A Peer-Reviewed Journal | Vol. LXXIV, No. 1 | JAN.FEB.MAR 2018
ADVANCING PRACTICE STARTS HERE & NOW IPA’s Proactive Legislative Priorities Plus: Do Pharmacists in Iowa Have Provider Status?
INSIDE: Board of Trustee Election Candidate Profiles Advisory Committee Reports Iowa Pharmacists Host Their Legislators
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 Shannon Rudolph, PharmD
COVER STORY Advancing Practice Starts Here & Now pg. 26
A look at IPA’s 2018 legislative priorities, which look to expand practice for both pharmacists and pharmacy technicians.
OFFICERS CHAIRMAN Rick Knudson, PharmD, BCPS, MS, MBA, Clear Lake PRESIDENT Craig Logemann, RPh, BCACP, CDE, Ankeny PRESIDENT-ELECT Cheryl Clarke, BS Pharm, RPh, FAPhA, Waukee TREASURER Sue Purcell, RPh, Dubuque SPEAKER OF THE HOUSE Steven Martens, PharmD, Grundy Center VICE SPEAKER OF THE HOUSE Jim Hoehns, PharmD, FCCP, BCPS, Cedar Falls
TRUSTEES REGION 1 Christopher Clayton, PharmD, MBA, Manchester REGION 2 Thane Kading, BS Pharm, RPh, Iowa City REGION 3 Rachel Digmann, PharmD, BCPS, Ankeny REGION 4 Carol Anderson, PharmD, Mason City AT LARGE Jessica Frank, PharmD, Winterset Deanna McDanel, PharmD, BCPS, BCACP, Coralville Heather Ourth, PharmD, BCPS, BCGP, Ackworth Nora Stelter, PharmD, CHWC, Urbandale HONORARY PRESIDENT June Johnson, BS, PharmD, FASHP, FCCP, BC-ADM, Des Moines PHARMACY TECHNICIAN Meg Finn, CPhT, North Liberty STUDENT PHARMACISTS Michael Harvey, Drake University Grant Jerkovich, The 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.
Iowa Pharmacists Host Their Legislators Iowa pharmacists welcome their legislators to their pharmacy and discuss issues. pg. 33
2018-2019 Board of Trustees Election Preview the candidates before you cast your ballot. pg. 6
FEATURES
Board of Trustee Election . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2018 Midwest Pharmacy Expo . . . . . . . . . . . . . . . . . . . . . . . . . . 12 IPA Advisory Committee Reports . . . . . . . . . . . . . . . . . . . . . . . 18 College of Pharmacy Deans’ Columns . . . . . . . . . . . . . . . . . . . 22 COVER STORY: Advancing Practice Starts Here & Now . . . 26 IPA’s 2018 Legislative Priorities . . . . . . . . . . . . . . . . . . . . . 29 IPA Legislative Day 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 RAGBRAI Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
IN EVERY ISSUE
President’s Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Health Care Hot Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Iowa Pharmacy News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Practice Advancement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Public Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Board of Pharmacy Update . . . . . . . . . . . . . . . . . . . . . . . . . 34 Technician’s Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 IPA Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Member Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 IPA Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Calendar of Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Pharmacy Time Capsule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Mission Statement
The Iowa Pharmacy Association empowers the pharmacy profession to improve health outcomes. JAN.FEB.MAR 2018 |
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PRESIDENT’S PAGE
A COMMON THEME
A
s the new year begins, a common theme with my patients revolves around the economics of healthcare. Patients are contemplating the selection of their health or medication insurance for 2018. They are also considering the affordability of their daily medications. Many of my encounters are with patients with diabetes who are faced with adding a new medication(s) to their current regimen. Unfortunately, the high cost of brand-name medications often forces us to choose less than ideal medications (e.g.: sulfonylureas or intermediate-acting insulin). A recent Consumer Reports survey1 examined 1200 adults who currently take prescription medications. 22% of them had a price hike in one of more of their medications over the past year. Close to one third of these people said they paid at least $50 per month extra for one of more of their prescriptions. The additional costs often force patients to not comply with their provider’s treatment plan (16% did not take the drug as scheduled and 15% cut pills in half without doctor approval). I recently signed a petition with the American Diabetes Association called “Stand Up for Affordable Insulin – www.makeinsulinaffordable.org”. Here are some interesting statements from their website: • The average price of insulin tripled from 2002 to 2013 • The cost of insulin in Europe is about 1/6th of what it is in the U.S. We all understand that this is a complex issue which will require
significant efforts to reverse the current trends. A recent Pharmacotherapy article outlines 52 policy proposals that have been suggested to reduce U.S. branded prescription costs.2 The author of the article summarizes the current problem with this quote. “The lack of an approach that everyone agrees on to address prescription drug spending is largely due to the complexity of the U.S. pharmaceutical market. As a result, the status quo is often the chosen option, which rewards parties with a vested interest in the current system.” Below are the major categories of the 52 different policy proposals listed in the article: • Revising the patent system • Encouraging research to increase development of new drugs • Altering pharmaceutical regulation • Decreasing market demand • Developing alternative pricing policies Another recent article of interest in Pharmacy Today summarizes practical strategies implemented by pharmacists to assist patients on high-cost medications.3 The possible solutions are numerous and require us to be creative in ways to assist our patients. The author also reviews legislative strategies from various states to help address the high cost of medications. Many questions remain about how we can appropriately address the widespread problem with the high cost of healthcare and specifically brand-name medications.
Craig Logemann, RPh, BCACP, CDE Ankeny IPA President
• What are the best strategies for policy makers to consider in attacking this widespread problem? • How can we ensure a more transparent system for pricing negotiations – especially with PBMs? I want to say thanks for your involvement with this complex issue affecting our nation and state’s healthcare system. Addressing the high cost of healthcare will require teamwork. Let us do whatever we can do to help be problem solvers with this complex issue. Let’s continue to be involved with informing our policy makers regarding the lack of transparency in the pricing of medications. Share your recommendations with others. Continue to advocate for your patients in searching for cost-effective medication options. References
1. Consumer Reports Dec 14, 2017. Accessed from www.consumerreports.org on 12/17/17. 2. Alexander GC, Ballreich J, Socal MP, et al. Pharmacotherapy 2017;37(11):1469-78. 3. Pharmacy Today 2017 (Nov. edition):36-9.
• How can we start reversing the trend of significant cost increases of brand-name medications?
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IPA BOARD ELECTION
BOARD OF TRUSTEES ELECTION Vote for the 2018-2019 Iowa Pharmacy Association Board of Trustees! ELECTRONIC BALLOTS WILL BE SENT THURSDAY, FEBRUARY 1, 2018. Each candidate’s personal statement and bio will be available online with the electronic ballots. All IPA pharmacist members vote for all elections. Ballots will close Tuesday, February 13 at 12:00 midnight. To request a paper ballot, contact the IPA office at 515-270-0713.
FOR THE OFFICE OF PRESIDENT Cheryl Clarke, BS Pharm, RPh, FAPhA Waukee
Cheryl Clarke, BS Pharm, RPh, FAPhA, is assistant dean for clinical affairs and associate professor of pharmacy practice at the Drake University College of Pharmacy and Health Sciences. She administers the experiential education programs for the Doctor of Pharmacy, Occupational Therapy Doctorate, and undergraduate health sciences programs. Prior to joining Drake, Clarke served in a variety of roles at the Iowa Pharmacy Association (IPA) including senior vice president of professional and public affairs. During her tenure at IPA, she administered the IPA policy process, directed the drug utilization review programs for clients such as Iowa Medicaid, and supported the development and implementation of patient care payment models including the Iowa Medicaid Pharmaceutical Case Management program. Clarke is a 1986 graduate of the Drake University College of Pharmacy and is currently completing the Doctor of Education Leadership program at Drake University. Clarke is an active member of a variety of professional associations including IPA where she has served on the board of trustees, policy committee chair, house delegate, and numerous committees. She was co-chair of the IPA/Iowa Board of Pharmacy Patient Safety Task Force and a former member of the State of Iowa Pharmacy and Therapeutics Committee. Clarke is past president of the Iowa Rural Health Association and recipient of its Jerry Karbeling Award. Clarke is an APhA-APPM Fellow of the American Pharmacists Association and has served on various APhA policy committees and as a house delegate.
About the Board The IPA Board of Trustees is the governing body responsible for advancing the goals and objectives of the association. The board ensures clear communication between IPA and its members and maintains a strong awareness of our members’ needs, desires and attitudes. With that understanding, the Board shapes the association’s personality, defines its goals, sets its budget, and charts its future. Each year, IPA members have the opportunity to choose who will represent them on the board. Candidates are selected by a nominations committee and are then ratified by the IPA House of Delegates at the Annual Meeting in June. The election is held the following February and those elected are inaugurated at the following Annual Meeting. Trustees are elected to serve a 2-year term. The board meets for a retreat each summer and then meets in November, February and April at the IPA office in Des Moines, and again at the IPA Annual Meeting the following June.
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The Nomination Process
Each year, the IPA president appoints a Nominations Committee, consisting of at least five members and chaired by the immediate past-chairman of the IPA Board of Trustees. The committee selects nominees for each elected position at IPA with the goal of filling a ballot with active IPA members that represent the diversity of practice settings that Iowa enjoys. The committee’s slate of candidates is presented for approval during the House of Delegates at the IPA Annual Meeting. Once approved, the ballot is sent to the membership at the beginning of the following year.
IPA BOARD ELECTION FOR THE OFFICE OF PRESIDENT-ELECT
Connie Connolly, RPh, BCACP DeWitt
Connie Connolly is a community pharmacist providing patient centric care at Osterhaus Pharmacy in Maquoketa, Iowa. Her practice includes providing consultant services in long term care, adherence packaging, hospice care, MTM, immunizations and collaborative care with other providers. She is a preceptor for the Community Pharmacy Residency program at Osterhaus and an adjunct professor for both the University of Iowa and Drake University colleges of pharmacy. Connolly earned her BS degree from the University of Iowa College of Pharmacy and holds nationally recognized Board Certification in Ambulatory Care through the Board of Pharmacy Specialties. Early in her career, she was a field facilitator training pharmacists in the practice of pharmaceutical care in the community setting. Connolly was the founding president of North Iowa Pharmacy, Inc. She served as co-chair of the IPA/Iowa Board of Pharmacy Patient Safety Task Force, a member of the Iowa Medicaid DUR Committee, the Editorial Advisory Board of the Journal of the American Pharmacists Association and was a public member of the Iowa Board of Optometry for three terms. Connolly currently serves on the Pharmacy Services Workgroup of CPESN Iowa and CPESN USA. She is an active member of APhA. In her 28 years of membership, Connolly has served on many IPA committees and task forces beginning with the PBM Task Force in 1997. She has served on both the Public Affairs and Professional Affairs Committees, serving as the Vice Chair and Chair of the former in 2010-2011. Having served as Vice Speaker and Speaker of the House in 2013-2015, she continues to participate as a House delegate and an IPA Education Committee member. Connolly is a Leadership Pharmacy Alumnus and is a recipient of the Distinguished Young Pharmacist Award.
Lisa Mascardo, PharmD, FASHP Coralville
Lisa Mascardo, PharmD, FASHP, is the director of ambulatory pharmacy services at The University of Iowa Hospitals and Clinics (UIHC). Lisa oversees the provision of all ambulatory pharmacy services including Specialty Pharmacy Services, eight ambulatory pharmacies within UIHC, two off-site pharmacy locations, mail order, MTM, infusion, and the Holden Comprehensive Cancer Center. Lisa is responsible for the Investigational Drug Service and the provision of clinical pharmacy services in the ambulatory clinics, including the pharmacistrun Anticoagulation Service and Pharmacotherapy Clinics. Lisa was previously a pharmacy manager at UIHC in Acute Care and a clinical pharmacist in oncology. She is an adjunct assistant professor with The University of Iowa College of Pharmacy, and works with student pharmacists and residents on pharmacy management rotations. Dr. Mascardo received her B.S. in Pharmacy and PharmD degrees from The University of Iowa College of Pharmacy. Lisa is an active member of the Iowa Pharmacy Association, having served on the IPA Board of Trustees and as Speaker of the House of Delegates. She is a past member of the Policy Committee on Public Affairs and the Health-System Liaison Board. In 2013, she was recognized as Iowa Pharmacy Association’s Health System Pharmacist of the Year. As an active member of the American Society of Health-System Pharmacists (ASHP), Lisa has represented Iowa as a delegate to the ASHP House of Delegates for multiple years. In 2015, she was recognized as Fellow of ASHP. She is currently serving a 3-year term as the Chair of the ASHP Council on Pharmacy Practice. She is also the chair of the Vizient/University HealthSystem Consortium’s Ambulatory Pharmacy Development Committee and serves on their Pharmacy Council Executive Committee.
FOR TRUSTEE - REGION 1
Sharon Cashman, RPh Waverly
Sharon Cashman graduated with a Bachelor of Pharmacy degree from The University of Iowa, where she was an active member of Kappa Psi and worked for the Iowa Drug Information Services. She is currently the director of pharmacy services for Waverly Health Center, overseeing the inpatient and retail pharmacies. Sharon serves as adjunct faculty for the Univeristy of Iowa College of Pharmacy, IPPE 1 and 2 students in both hospital and community pharmacy and is in her seventh year of the hospital practice preceptor for the NEIFP residency program. Sharon actively promotes the Planetree philosophy of patient centered care at Waverly Health Center. Her responsibilities include the support of pharmacy staff members as they assist their customers and patients. She is also involved in the Community Collaborative that focuses on transition of care, antimicrobial stewardship, adverse drug reactions and opioid use. In 2017, she entered into the CPESN network, which promotes community pharmacy enhanced services. Sharon stays current in the field through her participation in Black Hawk-Bremer Pharmacy association, IPA Midwest Pharmacy Expo and the IPA 2/2/2 educational series. She has served on the IPA Education Advisory Committee, the Medicaid/PBP Advisory Committee, the IPA House of Delegates, and the IPA RAGBRAI Committee.
Jill Stegall, PharmD Waterloo
Jill Stegall is the retail pharmacy manager for Wheaton Iowa. She received her PharmD from the University of Iowa College of Pharmacy in 2002. She has worked in retail pharmacy, including chain, independent, and hospital owned, for the past 15 years. She has been with Wheaton Iowa since 2013 and in her current role managing the retail pharmacies since 2015. Jill has led many change efforts in the pharmacy to advance technology and expand services. The pharmacy implemented new pharmacy dispensing software, automated counting devices and medication synchronization software. The pharmacy will implement a dispensing robot in January. Jill has collaborated with the Director of Pharmacy and Transitions of Care Pharmacist to offer meds to beds upon hospital discharge. Under her leadership, they have expanded immunization services offering vaccinations at all 3 sites. Jill has been involved with the Iowa Community Pharmacy Enhanced Services Network (CPESN), New Practice Model and Wellmark Value Based Pharmacy Program. Jill is a past participant of the IPA Leadership Pharmacy Conference (2016).
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IPA BOARD ELECTION FOR TRUSTEE - REGION 3
Sally Haack, PharmD, BCPS Urbandale
Sally Haack attended Drake University graduating with her Doctor of Pharmacy degree. Following two years of work at a community pharmacy, she joined the faculty at the Drake University College of Pharmacy and Health Science in 2004. She is currently an associate professor of pharmacy practice. Her position involves coordinating a pharmacy skills-based lab course for 3rd year student pharmacists and precepting students at Primary Health Care, an FQHC in Des Moines. At Primary Health Care she provides diabetes education for patients and also participates in clinic-based projects, such as medication reconciliation and medication quality improvement projects. Her research interests center on service-learning and cultural dynamics of health. She became a Board Certified Pharmacotherapy Specialist in 2008 and was presented with Drake’s Hartig Distinguished Professor Award in 2016. Sally is professionally active as a member of the Iowa Pharmacy Association. She participated in the New Practitioner Leadership Conference in 2005 and has served as a delegate at many IPA Annual Meetings. Additionally, she has served on four policy committees with most recently leading the Policy Committee on Public Affairs as its chair in 2016. She was presented with the Distinguished Young Pharmacist Award from IPA in 2009. Sally is also active nationally in the American Association of Colleges of Pharmacy. Sally has served on Pharmacy Practice Section committees and on the executive team for the Health Disparities and Cultural Competency Special Interest Group.
Candace Jordan, RPh, PharmD, BCPS Ankeny
Candace Jordan received her Doctor of Pharmacy degree from Creighton University School of Pharmacy and Health Professions in 2009. She completed her post graduate pharmacy practice residency at Mercy Medical Center in Des Moines. She is currently obtaining her Master in Business Administration-Healthcare Management with an expected graduation date of February 2018. Currently, she is the Manager of the Pharmacy Department at Mercy West Lakes Hospital in West Des Moines and the Rural Pharmacy Manager for the Central Iowa Rural Affinity Hospitals to Mercy Medical Center. She is a co-preceptor for Mercy PGY1 and PGY2 Practice Management Rotation in addition to preceptor for Drake University and Creighton University IPPE and APPE students. Prior to West Lakes, she was at the VA of Central Iowa for three years, where she was a clinical inpatient pharmacist and developed the VA Central Iowa Residency Program. Candace was the first student member of the National Education Advisory Board for ACSP in 2006-2009. She is currently a member of ASHP and ACCP. She was an incentive grant reviewer for APhA in 2012. She is currently the Chair of the Health-System Liaison Board for IPA and an Iowa Delegate. She was on the Iowa Board of Pharmacy Continuing Professional Development (CPD) Task Force (2012), an IPA Journal Article Peer Reviewer (2011-2013) and a member of the Policy Committee on Public Affairs (2009-2010). She was selected for the Iowa Pharmacy Association Leadership Pharmacy Academy in 2014. She has presented at Expo, Pharmacy Technician Forum and Drake during her time as a pharmacist.
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FOR TRUSTEE - AT LARGE
William Baker, BS Pharm Iowa City
William Baker received his BS Pharmacy Degree from The University of Iowa College of Pharmacy in 1979. In 2007, Bill completed the Executive Certificate Programs at Wharton School for Business in Marketing and Executive Management for Pharmacy Leaders. After graduation in 1979, Bill worked as a staff pharmacist for 2 pharmacies in eastern Iowa and as a pharmacy manager for 20 years for Osco Drug in Iowa City. He is a Certified Diabetes Educator and was the Regional Coordinator for the Osco Drug Diabetes Care Program from 1997–2001. In 1998, Bill received the American Stores - President’s Excellence Award for his work in Patient Care Programs. In 2000, he took a full time position as manager of Clinical Programs for Osco Drug, responsible for developing and implementing various programs across the enterprise. In 2003, Bill moved into a marketing role supporting the pharmacy initiatives and in 2008 began a position in human resources as a Manager of Regional Recruiting and College Relations for the parent company Supervalu. Bill began his current role as District Pharmacy Supervisor for CVS/Health in 2011, overseeing the retail pharmacy operations for 26 pharmacies operating in four states (Iowa, Illinois, North Dakota and Minnesota). Bill has continued a strong relationship with the University of Iowa College of Pharmacy as an adjunct professor as well as a clinical instructor from 1990-1994. He has also served on several boards and committees at the college, including the Diversity Committee, Curriculum Committee and Alumni Board. Bill has served on various IPA committees including Public Affairs and Professional Affairs committees and the IPA Board of Trustees. Bill has been a delegate for the IPA Annual Meeting for several years.
Michael Fuller, RPh Ankeny
Michael Fuller is the healthcare supervisor for Walgreens for the state of Iowa. He is based in Ankeny, Iowa, but covers the entire state. Michael received his PharmD Degree from the University of Iowa in 1997. Through his career he has worked as an overnight pharmacist and a staff pharmacist in Cedar Rapids, Iowa, and as a pharmacy manager from 1997 to 2007 for a Walgreens pharmacy in Cedar Rapids, IA. In 2007, Michael accepted the role of pharmacy supervisor for Walgreens for Central Iowa. In 2015, Michael accepted his current role as healthcare supervisor for Walgreens for the state of Iowa. Michael has served as an adjunct professor for the University of Iowa and preceptor for University of Iowa students and Drake University student pharmacists.
IPA BOARD ELECTION FOR TRUSTEE - AT LARGE
Craig Clark, RPh Cedar Rapids
Craig Clark grew up in a small farming community in western Iowa. He graduated in 1978 from The University of Iowa College of Pharmacy. After working for two years in a community medical clinic pharmacy in Cedar Rapids, he and his wife purchased a small apothecary pharmacy in December 1980. After 10 years, the pharmacy moved to its current Cedar Rapids location, in which Craig initiated a community clinical practice. In the fall of 2017, the pharmacy was expanded to allow a larger dispensing area and more private consultation space for these clinical services. Craig was one of the first forty community pharmacists to complete the certification from the Iowa Center of Pharmaceutical Care. Through this initiative, he transformed his business practice, and subsequently became an adjunct faculty member and preceptor for University of Iowa student pharmacists. In the college’s first year of transition into the PharmD program, he was nominated by the P4 students as the 1997 Preceptor of the Year. In 2014, he was awarded the Bowl of Hygeia. As the Bowl of Hygeia represents, Craig is very involved in his community, serving a number of volunteer organizations. He has served on several church committees, has held multiple offices on several parachurch ministries and several for-profit boards. He is a charter member of the Hiawatha Lions Club, founded in 1981. Recognized and awarded for his long service in organizations such as Youth for Christ, residential care and intermediate care facilities for the intellectually disabled, he continues speaking to community groups and volunteering for the intellectually disabled community.
Toni Sumpter, PharmD, CNTP Adel
Dr. Toni Sumpter has spent the last 18 years in community pharmacy serving the public and helping people understand their medications. A native Iowan, Toni earned a bachelor’s degree in pharmacy from The University of Iowa in 1984, a doctorate in pharmacy from The University of Texas in 1986 then completed a drug information residency at the Medical College of Virginia. Her special interest in wellness and the principles of nutrition and dietary supplementation has led her to continue studies through the Nutrition Therapy Institute of Denver, Colorado, to become a Certified Nutrition Therapy Practitioner. Early in her career she utilized her drug information skills in academics, the pharmaceutical industry, and served as ACCP’s first Associate Director where she edited the first edition of the Pharmacotherapy Self-Assessment Program. Toni’s passion for helping people compelled her to open her own pharmacy in 2003; Sumpter Pharmacy and Wellness, an independent pharmacy in Adel, Iowa, is a founding member of the Community Pharmacy Enhanced Services Network (CPESN) of Iowa. At present, Toni is collaborating with Dallas County Public Health and Mercy Clinic in Adel on a pilot project to improve outcomes in patients with diabetes, as part of the Iowa State Innovation Model (SIM) grant. Three years ago the pharmacy invested in strip-packaging technology with the vision of empowering retail pharmacy customers to improve medication adherence. Toni has been a member of IPA since moving back to Iowa in 2000, has served on its Professional Affairs Committee, and regularly attends the Midwest Pharmacy Expo.
TECHNICIAN TRUSTEE
Jessica Burge, CPhT Des Moines
Jessica Burge is the medication history technician supervisor at Mercy Medical Center in Des Moines, Iowa. She has been a certified pharmacy technician for over ten years and has experience in retail and hospital pharmacy. Jessica’s current job duties include overseeing the med history technicians on her team, planning for further hospital coverage of med history tech services, and working closely with other hospital staff to ensure patient safety and accurate med lists. Jessica is currently involved in a research project where her team is collecting data to show the importance of an accurate medication history when a patient is admitted to the hospital. Jessica’s previous pharmacy technician experience was at Hy-Vee Pharmacy where she was the head technician for many years. Along with day to day duties, she was in charge of inventory management, she helped in organizing a pill planner program for patients, and she was involved in starting flu shot clinics at various businesses in the community. In the past two years, Jessica has worked as a medication history technician, collecting accurate medication lists from patients when they are admitted to the hospital. She helped in training new staff when the medication history technician program expanded in 2016 and earlier this year was promoted to medication history technician supervisor. Jessica has been a member of IPA for the past 4 years. She is an active member of the Pharmacy Technician Advisory Committee and has served as a delegate in the IPA House of Delegates. Jessica has attended the Annual meeting for the last three years and presented on medication history at the 2016 Practice Advancement Forum.
NOTE ON TECHNICIAN BALLOT
The second candidate for the Technician Trustee position withdrew after the slate of candidates was ratified by the IPA House of Delegates during the 2017 IPA Annual Meeting. Per the association’s bylaws, another candidate may not be added to the ballot once it has been ratified by the House of Delegates. As such, Jessica Burge, CPhT, as the remaining approved candidate for the Technician Trustee will run unopposed.
JAN.FEB.MAR 2018 |
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HEALTHCARE HOT TOPICS
Opioids Declared National Public Health Emergency
President Trump officially declared the opioid crisis a national public health emergency in October 2017. The declaration allows for some grant money to be used to combat opioid abuse, including hiring specialists and expanding the use of telemedicine services to improve access to treatment, educate prescribers, and initiatives to develop nonaddictive painkillers. The President also stated the government would produce an advertising campaign focused on prevention and work to suspend the rule that prevents Medicaid from funding drug rehabilitation facilities.
FDA Approves New Shingles Vaccine - Shingrix
At the time of declaration of a public health emergency, no funding was requested to support such initiatives.
In October 2017, the FDA approved Shingrix as an immunization for patients 50 years of age and older to prevent shingles. Five days later, the Advisory Committee on Immunization Practices (ACIP) recommended Shingrix as the preferred vaccine to prevent shingles and related complications for healthy adults 50 years of age and older even if they have already received Zostavax. These recommendations will not become official CDC policy until approved by the CDC director and published in the Morbidity and Mortality Weekly Report. Immunization schedules are generally updated by the CDC/ACIP each February. Shingrix is administered intramuscularly and is recommended in two doses administered two to six months apart.
CMS Finalizes 340B Cuts
Drug Supply Shortages
CMS announced their intent to finalize proposed rule changes to the Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Quality Reporting System, which will reduce the reimbursement to hospitals and surgical centers for 340B medications. The change is effective as of January 1, 2018 and healthcare providers can expect to see a reimbursement reduction from Average Sales Price (ASP) plus 6% to ASP minus 22.5%. CMS has allowed a few exceptions, such as vaccinations. CMS also exempted specific settings including rural sole community hospitals, children’s hospitals, and certain cancer hospitals.
Aetna Merger with CVS Health
CVS Health announced their plan to acquire Aetna in a deal worth $77 billion that combines CVS’s pharmacies and PBM with the insurance provided by Aetna. In announcing the acquisition, CVS Health claimed the acquisition could “remake the consumer health care experience.” Analysts are expecting the merger will result in reduced costs for patients. However, there is concern that patients may have their pharmacy choice limited to CVS pharmacies and diminished medication coverage. The deal is expected to be completed in the second quarter of 2018.
Drug supply shortages have been increasingly common over the last several years, but the aftermath of Hurricane Maria has worsened the situation dramatically. Puerto Rico’s factories produce medications and medical supplies for across the globe, and their output accounts for nearly 10% of the medications used by Americans. Small volume IV fluids have been one of the most significant shortages to have an impact in the United States, but the FDA is monitoring other products in the wake of the hurricane damage suffered by manufacturers in Puerto Rico. The FDA announced in October that they are monitoring 30 medically important drugs and 10 biological medications. Fourteen of those products lack suitable alternatives.
Schizophrenia Medication Approved with Digital Sensor
The FDA approved Abilify MyCite (aripiprazole) in November 2017, which is the first medication to be equipped with a digital ingestion tracking system. The medication is approved for schizophrenia, acute treatment of mania and mixed episodes in bipolar I disorder, and for adjunct therapy in depression management. Although the package insert states that the medication has not been shown to necessarily increase adherence, this technology can illustrate an accurate account of adherence based
on data from a sensor that records when the medication was taken. Once ingested, the sensor communicates with a patch the patient would wear on his or her body; the patch then sends the information to a mobile application that the patient can access. The patient may also allow access to the adherence record to pharmacists, physicians, caregivers, and other individuals involved in his or her care.
Amerisource Bergen Acquires Independent Wholesaler
Amerisource Bergen expects their revenue to grow by eight to eleven percent in 2018 after the acquisition of the United States’ largest independent wholesaler, H.D. Smith. The sale was agreed upon at $815 million and is expected to become final in early 2018 after the regulatory review process is complete. H.D. Smith has ten distribution centers across the nation serving community pharmacies, specialty pharmacies, long-term care, hospitals, institutions, and independent clinics.
AHA/ACC Redefine Hypertension
The American Heart Association (AHA) and American College of Cardiology (ACC) have redefined hypertension for the first time since 2003. Hypertension is now defined as having a systolic blood pressure over 130 mmHg or diastolic blood pressure over 80 mmHg. It is important to note that categories have been redefined, as seen below, and there is no longer the prehypertension category. The guidelines emphasized the need to have proper technique and a diagnosis based off of two to three readings that have been taken at different times. • Normal: Systolic <120 mmHg and diastolic <80 mmHg • Elevated: Systolic 120-129 mmHg and diastolic <80 • Stage 1: Systolic 130-139 mmHg or diastolic 80-89 mmHg • Stage 2: Systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg • Hypertensive crisis: Systolic >180 mmHg and/or diastolic >120 mmHg With these changes, it is predicted that the amount of people diagnosed with hypertension will increase by 14 percent. ■
JAN.FEB.MAR 2018 |
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Learn, Connect & Be Inspired with Your Colleagues from Across the Midwest! The Midwest Pharmacy Expo brings together pharmacists, pharmacy technicians and student pharmacists from across the Midwest for the regionâ&#x20AC;&#x2122;s premier live continuing pharmacy education event.
Now in our fifth year, we invite you to enjoy a weekend featuring high quality live continuing education, engaging networking opportunities, and inspiring keynote speakers in a professional and relaxed Midwest atmosphere.
EXPO LOCATION & LODGING Holiday Inn Des Moines-Airport & Conference Center 6111 Fleur Dr, Des Moines, IA 50321
Eat, sleep, park and enjoy Expo all in the same location!
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| The Journal of the Iowa Pharmacy Association
16.5 hrs of CPE for Pharmacists & 10 hrs for Technicians!
Agenda February 16, 2018
Clinically Intensive Workshops 6.5 hrs CPE for Pharmacists
7:30 am Registration 8:30 am Welcome 8:45 am Biostatistics and Trial Design: An Interactive Primer for Pharmacists P 10:45 am -Break11:00 am Chronic Care Mgmt Part I: Mental Health, Cardiology, Endocrinology P 12:30 pm Lunch & Networking (lunch provided) 1:30 pm Chronic Care Mgmt Part II: COPD/Asthma & Oral Chemotherapy P 3:00 pm -Break3:30 pm Physical Assessment: A Refresher for Pharmacists 5:00 pm Wrap-up and Adjourn
February 17, 2018
Midwest Pharmacy Expo 6.0 hrs CPE for Pharmacists & Technicians 6:30 am Registration Opens 7:00 am Industry Symposium Breakfasts 8:30 am Welcome 9:00 am Keynote: “The Need for Advanced Clinical Decision Support Systems for the Management of Patients with Polypharmacy” by Jacques Turgeon P/T 10:00 am -Break10:15 am Session 1 USP <800>: Pearls for Implementation P/T Potential Perils of PPIs: Risks, Misuse, and Deprescribing P Aspirin: Who Needs It? P Medication Management with Celiac Disease: Pearls for Technicians T 11:15 am -Break11:30 am Session 2 Contraception: A Pharmacist’s Guide to Prescribing P Nutrient Depletion: How to Answer Patient Questions P/T Anticoagulation: The Do’s and Don’ts of Bridge Therapy P Quest for the Ideal Anticoagulant: A Patient-centered Approach to Treatment T
12:30 pm Lunch and Exhibit Hall 2:00 pm Session 3 Direct-to-consumer Genetic Testing: Hype or Hope? P/T Pain Management Strategies: Alternatives to Opioids P Heart Failure Guideline Update P Build a Better Pharmacy Team with Training and Mentoring T 3:00 pm -Break3:15 pm Session 4 Medical Cannabis: The Pharmacist’s Perspective P/T CMS Rules for Participation/LTC Regulations: What You Need to Know P Hypertension: What’s Your Goal? P L to Z: Tick and Mosquito Borne Diseases T 4:15 pm -Break4:30 pm Session 5 Biosimilars: Challenges and Opportunities P Breaking the Trend: Helping Patients Manage Fall Risk P/T Dyslipidemia Treatment: Hybridizing Clinical Practice Guidelines P Common Drug Interactions: A Practical Review for Pharmacy Technicians T 5:30 pm Adjourn 5:45 pm Political Leadership Reception**
February 18, 2018
Midwest Pharmacy Expo 4.0 hrs CPE for Pharmacists & Technicians 6:30 am 7:00 am 8:00 am 9:30 am 9:45 am 10:45 am 11:00 am 12:30 pm
Registration Opens Industry Symposium Breakfasts New Drug Update P/T -BreakPharmacist’s Liability in the 21st Century P/T -BreakGamechangers in Pharmacy: 2017 P/T Adjourn CE accredited sessions in bold P - accredited for pharmacists T - accredited for pharmacy technicians **Additional ticket purchase required
See the full agenda & register at
MidwestPharmacyExpo.com JAN.FEB.MAR 2018 |
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IOWA PHARMACY NEWS
AmeriHealth Caritas Exits Iowa Medicaid, State Scrambles
On October 31, 2017, AmeriHealth Caritas announced that they would withdraw from the Iowa Medicaid program, effective November 30, 2017. AmeriHealth was one of three MCOs managing Iowa’s Medicaid program and had the largest enrollment. Those affected by the AmeriHealth exit were originally given the option to choose between the remaining two providers – UnitedHealthcare and Amerigroup. However, Amerigroup announced it was unable to handle additional enrollees. Therefore, Iowa Department of Human Services put in place a “suspension of choice,” and on December 1, nearly all of the 213,000 Iowans covered by AmeriHealth were reassigned to UnitedHealthcare. About 10,000 Iowans who initially chose to open enroll in Amerigroup by November 16, prior to the company announcing it was at capacity, will be managed by the state under Iowa Medicaid Fee-for-Service (FFS) until Amerigroup can take on additional members. However, members already enrolled in an MCO are not able to change to Iowa Medicaid FFS for any reason. Furthermore, any new members will be assigned to UnitedHealthcare. The Iowa Department of Human Services is seeking proposals for one additional MCO and originally announced that a new MCO would be contracted by July 1, 2018, but this has been extended until July 1, 2019.
Iowa Stopgap Withdrawn
The Iowa Insurance Division withdrew their waiver for Section 1332 of the Affordable Care Act. The proposed “stopgap measure” was intended to prevent the 72,000 Iowans that use the individual market from becoming uninsured in 2018. The proposed measure would have encouraged more plans to enter the insurance exchange for 2018 and offer competitive plans with lower monthly premiums for Iowans. The
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waiver was withdrawn on October 23, just one week before open enrollment as officials say there would not have been enough time for implementation. Medica (Minnetonka, MN) is the only individual insurance carrier for 2018.
State Receives Waiver on Retroactive Medicaid Payments
Iowa was granted a waiver from CMS to eliminate retroactive payments from Medicaid. The change is expected to affect 40,000 Iowans and will save Medicaid $36.7 million. The state said the move would encourage individuals “to obtain and maintain health insurance coverage, even when healthy.” Providers and health institutions expressed strong opposition as the change would add a significant financial burden on them.
IPA Voices Concerns over IV Fluid Shortages
After Hurricane Maria devastated Puerto Rico last September, both Baxter small and large volume IV fluids went on shortage. This is due to the fact Puerto Rico has over 100 healthcare production facilities, half medication related, that were impacted by the hurricane. Due to the widespread and large impact the shortages are having on patient care, IPA worked to collect impactful stories from our members to share with Iowa’s Congressional delegation, which has aligned with other national association efforts on the topic. In addition, IPA hosted a webinar on December 21, 2017 to discuss the challenges being faced and strategies that have been successful regarding the IV fluid shortages. Challenges discussed included the impact on workflow, additional medication and supply shortages, supply chain allocations, and concerns regarding patient care. A variety of strategies were discussed, such as partnering with outside hospitals, conservation, creating a drug shortage committee, communication, talking to policy makers, and continual monitoring of the shortage.
IPA will utilize this information to educate IPA members and other hospital-based pharmacists on how to collaborate to manage this drug shortage crisis. Action steps, such as EMR edits, education, reaching out to Congress, consistent communication, and commitment to conserve can assist members in handling the challenges during this and future drug shortages.
Stakeholder Group Seeks to Improve Immunization Rates in Iowa
IPA is collaboration with the Iowa Public Health Association brought together a group of stakeholders on December 13 to discuss adult immunizations in Iowa. Invitees to the meeting included representatives from the pharmaceutical industry, Iowa hospitals, Iowa Medical Society, Iowa Department of Public Health, and Iowa Healthcare Collaborative amongst others. The goal of this meeting was to gather information to better understand the immunization landscape in Iowa. There was a consensus that healthcare practitioners tend to have a strong focus on childhood vaccines, but as a healthcare community we don’t always have a similarly strong focus on adult immunizations. IPA discussed ways that pharmacists in Iowa are successfully addressing adult immunizations and others shared their experiences as well. The group plans to share information back to their respective organizations and then reconvene in February to develop actionable steps to improve adult immunization rates in Iowa.
DEA Take Back Day Breaks Collection Record
The DEA collected a record 912,305 pounds, or 456 tons, of expired or unwanted medications during its 14th National Prescription Drug Take Back Day on October 28, 2017. In Iowa, 11,526 pounds of medication were collected. Since the first Take Back Day in the fall of 2010, the initiative has collected over 9 million pounds of medications nationwide. The next Take Back Day is April 28, 2018.
IOWA PHARMACY NEWS
One-Day Event to Focus on Antimicrobial Stewardship Programs
According to the CDC, at least 2 million people in the United States are infected with antibiotic resistant bacteria. Of these 2 million, at least 23,000 patients die annually due to these infections. While Joint Commission already uses a Medication Management standard for antimicrobial stewardship programs (ASP), in the near future the Centers for Medicare & Medicaid Services (CMS) will have a Condition of Participation (CoP) on antimicrobial stewardship for hospital and nursing home settings. While some Iowa hospitals have strong ASPs with pharmacists playing critical roles, others are struggling to start one. To help Iowan hospitals who are still working on or not yet started an ASP, IPA and the Iowa Hospital Association will be hosting a multidisciplinary conference April 17, 2018. The free event will focus on the process to implement ASP and the return on investment for such programs through keynote speakers and various breakout sessions. The intended audience
will be pharmacists, physicians, nursing staff, and hospital administration. The ultimate goal is to provide these hospitals with best practices and steps to both starting and expanding ASPs in their hospital. Watch IPA communications for more details.
• The average age of retirement is 67 years of age
Trends in Iowa’s Pharmacy Workforce
• There has been a 10% decrease in the number of communities with a pharmacist working
The University of Iowa’s Iowa Health Professions Tracking Center within the Office of Statewide Clinical Education Programs, Carver College of Medicine, tracks the healthcare workforce in Iowa each year. The pharmacy workforce advisory committee met on December 1, 2017 to review the trends from 1996 to 2016. Since 1996, the pharmacist workforce has seen a 26% growth. However, this growth has considerably decelerated over the years with only a 1.7% increase since 2012. Other statistics include: • The majority of Iowa pharmacists have PharmD degrees (60%) • The majority of Iowa pharmacists are female (64%)
• Hospital pharmacists are the sector of the profession with the largest growth (57% increase) versus community pharmacists (13% increase) and all other pharmacists (38% increase)
• More communities have a pharmacist working than either a physician, advanced practice nurse, or physician assistant (24% of Iowa’s 947 communities) • There is at least one pharmacist practicing in every county across the state of Iowa who is a graduate from either Drake University College of Pharmacy & Health Sciences or the University of Iowa College of Pharmacy Important to note is that pharmacy post-graduate residents are not currently included in these trends. As residency programs in Iowa continue to grow, the advisory committee has recommended tracking trends in this population moving forward. ■
IPA Convenes Behavioral Health Ad Hoc Committee This past fall, IPA president Craig Logemann convened a group of key IPA members and other stakeholders to address the role of pharmacists in increasing the quality of and access to behavioral healthcare resources in the state of Iowa. The purpose of this ad hoc committee is two-fold – first, to identify opportunities and best practices for pharmacists to assist patients and other health care providers with issues related to behavioral health and mental illness, and second, to provide the IPA Board of Trustees recommendations for policy and practice guidelines to assist pharmacists in serving patients with behavioral health needs and mental illness. The workgroup convened for a conference call on November 16, 2017, to gather initial thoughts on key
considerations in preparation for a live, in-person meeting, which occurred on December 20, 2017. The group discussed current behavioral health practice settings that integrate the role of the pharmacist as well as necessary steps to bring all pharmacy practice areas into a higher level of behavioral health care services. The ad hoc committee developed specific deliverables that will be proposed to the IPA Board of Trustees in February 2018. These deliverables focus around three primary recommendations, which include: 1. Educate patients, the public, and other healthcare providers on the role of pharmacists in patient care services
3. Overcome legislative and regulatory restrictions to expand pharmacists’ role with addressing behavioral health conditions Thank You to the Members of this Ad Hoc Committee! Tami Argo Sarah Babb Anisa Fornoff Sarah Grady Tom Greene Christie Kahlon Korey Kennelty Mitsi Lizer Steven Martens
Heather Ourth Wes Pilkington Justin Rash Cheri Schmit Steven Sehr, MD Susan Shields Ashley Smith John Swegle
2. Equip the pharmacy profession with skills for providing care to patients with behavioral health conditions JAN.FEB.MAR 2018 |
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IOWA PHARMACY NEWS
ECORETURNS VS. THE DRUG REPOSITORY PROGRAM What do I do with this unwanted medication? In July of 2017, IPA and SafeNetRx partnered to unveil EcoReturns as a medication disposal program that replaced the TakeAway program. EcoReturns provides patients with a way to safely dispose medications that they no longer want or need, which helps prevent drug diversion and misuse. The Iowa Board of Pharmacy fully funds EcoReturns, so there is no cost for pharmacies to participate.
SAVE THE DATE! June 8-9, 2018
Des Moines Marriott Downtown IPA’s Annual Meeting is an opportunity for you to join your pharmacy colleagues from across the state to participate in the policy adoption process in the House of Delegates, network with Iowa’s pharmacy leaders, recognize your colleagues’ achievements and celebrate the past year!
DON’T MISS YOUR FAVORITES: • Policy Discussion • Annual Banquet • IPA Foundation Silent Auction • IPA Awards • Poster Presentations • and more!
REGISTRATION & AGENDA COMING SOON!
EcoReturns accepts unused or expired prescription and over-the-counter medications, including tablets/capsules, ointments/creams/powders/gels/lotions, inhalers/nebulizer solutions, and liquids. Liquids must be wrapped in a paper towel and placed in a sealed plastic bag before being place in the EcoReturns bin. Unfortunately, EcoReturns are NOT able to accept controlled substances of any kind (CII-CV), sharps (ie. syringes, lancets, pen needles), or DME supplies (ie. rubbing alcohol, test strips, compression stockings). The great thing about the EcoReturns program is that it is free for pharmacies to participate and requires minimal effort on the pharmacy’s end. All you have to do is send the EcoReturns unit back once it’s full to the location on the return label, which is given when the unit is initially delivered. After SafeNetRx receives the box, they will automatically send a new unit to the pharmacy. If you would like additional units for special events, contact SafeNetRx at EcoReturns@SafeNetRx.org. If your pharmacy doesn’t currently participate in the program and would like to get started, contact IPA at ipa@iarx.org. The only requirement to enroll is that your location must be an open-door pharmacy. In addition to EcoReturns, SafeNetRx oversees Iowa’s Drug Donation Repository program, which provides medications and medical supplies for little or no cost to Iowans who are at or below 200% of the federal poverty
level. Patients may also be eligible if they are uninsured or under-insured. The program accepts donations from pharmacies, healthcare providers, and individuals, as long as the medications remain in their original sealed container or tamper-evident packaging with at least 6 months remaining before expiration. This also includes items such as test strips, pen needles, and blood glucose meters. Medications packaged in sealed adherence packaging, such as blister cards, are also eligible for repository as long as multiple medications are not comingled in the same compartment. SafeNetRx is not able to accept controlled substances or refrigerated products. The Drug Donation Repository Program is not only beneficial to patients in need, but also helps reduce waste, recycle unused but perfectly good medications, and lower healthcare costs to society. Pharmacists have a great opportunity to educate patients who desire to dispose of their unwanted prescriptions about the program and see if they would be willing to donate eligible medications. If your pharmacy is interested in getting involved, please contact SafeNetRx at 1-866-282-5817. You can also look forward to donation envelopes being included with outgoing EcoReturns disposal units in the near future! Here’s a quick guide to help you decide what can and cannot be donated to the Drug Donation Repository Program: Blister pack or unopened packages with expiration ≥6 months
Donate
Controlled Substance (CII-CV)
Direct patient to disposal at special locations
Opened packages or products with expiration <6 months
EcoReturns Box
IOWA PHARMACY NEWS
GOV. REYNOLDS SETS PRIORITIES TO COMBAT OPIOIDS On October 26, Gov. Kim Reynolds outlined four specific priorities for the state to combat opioids during the Identify, Prevent, Recover: Combatting Opioids in Iowa conference at Drake University and hosted by the Governor’s Office of Drug Control Policy and the Drake University College of Pharmacy and Health Sciences. Below are the governor’s priorities as announced:
1. Increase Prescriber Use of Iowa’s Prescription Monitoring Program (PMP) • Expand Prescriber Usage – Today, 45 percent of prescribers in Iowa are signed up with the prescription monitoring program. The Iowa Board of Pharmacy and stakeholders should identify ways to improve participation from prescribers while minimizing the administrative burden. This should include the goal of getting all prescribers to report any controlled substance dispensing activities to the PMP. • Proactive Notifications – The Iowa Board of Pharmacy and stakeholders should identify ways to automatically notify prescribers and pharmacies to check the PMP when patients exceed reasonable prescription opioid doses to prevent prescription drug shopping. Addiction helpline information should be included in those alerts. • Expand Prescriber Knowledge – The Iowa Board of Pharmacy and stakeholders should identify ways to provide prescribers routine, confidential reports, so prescribers can be aware of their prescribing practices. • Expand the Type of Prescriptions Reported – The Iowa Board of Pharmacy and stakeholders should identify ways to have Schedule V prescription drugs added to the prescription monitoring program. Right now, Schedule II–IV are reported, but other opioid prescriptions are not captured (e.g., codeine cough suppressants). • Explore Integration – Healthcare information technology is ever expanding, and seamless data integration is critical to improving value in our healthcare system. The Iowa Board of Pharmacy and stakeholders should explore easierto-use integration of the prescription monitoring program with electronic health records (EHRs), including pharmacy processing software and the Iowa Health Information Network (IHIN). • More Education – Licensing boards, medical schools and stakeholders should continue expanding education and encouragement of health care professionals to use the prescription monitoring program.
2. Reduce Opioid Prescribing to Prevent Misuse in Iowa • More Prescriber Education on Prescribing – According to the Iowa Board of Pharmacy, controlled substance prescriptions, including opioids, are down 10 percent this year compared to last year. We are making progress. Licensing
boards, medical schools and stakeholders should work to expand education and training to bring prescribing down while maintaining patient access to necessary care. • Encourage Adherence to the Centers for Disease Control and Prevention (CDC) Opioid Prescribing Guidelines – In 2016, the CDC developed guidelines for prescribing opioids. While medical professionals are best equipped to know what a patient needs, licensing boards, medical schools and stakeholders should work to expand knowledge and adherence to the CDC guidelines.
3. Enhance Intervention for Iowans Misusing or Addicted to Opioids • Expanding Naloxone Access – In 2016, Iowa expanded naloxone access, issued a standing order and improved affordability for law enforcement, EMTs and patient advocates. Iowa should build on that and explore options to expand Naloxone access. Intervention helps prevent the spread of communicable diseases. • Good Samaritan Law – Iowa should explore joining 36 other states in enacting a Good Samaritan Law that promotes timely overdose reporting by immunizing other drug users from criminal prosecution if they call 911 when an overdose is occurring. However, drug dealers or other victim crimes should not be immunized from criminal prosecution.
4. Enhance Substance Use Disorder (SUD) Treatment, Particularly Medication Assisted Treatment (MAT) for Opioid Addicted Iowans • Improve Patient Access to Medication Assisted Treatment – Currently, Iowa is participating in a multi-year grant administered by the Iowa Department of Public Health for Medication Assisted Treatment focused on prescription drug and opioid addiction in 10 of the highest need counties in the state. Iowa Medicaid, public health, local medical professionals and stakeholders should utilize evidence-based practices from this grant to improve Medication Assisted Treatment in underserved counties where opioid prevalence is high. • Expanding Rural Access – Iowa Medicaid, public health, local medical professionals, and stakeholders should work creatively with federal guidelines to expand methadone treatment access in rural Iowa, especially in areas where opioid addiction is most prevalent. • Reduce Barriers to Medication Assisted Treatment Drugs – Public and private insurance payers, along with safety-net payers, should work collaboratively to reduce barriers and improve access for Iowans needing Medication Assisted Treatment drugs based on evidence-based policies. ■
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COMMITTEE REPORTS Advisory Committee on Medicaid & Pharmacy Benefits Programs
Medicaid Managed Care Issues & Wellmark Coverage for Iowans IPA members serving on the Medicaid & Pharmacy Benefits Program Advisory Committee convened in Des Moines on September 28, 2017. While the committee discussed the many issues facing their pharmacy practice as it related to working with third party payers, the committee was able to have direct discussions with representatives from the Iowa Medicaid Enterprise (IME) and Wellmark.
IPA ADVISORY COMMITTEE REPORTS IPA advisory committees provide guidance to the Board of Trustees and staff regarding specific practice areas. Committees meet at least once a year at IPA headquarters in Des Moines, and may be asked to provide feedback by email or conference call throughout the year. The following pages feature recaps from this year’s committee meetings include topics discussed and recommendations given.
Serving on a Committee
Serving on an IPA committee gives you the opportunity to influence the direction of the association and the advancement of pharmacy practice across the state. Each year, IPA’s president selects pharmacists, residents, pharmacy technicians and student pharmacists from a variety practice settings and areas of the state to serve on committees. See the list of committees at: www.iarx.org/committeestaskforces IPA committees are formed in the late summer months. If you are interested in serving on a committee, contact Anthony Pudlo at apudlo@iarx.org or 515-270-0713.
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The committee focused their discussion with IME on the struggles during the transition to managed care oversight and the potential for value-based models of care within Medicaid. IME discussed the state’s timeline and process for renewing contracts with the MCOs and mechanisms for penalties against them. The committee shared various concerns with the transition and current processing IME and the MCOs, including specific NDC coverage, drug shortages, the amount of brand names on the preferred drug list, coverage of insulin pen needles and KetoStix, coverage of naloxone under the statewide standing order, and medication adherence. In addition, IME reviewed the timeline for the fourth cost of dispensing survey with plans for it to be sent to pharmacies in January/February 2018. It was noted that participation rates have been solid in the past with a good cross section of the pharmacy demographics. The committee had the opportunity to meet with representatives from Wellmark for open dialogue on Wellmark’s value-based pharmacy program, pharmacy benefit updates for 2018, ACO activity, the opioid epidemic, and other issues of concern. Wellmark highlighted minor formulary changes planned for 2018 and the limited uptake on their value-based formulary. Wellmark also described their goal to automate the prior authorization process in 2018 to reduce burden on the many stakeholders involved in the process. Wellmark reviewed concerns from their members on specialty medications, specifically oncology treatments and direct-to-consumer advertising of these products.
Committee Members Kim Spading* Randy McDonough** Nancy Bell Sharon Cashman Maia Determan Tom Donnor Jessica Frank Ryan Frerichs Mike Fuller Terry Jacobsen Grant Jerkovich Bridget Jermeland Chris Parker Wes Pilkington Lynn Rich
Mark Richards Lori Rissman Marshall Sanders Jess Smith Emily Vyverberg
COMMITTEE REPORTS Health System Liaison Board
Education Advisory Committee
Opioid Use, Compounding, Mental Health, ValueBased Purchasing
Committee Prepares for Comprehensive Offerings in 2018
With no shortage of issues to discuss, the Health-System Liaison Board convened on October 5, 2017. With a full agenda, the committee showcased their knowledge and interest on multiple front-line practice issues for hospitals and health-systems. Committee members echoed practitioners concerns on opioids, compounding, and the 340B drug pricing programs. Key recommendations brought forward include: • Develop educational resources and talking points regarding PBM limitations on opioid prescribing • Seek delay of enforcement by the Iowa Board of Pharmacy for implementation of USP 800 standards • Educate the membership on USP 800 standards and resources for training • Expand the scope of practice and compensation for pharmacists in the mental health • Provide education on changes within value-based purchasing and MACRA/Quality Payment Program • Facilitate discussion between HSLB and CPESN Iowa leadership for opportunities with antimicrobial stewardship
The IPA Education Advisory Committee convened via conference call on November 2, 2017 to guide new and existing educational offerings to IPA members. The committee reviewed proposed agendas for the 2018 IPA Annual Meeting and Practice Advancement Forum. In 2018, the Practice Advancement Forum will integrate pharmacy resident presentations on their longitudinal research projects to serve as a forum for sharing innovative practice initiatives. The committee spent much of its time discussing the pursuit of study groups for IPA pharmacist members considering a Board of Pharmaceutical Specialties (BPS) certification as well as IPA pharmacy technicians seeking national certification. The committee encouraged IPA to seek a partnership with the Veteran’s Administration (VA) and their well-established study groups for BPS certification. This advisory committee will meet again in the spring of 2018 to review the success of the Midwest Pharmacy Expo and plan for other offerings in 2018.
• Identify current ID pharmacists for showcasing services to colleagues at the Iowa Hospital Association • Assess the impact of technician shortages on workload of pharmacy departments • Develop strategy to address technician recruitment • Continue to partner with IHC on educational efforts regarding opioid guardianship, partial filling for CII medications, appropriate prescribing habits, and other opioid-related topics. • Encourage IPA members to complete the hospital and ambulatory care self-assessments
Committee Members Candy Jordan* Shane Madsen** Shana Brunsvold Amanda Bushman Eliza Dy-Boarman Darla Eastman Angie Fouts Rachel Gean Derek Grimm Tracy Harlan Fischer Herald Jeff Houseman Mindy Jorgenson Sue Keller Matt Kent
Lisa Lambi Alex Mersch Kiera Murray Melissa Nelson Jessica Nesheim Kate Pape Zach Pollock Holly Randleman Mark Sorenson Grant Stimes Nick Vollmer Geoff Wall Kaiwen Wang Daniel Wentworth
Committee Members Emily Beckett* Chris Parker** Brittany Bruch Sharon Cashman Connie Connolly Rachel Gean Geena Hopwood Ryan Jacobsen Carrie Koenigsfeld John L’Estrange Nic Lehman Marie Ljosenvoor Cindy Marek Emily Neddermeyer Stevie Veach *Chair **Vice Chair
Kate Waack Nancee Waterbury Sara Wiedenfeld Pamela Wiltfang
JAN.FEB.MAR 2018 |
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BECOME A MEMBER OF THE IOWA PHARMACY ASSOCIATION
POSITION YOURSELF to lead and shape the future of your profession and join a network of pharmacists, pharmacy technicians and student pharmacists advocating the advancement of practice for the health and well-being of our patients.
ADVANTAGES FOR YOU Equipping you for today’s rapidly evolving health care system with free and convenient CPE and opportunities to connect with colleagues across the state.
ADVOCACY FOR YOUR PROFESSION Enabling you to confidently engage your elected officials while representing your interests with the Board of Pharmacy, state agencies, health care organizations, and provider groups.
85
%
of membership dues directly fund initiatives that advance the pharmacy profession
ADVANCEMENT FOR YOUR PRACTICE Creating opportunities for you and your colleagues to collaborate with healthcare teams and integrate pharmacy practice into emerging healthcare models.
IOWA PHARMACY NEEDS YOUR UNIQUE VOICE AND EXPERIENCE!
LEARN MORE & JOIN TODAY AT
WWW.IARX.ORG FREE CPE!
IPA members receive CEI’s Relicensure or Recertification CPE Libraries for FREE!
All the required CPE for relicensure or recertification conveniently bundled by CEI and free for IPA members!
COMMITTEE REPORTS Long Term Care and Senior Care Advisory Committee
Pharmacy Technician Advisory Committee
Reviews Statewide Initiatives; Medicaid Concerns; Practice Resources
Advanced Technician Roles A Hot Topic
With the growing proportion of Iowans needing long-term care, the profession of pharmacy continues to position itself to improve the care of patients in skilled nursing facilities, nursing homes, and other rehabilitation facilities. The IPA Long-Term Care & Senior Care advisory committee spent much of its meeting on October 5, 2017 discussing the evolution of national and statewide initiatives as well as the concerns that have come from various third-party payers and regulatory bodies. The committee discussed common practices regarding pharmacists’ role in antimicrobial stewardship when working with facilities, including providing education to facility staff to mitigate downstream concerns. Collaborative practice agreements for managing therapy to prevent falls, discontinuing PRN medications, therapeutic substitutions, or gradual dose reductions were discussed. Recommendations: • Connect IPA members with Telligen workgroup on antimicrobial stewardship education • Continue to address OTC coverage in LTC facilities with Iowa Medicaid and MCO’s • Share sample data use agreements amongst IPA membership • Collaborate with BOP regarding implementation of USP 800
Advanced roles for pharmacy technicians continues to drive practice change across all pharmacy practice settings in Iowa. While specific examples of technicians engaged in medication history, sterile compounding, product verification, and telepharmacy were discussed, the committee determined there is a need for a broader discussion by the IPA membership on the advanced roles of technicians. The committee reviewed current trends in IPA pharmacy technician membership and attendance at IPA meetings. The committee discussed the value of attending IPA meetings alongside the rest of their pharmacy staff, and encouraged marketing materials to reflect this. The committee encourages all IPA members to talk about the value of professional involvement with their technician colleagues. Recommendations: • Seek case scenarios from technician members for the impact of pharmacy technicians in advanced practice settings to advance legislative priorities • Encourage IPA policy committees to create policy on advanced technician designations and address responsibilities, training, professionalism, and buy-in from pharmacists and technicians • Encourage members to provide career path education on being a pharmacist and a pharmacy technician as two options in the profession • Work with Education Committee and other stakeholders to develop study groups for technicians seeking national certification • Collaborate with IMP3 to further provide education and resources on professional burnout
Committee Members Mark McMullen* Becky Kehoe** Samantha Alukas Rocky Anderson Teryn Bibb David Brothersen Megan Elsbury Lorin Fisher Anisa Fornoff Kee Gales Katarina Hockey Christie Kahlon Chelsea Khaw Micaela Maeyaert
Matthew Maker Marcia McNulty Kristin Meyer Dick Michael Justin Rash Jeff Reist Katharyn Smith Leslie Tierney Michael Williams Jr
Committee Members Lori Foster* Tammy Sharp-Becker** Jessica Burge Breann Bowe Meg Finn Anna Fishel Sonya Jones Judy Mentzer Angie Miller Kaye Moeller Shawnae Morey Morgan Reynolds Jill Shoopman Alyce Steig *Chair **Vice Chair
Julia Strause Christina Ulrey Amanda West
JAN.FEB.MAR 2018 |
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FROM THE DEAN
A YEAR OF TRANSFORMATION Renae Chesnut, RPh, EdD, MBA Dean Drake University College of Pharmacy & Health Sciences
A
s I reflect on the transformations that have occurred at Drake University and in our College of Pharmacy and Health Sciences over the past year, I am reminded of a quote by William Pollard, “Without change there is no innovation, creativity, or incentive for improvement. Those who initiate change will have a better opportunity to manage the change that is inevitable.” Our College of Pharmacy and Health Sciences has continued our tradition of innovation and creativity through new and renovated facilities, our educational offerings, and our partnerships – all of which have resulted in gaining momentum as the changes have had an impact on our students, faculty and staff, partners, and the patients that we help to serve. This academic year marked the opening of our Science Connector Building, an interdisciplinary teaching and learning facility. Our pharmacy students are benefitting from new state-of-the-art laboratories, research facilities, collaborative spaces, and classrooms. Thank you to all of the IPA members who donated to the IPA Student Collaboration space – it is a true reflection of the importance of collaboration, a value shared by IPA and our college. Additional physical transformations within our college have taken place with renovations within the College facilities that include the Porter Clinical Skills Center, as
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| The Journal of the Iowa Pharmacy Association
well as a complete transformation of the previous University bookstore location to become our Occupational Therapy Doctorate program facility. We continue our tradition of innovation within our curricula by adding new educational offerings that include enhancements to our PharmD curriculum. A new PharmD curriculum course series, Continuing Professional Development, began this year that will further prepare our students as they progress through our curriculum for professional practice through additional mentoring and guidance for success. Our educational offerings will continue to grow with the addition of nine new faculty members who bring additional expertise to our college. The wide-array of experience and knowledge that they bring will keep us moving forward and transforming the ever-changing healthcare landscape. Among them is the first faculty member in our new athletic training program, which will enroll its first class of master’s degree students in the fall of 2019. In addition to our new faculty, additional innovative interprofessional partnerships provide value to our students and the patients we serve with our various experiential partners. We continue to be leaders in the Des Moines Area Interprofessional Collaborative which includes the other four healthcare professional schools in central Iowa – Des Moines University, Grandview College, Mercy College of Health Sciences and Des Moines Area
Community College. And we recently partnered with the Governor’s Office to hold the Iowa Opioid Forum where her actions steps for prevention, treatment, and recovery were announced. Our students continue to be leaders of change as well. Three pharmacy students serve as legislative interns with two of our pharmacy alumni serving in the Iowa legislature. Our professional pharmacy fraternities promote change and service that resulted in all three receiving national recognition. Our students have also conducted alcohol and other medication awareness events for our college community as well as local area elementary, middle and high schools. Other students have received local, state, and national awards for their leadership and research endeavors. This past fall we honored Geoff Wall, professor of pharmacy practice, and Michelle Mages, P4 student with the inaugural Richard Morrow Transformational Leadership Awards. Thank you to all of the IPA members that have assisted us as we transform and gain momentum – whether as a preceptor, role model, donor, recruiter, or volunteer. We have more work to do as we seek ways to further our vision of being “A diverse community of learners leading the way to a healthy world.”■
FROM THE DEAN
MEMO TO MAX To:
Max Eggleston
From: Don, Dean #9 Re:
Heavenly Hawkeyes!
R
egrettably, we never met. I became UI Dean #9 a decade after you set-up practice inside the Pearly Gates. Much has happened in Hawkeye Nation since so I thought you would appreciate an update. The all-PharmD and subsequent implementation of a highly avant-garde curriculum; unprecedented advances in drug discovery, development, and delivery; an unimaginable technological/ patient care delivery interface; and, construction of one of the finest educational facilities our profession has ever witnessed are but a few of the many extraordinary accomplishments to which your alma mater has contributed. On a more personal level, Black and Gold graduates have continued to shine…..the College’s pinnacle award is now named after your mentee, Bob Osterhaus, and his lovely wife, Ann; Bob O’s son became President of APhA (yes, that’s right, Matt O!... and he was one of two Hawkeyes to serve in this capacity within a three-year time span…Jenelle Sobotka, of Diagonal fame, was the other); Tom Temple retired as IPA’s CEO after a highly distinguished 34-year run; Chris Decker, Tom’s mentee, remains at the helm of the Pharmacy Society of Wisconsin and has emerged as one of the nation’s most accomplished state association execs; Paul Abramowitz, UI’s former CPO (and honorary alum) became CEO of ASHP; and, many, many other Hawkeyes have assumed key leadership positions at the state, regional, national, and international
level. The luminescence of Iowa’s legacy of leadership continues to shine brightly. Max, given these and many other noteworthy successes, we would appreciate your assistance. First, we owe a debt of gratitude to countless Hawkeyes who graced our halls for many decades past and who helped bring to the fore unprecedented advances in pharmacy education, training, patient care, and discovery… the high regard with which our program is held today is due in large measure because we were able to stand on the shoulders of giants past. The contributions of these individuals helped immeasurably to pave the way for today’s understudies…please extend to them our heartfelt thanks and admiration. Second, we (pharmacy at large) could use of good dose of continued enlightenment. On the one hand, pharmacy’s role is the interdisciplinary management of patients has never been more embraced by others in healthcare delivery. That said, healthcare resources are being challenged in ways that have never been witnessed previously. Pharmacy needs the continued strength of character, creativity, resolve, ingenuity, resourcefulness, and tenacity of those past to continue to advance its societal purpose. Yesterday’s lessons can be today’s best teacher. Today’s emerging pharmacy leaders need the enlightenment and encouragement of lessons past. And third and finally, one of the many reasons I admire those who passed before us, including you, Max, was the commitment demonstrated to make our journey that much easier. You and those like you planted trees for
Donald Letendre, PharmD Dean The University of Iowa College of Pharmacy
fruit that would only be savored by future generations. We have harvested much because of your labors and time-honored commitment to hard work, deliberation, collaboration, and compromise. Let us learn those precious values of selflessness and perseverance. I wish I had the honor and pleasure of sharing one day with you, Max. I would treasure your insights and, based on those who knew you well, your humor. During the spirit of Christmas and the dawn of a New Year, we honor those who went before us and instilled the pride we share as Hawkeyes. So, thank you, Max… and please pass along heartfelt thanks to those Heavenly Hawkeyes with whom you share a very special place. Our profession has and will continue to benefit immensely from your enumerable contributions. ■
Author’s note Max W. Eggleston University of Iowa College of Pharmacy Graduate: June 1, 1947 (BSPh) Died: November 6, 1997 Notable accolades: 1995 Remington Medalist 2012 Osterhaus Medal for Lifetime Achievement (posthumously)
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STUDENT PHARMACISTS: APPLY TODAY! BILL BURKE STUDENT PHARMACIST LEADERSHIP CONFERENCE September 28-29, 2018 Application Deadline - May 1, 2018
THE MAX W. EGGLESTON EXECUTIVE INTERNSHIP IN ASSOCIATION MANAGEMENT Application Deadline – March 1, 2018
The Eggleston Executive Internship in Association Management is a 12-week program held each year during the summer months in the IPA offices in Des Moines. The Bill Burke Student Pharmacist Leadership Conference is scheduled for September 2829, 2018, in Iowa City, Iowa. The conference will provide additional opportunities for networking and learning. The Bill Burke Student Leadership Conference aims to: • Instill quality organizational leadership skills • Increase awareness of issues impacting the profession of pharmacy • Encourage development of leadership skills and involvement in professional and community activities • Recognize pharmacy students who have displayed leadership potential • Improve communication and teamwork skills
To Apply
Current P1 through P3 student pharmacists from Drake University and The University of Iowa can go to www.iarx.org/BillBurke for more information or to complete an application before May 1, 2018.
“I can count pills, pour liquids, and compound medications but this is just a small part of a being a pharmacist. Being a consultant to my patients – that’s where I’ve used my education and where I have been of greatest service.” - Bill Burke
During the internship experience, the intern will receive educational instruction in each of the association’s divisions as follows: • Public Affairs and Business Development • Professional and Educational Affairs • Organizational and Administrative Affairs • Foundation and Charitable Giving The ideal candidate is an IPA student pharmacist member currently in their second year of pharmacy school.
To Apply
Applicants should submit their online application at www.iarx.org/ExecIntern along with a current resume and writing sample to Anthony Pudlo at apudlo@iarx.org by March 1, 2018. For more information, please review the IPA website or contact IPA at 515-270-0713.
The Bill Burke Student Pharmacist Leadership Conference and the Max W. Eggleston Executive Internship in Association Management are supported by the Iowa Pharmacy Association Foundation as part of its mission to support student pharmacists and leadership development within the pharmacy profession in Iowa.
PRACTICE ADVANCEMENT
State Innovation Model (SIM) IPA continues to work with the Iowa Healthcare Collaborative (IHC) as a subcontract on the State Innovation Model (SIM) for the third year of a four-year federal CMMI grant. The project focuses on care coordination and practice transformation in key regions of the state. IPA’s initiatives to serve the SIM communities involve educational efforts on pharmacists’ role in clinical care coordination, IPA Goes Local events, support of value-based pharmacy networks, and promote integration of pharmacy services into Iowa’s Health Information Exchange. State Innovation Model Community & Clinical Care Initiative Lyon
Osceola
Dickinson
Emmet
Winnebago
Worth
Mitchell
Howard
Winneshiek
Allamakee
Kossuth
Sioux
1
O’Brien
Clay
Palo Alto
Hancock
Gerro Gordo
Floyd
Chickasaw
Fayette Plymouth
Cherokee
Buena Vista
Pocahontas
Ida
Sac
Calhoun
Woodbury
Humboldt
Wright
6
Franklin
Butler
Black Hawk Hamilton
Webster
Hardin
Clayton
Bremer
Buchanan
Delaware
Linn
Monona
Crawford
Carroll
Greene
Boone
Story
Dubuque
Grundy
Tama
Marshall
4
Benton
Jones
Jackson
Cedar Harrison
Dallas Shelby
Audubon
2
Guthrie
Polk
Jasper
Poweshiek
Iowa
Johnson
7
Clinton
Scott
Muscatine Marion
Pottawattamie
Mills
Fremont
Cass
Montgomery
Adair
Madison
5
Warren
Mahaska
Keokuk
Washington Louisa
Adams
Union
Clarke
Lucas
Monroe
Wapello
Jefferson
Taylor
Ringgold
Decatur
Wayne
Appanoose
Davis
Van Buren
Page
Henry
platform to assist in clinical decisionmaking as part of their contract. Given the many exciting changes for 2018, at least one representative from each of the 82 participating CPESN Iowa pharmacies has been asked to attend a live meeting on Friday, February 17 in Des Moines in conjunction with the Midwest Pharmacy Expo. Participants are encouraged to stay for the conference to engage in the relevant educational programming and to continue to refine your patient care skills. CPESN luminaries have reminded participating pharmacies that in order to participate, they must sign participation agreements for both CPESN Iowa and CPESN USA. Participating pharmacies need to complete the CPESN Pharmacy Locator App survey in order for their pharmacy to be included on the national web-based platform.
Des Moines
3
Lee
1. Community Partners of Sioux County 2. Dallas County Public Health Nursing Services
4. Linn County Board of Health
6. Webster County Health Department
3. Great River Health Center
5. Marion County Public Health Department
7. UnityPoint Health - Trinity Muscatine
Over the past several months, pharmacists and pharmacy technicians living or working in these key regions of the state may have noticed email communications regarding the SIM initiative. Moving into the new year, IPA is interested in hearing from YOU about the opportunities and challenges related to care coordination and practice transformation in your communities. Please reach out to IPA to send feedback, be added to the email listserv, or become more engaged in SIM efforts.
CPESN Iowa: 2018 is the Year of Action
While 2017 primarily focused on organization for this enhanced services network, CPESN Iowa leadership has described 2018 as the “Year of Action.” Moving into the new year, CPESN Iowa expects to sign their first contract with an Enhanced MTM payer. Payment to pharmacies will be based on their ability to manage and reduce healthcare risk for a panel of patients. Participating pharmacies will have access to a pharmacokinetic
IPA, APhA Foundation Launch Project IMPACT: Immunizations
HIV Screening and Referral Project Launches in Iowa
IPA is collaborating with the Iowa Department of Public Health to help community-based pharmacies assist in filling gaps in HIV screenings and linkage to care. In the CDC’s most recent State HIV Prevention Progress Report, Iowa was ranked 47th for the percent of persons aged 18-64 who have had at least one HIV screening test. At 31.5% of persons in this age group tested, Iowa is far below the national goal (44.2%) and national average (43.5%). Iowa has much room to improve in order to reach this goal. The goal of the initiative is to have ten initial pharmacies become trained and provided supplies to screen patients for HIV through a CLIA-waived point-ofcare test. By the end of 2018, the goal will be to expand this initiative to 40 pharmacies. The purpose of this pilot is to assess barriers, develop training, and determine best practices when screening for HIV in the community pharmacy setting. IPA will be planning extensive outreach and education to all IPA members about the important role of pharmacists in discussing HIV and other infectious diseases with your patients.
After seeing success in a small pilot project in Washington, the American Pharmacists Association (APhA) Foundation chose to work with the Iowa Pharmacy Association and 15 Iowa pharmacies to implement a scaled demonstration of Project IMPACT: Immunizations in Iowa. Starting in December 2017, Project IMPACT: Immunizations uses an innovative care model and a bi-directional immunization information system to assist in identifying patient vaccination needs. This system will utilize information from IRIS to make a vaccine forecast for each adult patient based off of ACIP recommendations and vaccine history (based on data in IRIS). The pharmacists’ roles will be to clinically evaluate these forecasts, counsel patients regarding recommended vaccinations, administer vaccinations, and ensure proper documentation and follow up. This research aims to study community pharmacy’s role in increasing adult immunization rates and to provide data to help support efforts for sustainable pharmacy services. The pilot project found that for every patient that requested an influenza vaccine, an average of 1.45 additional vaccine needs were identified using a technology that interfaces with the state immunization registry. Of those needs, 33.5% of vaccines were administered within the 6-month study period, increasing the number of adult immunizations provided. The parameters of the original pilot project have been slightly adjusted for implementation in Iowa. ■
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COVER STORY
ADVANCING PRACTICE IN IOWA STARTS HERE & NOW
T
his is a crucial time in the history of the profession. Pharmacy is in the midst of a paradigm shift where pharmacy services are better integrated across the healthcare continuum to improve patient outcomes and decrease total costs of care. With the strong heritage of Iowa pharmacy, it’s no surprise that Iowa is one of the states at the forefront of this practice innovation. However, changes need to be made to further drive this practice advancement, some of those changes being legislative in nature. For the first time in over 10 years, IPA is excited to announce a very proactive legislative agenda that strives to elevate the entire pharmacy profession. This January, IPA will work with legislators to introduce a bill that provides the authority for pharmacists to prescribe ACIP-recommended immunizations for patients 11 years of age and older, and down to 6 months of age for influenza vaccines. This bill would also allow pharmacists to dispense medications for specified public health needs (pointof-care testing for group A strep and influenza, tobacco cessation therapies, and naloxone) under a statewide protocol. With a shortage of primary care services in Iowa, this is especially important. However, IPA has had policy
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| The Journal of the Iowa Pharmacy Association
to support pharmacist-administered immunizations since 1998 and statewide protocols since 2015. In many settings, pharmacists will not be in a position to provide additional direct patient care services without the role of pharmacy technicians also being expanded. Therefore, IPA’s proposed legislation will also allow technicians to perform two technical tasks that currently only licensed pharmacists are legally able to perform: final product verification and prescription transfers. The concept of technician product verification (formerly known as tech check tech) has a long history in Iowa. In 2007, IPA adopted policy to support processes where “certified pharmacy technicians verify the work of other technicians in order to expand pharmacist participation in patient care activities.” In 2009, this policy was partially translated into Code, which allowed “tech check tech” in hospital and institutional settings. However, IPA desired evidence to prove that this process would be beneficial across the pharmacy profession. For the past four years, IPA, in collaboration with Drake University, has conducted a research pilot project
under the jurisdiction of the Iowa Board of Pharmacy. This project, known as New Practice Model, included 17 community pharmacies from 11 different companies and allowed trained and certified pharmacy technicians to check the final step in the prescription dispensing process, product verification, after a pharmacist has performed the clinical drug utilization review. This project demonstrated that trained and certified pharmacy technicians verify prescriptions as accurately as pharmacists in the community pharmacy setting. Furthermore, the research also produced evidence to support that when this technical function is delegated to a trained pharmacy technician, pharmacists reallocate their time to patient care services. The concepts of advancing the roles of pharmacists and pharmacy technicians has been front of mind for IPA members for decades. With research, enthusiasm, and the passion of hundreds of IPA members to support these advancements, 2018 will be another historic year for Iowa pharmacy!
What is a ‘statewide protocol?’ A statewide protocol would allow pharmacists to prescribe and dispense
COVER STORY
specific treatments. Unlike statewide standing orders, such as Iowa’s naloxone standing order, the pharmacist operating under a statewide protocol would be considered the prescriber on the prescription or order. Statewide protocols increase patient access to timely care for public health needs and create consistency across Iowa.
What is ‘technician product verification?’ Technician product verification (formerly “tech check tech”) allows a certified pharmacy technician to conduct the final verification in accurately dispensing a medication. IPA created a change in terminology from “tech check tech” to “technician product verification” for two primary reasons: 1. To better illustrate which activity the technician is performing to mitigate any confusion (i.e. product verification only, not clinical DUR) 2. This language is less limiting as it allows pharmacy technicians to not only check the work of other technicians, but also student pharmacists and robotics to be more reflective of modern workflows.
What other legislative priorities does IPA have? While IPA’s bill will address statewide protocols, pharmacist-administered immunizations, and technician roles, IPA has been supportive of the Board of Pharmacy’s bill to address the opioid epidemic through improvements to the Prescription Monitoring Program (PMP). IPA will also continue to support fair and transparent drug reimbursement for pharmacies, including Iowa Medicaid’s survey-based cost of dispensing plus average acquisition cost (AAC) methodology. ■ IPA’s legislative priorities and position statements are outlined on page 29.
DO PHARMACISTS IN IOWA HAVE PROVIDER STATUS? In recent years, “provider status” has been a hot topic in pharmacy practice. Many times, individuals think of “provider status” as synonymous with the proposed federal legislation - H.R.592/S.109, the Pharmacy and Medically Underserved Areas Enhancement Act. While passage of this legislation would allow pharmacists in medically underserved areas to be recognized and paid as providers at the federal level under Medicare Part B, provider status has different meanings at the state level, too. Tennessee. Washington. California. Oregon. The list goes on. The passage of provider status bills at the state level are becoming more common, leading some people to ask, “why doesn’t Iowa have provider status?” In reality, Iowa does have provider status at the state level! Surprised? Actually, over 37 states have some type of state level provider status, and Iowa’s has been in existence for decades. State-level provider status is a three-pronged approach: (1) designation as a provider, (2) optimization of pharmacists’ scope within the pharmacy practice act, and (3) payment for services. In other words, even though pharmacists are designated as providers (“practitioners”) within Iowa Code, other considerations are needed to make provider status effective in practice. By optimizing the pharmacy practice act, pharmacists’ practice can include activities such as immunizations, collaborative practice agreements, and point-of-care testing. Fortunately, pharmacists have had the authority to perform such provider-based activities for years, and IPA continues to advocate for expanded scope of practice. However, the last piece, payment for services, is often the final puzzle piece for pharmacist provider status at the state level. Even when pharmacists are
designated as providers in Code and have a favorable scope of practice, payment models for pharmacist-based services are essential for sustainability. One proposed solution is amending Administrative Code within Medicaid and the Insurance Division to include pharmacists as providers and require payment for their services. However, another distinct method is that insurance companies and other payors can independently choose to recognize pharmacists and pay them for services (even if it’s not outlined in the Insurance Division Code). Such innovative payment models in Iowa include employer-based wellness programs, the Value-Based Pharmacy Program (implemented by a commercial insurer in Iowa), pharmaceutical case management, and other IPA-based initiatives. Many of these projects have generated data that continues to support pharmacists’ role in improving health outcomes, bolstering the case for payment for pharmacy services in a healthcare system shifting to value-based models. At the federal level, H.R. 592 links pharmacist provider status to payment for Medicare Part B for a limited subset of patients and in specific regions of the country. At the state level, there are many considerations to write the ideal prescription for provider status. Given the complexity of the issue, each state has taken a unique approach. However, whether at the state or federal level, the goal of provider status is to position pharmacists to improve patient outcomes. Regardless of current legislation, the best thing you can do for the pharmacy profession is to practice as a provider: every day, utilize your knowledge and skills to serve your patients, optimize your pharmacy practice, collaborate with the healthcare team, and strive to improve health outcomes in your community. ■
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LEGISLATIVE PRIORITIES
2018 LEGISLATIVE PRIORITIES & POLICY POSITIONS The Iowa Pharmacy Association’s Legislative Committee and Board of Trustees have established the following legislative priorities for 2018.
State Legislative Priorities
Expanded Role of Pharmacists IPA supports the development of statewide protocols that allow pharmacists to deliver expanded patient care services under standardized protocols to address public health needs. Statewide protocols create the opportunity for pharmacists to provide additional care with prescription medications to positively impact public health. Examples of statewide protocols include: administering immunizations; smoking cessation counseling and treatment; dispensing travel medications or hormonal contraceptives; furnishing naloxone for opioid overdose; and point of care testing and treatment. As of June 2016, 25 states have passed legislation allowing pharmacists to provide expanded services under statewide protocols. Delegated Tasks to Certified Pharmacy Technicians IPA supports the delegation of additional technical functions and duties related to the prescription dispensing process to certified pharmacy technicians. Technician product verification and prescription transfers are two technical functions that can be safely delegated to certified pharmacy technicians to improve patient care. By delegating additional technical functions to certified pharmacy technicians, pharmacists can spend more time in direct patient care activities. Technician product verification, currently defined as “tech-check-tech” has been in the Pharmacy Practice Act since 2008 as a practice exclusively allowed in institutional pharmacy settings. IPA’s New Practice Model initiative has piloted technician product verification in the community pharmacy setting, demonstrating increased patient safety through fewer dispensing errors and greater patient care services provided in pilot sites. Expanded delegation to CPhTs of these technical tasks will allow pharmacists and certified pharmacy technicians to practice at top of their training resulting in improved pharmaceutical care for patients.
Addressing the Opioid Epidemic IPA will support the Iowa Board of Pharmacy’s legislation to improve the Iowa Prescription Monitoring Program (PMP) by requiring daily pharmacy reporting, proactive notifications and prescriber registration. Additional principles to address the opioid epidemic that are supported by IPA include: electronic prescribing of controlled substances, pharmacist intern access to the PMP, increased coverage for and access to medication assisted treatment, and an expanded role for pharmacists and pharmacies to serve patients in treatment and recovery. The Iowa Board of Pharmacy currently administers the Iowa PMP. IPA works closely with the Board of Pharmacy, along with other stakeholders to address the current opioid abuse epidemic and provide strategies and solutions to policymakers and legislators.
State Regulatory Priorities
Iowa Health Link – Medicaid Managed Care – Department Of Human Services IPA is committed to working with DHS, the Iowa Medicaid Enterprise (IME), the Governor’s office and the Managed Care Organizations that have contracted with the state of Iowa. Medicaid modernization ‘Iowa Health Link’ has the opportunity to lower healthcare costs to the state by managing and maximizing provider services to Medicaid beneficiaries. IPA believes oversight of the MCO’s will be critical to ensure provider services (such as pharmacist services including MTM) are not reduced, but rather optimized; and that prescription drug reimbursement remain at the statutorily set rate of AAC + $10.02, as determined by a cost-of-dispensing provider survey. Pharmacy Benefits Managers – Iowa Insurance Division IPA supports statutory updates to align Iowa’s PBM laws with the 8th circuit decision in PCMA v. Iowa as well as expressing direct oversight of Pharmacy
Benefits Managers (PBMs) by the Iowa Insurance Division. IPA is committed to working with Iowa Insurance Division to ensure consumer protection and fair PBM practices for Iowans and transparent reimbursement for medications dispensed by pharmacies in Iowa. Collaborative Practice – Iowa Board Of Pharmacy – Board Of Medicine – Board Of Nursing IPA supports a review and revision of Board of Pharmacy (and corresponding Board of Medicine) rules related to Collaborative Practice Agreements. Since 2006, the Iowa Board of Pharmacy and Board of Medicine have had joint rules governing collaborative practice agreements between pharmacists and physicians in the state of Iowa. IPA believes the opportunity to increase the public health impact of services that can be delegated to a pharmacist by other healthcare providers can be achieved through updating the current BOP rules related to Collaborative Practice Agreements.
Policy Positions
Medical Cannabis IPA supports an active role for pharmacists and consultant pharmacists in the dispensing and medication management of cannabis used for legal medical purposes in the state of Iowa. Needle Exchange IPA supports hypodermic needle exchange programs as part of a comprehensive approach in preventing the spread of infectious diseases. IPA will continue to work with interested stakeholders and health provider groups to monitor any potential legislation and work with lawmakers to promote education on the risks of sharing hypodermic needles and syringes, and the potential of needle exchange programs to reduce this risk. ■
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THANK YOU!
Thank you to all who contributed to the IPPAC or LDF in 2017!
The Iowa Pharmacy Political Action Committee (IPPAC) is a fund used to strategically strengthen relationships with legislators that are supportive of pharmacy interests. The IPPAC is funded by contributions from individual pharmacists, pharmacy technicians, or student pharmacists, as well as member PACs of other organizations.
IPAâ&#x20AC;&#x2122;s Legislative Defense Fund (LDF) consists of donations from corporate sponsors. Since corporations are prohibited from contributing to candidates (and therefore, the IPPAC), these funds are used to pay for advocacy activities, which include IPAâ&#x20AC;&#x2122;s Legislative Day and Capitol Screenings, contracted lobbyists and external consultants, and IPPAC administration and fundraising costs.
2017 IPPAC Donors
2017 LDF Donors
Carol Anderson Kenneth Anderson Elizabeth Bald Brett Barker Connie Connolly Kyra Corbett Bernard Cremers Sarah Derr Ashley Dohrn Stanley Fullerton Kate Gainer Tom Greene Robert Greenwood Derek Grimm Anthony Guerra Richard Hartig Hy-Vee, Inc. Employees PAC #6282 Ryan Jacobsen Jennifer James June Johnson
Anderson Pharmacy Kenneth Anderson Bellevue Pharmacy Kevin McClimon Clayton Drug - Chris Clayton Coon Rapids Pharmacy Dan Pomeroy Cornerstone Apothecary Denver Drug - Brett Hansen Dowd Drug James Vandevanter Drilling Morningside Pharmacy William Drilling Fontanelle Drug - Kaye Bax Greenwood Drug Robert Greenwood Greg Hoyman GRX Holdings - Greg Johansen Koerner Whipple Pharmacies Todd Wragge Kwik-Rx Pharmacy - Tom Fox LaGrange Pharmacy R. Micheal LaGrange Lewis Drug
Russ Johnson TJ Johnsrud Thomas Kelly Matthew Kent Tyson Ketelsen Craig Logemann Erik Maki Gary Maly Kristin Meyer Mary Milavetz Emily Muehling Robert Nichols Bob Osterhaus Lisa Ploehn Anthony Pudlo Susan Purcell Susan Shields Sarah Sougstad Stevie Veach Todd Wragge
Medical Associates Pharmacy Wendy Kinne Meyer Pharmacy - Ryan Frerichs Moser Family Pharmacy Jay Paul Moser Oard-Ross Drug Anthony Beraldi Rashid Pharmacy Dwayne Plender South Side Drug - Eric and Gene Carlson Stangel Pharmacy Aaron Stangel Sumpter Pharmacy & Wellness Toni Sumpter Southwest Iowa Pharmacists Association Theresa Krueger Thompson Dean Drug Gary Maly Towncrest Pharmacy Randy McDonough Union Drug - Steven Metcalf Valley Drug Store - Linda Grimm
STRENGTHEN ADVOCACY. STRENGTHEN PHARMACY. Your contributions to either the IPPAC or Legislative Defense Fund 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
LEGISLATIVE DAY
AGENDA Embassy Suites, Downtown Des Moines
8:00–9:00 am: Registration at Embassy Suites 9:00–9:20 am: IPA’s Good Government Award Presentation IPA’s advocacy team will provide an overview on the issues that IPA members should discuss with their legislators at the Capitol.
9:20–10:20 am: Welcome & Legislative Briefing
IPA will award an Iowa legislator who has worked strongly on behalf of pharmacy and healthcare issues with its annual Good Government Award.
Iowa State Capitol Building
10:30 am–1:00 pm: Capitol Visits & Lunch
Pharmacist and student pharmacist attendees will group together, pairing up in advance of Capitol Hill visits. Attendees will travel by bus to the Iowa state capital to meet with their state senator and state representative. Box lunches available in capitol rotunda.
**All attendees are encouraged to contact their legislators in advance to schedule a meeting and/or lunch during this time block. Pharmacist mentors will be introduced to form small groups prior to departing.
1:15 pm: IPA Group Photo
Meet at the stairs of the Capitol rotunda for a group picture. Photo taken at 1:15 sharp – please arrive five minutes early. White coats encouraged.
Embassy Suites, Downtown Des Moines
1:45–4:30 pm: Pharmacy Law CPE Details to the right
CPE SESSION DETAILS
Full CPE Information is available at www.iarx.org/IPALegDay
1:45-2:15 pm: Pharmacist Statewide Protocols Ryan Burke, PharmD, American Pharmacists Association
In line with IPA’s legislative priorities, an increasing number of states are implementing statewide protocols. Ryan Burke will provide a national perspective on statewide protocols and how they are being used as an innovative tool in increasing healthcare access for patients.
2:15-2:45 pm: Pharmacist Legislator Panel Rep. John Forbes (D-40) and Sen. Tom Greene (R-44)
For the first time in IPA’s history, pharmacists are serving in both legislative chambers, and both political parties. Hear their perspectives on Iowa’s 2018 legislature and the state’s priorities.
2:45-3:45 pm: Deploying Practical Solutions to Fight the Opioid Crisis
Katy Brown, PharmD - Telligen Brett Faine, PharmD, MS - The University of Iowa Hospitals and Clinics Josh Feldmann, PharmD - Mercy Family Pharmacy - Dubuque Jarek Vetter, PharmD - Broadlawns Medical Center Countless stakeholders and state officials are all seeking ways to help stem the spread of opioid-related deaths across the country. IPA has convened a panel of experts to discuss practical solutions that can be implemented in pharmacies to help identify and address potential problems.
4:00-4:30 pm: Update from our State Leaders
Governor Kim Reynolds Lt. Governor Adam Gregg Jerry Foxhoven, Director, Iowa Dept. of Human Services
Register at www.iarx.org/IPALegDay
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PUBLIC AFFAIRS
IPA WORKING FOR YOU Medicaid & MCO Concerns Addressed in 2017: 55 Communicated up-to-date
announcements to pharmacies during AmeriHealth Caritas’ exit and MCO transition
55 Resolved reimbursement concerns
when pharmacies where being incorrectly reimbursed at FUL pricing for brand medications
55 Brought Preferred Drug List
discrepancies to the attention of Iowa Medicaid Enterprise
55 Advocated for efficient processes that
do not put unnecessary financial burden on pharmacies when dispensing fee adjustments are implemented
55 Supported pharmacies through the audit appeals process
55 Ensure AAC reimbursement rates
are calculated fairly through Myers & Stauffer
55 Streamlined the processing of crossover claims for dual eligible patients
55 Helped pharmacies navigate the DME contracting process
55 Advocated for insulin pen needles to
be included as a pharmacy benefit for Medicaid patients
Still Experiencing Issues? Tell Us Now! If you are experiencing an issue with one of the MCOs that does not reach adequate resolution through their respective helplines, please do not hesitate to contact IPA through our survey link on the IPA homepage.
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Iowa Hires New Medicaid Director
The Iowa Department of Human Services (IDPH) hired Michael Randol as the State’s new Medicaid director. Randol has been the director of the Kansas’ Medicaid program since 2015 and has been involved with the program since 2012. Like Iowa, Kansas also uses managed care organizations to manage the program. Randol will fill the vacancy left when the previous Iowa Medicaid director, Mikki Stier, was appointed the deputy director of the Iowa Department of Human Services.
IPA hosts Legislative Reception with Iowa’s Pharmacist Legislators
On November 9, IPA hosted a unique event to support Iowa’s two pharmacist legislators – Rep. John Forbes (D-40, Urbandale) and Sen. Tom Greene (R-44, Burlington). Members had the opportunity to meet the legislators and discuss legislative issues. Both legislators spoke about pharmacy-related events of the last legislative session and legislative action they would be pursuing in 2018, including a bill to return Iowa Medicaid to state control. This was the first time that IPA has hosted such an event, reflective of the unique position of having two pharmacists in the state legislature - one in each chamber and one from each political party.
PUBLIC AFFAIRS
IOWA PHARMACISTS HOST THEIR LEGISLATORS Rep. Amy Nielsen visits Mercy Medical Center, Cedar Rapids Pharmacy
First term Representative Amy Nielsen visited with Jennifer Goings, PharmD, MBA, outpatient, transitions of care and MTM pharmacy manager at Mercy Medical Center, Cedar Rapids in late October. It was Rep. Nielsen’s first visit inside health-system pharmacy. After a tour of the inpatient pharmacy explaining the various automation devices and staff the pharmacy relies Rep. Amy Nielsen (l) and Jennifer Goings, on to deliver exceptional care PharmD, at Mercy Medical Center to patients, Rep. Nielsen and Dr. Goings discussed the importance of the pharmacist’s role in taking care of patients throughout the healthcare continuum. “It was a great opportunity and conversation discussing the continued need for pharmacist provider status and be able to highlight some of the great work being done by pharmacists not only at Mercy, but across the state and nationally,” said Dr. Goings. “Being able to have my own representative come onsite and learn more about the pharmacy profession was very rewarding.”
Greenwood Pharmacy Hosts Rep. Ras Smith
Southwest Iowa Pharmacy Association Meets with Sen. Dan Dawson
Left to Right: Tom Fox, RPh, SIPA Treasurer; Melanie Ryan, PharmD, SIPA Board Member; Morganne Haer, Creighton University School of Pharmacy and Health Professions Student Board Member; Samantha Haugaard, Creighton University School of Pharmacy and Health Professions Student Board Member; Sen. Dan Dawson; Jacob Duncan, University of Nebraska College of Pharmacy Student Board Member; Tony Beraldi, RPh, SIPA President; Ron Baker, RPh, SIPA VicePresident; Not Pictured: Rory Ruma, PharmD, SIPA Secretary
The Southwest Iowa Pharmacy Association (SIPA) met with Sen. Dawson in October. They discussed pharmacists’ value to the healthcare team, the importance of the Medicaid AAC plus dispensing fee reimbursement model, and DME concerns. Sen. Dawson served on an interim opioid interim committee this past fall, and discussions regarding the Prescription Monitoring Program were especially pertinent.
Want to Host a Legislator at Your Pharmacy? Rep. Ras Smith (l) with Rob Nichols at Greenwood Pharmacy in Waterloo
“It’s important to engage with your state legislators and discuss the invaluable role pharmacists play as medication use experts,” said Greenwood Pharmacy’s Rob Nichols, PharmD. “During Rep. Smith’s visit we talked about pharmacies as immunization centers, enhanced services networks, adherence services, and pharmacy’s role in mental health.”
Every pharmacy practice site offers a great opportunity to host your legislator and showcase the value of the profession. Interested but not sure where to start? Contact IPA for guidance and resources at 515270-0713 or ipa@iarx.org.
JAN.FEB.MAR 2018 |
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PUBLIC AFFAIRS
BOARD OF PHARMACY: WINTER UPDATE The items below summarize some of the discussion during the Wednesday, November 1, 2017 open session of the Iowa Board of Pharmacy.
provided when drugs are packaged in unit-dose drug distribution systems. This proposed rule identifies the minimum standard for such repackaging activities.
Upgrades for the Prescription Monitoring Program
2) Telepharmacy: This proposed amendment would allow a telepharmacy to utilize the services of a delivery driver when that individual is registered as a pharmacy support person. The proposed amendment would only authorize the individual to engage in delivery activities and not in the entirety of other nontechnical functions for which a pharmacy support person is authorized.
The Board of Pharmacy extended their deadline for Request for Proposals (RFP) from November 3, 2017 to November 13, 2017 to update the Iowa Prescription Drug Monitoring Program (PMP). This extension does not change the Board’s intent to go live with a new upgraded PMP system, which is scheduled for April 2, 2018. Intended upgrades with this RFP include: easier synchronization to EHRs and pharmacy software systems, a more user-friendly platform, and more timeliness with data pulls.
Votes to Approve Proposed Rule Changes & Notices of Intended Action
The Board voted to approve these proposed rule changes as Notice of Intended Action, which now will allow for an open public comment period in early 2018. A short summary of some of those proposed changes include: 1)Repackaging of VA medications: Patients within the Veterans Administration (VA) healthcare system are limited in where they may obtain their prescriptions drugs under the VA benefit, and VA pharmacies do not provide prescription drugs in unit-dose drug distribution systems, which are usually required in care facilities. This amendment proposes to adopt a new rule that would allow pharmacies to repackage prescription drugs originally dispensed by a VA pharmacy for a patient residing in a care facility. In the care facility, drug security and accountability are better
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3) Prescription Monitoring Program (PMP): The proposed amendments increase the frequency of a dispenser’s reporting of controlled substance dispensing to the Iowa PMP from “at least weekly” to “the next business day following dispensing.” The amendments increase the frequency of such reporting to provide prescribers and pharmacists more timely information when utilizing the data in their prescribing and dispensing decision making. 4) Care facility practice: The proposed amendments to the chapter update language for consistency, remove redundant rules, combine and condense rules where appropriate, and clarify prescription requirements for controlled substances to be consistent with federal regulations. The proposed amendment to Chapter 10 updates a cross reference. 5) Restructuring expanded/clinical services of pharmacists: The proposed amendments create a new chapter for rules relating to some areas of pharmacy practice that are not required of all pharmacies, such as provision of immunizations or participation in collaborative practice agreements, but
for which the Board has established minimum practice standards. The purpose of moving these rules to a separate chapter is to narrow the scope of Chapter 8 to those minimum standards that are required of every pharmacy licensed in Iowa. 6) Central fill/processing: The proposed amendments clarify records requirements and update language to be consistent with other Board rules. The proposed amendments also remove redundancies in rules that exist in other applicable chapters of Board rules. IPA will be submitting comments to the Board of Pharmacy on these proposed rule changes. Please share any of your thoughts on the proposed language with Anthony at apudlo@iarx.org. As an individual, you may also submit personal comments at https://rules.iowa.gov.
Votes to Approve Proposed Amendments to Iowa Code
The Board voted to propose amendments to various sections of the Iowa Code as part of the legislation that the Board of Pharmacy would submit to the 2018 legislature. The Board tabled initial discussions that would affect the PMP, but later approved via conference call. The Board voted to include these various provisions in their proposed legislation: 1) Wholesale and limited distribution: This bill updates Iowa Code to be in compliance with the federal Drug Supply Chain Security Act of 2013, (DSCSA), which contains a provision that prohibits states from enacting laws that are more or less strict than DSCSA. The board currently licenses many types of drug distributors under a single “Wholesaler Distributor” license. Under DSCSA,
PUBLIC AFFAIRS
entities engaging in the wholesale distribution of prescription drugs are held to a higher minimum standard than entities engaged in exempted distribution activities. This bill creates specific license categories for Third-Party Logistics providers and Limited Distributors to shield entities exempt from DSCSA from the standards required of wholesale distributors under federal law. 2) Addition of a pharmacy technician to the Board: This bill increases the composition of the Board of Pharmacy by one member to include a registered, certified pharmacy technician. The technician member would be required to have been actively engaged in the practice of pharmacy as a certified pharmacy technician for at least five years in Iowa. 3) Controlled Substance Act registrations: This bill removes the specific frequency of registration such that the Board can align registration with the registrant’s underlying professional
license, or home state license or registration for registrants located outside of Iowa shipping into Iowa. This change prevents the registrant from having an active controlled substance registration when the registrant might not otherwise be eligible. The bill also provides the Board the option of taking formal disciplinary action against a registration when the violation does not rise to the level of restriction, suspension, or revocation. The bill adds controlled substances to Schedule I and Schedule II consistent with scheduling action taken by the United States Drug Enforcement Administration. 4) Prescription Monitoring Program (PMP): The proposed amendment would allow for the Board to distribute proactive notifications based on thresholds or criteria designed to identify doctor or pharmacy shopping or the patient’s excessive use of a controlled substance. The proposed amendment would add Schedule V controlled substances to
be collected by the PMP, except when those medications are dispensed by a pharmacist without a prescription. The bill also restructures the PMP advisory council from a council appointed by the governor whose membership is specifically defined and limited in number, to an advisory committee consisting of an unspecified number of healthcare professionals and nonhealthcare professionals and whose members are appointed by the Board. 5) E-Prescribing of Controlled Substances: The proposed amendment would require that no prescription for a controlled substance may be dispensed unless the prescription is an electronic prescription transmitted to a pharmacy in compliance with federal requirements for the electronic prescribing of controlled substances. Exemptions and request to waiver the timeline of such implementation would be accepted. An effective date of July 2019 has been proposed. ■
The Iowa Pharmacy Association Career Center gives you access to Iowa’s top pharmacists and pharmacy technicians. Our members are highly engaged and dedicated to taking pharmacy practice to the next level.
Post your next open position to reach our top-level talent pool of active and passive job seekers to join your practice today!
www.iarx.org/CareerCenter
Your Next Great Hire is Here
TECHNICIAN CORNER
PRE-PACKAGED MEDICATION IN A COMMUNITY SETTING Lori Foster, CPhT Springville, Iowa
A
t the community pharmacy where I am employed, we offer a packaging service using technology that dispenses a patient’s medication in individually labeled cellophane dosage packets. We have found great benefit to our patients, and have received many thanks from social workers, prescribers, home health aides, and family members. Populations receiving the most benefits from our prepackaged medications include early- to mid-stage dementia patients, group-home residents (especially those who self-administer medications), those with multiple doses per day, those with literacy or language barriers (as we have the ability to print auxiliary symbols), or anyone desiring ease of adherence. Benefits include improved adherence, more timely medication changes, inclusion of over-the-counter medications, descriptions of capsule/ tablet appearances, and portability of dosages. For example, a patient can tear off as many packets from the dispensing box as needed for a night out, adult day-care, or other situation where convenience and discreetness may be preferred. Considerations for the patient before conversion to prepackaging include physical and/or visual barriers,
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multiple PRN medications, HIPAA and environmental concerns with printed cellophane packaging, and regimens with frequent changes (i.e., warfarin). Implementation actions for new patients include completing an intake form to specify preferred or optimal time-of-day administration for each medication and a short orientation to packaging appearance and use. The pharmacy process includes transferring prescriptions if needed, multiple double-checks during the order-entry, fill, and finalization process, and as always, a final verification by one of our pharmacists. The technology we use includes our order-entry computer, the machine that dispenses individual medications from internal bins and concurrently prints the package/labels, and our point-of-sale system.
We have many patients and their representatives’ express gratitude for the way we make medication use so much simpler for them, and we find it very rewarding. ■
Pharmacy Technicians: We Want to Hear from You!
Do you or someone you work with continually demonstrate excellence as a pharmacy technician? Each quarter, IPA highlights a pharmacy technician member whose dedication to patient care and innovation within the pharmacy profession makes them an example for others. If you or someone you know exemplifies these characteristics and would like to share their passion for the profession, please contact IPA at ipa@iarx.org.
TECHNICIAN CORNER
NEWLY PTCB CERTIFIED IOWA TECHNICIANS October 1 - December 31, 2017
Please join IPA in congratulating the following pharmacy technicians on becoming PTCB-certified! Maisaa Abudagga Kaylene Ahrens Craig Anthofer Christine Bell Ann Bennett Rhonda Burman Ariana Christ Savanah Cosgrove Alexandra Curran Cynthia Darling Emily Davis Rochelle Dicus Jonathan Fash Shena Geisinger
Brooke Gordon Ericka Head Kirsten Hendren Zoe Kedrowski Sarah Kelly Vicky King-Dow Kaleigh Kinser Nicole Klocke Nydia Landeros McKenna McCreedy Jenna Mendez Dahaby Mohammed Heather Owensby Farrah Peterson
In a world where our patientsâ&#x20AC;&#x2122; health requires the best in care,
PTCB CHOOSES
EXCELLENCE. ptcb.org
Carl Ploegstra Daniel Rasmussen Bridget Riffey Adam Robbins Joseph Ryken Chelsey Savochka Rachel Schaefer Cierra Shaw Mary Stephens Amanda Swenson Courtney Temple Janet Thomsen Allison Townsend Logan Villhauer
Bethany Volz Jessi Wade Maria Whitaker Tiffany Wiese Ellie Wingert
PTCB is the leading certifying body for pharmacy technicians. We are most trusted. All 50 states, DC, Guam, and Puerto Rico accept PTCB Certification. We are the only certification that is nationally accepted. We specialize in pharmacy technicians. Our sole focus is on certifying technicians for their many roles across pharmacy settings.
We have nothing to hide. Our Pharmacy Technician Certification Exam (PTCE) is challenging, and we publish extensive detail about the exam.
We are informed by research.
We rely on evidence to evaluate the PTCB Program and strengthen its value.
Patient safety demands rigor.
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Choose PTCB. Choose Excellence. JAN.FEB.MAR 2018 |
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TECHNICIAN CORNER
TECH TIDBITS Highlights from IPA’s monthly e-newsletter specifically for pharmacy technician members. Rising Cost of Prescription Medications
Prescription medication prices are on the rise. Whether it’s national news headlines or your patients commenting on increasing costs with monthly medication refills, you’re likely seeing the impacts of this national trend on a regular basis. Depending on your practice setting, the impact may be more prevalent as you try to control inventory and manage how medications are stocked or prioritized in your pharmacy. According to a recent American Society of Health-System Pharmacists (ASHP) report, prescription medication prices rose by nearly 6% last year, and more than half of the increase resulted from price hikes of existing medications. In 2017, the increase in total medication expenditures is predicted to be 6-8% across all settings. These costs may impact both patients and the financial outcomes of your pharmacy or hospital and translate to frustration among patients, inefficiencies in workflow, and required budgetary monitoring. Specialty drugs, especially new immunoncology agents, are the biggest driver of heightened drug costs, but diabetes therapy remains the medication class with the greatest total expenditures across all areas of practice. In 2016, $49.46 billion, nearly 12% of all medication expenditures, was spent on antidiabetic agents. Antiviral, psychotherapeutic, and respiratory therapy agents followed closely with total expenditures over $94 billion. These costs prompt members of the pharmacy team to carefully examine their own drug utilization patterns to appropriately anticipate drug spending. As a pharmacy technician, you can have a vital role combating these costs by managing inventory, working with insurance companies to properly bill
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for medications, and partnering with pharmacists to create workflows which allow for medication therapy management and optimization of drug therapies.
Electronic Prescribing of Controlled Substances
As technicians, you may receive inquiries from prescriber practices inquiring about electronic prescribing of controlled substances (EPCS). This is a process that will allow your pharmacy to receive controlled substance prescriptions electronically from prescribers’ offices. Using EPCS is not very different from the process your pharmacy currently uses for electronic prescriptions. There are benefits for all stakeholders: patients, prescribers, and pharmacies. You could also become an advocate for EPCS by mentioning the electronic process to physician’s offices that you interact with in regards to a controlled medication. Once your pharmacy goes live with EPCS, inform your patients that this service is available. There are a few steps your pharmacy will need to take before being able to start EPCS. There may need to be some upgrades in your pharmacy’s software system in order to assure compliance with both the DEA and SCRIPT. Thirdparty audit of the software and network certification are also required. The good news is that much of this work can be done by your pharmacy’s software vendor. A good place to start the process is by contacting your vendor for guidance. The vendor may already have completed some of the required steps. The process for prescribers has additional and very important steps. Of note is the Two-Factor Authentication credential, which could be a badge and thumbprint verification. This credential could involve software upgrades, so the software vendor
is the best place to start. If prescribers or your pharmacist have any questions about EPCS, there is an online resource at getEPCS.com which explains the process in both print and video format. In addition, Surescripts provides a locator database to find pharmacies and physicians that utilize e-prescribing and EPCS (http://www.surescripts.com/ network-connections). EPCS could seem like a cumbersome process to get started; however, the most important aspect to keep in mind is the potential for improving safety and patient care.
When the Weather Outside is Frightful - Frostbite Risk
With the weather getting colder, Iowans are going to be at greater risk for frostbite. If it is cold and windy enough, frostbite can occur within a few minutes of being outside. Frostbite occurs when tissue freezes from lack of circulation and heat loss, due to extremely cold temperatures and wind chills. Symptoms include blisters, difficulty moving the area, hard, waxy skin, numbness, white or grey skin, and if severe, blackened skin.1 Currently, there are two classification systems for frostbite. The traditional classification, focusing on depth of tissue damage, is broken down into first-degree through fourth-degree frostbite, with first degree being the least severe. The newer classification focuses more on risk of amputation or sequelae. Grade 1 shows no risks of complications, while grade 4 predicts amputation in addition to functional sequelae.2 If someone has developed frostbite, have them take off wet clothing, try to warm the area with warm (not hot) water or body heat, and make sure they see a physician. In addition to the fact hot water causes increased pain during rewarming, it has not been shown
TECHNICIAN CORNER
to warm the area much faster than when using warm water. Guidelines recommend either ibuprofen or an opioid, depending on the severity of the pain, to reduce pain during rewarming. Applying topical aloe vera before wound dressing may improve outcomes for more superficial damage by decreasing clot formation and inflammation.2 If the damage is severe enough and normal rewarming is not working, medications to reduce clotting, such as alteplase, heparin, and enoxaparin can be used to decrease the risk of amputation caused by blood clots. In addition to reducing clotting, prostacyclins, such as Iloprost, can also be used to increase blood flow to the area and reduce amputation risk in cases of severe frostbite.1 Sometimes a tetanus shot or antibiotics may be given to reduce the risk of infection, since the damaged tissue is more susceptible to infection. If the frostbite is bad enough, a patient may need to have the dead tissues removed.2 The good news is there are many things one can do to reduce the risk of frostbite. It is important to dress warm in the winter, such as wearing gloves/mittens, face masks, hats, and layered clothing, especially when staying outside for longer periods of time. There is thought that using ointments or lotion on the skin can reduce the risk of frostbite, however it can actually make one more susceptible.
One study showed when test subjects had ointment on half of their face, their skin temperature decreased at a similar rate to the half without ointment. However, the test subjects perceived that the ointment to have a warming effect. This leads to a false sense of protection, which can decrease the amount of adequate preventative measures needed against the cold.3 Pay attention to the temperature and wind chill, as they can dictate the amount of time one can spend outside before being at risk for frostbite, as seen below in a chart produced by National Weather Service.4 If someone is starting to experience symptoms of frostbite, such as numbness or pain, get them to a warm area as soon as possible.2 It is important to note, frostbite does not only occur during winter. It can also occur if someone uses an icepack for too long or without placing a cloth between it and the skin.1 References:
1. https://www.uptodate.com/contents/ frostbite?source=history_mobile#H1 2. http://www.wemjournal.org/article/S10806032(14)00280-4/fulltext 3. https://www.ncbi.nlm.nih.gov/ pubmed/10998829 4. http://www.nws.noaa.gov/om/cold/wind_chill. shtml
CPhT Recertification CPE for FREE! Join IPA and receive CEIâ&#x20AC;&#x2122;s Technician Library for FREE!
The Technician Library includes pharmacy technician certification CPE activities in categories consistent with the PTCB Domains, including pharmacy law, patient safety, immunizations, and current drug therapy. Also included are live webinars to get those live credit hours.
Members: Login at www.iarx.org/cei_libraries to take advantage of your benefit and spread the word to your colleagues.
JOIN NOW & Receive Your Free CPE! www.iarx.org/membership 515.270.0713 | ipa@iarx.org
JAN.FEB.MAR 2018 |
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IPA FOUNDATION
THANK YOU FOR SUPPORTING THE IPA FOUNDATION IN 2017!
The Iowa Pharmacy Foundation sincerely thanks those members who make a contribution to the future of the profession by supporting the efforts of the Foundation…these contributions truly make a difference. The following list of contributors is for January 1, 2017 – December 31, 2017. Platinum Level ($1000+) Tim & Sherry Becker Ashley Branum Renae & Eddie Chesnut Connie & Chris Connolly Jay & Ann Currie Steve Firman Kate & Bob Gainer Gary Maly Bob Greenwood Tom & Heather Halterman Julie Kuhle Donald E. & Louise Letendre Nick Lund Gary & Mary Milavetz Anthony Pudlo Al Shepley Troy Trystad Ben Urick & Katie Owen Gold Level ($500-$999) Mark Adams Carol Anderson Bill Baer Barry Carter Sharon Cashman Nicholas Dahlke Levi Gates Jim Hoehns Lisa Lambi Kristin Meyer Kevin Moores Rachel Otting Chuck & Janalyn Phillips Lisa & Andy Ploehn Doug Schara Mark Sorenson Bob Stessman CoraLynn Trewet Pat Wilsbacher
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Silver Level ($250-$499) Michael Andreski Sarah Cashman Carter Chapman Cheryl Clarke Chris Clayton Sarah Derr Michele Evink Allen Fann Mike Farley Tisha Field Ryan Frerichs Greg Hoyman Manda Johnson Margaret Karbeling Megan Lewis Craig Logemann Zach Lough Michael Pursel Holly Randleman Gordon Reed Bob & Monica Sack Susan Shields Sarah & John Swegle Tom & Cathy Temple James Wallace Bronze Level ($100-$249) Bruce Alexander Brianne Bakken Christine & Michael Catney Carl Chalstrom Jonathan Clingman Angela Davis Paula Emerson Joshua Feldmann John Forbes Stanley Fullerton Matthew Glasow Tom Greene Kyle Hilsabeck Hal Jackson
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Ryan Jacobsen Terry Jacobsen Sandra Johnson Russ & Lucile Johnson TJ Johnsrud Dennis Jorgensen Thane Kading Carson Klug Rick Knudson Nicholas Lehman Jeff & Shelley Longstaff Paul Luckman Eugene & Susan Lutz Ed Maier Erik Maki Steven Martens Thomas McBride Deanna McDanel Rex & Phyllis McKee Laura Miller Jennifer Moulton Leman Olson Jymm Oplt Bob & Ann Osterhaus Matt & Marilyn Osterhaus Nathan Peterson Sue & Kevin Purcell Justin Rash Jeff & Diane Reist Andrew Riesberg Richard Riesberg Ethan Sabers Kayla Sanders Cheri Schmit Valerie Schnoebelen Jim Scott Bernard Sorofman Amanda Stefl Anne Stella Nora Stelter Stevie Veach Susan Vos
Alex Weirich Madison Williams Bill Wimmer Business Partner Contributors Brehme Drug, Inc. Cardinal Health Chris Connolly/ Wells Fargo Advisors Drake University College of Pharmacy & Health Sciences Dubuque Area Pharmacy Association Eagle Grove Pharmacy Great River Health Systems Greenwood Drug GRX Holdings Hy-Vee Corporate Johnson County Pharmacy Association Kappa Psi Pharmaceutical Main at Locust Pharmacy Manning Pharmacy McGowen, Hurst, Clark, Smith PC McKesson Corporation Miller Purcell North Iowa Pharmacy Inc. NuCara Pharmacies Osterhaus Pharmacy Pharmacists Mutual Companies Quad City Area Pharmacy Association Sanofi South Side Drug TelePharm The University of Iowa College of Pharmacy Thrifty White Pharmacies Towncrest Pharmacy Wasker, Dorr, Wimmer, Marcouiller
Inspiring generosity and fulfilling the aspirations of the pharmacy profession through support of education, practice based research, and practice development
THE FOUNDATION INSTITUTE
1960: The Iowa Pharmacy Foundation is established
To keep Iowa pharmacy thriving requires a sustained commitment to supporting our student pharmacists, developing future leaders and advancing initiatives to innovate practice. Since 1960, Iowa’s pharmacy professionals have understood this and responded generously by regularly supporting the IPA Foundation.
The first student scholarships and loans are awarded by the foundation to student pharmacists at Drake University and The University of Iowa
1978: Max W. Eggleston Executive Internship in Association Management is established to provide student pharmacists an educational experience in association management.
In response, the IPA Foundation Institute was created to recognize those who, through a sustained commitment to an annual or monthly gift, are committed to supporting foundation initiatives with students, leadership development and practice advancement. In addition to joining a prestigious group of donor leaders, recognized by their level of annual giving, the Foundation Institute is an easy and convenient way to show your support for your profession. Simply designate an amount and frequency, and your gift is automatically deducted from your account. Current Foundation Institute Members Bill Baer Tim & Sherry Becker Renae & Eddie Chesnut Connie & Chris Connolly Steve Firman Kate & Bob Gainer Tom & Heather Halterman Julie Kuhle Donald L. & Louise Letendre Katherine Linder Gary Maly Kristin Meyer Anthony Pudlo Cheri Schmit Bob Stessman James Wallace If you share the Foundation’s vision of advancing pharmacy practice in Iowa, consider joining the Foundation Institute.
1989: The Leadership Pharmacy Conference is established to assist new practitioners with developing their leadership skills.
1994: Iowa Center for Pharmaceutical Care (ICPC) is established with the help of $300,000 and staff support from the foundation, Drake University and the University of Iowa colleges of pharmacy to allow community pharmacists to implement more patient care services.
2007: With support from both colleges of pharmacy and the IPA Foundation, the Collaborative Education Institute (CEI) was incorporated to serve continuing education needs of Iowa pharmacists and pharmacy technicians.
2010: The New Practice Model Task Force began meeting as a continuation of an unofficial discussion group started by the foundation in 2009. The task force leads to the creation of the New Pratice Model pilot program to study tech-check-tech in 17 Iowa community pharmacies.
Since 1960, the Iowa Pharmacy Association Foundation has invested in the future of the pharmacy profession in Iowa by building strong leaders, investing in innovative practice initiatives and securing high quality education for tomorrow’s practitioners. The result has been, and continues to be, a progressive and innovative culture in Iowa that continues to lead in how pharmacy is practiced across the country. Consider investing in the future of your profession by donating to the IPA Foundation general fund today at www.iarx.org/IPAFWaystoDonate. Donations to the IPA Foundation are 100% tax deductible.
The IPA Foundation has a unique opportunity to claim your favorite day(s) of the year as your own...at least on paper. With your charitable donation, you may purchase days in the 2017 IPA/IPAF Annual Report Calendar to celebrate ANY occasion!
OWN A DAY! Text & Photo - $100.00
To reserve your days, contact David Schaaf at 515-270-0713 or dschaaf@iarx.org. Donations are 100% tax deductible and will go to the Foundation. Hurry and claim your day(s) before someone else does and before April 1, 2018!
Description (under 10 words):
Text Only - $50.00 Month/Day: _______/_________ Name: ___________________________________________________________________________________________________________________ Address: _________________________________________________________________________________________________________________ City: _____________________________________________________________ State: ________________ Zip: _____________________________ Phone: _______________________________________________ Email: ______________________________________________________________
PAYMENT INFORMATION Make checks payable to: Iowa Pharmacy Association Foundation, 8515 Douglas Avenue, Suite 16, Des Moines, Iowa 50322 Please Charge my Credit Card $___________ Card Type (circle one):
Visa
Mastercard
Discover
American Express
Cardholder Name: _________________________________________________________________________________________________________ Card Number: ____________________________________________________________ Exp Date: ________________ Card ID #: _____________ Billing Address (if different from above): _______________________________________________________________________________________ Signature: ________________________________________________________________________________________________________________ MAIL TO: Iowa Pharmacy Association Foundation 8515 Douglas Avenue, Suite 16 Des Moines, Iowa 50310
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Fax: 515-270-2979 Questions? Contact: Laura Miller - 515-270-0713 lmiller@iarx.org
F201-350-000@ ___________________ F201-350-000@ ___________________ Ck#__________ Date _______________ ID number_________________________
RAGBRAI: TAKE 5! Ride with the IPA Foundation RAGBRAI Team! July 22-28 The Register’s Annual Great Bicycle Ride Across Iowa (RAGBRAI) is scheduled for July 22-28, 2018, and the IPA Foundation will be sponsoring a team of cycling pharmacy ambassadors! Now in its 5th year, the IPA Foundation RAGBRAI team connects with Iowa pharmacists and pharmacies along the RAGBRAI route, educates Iowans on the important role of pharmacy, and serves riders with OTC treatments. Any Iowa pharmacist, pharmacy technician or student pharmacist is welcome to ride one day, a few days, or the entire week and spread the word about pharmacy from river to river. Sign up early to guarantee a spot on the team! The team will be limited to 20 weekly riders and an additional 10 riders per day. A wait list will be used for additional interested riders. The team will be divided into three groups: beginner, intermediate and advanced. Each team will have a captain and 5-7 additional riders with a list of pharmacies to visit for the day.
Not a Cyclist? No problem!
IPA Foundation RAGBRAI team is more than riders. We need volunteers to help get the team from the Missouri River to the Mississippi River, as well as help with outreach efforts along the RAGBRAI route with screenings and other pharmacy promotions. Donations to support individual riders are also welcomed! Interested in participating and have questions? Contact Laura Miller at lmiller@iarx.org or 515-270-0713.
IPA Foundation Team Riders Receive... Week-Long Riders receive all benefits of the daily rider, plus: • IPA Foundation Team Bike Jersey (free) • Transportation to the start and from the finish to a central Iowa meeting location • 2 days of laundry service • Indoor accommodations with host families (as available) Daily Riders (up to 3 days): • IPA Foundation Team Bike Jersey (discounted rate) • Transportation of gear and supplies • Official registration through RAGBRAI • Official RAGBRAI wristband • Camping with host families or the RAGBRAI campgrounds (if needed) • Snacks for each day • Water and coffee available each day • Personal shower tents (shower bag is rider’s responsibility) • SAG service for tired riders if needed or half-day riders • Electrical charge station
How to Join the IPA Foundation Team Go to www.iarx.org/RAGBRAI for instructions on how to join the IPA Foundation team.
Important Registration Deadlines: Weekly Riders: Early Bird - March 1; Final - March 31 Daily Riders: Early Bird - March 1; Final - May 31
FEES Week-Long Rider (20 max)
Early (by 3/1)
Late (by 3/31)
Pharmacist Member
$800
$1000
Technician/Student Member
$450
$600
Non-IPA Members (includes spouse & children)
$1000
$1150
Daily Rider (max 3 days)
Early (by 3/1)
Late (by 5/31)
$125/day
$125/day
The IPA Foundation RAGBRAI team serves as a representative of the pharmacy profession and as such, all riders are expected to conduct themselves in a professional manner during their time with the team.
JAN.FEB.MAR 2018 |
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MEMBERS SECTION
IPA MEMBER SPOTLIGHT:
Kate Oltrogge Pape, PharmD, BCPS
Written by:
Julie Schlichting 2018 PharmD/MPA Candidate Drake University
T
hink back to that one person who encouraged you to consider pharmacy as a career. Now, consider all of the pharmacists, pharmacy technicians, professors, and mentors who have helped shape your career to what it is today. Kate Oltrogge Pape, PharmD, BCPS has a very successful career as a burn/trauma/surgery clinical pharmacy specialist at the University of Iowa Hospitals and Clinics (UIHC) and clinical assistant professor at the University of Iowa College of Pharmacy. This all started by having a pharmacist introduce her to the profession. Kate has had numerous mentors who she credits helped her in her success. She emphasizes the importance to “Network, network, network! There are so many other pharmacists out there that want to help you advance in your career. Take advantage of those opportunities and listen to their advice. I wouldn’t be where I am today without the help and guidance from so many pharmacists that helped me from day one to achieve my goals!”
Where it All Began
Kate started her journey in pharmacy at Denver Drug in Denver, Iowa, after being encouraged by pharmacyowner, Richard Siech, to explore the
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profession. While she enjoyed working in both a community and home infusion pharmacy during school, she found her passion for critical care pharmacy during her rotations. She pursued both a PGY-1 and a Critical Care PGY-2 at Froedtert hospital in Milwaukee. After spending a year in the medical ICU at Aurora St. Luke’s in Milwaukee, she took a position at UIHC. She was excited to work again at an academic health center as a clinical specialist. Also, she was looking forward to the opportunity to be a clinical professor, since she appreciated the insight and impact practicing pharmacists brought to her pharmacy education while studying at the University of Minnesota.
Giving a Voice to Burn Specialist Pharmacists
Despite the fact Kate had no burn experience prior to working at UIHC, she has been successful in becoming the first pharmacist dedicated to the burn unit at UIHC. In combination with her critical care expertise, interaction with a group of great surgeons and nurses, as well as a being a member of strong network of burn pharmacists, she has overcome this steep learning curve. While she is now in her sixth year in this role, she is still learning. This burn pharmacist network consists of members of the American Burn Association (ABA) Pharmacy Special Interest Group. This group actively participates in an email listserv and meets annually to present protocols and share research. In addition to her daily activities involving, but not limited to, multidisciplinary rounds, therapeutic drug monitoring, response to medical emergencies, and discharge counseling, she precepts students and participates and leads interprofessional research
and quality improvement. To add to all of her accomplishments at UIHC, she has taken part in helping pharmacists become more recognized by ABA. She was one of the first two pharmacists to be nominated for their Program Committee and was asked to be the pharmacist on a team of mostly physicians to update pain management guidelines. It’s opportunities like this that have really helped to promote the role of the pharmacist to other key members of the healthcare team.
Experiences with IPA
In addition to her involvement with the ABA, she has been highly involved at IPA. In the past, Kate has participated in RAGBRAI, attended the Midwest Pharmacy Expo, and the Leadership Pharmacy Conference. Currently, she is a member of the IPA Health-System Liaison Board. She believes IPA gives members access to a great network of pharmacists and is valuable in its ability to give a voice to Iowa pharmacists and pharmacy technicians practicing in all areas of the profession.
“Making those connections and having that group in your network is priceless.” With all of her experiences with IPA, her most memorable was riding with IPA’s team during RAGBRAI. She enjoyed promoting the profession of pharmacy, visiting pharmacies throughout the state, and helping provide first aid to riders along the way. At the Leadership Pharmacy Conference, Kate took away the message that leaders are not always those who are the most outspoken. She also reflected on the connections she created during the Leadership Pharmacy Conference with
MEMBERS SECTION
pharmacists in a variety of professions throughout Iowa. Kate noted, “Making those connections and having that group in your network is priceless.”
Network, Network, Network!
Throughout her pharmacy journey, Kate has emphasized the importance of networking. Kate has recognized numerous pharmacists and other healthcare providers who have helped get her to where she is today. She is giving back to the profession in so many ways with her participation at IPA, ABA, precepting students and residents, research, and so much more. Current and future pharmacists can follow Kate’s lead by making sure to “Network, network, network!” as well as take advantage of and continue the long pharmacy tradition of generosity in mentoring, supporting, and providing opportunities to each other and future pharmacists. ■
WELCOME NEW IPA MEMBERS! OCTOBER 1 - DECEMBER 31, 2017: Megan Alexander, Manning Caitlin Anderson, Clinton Ashley Beagle, Tiffin Shelby Bennett, Cherokee Joseph Brooks, McGregor Gretchen Brummel, Wausau, WI Andrea Chase, Coralville Jamie Deveno, Nevada Steven Donnelly, Clive Brett Faine, Iowa City Victoria Gehrke, Waukee Naomi Graves, Hawarden Rennet Gruver, Preston Ericka Head, Des Moines Vanessa Helt, Dyersville Elise Houselog, Sergeant Bluff Cassaundra Johnson, West Des Moines Nikkole Leick, Dubuque Mitsi Lizer, Des Moines Kaitlin Luett, Maquoketa Megan McGehee, State Center Jennifer Morris, Manning Dawn Morse, Urbandale Larry Roberts, San Antonio, TX Jarek Vetter, Carlisle Zachary Wagner, Webster City Lexa Wright, Coralville Eagle Pharmacy, Lakeland, FL Trinity Pharmacy, Fort Dodge
THANK YOU FOR SUPPORTING IPA!
MEMBER MILESTONES Congratulations to Helen Eddy, RPh, MBA, (West Des Moines) who was named director of the Polk County Health Department. Eva Coulson, PharmD, (University of Iowa Hospitals and Clinics) was elected as the Resident Trustee on the Board of Trustees for the Society of Palliative Care Pharmacists. Congratulations, Eva! James Ponto, MS, RPh, BCNP, FASHP, FAPhA, (The University of Iowa College of Pharmacy) was appointed to and elected chair of the Radiopharmaceutical Compounding Expert Panel of the United States Pharmacopeia. Congratulations, Jim! Congratulations to Mike Farley, PharmD, BCPS, (The University of Iowa College of Pharmacy) who received the Excellence in Teaching Award given by the Society of Hospital Medicine (SHM) Iowa Chapter. Congratulations to Geoff Wall, PharmD, FCCP, BCPS, CGP, (Drake University) and Michelle Mages (P4, Drake University) who are the inaugural recipients of the Drake University College of Pharmacy and Health Sciences’ Richard Morrow Transformational Leadership Award. Congratulations to Darla Eastman, PharmD, BCPS (Des Moines)and Jason Salton, PharmD (Winterset) who were among those named Drake University College of Pharmacy and Health Sciences’ Preceptors of the Year. Micaela Maeyaert, PharmD, BCPS, (Spencer Hospital) obtained her board certification in pharmacotherapy. Congratulations Micaela! Congratulations to Marisa Zweifel, PharmD, BCPS, (Spencer Hospital) who obtained her board certification in pharmacotherapy. Congratulations to Brett Barker, PharmD, (NuCara) who was elected mayor of Nevada, Ia.
IN MEMORIAM Steve Hoag passed away on October 16, 2017 at the age of 73. Stephen served as dean of the Drake University College of Pharmacy and Health Sciences from 1993-2003 (with a term as Interim Provost from 2001-2002) JAN.FEB.MAR 2018 |
45
IPA IN ACTION
Over 225 Iowans Reconnect at ASHP Midyear 2017
Over 225 pharmacists, student pharmacists, and pharmacy technicians attended the 2017 ASHP Midyear Clinical Meeting held in Orlando, Florida from December 3-7. ASHP used this meeting to celebrate their 75th anniversary by reflecting on the impact they have made for the profession, but also reflecting towards what the future holds with their theme, “Creating the Future.” Attendees heard from former First Lady Michelle Obama during the opening session, experienced networking opportunities, and attended educational sessions regarding their practices as well as current events facing pharmacy. The Iowa Reception, which is generously hosted by IPA, Drake University, and The University of Iowa, brought together over 225 members of Iowa’s pharmacy family to reconnect and network.
IPA Hears from the Public Health Experts at APHA (big “H”) Meeting
Held in conjunction with the American Public Health Association’s (APHA) Annual Meeting, IPA staff attended the workshop, Building Health Department and Pharmacy Partnerships to Improve Community Health, on November 4, 2017 in Atlanta. This workshop provided great insight on current public health partnerships around the country related to HIV screening and referral, hypertension, smoking cessation, and emergency preparedness. As IPA works with the Iowa Department of Public Health on several similar initiatives, this workshop provided staff with the knowledge and understanding to ensure such initiatives in
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Iowa are successful. This event was hosted by the National Association of Chain Drug Stores (NACDS).
IPA Presents on DC Panel on Hospital Compounding
More than five years have passed since the New England Compounding Center (NECC) incident. Over the previous years, there has been much dialogue, creation of new policies, and development of tools and accreditation programs, creating the need for the Roundtable on Patient Safety and Hospital Compounding that was convened on October 11, 2017 in Washington, DC. With much national association presence at the event, IPA was asked to attend to speak on state-level issues to help assess what works best, and where gaps remain, in hospital medication safety. The event sought to set forth a next phase of consensus recommendations that build upon the vital work that has occurred in the previous five years. Based on insight provided by our members, IPA spoke to the struggles of implementing compounding standards and state regulations while being mindful to the future of pharmacy practice and the safety of patients.
IHA Workforce Symposium Trends in Pharmacy Discussed
On December 12, 2017, the Iowa Hospital Association gathered health care professionals to discuss the many workforce issues facing the industry today. Attendees learned about ideas to improve their organizational culture, leadership efforts, and collaboration across generations, while gaining an
understanding of workforce issues, trends, and policies for Iowa hospitals and clinics. IPA staff presented on a panel with representatives for the professions of medicine, nursing, and behavioral health. Attendees learned about the current demand for pharmacist-delivered care, yet the lack of structure for compensation of such services. IPA staff also described trends on the advancing skills and services of pharmacy technicians to provide pharmacists with the time and resources to provide such clinical services.
APhA-ASP MRM Comes to Des Moines!
The American Pharmacists Association – Academy of Student Pharmacists (APhAASP) Midyear Regional Meeting was hosted by the Drake University chapter on October 27-29, 2017 at the Sheraton Hotel in Des Moines. The event was an excellent opportunity to connect, reconnect, and learn for student pharmacists. The passion that student leaders bring to this meeting leaves a lasting impression on those you interact with. IPA had the opportunity to meet students from across the region on Saturday, October 28 as part of the exhibit hall. It was a great mechanism to showcase what makes Iowa pharmacy so special!
IHC Annual Meeting
The Iowa Healthcare Collaborative (IHC) held their 14th Annual Conference on November 8. The conference was held at Prairie Meadows in Altoona. Attendees primarily consisted of hospital senior administrators, nurses, and quality assurance professionals, but a few IPA pharmacist members were also there to represent our profession. Educational tracks included “Leading Organizational Transformation,” “Responding to the
IPA IN ACTION Opioid Crisis in Iowa,” “Driving Value through Delivery System Innovation,” and “Leveraging Technology and Data Analytics in an Integrated Care System.” IPA’s own Ryan Frerichs, Randy McDonough, and Toni Sumpter developed a presentation for the diverse audience that showcased the value pharmacy services can provide. They discussed the Community Pharmacy Enhanced Services Network (CPESN) model of care delivery, and encouraged the healthcare providers in the audience to collaborate with their local pharmacies in order drive innovation, value, and improved patient outcomes.
Opioid Summit at Drake University
On October 26, Drake University College of Pharmacy & Health Sciences hosted Identify, Prevent, Recover: Combatting Opioids in Iowa, an summit in partnership with the Governor’s Office. The one-day conference featured a “Provider Strategies” panel that focused on ways the healthcare community is working to curb the opioid epidemic while providing needed patient care. The second panel featured various state agencies to discuss “Iowa’s Response”
to the problem. Hot topics included the Prescription Monitoring Program (PMP) and electronic prescribing of all controlled substances. Most panelists agreed that these technological advancements assist in the patient care process. Although electronic prescribing of controlled substances is legal, many health systems are not yet equipped with the advances in prescribing software and dual authentication that is required to be compliant with DEA rules. The Board of Pharmacy discussed updates and desired features of the PMP, including proactive notifications. Proactive notifications consist of reports sent to prescribers or pharmacies that show any “red flags” or trends in that provider’s prescribing/ dispensing of opioid medications. The event took an emotional turn as Caleb, an Iowa resident, shared his struggles and successes with overcoming an opioid addiction. At the conclusion of the event, Governor Kim Reynolds laid out a four-pronged plan to combat the opioid crisis: encouraging participation in the PMP, reducing the number of opioid prescriptions in Iowa, passing a Good Samaritan Law to protect users
from prosecution if they seek emergency attention in an overdose situation, and increased access to medication-assisted treatment (MAT). These strategies complement IPA’s goals of increasing PMP registration and improving pharmacists’ role in behavioral healthcare.
Health Mart Shares ‘Revenue Remedies’
In recognition of the ever-changing pharmacy environment, Health Mart and McKesson offer the “Revenue Remedies” continuing education series to discuss innovative strategies for independent pharmacies to drive revenue. IPA member Josh Borer (Atlantic, IA) led participants through the two-hour workshop, which encouraged attendees to identify areas where their pharmacies could expand their business model to increase profitability while improving patient outcomes. He offered practical solutions and emphasized the importance of optimizing provider relationships. Participants left the programming with an individualized plan to implement workflow efficiencies at their respective pharmacy sites. ■
IPA GOES LOCAL 2018: UNDERSTANDING MENTAL HEALTH CARE ACCESS IN IOWA Despite a high prevalence of mental health and substance use issues, Iowa is the 3rd lowest state in overall mental health care rankings for adults. Iowa ranks particularly low in access to care, mental health workforce availability, patients that did not receive treatment, and patients with unmet needs.
IPA Goes Local is a partnership between IPA and Iowa’s regional pharmacy associations to bring a live CE program to locations across the state and see what our members are doing on a local level.
www.iarx.org/GoesLocal
For the 2018 IPA Goes Local program, IPA is partnering with the Iowa Behavioral Health Association (IBHA) to present a team-based approach to caring for patients with mental health conditions through education, prevention, treatment, and advocacy. Attendees will then discuss local strategies and ways to collaborate to improve mental health care in Iowa. In conjunction with each Goes Local event, IPA will also hold Mental Health First Aid courses. These 8-hour courses teach you how to help someone who may be experiencing a mental health or substance use challenge. The training helps you identify, understand and respond to signs of addictions and mental illnesses. Watch communications from IPA and your local pharmacy association for times, dates, locations and registration. JAN.FEB.MAR 2018 |
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IPA ACTION
CALENDAR OF EVENTS FEBRUARY 2018 8
Professional Burnout & Professional Resiliency Conference - Des Moines, IA
13
2/2/2 Webinar: Million Hearts Campaign
8
6
IHC Patient Safety Conference - Ankeny, IA
7
SIM Learning Community - Ankeny, IA
7-8
NACDS RxImpact Day - Washington, DC
13
2/2/2 Webinar
14
Iowa Board of Pharmacy Meeting Iowa Reception at APhA Annual Meeting Nashville, TN
2/2/2 Webinar
23
Iowa Board of Pharmacy Meeting - Des Moines, IA
JUNE 2018
16-19 APhA Annual Meeting - Nashville, TN
10
2/2/2 Webinar
16-18 PQA Annual Meeting - Baltimore, MD
MARCH 2018
APRIL 2018
21-24 NACDS Annual Meeting - Palm Beach, FL
MAY 2018
16-18 Midwest Pharmacy Expo - Des Moines, IA
18
11-12 NCPA Congressional Pharmacy Summit Washington, DC
3-5
ASHP Summer Meeting - Denver, CO
7
IPA Practice Advancement Forum - Des Moines, IA
8-9
IPA Annual Meeting - Des Moines, IA
12
2/2/2 Webinar
JULY 2018 4
2/2/2 Webinar
25
Iowa Board of Pharmacy Meeting - Des Moines, IA
10-11 Governor’s Conference on Public Health Des Moines, IA
SAVE THE DATE! IPA’s free monthly webinar series held on the second Tuesday of every month at 2:00 p.m. CST. February 13, 2018: Million Hearts Campaign: Where We Have Been & Where We Are Going March 13, 2018: TBD April 10, 2018: TBD Register for an upcoming 2/2/2 or view previous webinars at www.iarx.org/222.
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June 7, 2018 Des Moines Marriott Downtown Held 1 day before the 2018 IPA Annual Meeting, at the same location.
PHARMACY TIME CAPSULE
19 83
Issues & events that have shaped Iowa pharmacy (or are fun to remember!)
JANUARY
The Orphan Drug Act, which created incentives to create medications that treat rare diseases, was passed. This law focused on diseases that affected small groups of people and had inadequate therapies. The diseases specifically listed were Tourette syndrome, muscular dystrophy, amyotrophic lateral sclerosis, and Huntington’s Disease.
FEBRUARY
The Iowa Board of Pharmacy adopted regulations to stop the sales of starch blockers. Starch blockers were used as diet pills that were claimed to contain a protein that reduced starch digestion. They were categorized as food until a Federal district judge ruled to change its classification to “drug.” Independent tests showed a lack of efficacy, thus causing the Food and Drug Administration (FDA) to order them to go off of the market. The 4th Annual Legislative Day was a success in the fact it quintupled in participation since the first year of 30 to 150 participants. To add to the excitement, IPA’s medication dispensing bill was approved by the Senate Human Resource Committee that afternoon. Under the current law, dispensing physicians were delegating drug dispensing to assistants with little oversight, which included not being present at the site during drug dispensing. This bill worked to clarify and standardize who can legally dispense prescription medications in hopes of improving patient safety and health.
IPA’s Legislative Counsel Bill Wimmer (left) and Exec. Director Tom Temple (right) at the Legislative Reception with Rep. Richard Running, Chairman of the House Human Resources Committee.
Board of Pharmacy Member Bob Bellinger (left) and pharmacist John Forbes (right) with former Speaker of the House, Rep. Dale Cochran of Eagle Grove.
Pharmacist Max Eggleston (left) with Representative Ray Legeschulte and his wife Virginia.
MAY
An APhA led study looking at patient perceptions of pharmacist paid services (n=1,254) show the following… • 57% stated they would pay a pharmacist for not filling a prescription they deemed inappropriate. • 39% stated they would pay a pharmacist to complete medication reconciliation, physician consultations, and appropriate monitoring as needed during refills. • 39% would pay for a pharmacist $10 to consult on minor health needs (colds, acne, constipation, rashes, and diarrhea), while the same percent would pay a physician $35 for the same services. Tom Temple, IPA Executive Director, was elected to serve as Chairman of the Medical Assistance Advisory Committee (MAAC). The FDA approved Rufen® (ibuprofen) as the first prescription drug television advertisement directed at consumers.
OCTOBER
In reaction to the Tylenol cyanide tainting in 1982, the Federal Anti-Tampering Act was enacted, which made it illegal to tamper with consumer products.
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.
JAN.FEB.MAR 2018 |
49
ADVERTISER
NEED A RELIEF PHARMACIST? CONTACT “JOSEPH IN RELIEF” Joseph Thompson, RPh 9616 Quail Ridge Urbandale, IA 50322 h. 515.278.0846 c. 515.991.2684
ADVERTISE IN OUR PUBLICATIONS Place your ad/classified ad with us. All ads, contracts, payments, reproduction material and all other related communication should be addressed to David Schaaf at dschaaf@iarx.org or call the IPA office at 515.270.0713 for more information.
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YOUR
&
PROFESSIONAL SKILLS
REPUTATION DONâ&#x20AC;&#x2122;T HAVE TO BE DAMAGED AS A RESULT OF IMPAIRMENT.
The Iowa Monitoring Program for Pharmacy Professionals (IMP3), a voluntary, confidential program of the Iowa Board of Pharmacy, is designed to assist pharmacists, pharmacist interns and pharmacy technicians in
P 3 I M
obtaining the necessary help for successful rehabilitation from substance abuse as well as mental and physical disabilities. This provides an opportunity for licensed professionals to receive proper treatment and maintain their professional status, while protecting the safety of the public.
I
O W A
IOWA MONITORING PROGRAM
for Pharmacy Professionals
To learn more about IMP3, visit imp3.iowa.gov. To self-report to IMP3, contact IMP3 staff at 515.725.2253.
See what our tomorrow looks like at: phmic.com/tomorrow2