IPA Journal JUL/AUG/SEPT 2019 by Iowa Pharmacy Association

A Peer-Reviewed Journal | Vol. LXXV, No. 3 | JUL.AUG.SEP 2019

CONNIE CONNOLLY IPAâ&#x20AC;&#x2122;s 141st President & Bridge Builder

INSIDE: Annual Meeting Recap Legislative Session Recap CBD in the Pharmacy: Questions Answered

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 Kate Gainer, PharmD Anthony Pudlo, PharmD, MBA, BCACP Laura Miller Casey Ficek, JD Matthew Pitlick, PharmD, BCPS Amanda Abdulbaki, PharmD

COVER STORY 2019 IPA Annual Meeting pg. 8

See it all - the policy, awards, leadership and pies - from this year’s new-look IPA Annual Meeting. Figure 1: TOC Pharmacist Services

OFFICERS

Inpatient chart review

CHAIRMAN Cheryl Clarke, EdD, RPh, FAPhA - Waukee

• Review of admission medication reconciliation • Daily chart review to identify and intervene on drug therapy problems • Begin discharge planning including identifying barriers to access

PRESIDENT Connie Connolly, RPh, BCACP - DeWitt

Discharge time out

PRESIDENT-ELECT Diane Reist, PharmD, RPh - Cedar Rapids

• Review discharge medication reconciliation to identify and intervene on drug therapy problems

TREASURER Tim Becker, RPh, FACP - Mason City SPEAKER OF THE HOUSE Ashley Dohrn, PharmD, BCGP - Le Claire VICE SPEAKER OF THE HOUSE Kristin Meyer, PharmD, CGP, CACP, FASCP - Marshalltown

TRUSTEES REGION 1 Sharon Cashman, RPh - Waverly REGION 2 Shane Madsen, PharmD, BCPS - North Liberty REGION 3 Sally Haack, PharmD, BCPS - Norwalk REGION 4 Gary Maly, PharmD - Sioux City AT LARGE Bill Baker, BS Pharm - Iowa City Craig Clark, RPh - Cedar Rapids Bill Doucette, PhD, RPh- Iowa City John Hamiel, PharmD - Waterloo HONORARY PRESIDENT Tony Beraldi, RPh - Council Bluffs PHARMACY TECHNICIAN Jessica Burge, CPhT - Des Moines STUDENT PHARMACISTS Joshua Hart - Drake University Crissy Lawson - University of Iowa 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) publishes 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 the Iowa Pharmacy Association.

Discharge counseling

Legislative Session Recap See how pharmacy fared in the 2019 Iowa Legislative Session. pg. 35

FEATURES

Peer• Review: Development and medications Face to face counseling on new and changed Implementation of a Transitions of Care Transitions of care note Pharmacist Service. pg. 30 • Fax a note to the patient's preferred outpatient pharmacy noting the new, changed, and stopped medications

2019 Annual Meeting Recap . . . . . . . . . . Follow-up . . . . . .phone . . . call . . . . . . . . . . 8 Speaker’s Address . . . . . . . . . . . . . . . • . Patient .obtain . . new .contacted . .medications . . .24-72 . . .hours . . post-discharge . . . 10 to ensure they were able to and to review potential side effects Policies Adopted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 IPA Awards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 CPESN Iowa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 New EPA Regulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Commencement 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Peer Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 2019 Legislative Session Recap . . . . . . . . . . . . . . . . . . . . . . . . . . 35 CBD in the Pharmacy? Questions Answered . . . . . . . . . . . . . . 39

IN EVERY ISSUE

CEO’s Column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 President’s Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Health Care Hot Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Iowa Pharmacy News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Practice Advancement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Public Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Technician Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 IPA Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Members Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 IPA in Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Calendar of Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Pharmacy Time Capsule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Mission Statement

The Iowa Pharmacy Association empowers the pharmacy profession to improve health outcomes. JUL.AUG.SEP 2019 |

A continuous quality improvement program can be a lifesaver! M A K E YO U R PATI E NTS AND YO U R P H A R M ACY SAF E R .

FOR LESS THAN A DOLLAR A DAY ... • • • •

Increase patient safety – learn from collected safety data and online resources Maintain compliance – meet accreditation, credentialing, PBM and state QA requirements Reduce costs – increase operations efficiency, reduce potential risk and cut down on “re-do” Rxs Safeguard your data – Patient Safety Organizations offer confidentiality and legal protection

Learn more at www.medicationsafety.org or call us at (866) 365-7472. The Alliance of Medication Safety (APMS) is a federally listed Patient Safety Organization (PSO).

CEO’S COLUMN

HARD TO FIND THE WORDS

n April this year I drove to Madison, WI, a drive I had made many times. But this felt different. I was going to visit my friend and mentor, Chris Decker, who had been admitted to hospice care a few weeks earlier. I knew this would likely be the last time I saw Chris, and my heart was heavy. However, after a long visit, one no different than our other times together, I left with a smile on my face. It was a testament to how Chris lived, and how he made others feel, not only at the end of his life, but every day he lived. (09.06.64 – 07.30.19) Chris was the executive vice president and CEO for the Pharmacy Society of Wisconsin, my counterpart from my home state, and I from his. In March of 2016, Chris was diagnosed with stage 4 glioblastoma, an aggressive brain cancer. Chris beat the odds at every turn, and truly believed ‘The Median Isn’t the Message.’ He endured 3 brain surgeries with tumor removal, underwent chemotherapy and radiation, and for nearly one year diligently wore electric patches on his head to disrupt the tumor growth in his brain. Anyone who knows Chris, knows that he believed he would win, and he lived each and every day – not with a label or diagnosis – but with a sense of optimism that was truly contagious. He strived to be ‘regular Chris’ and made others around him feel inspired and fueled by his positivity. Chris’ mentorship and friendship will have a lasting impact on my life, as his leadership and vision have and will continue to have an immeasurable impact on the profession of pharmacy. I’ve struggled to find the right words to talk about Chris since his death,

but a few words stand out as lessons I learned from Chris that will stick with me – both in pharmacy and in life. 1. Where there’s a will, there’s a way. I heard Chris say this more times than I can count. Usually in a room with palpable disagreement, or a sense of hopelessness. It was a simplistic way to acknowledge philosophical alignment and bring down real or perceived barriers. Chris often followed this statement with, ‘or we’ll make our own way!’ This statement jumpstarted major initiatives and programs, and is a way I strive to lead as well. 2. Fail forward. In my first meeting with Chris after I became the exec in Iowa, he talked about the importance of resiliency and accepting failures when in a leadership position. In this conversation he also taught me two phrases (which I’ve shamelessly stolen): ‘the critics don’t count’ and ‘fail forward.’ I learned to embrace failure and setbacks, and always take time to reflect and extract a lesson for improvement.

Kate Gainer, PharmD Executive Vice President & CEO Iowa Pharmacy Association

be remembered as THE difference maker. While there is a huge sense of loss for the pharmacy profession, the pharmacy family, Chris’ personal family and friends; when we – collectively and individually – strive to make a difference, we’ll carry Chris’ legacy forward for years and years to come.

3. What matters most. For nearly 10 years I had the opportunity to learn from Chris about leadership, association work and the profession of pharmacy. Most of our conversations during the last year of Chris’ life were about family. His favorite moments and proudest achievements weren’t pharmacy related, but rather related to his three children. This lesson, above all the lessons I learned from Chris, reminds me of what truly matters most. Chris never sought credit or recognition in his work, but rather he strived to make a difference. To those who knew him, he will JUL.AUG.SEP 2019 |

PRESIDENT’S PAGE

BUILDING BRIDGES Connie Connolly, RPh, BCACP DeWitt IPA President

IPA President Connie Connolly’s inaugural address given at the 2019 IPA Annual Meeting on June 20, 2019, in Cedar Rapids.

t was recently voiced to me by a colleague that I am a connector, or bridge builder. I consider that to be one of the highest compliments I have been paid. I take pride in the fact that I have been able to work in so many different practices and locations. It has been a pleasure for me to meet so many pharmacists and I can often introduce people from different practice areas to one another because of the privilege I have had to spend time with such a diverse segment of our profession. There is a TED talk I have viewed that describes a man getting feedback from a young student who told him that because of his actions, she decided to stay at school and complete her college degree. The man’s action involved the gift of

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a lollipop. The man did not even remember anything about what he had done to help this young woman. Despite this, it had made such an impact on her, she had to find him 4 years later and thank him for giving her a “lollipop moment”. I thank you all for giving me “lollipop moments”, many of which have led me to this podium, and I can only hope that I can do the same for others. When we interview our residency candidates at my practice site, we ask them to tell us about their pharmacy journey…. Why they chose to be a pharmacist. The stories are varied, but inevitably they say they want to CARE. At a recent leadership meeting, Nancy Alvarez, former president of APhA, related a story I would like to share about a patient who was asked about his recent interaction with a pharmacist team. Former San Diego Charger Rolf Benirschke asked the patient 3 questions that are explained in his book: Alive and Kicking: The first question was, “Do you trust your pharmacists?” He said, yes, I really do. I believe they tell me the truth about my medications.

Then, he was asked, “Do you believe the pharmacists excel at what they do?” He answered, yes, I know they have a lot of training and I do believe they excel at what they do. Finally, he inquired, “Do you believe your pharmacists cared about you?” He hesitated, thought a moment, and then said, “No….no, I am not sure I can say they do.” What do you bring to the table of pharmacy? How do you show patients and colleagues you care? What talents can you refine and share in the collective arena of healthcare? I know that you all have a great educational background and can solve medication therapy problems better than any other profession, but I would ask you to do more.

“What can you personally do every day to help just one patient live a healthier life and show you care about them?” What can you personally do every day to help just one patient live a healthier life and show you care about them? Is it listening so they feel that they are valued? Is it helping them obtain insurance coverage? Is it empowering a patient to voice their concerns

PRESIDENT’S PAGE

to another provider? Is it explaining a process so a patient can get to a needed healthcare appointment or receive needed services? How about writing or speaking to an elected official to explain what is needed to make healthcare more effective and efficient? I can look at this room and know that the brainpower to solve these problems is within these walls. If it is not, the means of engaging those who can devise the solution is here tonight.

“I can look at this room and know that the brainpower to solve these problems is within these walls.” I would challenge each of you to stretch a little more each day to find ways to solve these issues. All of you bring value and a unique perspective to the table by virtue of being the most accessible healthcare professional. We are accessible in hospitals, in nursing homes, in ambulatory care centers, and in community pharmacies. Even if you never interact with a patient in your practice, your access to patient data and your connections to the varied healthcare disciplines is a tool we need to use more frequently. We need to continue to network and engage with other pharmacists and other healthcare professionals, especially those who practice in a different area than our own in order to gain insight and create a collective narrative about what it is we can accomplish as pharmacists. Reach out to those practitioners you may have known in college and with whom you may have lost touch. Ask them about their practice and go a step further: ask how they are doing. Learning this information will help you be a better advocate for your patients and your profession by getting more insight about what really happens in the healthcare system.

Part of our caring extends beyond what we do for our patients, to what we do for our professional colleagues. I would especially ask you to make time to contact and engage our colleagues in the chain or hospital pharmacy environment as I am concerned for their emotional and physical well-being. No one should have to work in conditions that do not allow for breaks or be forced to meet demands that they deliver a prescription before they feel it has been properly reviewed for safety and appropriateness. Our fellow professionals need our help to educate legislators and decision-makers about the changes that must be made to allow pharmacists to provide the best care for their patients.

“IPA cannot effectively represent pharmacists from all areas of practice if we do not have members who practice in all areas.”

have more than 2500 pharmacists in the state of Iowa, as well as many pharmacy technicians and students, who are potential members of this organization. Engage with your current and former classmates or coworkers and ask them if they are members. Encourage them to join and contribute to our dialogue. The legacy we have of learning and leading in the pharmacy profession will continue to be enhanced by everyone’s participation. I look forward to having a dialogue with each of you. We are the drivers of our own destiny. We know how we can help our patients; together we can find ways to let the world know how we care. Thank you again for the honor of continuing to be a bridge builder - a caring connector - by being your president. ■

Of course, I believe that the most efficient way to foster this vision for caring is to maintain your membership and active involvement in IPA. IPA cannot effectively represent pharmacists from all areas of practice if we do not have members who practice in all areas. We

JUL.AUG.SEP 2019 |

AN ANNUAL MEETING UNLIKE ANY OTHER Each year pharmacists, pharmacy technicians, and student pharmacists come together from across the state to discuss policy, share innovative ideas, and make meaningful connections with colleagues and pharmacy leaders. The 2019 IPA Annual Meeting saw several changes, starting with a move to a Thursday-Friday format. In addition to concluding business before the weekend, the new agenda allowed for more poster presentations and new Innovation and Research Forums, making Annual Meeting the epicenter of pharmacy practice in Iowa.

Annual Meeting kicked off on Thursday with a keynote from ASHP President Kathleen Pawlicki and APhA President Brad Tice providing a national perspective.

With IPA celebrating 20 years as a unified association, a panel of those who led the unification effort shared the story of how the Iowa Pharmacists Association and the Iowa Society of HealthSystem Pharmacists became one organization.

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The new Innovation and Research Forum allowed researchers and pharmacy residents the opportunity to present their projects to their Iowa peers. The annual Bowl of Hygeia recipient was again surprised. See who received one of the professionâ&#x20AC;&#x2122;s highest honors on page 16.

Matt Hosford, vice president and chief pharmacy officer at Wellmark Blue Cross and Blue Shield, provided Fridayâ&#x20AC;&#x2122;s keynote.

The revamped schedule allowed for two poster sessions, allowing for more posters and more time for presenters to discuss their innovative projects.

Adopted Policy . . . . . . . . . p. 13 Board Transition . . . . . . . . . p. 14 Awards . . . . . . . . . . . . . . p. 16 Technicians Have a Voice. . . . p. 43 Silent Auction . . . . . . . . . . p. 44

JUL.AUG.SEP 2019 |

RICH IN HISTORY Jim Hoehns, PharmD, FCCP, BCPS Cedar Falls 2018-2019 Speaker of the House

IPA Speaker of the House Jim Hoehns’ address during the first session of the 2019 IPA House of Delegates on June 20, 2019, in Cedar Rapids

ood morning everyone. Thank-you Vice-Speaker Dohrn and fellow delegates. Welcome to the 2019 House of Delegates of the Iowa Pharmacy Association. As I was reflecting on comments to share with you today…I was thinking broadly about “history”. Both my own history, but more importantly about that of pharmacy and the Iowa Pharmacy Association. When I was in high school I had an excellent history teacher. His name was Dennis Vogel (or Mr. Vogel). Mr. Vogel had a passion for his subject which I greatly appreciated. He was a great teacher. So, this morning, I’m going to channel Dennis Vogel and share some Iowa pharmacy history. Let’s do a quick “history” review. In 1846, Iowa became the 29th state in the Union. The Iowa Pharmacy Association was organized in 1880.

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So, this is the 139th year of the Iowa Pharmacy Association. 1880 was also the year the Iowa Board of Pharmacy was founded. The University of Iowa College of Pharmacy was founded in 1885. Drake University College of Pharmacy and Health Sciences has an interesting history. It was started in 1887, was closed for a time period, and then brought back in 1939. The University of Iowa Hospitals and Clinics started their pharmacy residency in 1946. The first House of Delegates was held in 1965. The oldest licensed pharmacist in Iowa? That would be Joe Beraldi (Council Bluffs/Oard-Ross Drug). Joe is 93 years old and can recall delivering prescriptions on his bicycle and working as a soda-jerk. Joe still works at the pharmacy with his son Tony, also a pharmacist, and their pharmacy has been serving patients in Council Bluffs since 1908. I should also note that Tony Beraldi will be installed as IPA’s next honorary president. How about the oldest IPA member? That would be Bob Osterhaus who is 88 years old. Bob beats out Hal Jackson (2nd oldest) by just 14 days. Our annual meeting is rich in history. As you know, at this meeting Iowa pharmacy is celebrating the 20th Anniversary of a unified association.

That is, in 1999 the Iowa Pharmacists Association and the Iowa Society of Health-System Pharmacists joined ranks to better promote the profession with a unified voice and vision. This is a wonderful opportunity for us to reflect on the lasting success of this joint effort. I am very much looking forward to the panel discussion tomorrow to learn more, firsthand, about the obstacles those leaders faced and their vision and fortitude to make it happen. Today we will hear from the Policy Committees on Professional Affairs and Public Affairs. I want to thank the two chairs, Ginelle Bryant and Angie Danielson, and the committee members for their outstanding work. We will hear several recommendations from our colleagues pertaining to such topics as cannabis-derived products, technician-administered immunizations, digital health technology, and home infusion practice. These are all important topics which will affect pharmacists regardless of practice setting. I would like to take a moment, though, to highlight one other item we will be discussing in this session. The Policy Committee on Public Affairs will be submitting a recommendation to work with the

Iowa Board of Pharmacy to evaluate the need for modernizing the current Iowa Pharmacy Practice Act. I will leave the specifics to Angie and her committee. I just briefly want to share some of the history of our current Practice Act. This was a multiyear effort which spanned 1983 to 1987. In 1983 IPA President Gene Lutz proposed a rewrite of the Iowa Pharmacy Act and the IPA Board of Trustees established a task force that would draft the new Pharmacy Practice Act. Between 1984 and 1986 the House of Delegates discussed the draft Practice Act and the Task Force made revisions based upon feedback from the House of Delegates. In 1986 the House of Delegates unanimously approved the final draft of the Practice Act. In 1987 the new Practice Act was introduced to the Iowa Legislature, where it passed, and was signed into law by Governor Branstad in May 1987. To my understanding, this large, important task was a joint effort between the Iowa Board of Pharmacy and the Iowa Pharmacy Association. Who were these IPA task force members who stepped up to this task? Let me read their names: Max Eggleston (chairperson), Betsy Chrischilles, Joe Cunningham, Lloyd Matheson, Steve Mullenix, Phyllis Olson, and Tom Temple. A lot of names there we all recognize. I wanted to highlight this piece of history as there is now consideration for revising our Practice Act. I am inspired by the professional dedication and persistence that task force embodied and the work they accomplished for all of us. This is an exciting topic and one of great interest to all of us. It also emphasizes the importance of what you, what we, are doing here today in the House of Delegates. You are helping shape the direction and focus for our profession. Your voice truly matters. I have one last piece of “history” to share. Just recently, June 6th this year, commemorated the 75th Anniversary of the Allies’ D-day invasion of Europe in World War II. I enjoy reading about World War II history. I recently finished reading the book “Band of Brothers” by Stephen Ambrose. I have not seen the HBO miniseries based on the book, but

I know it is well liked. This wonderful book tells us about Easy Company. Part of the 101st Airborne Division, US Army. These were 140 men and 7 officers who volunteered for the paratroopers. They came together in the summer of 1942. They came from different backgrounds and different parts of the country. They were farmers and coal miners, mountain men and sons of the Deep South. Some were desperately poor, others from the middle class. They were special in their values. “They were idealists, eager to merge themselves into a group fighting for a cause, actively seeking an outfit with which they could identify, join, be a part of, relate to as a family.” “They volunteered for the paratroopers, they said for the thrill, the honor, and the $50 monthly bonus paratroopers received. But they really joined for two profound, personal reasons. Each man had a realization that doing his best was a better way of getting through the Army than hanging around with the sad excuses for soldiers they met in the recruiting depots or basic training. They wanted to make their Army time positive, a learning and maturing and challenging experience. Second, they knew they were going into combat, and they did not want to go in with poorly trained, poorly conditioned, poorly motivated draftees on either side of them. When the shooting started, they wanted to look up to the guy beside them, not down.” Truly, this was a group of special individuals. But I think there are some parallels for us to consider today. If you are here today, you, too, are likely “eager to join a cause, seeking a group with which you can identify and relate to as a family”. This is one of the wonderful things about the Iowa Pharmacy Association and being here today. We are a family. There are so many pharmacists in this room that I “look up to” and am motivated by. When you look around this room, I hope you feel the same as I do. Thank-you and I look forward to our discussion today.

JUL.AUG.SEP 2019 |

CELEBRATING LEADERSHIP Each year prior to Annual Meeting, IPA hosts its Leadership Dinner to recognize the past, present and future leadership within Iowa pharmacy and the association. Current board members, past presidents and honorary presidents, the deans from both Iowa colleges of pharmacy, and other distinguished guests gathered for this yearâ&#x20AC;&#x2122;s dinner at the Elmcrest Country Club in Cedar Rapids. Among those recognized was IPA President Cheryl Clarke, who, like many IPA presidents before her, received her Duffy caricature. For completing a 9-year tenure on the IPA Foundation Board of Directors, and the past two as president, Bill Baer received a custom bobblehead featuring his likeness in a new tradition for outgoing foundation directors.

IPA also presented its Jerry Karbeling Leadership Award to Kelli Jo Welter from Drake University and Mohammed Fredericks from the University of Iowa.

Cheryl Clarke receives her Duffy caricature

Jill Hoag gives remarks after receiving the Robert G. Gibbs Distinguished Pharmacist Award on behalf of her late husband Stephen Hoag

Bill Baer receives his bobblehead

IPAâ&#x20AC;&#x2122;s 2018-2019 committee chairs recognized for their leadership and service (l to r) Pamela Wiltfang (Education Advisory Committee), Randy McDonough (Advisory Committee on Medicaid and Pharmacy Benefits Programs), Steve Firman (Legislative Advisory Committee), and Shane Madsen (Health-System Liason Board)

IPA President Cheryl Clarke (center) receives recognition from ASHP, presented by ASHP President Kathleen Pawlicki (right)

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2019 HOUSE OF DELEGATES: POLICIES ADOPTED 19-U1: Cannabis-Derived Products in Pharmacy Practice

1. IPA supports the role of pharmacists in the education of patients and healthcare professionals on evidence-based use of cannabis-derived products. 2. IPA supports standardized labeling for all cannabis-derived products. 3. IPA supports the collection and documentation of information in the patient’s medication profile about use of cannabis-derived products. 4. IPA supports the important role of the pharmacist in assisting a health-system, long-term care facility, and other pharmacy practices when developing policy and procedure for the handling and management of cannabis-derived products. 5. IPA supports pharmacist oversight of dispensing and consultation for patients receiving cannabis-derived products.

19-U2: Revisions to the Iowa Pharmacy Practice Act 1. IPA supports the development of a joint task force with the Iowa Board of Pharmacy to evaluate the current Iowa Pharmacy Practice Act and the need for modernization.

2. IPA supports a thorough consensus building process among stakeholders within and outside of the profession of pharmacy prior to finalizing the recommendations from the joint task force.

19-R1 Immunization Administration by Pharmacy Technicians

1. IPA supports immunization administration by certified pharmacy technicians with training in immunization administration as a technical function that may be delegated by an immunizing pharmacist with direct supervision. 2. IPA supports the provision of standardized training, continuing education, and ongoing competency evaluations of immunizing certified pharmacy technicians. 3. IPA supports voluntary participation by a certified pharmacy technician in the training and provision of immunization administration. Furthermore, IPA supports a pharmacist’s discretion in delegating immunization administration to an immunizing certified pharmacy technician. 4. IPA supports the role of pharmacists as the healthcare professional providing clinical assessment, decision making, and patient counseling for all immunizations administered by an immunizing certified pharmacy technician. 5. IPA supports public and private payers compensating pharmacists for the clinical assessment, decision making, and patient counseling, regardless of who administers the immunization.

19-R2 Digitial Health Technology

1. IPA supports the use of digital health technology to empower patients to take an active role in their health. 2. IPA supports the ongoing education and training of pharmacists to assist patients in the selection and utilization of digital health technology. 3. IPA supports the ethical use of patient information collected by digital health technology, including an effective informed consent process when appropriate. 4. IPA supports ongoing research regarding the selection, approval, and management of digital health technology to further the goal of delivering safe and effective patient care. 5. IPA supports digital health technology to be interoperable and structured to allow secure incorporation of health information into the patient’s electronic health record and other essential clinical systems as patient-reported outcomes (PROs).

19-R3 Home Infusion Pharmacy Practice

1. IPA supports the role of pharmacists in home infusion pharmacy practice to establish relationships with patients and providers that will facilitate coordination and continuity of care, improve access to care, and improve patient outcomes. 2. IPA supports fair, equitable, and consistent reimbursement by all public and private payers for all home infusion products and professional services, including those provided by a pharmacist. 3. IPA supports access to home infusion care based on scientific, professional, and ethical principles of quality patient care without barriers imposed by public and private payers. 4. Including but not limited to, supplies, administration, interpretation of results, and consultation.

19-NBI-01 Prescription Adaptation

1. IPA supports legislative authority for pharmacist prescription adaptation to allow pharmacists to use their professional judgment in adapting prescription orders in the best interest of the patient while meeting the intent of the prescriber. 2. IPA supports documentation in a patient’s pharmacy record, on the prescription order, and communication to the prescriber when changes are made via prescription adaptation. 3. IPA supports audit protection from third parties and PBMs for pharmacies with prescription orders adapted by pharmacists. IPA also supports efforts to prohibit payors from recouping monies for otherwise valid prescriptions with documented pharmacist adaptation pursuant to state scope of practice.

JUL.AUG.SEP 2019 |

THANK YOU IPA BOARD OF TRUSTEES!

Outgoing 2018-2019 Trustees IPA would like to thank the outgoing trustees listed below for their dedication and service to the pharmacy profession in Iowa. Their leadership guided the association through several important issues this year and their insight has been invaluable in strengthening pharmacy practice in our state. Craig Logemann, RPh, BCACP, CDE Ankeny Chairman of the Board Jim Hoehns, PharmD, FCCP, BCPS Cedar Falls Speaker of the House Jim Mennen, RPh Coralville Trustee - Region #2 Carol Anderson, PharmD Mason City Trustee - Region #4 Heather Ourth, PharmD, BCPS, BCGP Ackworth Trustee at Large Deanna McDanel, PharmD, BCPS, BCACP Coralville Trustee at Large John Rovers, PharmD, MIPH Des Moines Honorary President Bridget Tunink, Student Pharmacist Drake University Austin Miller, Student Pharmacist University of Iowa

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Welcome 2019-2020 IPA Board of Trustees

IPA welcomes the incoming Board of Trustee members and thanks them for their willingness to serve the profession this year. The board began their term reviewing IPA’s strategic plan at the board retreat on July 11-12 in Moravia. Chairman of the Board Cheryl Clarke, BS Pharm, RPh, FAPhA Waukee President Connie Connolly, RPh, BCACP DeWitt President-Elect Diane Reist, PharmD, RPh Cedar Rapids Treasurer Tim Becker, RPh, FACP Mason City Speaker of the House Ashley Dohrn, PharmD, BCGP Le Claire Vice Speaker of the House Kristin Meyer, PharmD, CGP, CACP, FASCP Marshalltown

Trustee - Region #1 Sharon Cashman, RPh Waverly

Trustee at Large John Hamiel, PharmD Waterloo

Trustee - Region #2 Shane Madsen, PharmD, BCPS North Liberty

Honorary President Tony Beraldi, RPh Council Bluffs

Trustee - Region #3 Sally Haack, PharmD, BCPS Norwalk Trustee - Region #4 Gary Maly, PharmD Sioux City Trustee at Large Bill Baker, BS Pharm Iowa City

Pharmacy Technician Jessica Burge, CPhT Des Moines Student Pharmacist Representatives Joshua Hart Drake University Crissy Lawson University of Iowa

Trustee at Large Craig Clark, RPh Cedar Rapids Trustee at Large Bill Doucette, PhD, RPh Iowa City

An IPA Board First!

Following the installation of IPA’s 2019-2020 Board of Trustees last week, this is the first time in our history that all three of our presidential officers are women with (l to r, starting 2nd from left) Chairman Cheryl Clarke, President-elect Diane Reist, and President Connie Connolly!

THANK YOU!

OH PIE GOODNESS

SPONSORS Independent Pharmacy Cooperative

For the third year, the Iowa Pharmacy Political Action Committee (IPPAC) held its Pie in the Face fundraiser at Annual Meeting.

McKesson Pharmacists Mutual CPESN PharmServ

Attendees voted via donation for who — Kate Gainer, Connie Connolly, Jim Hoehns or Anthony Pudlo — would receive a pie in the face at conclusion of the House of Delegates session on Friday.

PrescribeWellness QS/1 Smith Drug Company Wellmark DocStation

Kate Gainer “won” by a large margin and received her prize courtesy of Bob Greenwood.

CSL Behring SafeNetRx Iowa Department of Public Health

With over $5000 raised, a bonus pie in the face was received by IPA’s director of public affairs, Casey Ficek.

Lilly USA, LLC National Association of Chain Drug Stores HyVee NuCara Cardinal Health Onnen Company Drake University The University of Iowa

2019 ANNUAL REPORT See the events, achievements and people that made 20182019 a great year at IPA!

Available online at

www.iarx.org/AnnualReport

2019 ANNUAL REPORT

JUL.AUG.SEP 2019 |

2019 PROFESSIONAL AWARDS

BOWL OF HYGEIA Marilyn Osterhaus, RPh - Maquoketa

ROBERT G. GIBBS DISTINGUISHED PHARMACIST

HONORARY PRESIDENT John Rovers, PharmD, MIPH - Des Moines

Stephen Hoag, PhD - (Posthumously) Presented to wife Jill Hoag and son Joel Hoag

DISTINGUISHED YOUNG PHARMACIST

EXCELLENCE IN INNOVATION

Wesley Pilkington, PharmD - Waterloo

Angie Hoth, PharmD, MPH - Iowa City

Presented by Kim Dornbier of Pharmacists Mutual

HEALTH-SYSTEM PHARMACIST OF THE YEAR Sharon Cashman, RPh - Waverly

16 | The Journal of the Iowa Pharmacy Association

PATIENT CARE PARTNER Christopher Hill, DO - Waterloo

PHARMACY TECHNICIAN OF THE YEAR Jessica Burge, CPhT - Des Moines

IPA takes great pride in recognizing individuals for their contributions of leadership, patient care, professional involvement and public service. The following awards were presented during the 2019 IPA Annual Meeting.

JERRY M. KARBELING LEADERSHIP AWARD

POSTER PRESENTATION

Kelli Jo Welter, Drake University Mohammed Fredericks, University of Iowa

“Improving Transitions from Hospital to Home through Expanded Discharge Communication Between Pharmacy Providers”

Presented by the IPA Foundation

Chelsea McIntire, PharmD; Diane Reist, PharmD; Jordan Schultz, PharmD, MSCS, BCACP Presented by the IPA Foundation

APPRECIATION AWARD - INDIVIDUAL New Practice Model

50 YEAR PHARMACISTS Larry Brummel, McGregor; Kenneth Bear, Monterey, CA; Raymond Buser, Fairfax; Gary Cottington, Pella; Charles Dayton, Iowa City; Jerry Hartleip, Dike; Larry Roehrkasse, Stillwater, MN; John Sullivan, Leon; Nancy Wallen, Ainsworth Not Pictured: James Burlingame, Tyler, TX; Charles Davoren, West Des Moines; Charles Dayton, Iowa City; Frank Drey, Marshalltown; Kenneth Ewen, Emmetsburg; Terrance Fahlenkamp, Moline, IL; Bill Mather, Greenfield; Gerald Pirch, Clinton; Dwayne Plender, Orange City; Ronald Willemsen, Pella; Camille Wissmann, Windsor, CO

APPRECIATION AWARD - CORPORATE Independent Pharmacy Cooperative

JUL.AUG.SEP 2019 |

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HEALTHCARE HOT TOPICS

CMS Fails to Finalize DIR Reform

CMS failed to finalize a proposal to move direct and indirect renumeration (DIR) fees to point of sale for Medicare Part D plans. Even with over 4,000 comments in support of this change, CMS did not include this change in the final ruling. DIR fees are misused by payers to claw back reimbursement to pharmacies for prescription drugs that they provide to Medicare beneficiaries. Penalties for pharmacies’ alleged failure to achieve certain benchmarks have come because the benchmarks often are vague, undefined, inconsistent, unachievable or outside of the control of pharmacies. With this final rule from CMS it shows that DIR fees are at least on the radar.

Measles Outbreak Across the US

Measles cases have surpassed the 2018 number (963 cases) in the first 5 months in 2019. As of June 6th, 1,022 individual cases of measles have been confirmed in 28 states. This is the greatest amount of cases reported in the United States since 1992 and since measles were declared eliminated in 2000. Most of the U.S. cases this year take place where “outbreaks” have swept parts of New York, California, Illinois, Texas and Washington state. CDC noted that if the outbreaks continue through the summer and fall, the country could lose its measles elimination status. It is too early to determine whether the outbreak is slowing down. CDC noted that primary symptoms of the highly infectious disease included fever, runny nose, cough, and a rash that can spread across the entire body. To prevent the disease, the agency is urging vaccination.

USP 800 Goes Live

The official date for the new and revised USP 800 standards goes into effect December 1, 2019. There are many resources put out by USP to help guide pharmacists in making sure they are ready for the rollout. The driving force behind the enforcement of USP 800 is that more than 8 million US healthcare workers are exposed to hazardous drugs every year. These practice and quality standards for handling hazardous drugs in the healthcare setting will help promote patient safety, worker safety, and environmental protection. USP also has a HazRx mobile app that

allows you to search any drug to identify if it is considered hazardous, how to safely engage with the hazardous drug, and discover additional resources and education available.

Updated 340B Website

Health Resources and Services Administration (HRSA) finally launched a long-awaited website for 340B hospitals - 340bpricing.hrsa.gov. This new online tool helps hospitals determine the maximum that pharmaceutical companies can charge for drugs. It also adds monetary penalties for drug companies that overcharge hospitals in the program. Until this website launched, hospitals and clinics had no way to be sure they were paying the correct amount for the drugs they purchased. With rising drug prices, 340B programs are crucial in helping hospitals provide access to healthcare services for all patients.

Alexa Now HIPAA Compliant

Amazon’s Alexa is now HIPAA compliant, opening up opportunities for mobile health (mHealth) uses. Platforms utilizing mHealth have the potential to substantially improve the healthcare experience for both consumers and clinicians. Voice assistants overcome challenges for individuals who cannot use keyboards or touch screens. mHealth could play a key role in aiding those in recovery from surgery, chronic care management, and seniors.

Drug Prices in TV Ads

Drug companies are now required to disclose list prices of medications costing more than $35 for a month’s supply in all direct-to-consumer television advertisements for drugs covered by Medicare and Medicaid. Drug makers must also update the price they disclose every quarter. The drug industry opposed this regulation, arguing that revealing the list price will confuse consumers and could violate companies’ First Amendment rights. Concerns were also raised over confusing patients with insurance who frequently pay less than list price for medications. HHS officials say television advertisements will also include disclaimers stating, “if you have insurance that covers drugs, your cost may be different.” This is a step in the

right direction for more transparent drug pricing.

EpiPen Back Order Continues

Much to the dismay of parents, patients, and clinicians, ongoing shortages of EpiPen have hit the 1-year mark with no end in sight. Shortages are expected to result in tighter supplies, which could continue through the summer as peak refill season comes with parents preparing for a new school year. “Manufacturing delays” are linked to a subsidiary of Pfizer – Meridian Medical Technologies, which makes the devices according to Mylan. Mylan distributes and sells EpiPens. On June 5th the FDA announced the extension of the shortage by 4 months for the EpiPen and its generic.

Cannabis Companies Push FDA to Ease Up on CBD

Cannabis industry officials have been lobbying the FDA to ease the path to market for CBD products. Currently, CBD is not allowed in dietary supplements or foods. In 2018 the Farm bill removed hemp and derivatives like CBD from the controlled substance list, so long as the products did not have more than 0.3% THC. The law preserved the FDA’s authority to regulate the cannabis compounds. Companies producing CBD products have suggested the FDA might mimic regulation of folic acid as a road map for CBD. Folic acid can be purchased over the counter for some uses but it must be prescribed by doctors at higher concentrations.

Naloxone Access via Pharmacist Decreasing Opioid Deaths

A study published in JAMA found that states utilizing pharmacists to expand naloxone access have seen significant declines in fatal opioid-related overdoses. In Iowa, pharmacists are authorized to provide naloxone under a statewide protocol. States with laws like Iowa specifically granting pharmacist direct authority to provide naloxone saw reductions in opioid-related overdose fatalities. Other types of naloxone access did not seem to affect mortality. IPA has created a webpage with all the resources needed to help pharmacies participate in providing naloxone to caregivers in their communities. ■ JUL.AUG.SEP 2019 |

IOWA PHARMACY NEWS

IT’S NEVER TOO LATE Matt Pitlick, PharmD, BCPS 2018-2019 IPA Executive Fellow

hat an incredible year this has been! It has been an absolute pleasure to be the third fellow at IPA and working with all the extraordinary IPA members and staff, although this was not always in my career plan. Many of you know that at the time of my starting the fellowship I had been a practicing pharmacist and faculty member for 10 years. My career plan was to continue down the pharmacy practice faculty path, work towards promotion, and eventually work into academic administration… a pretty linear and progressive career path. However, once my wife Jamie, our three children, and I decided to move back to Iowa, my previously straight career path took a detour. In June 2017, my wife could not pass up the amazing opportunity to come back and teach pharmacy at Drake University, and it was the right time to move our family home to Iowa to be closer to family and friends. Although in doing so, I did not have a position lined up. I had been interviewing for positions since January 2017 and did so until March 2018 for the fellowship. In total, I applied for almost 30 positions, interviewed for half of those, and things did not work out for a variety of reasons. Needless to say, this was an incredibly frustrating and disappointing process. I was becoming angry and bitter with where I was at in my career… this was not my plan.

| The Journal of the Iowa Pharmacy Association

After a lot of reflection, I decided to write down on paper what I wanted out of the next 10 years of my career as nothing seemed to be working out. When I was finished, the product looked like an association management type of position. I never thought of working in association management but had been involved in various associations during my time as a faculty member. I knew these positions do not come up all that often so I focused my attention elsewhere. My wife and I were hosting a brunch for some of our close friends from pharmacy school, one being a friend for over 15 years now, Anthony Pudlo. He knew I was not where I wanted to be in my career and casually said, “You should do the fellowship”. I immediately told him, “No”. I thought to myself, I can’t go “backwards” in my career. As the next week came, my wife told me that I said no pretty quickly to idea of completing a fellowship. I thought about it more and decided why not… why not try something new and exciting, why not bet on myself. I realized this would be a great opportunity to learn from a leading and respected pharmacy organization as well as break into association management as a career option, meet new people, and open new doors if selected. So, I called Anthony, told him my plans to apply, and we had a great conversation about what I wanted in my career and why I wanted to complete the fellowship. I was honored and humbled to be offered the position, and here we are, a very fast year later that I never would have dreamed when I started on my career detour. I wanted to tell you this because of the workforce climate we are in, with

people unhappy with their jobs, being burned out, or just wanting to make a change but think you are stuck… It’s never too late! If you have an idea for a new business or want to break into a new practice area… bet on yourself! Students, residents, and new practitioners – do not close any doors throughout your careers as you never know what opportunity may come knocking. Remember to lean on your network when you need it. I would not be where I am today without great friends and network. What you think may be going “backwards” in your career, is actually leading to three steps forward. There are so many people to thank for this past year including: the 2018-2019 IPA Board of Trustees and IPA Foundation Board of Directors, the IPA staff - Casey, David, Laura, Kellie, Mindy, Dawn, and Marla, and a special thanks to Kate and Anthony. Your mentorship, guidance, advice, and constant support throughout this last year have helped me reach my goals while contributing to the mission, vision, and goals of the updated strategic plan of IPA. I also need to thank my wife, Jamie. Without her support and “reminders” that I should pursue the fellowship, I would not be in this position today. While it is bittersweet to be moving on as I’ve enjoyed this experience tremendously, I won’t be going far. I will be on staff at the Iowa Healthcare Collaborative in Des Moines and will be collaborating on many of the same state-wide initiatives we are a part of at IPA. You all have welcomed me with open arms and I’m so proud to once again be part of the Iowa pharmacy family! ■

IOWA PHARMACY NEWS

BPS Study Group Launches After Successful Pilot

After a pilot project in early 2019, IPA will start the BPS Study Group program, which will be offered twice per year to members and non-members. The goal is to complement various study materials currently available to help pharmacists learn together as they plan to sit for either the initial or recertification Board of Pharmaceutical Specialties (BPS) exams for the BCPS, BCACP, and BCGP designations. This 12-week course will cover several topics that follows the blueprint for exam content. Study groups will meet virtually once per week at 8:00 pm. Each participant is required to lead at least one discussion, and other content experts from across the state will lead these webinar-based learning modules. Past participants have seen this study group as a great way to stay accountable to your studying while ensuring your understanding of all knowledge areas of the exams. IPA hopes this study group will utilize the professional membership network to help pharmacists conquer their next career milestone! For more information and to register, visit www.iarx.org/BPSStudyGroup. Upcoming Study Group Schedule: • Winter/Spring 2020 Program: January 7 – March 24 • Summer 2020 Program: July 7 – September 22

EcoReturns Contract Not Renewed with Board of Pharmacy

The Iowa Board of Pharmacy recently announced that it did not renew its contract for the EcoReturns program. The program will undergo changes on July 1, 2019, under a new program administrator. The Iowa Pharmacy Association and SafeNetRx would like to thank the 400+ community-based pharmacies for being a partner in the EcoReturns medication disposal program! The Board of Pharmacy will begin transitioning the purchasing of drug disposal supplies to the new selected

vendor, Sharps Compliance. As participating pharmacies finish their current supply, Sharps Compliance will begin shipping replacement units and liners. Participating pharmacies will receive communications from the Board of Pharmacy. All questions regarding the drug disposal program should be directed to Jennifer Tiffany at the Board offices at Jennifer.Tiffany@iowa.gov.

IPA Membership Task Force Meets

The IPA Membership Task Force called by 2018-2019 IPA President, Cheryl Clarke, met on May 14, 2019. The group of over 20 pharmacists, technicians, and students discussed results from a member survey and different ways to engage the IPA membership and obtain new members. The task force developed over 50 recommendations for the Board of Trustees to consider at the board retreat this summer.

Tools Available for Statewide Protocol Participation

Are you ready for pharmacist statewide protocols for immunizations, naloxone, and nicotine replacement therapy? With the finalization of the Board of Pharmacy regulations, IPA has developed tools and education to assist you in participating in Iowa’s statewide protocols.

Building Resilience, One Episode at a Time!

After IPA successfully advanced legislation in 2018 to allow pharmacists to provide immunizations, naloxone, and nicotine replacement therapy under statewide protocols, IPA is here for you to understand the details of each protocol and what you need to do to prepare yourself and your practice to participate in each protocol.

IPA’s ResilienceRx podcast on the Pharmacy Podcast Network is your prescription for resilience. Hear stories from pharmacy leaders and tips for personal growth and well-being.

IPA has created webpages listed below with all of the resources needed for pharmacies to get ready, set, and GO for each statewide protocol!

www.pharmacypodcast.com

Subscribe to the Pharmacy Podcast Network at: Apple podcasts Spotify

Immunizations: www.iarx.org/immunization Naloxone: www.iarx.org/naloxone Nicotine Replacement Therapy: www.iarx.org/NRT

JUL.AUG.SEP 2019 |

Smokeout. November 21, 2019. Cancer dot org, slash smokeout.

IOWA PHARMACY NEWS

CELEBRATE THE GREAT AMERICAN SMOKEOUT NOVEMBER 21, 2019 The Great American Smokeout is an annual event that encourages people who smoke to make a plan and quit for the day. Sponsored by the American Cancer Society, this event will take place on November 21, 2019 and serves as an effort to promote cancer prevention, reduce second hand smoke exposure and improve the health of all Americans.

The Quitline Iowa website also offers providers a Quitline Iowa 101 training, as well as a CME and CE certified training program on the Ask, Advise and Refer (AAR) tobacco-cessation intervention protocol. The AAR protocol training also includes a review of approved pharmacotherapy that may help tobacco use cessation.

Around 17 percent of Iowans aged 18 and older reported as being current smokers in 2016 (BRFSS, 2016). Tobacco use increases the risk for coronary heart disease, stroke and lung cancer.

The Iowa Department of Public Health (IDPH) now offers a program for teens who want to quit using tobacco, including e-cigarettes and vape. The new My Life My Quit program includes educational materials designed for teens and created through focus groups with teens, subject matter experts and community stakeholders. Teens can text or call a toll-free number (855891-9989) dedicated for teens, or they can visit mylifemyquit.com for realtime coaching. Through the program, teens work with a coach who listens and understands their unique needs, provides personalized support, and helps them build a quit plan to become free from nicotine.

As a healthcare provider, you have a special role in educating your patients about tobaccoâ&#x20AC;&#x2122;s impact on health and tobacco cessation services offered here in Iowa. This November celebrate the Great American Smokeout by encouraging your patients to call Quitline Iowa at 1-800-QUIT-NOW (784-8669) to access qualified tobacco cessation coaches and other necessary support for successful tobacco cessation. Quitline Iowa is a tollfree number available to anyone living in Iowa ages 13 and older. Quitline Iowa is available 24 hours a day and seven days a week.

| The Journal of the Iowa Pharmacy Association

If you have any questions, you may contact Tabetha Gerdner, Tobacco Use

Prevention and Control Division at the IDPH, at (515) 281-7132. References: Iowa Department of Public Health (IDPH), (2017). Health in Iowa BRFSS Annual Report from the Iowa 2016 Behavioral Risk Factor Survey. Des Moines: Iowa Dept. of Public Health, 2017. Retrieved September 2019 from http://www.idph.iowa.gov/ brfss.

This article was prepared by the Iowa Comprehensive Cancer Control Program in collaboration with the Tobacco Use Prevention and Control Division at the Iowa Department of Public Health. For more information, please call 515-2817689 or visit www.idph.iowa.gov.

CPESN IOWA

CLINICAL INTEGRATED NETWORKS – WHAT ARE THEY? WHY DO THEY MATTER?

hen I am talking to prospective pharmacies about joining the CPESN I get a number of questions about what being clinically integrated means and how it is different. A clinically integrated network (CIN) is defined as a collection of health providers that join together to improve care and reduce costs. Clinical integration is a concept that physicians and other types of providers have adopted to address the changing healthcare landscape. Other provider types have taken the lead in showing that the clinically integrated model can successfully drive value and quality, and are therefore able to engage in negotiations with payers and other stakeholders. According to the U.S. Department of Justice, CINs all share four defining characteristics. In order to operate legally as a CIN, a network must: • Have providers play a key leadership role • Commit to comply with clinical guidelines • Strategically use data and technology • Demonstrate its value Care delivery and compensation methods are changing and pharmacy needs to change with them in order to remain viable. CPESN USA was created to clinically integrate and

organize thousands of pharmacy providers to approach the marketplace with enhanced services that are novel and improve quality to reduce overall cost of healthcare. As a clinically integrated provider-run network of CPESN Networks, CPESN USA makes sure to align with all of the defining characteristics of a CIN through its funding and governing structure as well as its activities, including: • Spending most of its resources on quality assurance, quality improvement, best practices and new, innovative services lines • Governed by pharmacy owners (providers)

Lindsey Ludwig, RPh Executive Director CPESN Iowa

from the network. Following the standards and actually providing a differentiating service in the marketplace is critical to long term survival and success of the network and its members. If you are interested in learning more about CPESN IOWA contact Lindsey Ludwig at 515-480-7795 or lludwig@ cpesniowa.com. ■

• Driving quality standards along with new and novel services offerings • Conducting regular quality reviews of participating pharmacies • Making investments in technology for sharing data, measurement and quality reporting • Requiring “Skin in the Game” through participation fees • Being selective in who participates and removing pharmacies that don’t perform

“A clinically integrated network (CIN) is defined as a collection of health providers that join together to improve care and reduce costs.”

Why does clinical integration matter? CINs create accountability for payers and providers. Pharmacies who don’t engage and perform will be removed

JUL.AUG.SEP 2019 |

PRACTICE ADVANCEMENT

Medication Management Accelerator Grant

IPA is participating in a grant project with the Iowa Healthcare Collaborative that will give $15,000 to six clinics in Iowa to embed pharmacist delivered patient care services. The project will last five months with the goal of developing a sustainable model for the clinics to continue to offer pharmacist services. IPA staff will serve as technical assistance and support for the six clinics which are: • Des Moines University Family Medicine – Des Moines • Horn Physician Clinic – Ida Grove • Lucas County Health Center – Chariton • Northeast Iowa Medical Education Foundation - Waterloo • Orange City Area Health System – Orange City • Primary Health Care Inc. – Des Moines

Pharmacies Conclude Efforts in APhAF’s Project IMPACT: Immunizations

As part of APhA Foundation’s Project IMPACT: Immunizations project, 16 Iowa community-based pharmacies are concluding efforts in phase 2 of this initiative that worked to evaluate the impact of an innovative practice model on identification of unmet vaccination needs and vaccination rates. Data is currently being analyzed on the nearly 2,500 patients impacted by pharmacists conducting comprehensive vaccine assessments with assistance from bidirectional information sharing with the state’s immunization registry. In addition, Project IMPACT: Immunizations was recognized internationally by the International Pharmaceutical Federation (FIP) with the FIP Pharmacy Practice Improvement Award. The award recognizes a program developed during the previous year that aims to improve or expand pharmacy practice and innovatively envision the pharmacist’s role. A multi-year initiative, Project IMPACT Immunizations was designed to evaluate what population health improvements are possible when pharmacists implement an innovative care model in community

| The Journal of the Iowa Pharmacy Association

pharmacy practice settings to address unmet adult vaccination needs. In 2017, the results of the pilot phase of Project IMPACT Immunizations showed that adult vaccination needs are better addressed when pharmacists have access to bi-directional immunization information systems (IIS) data that enables them to review comprehensive vaccination histories at the point-of-care. APhA Foundation and IPA hope to see similar results with Phase 2 of the initiative. IPA is thankful to have great partners implementing this process of care and resolving the unmet vaccination needs of so many patients!

Iowa Pharmacies Get Involved in the National DPP

The National Diabetes Prevention Program (DPP) was developed to offer affordable, high-quality lifestyle change programs for people with prediabetes to reduce their risk of type 2 diabetes and improve their overall health. Through the National DPP, healthcare organizations including pharmacies can refer to or deliver a CDCrecognized lifestyle change program. The lifestyle change program is designed to prevent or delay type 2 diabetes by teaching participants to make lasting lifestyle changes, like eating healthier, adding physical activity into their daily routine, and improving coping skills. CDC-recognized lifestyle change programs run for 1 year. In the first 6 months, your patients will meet weekly for 1 hour to learn different strategies for: • Eating healthy without giving up all the foods they love • Adding physical activity into their busy schedules • Dealing with stress • Coping with challenges that can derail their hard work—like how to choose healthy food when eating out • Getting back on track if they stray from their plan—because everyone slips now and then In the second 6 months, they will meet monthly for 1 hour to build on the skills they’ve learned and maintain their positive changes. They will review key concepts such as setting goals, tracking food and physical activity, staying

motivated, and overcoming barriers. The second 6 months is essential to help your patients stick with new habits. Over the course of 1 year, CDC-recognized lifestyle change programs offer about 24 hours of instruction to lower your patients’ risk of type 2 diabetes by more than half. In Iowa, currently Eagle Grove Pharmacy in Eagle Grove and Pharmacy on 8th in Wellman have CDC-recognized lifestyle change programs utilizing their pharmacists to guide patient education. For more information on the requirements for CDC recognition, please visit https:// www.cdc.gov/diabetes/prevention/ requirements-recognition.htm.

HIV Screening Initiative Underway Across the State

Eight community pharmacies across the state have been providing free HIV screenings within their communities since January. The project, in conjunction with the Iowa Department of Public Health’s Bureau of HIV, STD and Hepatitis, aims to improve HIV routine screening rates and reducing the gap in linkage to care for any patients that test positive. Forty-three tests have been delivered through September. The second cohort, consisting of seven community pharmacies, attended a full day of training in Iowa City delivered by the CDC, Iowa Department of Public Health and IPA. Objectives of this comprehensive training were to understand the CDC testing recommendations and transmission risks as well as counseling patients on reactive and non-reactive test results. This second cohort of pharmacies will begin offering free HIV screenings in their communities this fall. With the goal of 40 sites providing HIV screenings, IPA is looking to gain more interest in the following counties: Palo Alto, Pocahontas, Calhoun, Webster, Humboldt, Kossuth, Clarke, Decatur, Wayne, Lucas, Monroe, Appanoose, Wapello. These are areas of the state that the Iowa Department of Public Health considers focus areas, based on their epidemiology reporting. To participate in the project or to learn more, please contact Kellie Staiert, IPA’s Lead Project Manager at kstaiert@iarx.org. ■

Is your Pharmacy Ready to implement Technician Product Verification? Inside IPAâ&#x20AC;&#x2122;s TPV Toolkit, our Readiness Assessment will give you a gauge of your readiness to implement technician product verification to optimize patient care at your pharmacy practice. The assessment should be completed individually at each unique pharmacy location with input from an owner/district supervisor/pharmacy director, pharmacist-in-charge/ pharmacy manager, and lead technician. With the use of this assessment, you will know that it is likely a good time within your pharmacy to consider utilizing technician product verification to optimize patient care delivered by your pharmacists. This readiness assessment is just the first step as you begin the implementation process.

To learn more and to purchase the TPV Toolkit, visit www.iarx.org/TPV.

STUDENT LOAN REFINANCING

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Claim your 1001 toward your student loans at sofi.com/IPA. Checking your rate will not affect your credit score.2 Terms and Conditions Apply. SOFI RESERVES THE RIGHT TO MODIFY OR DISCONTINUE PRODUCTS AND BENEFITS AT ANY TIME WITHOUT NOTICE. To qualify, a borrower must be a U.S. citizen or permanent resident in an eligible state and meet SoFi’s underwriting requirements. See SoFi.com/elgibility for details. SoFi refinance loans are private loans and do not have the same repayment options that the federal loan program offers such as Income Based Repayment or Income Contingent Repayment or PAYE. Licensed by the Department of Business Oversight under the California Financing Law License No. 6054612. SoFi loans are originated by SoFi Lending Corp., NMLS # 1121636. Information as of July 2018. 1 Additional terms and conditions apply. Offer is subject to lender approval. To receive the offer, you must: (1) register and/or apply through the referral link you were given; (2) complete a loan application with SoFi; (3) have and provide a valid US bank account to receive bonus; (4) and meet SoFi’s underwriting criteria. Once conditions are met and the loan has been disbursed, you will receive your welcome bonus via automated clearing house (ACH) into your checking account within 30 calendar days. Bonuses that are not redeemed within 180 calendar days of the date they were made available to the recipient may be subject to forfeit. Bonus amounts of $600 or greater in a single calendar year may be reported to the Internal Revenue Service (IRS) as miscellaneous income to the recipient on Form 1099-MISC in the year received as required by applicable law. Recipient is responsible for any applicable federal, state or local taxes associated with receiving the bonus offer; consult your tax advisor to determine applicable tax consequences. SoFi reserves the right to change or terminate the offer at any time with or without notice. 2 To check the rates and terms you may qualify for, SoFi conducts a soft credit pull that will not affect your credit score. A hard credit pull, which may impact your credit score, is required if you apply for a SoFi product after being pre-qualified.

Celebrate your savings.

FEATURE

NEW EPA REGULATIONS – WHAT EVERY PHARMACY NEEDS TO KNOW

harmaceutical waste management in Iowa has just become easier and yet more difficult. I feel an explanation is in order. As of August 21, Iowa pharmacies are now subject to the Environmental Protection Agency’s (EPA) new Subpart P regulations regarding the management of hazardous waste pharmaceuticals (HWP). These long awaited regulations offer some much needed regulatory relief, but also impose numerous requirements that have been widening some pharmacists’ eyes. The new regulations pertain to all healthcare facilities as defined by the EPA. In short, everywhere human or animal pharmaceuticals are sold or administered. That’s quite a broad stroke. What stretches the gamut ever further is that even over-the-counter (OTC) medications and dietary supplements are considered pharmaceuticals.

Impact on Reverse Distribution: In order for a pharmacy in Iowa to send back the newly regulated hazardous waste pharmaceuticals, certain conditions must be met including the reverse distributor must be in a state that has adopted the new Subpart P regulations. This may pose a problem as some reverse distributors are in states that do not plan on adopting the new regulations for years. Fortunately, the Iowa Pharmacy Association endorses a local Iowa reverse distributor, National Pharmaceutical Returns. Amber Hollar, President of National Pharmaceutical Returns says “NPR is excited to be the first reverse distributor in the country operating under EPA’s new Subpart P regulations. Compliance is our utmost concern and we will take the time to educate all our customers on the changes they can expect and guide them effortlessly through the returns process.

While pharmaceutical waste management has been on the radar of most of the larger institutions, it has typically gone unnoticed by the other sectors that are now directly impacted such as retail pharmacies, clinics, dentists, optical facilities, veterinary facilities, long-term care facilities and doctor offices just to name a few. That’s all about to change.

Healthcare Facility Requirements: Facilities operating under Subpart P are required to meet numerous requirements such as: site notification, storage, labeling, handling, recordkeeping, reporting, transportation and disposal of hazardous waste pharmaceuticals. This will likely be the biggest challenge and expense facing pharmacies under the new regulations.

There are many aspects to the new regulations. I’d like to touch on a few of the key regulatory components from the pharmacy’s perspective.

Nationwide Sewer Ban of HWP’s: Sewering or drain disposing of any hazardous waste pharmaceuticals is strictly prohibited. Thinking about throwing them in the trash? Think again. Iowa prohibits the landfilling of hazardous waste as well.

Pharmacies are hazardous waste generators: EPA considers healthcare facilities to be generators of solid wastes, which will very likely include hazardous waste pharmaceuticals. Under specific conditions EPA will allow the return of the potentially creditable hazardous waste pharmaceutical back to a reverse distributor to facilitate credit. For example, undispensed prescription drugs with less than one year expiration date in their original packaging. HWP’s that do not meet those requirements are restricted from being sent back through reverse distribution even if the reverse distributor is in a state that has adopted Subpart P. Unauthorized waste reports will be sent to your facility and the regional EPA Administer if non-conforming HWP’s are sent back to the reverse distributor!

Nicotine Exemption: Nicotine replacement therapies in the form of gum, patches and lozenges are exempt from being hazardous waste. This is welcomed relief as nicotine was previously considered an acutely hazardous waste. Empty Container Relief: If specific conditions are met, it is now easier for hazardous waste containers to be empty. For example, packaging that once contained warfarin sodium is no longer considered a hazardous waste and can be handled as such. DEA/HWP Exemption: DEA controlled substances that are also hazardous wastes can be handled as non-hazardous if

Jeff Hollar President PharmWaste Technologies, Inc.

specific conditions are met. Primarily DEA regulations are followed and the DEA/ HWP waste stream is incinerated at one of five approved combustors. Both EPA and DEA (Drug Enforcement Administration) are quick to point out that current medicine disposal devices that use deactivation agents such as activated carbon that are used and thrown in the trash do not meet DEA’s non-retrievable standard despite some manufacturer claims. We strongly recommend no medicine disposal devices be thrown in the trash as they may very likely contain hazardous waste pharmaceuticals which is not permitted in Iowa landfills. Optional for VSQG’s: Most healthcare facilities qualify as Very Small Quantity Generators (VSQG’s). That is the lowest possible generator class for business hazardous waste generation. That’s good news as VSQG’s can opt not to participate in Subpart P. A strong case can be made for healthcare facilities to prove their VSQG status and opt out of participating in Subpart P. The catch is that they need to provide documented proof to this effect if they are ever audited. What’s my first step?: Identify which of your pharmaceuticals are hazardous and determine your generator status. One can then surmise if Subpart P is optional or required. From there it’s a matter determining regulatory requirements and developing policies and procedures so those requirements are followed. Free resource: To learn more about EPA’s new pharma rule visit our website at www.pwaste.com or call me directly at 515-276-5302. Our educational website is chock full of great information and has received numerous kudos from the both the pharmaceutical and regulatory community. JUL.AUG.SEP 2019 |

CLASS OF 2019

CONGRATULATIONS! Drake University College of Pharmacy and Health Sciences Class of 2019

Chintan Barot Brittany Behrens Jessica Berei Lauren Blum Brandon Boelts Austin Brandes Anna Burns Samantha Campbell Abigail Caslow Scott Caslow Carter Chapman Andrea Chargo Da Won Choi William Cleveland Samantha Dao Christopher Dawson Andre Do Nicole Draker Colby Dunn Mary Elder Erin Engbring Maxx Enzmann Lisa Feldmann Kristin Fipps Courtney Forschen Kee Gales Matthew Glasow Allison Golbach Kathryn Gray Spencer Gray Lucas Groeneveld Karli Gunn Melissa Harvey Michael Harvey Claire Herbst Amanda Hoerres

Meredith Hollman Marissa Holloway Olivia Hopton Brianna Hostert Lisa Huska Anastasia Hutton Michelle Jacob Hailey Jensen Yoon Young Jeong Jobin Joseph Matthew Kent Rachel Kiehne Nathan Koch Nita Kumaran Emily Lammers Gabrielle Landes Sara Lauterwasser Samantha Lee Zachary Lough Mercy Macharia Elena Maloletko Jenna ManatreyLancaster Kayla Manning Anna Marceau Kylie Markovich Danielle McKay Andrew Mitchell-Bueso Benjamin Modrell Hannah Mortland Michaela Newell Kelley Nguyen Ryan Nguyen Jacqueline Nordvall Michael Ohman Sara Olson

Jonathan Opheim Katherine Oâ&#x20AC;&#x2122;Reilly Cassandra Owens Jacqueline Parmentier Avani Patel Kelsey Piech Samantha Renfro Jakob Rhodes Emily Ryan Christopher Sahli Tylan Schreiner Julie Schultz Shawna Seibel Allison Sekula Taylor Sheahan Emma Sheldon Kayla Spars Katarzyna Spyrka Nichole Stark Rachel Strickler Alexander Stumphauzer Alyssa Sykuta Jess Thompson Brian Thoreson Jaclyn Tran-Nguyen Heather Vasquez Nicholas Vollmer Anna Wade Jacqueline Whitman Amanda Wiedemeier Amanda Wilken Andrew Winquist

Photos: Drake University College of Pharmacy and Health Sciences

| The Journal of the Iowa Pharmacy Association

CLASS OF 2019

CONGRATULATIONS! The University of Iowa College of Pharmacy Class of 2019

Ahamed Ahamed Abbey Ahlrichs Alyssa Berry Chelsea Brandt Katarina Brown Benjamin Buffington Rebecca Burgett Thy Cao Marianne Carter Jessica Coon Trang Dang Erin Day Zachary Delanoit Huiwen Deng Shelby Dick Connor Dierks Sadie Donahue Theresa Doyle Tess Dyson Adaeze Emecheta Brittany Faley Jacob Felckowski Joshua Formanek Miranda Fullerton Benjamin Gardner Paula Gawedzki Kristen Gerdesmeier Jillian Ginger Leah Granroth Alyssa Grycko Erik Gunderson Jinny Guo Bess Hanrahan Fischer Herald Erika Hilleman Giang Ho Steven Hong

Aron Hrubetz Sharon Huang Anthony Hunt Kyle Irland David Iverson Morgan Jacks Levi Jellison Grant Jerkovich Sophia Johnson Kaylee Kacmarynski Joshua Kirchner Meagan Koepnick Chase Kooyman Liza Kramer Torey Kranau Kelby Kwok Jordan Langreck Jisoo Lee Sarah Liebergen Sarah Lothspeich Zachary Lynch Kyle Lyons Trevor Mace Jasmine Mangrum Breannah May Joshua McDonald Mackenzie Meade Darin Meinen Gavin Meyer Agassi Mila Asma Mumtaz Mitchell Myers Abigail Narayan Briana Negaard Anh Thu Ngo Jessica Ngo Tony Nguyen

James Nguyen Corbin Nichol Molly Oâ&#x20AC;&#x2122;Brien Corey Osborn Whitni Patterson Autumn Petersen Abigayle Renner Suman Rijal Amna Rizvi-Toner Lauren Roder Alison Russell Abigail Sakellaris Rebecca Serino Maureen Smith Jessica Streit Jared Szabo Dayton Trent Jasmin Valentin Haley Ver Steeg Ashleigh Wallace Bradley Weis Andrea Weldon Daniel Wentworth Jaelyn Westfield Brittanie Wieland Samuel Williams Kate Zakrzewski Kelsey Zenti

Photos: The University of Iowa Office of Strategic Communications\Justin Torner

JUL.AUG.SEP 2019 |

PEER REVIEW

DEVELOPMENT AND IMPLEMENTATION OF A TRANSITIONS OF CARE PHARMACIST SERVICE Sarah C. Sougstad, PharmD, BCPS1; Jeffrey B. Ziffra, DO2; Shana A. Brunsvold, PharmD, BCPS1; Cheryl R. Larson, RPh, BCPS1 MercyOne North Iowa Medical Center Acute Care Pharmacy Department 1

MercyOne North Iowa Medical Center Department of Cardiology 2

Correspondence Sarah C. Sougstad, Acute Care Pharmacy Department MercyOne North Iowa Medical Center 1000 4th St. SW Mason City, IA 50401 Telephone: 641-428-2299 Fax: 641-428-7431 Email: sougstas@mercyhealth.com

The transitions of care pharmacist pilot program was determined by the local institutional review board to be a quality improvement project.

Authors have the following to disclose concerning possible financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject matter of this study: Sarah Sougstad: Nothing to disclose Jeffrey Ziffra: Nothing to disclose Shana Brunsvold: Nothing to disclose Cheryl Larson: Nothing to disclose

| The Journal of the Iowa Pharmacy Association

Abstract Background Patients are at risk for medication errors during transitions of care (TOC) from the community to the hospital and vice versa. Pharmacist involvement during TOC has been shown to improve patient care and safety. The primary objective of this study was to develop and implement a TOC pharmacist service at MercyOne North Iowa Medical Center. Methods This was an observational case series with prospective chart review and intervention by a TOC pharmacist. Metrics of the study included time spent with each patient; number and type of interventions made by the pharmacist; 30-day all cause readmission; error reports from the hospital’s voluntary error reporting system; Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores related to medications and transitions of care; and provider, nurse, and outpatient pharmacy satisfaction.

Introduction

MercyOne North Iowa Medical Center is a 205-bed community hospital located in Mason City, Iowa with 11,000 discharges annually. Inpatient service lines include critical care, cardiology, orthopedics, neurology, mental health, internal medicine, and general surgery. The inpatient pharmacy provides 24-hour on-site pharmacist service with a hybrid model of central and decentral services.

Results 195 patients met inclusion criteria and were enrolled during a five week period. 346 interventions were made by the TOC pharmacist. The readmission rate for patients in the TOC pharmacist pilot was 8.8% compared to the hospital-wide baseline 30-day readmission rate of 9.46%. There were 17 medication error reports on patients in the pilot. HCAHPS scores for patients in the pilot were higher than the hospital baseline. Conclusions This five-week TOC pharmacist pilot project demonstrated the benefits of a TOC pharmacist service at MercyOne North Iowa Medical Center. Keywords Patient readmission, patient satisfaction, pharmaceutical services, medication errors, counseling, pharmacists

Pharmacy technician “medication historians” record the majority of medication histories for patients admitted to the hospital. Pharmacists round with the multidisciplinary patient care team Monday through Friday in critical care, cardiology, internal medicine residency, and the hospitalist service line. Depending on available staff, one to three of the three hospitalist teams will have a pharmacist available for rounding.

PEER REVIEW

The hospital’s Patient Care Experience Strategy Team identified problems with transitions of care as a patient safety concern and convened a group of stakeholders in August 2017 to develop plans for process improvement. The group sought to discharge patients from the hospital with an accurate medication list that is understood by the patient, and with prescriptions that can be obtained in a timely manner. The group spent time reviewing current processes related to discharge medication reconciliation and developed a list of 196 problems to be addressed. Examples of issues identified included patients not understanding the purpose of their medications, prior authorizations not being completed, and outpatient pharmacies not being notified of discontinued medications. A review of current literature showed that pharmacist involvement in transitions of care (TOC) improves patient safety and outcomes. Successful TOC programs include a dedicated pharmacist providing face-to-face patient education, specific discharge instructions, and follow-up phone calls1. A recent meta-analysis demonstrated a 32% decrease in 30-day hospital readmissions with pharmacy-supported transitions of care interventions2. After review of current literature and local processes, the group recommended that the hospital hire a transitions of care (TOC) pharmacist. We describe a fiveweek pilot project of a TOC pharmacist service at MercyOne North Iowa Medical Center.

Methods

The primary goal of this pilot project was to develop and implement a TOC pharmacist service. The TOC pharmacist pilot program was determined by the local institutional review board to be a quality improvement project. One full-time equivalent (FTE) pharmacist position was dedicated to providing TOC services for five weeks (9/18/17-10/20/17) at MercyOne North

Iowa Medical Center. The pharmacist worked Monday through Friday day shift. The TOC pharmacist was responsible for guidelinedirected, comprehensive medication therapy management of complex patients at high risk for hospital readmission. The TOC pharmacist assisted with, reviewed, and/or intervened on the medication history, admission medication reconciliation, discharge medication reconciliation, medication counseling, and follow-up care of patients included in the TOC pilot project.

Figure 1: TOC Pharmacist Services Inpatient chart review • Review of admission medication reconciliation • Daily chart review to identify and intervene on drug therapy problems • Begin discharge planning including identifying barriers to access Discharge time out • Review discharge medication reconciliation to identify and intervene on drug therapy problems Discharge counseling • Face to face counseling on new and changed medications Transitions of care note • Fax a note to the patient's preferred outpatient pharmacy noting the new, changed, and stopped medications Follow-up phone call • Patient contacted 24-72 hours post-discharge to ensure they were able to obtain new medications and to review potential side effects

The LACE index was chosen as one method for identifying patients at high risk for readmission. LACE is an acronym that stands for length of stay, acuity of admission, comorbidities, and emergency department visits3. Patients were eligible to be reviewed by the TOC pharmacist if they were taking ten or more home medications or on warfarin at home, had a LACE index >/=9, or a working diagnosis of chronic obstructive pulmonary disease, congestive heart failure, myocardial infarction, or community acquired pneumonia, or per request. A daily report was generated to identify patients who met criteria. Patients were excluded from TOC pharmacist services if another pharmacist was involved in their care through rounding with the multidisciplinary care team. Patients were followed by the TOC pharmacist throughout the hospital stay as time allowed. Services provided included inpatient chart review, discharge time out, discharge counseling, transitions of care notes, and a follow up phone call 24-72 hours after discharge. See Figure 1 for an overview of each service provided. The pharmacist recorded the length of time spent with each patient after each service provided. The initial inpatient chart review

started with a review of the patient’s home medication list as recorded by the pharmacy technician medication historian. Potential errors were identified by reviewing the chart and noting potential drug therapy problems such as therapeutic duplication. The TOC pharmacist collaborated with the medication historian to correct potential errors in the home medication list. After the medical provider completed admission medication reconciliation, the pharmacist reviewed the inpatient medication orders to ensure essential home medications were continued and medications ordered were appropriate for the working diagnosis. Interventions on drug therapy problems were made with the patient’s medical provider via phone call or in-person conversation. Daily chart review included relevant medication monitoring, intervening on potential drug therapy problems, and discharge planning including identifying potential need for prior authorization of new medications. A “discharge time out” process was developed to identify potential drug therapy problems before the patient left the hospital. After the medical provider completed discharge medication reconciliation, the pharmacist took a “time out” to review the new home medication list to identify and intervene on potential drug therapy problems. JUL.AUG.SEP 2019 |

PEER REVIEW

Discharge counseling was performed with a focus on new, changed, and discontinued medications. The TOC pharmacist reviewed the purpose, use, and side effects of each new medication with the patient. The pharmacist also addressed potential barriers to obtaining medications. Upon discharge, a transitions of care note was faxed to the patient’s preferred outpatient pharmacy with pertinent information including new, changed, and discontinued medications. A follow up phone call was made to the patient 24-72 hours after discharge. The pharmacist asked if the patient was able to obtain any new medications and reviewed possible side effects. The TOC pharmacist assisted the patient with contacting the appropriate medical provider if concerns were identified. The TOC pharmacist prioritized discharge time outs when unable to complete all services for every patient due to time constraints. Patients going home on multiple new medications were also prioritized. Metrics of the study included time spent with each patient; number and type of interventions made by the pharmacist; 30-day all cause readmission; error reports from the hospital’s voluntary error reporting system (including “near misses” that did not reach the patient); Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores related to medications and transitions of care; and provider, nurse, and outpatient pharmacy satisfaction.

Results

195 patients met TOC pharmacist pilot criteria. See Table 1 for the number of services performed and average time spent with each patient. 346 interventions were made by the TOC pharmacist. See Figure 2 for percentage of interventions by category. The most common intervention types were “clarify drug order” and “minor adverse drug event prevention.”

| The Journal of the Iowa Pharmacy Association

Figure 2: Type of Intervention

New treatment recommendation 3%

Other 7%

Dose adjustment 4% Major adverse drug event prevention 6%

Prescription needed 8%

Clarify drug order 49%

Minor adverse drug event prevention 23%

The hospital-wide baseline 30-day readmission rate was 9.46% (9/18/1610/20/16). The readmission rate for patients in the TOC pharmacist pilot was 8.8% or 15 patients out of 170 patients. There were 17 medication error reports on patients in the TOC pharmacist pilot. Three of these reports were caught, reported, and/or corrected by the TOC pharmacist. Six reports may have been prevented if the TOC pharmacist were able to be involved (for example, patient discharged after TOC pharmacist hours). Eight reports were outside the scope of the TOC pharmacist pilot (for example, nursing issues). HCAHPS survey scores for patients in the pilot were higher than the hospital baseline satisfaction scores (Figure 3).

Surveys were distributed on nursing units and to medical provider groups after the completion of the TOC pharmacist pilot. 10 surveys were completed by colleagues, with seven of these completed by nurses. 10 out of 10 respondents indicated that the transitions of care pharmacist improved patient care. The average score for how satisfied the colleague was with their interaction with TOC pharmacist was 9.5 on a 10 point scale. Surveys were distributed to outpatient pharmacies where transitions of care notes had been sent during the TOC pharmacist pilot. Seven surveys were returned. Four of the respondents had received a transitions of care note and found it helpful. 100% of respondents indicated that it is important for the outpatient pharmacy to receive notification of new, changed, and

Table 1: TOC Pharmacist Services Performed TOC Pharmacist Service

Number of Patients with Service Performed

Average Length of Time Spent (minutes)

Inpatient chart review

109

Discharge time out

Discharge counseling

Transitions of care note

Not recorded

Follow-up phone call

PEER REVIEW

discontinued medications when a patient is discharged from the hospital.

Discussion

There were several limitations of our transitions of care pharmacist pilot. The one FTE pharmacist was not able to review all patients who met inclusion criteria. Discharge time outs were only performed on patients discharged during TOC pharmacist hours. The TOC pharmacist relied on the patient’s bedside nurse for notification that discharge medication reconciliation was completed. Some TOC services were not completed due to patients discharging before the TOC pharmacist was able to provide services or because another pharmacist became involved in their care. The average length of time for each service performed was recorded manually and was not recorded on every patient; when the pharmacist was interrupted multiple times while providing a service, the pharmacist often abandoned attempting to keeping track of time. The average length of time spent on each step is likely underestimated due to multiple interruptions while completing services. Statistical significance of results is unable to be calculated due to a lack of control group. The five week duration of the pilot resulted in a small sample size, and the pilot was restricted to one community hospital in northern Iowa.

The pharmacy department at our community teaching hospital was able to use the results obtained from this pilot study to develop and implement a transitions of care pharmacist position. A strategic initiative request for one FTE TOC pharmacist was submitted to senior leadership and subsequently approved.

now perform the follow up phone calls and consult the TOC pharmacist if assistance is needed.

In our model, the TOC pharmacist will report to the medication safety committee to ensure continuous quality improvement of facility-wide transitions of care. Organizational metrics for the service will include decreasing 30-day readmissions, improving HCAHPS scores related to medications and transitions of care, and decreasing transitions of care medication error reports.

Conclusion:

The TOC pharmacist service has been intermittently covered since then pending hiring and training of a new clinical pharmacist. Ongoing continuous quality improvement has led to some changes in the TOC pharmacist services. A discharge dashboard view within the electronic health record now allows faster identification of patients with completed discharge medication reconciliation. Transitions of care notes are faxed to the patient’s primary care provider and home health nursing service in addition to the patient’s preferred outpatient pharmacy when appropriate. Clinic health coaches

Future directions for the TOC pharmacist service include collaboration with the hospital’s new “Meds to Go” discharge prescription delivery service. This five-week TOC pharmacist pilot project resulted in the development of a permanent TOC pharmacist service at MercyOne North Iowa Medical Center.

References:

1. Phatak A, Prusi R, Ward B, et al. Impact of pharmacist involvement in the transitional care of high‐risk patients through medication reconciliation, medication education, and post discharge call‐backs (IPITCH Study). J Hosp Med 2016;11(1):39-44. Epub 5 Oct 2015. DOI 10.1002/ jhm.2493 2. Rodrigues CR., Harrington AR, Mudrock N, et al. Effect of pharmacy-supported transition-of-care interventions on 30-day readmissions: a systematic review and meta-analysis. Ann Pharmacother 2017; 51(10):866-89. Epub 9 Jun 2017. DOI 10.1177/1060028017712725 3. van Walraven C, Dhalla IA, Bell C, et al. (2010). Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. CMAJ 2010;182(6):551-7. Epub 1 Mar 2010. DOI 10.1503/ cmaj.091117

Figure 3: HCAHPS† Scores 100 90 80 70 60 50 40 30 20 10 0

Tell you what new medicine was for

Staff describe medicine side effect

Baseline (hospital-wide 2/17-9/17)

Understood purpose of taking meds

Pilot patients with pharmacist discharge counseling

† HCAHPS= Hospital Consumer Assessment of Healthcare Providers and Systems

JUL.AUG.SEP 2019 |

Advance IPA’s Legislative Agenda by Becoming a Champion Advocate Are you interested in becoming an important partner in helping IPA advance its legislative and regulatory agenda throughout the year? IPA is looking for Champion Advocates across Iowa to build relationships with their elected officials. Help us achieve our goal of having a Champion Advocate in every House and Senate district! Our goal is to have pharmacists establish trust and familiarity with their legislators to keep them aware of the key issues facing pharmacy. As you work to educate our representatives and senators, we can help build their understanding of our concerns regarding patient care and the role of the pharmacist.

By volunteering as a Champion Advocate, you would be kept up to date on the latest information relating to IPA’s advocacy agenda and would be ready to answer the call when IPA needs to make a grassroots push with legislators.

Responsibilities would include:

• Building relationships outside of the legislative session by hosting pharmacy visits with legislators and delivering PAC contributions when needed • Contact legislators during session to explain how pending legislation would affect your pharmacy practice • Relaying your personal experiences to help legislators understand the important role that today’s pharmacists play in enhancing the health care of Iowans • Stay informed with bill tracking/ IPA legislative priorities and participate in bi-weekly update calls

If you are interested in becoming a Champion Advocate or have any questions, contact Casey Ficek, IPA’s director of public affairs, at cficek@ iarx.org or 515-270-0713. Casey can help you identify your senator and representative and get started with setting up a pharmacy visit.

2019 LEGISLATIVE SESSION

THE 2019 LEGISLATIVE SESSION

he 2019 regular session of the 88th General Assembly adjourned on schedule this year. While many major pharmacy priorities failed to advance, several positive pieces of legislation were still enacted. Other positives included successfully defending against proposals that would have been detrimental to the practice of pharmacy in Iowa. Below are highlights of the action the Legislature took affecting pharmacy this session.

Enacted into Law

Medicaid Pharmacy Reimbursement IPA’s team of staff and lobbyists were again successful in defending and maintaining the Medicaid pharmacy reimbursement methodology at Average Acquisition Cost (AAC) + Cost of dispensing fee (now $10.07). A statutory mandate to continue utilizing this system was included in the final Health and Human Services budget passed late in the session. With numerous states now seeing the disastrous effects of allowing the MCOs and PBMs to control Medicaid pharmacy benefits, educating lawmakers, state officials, and the Governor’s office on maintaining the

current system is more important than ever. PBM Transparency PBMs were again a major focus of the legislative session. SF 563 was unanimously passed by the legislature and aims to make the role of PBMs in setting the cost of drugs more transparent. It requires each PBM to file an annual report with the Iowa Insurance Commissioner detailing the prices negotiated for prescription drugs, the administrative fees collected, and the rebates received from drug companies that it does not in turn pass on to its customer health plans. Medical Cannabidiol Included in the passage of a bill to update Iowa’s medical cannabidiol law was a change to help promote the utilization of pharmacists by medical cannabidiol dispensaries. Iowa Code now makes clear that a medical dispensary may employ a pharmacist or pharmacy technician.

Failed to Advance

Limiting Partial Fill Dispensing Fees HF 696 would have limited the dispensing fee for a partial fill to

Casey Ficek, JD Director of Public Affairs Iowa Pharmacy Association

only the amount authorized by the initial fill. Highlighting the benefits of utilizing partial fills for patients and the drawbacks in disincentivizing them by limiting the dispensing fee, IPA was successful in preventing the advancement of this legislation. Restructuring the Board of Pharmacy under IDPH Currently, the Board of Pharmacy is responsible for employing their own support staff and investigators. HF 212 would have moved all of the staffing responsibilities for the Board of Pharmacy, Medicine, Nursing, and Dentistry to the Iowa Department of Public Health. IPA has always maintained the importance of having an independent board, staffed by those who understand the details and intricacies of the pharmacy profession. IPA, along with organizations representing medicine, nursing, and dentistry, was successful in stopping this bill in the Senate. While all of these represent wins for the profession, much work is still needed to continue to keep Iowa one of the most progressive states for pharmacy in the country. To continue to advance a pro-pharmacy agenda, IPA will spend the interim educating lawmakers on the great opportunity to improve health care in Iowa by fully utilizing pharmacists. If you’re interested in helping build towards more success next year by hosting a legislator at your practice or serving as Champion Advocate, please contact IPA’s director of public affairs, Casey Ficek, at cficek@iarx.org or 515-270-0713. ■

Gov. Kim Reynolds signs SF 563, providing transparency to the role of PBMs in setting the cost of drugs.

JUL.AUG.SEP 2019 |

PUBLIC AFFAIRS

State Auditor to Investigate PBMs in Iowa Medicaid

Iowa’s state auditor, Rob Sand, announced in May that he will audit the PBMs that serve Iowa Medicaid. The issue in Iowa was brought to light by Rep. John Forbes, a pharmacist, who has been comparing what his pharmacy is reimbursed to what the state is being charged. To IPA’s and Forbes’ knowledge, pharmacies are being paid correctly by the MCOs’ PBMs (AAC + $10.07). However, the concern is that the PBMs may be charging the state more than what they are paying Iowa pharmacies, which is what the audit by Sand’s office will investigate. Rep. Forbes work on this issue was also featured in a report on Des Moines news station KCCI, bringing further attention to the issue. IPA met with Sand following the announcement of the investigation to offer our assistance as the investigation proceeds. It’s unclear how long the investigation will take, but Sand plans

to look at PBMs and whether the state could do something different to prevent possible overcharging.

IPA Legislative Advisory Committee Spring Meeting The IPA Legislative Advisory Committee met on May 30 at the IPA offices to recap the 2019 legislative session and prepare for the year ahead. New this year, a spring meeting was added to allow for immediate discussion of the events of the 2019 Legislative Session. Furthermore, the meeting provided IPA’s lobbying team with a clear sense of direction on IPA’s legislative priorities as they met with legislators over the summer months. This proved to be incredibly valuable as IPA staff, lobbyists, and members met with policy makers to build a foundation for success in 2020. Included on the agenda for the meeting was discussion on re-introducing legislation to expand pharmacist immunization authority, add additional statewide protocols, and

how to capitalize on the momentum in the fight against PBMs. The Committee will still meet in the fall to adopt IPA’s official legislative priorities for the 2020 legislative session.

New MCO Joins Iowa Medicaid

On July 1, Iowa Total Care became the latest managed-care organization (MCO) to begin providing benefit administration services under Iowa’s Medicaid program. July 1 also marked the last day UnitedHealthcare would be actively providing services as an MCO in Iowa. Director Mike Randol traveled the state in May to meet with providers and members in preparation for the change. Randol stated that both the Iowa Medicaid Enterprise (IME) and ITC were working vigorously to ensure a smooth transition. However, if you are encountering any issues since July transition, please contact IPA’s Director of Public Affairs, Casey Ficek, or IPA’s Executive Fellow, Amanda Abdulbaki for assistance. ■

STRENGTHEN ADVOCACY. STRENGTHEN PHARMACY.

The Iowa Pharmacy Political Action Committee is a fund used to strategically strengthen relationships with legislators that are supportive of pharmacy interests. Your contributions to the IPPAC aid in advocating for practice advancement, PBM regulation and other important issues facing our profession. For more information or to contribute, visit www.iarx.org/IPPAC IPPAC can only accept individual contributions. Corporate contributions can be made to the Legislative Defense Fund. Visit the website above for more information.

| The Journal of the Iowa Pharmacy Association

PUBLIC AFFAIRS

BOARD OF PHARMACY: REGULATORY UPDATE technology required in a TPV program, set requirements for policies and procedures, and set requirements for record keeping.

The Iowa Board of Pharmacy convened for open session on May 2, 2019 to discuss multiple requests, hear from the public, and consider several proposed rules.

IPA Presentation

IPA’s Anthony Pudlo and Casey Ficek gave a presentation to the Board regarding the current state of the pharmacy profession across the country. Anthony Pudlo discussed issues and trends that state and national associations are currently working on. Casey identified the legislative and regulatory trends related to practice advancement that are occurring across the country.

Vote of Adoption on New Regulations

Adoption of Rules for Technician Product Verification The rules implementing IPA’s 2018 Technician Product Verification legislation were finalized and adopted by the Board. Effective June 26, the rules replaced the previous rules related to “tech-check-tech.” The rules establish minimum standards for implementation, including a limitation on the number of checking technicians allowed per pharmacist within the prescription filling process. The new rules also set requirements for a certified pharmacy technician to participate in product verification activities, identify minimum scanning

USP 800 The Board also finalized and adopted rules relating to the implementation of USP General Chapter 800 in Iowa. After receiving numerous public comments on the initial noticed rules, the Board modified them to retain the enforcement date as determined by USP, but allow compounding pharmacies to seek delayed compliance of up to 18 months. The Board may grant a request for delayed compliance if the pharmacy can demonstrate progress towards full compliance and adequate protection of public health, safety, and welfare during the delayed compliance. The proposed rule and revisions were approved by the Administrative Rules Review Committee on June 11 and became effective on June 26. ■

Tune-in to IPA’s BOP: What, Why & How podcast following each Iowa Board of Pharmacy meeting to recap the board’s actions and earn pharmacy law CE. More information at www.iarx.org/BOP_ Podcast.

IPA WORKING FOR YOU Addressing Your Iowa Medicaid & MCO Concerns IPA has begun to engage Iowa Total Care, a subsidiary of Centene, which will start in the managed care marketplace in Iowa on July 1, 2019. Twila Johnson, PharmD, has been named pharmacy director for the MCO and IPA looks forward to collaborating with Iowa Total Care. Iowa Total Care is now enrolling all provider types including pharmacy and durable medical equipment providers. UnitedHealthcare (UHC) will be leaving the Iowa Medicaid managed care marketplace no sooner than June 30, 2019. Governor Reynolds ended negotiations with UHC when terms could not be reached. All Iowa Medicaid beneficiaries who were previously with UHC will now be split with the two remaining MCO’s, Amerigroup Iowa, Inc. and Iowa Total Care. Since requiring all diabetes supplies to be billed under the medical benefit as durable medical equipment (DME) and no longer at pharmacy point of sale, the Iowa Medicaid Enterprise (IME) has increased the fee schedule reimbursement for diabetes test strips, syringes, lancets, and control solution. Please reach out to IPA if you are having trouble enrolling as a DME provider. IPA has created resources to assist pharmacies with DME which are available on the IPA website. IPA will continue to advocate on your behalf to best care for Medicaid beneficiaries.

JUL.AUG.SEP 2019 |

PUBLIC AFFAIRS

IPA Advocacy at the Federal Level Throughout 2018 and into 2019, IPA has done significant outreach and relationship building with Iowa’s Congressional delegation and their staff. Through attending congressional fly-ins, hosting pharmacy visits, and providing the expertise and knowledge of IPA members and staff when needed, IPA has been able to contribute in shaping the national policy discussion surrounding pharmacy. In September, IPA Executive Vice President & CEO Kate Gainer and Director of Public Affairs Casey Ficek attended the ASHP Legislative Day in Washington DC. as part of their Policy Week 2018. The group met with Rep. David Young, Rep. Dave Loebsack, and Sen. Joni Ernst to discuss how issues like drug shortages, rising drug costs, and the opioid crisis affect patients. In October, IPA worked closely with Senator Ernst and her staff to provide support as they introduced the Access to Increased Drug Disposal (AIDD) Act, which will appropriate grant money to states seeking to expand medication disposal options. IPA provided two letters of support for the legislation, which was ultimately included in the large opioid package passed in October. In February, Senator Ernst was the featured speaker at the Midwest

| The Journal of the Iowa Pharmacy Association

Pharmacy Expo’s Political Leadership Reception. Senator Ernst discussed the work she has done to improve access to care, bring down drug costs, and curb problematic PBM practices.

In March, Casey and IPA’s executive fellow Matt Pitlick joined pharmacy advocates from all 50 states in Washington, D.C., for the NACDS RxIMPACT Day to advance pharmacy value and viability. With a patient-focused agenda, IPA and NACDS discussed with Iowa’s congressional offices the threat of direct and indirect remuneration (DIR) fees and the urgency for reform. Advocating for pharmacists to provide additional services given their extensive education, and discussion of the ongoing efforts to help address opioid abuse and addiction were also central to the advocacy agenda.

Casey and seven other IPA members attended the NCPA Congressional Flyin in April, where they met with all of Iowa’s congressional offices on numerous issues affecting community pharmacies. Following these meetings and the disappointing news that CMS would not address DIR reform this year, IPA has been working closely with our national partners to urge congressional action. IPA was successful in urging all four of Iowa’s House Representatives, as well as Senator Ernst, to sign on to a letter to President Trump expressing their disappointment in the administration’s decision. IPA is also leading a letter from a coalition of Iowa pharmacies to encourage Senator Grassley to include DIR reform in his upcoming drug pricing legislation from the Senate Finance Committee.

PUBLIC AFFAIRS

CBD IN THE PHARMACY? QUESTIONS ANSWERED Can Cannabidiol Derived Products be Sold in the Pharmacy?

With the recent proliferation of products and therapies derived from cannabidiol (CBD), many pharmacies have been contacting IPA to determine whether CBD products can be sold in their stores. Until recently, the question was answered with an unequivocal “no” from both the Iowa Board of Pharmacy and Iowa Department of Public Health. However, with the passage of Iowa’s Hemp Act and a recent FDA hearing on cannabisderived products, the question has again been brought to the forefront. What did the Iowa Hemp Act change? During the 2019 Legislative Session, lawmakers cleared a bill allowing for the growth and sale of industrial hemp in Iowa. While there has been much confusion regarding the intent of the law, Iowa Attorney General Tom Miller issued a clarification in July. According to the AG’s statement, “Any product containing cannabidiol is currently classified as a Schedule I controlled substance under Iowa law and is, thus, illegal. At this time, the only exceptions to this classification are FDA-approved medications and Iowa’s medical CBD program, which is administered by the Iowa Department of Public Health.”

How does the change in Iowa’s law conform with federal law? At the federal level, the Agriculture Improvement Act of 2018, Pub. L. 115334, (the 2018 Farm Bill) was signed into law on Dec. 20, 2018. Similar to Iowa’s Hemp Act, the 2018 Farm bill included removing hemp from the Controlled

Substances Act (CSA), which means that cannabis plants and derivatives that contain no more than 0.3 percent THC on a dry weight basis are no longer controlled substances under federal law. The 2018 Farm Bill, however, explicitly preserved FDA’s authority to regulate products containing cannabis or cannabis-derived compounds under the Food, Drug, and Cosmetic (FD&C) Act and section 351 of the Public Health Service Act (PHS Act). The FDA treats products containing cannabis or cannabis-derived compounds as it does any other FDA-regulated products — meaning they’re subject to the same authorities and requirements as FDAregulated products containing any other substance. This is true regardless of whether the cannabis or cannabis-derived compounds are classified as hemp under the 2018 Farm Bill.

What CBD products has the FDA approved?

Currently, the FDA has only approved one-cannabis-derived (Epidiolex) and three cannabis-related drug products (Marinol, Syndros, and Cesamet), all of which require a prescription. There are no other FDA-approved drug products that contain CBD. Furthermore, federal policy maintains that adding CBD oil to food products is the same as adding a prescription drug. However, under the FD&C Act, cosmetic products and ingredients are not subject to premarket approval by FDA. Certain cosmetic ingredients are prohibited or restricted by regulation, but currently that is not the case for any cannabis or

cannabis-derived ingredients, such as topical creams, patches and sprays that do not include THC. Still, ingredients not specifically addressed by regulation must comply with all applicable requirements, and no ingredient – including a cannabis or cannabis-derived ingredient – can be used in a cosmetic if it causes the product to be adulterated or misbranded in any way.

What does this mean for my pharmacy?

This article does not constitute legal advice and pharmacists must ensure they do their due diligence before stocking any CBD oil product on their shelves. CBD oil products present the opportunity to expand profitability on OTC products. However, choosing which CBD product to sell in your pharmacy can be a complicated decision, involving both the legality of the product and its clinical effectiveness. To fully ensure compliance with all state and federal regulations, it is recommended you consult with an attorney prior to deciding to sell CBD oil products.

How does this impact hospital, long-term care, and other health facilities?

While neither the federal nor state bills legalize the sale or manufacturing of all hemp-derived products, they do decriminalize possession of CBD products derived from hemp. This should enable health facilities to define more clearly their policies and procedures when determining how to handle patients who are in possession of CBD products.■

JUL.AUG.SEP 2019 |

TECHNICIAN CORNER

Advancing the Role of the Pharmacy Technician, Technician Study Group IPA recognizes the importance of advancing the role of the pharmacy technician and has received funds from the Pharmacy Technician Certification Board Partnership Funds Program to implement a Technician Engagement Strategy in Iowa.

Starting in December 2019, IPA will offer Technician Study Groups for pharmacy technicians and candidates who will be taking one of the national pharmacy technician certification exams - the Pharmacy Technician Certification Exam (PTCE) or the Exam for Certified Pharmacy Technicians (ExCPT). The study group will meet virtually every Wednesday at 8:00 pm starting December 4, 2019 and ending February 19, 2020. There is a planned two-week break during the holiday season. At least 12 participants will be required to start the study group. Cost of this 10-week study group is $75 for IPA members and $150 for non-members. IPA has developed the Technician Study Group as direct response to our members. The study group is designed to bring together pharmacy technicians from around the state to network and troubleshoot studying for one of the certification exams. IPA developed this program to complement various printed study materials that pharmacy technicians may already be using. Share this program with your technician colleagues as they prepare for this important milestone in their professional career! To register, please visit IPA’s website - www.iarx.org. If you are interested in facilitating one of the weekly study groups or would like to learn more, please contact Kellie Staiert, IPA’s Lead Project Manager at kstaiert@ iarx.org

Authorized Generic vs. ANDA Generic (From IPA’s May 2019 Tech Tidbits newsletter)

Is an authorized generic drug the same thing as a generic drug? The FDA has a complete explanation on its website, here is an excerpt: “No. The term “authorized generic” drug is most commonly used to describe an approved brand name drug that is marketed without the brand name on its label. Other than the fact that it does not have the brand name on its label, it is the exact same drug product as the branded product.” How is an authorized generic drug different from what is commonly understood to be a generic drug? Another excerpt from the FDA states: A generic drug is the same as the brand-name drug in active ingredient, conditions of use, dosage form, strength, route of administration, and (with certain permissible differences) labeling. To obtain approval of a generic drug, a company must submit an Abbreviated New Drug Application (ANDA) to the FDA and prove that its product is the same as the brand-name drug in the ways described above, and that it is “bioequivalent”, meaning it gets to the part of the body where the drug works at the same time and in the same amount. An authorized generic drug is the same as the brand-name drug but does not use the brand name on the label. Because an authorized generic drug is marketed under the brand name drug’s New Drug Application (NDA), it is not listed in FDA’s Approved Drug Products with Therapeutic Equivalence Evaluations (the Orange Book). An authorized generic is considered to be therapeutically equivalent to its brand-name drug because it is the same drug. This is true even if the brand-name drug is “single source”, meaning there are no ANDAs approved for the product, or coded as

non-equivalent (e.g., BX) by FDA in the Orange Book. This article was originally published in the April 2019 edition of the Newsline by PAAS National® *. Visit www. paasnational.com or call toll-free at 888870-7227 to learn more.

Staying Safe in the Sun

(From IPA’s June 2019 Tech Tidbits newsletter) With the summer months upon us, there is no better time to refresh ourselves on safe sun habits and learn about FDA regulations about sunscreens. As a technician, you are in a unique position to help patients with sunburn prevention strategies and products. This tidbit will help you get more familiar with guidelines and tips crucial to preventing the adverse effects of too much sun. The best way to stay safe is to limit time in the sun. Overexposure is considered to be the primary cause of skin cancer. This means avoiding exposure when the sun’s rays are the strongest, between 10 AM and 2 PM. One of the best prevention methods patients can do is regular use of a broad-spectrum sunscreen with an SPF of 15 of higher. SPF stands for Sun Protection Factor. The SPF rating describes how much protection a sunscreen provides and it will vary with each specific product. Broadspectrum sunscreens offer protection from both UVA and UVB radiation. UVB is primarily responsible for burns and is the primary cause of skin cancer. UVA is responsible for contributing to skin cancer formation and penetrates deep into the skin, causing damage to underlying skin structures. Patients should apply sunscreen at least every 2 hours, regardless of SPF, or after swimming or significant perspiration. Photosensitizing Medications We know that some medications can trigger photosensitivity, or increased sensitivity to the sun. These medications include, but aren’t limited to, doxycycline, tretinoin, ciprofloxacin, * © 2019 PAAS National® All Rights Reserved

| The Journal of the Iowa Pharmacy Association

TECHNICIAN CORNER

sulfamethoxazole/trimethoprim, and hydrochlorothiazide. Patients using these medications pose an opportunity to educate and direct towards sun protection measures your pharmacy offers. Other measures patients can take to minimize the effects of the medication include taking them in the evening if appropriate, which may lower drug levels during maximum sun exposure, and waiting 15-30 minutes after applying topical photoactive medications to apply sunscreen. FDA regulations Recently enacted regulations from the FDA are aimed at improving quality, safety, and efficacy of sunscreens. Staying up to date with the latest science in important to ensure the most effective sun care options. The FDA proposed that of the 16 marketed active ingredients in sunscreens, two ingredients – zinc oxide and titanium dioxide- are generally recognized as safe and effective (GRASE). Two ingredients – PABA and trolamine salicylate – are not GRASE due to safety issues. The other 12 ingredients have insufficient safety data to make a positive GRASE determination, and the FDA is seeking more data. Other proposed regulations include raising the maximum SPF value on labels from 50+ to 60+, requiring sunscreen with SPF of 15+ to provide broad spectrum protection, that the magnitude of protection against UVA radiation increase in proportion to the SPF, new sunscreen product label requirements to assist consumers in more easily identifying key information, and proposing that products that combine sunscreen and insect repellent are not GRASE. ■

NEWLY CERTIFIED IOWA TECHNICIANS April 1 - June 30, 2019

Congratulations to the following pharmacy technicians on becoming PTCB-certified! Lucille Ackers Samantha Barnes Joseph Baumann Jennifer Beck Jenna Bemiss Nirjan Bhattarai Robert Boulter William Bradley Shelbie Brotherson Melissa Campbell Brandon Chahine Colton Clymer Matthew Coakley Alana Coble Verna Conklin Nikole Cook Andrea Cook Haley Cox Tiffany Dale Zefira Dervisevic Macayle DeVore Donell Dittmer Beau Finley Danielle Folsom April Gohring Allyson Gries Kaitlin Hansen Spencer Heggen Karlie Henaman Mathew Hintz

Jonna Hoffman MaKayla Hoing Noah Hrubetz Laney Hufendick Tilak Humagai Braedon Inagaki April Jackson Emily Jester Jennifer Jones Melissa Kappelman Linda Kazane Heather Ketcham Kamil Kirja Joan Knutson Jacob Leisinger Madelyn Lewis Keegan Lilly Sarah Mandel Jessie McDanolds Alexa McLaughlin Madison Meardon Victoria Mendoza Dylan Michael Haley Miller Brooke Mills Trey Mueller Maria Lorraine Navalta Zachery Nunemaker Shannon Palmer Samantha Pedelty

Rigoberto Perez Ngoc Phan Tiffany Rangel Anna Rehberg Caylan Ringgenberg Katelyn Roling Lauren Rowbottom Mindy Rummans Evangeline Scheibe Amber Schneider Melody Sedlacek Kathy J. Simonton Eferonia Soliman Isabella Steinhauer Phoebe Stratton Lesli Tapia Hailey Tweden Cody Underwood Sara Utterback Britnee Valentine Johnnie Veatch Keanu Vernon Gloria Villanueva Rachel Vincent Rebecca Weatherwax Alyssa Weber Nicole Wendel Kaley Wolff Tim Zuo

CPhT Recertification CPE for FREE! Join IPA for your FREE subscription to CEI’s Technician Catalog! CEI’s Technician Catalog is a web-based subscription that contains accessible and convenient continuing education courses for technicians to recertify and advance their career path.

Technician Members!

To receive the Tech Tidbits newsletter each month, be sure that your email is up-to-date in your member profile on IPA’s website www.iarx.org.

Members: Login at www.iarx.org/cei_libraries to take advantage of this new benefit for members and spread the word to your colleagues.

JOIN NOW & Receive Your Free CPE! www.iarx.org/membership | 515.270.0713 | ipa@iarx.org

JUL.AUG.SEP 2019 |

Specializing in certifying pharmacy technicians because patient safety matters. Choose PTCB. Choose Excellence.

ptcb.org

TECHNICIAN CORNER

TECHNICIANS HAVE A VOICE AT IPA ANNUAL MEETING

s technicians, we all have ideas and opinions about the changing pharmacy technician roles that we play each day in our profession. It’s exciting, and even more exciting is the fact that technicians can have a powerful voice. I witnessed this for the first time 3 years ago at the IPA Annual Meeting that I attended. As a technician, I was nervous. I already had these thoughts in my head that this meeting was for pharmacists, but I decided to attend with a fellow colleague and see what it was all about. I was asked to be a delegate for the House of Delegates that year, which was my first surprise. You mean I get to voice my opinion and vote on policy? I can get up and state my opinion on an important topic regarding technicians that could affect me? Sign me up!

You mean I get to voice my opinion and vote on policy? I can get up and state my opinion on an important topic regarding technicians that could affect me? Sign me up! The meeting was great. I met so many amazing people and had great discussions. I could feel inside that it had lit a fire in me. These people care about what technicians want and what we are doing to go above and beyond in our profession. The

IPA Annual Meeting also has a great element of poster presentations from the students of Drake University and University of Iowa. Each presenter was equipped with an amazing amount of information that they were ready to share. I was amazed.

I could feel inside that it had lit a fire in me. These people care about what technicians want and what we are doing to go above and beyond in our profession. Another great component of the IPA Annual Meeting was the banquet and awards ceremony the first evening; it left me speechless. Awards were given to professionals that care about pharmacy practice and want to be involved with IPA – including technicians (see page 16 for full list of honorees). I loved reading about the Pharmacy Technician of the Year and what great things they were doing in their area of pharmacy. It was inspiring! It proves that we aren’t here to just count some pills. These technicians can do amazing things! I knew that I wanted to be one of these people and be as well-rounded of a pharmacy technician as I could be.

Amanda West, CPhT, CSPT Health Enterprises Marshalltown

It’s the perfect opportunity to learn and grow, meet new people, and eat amazing little desserts while bidding during the silent auction, all while being a voice for my fellow technicians in Iowa. Join us next year at IPA Annual Meeting and see the amazing things happening for technicians in Iowa! ■

From the networking, to the poster presentations, to the banquet (and of course, let’s not forget Anthony Pudlo’s amazing DJ skills), IPA Annual Meeting is off the charts.

JUL.AUG.SEP 2019 |

IPA FOUNDATION

IPA FOUNDATION BOARD OF DIRECTORS TRANSITIONS TO 2019-2020 With the new administrative year comes a new IPA Foundation Board of Directors. The foundation would like to welcome new director Craig Logemann. Steve Firman will serve as president with Bob Stessman serving as vice president.

Steve Firman, BS Pharm, MBA, FAPhA Cedar Falls President

Bob Stessman, RPh Manning Vice President

Renae Chesnut, BS Pharm, EdD, MBA Des Moines Drake University College of Pharmacy & Health Sciences

Gary Milavetz, BS, PharmD, RPh, FCCP, FAPhA Iowa City The University of Iowa College of Pharmacy

Kate Gainer, PharmD West Des Moines Secretary/Treasurer

Carl Chalstrom, RPh Anamosa

Bob Greenwood, RPh Waterloo

Tom Halterman, RPh West Des Moines

Rick Knudson, PharmD, BCPS, MS, MBA Clear Lake

Julie Kuhle, RPh Indianola

Craig Logemann, RPh, BCACP, CDE Ankeny

John Swegle, PharmD, BCPS Mason City

2019 SILENT AUCTION GOES VIRTUAL The 2019 IPA Foundation Silent Auction featured over 90 items up for bid and some friendly competition on several hot items. In addition to bidding on the fantastic array of items, the Silent Auction featured the Red Envelope Challenge and the beer and wine ring toss. New this year, all bidding and game item purchases were done through an app. The foundation would like to thank everyone who donated items, placed winning bids, threw rings and accepted a new Red Envelope Challenge. Over $11,000 was raised to support foundation initiatives that support student pharmacists and practice advancement across the state!

| The Journal of the Iowa Pharmacy Association

IPA FOUNDATION

LEADERSHIP PHARMACY WELCOMES 2019 CLASS

CONGRATULATIONS!

The IPA Foundation would like to congratulate these 10 Iowa pharmacists who were selected to participate in the 2019 Leadership Pharmacy Conference: Michael Daly, PharmD - Drake University/The Iowa Clinic Matthew Farley, PharmD - Fresenius Kabi Brian Glenn, PharmD - Clarke County Public Hospital Alex Mersch, PharmD - University of Iowa Hospitals and Clinics Michael Schnackenberg, PharmD - Hy-Vee Pharmacy, Des Moines

Matt Witry , PharmD, PhD

Adam Weinkauf, PharmD - UnityPoint Health – St. Luke’s Hospital

On your selection to the 2019 Leadership Pharmacy Conference!

Terry Wiedenfeld, PharmD - Mercy Medical Center, Sioux City Pamela Wong Wiltfang, PharmD - NuCara Pharmacy Matthew Witry, PharmD, PhD - University of Iowa College of Pharmacy Heidi Wood, PharmD - University of Iowa Hospitals and Clinics

A BIG thank you to all pharmacists and technicians in the state for the health care and leadership you provide every day to Iowans!

These Iowa pharmacists will join 10 of their peers from Wisconsin in Galena, Illinois, on August 8-10, 2019, for a conference that provides strong leadership training, increases awareness of state and national pharmacy issues, encourages involvement in professional and community activities, and develops new practitioners for leadership roles within the profession. The Leadership Pharmacy Conference is a unique opportunity for pharmacists in their first three to fifteen years of practice. Since its inception in 1989, over 350 Iowa pharmacists have completed Leadership Pharmacy and have gone on to become IPA presidents, board members, committee chairs, and leaders within their practice sites. This program is available to pharmacists in Iowa and Wisconsin who are interested in becoming leaders in their profession. Twenty pharmacists, ten from each state, are selected annually to participate. ■

JUL.AUG.SEP 2019 |

IPA FOUNDATION

SUMMARY REPORTS OF THE 2018 OUTCOMES INNOVATIVE PHARMACY GRANT AWARDEES In 2018, the IPA Foundation awarded a total of $37,000 in grants to four projects through the Outcomes Innovative Pharmacy Grant program. As required by the grant, each recipient has provided a summary of their project. Each recipient also presented a poster at the 2019 IPA Annual Meeting in Cedar Rapids, Iowa.

OUTCOMES INNOVATIVE PHARMACY GRANT About the Outcomes Innovative Pharmacy Grant

The grant program stems from the Outcomes Innovative Pharmacy Endowment that was established by the original investors of OutcomesMTM, a medication therapy management, or MTM, service provider based in Iowa. In 1999, the Iowa Pharmacy Association provided seed money to support this innovative startup, which became a national leader in MTM services. Following the purchase of OutcomesMTM by Cardinal Health in 2015, the endowment was created as a way for those original investors to give back to the pharmacy profession and keep the innovative spirit and legacy of the company and Iowa pharmacy alive. Applicants must be an Iowa-licensed pharmacist or an Iowa-based researcher working with Iowa pharmacists in an innovative pharmacy practice. Applicants must also be active members of the Iowa Pharmacy Association. The application deadline for the next grant cycle is December 1, 2019. Information can be found at www.iarx.org/outcomesgrant.

Creation and Implementation of a Pharmacy Network in Iowa-Year 2 Grantee: Randy McDonough

Community pharmacy enhanced services networks (CPESN) is gaining momentum nationally as a network of networks. CPESN-USA is the national network providing support, practice tools, and products to local and regional networks. CPESNIOWA was an early leader of this initiative. CPESN-Iowa is a network developed and managed by community pharmacists who proactively are responding to the changes occurring in healthcare and provided solutions to improving medication management. Participating CPESN-Iowa pharmacies agree to engage in the network, collaborate and share ideas, and share practice data as determined by the network. The goal of CPESN-Iowa is to improve the quality of patient care through medication optimization services and reduce total costs of care. This is accomplished through the active integration of community pharmacists with the larger health care team/system. The objectives of this Outcomes Grant is to operationalize the strategic, and marketing plans for CPESN-Iowa and to provide support to individual network pharmacies to help them succeed in providing enhance services and realize clinical revenue for participating in network contracts. A strategic initiative for CPESN-Iowa was securing a network wide contract. This was successfully accomplished in 2018 with the first contract initiated with Tabula Rasa Health Care (TRHC) in which CPESN-Iowa pharmacies provided Medication Safety Reviews (MSRs) for patients enrolled in enhanced MTM services. Seventy-eight pharmacies participated in the enhanced MTM contract with TRHC and collectively received $463,850.00 in clinical revenue. Additionally, CPESNIowa expanded its marketing effort by contracting with the Iowa Pharmacy Association to connect the network to major stakeholders including medical groups, health agencies, MCOâ&#x20AC;&#x2122;s and other potential payors. CPESN-Iowa hired an executive director who has helped to provide support services to individual network pharmacies, provide administrative services to the network, and assist in recruiting and maintaining network pharmacies. Currently, CPESN-Iowa has 104 network pharmacy members providing Iowa with a high ranking for network adequacy.

Pharmacist Led Diabetes Management Using BiDirectional Text Message Reminders Grantee: Rachel Finkelstein

This randomized controlled pilot study evaluated the impact of a 4-month long combined intervention consisting of pharmacist-led remote management of Type 2 diabetics coupled with bi-directional daily text reminders for patients to check their blood sugar and respond with the value. Patients

| The Journal of the Iowa Pharmacy Association

IPA FOUNDATION

in the control group received usual care from their primary care providers without any texting component. The primary outcome was the difference in A1c between control and intervention groups at 4 months. Patients 18-99 years old were eligible if they had an A1c greater than or equal to 8%, spoke English or Spanish, owned a mobile phone capable of texting, owned a glucometer, and were seen in clinic within the last 12 months. A web-based texting platform was used to send the text reminders and blood glucose readings submitted by patients were evaluated on, at minimum, a weekly basis. Patients were contacted via phone regarding out of range readings. Pharmacists worked closely with patients and their primary care providers to ensure appropriate glycemic control. A total of 22 patients were enrolled, 11 in both control (5 female) and intervention (4 female) groups. The baseline A1c for the control group ranged from 8.0-11.5% and 8.2-13.7% in the intervention group. This study helps provide insight regarding the advantages and disadvantages of the role of texting in diabetes management and in pharmacist workflow.

Community Pharmacist Provision of Chronic Care Management Services for Medicare Beneficiaries with Uncontrolled Hypertension Grantee: Jim Hoehns

Chronic Care Management (CCM) is a billable patient care service for Medicare patients by qualified health professionals, but it is not directly billable by pharmacists. Our project created a collaborative practice and business agreement for community pharmacists (Greenwood Pharmacy) to provide CCM services to patients of Northeast Iowa Family Practice Center (NEIFPC). Community pharmacists recorded care documentation directly in the NEIFPC electronic health record. Outcomes included precise measures of time effort (via Time Tracker® ), revenue potential for CCM services, and changes in blood pressure control over 9 months. There were 26 patients who received at least one pharmacist encounter. There were 71 community pharmacist care notes documented in the NEIFPC EHR. From July 1, 2018 to February 28, 2019 a total of 5,632 CCM minutes (NEIFPC 3012, Greenwood 2620) were provided. There were 123 CCM claims billed for total revenue of $5085 (NEIFPC $2674.67, Greenwood $2410.33). Without CCM services provided by Greenwood Pharmacy, NEIFPC would have only been able to bill 51 claims for $2229 in revenue. Community pharmacist CCM services resulted in a 7.2 mm Hg decline (P=0.006) in SBP and a 2.4 mm Hg decline (P=0.079) in DBP.

hypertension was significantly improved for study patients. This community pharmacist-primary physician CCM collaboration may serve as a model for other practice sites to establish CCM services for Medicare patients.

The Community Provider-Pharmacist Collaboration to Improve Patient Outcomes through Electronic Medical Record (EMR) Sharing Grantee: North Liberty Pharmacy

The North Liberty Family Health Centre (NLFHC) and North Liberty Pharmacy have a long-standing collaborative relationship. This relationship is unique in the fact that both healthcare entities are independent and are not affiliated with a hospital system. Currently, providers from NLFHC refer patients to the pharmacy’s AADE-accredited diabetes education program and the practices have developed and implemented a GLP-1 agonist collaborative practice agreement. Receiving the IPA Outcomes grant allowed us to hurdle roadblocks and begin the process, as both parties were excited to make it a reality. As part of the goal of gaining EMR access, we worked with the physicians and clinic staff to create an access agreement, set up VPNs, add new users to the EMR, and train the pharmacists on the EMR. As this was a demonstration project, we did not have finite results or outcomes. However, we have some examples of how EMR access helps both the pharmacy and the clinic. The pharmacists are able to find lab and vital data without interrupting the workflow of either the pharmacy or clinic. Progress notes can be used to clarify treatment goals. Patient safety is maintained by verifying allergies and immunization records. We have plans to continue moving this project forward in order to achieve our secondary goals of documentation within the EMR and collaborating to provide patient care services. We are currently exploring Chronic Care Management as a potential collaborative service. It is our hope that our project can help serve as an example of local independent healthcare entities collaborating to provide better patient care, including the steps necessary to gain EMR access. We thank the providers and staff at North Liberty Family Health Centre and IPA for allowing us this opportunity to move pharmacistprovider collaboration forward. ■

This shared CCM hypertension project between a community pharmacy and primary care physician clinic was successful. It resulted in pharmacists being able to modify drug therapy, document their patient care notes in the physician EHR, and to receive CCM payments for their services. Treatment of

JUL.AUG.SEP 2019 |

MEMBERS SECTION

IPA MEMBER SPOTLIGHT:

Jen Morris, PharmD

Written by:

Julie Schultz 2019 PharmD Candidate Drake University

or those who are unsure about what career path to pursue, a career assessment is an invaluable tool to utilize. This is exactly what this IPA member chose to do after trying her hand at a variety of career paths, including engineering, accounting, and education, to name a few. Jen Morris found that pharmacy was a top match in the career assessment she performed while attending Iowa State University. With this information and words of encouragement from mentors in her hometown of Manning, Iowa, she chose to pursue pharmacy at Drake University. This Member Spotlight highlights the benefits of strong mentorship and collaboration between individuals within pharmacy, especially in rural communities. Jen graduated with a Doctor of Pharmacy degree in 2006 (the career assessment results were correct!). At the beginning of pharmacy school, she secured a job at Medicap Pharmacy in Urbandale with John Forbes as her boss. Forbes evolved into one of Jen’s mentors, and she found that this job was “the right place to learn about the profession and how to be a pharmacist.” An opportunity to move back to her

| The Journal of the Iowa Pharmacy Association

hometown arose after graduation and Jen took it. Bob and Lois Stessman, the couple who encouraged Jen to pursue a career in pharmacy, offered Jen a new position to work at both Manning Pharmacy, an independent store they owned and operated, and the local critical access hospital. An opportunity like this was too good to pass on as pharmacist positions were few and far between in her hometown of only 1,500 people. “I love the opportunity to take care of my family, friends, and neighbors in the community I grew up in,” Jen describes. She continued in this role for 12 years. As the profession evolved, the time demands of maintaining electronic health record systems and Pyxis machines, along with increased quality initiative requirements, pushed Jen to transition from working in a dual position to become the Director of Pharmacy at Manning Regional Healthcare Center (MRHC) full time in July of 2018. MRHC is a critical access hospital that provides a vast array of pharmacy services for the Surgery Department, ER, Medical-Surgical/Skilled Care Floor, and Clinics; provides chemotherapy; and takes part in Long Term Care Clinical Team meetings. As the only pharmacist in her current setting, Jen makes it a priority to sit face-to-face with each patient on the Medical-Surgical floor for medication education. She also meets with the Recovery Center Substance Abuse clients each month for medication education, in addition to all other daily tasks. Jen finds that the most challenging aspect of working in a Critical Access Hospital is fulfilling all roles of the pharmacy director position as the only pharmacist. She looks

to meaningful collaboration with pharmacists in western Iowa and in the Mercy network for advice and to bounce ideas off each other. “Having those connections is crucial for a small hospital to stay current clinically and prevent us from recreating the wheel on policies.” Additionally, there still is collaboration between Manning Pharmacy and Manning Regional Healthcare Center happening that benefits the pharmacists involved, rotation students, and the patients in the community. Telepharmacy plays a key role in this setting. This service takes over when Jen leaves work for the day and they have become an important part of the pharmacy care in Manning and add to the level of medication safety in rural care. Jen states, “as rural populations continue to decline, having convenient access to healthcare is such a critical piece to attracting families.” Jen credits Kala Chapman, a certified pharmacy technician, for performing at peak level to keep the pharmacy department organized and running smoothly. Chapman is not only involved in the purchasing and billing aspects of pharmacy, but also is responsible for performing the compounding for the hospital. Jen states, “I value being on a team of healthcare workers that pull together to provide the best care possible for patients.” It is easy to get caught up in the routine requirements of work. However, Jen always finds time for activities she is passionate about, such as serving on the Library Board, being Chairman of the Zion Lutheran Preschool Board, and teaching Sunday school. Spending time with her husband, Alan, and three children (Camden, Brennen, and Harper) and

MEMBERS SECTION

doing outdoor activities, like camping and hiking or working in the garden, and playing the flute in church, are ways Jen keeps her mind clear and feels refreshed.

MEMBER MILESTONES

The mentorship that students and pharmacists receive is crucial in creating lasting relationships and fostering support. Jen credits her mentors for pushing her to be the best pharmacist she can be for the benefit of her patients in a small, rural community. The collaboration reciprocated among health care professionals is also credited to be a critical advantage in performing to the best of your ability. In today’s fast-paced society, IPA supports taking advantage of reaching out to your mentors and continuing in your collaboration efforts to avoid burnout and be at the top of your game. ■

Abby Cate, PharmD, recently started as a pharmacist at Medicap Pharmacy in Urbandale. Congratulations, Abby!

WELCOME NEW IPA MEMBERS! APRIL 1 - JUNE 30, 2019: Leah Amundson, Lakeville, MN Matt Austin, Coralville Jeni Burckart, La Crosse, WI Kirk Crabtree, Oxford Jodi Delaney, Fort Dodge Rhonda Edwards, Monroe Sarah Greiner, Washington Jane Gressang, Iowa City Benjamin Jagow, Urbandale Jenifer Maki, Johnston Teresa McAfee, Monmouth Deb Nadarevic, West Des Moines Trenton Powell, Le Mars Gary Robb, Saint Germain, WI Aimee Wiedenman, Brooklyn Jonathan Wilson, Iowa City

Carson Klug, PharmD, began a new position at Broadlawns Medical Center. Congratulations, Carson! Nathan Peterson PharmD, BCPS, received a Wartburg College Young Alumni Award. Congratulations, Nathan! Congratulations to Emily Rogers who recently joined Iowa Total Care as pharmacy director! Chelsea Schott, PharmD, MBA, recently started as regional support pharmacist for Thrifty White. Congratulations, Chelsea! Congratulations to Jamie Sinclair, BS Pharm, MS, RPh, FASHP, who was elected to the ASHP Board of Directors! Congratulations to Amanda West, CPhT, CSPT, on her new position as 340B compliance analyst at Health Enterprises in Cedar Rapids!

THANK YOU FOR SUPPORTING IPA!

MEMBERS: Have You Accessed Your FREE Continuing Education Benefits Yet? IPA members receive a FREE subscription to CEI’s web-based Pharmacist or Pharmacy Technician Course Catalog, which include all required CPE for pharmacist relicensure and pharmacy technician recertification, for FREE. In addition, you also receive FREE continuing education credit for IPA’s BOP: What, Why & How podcast series and select 2/2/2 webinar recordings!

Have you taken advantage yet? See how at www.iarx.org/accesscpe JUL.AUG.SEP 2019 |

2020 Community Pharmacy Scholarship Apply at phmic.com/scholarship • Apply October 1 - December 2, 2019 • Recipients selected will be awarded $2,500 each • Up to $50,000 awarded annually

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phmic.com

IPA IN ACTION Powerful Content & Personal Connections – ASHP Summer Meeting 2019

On June 8-12, 2019, Iowa pharmacists attended the 2019 ASHP Summer Meetings & Exhibition in Boston, MA. The enthusiasm and positive spirit throughout the week helped create a productive and fun atmosphere for learning powerful content and making personal connections.

Pharmacists on Full Display at 2019 Iowa Governor’s Conference on Public Health

With poster and podium presentations focused on pharmacists, attendees at the 2019 Iowa Governor’s Conference on Public Health on April 23-24 learned about the great opportunities to partner with the profession of pharmacy across the state.

IPA was well-represented with members in the House of Delegates and spread throughout the meeting to network with other hospital pharmacy professionals and to build partnerships for future collaboration and practice advancement. Save-the-Date: 2020 ASHP Summer Meeting on June 6-10 in Seattle, WA

IPA Meets with Australian Pharmacist

Posters described the leadership role of pharmacists in antimicrobial stewardship and penicillin skin testing, as well as the opportunities that come from embedding pharmacists in primary care clinics. In addition, a podium presentation focused on the untapped potential of pharmacists to address the gaps in the behavioral health system. This presentation focused on the efforts of IPA’s behavioral health ad hoc committee that convened in 2017 and 2018.

Katy the Kangaroo Visits Central Iowa Elementary Schools

While IPA does not stand for the International Pharmacists Association, IPA leadership and staff met with Neil Petrie, consultant pharmacist from Melbourne, Australia, on April 26. Neil’s connection to Iowa pharmacists dates back to working with the Iowa Center for Pharmaceutical Care (ICPC) as well as accepting APPE rotation students. The discussion focused on current initiatives in value-based healthcare and behavioral health opportunities.

McKesson & RxOwnership Speaks to Opportunities within Independent Ownership

On May 1 at Drake University, and on May 2 at University of Iowa, student pharmacists discussed openly with representatives from RxOwnership about opportunities within independent pharmacy ownership. Students received a crash course in financial statements as well as understanding various mechanisms to purchase a pharmacy. IPA would like to thank McKesson and their RxOwnership group for engaging student pharmacists in the opportunities available upon graduation!

Katy the Kangaroo made visits to two different Des Moines area elementary schools. IPA’s own Matt Pitlick played the role of Katy and was joined by P4 rotation student, Julie Schultz, and IPA CEO Kate Gainer. They educated the children about the role of pharmacists and medication safety. IPA developed Katy’s Kids in 1988 and continues to present the program to teach young children about medicine and medication safety.

JUL.AUG.SEP 2019 |

IPA IN ACTION

CALENDAR OF EVENTS

Find additional details to these events and more at www.iarx.org. Click on the “Calender of Events” link under the Events tab.

NOVEMBER 2019

JANUARY 2020

3-6

PharmSci 360 - San Antonio, TX

IPA Goes Local Burnout and Resiliency - Iowa City, IA

5-6

Iowa Board of Pharmacy Meeting - Des Moines, IA

7-10 ASCP Annual Meeting - Grapevine, TX 12-13 Leading without Leading to Burnout - Cedar Rapids, IA 13-14 2019 Midwest Rural Agricultural Safety and Health Conference - Marshalltown, IA 15

NAMI Iowa Annual Conference

DECEMBER 2019 3

IPA Goes Local Burnout and Resiliency - Ames, IA

8-12 ASHP Midyear - Las Vegas, NV

2/2/2 is IPA’s free monthly webinar series that keeps 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.

IPA Legislative Day - Des Moines, IA

FEBRUARY 2020 7-9

Midwest Pharmacy Expo - Des Moines, IA

MARCH 2020 20-23 APhA Annual Meeting -Washington, D.C.

APRIL 2020 7-8

Iowa Governor’s Conference on Public Health Des Moines, IA

CEImpact Immunization Training - Des Moines, IA

IPA LEGISLATIVE DAY January 29, 2020 www.iarx.org/IPALegDay

JOIN US ON:

November 12, 2019: E-prescribing December 10, 2019: TBD January 14, 2019: TBD Register for these upcoming webinars and view previous ones at www.iarx.org/222. Topics subject to change

| The Journal of the Iowa Pharmacy Association

Feb. 7-9, 2020 Hilton Des Moines Downtown

MidwestPharmacyExpo.com

PHARMACY TIME CAPSULE

19 99

Issues & events that have shaped Iowa pharmacy (or are fun to remember!)

JANUARY:

The Iowa Board of Pharmacy announces “secret shoppers” program to enforce patient counseling and pro-DUR regulations. The formal establishment of the new professional organization for pharmacy in Iowa occurred. On January 1st, Iowa Society of Health-System Pharmacists and the Iowa Pharmacy Association were unified to represent all pharmacists, pharmacy students, and pharmacy technicians in Iowa. The Healthy and Well Kids in Iowa (HAWK-I) program began on January 1st which provided coverage for children age 18 and younger who did not qualify for Medicaid but were at 185% of the federal poverty level.

MARCH:

Jordan Cohen began as the new dean of the University of Iowa College of Pharmacy on March 1st succeeding Gilbert Banker. Cohen was previously dean of the University of Kentucky College of Pharmacy. Governor Tom Vilsack was the keynote speaker at IPA Legislative Day on March 3rd. His speech focused on the importance of quality health care to attract future Iowans. The Remington Medal was awarded to Carl Franklin Emswiller, Jr. of Leesburg, Virginia during APhA annual meeting in San Antonio, Texas on March 7th. Representative and Iowa Pharmacist, Robert Osterhaus, received the Hubert H. Humphrey Award from APhA on March 8th which recognizes a pharmacist for distinguished public service as an elected or appointment government official.

APRIL:

IPhA held its 93rd annual convention. This convention hosted several speakers who spoke on topics ranging from “Better Pharmacy Communication” between chain and independent pharmacy to “Legal and Public Health Aspects of Rx Price Posting and Discount Advertising Practices”.

MAY:

Certification in Geriatric Pharmacy established by CCGP IPA hosted a conference for Iowa Hospital and Health System Pharmacy Directors to discuss issues facing practitioners and consequently develop ways to advance pharmacy practice. The FDA added “pharmacist” to Over-the-Counter Medication labeling as in “Ask your doctor or pharmacist.” On November 10, a pharmacy postage stamp was issued in Cincinnati, Ohio to honor the 120th anniversary of the American Pharmaceutical Association. The stamp pictured a Bowl of Hygeia, that was associated with the American Pharmaceutical Association, and a Mortar and Pestle, associated with the National Association of Retail Druggists.

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.

JUL.AUG.SEP 2019 |

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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 Schaaf at dschaaf@iarx.org or call the IPA office at 515.270.0713 for more information.

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| The Journal of the Iowa Pharmacy Association

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ENGAGE CONNECT ENERGIZE ADVANCE

JOIN!

Find your spark, share your passion, or reinvigorate your fervor for pharmacy by plugging-in. IPA provides a unique opportunity for professional involvement that crosses the full spectrum of pharmacy practice. Tap into the wealth of knowledge and experience of the Iowa pharmacy community as you create meaningful connections with colleagues from a diverse array of practice settings. Share experiences and work sideby-side with your pharmacy family to advance the profession in Iowa.

Join IPA today at www.iarx.org