignity and an understanding attitude sets a pharmacist up for success. The Mission
Greg has seen the transition of pharmacy throughout his practice. He remembers when the electronic typewriter was the newest, most innovative technology in the workplace. No matter the change in technology, or the scope of pharmacy practice, one thing has always stayed constant during his time as a pharmacist – the patient and our mission as a
pharmacist to ensure the safety and wellbeing of our patients.
...one thing has always stayed constant during his time as a pharmacist – the patient and our mission as a pharmacist to ensure the safety and wellbeing of our patients. Greg made it his mission to help patients beyond his current practice by volunteering his time on a medical mission trip. Greg’s first mission trip was in 2005 to Alaska. While that was his first and last trip to Alaska, he has been going on mission trips ever since, finding his home in Honduras where he has gone back at least once a year since 2006. In Honduras, Greg functions as part of the medical team and has reorganized the medication procurement and distribution process to ensure the people of Honduras are receiving the medications they need. Greg feels that these mission trips to Honduras help keep him centered and bring him closer to his faith.
“...change and growth is possible, what is important is finding something you love to do.” Greg has loved every minute of his career as a pharmacist and he strives in his daily work to extend that passion on to his patients, students, coworkers and fellow pharmacists. He wants all pharmacists to know, especially student pharmacists and new practitioners that the initial pathway they choose to go down is not a life sentence, “change and growth is possible, what is important is finding something you love to do.” ■
member section
MEMBER MILESTONES Congratulations to Gayle Mayer, RPh, BSPharm, (Spencer) and Dave Weetman, RPh, MS, (University of Iowa Hospitals and Clinics) on being named ASHP Fellows for 2016!
Mayer
Weetman
Ryan Frerichs, PharmD, (Meyer Pharmacy) began his term as Board Chair of the Waverly Chamber of Commerce. Congratulations Ryan! Congratulations to Nancy Bell RPh, PharmD, (Pfizer Global Medical, West Des Moines) for receiving the We Work For Health Champions award from the Pharmaceutical Research and Manufacturers of America (PhRMA). The award recognizes honorees for their extraordinary efforts in policy advocacy and community service. Congratulations to Connie Connolly, RPh, BCACP, (Osterhaus Pharmacy) and William Doucette, PhD, (University of Iowa) as their study â&#x20AC;&#x153;Estimating the cost of unclaimed electronic prescriptions at an independent pharmacyâ&#x20AC;? was published in the Journal of the American Pharmacists Association.
Connolly
Doucette
Congratulations to Jim Ponto, MS, RPh, BCNP, (University of Iowa Hospitals and Clinics) who was reappointed for a 3-year term on the Board of Pharmacy Specialties Board of Directors as a Specialist Member. Zachary Pollock, PharmD, MS, (North Liberty) became the Associate Director of Clinical Cancer Services at the Holden Comprehensive Cancer Center for University of Iowa Health Care. Congratulations Zach!
Welcome NEW IPA MEMBERS THANK YOU FOR SUPPORTING IPA! JANUARY 1 - MARCH 31, 2016: Christina Baumgart, Decorah Lindsy Benedict, Iowa City Amanda Bertjens, Dubuque Quinn Bott, Platte City, MO Breann Bowe, Ankeny Joan Buse, Lake City Megan Campbell, Altoona jeanette champion, Pleasant Hill Jamie Deveno, Nevada Tammy Dickinson, Tiffin Kelly Dighton, Cedar Falls Sara Dooley, Des Moines Kelly Dunn, Rock Island, IL Darla English, Moline, IL Jennifer Gorelik, Des Moines Megan Hanna, Fort Dodge Jeanne Holt, Arbela, MO Jane Hoyman, Emmetsburg Rosemary Jacks, Waverly Michelle Jensen, Cedar Rapids Lynn Kassel, Des Moines Vicki Kehl, Dubuque Jennifer Kelly, Missouri Valley Tina Kindred, Osceola Maren Koka, Ankeny Candy Lawson, Nevada Heidi Ludovissy, Holy Coss Lyudmyla Lyashenko, Camanche Denise Meek, Cedar Rapids Chaise Mefferd, Dunlap Christine Mellencamp, Des Moines BreAnne Meyers, Dunlap Sandra Nauman, Mason City Darci Olson, Conrad Shirley Poole, Osceola Stacey Potts, Dubuque Angela Reimers, Lake Park Morgan Reynolds, Des Moines Sandy Schmith, Boyden Zach Schultz, Cedar Rapids Cary Spoon, Ames Maria Stanley, Newton Mary Vaughn, Aledo, IL paula waite, eldon Cindy Wardrip, East Moline, IL Kristi Wieland, Creston Stephen Wise, Bettendorf Jana Woltz, Davenport Amanda Work, Missouri Valley Reanna Yenger, Newton
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member section
QUALITY CPE - FREE For All IPA Members! Have You Redeemed Your Free CPE Bucket Yet?
IPA members receive all of the CPE required for relicensure or recertification for FREE! Have you taken advantage of this important membership benefit yet? Through a partnership with the Collaborative Education Institute (CEI), IPA members receive CEI’s pharmacist Relicensure Bucket or the pharmacy technician CPhT Recertification Bucket at no charge. With key deadlines approaching for relicensure and recertification, be sure to redeem your free bucket and complete your CPE at your convenience.
The Relicensure Bucket includes pharmacist CPE activities in categories that are required in most states. Annually, new activities in the area of pharmacy law, patient safety, immunizations, current drug therapy topics and live webinars are included. The Recertification Bucket includes Pharmacy Technician Certification CPE activities in categories consistent with the PTCB Domains, structured as 10, 1 hour written modules that you can print and complete on the go. Also included are live and on demand webinars in the area of pharmacy law and patient safety.
Instructions to obtain can be found at www.iarx.org/cei_buckets (member login required).
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The road from the contemplation of a sale to the closing of a deal is filled with obstacles, road blocks and speed bumps. Let us help you navigate them successfully. 1. Contemplating a sale
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This is what we do every day, all day. It’s a full time job. Don’t 10. Closing the Deal attempt it on your own. Let us help you get to the end of the road successfully. Visit our website to view a list of references that you can contact.
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BEComE A mEmBEr of THE iowA PhArMAcy AssociAtion
Position yourself to lead and shape the future of your profession and join a network of pharmacists, pharmacy technicians and student pharmacists advocating the advancement of practice for the health and well-being of our patients.
AdvAntAges for You Equipping you for todayâ&#x20AC;&#x2122;s rapidly evolving health care system with free and convenient CPE and opportunities to connect with colleagues across the state.
AdvocAcy for Your ProfEssion Enabling you to confidently engage your elected officials while representing your interests with the Board of Pharmacy, state agencies, health care organizations, and provider groups.
85
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of membership dues directly fund initiatives that advance the pharmacy profession
AdvAnceMent for Your PrACTiCE Creating opportunities for you and your colleagues to collaborate with healthcare teams and integrate pharmacy practice into emerging healthcare models.
iowA PhArMAcy needs your unique voice And exPerience!
leArn More & join todAy At
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technician’s corner
Advancing Roles of Hospital Pharmacy Technicians Jessica Burge, CPhT Mercy Medical Center, Des Moines
Rachel Levin, CPhT Mercy Medical Center, Des Moines
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I
n a hospital setting, up to 67% of patient’s medication histories have one or more discrepancies at the time of admission. Those medication errors have the potential to cause harm to patients in up to 27% of those cases. To avoid these detrimental errors, hospitals, such as Mercy, have started implementing the use of Medication Reconciliation Technicians, opening a new and exciting way for certified pharmacy technicians to work directly with doctors and other medical professionals, and to be more directly involved with patient care. Med rec techs are responsible for putting together the best possible medication history for a patient, including patient’s prescriptions, vitamins and supplements, over the counter medications, samples from doctors, and injectable medications. Once the medication information is gathered (name, dose, route, form, and frequency), all information must be verified with several different sources. Many times patients don’t have knowledge of their medication; they can confuse medication names, not know the strengths, or not even know what they are taking at all. Some patients coming into the hospital are intubated or are in an altered mental status. Med rec techs must be able to use several different sources available to them to ensure that the medication information they are entering into the patient’s chart is 100% correct. Med rec techs must also have a basic knowledge of medications, what they are for, and possible interactions on a patient’s medication list, so that they can bring any possible hazards to the attention of the physician and pharmacist. In addition to getting information on the medications the patient is taking, med rec
techs are also responsible for gathering allergy information, recent changes to medication, and time of last dose. Compliance information is another large part for a med rec tech, as a patient’s non-compliance can often attribute to a hospital visit. They must use the patient’s word and pharmacy records to determine if a patient is taking medications as prescribed. The information that med rec techs enter into the patient’s chart is then reviewed by the physician, so they may review, order, and make changes to the patient’s medication list. They allow the doctor to know that the medications they are ordering for a patient are correct and allows them to make better decisions about patient care. Med Rec Techs working in Mercy’s ER have had such an impact on reducing medication errors that the hospital has approved expansion of the med rec tech program in late 2015. ■
Pharmacy Technicians: We Want to Hear from You! Do you or someone you work with continually demonstrate excellence as a pharmacy technician? Each quarter, IPA highlights one IPA pharmacy technician member whose dedication to patient care and innovation within the pharmacy profession makes them an example for others. If you or someone you know exemplifies these characteristics, please contact IPA at ipa@iarx.org to be able to spotlight their passion for the profession.
technician’s corner Technicians Can Register & Use the PMP
Since July 1, 2012 technicians have been able to register for the PMP as a “Practitioner’s Agent” associated with their supervising pharmacist. This registration form may be found on the Iowa Board of Pharmacy website under “PMP Information for Practitioners.” Each pharmacist registered with the PMP may delegate access to the PMP for up to three associated agents. Technicians registered as “Practitioner’s Agents” may then request PMP information in the same manner as a pharmacist. The stipulation is that the technician must be logged in under his or her own credentials and instructed to do so by the supervising pharmacist. When a technician requests a PMP report on behalf of the pharmacist they share responsibility for the requested report. According to the 2015 Annual PMP Report by the Iowa Board of Pharmacy, there are 2,692 pharmacists registered with the PMP and 1,114 Practitioner’s Agents, which includes pharmacy technicians as well as support staff for prescribing practitioners.
50+ Technicians Attend Expo Tech Forum
Over 50 pharmacy technicians from across the Midwest attended the new Expo Tech Forum. The 1-day technician CPE conference was held in conjunction with the Midwest Pharmacy Expo. Following an energetic and motivation Expo keynote from bestselling author, psychiatrist and ADHD expert Dr. Ned Hallowell, the Tech Forum began with a joint session for technicians on communication skills. Technicians then had choice of a community-focus or hospital-focus track over four breakout sessions with topics covering compounding, medication synchronization and
reconciliation, understanding labs and reducing medication errors. Most of the technicians that attended the Tech Forum also took advantage of the opportunity for additional CPE by attending Expo’s Sunday sessions New Drugs, Gamechangers and A Look Ahead. Next year’s Midwest Pharmacy Expo will be February 17-19, 2017, at the Des Moines Airport Holiday Inn, with the Expo Tech Forum being held on Saturday, February 18, 2017. Save the date, tell your colleagues and join us next year to learn, connect and be inspired with your colleagues from across the Midwest! ■
IPA Technician Members Receive ALL Required CPE for CPhT Recertification for FREE! Looking for recertification CPE? Pharmacy technician members of IPA now receive the Recertification Bucket from CEI for FREE!
The Recertification Bucket includes Pharmacy Technician Certification CPE activities in categories consistent with the PTCB Domains, structured as 10 one-hour written modules that you can print and complete on the go. Also included are live and on demand webinars in the area of pharmacy law and patient safety.
Login at www.iarx.org/cei_buckets to take advantage of this new benefit for members and spread the word to your colleagues.
JOIN NOW & receive your free recertification bucket! www.iarx.org/membership | 515.270.0713 | ipa@iarx.org
APR.MAY.JUN 2016 |
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technician’s corner
Newly PTCB January Certified Iowa Technicians 1 - March 31, 2016
Please join IPA in congratulating the following pharmacy technicians on becoming PTCB-certified! Kayla Angelo Samantha Appelgate Collette Arens Bates Jennifer Aultman Stormie Barton Joan Bean Ellise Bechler Rikita Bhakta Lyvia Bulman Tabitha Cable Rebecca Christensen Danelle Clarke Suzanne Claude Emma Clausen Jared Clement Megan Collison Anna Dake Kirsten Dale Courtney Dawson Dawn Delgado Crystal Deuitch Joan Donovan Megan Edgren
Spencer Endecott Deborah Engel Melinda Eshbaugh Tayler Fenton Kelly Ferris Mariah Fonza Leslie Fritz Rachel Geisler Sara Groomes Jordan Hall Cambridge Hampsher Emily Hanson Lisa Heston Hanna Hinschberger Brittany Hoffman Ryan Hogan Patricia Homeister Shalome Jackson Makenzie Jewett Angel Kahaly Linda Keizer Jacob Klein Andrew Kraninger
Richard Lam Quyen Lang Jane Laubengayer Brittany Leonard Courtney Martin Thomas McNamar Alex McVey Elizabeth Meinders Christine Mellencamp Shane Melver BreAnne Meyers Ashley Miller Margaret Miller Nathan Mott Caleb Neff Nichole Nunemaker Katie Olsen Samantha Patent Charles Patterson Kaitlyn Pegump Casey Phelps Nevin Radechel Emily Rogers
THE PTCB
ADVANTAGE • Improved employment opportunities • Demonstrated value to the pharmacy team • Validated achievement • Future career growth options • Prestige among coworkers • Potential for higher salary
Sherry Roof Taylor Schmidt Aaron Schmitz Abigail Schrock Hannah Schubert Gerri Siford Elizabeth Simon Janna Simpson Klint Sinclair Grace Stanley Kylie Sterk Evan Streck Nicole Tedford Cassie Uhlenhopp Malori Von Thun Emily Wallace Carrie Weber Jessica Wells Nicholas West Haley Westphal Alexus Wiand Tracy Wood
Certification by PTCB is the gold standard for pharmacy technicians. Many employers now require their employees to be PTCB-Certified Pharmacy Technicians (CPhTs). PTCB has a new website, a streamlined application process, sponsorships, and free verifications. The Pharmacy Technician Certification Exam (PTCE) reflects current knowledge areas demanded across all practice settings. PTCB’s requirements to become a CPhT include a high school diploma and a passing score on the PTCE. Learn more and apply at www.ptcb.org.
Get the
PTCB ADVANTAGE SETTING THE STANDARD www.ptcb.org
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CONNECT ONLINE:
Become a
PTCB CPhT TODAY
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college of pharmacy news Inspirational Pharmacy Student Joins Tour for Diversity in Medicine
Andrea Prince-Gomez, a third-year Drake University pharmacy student from Ferguson, Mo., has been accepted to the Tour for Diversity in Medicine, a program that advocates for students from underrepresented populations to join healthcare fields. She will travel the country with other members of the organization beginning in February as its first representative for the field of pharmacy.
Kathryn Marwitz Accepted to Nation’s Top Public Health Master’s Program
Kathryn Marwitz, a graduating PharmD candidate with a concentration in global and comparative public health, was recently accepted into Johns Hopkins University’s Master of Public Health program. The Johns Hopkins Bloomberg School of Public Health has been ranked No. 1 in the nation among schools of public health since 1994, according to U.S. News and World Report.
Student Spotlight
Dalton Fabian: selected to complete a rotation at APhA Catherine DeFino: placement in the Mayo Clinic’s summer internship Michelle Mages: placement in the Mayo Clinic’s summer internship Alexis Schrieber: selected for Johns Hopkins Summer Pharmacy Internship Program Alexa DeVita: selected for Johns Hopkins Summer Pharmacy Internship Program Kelsey Japs: APhA 2016 George R. Archambault Scholarship recipient
Faculty Spotlight
Cassity Gutierrez, Associate Professor of Health Sciences & Director of PreProfessional Programs: manuscript accepted for publication in Pedagogy in Health Promotion, “Using Photovoice with Undergraduate Interprofessional Health Sciences Students to Facilitate
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Understanding of and Dialogue about Health Disparities within Communities”
Granberg Leadership: June Johnson
Michael Andreski, RPh, MBA, PhD Assistant Professor of Social and Administrative Pharmacy: • Iowa Pharmacy Association/Iowa Department of Public Health $2000 “Survey of Clinical Services Offered by Iowa Community Pharmacists”
Franson to Recieve National Alumni Award
• Telligen Community Initiatives $26,500 “Iowa New Practice Model: A Demonstration Project to Study the Effects of Implementing TechCheck-Tech Programs in Community Practice to Engage Community Pharmacists in Clinical Pharmacy Services in Iowa-Extension to total of 24 months”
2016 CPHS Alumni Achievement Awards
Drake University’s College of Pharmacy and Health Science’s Alumni Achievement awards were presented during the annual Pharmacy & Health Sciences Day on Feb. 18. Recipients of the annual Alumni Achievement awards are honored for their exceptional contributions to the college, distinction in their careers, and/or civic and community contributions. Anthony Bono, PH’78 Lisa Stalheim Crose, BSPS’03 Felix Gallagher, PH’00 Gregory Johansen, PH’76 Craig Mandel, AS’66, PH’69 Young Alumni Award Recipient Allyson Wierda Schlichte, PH’06
Faculty & Preceptor Awards
Hartig Distinguished: Sally Haack
Tim Franson, PH’74, will be one of seven almuni that the Drake University National Alumni Association Board of Directors will recognize with an award reception Thursday, April 28. Franson is chief medical officer for YourEncore, an open innovation vendor. Franson previously was a principal in FaegreBD Consulting’s health and biosciences practices, where he used his extensive clinical and regulatory experience in all pre- and post-approval phases of pharmaceutical development. Franson is also board certified in internal medicine and infectious diseases. He currently serves as an adjunct professor at the Indiana University School of Medicine, and is immediate past president and a member of the Board of Trustees of the United States Pharmacopeial Convention. Franson has volunteered for organizations including the Little Red Door Cancer Agency and Villages of Indiana, and is a member of Drake’s College of Pharmacy and Health Sciences National Advisory Council.
All Pharmacy Reunion April 29-30
Reconnect with the friends who made your Drake experience so exciting and memorable at Drake’s 2016 AllPharmacy Reunion! Come celebrate the appointment of Renae Chesnut, the College’s new dean, with your fellow Bulldogs!
Mentor of the Year: Andrea Kjos Teacher of the Year: Ron Torry
Faculty Preceptor of the Year: Sarah Grady IPPE Preceptor of the Year: Katie Thaut APPE Preceptor of the Year: Amy Munemoto & Brenda Riesenberg Health Sciences preceptor of the Year: Michael Carruthers
Renae Chesnut Named Dean of the Drake University College of Pharmacy and Health Sciences Read the full story on page 18.
college of pharmacy news UI College of Pharmacy Building Plans Advance
The UI College of Pharmacy has been working for years to develop plans for a new physical facility—one that will provide optimal spaces to advance pharmaceutical sciences and educate future pharmacists. While the building isn’t anticipated to be completed until 2019, several advances in the planning process have been made. • A groundbreaking ceremony is set for Sept. 29, 2016. • A core committee of collegiate and UI Foundation faculty and staff has been formed to discuss various aspects of the facility. • The architectural firm, OPN Architects Inc., was chosen by a GBP1 Institutional Architectural Selection Committee and ultimately approved by the Iowa Board of Regents. A second architectural firm, SLAM Collaborative, was brought on board specifically for their experience with healthscience related buildings, as well as interdisciplinary solutions. • The architects have designed the building with Universal Design principles in mind. These principles include equitable use, flexibility in use, simple and intuitive use, perceptible information, tolerance for error, low physical effort, and size and space for approach and use.
National Leaders to Convene for Leadership Symposium
The UI College of Pharmacy has planned the Zada Cooper Leadership Symposium on April 30, 2016. Attendees at this free conference will benefit from hearing from some of the foremost leaders in the pharmacy field. Subjects will range from the legacy and importance of leadership, to the role of mentorship in professional settings. The event is open to all, but registration is requested. Find out more at pharmacy. uiowa.edu/leadership-symposium.
Abrons Positively Impacts Dominica’s Health
In January 2016, Jeanine Abrons, clinical assistant professor in the Division of Applied Clinical Sciences, traveled to Roseau, Dominica. Her visit served many purposes, but mostly centered around a special partnership with Jolly’s Pharmacy, one of the largest private community pharmacies in Dominica. Each year, Abrons collaborates with Jolly’s on projects and activities to serve Dominica residents and pharmacists, which includes a student rotation to provide a contrast between government and private pharmacy in Dominica as well as providing a contrast between traditional and western medicine. The partnership continues to grow and thrive. During Abron’s recent visit in 2016, partnership activities included speaking on a local radio talk show, where she discussed the evolution of a pharmacist’s role. She also assisted with health screenings at the National Cooperative Credit Union, which included, cardiovascular and diabetes health screenings. Her 2016 visit also included nonpartnership related activities, such as work to help displaced residents after Tropical Storm Erika and a visit to LaPlaine Health Center, Dominica’s local governmental health clinic.
Parsai Recognized with RESPy Award
Shiny Parsai, a 2016 Doctor of Pharmacy candidate, was selected as the Walmart/ Pharmacy Times Respect, Excellence and Service (RESPy) Award Winner for January. The RESPy Award program is designed to recognize pharmacy students nationwide for extraordinary humanitarian work in the community. Whether it’s improving access to medicine for the homeless, developing adherence programs for care facilities
or coordinating responses to natural disasters, RESPy winners inspire future pharmacy leaders with their actions.
Duba Elected to Lead AACP Section of Library and Information Science
Vern Duba, MA, was elected as Chair-Elect for the American Association of Colleges of Pharmacy Section of Library and Information Science. The term is a four-year commitment, first as secretary, then chair-elect, followed by chair, and immediate past chair. As chair-elect he will oversee planning for the Program Committee of the Section and preside at the annual meeting sessions. During his time in the position, Duba will continue to chair the CAPE Editorial Review Board and serve as subject section editor for the Basic Resources for Pharmacy Education. Duba is a clinical assistant professor in the Department of Pharmacy Practice and Science and Instructional Services Specialist in the Office of Academic Affairs. He has been a member of AACP since 1999.
UI College of Pharmacy Seeks Professional Mentors
In the six years since the UI College of Pharmacy’s Professional Mentorship program began, over 300 practitioners have shared their knowledge, experience, and guidance with future pharmacists. The program pairs pharmacy professionals with firstyear pharmacy students to serve as a guidepost and point of contact to the student throughout their academic career. These relationships are a valuable resource for students, as well as rewarding and enriching for both students and professionals. Students learn practical career information, create professional contacts for future opportunities, and often set up shadowing or rotation experiences. If you are interested in becoming a mentor, please contact Barbara Kelley at barbara-kelley@uiowa.edu. APR.MAY.JUN 2016 |
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STUDENT SECTION
Faces of the Pharmacy Profession: Military Pharmacy Christina Bravos
2017 PharmD Candidate Drake University 2015-2016 IPA Board of Trustees
T
he streets of the pharmacy profession have numerous avenues to travel down and explore as a student before graduation and even after becoming a licensed pharmacist. This is one of many factors that draws students to pharmacy. Pharmacy within the branches of the military is one of these avenues that is both less traveled and less is known about the function of a pharmacist in this setting.
branches are not just pharmacists, they must be able to wear different hats depending on the situation and adapt. The military places a great amount of responsibility on new pharmacists with high expectations for quality outcomes. With this responsibility and expectation, pharmacists can use this opportunity to move their career in directions that are not readily available to new pharmacists in other sectors.
Each branch of the military - Air Force, Army, Coast Guard and Navy (Marine Corps) - has slightly different benefits for their pharmacists and varying job descriptions as well. However, the goal of each branch is the same - working together cohesively to provide the best healthcare for those active duty, veterans and their families. While this goal is easier to accomplish stateside, providing this service to deployed members and those stationed overseas requires overcoming unique obstacles. For example, the wars in Iraq and Afghanistan were the first time that mail-order pharmacy was used to send prescriptions overseas to those in combat. The key to success is communication between branches and within branches.
Pharmacy in the military is more than being a pharmacist. It is being a role model and leader to those around you. Being able to adapt to any situation that comes your direction, even outside of the medical field is key. When I was exploring different areas of pharmacy, this is what immediately attracted me to the military lifestyle. I have expansive interests and thrive on multifaceted roles that do not require one sole focus.
Effective communication and quality leadership skills are required to be a successful pharmacist in the Armed Forces. Effective communication and quality leadership skills are two attributes that are required to be a successful pharmacist in the Armed Forces. Pharmacists within the different
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When applying for the Health Services Collegiate Program (HSCP), I did not think my chances were great, but it was one of those decisions that if I did not try, I knew I would be asking myself “What if?” for years to come. In May of 2015, I was given the opportunity to sign my contract with the United States Navy and words cannot describe the anticipation and excitement I feel for May 2017 and postgraduation. To me, military pharmacy is a hidden gem within the profession that has the ability to impact, arguably, one of the most deserving populations in the United States. ■
STUDENT SECTION
OVER 90 HEALTH SCREENINGS Given AT STATE CAPITOL
APply to the Bill Burke Student Pharmacist Leadership Conference September 23-24, 2016
Deadline to Apply – May 1, 2016 The 21st annual Bill Burke Student Pharmacist Leadership Conference is scheduled for September 2324, 2016, at the Marriott Hotel & Conference Center in Coralville. The conference will be held in conjunction with the IPA Foundation’s annual Eggleston-Granberg Golf Classic to provide additional opportunities for networking and learning. Events are also scheduled on September 23 to be held at Brown Deer Golf Club, after the Golf Classic. The Bill Burke Student Leadership Conference aims to: • Instill quality organizational leadership skills • Increase awareness of issues impacting the profession of pharmacy
“I can count pills, pour liquids, and compound medications but this is just a small part of a being a pharmacist. Being a consultant to my patients – that’s where I’ve used my education and where I have been of greatest service.” - Bill Burke, RPh
As part of IPA’s Legislative Day, student pharmacists from Drake University and The University of Iowa set up in the Capitol Rotunda to provide a variety health screenings to legislators and Capitol staff. Through these screenings, students were able to demonstrate the value of pharmacists and start the conversation about advancing the pharmacists role in providing for the health and wellbeing of Iowans.
• Encourage development of leadership skills and involvement in professional and community activities • Recognize pharmacy students who have displayed leadership potential • Improve communication and teamwork skills
To Apply
Online applications are now being accepted for current P1 through P3 student pharmacists from Drake University and The University of Iowa. Go to www.iarx.org/billburke for more information or to complete an application before May 1, 2016.
Screenings Provided: Cholesterol: 15 Blood Sugar: 20 Blood Pressure: 32 Body Fat: 27 TOTAL: 94
APR.MAY.JUN 2016 |
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Pharmacy Time Capsule
19 89
Issues & Events that have shaped Iowa pharmacy (or are fun to remember!)
FEBRUARY
Randy McDonough won a 1989 Ford Tempo GL sports sedan in a nationwide sweepstakes by Percogesic analgesic.
MAY
Governor Branstad released his 1990/91 budget with a recommendation to freeze reimbursement for both drug product cost and medical supplies. After extensive discussion between IPA officials and representatives of the Governor’s office, Department of Management and Department of Human Services, the Governor amended his budget to provide inflationary increases in the cost of drug products, durable medical equipment, and medical supplies. After months of debate, the joint Senate/House Appropriations Subcommittee released proposed funding for the bill. The Medicaid Appropriations bill was signed by the Governor in May with the following changes: • Maintenance of AWP as the drug product cost reimbursement standard • A 2.25% increase in the pharmacist’s professional fee ($3.78 – $3.87) • Maintenance of the additional 1 cent/dose reimbursement policy for unit dose dispensing. • A $100,000 expansion in pharmacy’s drug utilization review program • Restoration of full reimbursement for medical supplies and durable medical equipment which had previously been frozen at 1985 levels
The University of Iowa College of Pharmacy was allocated $11.2 million from the capitol contingency fund to support major renovation/addition to the current building.
JUNE
IPA’s 109th president, Jerry Karbeling, gave his inaugural address at the Annual Meeting in Okoboji. Karbeling’s speech entitled “Reaching Out” encouraged all active members to reach out to those nonmember, non-participating pharmacists and encourage their support for the profession. At the time, Karbeling noted membership was at nearly 70%. Karbeling noted, “we can find dozens of reasons to encourage [non-members] to be involved.” His words still stand true today, as the impact we make by working together as a profession is stronger than working towards that change alone.
JULY
Testing of the Pharmacy NETWORK’s new on-line claims submission began on July 11.
OCTOBER
Lloyd Jessen was named Executive Secretary of the Iowa Board of Pharmacy Examiners. Jessen replaced Norman C. Johnson who announced his retirement from the Board in April 1989 after serving as chief executive for more than 12 years. Jessen assumed his position as Executive Secretary on January 1, 1990. The Young Pharmacist Leadership Conference (now Leadership Pharmacy) was created to provide an opportunity for pharmacists in their first 10 years of practice to develop organizational skills which enable both personal and professional growth. Fun fact: in 1989 there were only 74 colleges and schools of pharmacy compared to 132 as of July 2015.
The Iowa Pharmacy Association Foundation is committed to the preservation of the rich heritage of pharmacy practice in Iowa. By honoring and remembering the past, we are reminded of the strong tradition we have to build upon for a prosperous future for the profession.
APR.MAY.JUN 2016 |
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Calendar of Events 2016 CALENDAR OF EVENTS MAY 2016
17-18
IPA Annual Meeting - W. Des Moines
1
IPRN Client Meeting - Des Moines
28-29
Iowa Board of Pharmacy Meeting - Des Moines
3
Addressing Iowa’s Critical Need for Health Care Providers in Rural Areas - Harlan
JULY 2016
3-4
Board of Pharmacy Meeting - Des Moines
3
IPRN Client Meeting - Des Moines
6
Advances in Diabetes & Obesity Management 2016 Iowa City
8
Falls Prevention Symposium - Ankeny
12
2/2/2 Webinar: DIR Fees
10
2/2/2 Webinar: Open Forum on Proposed IPA Policies
23-27
AACP Annual Meeting - Anaheim, CA
12 IPA Goes Local: Dubuque Area Pharmacy Association
24-30 RAGBRAI
19
IPA Goes Local: Quad Cities Area Pharmacy Association - Davenport
AUGUST 2016 4-6
NABP District 5 (Iowa) Meeting - Lincoln, NE
23-25
AACP 2016 Spring Institute - Minneapolis, MN
4-7
Leadership Pharmacy Conference - Galena, IL
23-26
Iowa Governor’s Conference on Aging and Disabilities - Des Moines
6-9
NACDS Total Store Expo
7
IPRN Client Meeting - Des Moines
JUNE 2016
9
2/2/2 Webinar: USP Compounding Standards
1-2
Building Your Diabetes Education and Prevention Program - Des Moines
10-11
Iowa Board of Pharmacy Meeting - Des Moines
3
Culturally Responsive Health Care in Iowa Conference - University of Iowa Public Health Bldg
25
IPA Goes Local: Southwest Iowa Pharmacists Association - Council Bluffs
3-4
Iowa Board of Pharmacy Meeting - Des Moines
5
IPRN Client Meeting - Des Moines
11-15
ASHP Summer Meetings and Exhibition - Baltimore, MD
14
2/2/2 Webinar: Cyber Liability
16
Practice Advancement Forum - W. Des Moines
For the most up-to-date information on state and national events, visit www.iarx.org/events
FOR SALE
Script Pro SP 200 with collating center This machine was purchased new in 2010, and the pharmacy was recently closed. Will require refurbish, relocation, and installation by Script Pro (which buyer is responsible for). This would make the machine like new but at only a portion of the cost of a new one. A cost quote from Script Pro is available upon request. The refurbish is required by Script Pro in order for them to continue supporting the equipment. Asking $50,000 or best offer.
Contact Tom Deutsch at 641-394-3913
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NEED A RELIEF PHARMACIST? CONTACT “JOSEPH IN RELIEF” Joseph Thompson, RPh 9616 Quail Ridge Urbandale, IA 50322
1.888.278.0846 h. 515.278.0846 | c. 515.991.2684
ADVERTISE IN OUR PUBLICATIONS Place your ad/classified ad with us. All ads, contracts, payments, reproduction material and all other related communication should be addressed to David at dschaaf@iarx.org or call the IPA office at 515.270.0713 for more information.
2015 Recipients of the “Bowl of Hygeia” Award
Dan McConaghy Alabama
Tom Van Hassel Arizona
Nicki Hilliard Arkansas
Robert Shmaeff California
Sherman Gershman Connecticut
Kevin Musto Delaware
Fritz Hayes Florida
Ron Stephens Georgia
Kerri Okamura Hawaii
Steven Bandy Illinois
Jane Krause Indiana
Richard Hartig Iowa
Robert Nyquist Kansas
Larry Stovall Kentucky
Lloyd Duplantis Louisiana
Kenneth McCall Maine
Butch Henderson Maryland
Paul Jeffrey Massachusetts
Derek Quinn Michigan
Jenny Houglum Minnesota
Robert Wilbanks Mississippi
Richard Logan Missouri
Gayle Hudgins Montana
Heather Mooney Nevada
Richard Crowe New Hampshire
Edward McGinley New Jersey
Amy Bachyrycz New Mexico
Benjamin Gruda New York
David Moody North Carolina
Kevin Oberlander North Dakota
Danny Bentley Ohio
Gordon Richards, Jr. Oklahoma
Ann Zweber Oregon
Thomas Mattei Pennsylvania
Deborah Newell Rhode Island
Sharm Steadman South Carolina
Renee Sutton South Dakota
Mac Wilhoit Tennessee
Jim Cousineau Texas
Marvin Orrock Utah
John Beckner Virginia
Gregory Hovander Washington
Terri Smith Moore Washington DC
David Flynn West Virginia
Brian Jensen Wisconsin
Randy Harrop Wyoming
The “Bowl of Hygeia”
The Bowl of Hygeia award program was originally developed by the A. H. Robins Company to recognize pharmacists across the nation for outstanding service to their communities. Selected through their respective professional pharmacy associations, each of these dedicated individuals has made uniquely personal contributions to a strong, healthy community. We offer our congratulations and thanks for their high example. The American Pharmacists Association Foundation, the National Alliance of State Pharmacy Associations and the state pharmacy associations have assumed responsibility for continuing this prestigious recognition program. All former recipients are encouraged to maintain their linkage to the Bowl of Hygeia by emailing current contact information to awards@naspa.us. The Bowl of Hygeia is on display in the APhA Awards Gallery located in Washington, DC. Boehringer Ingelheim is proud to be the Premier Supporter of the Bowl of Hygeia program.